WO2017072924A1 - Energy treatment tool, medical treatment device, medical treatment device operating method, and treatment method - Google Patents

Energy treatment tool, medical treatment device, medical treatment device operating method, and treatment method Download PDF

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Publication number
WO2017072924A1
WO2017072924A1 PCT/JP2015/080621 JP2015080621W WO2017072924A1 WO 2017072924 A1 WO2017072924 A1 WO 2017072924A1 JP 2015080621 W JP2015080621 W JP 2015080621W WO 2017072924 A1 WO2017072924 A1 WO 2017072924A1
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WIPO (PCT)
Prior art keywords
energy
area
region
holding surface
living tissue
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PCT/JP2015/080621
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French (fr)
Japanese (ja)
Inventor
雅人 成澤
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オリンパス株式会社
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Priority to PCT/JP2015/080621 priority Critical patent/WO2017072924A1/en
Publication of WO2017072924A1 publication Critical patent/WO2017072924A1/en

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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

Definitions

  • the present invention relates to an energy treatment tool, a medical treatment apparatus, an operation method of a medical treatment apparatus, and a treatment method.
  • an energy treatment tool for applying energy to a living tissue to join or anastomote the living tissue has been activated.
  • Such an energy treatment tool does not leave a physical object such as a stapler in the living body, and thus has the advantage of having less adverse effects on the human body, while the bonding strength is weaker than that of the stapler etc.
  • extracellular matrix (collagen, elastin, etc.) of living tissue is composed of fibrous tissue. For this reason, when joining living tissues, the extracellular matrix is extracted from the living tissues, and it is thought that the joining strength is improved by closely encircling the extracellular matrices.
  • Patent Document 1 an energy treatment tool aimed at improving the bonding strength focusing on the extracellular matrix has been proposed (for example, see Patent Document 1).
  • the energy treatment tool described in Patent Document 1 strengthens the extraction and mixing of extracellular matrix by sandwiching a living tissue with a pair of jaws and applying mechanical vibration to the living tissue through the pair of jaws. There is.
  • the present invention has been made in view of the above, and provides an energy treatment tool, a medical treatment apparatus, an operation method of the medical treatment apparatus, and a treatment method capable of improving the bonding strength of living tissues. With the goal.
  • an energy treatment tool comprises a first holding member having a first holding surface, and the first holding surface facing the first holding surface and the first holding member
  • An energy treatment tool comprising a second holding member having a second holding surface holding the living tissue between the first and second peripheral regions, wherein the first holding surface is a first surrounding area which is an area surrounding the first area;
  • a first inclusion area which is an area including the first area, and the second holding surface is a state in which the first holding surface and the second holding surface are opposed to each other.
  • the energy treatment device includes a second surrounding area which is an area surrounding a second area projected onto the second holding surface, and a second inclusion area which is an area including the second area, Generating energy from at least one of the first surrounding area and the second surrounding area Comprising a first energy generating unit, and the first inclusion area, and a second energy generator for generating energy from at least one of said second inclusion area, characterized in that.
  • a medical treatment apparatus is characterized by including the above-described energy treatment tool, and an energy control unit that generates energy in the first energy generation unit and the second energy generation unit. .
  • the biological tissue is held between the first holding member having the first holding surface and the second holding member having the second holding surface, A first energy applying step of applying energy to the living tissue from at least one of a first peripheral region of the first clamping surface and a second peripheral region of the second clamping surface; and the first energy applying step is started A second energy applying step of applying energy to the living tissue from at least one of a first inclusion region of the first sandwiching surface and a second inclusion region of the second sandwiching surface;
  • the first peripheral area is an area surrounding the first area in the first holding surface
  • the second peripheral area is the first peripheral area with the first holding surface and the second holding surface facing each other.
  • Territory Is a region surrounding a second region projected on the second holding surface, the first inclusion region is a region including the first region, and the second inclusion region includes the second region. It is characterized by being an area.
  • a first energy applying step of applying energy to the living tissue from at least one of a surrounding region and a second surrounding region of the second sandwiching surface; and the first energy applying step is started;
  • a second energy applying step of applying energy to the living tissue from at least one of a first inclusion region in the holding surface and a second inclusion region in the second holding surface, and the first peripheral region is
  • the first surrounding area is an area surrounding a first area in the first sandwiching surface
  • the second peripheral area is a region surrounding the first sandwiching surface and the second sandwiching surface facing each other. It is an area surrounding a second area projected on a sandwiching surface, the first inclusion area is an area including the first area, and the second inclusion area is an area including the second area. It is characterized by
  • the energy treatment tool the medical treatment apparatus, the operation method of the medical treatment apparatus, and the treatment method according to the present invention, it is possible to improve the bonding strength of the living tissues.
  • FIG. 1 is a view schematically showing a medical treatment apparatus according to Embodiment 1 of the present invention.
  • FIG. 2 is an enlarged view of a tip portion of the energy treatment device shown in FIG.
  • FIG. 3 is a view showing the first holding member shown in FIG.
  • FIG. 4 is a view showing the first holding member shown in FIG.
  • FIG. 5 is a view showing the second holding member shown in FIG.
  • FIG. 6 is a block diagram showing the configuration of the control device and the foot switch shown in FIG.
  • FIG. 7 is a flow chart showing bonding control by the control device shown in FIG.
  • FIG. 8 is a view of the positional relationship between the living tissue and the first holding member in the state where step S1 shown in FIG. 7 is performed, as viewed from the first sandwiching surface side.
  • FIG. 8 is a view of the positional relationship between the living tissue and the first holding member in the state where step S1 shown in FIG. 7 is performed, as viewed from the first sandwiching surface side.
  • FIG. 9 is a diagram showing the behavior of the impedance calculated after step S4 shown in FIG.
  • FIG. 10 is a view showing a first holding member constituting the medical treatment apparatus (energy treatment tool) according to the second embodiment of the present invention.
  • FIG. 11 is a view showing a first holding member constituting the medical treatment apparatus (energy treatment tool) according to the second embodiment of the present invention.
  • FIG. 12 is a block diagram showing a configuration of a control device according to Embodiment 2 of the present invention.
  • FIG. 13 is a flowchart showing bonding control according to the second embodiment of the present invention.
  • FIG. 14A is a diagram showing a modification 1 of the first and second embodiments of the present invention.
  • FIG. 14B is a diagram showing a modification 1 of the first and second embodiments of the present invention.
  • FIG. 14C is a diagram showing a modification 1 of the first and second embodiments of the present invention.
  • FIG. 15A is a diagram showing a modification 2 of the first and second embodiments of the present invention.
  • FIG. 15B is a diagram showing a modification 2 of the first and second embodiments of the present invention.
  • FIG. 1 is a view schematically showing a medical treatment apparatus 1 according to Embodiment 1 of the present invention.
  • the medical treatment apparatus 1 applies energy to a living tissue to be treated, and performs treatment (such as bonding or anastomosis) on the living tissue.
  • the medical treatment apparatus 1 includes an energy treatment device 2, a control device 3, and a foot switch 4.
  • the energy treatment tool 2 is, for example, a linear type surgical treatment tool for performing treatment (such as bonding or anastomosis) on a living tissue through the abdominal wall.
  • the energy treatment unit 2 includes a handle 5, a shaft 6 and a holding unit 7.
  • the handle 5 is a portion held by the operator. Further, as shown in FIG. 1, the handle 5 is provided with an operation knob 51.
  • the shaft 6 has a substantially cylindrical shape and one end is connected to the handle 5. Further, at the other end of the shaft 6, a clamping unit 7 is attached.
  • An opening / closing mechanism (shown in the drawing) opens and closes the first and second holding members 8 and 8 '(FIG.
  • an electric cable C (FIG. 1) connected to the control device 3 is disposed inside the shaft 6 from one end side to the other end side via the handle 5.
  • FIG. 2 is an enlarged view of the distal end portion of the energy treatment device 2.
  • the clamping unit 7 is a portion that clamps a living tissue and performs treatment (such as bonding or anastomosis) of the living tissue.
  • the holding unit 7 includes a first holding member 8 and a second holding member 8 ′.
  • symbol which shows the structure of 2nd holding member 8 ' about the structure same as the 1st holding member 8, "'" is added to the code
  • the first and second holding members 8 and 8 ' are pivotally supported by the other end of the shaft 6 so as to be able to open and close in the direction of arrow R1 (FIG. 2), and hold biological tissue in accordance with the operation of the operation knob 51 by the operator. To be possible.
  • FIG. 3 and 4 are views showing the first holding member 8 shown in FIG.
  • FIG. 3 is a cross-sectional view taken along the line III-III in FIG.
  • FIG. 4 is a view of the first holding member 8 as viewed from above in FIG.
  • the III-III line is a line passing through the center position CP (FIG. 4) of the first holding surface 811.
  • the first holding member 8 is disposed below the second holding member 8 ′ in FIG. 1 or 2.
  • the first holding member 8 includes a first jaw 81, a first energy generator 82, and a second energy generator 83, as shown in FIGS.
  • the first jaw 81 is a long plate made of an insulating material such as ceramic, and is a portion pivotally supported by the other end of the shaft 6.
  • the first holding surface 811 on the surface 811 facing the second holding member 8 '(hereinafter referred to as the first holding surface 811), as shown in FIG. 3 or 4, the upper side (second holding member A protrusion 8111 is formed to protrude toward the 8 'side). Therefore, as shown in FIG. 3, the first holding surface 811 is formed in a convex shape having a step.
  • the protrusion 8111 is located at the central portion in the width direction of the first jaw 81 (in FIG.
  • the U-shaped portion 8112 is formed flat.
  • a region ArC (FIG. 4) that occupies substantially the entire tip surface of the protrusion 8111 is a region including the center position CP (FIG. 4) of the first holding surface 811.
  • the region including the region Ar1 corresponds to the first inclusion region according to the present invention.
  • the region ArC is referred to as a first inclusion region ArC.
  • a region ArS that occupies substantially the entire U-shaped portion 8112 excluding the projecting portion 8111 is a region surrounding the first region Ar1, and corresponds to a first peripheral region according to the present invention.
  • the region ArS is referred to as a first surrounding region ArS.
  • the first surrounding area ArS is set to an area surrounding the first inclusion area ArC.
  • the first energy generating unit 82 is fixed to the first holding surface 811 of the first jaw 81, and generates high frequency energy under the control of the control device 3.
  • the first energy generating unit 82 is, for example, a thin plate made of a conductive material such as copper, and has the same planar shape (substantially U-shaped) as the first surrounding area ArS, as shown in FIG. And is fixed to the first surrounding area ArS.
  • the first high frequency lead wire C1 (see FIG. 6) constituting the electric cable C is joined, and the first energy generation portion 82 is connected via the first high frequency lead wires C1 and C1 '(see FIG. 6).
  • the control device 3 supplies high frequency power between the control unit 3 and the first energy generation unit 82 'of the second holding member 8' to generate high frequency energy. That is, the first energy generating unit 82 is configured as an electrode to which high frequency power is supplied.
  • the second energy generating unit 83 is fixed to the first sandwiching surface 811 of the first jaw 81, and generates high frequency energy under the control of the control device 3.
  • the second energy generating unit 82 is formed of, for example, a thin plate made of a conductive material such as copper, and has the same planar shape (substantially rectangular shape) as the first inclusion region ArC as shown in FIG. And fixed to the first inclusion area ArC.
  • the second high frequency lead wire C2 (see FIG. 6) constituting the electric cable C is joined, and the second energy generation portion 83 is connected via the second high frequency lead wires C2 and C2 '(see FIG. 6).
  • the control device 3 supplies high frequency power between the control unit 3 and the second energy generation unit 83 'of the second holding member 8' to generate high frequency energy. That is, the second energy generating unit 83 is configured as an electrode to which high frequency power is supplied.
  • FIG. 5 is a view showing the second holding member 8 'shown in FIG. Specifically, FIG. 5 is a cross-sectional view corresponding to FIG. 3 and shows a state in which the first and second holding surfaces 811 and 811 'are opposed to each other by closing the first and second holding members 8 and 8'.
  • FIG. The second holding member 8 ′ has the same configuration and shape as the first holding member 8 as shown in FIG. 2 or 5. That is, as shown in FIG.
  • the second holding member 8 ′ includes the second jaw 81 ′ (the second holding surface 811 ′, the protrusion 8111 ′, the U-shaped portion 8112 ′, and the regions Ar 1 ′, ArS ′, And ArC 'is included, a first energy generating unit 82', and a second energy generating unit 83 '.
  • the second holding member 8 ′ is attached to the other end of the shaft 6 in a posture in which the first holding member 8 is turned upside down.
  • the region Ar1 ′ corresponds to the first region Ar1 of the first sandwiching surface 811 with the first sandwiching surface 811 and the second sandwiching surface 811 ′ facing each other.
  • the region Ar1 ' is referred to as a second region Ar1'.
  • the second area Ar1 ′ is an area including the center position CP ′ (FIG. 5) of the second holding surface 811 ′.
  • the area ArC ′ of the tip end face of the protrusion 8111 ′ is an area including the second area Ar1 ′, and corresponds to a second inclusion area according to the present invention.
  • the region ArC ' is referred to as a second inclusion region ArC'.
  • the region ArS ′ is a region surrounding the second region Ar1 ′, and corresponds to a second peripheral region according to the present invention.
  • the region ArS ' is referred to as a second surrounding region ArS'.
  • the second inclusion area ArC ′ and the second peripheral area ArS ′ are formed on the first holding surface 811 with the first holding surface 811 and the second holding surface 811 ′ facing each other. It is the area
  • FIG. 6 is a block diagram showing the configuration of the control device 3 and the foot switch 4.
  • the foot switch 4 is a portion operated by the operator with a foot. And according to the said operation (ON) to the foot switch 4, the control apparatus 3 starts joining control mentioned later.
  • it is not restricted to foot switch 4 as a means to start the said joining control, In addition, you may employ
  • the control device 3 generally controls the operation of the energy treatment device 2.
  • the control device 3 includes a high frequency energy output unit 31, a switch 32, a first sensor 33, and a control unit 34, as shown in FIG.
  • the high-frequency energy output unit 31 receives the first energy generation unit 82 or 82 'or the first high-frequency lead wire C1 or C1' or the second high-frequency lead wire C2 or C2 'under the control of the control unit 34.
  • the high frequency power is supplied to the second energy generating units 83 and 83 '.
  • the switch 32 switches the lead wire for supplying high frequency power from the high frequency energy output unit 31 to the first high frequency lead wire C1 or C1 'or the second high frequency lead wire C2 or C2' under the control of the control unit 34. .
  • the first sensor 33 detects the voltage value and the current value supplied from the high frequency energy output unit 31 to the first energy generation unit 82, 82 '. Then, the first sensor 33 outputs a signal corresponding to the detected voltage value and current value to the control unit 34.
  • the control unit 34 is configured to include a CPU (Central Processing Unit) or the like, and executes joint control according to a predetermined control program when the foot switch 4 is turned on. As shown in FIG. 6, the control unit 34 includes an energy control unit 341 and an impedance calculation unit 342.
  • the energy control unit 341 operates the switch 32 to switch the lead wires for supplying high frequency power to the first high frequency lead wires C1 and C1 ′, and drives the high frequency energy output unit 31 so that the high frequency energy output unit 31 (1)
  • the high frequency power is supplied to the energy generators 82 and 82 '(high frequency energy is generated).
  • the energy control unit 341 operates the switch 32 based on the impedance calculated by the impedance calculation unit 342 to supply the high frequency power to the lead wire from the first high frequency lead wires C1 and C1 'to the second high frequency wave.
  • the high-frequency energy output unit 31 supplies high-frequency power to the second energy generation units 83 and 83 '(generates high-frequency energy).
  • the energy control unit 341 makes the high frequency power supplied to the second energy generating unit 83, 83 'higher than the high frequency power supplied to the first energy generating unit 82, 82', or the first energy generating unit
  • the power amount of the high frequency power supplied to the second energy generation unit 83, 83 ' is made higher than the power amount of the high frequency power supplied to 82, 82'. That is, the energy control unit 341 generates the high-frequency energy from the first energy generation units 82 and 82 'by the second energy generation units 83 and 83' based on the highest temperature reached by the first energy generation units 82 and 82 '.
  • High-frequency energy is generated in the first energy generation units 82 and 82 'and the second energy generation units 83 and 83' so that the highest temperature reached by the second energy generation units 83 and 83 'at the time of generation of high-frequency energy
  • the impedance calculation unit 342 determines the impedance when high-frequency energy is applied to the living tissue from the first energy generation units 82 and 82 ′ based on the voltage value and the current value detected by the first sensor 33 (see FIG. Calculate the impedance of the living tissue.
  • FIG. 7 is a flowchart showing bonding control by the control device 3.
  • the operator holds the energy treatment tool 2 and inserts the distal end portion (a part of the pinching portion 7 and the shaft 6) of the energy treatment tool 2 into the abdominal cavity through the abdominal wall using, for example, a trocar.
  • the operator operates the operation knob 51 to clamp the living tissue with the first and second holding members 8 and 8 '(step S1: holding step).
  • the operator operates (turns on) the foot switch 4 to start bonding control by the control device 3 (step S2: Yes).
  • FIG. 8 is a view of the positional relationship between the living tissue LT and the first holding member 8 in the state where step S1 is performed, as viewed from the first holding surface 811 side.
  • the energy control unit 341 operates the switch 32 to switch the lead wire for supplying high frequency power to the first high frequency lead wires C1 and C1 ', and
  • the output unit 31 is driven, and supply of high frequency power from the high frequency energy output unit 31 to the first energy generation unit 82, 82 'is started (living tissue LT (region ArO (region indicated by oblique lines to the right in FIG. 8)) Start application of high-frequency energy)) (step S3: first energy application step).
  • step S3 when high-frequency energy is applied to the living tissue LT from the first energy generating units 82 and 82 ′, the positions of the first energy generating units 82 and 82 ′ in the living tissue LT High frequency energy is applied to the area ArO (FIG. 8) corresponding to the two surrounding areas ArS and ArS ′). That is, in step S3, before performing main junction of living tissue LT (application of high-frequency energy to region ArI (region shown by diagonal lines in the left diagonal in FIG.
  • region ArO located outside the region ArI Temporary joining of the living tissue LT is started by applying high frequency energy to the After step S3, the impedance calculation unit 342 starts calculation of the impedance of the living tissue LT (region ArO) based on the voltage value and the current value detected by the first sensor 33 (step S4).
  • FIG. 9 is a diagram showing the behavior of the impedance calculated after step S4.
  • the impedance of the living tissue LT exhibits the behavior shown in FIG.
  • the impedance gradually decreases in the initial time zone (high frequency energy application start time to time T1) where high frequency energy is applied. This is attributed to the fact that the application of the high frequency energy causes the cell membrane of the living tissue LT to be destroyed and the extracellular matrix is extracted from the living tissue LT.
  • the extracellular matrix is extracted from the living tissue LT, and the viscosity of the living tissue LT decreases (the living tissue LT softens).
  • the impedance gradually increases as shown in FIG. This is because Joule heat acts on the living tissue LT by the application of high frequency energy, and the living tissue LT itself generates heat, thereby reducing (evaporating) the water in the living tissue LT.
  • the extracellular matrix is not extracted from the living tissue LT, and the heat in the living tissue LT evaporates due to heat generation, and the viscosity of the living tissue LT increases (the living tissue LT coagulates It is a time zone).
  • step S5 the energy control unit 341 constantly monitors whether the impedance calculated by the impedance calculation unit 342 has reached the minimum value VL (FIG. 9) (step S5). In other words, the energy control unit 341 constantly monitors whether or not temporary bonding of the living tissue LT is completed by applying high-frequency energy from the first energy generation units 82 and 82 ′. When it is determined that the impedance has become the lowest value VL (step S5: Yes), the energy control unit 341 operates the switch 32 to supply the high frequency power to the first high frequency lead wires C1 and C1 '. To the second high frequency lead wires C2 and C2 '.
  • the energy control unit 341 ends temporary bonding of the living tissue LT (application of high frequency energy from the first energy generating units 82, 82 'to the living tissue LT (region ArO)) (step S6), and the high frequency energy output Start supply of high-frequency power from the unit 31 to the second energy generation unit 83, 83 '(start application of high-frequency energy to the living tissue LT (region ArI (FIG. 8))) (step S7: second energy application step ).
  • step S6 second energy application step
  • step S7 second energy application step
  • step S7 main junction of the living tissue LT is started by applying high-frequency energy to the region ArI of the living tissue LT.
  • step S7 the energy control unit 341 constantly monitors whether or not a predetermined time has elapsed since the main joining of the living tissue LT in step S7 is started (step S8). Then, when it is determined that the predetermined time has elapsed (step S8: Yes), the energy control unit 341 performs the main joining of the living tissue LT (from the second energy generating unit 83, 83 'to the living tissue LT (region ArI) The application of the high frequency energy) is ended (step S9).
  • the living tissue LT is joined by the above processing.
  • the medical treatment apparatus 1 (energy treatment tool 2) according to the first embodiment described above imparts high-frequency energy to the living tissue LT (area ArO) from the first and second surrounding areas ArS and ArS ′ to Perform temporary joining of the tissue LT. Thereafter, the medical treatment apparatus 1 applies high-frequency energy to the living tissue LT (area ArI) from the first and second inclusion areas ArC and ArC 'surrounded by the first and second surrounding areas ArS and ArS'.
  • the main junction of the living tissue LT is performed. That is, since the region ArO of the living tissue LT is temporarily joined, the extracellular matrix extracted from the region ArI at the time of main joining of the living tissue LT (region ArI) can be retained in the region ArI.
  • the medical treatment apparatus 1 energy treatment tool 2 according to the first embodiment, at the time of the main joining of the living tissue LT, the softened extracellular matrix extracted from the region ArI is closely entangled while retaining it.
  • the joint strength of the living tissue LT can be improved.
  • the first holding area ArC protrudes from the first surrounding area ArS, and the first holding surface 811 is formed in a convex shape having a step.
  • the second inclusion region ArC ′ protrudes with respect to the second surrounding region ArS ′, and is formed in a convex shape having a step. Therefore, a high load can be applied to the region ArI of the living tissue LT at the time of the main joining of the living tissue LT, and a strong bonding can be realized.
  • both the first holding surface 811 and the second holding surface 811 ′ are formed in a convex shape having a step, for example, a configuration in which only one is formed in a convex shape (the other is formed in a flat shape) Compared with the configuration), when the living tissue LT is held between the first holding surface 811 and the second holding surface 811 ′, unnecessary stress is not generated in the living tissue LT, and the living tissue LT (area ArI) High load can be applied uniformly to
  • the temporary joining of the living tissue LT is ended when the impedance of the living tissue LT (region ArO) becomes the lowest value VL Initiate main junction of tissue LT (region ArI)). Therefore, it can be appropriately determined whether or not temporary bonding of the region ArO of the living tissue LT is completed, and the above-described effect (the bonding strength can be improved) can be more suitably realized.
  • First energy generating unit 82, 82 'and second energy generating unit 83 such that the maximum temperature reached by second energy generating unit 83, 83' when generating high frequency energy from energy generating unit 83, 83 'becomes higher. , 83 'to generate high frequency energy. For this reason, it is possible to effectively suppress heat invasion to normal tissue outside the living tissue LT (region ArO).
  • the end timing of temporary joining of the living tissue is determined based on the impedance of the living tissue LT (region ArO).
  • the present invention is not limited thereto.
  • Living tissue (region ArI) As in the case of the final bonding, the determination may be made based on the time from the start of the temporary bonding.
  • the termination timing of the main junction of the living tissue (region ArI) may be determined based on the impedance of the region ArI, as in the temporary joining of the living tissue (region ArO).
  • the present invention is not limited thereto.
  • time T1 when the impedance of the living tissue LT (area ArO) becomes the lowest value VL for example, time T2 (FIG. 9) returned to initial value VI (FIG. 9) when temporary joining is started from time T1
  • the temporary joining of the living tissue LT (region ArO) may be terminated at any timing as long as
  • the switch 32 by providing the switch 32, the high-frequency energy generated in the first energy generating unit 82, 82 'and the second energy generating unit 83, 83' are applied to the living tissue LT.
  • the configuration has been described in which the generated high frequency energy can not be simultaneously applied, the present invention is not limited to this.
  • the switch 32 may be omitted and the configuration may be simultaneously applied. That is, even if there is a period in which the high-frequency energy generated by the first energy generating unit 82, 82 'and the high-frequency energy generated by the second energy generating unit 83, 83' are simultaneously applied to the living tissue LT. I do not care.
  • FIG.10 and FIG.11 is a figure which shows 1st holding member 8A which comprises the medical treatment apparatus 1A (energy treatment tool 2A) which concerns on Embodiment 2 of this invention.
  • FIGS. 10 and 11 correspond to FIGS. 3 and 4, respectively.
  • the first holding member 8A has the first jaw 81 and the second energy similarly to the first holding member 8 (FIGS. 3 and 4) described in the first embodiment.
  • a generator 83 is provided, and a first energy generator 82A is employed instead of the first energy generator 82.
  • the first energy generating unit 82A has the same shape as that of the first energy generating unit 82 described above (the same planar shape (substantially U-shaped) as the first surrounding area ArS), and is fixed to the first surrounding area ArS. ing. Then, the first energy generating unit 82A generates thermal energy under the control of the control device 3A (see FIG. 12).
  • a resistor heat generating source
  • a substantially U shape similar to that of the first energy generating unit 82A is an insulating material. (E.g., a ceramic heater).
  • the first heat generating lead wires C3 and C4 constituting the electrical cable C are joined to both ends of the resistor (not shown), and the first heat generating lead wire As a voltage is applied (energized) by the control device 3A via C3 and C4, heat is generated (heat energy is generated).
  • the second holding member 8A ′ has the same configuration and shape as the first holding member 8A.
  • symbol which shows the structure of 2nd holding member 8A ' about structure same as 1st holding member 8A, "'" is added to the code
  • the reference numeral indicating the configuration of the first holding member 8A is shown in parentheses. That is, as shown in FIG. 10 and FIG. 11, the second holding member 8A ′ is the second jaw 81 ′ and the second energy generating portion as in the second holding member 8 ′ described in the first embodiment.
  • the first energy generating unit 82A ' is provided in the same manner as the first energy generating unit 82A.
  • the second heat generating lead wires C3' and C4 '(see FIG. 12) constituting the electric cable C are joined to both ends of the resistor (not shown), and the second heat generating lead
  • the first energy generation unit 82A ′ is used to detect the thermal conductivity of the living tissue LT (region ArO) as described later.
  • FIG. 12 is a block diagram showing a configuration of a control device 3A according to Embodiment 2 of the present invention.
  • the switch 32 is omitted from the control device 3 (FIG. 6) described in the first embodiment described above, and the thermal energy output unit 35 And a second sensor 36 is added, and a control unit 34A in which some functions of the control unit 34 are changed is adopted. Since the switch 32 is omitted, the high frequency energy output unit 31 according to the second embodiment only includes the second energy generation unit 83, 83 'via the second high frequency lead wires C2, C2'. Are connected electrically.
  • the thermal energy output unit 35 applies (energizes) a voltage to the first energy generation units 82A and 82A 'through the heating lead wires C3, C4, C3' and C4 'under the control of the control unit 34A.
  • the second sensor 36 detects the voltage value and the current value supplied from the thermal energy output unit 35 to the first energy generation unit 82A ′. Then, the second sensor 36 outputs a signal corresponding to the detected voltage value and current value to the control unit 34A.
  • the control unit 34A employs a thermal conductivity calculation unit 343 instead of the impedance calculation unit 342 in the control unit 34 (FIG. 6) described in the first embodiment described above.
  • an energy control unit 341A is employed instead of the energy control unit 341.
  • the energy control unit 341A drives the thermal energy output unit 35, and applies a voltage from the thermal energy output unit 35 to the first energy generation unit 82A (generates thermal energy).
  • the energy control unit 341A applies a voltage for detecting the thermal conductivity from the thermal energy output unit 35 to the first energy generation unit 82A '.
  • the energy control unit 341A stops the drive of the thermal energy output unit 35 and drives the high frequency energy output unit 31 based on the thermal conductivity calculated by the thermal conductivity calculation unit 343, and the high frequency energy output unit
  • the high frequency power is supplied to the second energy output unit 83, 83 'from 31 (the high frequency energy is generated).
  • the energy control unit 341A generates a second energy generation unit based on the highest temperature reached by the first energy generation unit 82A when the thermal energy is generated from the first energy generation unit 82A.
  • the thermal conductivity calculation unit 343 applies thermal energy to the living tissue LT (area ArO) from the first energy generation unit 82A based on the voltage value and the current value detected by the second sensor 36.
  • the change (change in temperature) of the resistance value of the first energy generation unit 82A 'at that time is calculated, and the thermal conductivity of the living tissue LT (region ArO) is calculated based on the change in the resistance value.
  • FIG. 13 is a flowchart showing bonding control according to the second embodiment of the present invention.
  • the bonding control according to the second embodiment as shown in FIG. 13, with respect to the bonding control (FIG. 7) described in the first embodiment described above, the first energy generating unit 82, 82 'and the impedance calculating unit Steps S3A to S6A are employed instead of steps SS3 to S6 related to 342.
  • steps S3A to S6A will be described.
  • step S3A first energy application step. That is, in step S3A, temporary joining of the living tissue LT is started as in step S3 described in the first embodiment described above.
  • step S3A the energy control unit 341A applies a voltage for detecting the thermal conductivity from the thermal energy output unit 35 to the first energy generation unit 82A '.
  • step S4A the thermal conductivity calculation unit 343 starts calculation of the thermal conductivity of the living tissue LT (region ArO) based on the voltage value and the current value detected by the second sensor 36 (step S4A). ).
  • the thermal conductivity of the living tissue LT is increased. That is, when the thermal conductivity of the living tissue LT exceeds a predetermined value, it can be determined whether temporary joining of the living tissue LT is completed. Therefore, after step S4A, the energy control unit 341A constantly monitors whether the thermal conductivity calculated by the thermal conductivity calculation unit 343 exceeds a predetermined value (step S5A).
  • step S5A If it is determined that the thermal conductivity exceeds the predetermined value (step S5A: Yes), the energy control unit 341A proceeds from temporary joining of the living tissue LT (from the first energy generation unit 82A to the living tissue LT (area ArO) Application of the thermal energy (step S6A), and the process proceeds to step S7.
  • the medical treatment apparatus 1A has the following effects in addition to the effects similar to the first embodiment described above.
  • the first energy generating unit 82A (82A ') is formed of a ceramic heater or the like to ensure insulation. For this reason, it is possible to realize a configuration in which the first energy generation unit 82A (82A ') and the second energy generation unit 83 (83') are less likely to electrically short.
  • the first holding member 8A (second holding The members 8A ') can be miniaturized.
  • FIG. 14A to 14C are diagrams showing a first modification of the first and second embodiments of the present invention.
  • FIG. 14A and FIG. 14B correspond to FIG. 3 and show a modified example of the first embodiment (a modified example in which the first holding surface is flat).
  • FIG. 14C is a view corresponding to FIG. 3 and showing a modified example of the second embodiment (a modified example in which the first holding surface is flat).
  • the first jaw 81 has the protrusion 8111. That is, the first holding surface 811 had a convex shape having a step.
  • the first holding surface 811 is not limited to this.
  • the first holding members 8B and 8C (second holding members 8B', shown in FIGS. 14A and 14B). You may adopt 8C ').
  • the first holding member 8B adopts a first jaw 81B having a shape different from that of the first jaw 81 in addition to the first holding member 8 described in the first embodiment.
  • the protrusion 8111 is omitted from the first jaw 81 described in the first embodiment described above. That is, the first holding surface 811B of the first jaw 81B is configured to be flat.
  • the second energy generation unit 83 is a first region Ar1B that is a region including the center position CP in the first holding surface 811B (the first region Ar1 described in the first embodiment when viewed in a plan view) Having the same planar shape (substantially rectangular shape) as the first inclusion region ArCB (the same region as the region ArC described in the first embodiment when viewed in plan view) including the same region), It is fixed to the first inclusion area ArCB.
  • the first energy generation unit 82 is a first surrounding area ArSB surrounding the first area Ar1B in the first holding surface 811B (the same area as the area ArS described in the first embodiment when viewed in plan) And has the same planar shape (substantially U-shaped), and is fixed to the first surrounding area ArSB.
  • an air layer a gap
  • the second holding member 8B has the same configuration and shape as the first holding member 8A.
  • FIG. 14A as a symbol indicating the configuration of the second holding member 8B ′, “′ ′ ′ is added to the symbol indicating the configuration of the first holding member 8B for the same configuration as the first holding member 8B, and (1)
  • the reference numeral indicating the configuration of the holding member 8B is shown in parentheses. That is, as shown in FIG. 14A, the second holding member 8B ′ is the first holding member described above in place of the second jaw 81 ′ with respect to the second holding member 8 ′ described in the first embodiment.
  • a second jaw 81B '(including a second holding surface 811B') similar to the jaw 81B is employed.
  • the area Ar1B ′ is an area obtained by projecting the first area Ar1B of the first holding surface 811B onto the second holding surface 811B ′ with the first holding surface 811B and the second holding surface 811B ′ facing each other. And corresponds to a second area according to the present invention.
  • the region Ar1B ' will be referred to as a second region Ar1B'.
  • the region ArCB ′ is a region including the second region Ar1B ′ and corresponds to a second inclusion region according to the present invention.
  • the region ArCB ′ is described as a second inclusion region ArCB ′.
  • the area ArSB ′ is an area surrounding the second area Ar1B ′, and corresponds to a second surrounding area according to the present invention.
  • the region ArSB ′ is referred to as a second surrounding region.
  • the second inclusion region ArCB ′ and the second peripheral region ArSB ′ are configured such that the first sandwiching surface 811B and the second sandwiching surface 811B ′ are opposed to each other.
  • the first holding member 8C differs from the above-described first holding member 8B in that a first jaw 81C is employed instead of the first jaw 81B, as shown in FIG. 14B.
  • the first jaw 81C is different from the above-described first jaw 81B in that a projection 8113 is provided to fill the gap between the first energy generator 82 and the second energy generator 83.
  • the second holding member 8C has the same configuration and shape as the first holding member 8C. In FIG.
  • the first holding member 8D (second holding member 8D') shown in FIG. 14C is adopted instead of the first holding member 8A (second holding member 8A '). It does not matter. As shown in FIG. 14C, the first holding member 8D adopts the first jaw 81B described above in place of the first jaw 81 with respect to the first holding member 8A described in the second embodiment described above. The point is different. Under the present circumstances, the 1st energy generation part 82A is constituted by a ceramic heater etc., and insulation is secured. Therefore, as shown in FIG.
  • the first energy generating unit 82A and the second energy generating unit 83 are disposed such that there is no gap between the first energy generating unit 82A and the second energy generating unit 83. I don't care.
  • the size of the second energy generating unit 83 is increased to fill the gap, but the present invention is not limited to this, and the size of the first energy generating unit 82A may be increased to fill the gap. I don't care.
  • the second holding member 8D 'has the same configuration and shape as the first holding member 8D. In FIG.
  • “′ ′ ′ is added to the symbol indicating the configuration of the first holding member 8D for the same configuration as the first holding member 8D, and 1 indicates in parentheses the reference numeral indicating the configuration of the holding member 8D. That is, as shown in FIG. 14C, the second holding member 8D ′ is the first holding member described above in place of the second jaw 81 ′ with respect to the second holding member 8A ′ described in the second embodiment. A second jaw 81B 'similar to the jaw 81B is employed.
  • the first energy generation units 82 and 82A (82 'and 82A') and the second energy generation unit 83 (83 ') are the same. Although it was set so that it might become the thickness dimension of, it is not restricted to this.
  • the thickness dimension of the second energy generating unit 83 (83 ') may be set to be larger than the thickness dimension of the first energy generating units 82, 82A (82', 82A ').
  • FIG. 15A and 15B are diagrams showing a second modification of the first and second embodiments of the present invention.
  • FIG. 15A is a figure corresponding to FIG. 4, and is a figure which shows the 1st holding member 8E which concerns on this modification 2.
  • FIG. 15B is a view showing a second holding member 8E ′ according to the second modification.
  • the first holding member 8 (8A to 8D) and the second holding member 8 '(8A' to 8D ') have the same configuration. And although it had a shape, it is not restricted to this.
  • both the first holding surface 811 and the second holding surface 811 ' are not limited to the flat configuration, but only one of them is flat. The configuration may be adopted.
  • the first energy generating unit 82 (82A) and the second energy generating unit 83 are provided on the same first sandwiching surface 811 (first energy The generation unit 82 '(82A') and the second energy generation unit 83 'are provided on the same second holding surface 811'), but not limited to this, for example, as shown in FIGS. 15A and 15B. You may employ
  • the first holding member 8E shown in FIG. 15A includes the first jaw 81B and the first energy generator 82E described in the first modification.
  • the first energy generating unit 82E is configured of a ceramic heater or the like, and generates thermal energy. Then, as shown in FIG. 15A, the first energy generation unit 82E has the same planar shape (substantially U-shape) as the first surrounding area ArSB in the first holding surface 811B, and It is fixed. Moreover, 2nd holding member 8E 'shown to FIG. 15B is provided with 2nd jaw part 81 B' and the 2nd energy generation part 83E which were demonstrated by the modification 1 mentioned above. Similar to the first energy generating unit 82E described above, the second energy generating unit 83E includes a ceramic heater or the like, and generates heat energy.
  • the second energy generation unit 83E has the same planar shape (substantially rectangular shape) as the area ArCE ′ which occupies substantially the entire second sandwiching surface 811B ′, and the second energy generation unit 83E It is fixed.
  • the region ArCE ′ is a region including the second region Ar1B ′ and corresponds to a second inclusion region according to the present invention.
  • the area ArCE ' is described as a second inclusion area ArCE'. That is, the second inclusion region ArCE 'in which the second energy generation unit 83E is disposed only needs to include the second region Ar1B', and as shown in FIG. 15B, it extends to the second surrounding region ArSB '. It does not matter as an area.
  • the center of the first sandwiching surfaces 811 and 811 B (second sandwiching surfaces 811 ′ and 811 B ′) as the first region (second region) according to the present invention.
  • first regions Ar1 and Ar1B (second regions Ar1 ′ and Ar1B ′) including the position CP are employed, the present invention is not limited thereto, and other regions not including the center position may be used as the first region (second region). I don't care.
  • Embodiments 1 and 2 and Modifications 1 and 2 described above high frequency energy and thermal energy are adopted as energy for temporarily joining and main joining living tissue LT, but the invention is not limited thereto, and ultrasonic energy is adopted. It does not matter.
  • two types of different types of high frequency energy or thermal energy and ultrasonic energy may be combined as in the second embodiment described above, or as in the first embodiment described above, ultrasonic energy Only one kind of energy may be adopted.
  • the energy for temporarily joining the living tissue LT may be any of radio frequency energy, thermal energy, and ultrasonic energy, and the energy for main joining the living tissue LT is similarly high frequency energy, thermal energy, and Any energy of ultrasonic energy may be used.
  • main bonding of living tissue LT is started (termination of temporary bonding is completed) based on the impedance, time, and thermal conductivity of living tissue LT. Not limited to this.
  • main bonding of the living tissue LT may be started (termination of temporary bonding may be completed) based on physical properties such as hardness, thickness, or temperature of the living tissue LT.
  • the flow of bonding control is not limited to the order of the processing in the flowcharts (FIG. 7, FIG. 13) described in the first and second embodiments and the first and second modifications, and I do not care.

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Abstract

This energy treatment device 2 is provided with: a first holding member 8 having a first clamping surface 811; a second holding member 8' having a second clamping surface 811' that faces the first clamping surface 811 to clamp living tissue between the first clamping surface 811 and the same; first energy generation units 82, 82' for generating energy from a first peripheral region Ar1 on the first clamping surface 811 and a second peripheral region Ar1' on the second clamping surface 811; and second energy generation units 83, 83' for generating energy from a first inclusion region Ar2 on the first clamping surface 811 and a second inclusion region Ar2' on the second clamping surface 811. The first peripheral region Ar1 surrounds the first inclusion region Ar2 on the first clamping surface 811. The second peripheral region Ar1' surrounds the second inclusion region Ar2', which is formed by projecting the first inclusion region Ar2 onto the second clamping surface 811' in a state in which the first clamping surface 811 and the second clamping surface 811' are facing each other.

Description

エネルギ処置具、医療用処置装置、医療用処置装置の作動方法、及び治療方法Energy treatment tool, medical treatment apparatus, operation method of medical treatment apparatus, and treatment method
　本発明は、エネルギ処置具、医療用処置装置、医療用処置装置の作動方法、及び治療方法に関する。 The present invention relates to an energy treatment tool, a medical treatment apparatus, an operation method of a medical treatment apparatus, and a treatment method.
　近年、生体組織にエネルギを印加して当該生体組織を接合若しくは吻合するエネルギ処置具の開発が活発化している。このようなエネルギ処置具は、ステープラ等の物理的な物体を生体内に残すことがないため、人体への悪影響が少ないというメリットがある一方、接合強度が当該ステープラ等に比べると弱く、厚さによっては接合が不可能な生体組織もあり、接合強度の向上が望まれている。
　ところで、生体組織の細胞外基質（コラーゲンやエラスチン等）は、繊維状組織で構成されている。このため、生体組織を接合する際に、生体組織から細胞外基質を抽出し、当該細胞外基質を密接に絡ませ合うことで、接合強度が向上すると考えられる。
　そして、当該細胞外基質に着目し、接合強度を向上させることを目的としたエネルギ処置具が提案されている（例えば、特許文献１参照）。
　特許文献１に記載のエネルギ処置具は、一対のジョーにて生体組織を挟持し、一対のジョーを介して生体組織に機械的振動を与えることにより、細胞外基質の抽出や混合を強化している。 In recent years, development of an energy treatment tool for applying energy to a living tissue to join or anastomote the living tissue has been activated. Such an energy treatment tool does not leave a physical object such as a stapler in the living body, and thus has the advantage of having less adverse effects on the human body, while the bonding strength is weaker than that of the stapler etc. In some cases, there are living tissues that can not be joined, and improvement in the joining strength is desired.
By the way, extracellular matrix (collagen, elastin, etc.) of living tissue is composed of fibrous tissue. For this reason, when joining living tissues, the extracellular matrix is extracted from the living tissues, and it is thought that the joining strength is improved by closely encircling the extracellular matrices.
Then, an energy treatment tool aimed at improving the bonding strength focusing on the extracellular matrix has been proposed (for example, see Patent Document 1).
The energy treatment tool described in Patent Document 1 strengthens the extraction and mixing of extracellular matrix by sandwiching a living tissue with a pair of jaws and applying mechanical vibration to the living tissue through the pair of jaws. There is.
特開２０１２－２３９８９９号公報JP 2012-239899 A
　しかしながら、特許文献１に記載のエネルギ処置具では、一対のジョーにおける生体組織に接触する処置面は、平坦状に形成されている。すなわち、機械的振動またはエネルギにより軟化した細胞外基質は液状であるため、細胞外基質の抽出を強化したとしても、当該抽出した細胞外基質を一対のジョーの間に留まらせることは難しい。したがって、特許文献１に記載のエネルギ処置具では、接合強度を向上させることが難しい、という問題がある。 However, in the energy treatment device described in Patent Document 1, the treatment surface of the pair of jaws in contact with the living tissue is formed flat. That is, since the extracellular matrix softened by mechanical vibration or energy is a liquid, it is difficult to retain the extracted extracellular matrix between the pair of jaws even if the extraction of the extracellular matrix is enhanced. Therefore, in the energy treatment tool described in Patent Document 1, there is a problem that it is difficult to improve the bonding strength.
　本発明は、上記に鑑みてなされたものであって、生体組織の接合強度を向上させることができるエネルギ処置具、医療用処置装置、医療用処置装置の作動方法、及び治療方法を提供することを目的とする。 The present invention has been made in view of the above, and provides an energy treatment tool, a medical treatment apparatus, an operation method of the medical treatment apparatus, and a treatment method capable of improving the bonding strength of living tissues. With the goal.
　上述した課題を解決し、目的を達成するために、本発明に係るエネルギ処置具は、第１挟持面を有する第１保持部材と、前記第１挟持面に対向して当該第１挟持面との間で生体組織を挟持する第２挟持面を有する第２保持部材と、を備えたエネルギ処置具であって、前記第１挟持面は、第１領域を囲む領域である第１周囲領域と、前記第１領域を包含する領域である第１包含領域と、を有し、前記第２挟持面は、前記第１挟持面及び前記第２挟持面を互いに対向させた状態で、前記第１領域を前記第２挟持面に投影した第２領域を囲む領域である第２周囲領域と、前記第２領域を包含する領域である第２包含領域と、を有し、当該エネルギ処置具は、前記第１周囲領域と、前記第２周囲領域とのうち少なくとも一方からエネルギを発生する第１エネルギ発生部と、前記第１包含領域と、前記第２包含領域とのうち少なくとも一方からエネルギを発生する第２エネルギ発生部と、を備える、ことを特徴とする。 In order to solve the problems described above and achieve the object, an energy treatment tool according to the present invention comprises a first holding member having a first holding surface, and the first holding surface facing the first holding surface and the first holding member An energy treatment tool comprising a second holding member having a second holding surface holding the living tissue between the first and second peripheral regions, wherein the first holding surface is a first surrounding area which is an area surrounding the first area; A first inclusion area which is an area including the first area, and the second holding surface is a state in which the first holding surface and the second holding surface are opposed to each other. The energy treatment device includes a second surrounding area which is an area surrounding a second area projected onto the second holding surface, and a second inclusion area which is an area including the second area, Generating energy from at least one of the first surrounding area and the second surrounding area Comprising a first energy generating unit, and the first inclusion area, and a second energy generator for generating energy from at least one of said second inclusion area, characterized in that.
　また、本発明に係る医療用処置装置は、上述したエネルギ処置具と、前記第１エネルギ発生部と前記第２エネルギ発生部とにエネルギを発生させるエネルギ制御部と、を備えることを特徴とする。 A medical treatment apparatus according to the present invention is characterized by including the above-described energy treatment tool, and an energy control unit that generates energy in the first energy generation unit and the second energy generation unit. .
　また、本発明に係る医療用処置装置の作動方法は、第１挟持面を有する第１保持部材と第２挟持面を有する第２保持部材との間に生体組織が挟持された後、前記第１挟持面における第１周囲領域と、前記第２挟持面における第２周囲領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第１エネルギ付与ステップと、前記第１エネルギ付与ステップが開始された後、前記第１挟持面における第１包含領域と、前記第２挟持面における第２包含領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第２エネルギ付与ステップと、を備え、前記第１周囲領域は、前記第１挟持面における第１領域を囲む領域であり、前記第２周囲領域は、前記第１挟持面及び前記第２挟持面を互いに対向させた状態で、前記第１領域を前記第２挟持面に投影した第２領域を囲む領域であり、前記第１包含領域は、前記第１領域を包含する領域であり、前記第２包含領域は、前記第２領域を包含する領域であることを特徴とする。 Further, in the method of operating a medical treatment apparatus according to the present invention, the biological tissue is held between the first holding member having the first holding surface and the second holding member having the second holding surface, A first energy applying step of applying energy to the living tissue from at least one of a first peripheral region of the first clamping surface and a second peripheral region of the second clamping surface; and the first energy applying step is started A second energy applying step of applying energy to the living tissue from at least one of a first inclusion region of the first sandwiching surface and a second inclusion region of the second sandwiching surface; The first peripheral area is an area surrounding the first area in the first holding surface, and the second peripheral area is the first peripheral area with the first holding surface and the second holding surface facing each other. Territory Is a region surrounding a second region projected on the second holding surface, the first inclusion region is a region including the first region, and the second inclusion region includes the second region. It is characterized by being an area.
　また、本発明に係る治療方法は、第１挟持面を有する第１保持部材と第２挟持面を有する第２保持部材とで生体組織を挟持する挟持ステップと、前記第１挟持面における第１周囲領域と、前記第２挟持面における第２周囲領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第１エネルギ付与ステップと、前記第１エネルギ付与ステップが開始された後、前記第１挟持面における第１包含領域と、前記第２挟持面における第２包含領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第２エネルギ付与ステップと、を備え、前記第１周囲領域は、前記第１挟持面における第１領域を囲む領域であり、前記第２周囲領域は、前記第１挟持面及び前記第２挟持面を互いに対向させた状態で、前記第１領域を前記第２挟持面に投影した第２領域を囲む領域であり、前記第１包含領域は、前記第１領域を包含する領域であり、前記第２包含領域は、前記第２領域を包含する領域であることを特徴とする。 In the treatment method according to the present invention, a holding step of holding a living tissue with a first holding member having a first holding surface and a second holding member having a second holding surface; A first energy applying step of applying energy to the living tissue from at least one of a surrounding region and a second surrounding region of the second sandwiching surface; and the first energy applying step is started; A second energy applying step of applying energy to the living tissue from at least one of a first inclusion region in the holding surface and a second inclusion region in the second holding surface, and the first peripheral region is The first surrounding area is an area surrounding a first area in the first sandwiching surface, and the second peripheral area is a region surrounding the first sandwiching surface and the second sandwiching surface facing each other. It is an area surrounding a second area projected on a sandwiching surface, the first inclusion area is an area including the first area, and the second inclusion area is an area including the second area. It is characterized by
　本発明に係るエネルギ処置具、医療用処置装置、医療用処置装置の作動方法、及び治療方法によれば、生体組織の接合強度を向上させることができる、という効果を奏する。 According to the energy treatment tool, the medical treatment apparatus, the operation method of the medical treatment apparatus, and the treatment method according to the present invention, it is possible to improve the bonding strength of the living tissues.
図１は、本発明の実施の形態１に係る医療用処置装置を模式的に示す図である。FIG. 1 is a view schematically showing a medical treatment apparatus according to Embodiment 1 of the present invention. 図２は、図１に示したエネルギ処置具の先端部分を拡大した図である。FIG. 2 is an enlarged view of a tip portion of the energy treatment device shown in FIG. 図３は、図２に示した第１保持部材を示す図である。FIG. 3 is a view showing the first holding member shown in FIG. 図４は、図２に示した第１保持部材を示す図である。FIG. 4 is a view showing the first holding member shown in FIG. 図５は、図２に示した第２保持部材を示す図である。FIG. 5 is a view showing the second holding member shown in FIG. 図６は、図１に示した制御装置及びフットスイッチの構成を示すブロック図である。FIG. 6 is a block diagram showing the configuration of the control device and the foot switch shown in FIG. 図７は、図６に示した制御装置による接合制御を示すフローチャートである。FIG. 7 is a flow chart showing bonding control by the control device shown in FIG. 図８は、図７に示したステップＳ１が行われた状態での生体組織と第１保持部材との位置関係を第１挟持面側から見た図である。FIG. 8 is a view of the positional relationship between the living tissue and the first holding member in the state where step S1 shown in FIG. 7 is performed, as viewed from the first sandwiching surface side. 図９は、図７に示したステップＳ４以降に算出されたインピーダンスの挙動を示す図である。FIG. 9 is a diagram showing the behavior of the impedance calculated after step S4 shown in FIG. 図１０は、本発明の実施の形態２に係る医療用処置装置（エネルギ処置具）を構成する第１保持部材を示す図である。FIG. 10 is a view showing a first holding member constituting the medical treatment apparatus (energy treatment tool) according to the second embodiment of the present invention. 図１１は、本発明の実施の形態２に係る医療用処置装置（エネルギ処置具）を構成する第１保持部材を示す図である。FIG. 11 is a view showing a first holding member constituting the medical treatment apparatus (energy treatment tool) according to the second embodiment of the present invention. 図１２は、本発明の実施の形態２に係る制御装置の構成を示すブロック図である。FIG. 12 is a block diagram showing a configuration of a control device according to Embodiment 2 of the present invention. 図１３は、本発明の実施の形態２に係る接合制御を示すフローチャートである。FIG. 13 is a flowchart showing bonding control according to the second embodiment of the present invention. 図１４Ａは、本発明の実施の形態１，２の変形例１を示す図である。FIG. 14A is a diagram showing a modification 1 of the first and second embodiments of the present invention. 図１４Ｂは、本発明の実施の形態１，２の変形例１を示す図である。FIG. 14B is a diagram showing a modification 1 of the first and second embodiments of the present invention. 図１４Ｃは、本発明の実施の形態１，２の変形例１を示す図である。FIG. 14C is a diagram showing a modification 1 of the first and second embodiments of the present invention. 図１５Ａは、本発明の実施の形態１，２の変形例２を示す図である。FIG. 15A is a diagram showing a modification 2 of the first and second embodiments of the present invention. 図１５Ｂは、本発明の実施の形態１，２の変形例２を示す図である。FIG. 15B is a diagram showing a modification 2 of the first and second embodiments of the present invention.
　以下に、図面を参照して、本発明を実施するための形態（以下、実施の形態）について説明する。なお、以下に説明する実施の形態によって本発明が限定されるものではない。さらに、図面の記載において、同一の部分には同一の符号を付している。 Hereinafter, embodiments for carrying out the present invention (hereinafter, embodiments) will be described with reference to the drawings. The present invention is not limited by the embodiments described below. Furthermore, in the description of the drawings, the same parts are given the same reference numerals.
（実施の形態１）
　〔医療用処置装置の概略構成〕
　図１は、本発明の実施の形態１に係る医療用処置装置１を模式的に示す図である。
　医療用処置装置１は、処置対象である生体組織にエネルギを印加し、当該生体組織の処置（接合若しくは吻合等）を行う。この医療用処置装置１は、図１に示すように、エネルギ処置具２と、制御装置３と、フットスイッチ４とを備える。 Embodiment 1
[Schematic Configuration of Medical Treatment Device]
FIG. 1 is a view schematically showing a medical treatment apparatus 1 according to Embodiment 1 of the present invention.
The medical treatment apparatus 1 applies energy to a living tissue to be treated, and performs treatment (such as bonding or anastomosis) on the living tissue. As shown in FIG. 1, the medical treatment apparatus 1 includes an energy treatment device 2, a control device 3, and a foot switch 4.
　〔エネルギ処置具の構成〕
　エネルギ処置具２は、例えば、腹壁を通して生体組織に処置（接合若しくは吻合等）を行うためのリニアタイプの外科医療用処置具である。このエネルギ処置部２は、図１に示すように、ハンドル５と、シャフト６と、挟持部７とを備える。
　ハンドル５は、術者が把持する部分である。そして、このハンドル５には、図１に示すように、操作ノブ５１が設けられている。
　シャフト６は、図１に示すように、略円筒形状を有し、一端がハンドル５に接続されている。また、シャフト６の他端には、挟持部７が取り付けられている。そして、このシャフト６の内部には、術者による操作ノブ５１の操作に応じて、挟持部７を構成する第１，第２保持部材８，８´（図１）を開閉させる開閉機構（図示略）が設けられている。また、このシャフト６の内部には、制御装置３に接続された電気ケーブルＣ（図１）がハンドル５を介して一端側から他端側まで配設されている。 [Configuration of energy treatment tool]
The energy treatment tool 2 is, for example, a linear type surgical treatment tool for performing treatment (such as bonding or anastomosis) on a living tissue through the abdominal wall. As shown in FIG. 1, the energy treatment unit 2 includes a handle 5, a shaft 6 and a holding unit 7.
The handle 5 is a portion held by the operator. Further, as shown in FIG. 1, the handle 5 is provided with an operation knob 51.
As shown in FIG. 1, the shaft 6 has a substantially cylindrical shape and one end is connected to the handle 5. Further, at the other end of the shaft 6, a clamping unit 7 is attached. An opening / closing mechanism (shown in the drawing) opens and closes the first and second holding members 8 and 8 '(FIG. 1) constituting the holding unit 7 in accordance with the operation of the operation knob 51 by the operator. ) Is provided. Further, an electric cable C (FIG. 1) connected to the control device 3 is disposed inside the shaft 6 from one end side to the other end side via the handle 5.
　〔挟持部の構成〕
　図２は、エネルギ処置具２の先端部分を拡大した図である。
　挟持部７は、生体組織を挟持して、当該生体組織の処置（接合若しくは吻合等）を行う部分である。この挟持部７は、図２に示すように、第１保持部材８と、第２保持部材８´とを備える。
　なお、図２では、第２保持部材８´の構成を示す符号として、第１保持部材８と同一の構成については、当該第１保持部材８の構成を示す符号に「´」を付加している。以降の図も同様である。
　第１，第２保持部材８，８´は、矢印Ｒ１（図２）方向に開閉可能にシャフト６の他端に軸支され、術者による操作ノブ５１の操作に応じて、生体組織を挟持可能とする。 [Configuration of clamping unit]
FIG. 2 is an enlarged view of the distal end portion of the energy treatment device 2.
The clamping unit 7 is a portion that clamps a living tissue and performs treatment (such as bonding or anastomosis) of the living tissue. As shown in FIG. 2, the holding unit 7 includes a first holding member 8 and a second holding member 8 ′.
In addition, in FIG. 2, as a code | symbol which shows the structure of 2nd holding member 8 ', about the structure same as the 1st holding member 8, "'" is added to the code | symbol which shows the structure of the said 1st holding member 8 concerned. There is. The same applies to the subsequent figures.
The first and second holding members 8 and 8 'are pivotally supported by the other end of the shaft 6 so as to be able to open and close in the direction of arrow R1 (FIG. 2), and hold biological tissue in accordance with the operation of the operation knob 51 by the operator. To be possible.
　〔第１保持部材の構成〕
　図３及び図４は、図２に示した第１保持部材８を示す図である。具体的に、図３は、図２のIII-III線で切断した断面図である。図４は、第１保持部材８を図２中、上方側から見た図である。
　なお、III-III線は、第１挟持面８１１の中心位置ＣＰ（図４）を通る線である。
　第１保持部材８は、第２保持部材８´に対して、図１または図２中、下方側に配設される。この第１保持部材８は、図２ないし図４に示すように、第１顎部８１と、第１エネルギ発生部８２と、第２エネルギ発生部８３とを備える。 [Configuration of First Holding Member]
3 and 4 are views showing the first holding member 8 shown in FIG. Specifically, FIG. 3 is a cross-sectional view taken along the line III-III in FIG. FIG. 4 is a view of the first holding member 8 as viewed from above in FIG.
The III-III line is a line passing through the center position CP (FIG. 4) of the first holding surface 811.
The first holding member 8 is disposed below the second holding member 8 ′ in FIG. 1 or 2. The first holding member 8 includes a first jaw 81, a first energy generator 82, and a second energy generator 83, as shown in FIGS.
　第１顎部８１は、セラミック等の絶縁性材料で構成された長尺状の板体であり、シャフト６の他端に軸支される部分である。
　この第１顎部８１において、第２保持部材８´に対向する面８１１（以下、第１挟持面８１１と記載）には、図３または図４に示すように、上方側（第２保持部材８´側）に向けて突出する突出部８１１１が形成されている。このため、第１挟持面８１１は、図３に示すように、段差を有する凸状に形成されている。
　突出部８１１１は、第１顎部８１の幅方向（図３中、左右方向（長手方向に直交する方向））の中央部分に位置し、当該第１顎部８１の基端（図４中、下端部（シャフト６の他端に軸支される側））から先端側（図４中、上端部側）に向けて延びる形状を有する。また、突出部８１１１における突出方向の先端面（図３中、上方側の面）は、平坦状に形成されている。すなわち、第１挟持面８１１において、突出部８１１１を除くＵ字部分８１１２は、図４に示すように、第１顎部８１の基端から外縁に沿って先端に向けて延び、さらに先端から外縁に沿って基端に向けて延びる略Ｕ字形状を有する。また、当該Ｕ字部分８１１２は、図３に示すように、平坦状に形成されている。
　ここで、第１挟持面８１１において、突出部８１１１の先端面の略全体を占める領域ＡｒＣ（図４）は、当該第１挟持面８１１の中心位置ＣＰ（図４）を含む領域である第１領域Ａｒ１を包含する領域であり、本発明に係る第１包含領域に相当する。以下、領域ＡｒＣを第１包含領域ＡｒＣと記載する。また、第１挟持面８１１において、突出部８１１１を除くＵ字部分８１１２の略全体を占める領域ＡｒＳは、第１領域Ａｒ１を囲む領域であり、本発明に係る第１周囲領域に相当する。以下、領域ＡｒＳを第１周囲領域ＡｒＳと記載する。なお、本実施の形態１では、第１周囲領域ＡｒＳは、第１包含領域ＡｒＣを囲む領域に設定されている。 The first jaw 81 is a long plate made of an insulating material such as ceramic, and is a portion pivotally supported by the other end of the shaft 6.
In the first jaw 81, on the surface 811 facing the second holding member 8 '(hereinafter referred to as the first holding surface 811), as shown in FIG. 3 or 4, the upper side (second holding member A protrusion 8111 is formed to protrude toward the 8 'side). Therefore, as shown in FIG. 3, the first holding surface 811 is formed in a convex shape having a step.
The protrusion 8111 is located at the central portion in the width direction of the first jaw 81 (in FIG. 3, in the left-right direction (direction orthogonal to the longitudinal direction)), and the proximal end of the first jaw 81 (in FIG. 4) It has a shape extending from the lower end (the side pivotally supported by the other end of the shaft 6) to the tip side (the upper end side in FIG. 4). Further, a tip end surface (a surface on the upper side in FIG. 3) in the protrusion direction of the protrusion 8111 is formed flat. That is, in the first sandwiching surface 811, the U-shaped portion 8112 excluding the projecting portion 8111 extends from the proximal end of the first jaw 81 along the outer edge toward the tip as shown in FIG. Generally U-shaped extending towards the proximal end. Further, as shown in FIG. 3, the U-shaped portion 8112 is formed flat.
Here, in the first holding surface 811, a region ArC (FIG. 4) that occupies substantially the entire tip surface of the protrusion 8111 is a region including the center position CP (FIG. 4) of the first holding surface 811. The region including the region Ar1 corresponds to the first inclusion region according to the present invention. Hereinafter, the region ArC is referred to as a first inclusion region ArC. Further, in the first sandwiching surface 811, a region ArS that occupies substantially the entire U-shaped portion 8112 excluding the projecting portion 8111 is a region surrounding the first region Ar1, and corresponds to a first peripheral region according to the present invention. Hereinafter, the region ArS is referred to as a first surrounding region ArS. In the first embodiment, the first surrounding area ArS is set to an area surrounding the first inclusion area ArC.
　第１エネルギ発生部８２は、第１顎部８１の第１挟持面８１１に固定され、制御装置３による制御の下、高周波エネルギを発生する。
　具体的に、第１エネルギ発生部８２は、例えば、銅等の導電性材料からなる薄板で構成され、図４に示すように、第１周囲領域ＡｒＳと同一の平面形状（略Ｕ字形状）を有し、当該第１周囲領域ＡｒＳに固定されている。そして、第１エネルギ発生部８２は、電気ケーブルＣを構成する第１高周波用リード線Ｃ１（図６参照）が接合され、第１高周波用リード線Ｃ１，Ｃ１´（図６参照）を介して制御装置３により第２保持部材８´の第１エネルギ発生部８２´との間に高周波電力が供給されることで、高周波エネルギを発生する。すなわち、第１エネルギ発生部８２は、高周波電力が供給される電極として構成されている。 The first energy generating unit 82 is fixed to the first holding surface 811 of the first jaw 81, and generates high frequency energy under the control of the control device 3.
Specifically, the first energy generating unit 82 is, for example, a thin plate made of a conductive material such as copper, and has the same planar shape (substantially U-shaped) as the first surrounding area ArS, as shown in FIG. And is fixed to the first surrounding area ArS. Then, in the first energy generating unit 82, the first high frequency lead wire C1 (see FIG. 6) constituting the electric cable C is joined, and the first energy generation portion 82 is connected via the first high frequency lead wires C1 and C1 '(see FIG. 6). The control device 3 supplies high frequency power between the control unit 3 and the first energy generation unit 82 'of the second holding member 8' to generate high frequency energy. That is, the first energy generating unit 82 is configured as an electrode to which high frequency power is supplied.
　第２エネルギ発生部８３は、第１エネルギ発生部８２と同様に、第１顎部８１の第１挟持面８１１に固定され、制御装置３による制御の下、高周波エネルギを発生する。
　具体的に、第２エネルギ発生部８２は、例えば、銅等の導電性材料からなる薄板で構成され、図４に示すように、第１包含領域ＡｒＣと同一の平面形状（略矩形形状）を有し、当該第１包含領域ＡｒＣに固定されている。そして、第２エネルギ発生部８３は、電気ケーブルＣを構成する第２高周波用リード線Ｃ２（図６参照）が接合され、第２高周波用リード線Ｃ２，Ｃ２´（図６参照）を介して制御装置３により第２保持部材８´の第２エネルギ発生部８３´との間に高周波電力が供給されることで、高周波エネルギを発生する。すなわち、第２エネルギ発生部８３は、高周波電力が供給される電極として構成されている。 Similar to the first energy generating unit 82, the second energy generating unit 83 is fixed to the first sandwiching surface 811 of the first jaw 81, and generates high frequency energy under the control of the control device 3.
Specifically, the second energy generating unit 82 is formed of, for example, a thin plate made of a conductive material such as copper, and has the same planar shape (substantially rectangular shape) as the first inclusion region ArC as shown in FIG. And fixed to the first inclusion area ArC. Then, in the second energy generating unit 83, the second high frequency lead wire C2 (see FIG. 6) constituting the electric cable C is joined, and the second energy generation portion 83 is connected via the second high frequency lead wires C2 and C2 '(see FIG. 6). The control device 3 supplies high frequency power between the control unit 3 and the second energy generation unit 83 'of the second holding member 8' to generate high frequency energy. That is, the second energy generating unit 83 is configured as an electrode to which high frequency power is supplied.
　〔第２保持部材の構成〕
　図５は、図２に示した第２保持部材８´を示す図である。具体的に、図５は、図３に対応した断面図であり、第１，第２保持部材８，８´を閉じて第１，第２挟持面８１１，８１１´を対向させた状態を示す図である。
　第２保持部材８´は、図２または図５に示すように、第１保持部材８と同一の構成及び形状を有する。すなわち、第２保持部材８´は、図５に示すように、第２顎部８１´（第２挟持面８１１´、突出部８１１１´、Ｕ字部分８１１２´、及び領域Ａｒ１´，ＡｒＳ´，ＡｒＣ´を含む）と、第１エネルギ発生部８２´と、第２エネルギ発生部８３´とを備える。
　そして、第２保持部材８´は、第１保持部材８を上下反転させた姿勢で、シャフト６の他端に取り付けられる。
　ここで、第２挟持面８１１´において、領域Ａｒ１´は、第１挟持面８１１及び第２挟持面８１１´を互いに対向させた状態で、第１挟持面８１１の第１領域Ａｒ１を当該第２挟持面８１１´に投影した領域であり、本発明に係る第２領域に相当する。以下、領域Ａｒ１´を第２領域Ａｒ１´と記載する。本実施の形態１では、第２領域Ａｒ１´は、第２挟持面８１１´の中心位置ＣＰ´（図５）を含む領域である。また、突出部８１１１´の先端面の領域ＡｒＣ´は、第２領域Ａｒ１´を包含する領域であり、本発明に係る第２包含領域に相当する。以下、領域ＡｒＣ´を第２包含領域ＡｒＣ´と記載する。さらに、第２挟持面８１１´において、領域ＡｒＳ´は、第２領域Ａｒ１´を囲む領域であり、本発明に係る第２周囲領域に相当する。以下、領域ＡｒＳ´を第２周囲領域ＡｒＳ´と記載する。なお、本実施の形態１では、第２包含領域ＡｒＣ´及び第２周囲領域ＡｒＳ´は、第１挟持面８１１及び第２挟持面８１１´を互いに対向させた状態で、第１挟持面８１１の第１包含領域ＡｒＣ及び第１周囲領域ＡｒＳを当該第２挟持面８１１´にそれぞれ投影した領域である。 [Configuration of Second Holding Member]
FIG. 5 is a view showing the second holding member 8 'shown in FIG. Specifically, FIG. 5 is a cross-sectional view corresponding to FIG. 3 and shows a state in which the first and second holding surfaces 811 and 811 'are opposed to each other by closing the first and second holding members 8 and 8'. FIG.
The second holding member 8 ′ has the same configuration and shape as the first holding member 8 as shown in FIG. 2 or 5. That is, as shown in FIG. 5, the second holding member 8 ′ includes the second jaw 81 ′ (the second holding surface 811 ′, the protrusion 8111 ′, the U-shaped portion 8112 ′, and the regions Ar 1 ′, ArS ′, And ArC 'is included, a first energy generating unit 82', and a second energy generating unit 83 '.
The second holding member 8 ′ is attached to the other end of the shaft 6 in a posture in which the first holding member 8 is turned upside down.
Here, in the second sandwiching surface 811 ′, the region Ar1 ′ corresponds to the first region Ar1 of the first sandwiching surface 811 with the first sandwiching surface 811 and the second sandwiching surface 811 ′ facing each other. It is an area projected onto the sandwiching surface 811 ′, and corresponds to a second area according to the present invention. Hereinafter, the region Ar1 'is referred to as a second region Ar1'. In the first embodiment, the second area Ar1 ′ is an area including the center position CP ′ (FIG. 5) of the second holding surface 811 ′. The area ArC ′ of the tip end face of the protrusion 8111 ′ is an area including the second area Ar1 ′, and corresponds to a second inclusion area according to the present invention. Hereinafter, the region ArC 'is referred to as a second inclusion region ArC'. Furthermore, in the second holding surface 811 ′, the region ArS ′ is a region surrounding the second region Ar1 ′, and corresponds to a second peripheral region according to the present invention. Hereinafter, the region ArS 'is referred to as a second surrounding region ArS'. In the first embodiment, the second inclusion area ArC ′ and the second peripheral area ArS ′ are formed on the first holding surface 811 with the first holding surface 811 and the second holding surface 811 ′ facing each other. It is the area | region which each projected 1st inclusion area ArC and 1st surrounding area ArS on the said 2nd clamping surface 811 '.
　〔制御装置及びフットスイッチの構成〕
　図６は、制御装置３及びフットスイッチ４の構成を示すブロック図である。
　なお、図６では、制御装置３の構成として、本発明の要部を主に図示している。
　フットスイッチ４は、術者が足で操作する部分である。そして、フットスイッチ４への当該操作（ＯＮ）に応じて、制御装置３は、後述する接合制御を開始する。
　なお、当該接合制御を開始させる手段としては、フットスイッチ４に限られず、その他、手で操作するスイッチ等を採用しても構わない。 [Configuration of Control Device and Foot Switch]
FIG. 6 is a block diagram showing the configuration of the control device 3 and the foot switch 4.
In FIG. 6, the main part of the present invention is mainly illustrated as the configuration of the control device 3.
The foot switch 4 is a portion operated by the operator with a foot. And according to the said operation (ON) to the foot switch 4, the control apparatus 3 starts joining control mentioned later.
In addition, it is not restricted to foot switch 4 as a means to start the said joining control, In addition, you may employ | adopt the switch etc. which are operated by hand.
　制御装置３は、エネルギ処置具２の動作を統括的に制御する。この制御装置３は、図６に示すように、高周波エネルギ出力部３１と、スイッチ３２と、第１センサ３３と、制御部３４とを備える。
　高周波エネルギ出力部３１は、制御部３４による制御の下、第１高周波用リード線Ｃ１，Ｃ１´または第２高周波用リード線Ｃ２，Ｃ２´を介して、第１エネルギ発生部８２，８２´または第２エネルギ発生部８３，８３´に高周波電力を供給する。
　スイッチ３２は、制御部３４による制御の下、高周波エネルギ出力部３１から高周波電力を供給するリード線を、第１高周波用リード線Ｃ１，Ｃ１´または第２高周波用リード線Ｃ２，Ｃ２´に切り替える。
　第１センサ３３は、高周波エネルギ出力部３１から第１エネルギ発生部８２，８２´に供給されている電圧値及び電流値を検出する。そして、第１センサ３３は、検出した電圧値及び電流値に応じた信号を制御部３４に出力する。 The control device 3 generally controls the operation of the energy treatment device 2. The control device 3 includes a high frequency energy output unit 31, a switch 32, a first sensor 33, and a control unit 34, as shown in FIG.
The high-frequency energy output unit 31 receives the first energy generation unit 82 or 82 'or the first high-frequency lead wire C1 or C1' or the second high-frequency lead wire C2 or C2 'under the control of the control unit 34. The high frequency power is supplied to the second energy generating units 83 and 83 '.
The switch 32 switches the lead wire for supplying high frequency power from the high frequency energy output unit 31 to the first high frequency lead wire C1 or C1 'or the second high frequency lead wire C2 or C2' under the control of the control unit 34. .
The first sensor 33 detects the voltage value and the current value supplied from the high frequency energy output unit 31 to the first energy generation unit 82, 82 '. Then, the first sensor 33 outputs a signal corresponding to the detected voltage value and current value to the control unit 34.
　制御部３４は、ＣＰＵ（Central Processing Unit）等を含んで構成され、フットスイッチ４がＯＮになった場合に、所定の制御プログラムにしたがって、接合制御を実行する。この制御部３４は、図６に示すように、エネルギ制御部３４１と、インピーダンス算出部３４２とを備える。
　エネルギ制御部３４１は、スイッチ３２を動作させて高周波電力を供給するリード線を第１高周波用リード線Ｃ１，Ｃ１´に切り替えるとともに、高周波エネルギ出力部３１を駆動し、高周波エネルギ出力部３１から第１エネルギ発生部８２，８２´に高周波電力を供給させる（高周波エネルギを発生させる）。また、エネルギ制御部３４１は、インピーダンス算出部３４２にて算出されたインピーダンスに基づいて、スイッチ３２を動作させて高周波電力を供給するリード線を第１高周波用リード線Ｃ１，Ｃ１´から第２高周波用リード線Ｃ２，Ｃ２´に切り替え、高周波エネルギ出力部３１から第２エネルギ発生部８３，８３´に高周波電力を供給させる（高周波エネルギを発生させる）。 The control unit 34 is configured to include a CPU (Central Processing Unit) or the like, and executes joint control according to a predetermined control program when the foot switch 4 is turned on. As shown in FIG. 6, the control unit 34 includes an energy control unit 341 and an impedance calculation unit 342.
The energy control unit 341 operates the switch 32 to switch the lead wires for supplying high frequency power to the first high frequency lead wires C1 and C1 ′, and drives the high frequency energy output unit 31 so that the high frequency energy output unit 31 (1) The high frequency power is supplied to the energy generators 82 and 82 '(high frequency energy is generated). Further, the energy control unit 341 operates the switch 32 based on the impedance calculated by the impedance calculation unit 342 to supply the high frequency power to the lead wire from the first high frequency lead wires C1 and C1 'to the second high frequency wave. The high-frequency energy output unit 31 supplies high-frequency power to the second energy generation units 83 and 83 '(generates high-frequency energy).
　ここで、エネルギ制御部３４１は、第１エネルギ発生部８２，８２´に供給する高周波電力よりも第２エネルギ発生部８３，８３´に供給する高周波電力を高くする、あるいは、第１エネルギ発生部８２，８２´に供給する高周波電力の電力量よりも第２エネルギ発生部８３，８３´に供給する高周波電力の電力量を高くする。すなわち、エネルギ制御部３４１は、第１エネルギ発生部８２，８２´からの高周波エネルギの発生時での第１エネルギ発生部８２，８２´の最高到達温度より第２エネルギ発生部８３，８３´からの高周波エネルギの発生時での第２エネルギ発生部８３，８３´の最高到達温度が高くなるように第１エネルギ発生部８２，８２´及び第２エネルギ発生部８３，８３´に高周波エネルギを発生させる。 Here, the energy control unit 341 makes the high frequency power supplied to the second energy generating unit 83, 83 'higher than the high frequency power supplied to the first energy generating unit 82, 82', or the first energy generating unit The power amount of the high frequency power supplied to the second energy generation unit 83, 83 'is made higher than the power amount of the high frequency power supplied to 82, 82'. That is, the energy control unit 341 generates the high-frequency energy from the first energy generation units 82 and 82 'by the second energy generation units 83 and 83' based on the highest temperature reached by the first energy generation units 82 and 82 '. High-frequency energy is generated in the first energy generation units 82 and 82 'and the second energy generation units 83 and 83' so that the highest temperature reached by the second energy generation units 83 and 83 'at the time of generation of high-frequency energy Let
　インピーダンス算出部３４２は、第１センサ３３にて検出された電圧値及び電流値に基づいて、第１エネルギ発生部８２，８２´から生体組織に対して高周波エネルギが付与されている際のインピーダンス（生体組織のインピーダンス）を算出する。 The impedance calculation unit 342 determines the impedance when high-frequency energy is applied to the living tissue from the first energy generation units 82 and 82 ′ based on the voltage value and the current value detected by the first sensor 33 (see FIG. Calculate the impedance of the living tissue.
　〔医療用処置装置の動作〕
　次に、上述した医療用処置装置１の動作について説明する。
　なお、以下では、医療用処置装置１の動作として、制御装置３による接合制御を主に説明する。
　図７は、制御装置３による接合制御を示すフローチャートである。
　術者は、エネルギ処置具２を把持し、当該エネルギ処置具２の先端部分（挟持部７及びシャフト６の一部）を、例えば、トロッカ等を用いて腹壁を通して腹腔内に挿入する。そして、術者は、操作ノブ５１を操作し、第１，第２保持部材８，８´にて生体組織を挟持する（ステップＳ１：挟持ステップ）。
　次に、術者は、フットスイッチ４を操作（ＯＮ）し、制御装置３による接合制御を開始させる（ステップＳ２：Ｙｅｓ）。 [Operation of medical treatment apparatus]
Next, the operation of the above-described medical treatment apparatus 1 will be described.
In addition, below, as operation | movement of the medical treatment apparatus 1, junction control by the control apparatus 3 is mainly demonstrated.
FIG. 7 is a flowchart showing bonding control by the control device 3.
The operator holds the energy treatment tool 2 and inserts the distal end portion (a part of the pinching portion 7 and the shaft 6) of the energy treatment tool 2 into the abdominal cavity through the abdominal wall using, for example, a trocar. Then, the operator operates the operation knob 51 to clamp the living tissue with the first and second holding members 8 and 8 '(step S1: holding step).
Next, the operator operates (turns on) the foot switch 4 to start bonding control by the control device 3 (step S2: Yes).
　図８は、ステップＳ１が行われた状態での生体組織ＬＴと第１保持部材８との位置関係を第１挟持面８１１側から見た図である。
　エネルギ制御部３４１は、フットスイッチ４がＯＮになると（ステップＳ２：Ｙｅｓ）、スイッチ３２を動作させて高周波電力を供給するリード線を第１高周波用リード線Ｃ１，Ｃ１´に切り替えるとともに、高周波エネルギ出力部３１を駆動し、高周波エネルギ出力部３１から第１エネルギ発生部８２，８２´への高周波電力の供給を開始（生体組織ＬＴ（領域ＡｒＯ（図８に右斜めの斜線で示した領域））に対する高周波エネルギの付与を開始）する（ステップＳ３：第１エネルギ付与ステップ）。
　ここで、第１エネルギ発生部８２，８２´から生体組織ＬＴに対して高周波エネルギが付与された場合には、生体組織ＬＴにおいて、第１エネルギ発生部８２，８２´の位置（第１，第２周囲領域ＡｒＳ，ＡｒＳ´）に対応する領域ＡｒＯ（図８）に高周波エネルギが付与される。すなわち、ステップＳ３では、生体組織ＬＴの本接合（領域ＡｒＩ（図８に左斜めの斜線で示した領域）への高周波エネルギの付与）を行う前に、当該領域ＡｒＩの外側に位置する領域ＡｒＯに高周波エネルギを付与することにより生体組織ＬＴの仮接合を開始している。
　ステップＳ３の後、インピーダンス算出部３４２は、第１センサ３３にて検出された電圧値及び電流値に基づいて、生体組織ＬＴ（領域ＡｒＯ）のインピーダンスの算出を開始する（ステップＳ４）。 FIG. 8 is a view of the positional relationship between the living tissue LT and the first holding member 8 in the state where step S1 is performed, as viewed from the first holding surface 811 side.
When the foot switch 4 is turned on (step S2: Yes), the energy control unit 341 operates the switch 32 to switch the lead wire for supplying high frequency power to the first high frequency lead wires C1 and C1 ', and The output unit 31 is driven, and supply of high frequency power from the high frequency energy output unit 31 to the first energy generation unit 82, 82 'is started (living tissue LT (region ArO (region indicated by oblique lines to the right in FIG. 8)) Start application of high-frequency energy)) (step S3: first energy application step).
Here, when high-frequency energy is applied to the living tissue LT from the first energy generating units 82 and 82 ′, the positions of the first energy generating units 82 and 82 ′ in the living tissue LT High frequency energy is applied to the area ArO (FIG. 8) corresponding to the two surrounding areas ArS and ArS ′). That is, in step S3, before performing main junction of living tissue LT (application of high-frequency energy to region ArI (region shown by diagonal lines in the left diagonal in FIG. 8)), region ArO located outside the region ArI Temporary joining of the living tissue LT is started by applying high frequency energy to the
After step S3, the impedance calculation unit 342 starts calculation of the impedance of the living tissue LT (region ArO) based on the voltage value and the current value detected by the first sensor 33 (step S4).
　図９は、ステップＳ４以降に算出されたインピーダンスの挙動を示す図である。
　生体組織ＬＴに対して高周波エネルギを付与すると、生体組織ＬＴのインピーダンスは、図９に示す挙動を示す。
　高周波エネルギを付与した初期の時間帯（高周波エネルギの付与開始～時間Ｔ１）では、インピーダンスは、図９に示すように、徐々に減少していく。これは、高周波エネルギの付与によって、生体組織ＬＴの細胞膜破壊が生じ、生体組織ＬＴから細胞外基質が抽出されていることに起因する。言い換えれば、当該初期の時間帯では、生体組織ＬＴから細胞外基質が抽出され、生体組織ＬＴの粘度が低くなっていく（生体組織ＬＴが軟化していく）時間帯である。 FIG. 9 is a diagram showing the behavior of the impedance calculated after step S4.
When high frequency energy is applied to the living tissue LT, the impedance of the living tissue LT exhibits the behavior shown in FIG.
As shown in FIG. 9, the impedance gradually decreases in the initial time zone (high frequency energy application start time to time T1) where high frequency energy is applied. This is attributed to the fact that the application of the high frequency energy causes the cell membrane of the living tissue LT to be destroyed and the extracellular matrix is extracted from the living tissue LT. In other words, in the initial time zone, the extracellular matrix is extracted from the living tissue LT, and the viscosity of the living tissue LT decreases (the living tissue LT softens).
　そして、インピーダンスが最低値ＶＬとなった時間Ｔ１以降、インピーダンスは、図９に示すように、徐々に増加していく。これは、高周波エネルギの付与により生体組織ＬＴにジュール熱が作用し、生体組織ＬＴ自体が発熱することによって、生体組織ＬＴ内の水分が減少（蒸発）していることに起因する。言い換えれば、当該時間Ｔ１以降は、生体組織ＬＴから細胞外基質が抽出されなくなり、発熱により生体組織ＬＴ内の水分が蒸発して当該生体組織ＬＴの粘度が高くなっていく（生体組織ＬＴが凝固していく）時間帯である。 Then, after the time T1 at which the impedance reaches the lowest value VL, the impedance gradually increases as shown in FIG. This is because Joule heat acts on the living tissue LT by the application of high frequency energy, and the living tissue LT itself generates heat, thereby reducing (evaporating) the water in the living tissue LT. In other words, after the time T1, the extracellular matrix is not extracted from the living tissue LT, and the heat in the living tissue LT evaporates due to heat generation, and the viscosity of the living tissue LT increases (the living tissue LT coagulates It is a time zone).
　ステップＳ４の後、エネルギ制御部３４１は、インピーダンス算出部３４２にて算出されたインピーダンスが最低値ＶＬ（図９）になったか否かを常時、監視する（ステップＳ５）。言い換えれば、エネルギ制御部３４１は、第１エネルギ発生部８２，８２´から高周波エネルギが付与されることにより、生体組織ＬＴの仮接合が完了したか否かを常時、監視する。
　インピーダンスが最低値ＶＬになったと判断した場合（ステップＳ５：Ｙｅｓ）には、エネルギ制御部３４１は、スイッチ３２を動作させて高周波電力を供給するリード線を第１高周波用リード線Ｃ１，Ｃ１´から第２高周波用リード線Ｃ２，Ｃ２´に切り替える。すなわち、エネルギ制御部３４１は、生体組織ＬＴの仮接合（第１エネルギ発生部８２，８２´から生体組織ＬＴ（領域ＡｒＯ）への高周波エネルギの付与）を終了し（ステップＳ６）、高周波エネルギ出力部３１から第２エネルギ発生部８３，８３´への高周波電力の供給を開始（生体組織ＬＴ（領域ＡｒＩ（図８））に対する高周波エネルギの付与を開始）する（ステップＳ７：第２エネルギ付与ステップ）。
　ここで、第２エネルギ発生部８３，８３´から生体組織ＬＴに対して高周波エネルギが付与された場合には、図８に示すように、生体組織ＬＴにおいて、第２エネルギ発生部８２，８２´の位置（第１，第２包含領域ＡｒＣ，ＡｒＣ´）に対応する領域ＡｒＩ（領域ＡｒＯの内側の領域）に高周波エネルギが付与される。すなわち、ステップＳ７では、生体組織ＬＴの領域ＡｒＩに高周波エネルギを付与することにより生体組織ＬＴの本接合を開始している。 After step S4, the energy control unit 341 constantly monitors whether the impedance calculated by the impedance calculation unit 342 has reached the minimum value VL (FIG. 9) (step S5). In other words, the energy control unit 341 constantly monitors whether or not temporary bonding of the living tissue LT is completed by applying high-frequency energy from the first energy generation units 82 and 82 ′.
When it is determined that the impedance has become the lowest value VL (step S5: Yes), the energy control unit 341 operates the switch 32 to supply the high frequency power to the first high frequency lead wires C1 and C1 '. To the second high frequency lead wires C2 and C2 '. That is, the energy control unit 341 ends temporary bonding of the living tissue LT (application of high frequency energy from the first energy generating units 82, 82 'to the living tissue LT (region ArO)) (step S6), and the high frequency energy output Start supply of high-frequency power from the unit 31 to the second energy generation unit 83, 83 '(start application of high-frequency energy to the living tissue LT (region ArI (FIG. 8))) (step S7: second energy application step ).
Here, when high frequency energy is applied to the living tissue LT from the second energy generating units 83 and 83 ′, as shown in FIG. 8, in the living tissue LT, the second energy generating units 82 and 82 ′ are provided. The high frequency energy is applied to the area ArI (area inside the area ArO) corresponding to the position (first and second inclusion areas ArC and ArC ′) of That is, in step S7, main junction of the living tissue LT is started by applying high-frequency energy to the region ArI of the living tissue LT.
　ステップＳ７の後、エネルギ制御部３４１は、ステップＳ７における生体組織ＬＴの本接合を開始してから所定時間が経過したか否かを常時、監視する（ステップＳ８）。
　そして、所定時間が経過したと判断した場合（ステップＳ８：Ｙｅｓ）には、エネルギ制御部３４１は、生体組織ＬＴの本接合（第２エネルギ発生部８３，８３´から生体組織ＬＴ（領域ＡｒＩ）への高周波エネルギの付与）を終了する（ステップＳ９）。
　以上の処理により、生体組織ＬＴは、接合される。 After step S7, the energy control unit 341 constantly monitors whether or not a predetermined time has elapsed since the main joining of the living tissue LT in step S7 is started (step S8).
Then, when it is determined that the predetermined time has elapsed (step S8: Yes), the energy control unit 341 performs the main joining of the living tissue LT (from the second energy generating unit 83, 83 'to the living tissue LT (region ArI) The application of the high frequency energy) is ended (step S9).
The living tissue LT is joined by the above processing.
　以上説明した本実施の形態１に係る医療用処置装置１（エネルギ処置具２）は、第１，第２周囲領域ＡｒＳ，ＡｒＳ´から高周波エネルギを生体組織ＬＴ（領域ＡｒＯ）に付与して生体組織ＬＴの仮接合を行う。この後、医療用処置装置１は、第１，第２周囲領域ＡｒＳ，ＡｒＳ´にて囲まれる第１，第２包含領域ＡｒＣ，ＡｒＣ´から高周波エネルギを生体組織ＬＴ（領域ＡｒＩ）に付与して生体組織ＬＴの本接合を行う。
　すなわち、生体組織ＬＴの領域ＡｒＯが仮接合されているため、生体組織ＬＴ（領域ＡｒＩ）の本接合時に当該領域ＡｒＩから抽出された細胞外基質を当該領域ＡｒＩに留めることができる。したがって、本実施の形態１に係る医療用処置装置１（エネルギ処置具２）によれば、生体組織ＬＴの本接合時には領域ＡｒＩから抽出された軟化された細胞外基質を留保しながら密接に絡ませ合うことができ、生体組織ＬＴの接合強度を向上させることができる、という効果を奏する。 The medical treatment apparatus 1 (energy treatment tool 2) according to the first embodiment described above imparts high-frequency energy to the living tissue LT (area ArO) from the first and second surrounding areas ArS and ArS ′ to Perform temporary joining of the tissue LT. Thereafter, the medical treatment apparatus 1 applies high-frequency energy to the living tissue LT (area ArI) from the first and second inclusion areas ArC and ArC 'surrounded by the first and second surrounding areas ArS and ArS'. The main junction of the living tissue LT is performed.
That is, since the region ArO of the living tissue LT is temporarily joined, the extracellular matrix extracted from the region ArI at the time of main joining of the living tissue LT (region ArI) can be retained in the region ArI. Therefore, according to the medical treatment apparatus 1 (energy treatment tool 2) according to the first embodiment, at the time of the main joining of the living tissue LT, the softened extracellular matrix extracted from the region ArI is closely entangled while retaining it. The joint strength of the living tissue LT can be improved.
　また、本実施の形態１に係るエネルギ処置具２では、第１挟持面８１１は、第１包含領域ＡｒＣが第１周囲領域ＡｒＳに対して突出し、段差を有する凸状に形成されている。同様に、第２挟持面８１１´は、第２包含領域ＡｒＣ´が第２周囲領域ＡｒＳ´に対して突出し、段差を有する凸状に形成されている。
　このため、生体組織ＬＴの本接合時に生体組織ＬＴの領域ＡｒＩに高荷重を加えることができ、強固な接合を実現することができる。また、第１挟持面８１１及び第２挟持面８１１´の双方が段差を有する凸状に形成されているので、例えば、一方のみが凸状に形成された構成（他方が平坦状に形成された構成）と比較して、第１挟持面８１１及び第２挟持面８１１´で生体組織ＬＴを挟持した際に、生体組織ＬＴに不要なストレスを生じさせることがなく、生体組織ＬＴ（領域ＡｒＩ）に対して均一に高荷重を加えることができる。 Further, in the energy treatment device 2 according to the first embodiment, the first holding area ArC protrudes from the first surrounding area ArS, and the first holding surface 811 is formed in a convex shape having a step. Similarly, in the second holding surface 811 ′, the second inclusion region ArC ′ protrudes with respect to the second surrounding region ArS ′, and is formed in a convex shape having a step.
Therefore, a high load can be applied to the region ArI of the living tissue LT at the time of the main joining of the living tissue LT, and a strong bonding can be realized. Further, since both the first holding surface 811 and the second holding surface 811 ′ are formed in a convex shape having a step, for example, a configuration in which only one is formed in a convex shape (the other is formed in a flat shape) Compared with the configuration), when the living tissue LT is held between the first holding surface 811 and the second holding surface 811 ′, unnecessary stress is not generated in the living tissue LT, and the living tissue LT (area ArI) High load can be applied uniformly to
　また、本実施の形態１に係る医療用処置装置１では、生体組織ＬＴ（領域ＡｒＯ）のインピーダンスが最低値ＶＬになった場合に、生体組織ＬＴ（領域ＡｒＯ）の仮接合を終了する（生体組織ＬＴ（領域ＡｒＩ）の本接合を開始する）。
　このため、生体組織ＬＴの領域ＡｒＯの仮接合が完了したか否かを適切に判断することができ、上述した効果（接合強度を向上させることができる）をより好適に実現することができる。 Further, in the medical treatment apparatus 1 according to the first embodiment, the temporary joining of the living tissue LT (region ArO) is ended when the impedance of the living tissue LT (region ArO) becomes the lowest value VL Initiate main junction of tissue LT (region ArI)).
Therefore, it can be appropriately determined whether or not temporary bonding of the region ArO of the living tissue LT is completed, and the above-described effect (the bonding strength can be improved) can be more suitably realized.
　また、本実施の形態１に係る医療用処置装置１では、第１エネルギ発生部８２，８２´からの高周波エネルギの発生時での第１エネルギ発生部８２，８２´の最高到達温度より第２エネルギ発生部８３，８３´からの高周波エネルギの発生時での第２エネルギ発生部８３，８３´の最高到達温度が高くなるように第１エネルギ発生部８２，８２´及び第２エネルギ発生部８３，８３´に高周波エネルギを発生させる。
　このため、生体組織ＬＴ（領域ＡｒＯ）よりも外側の正常な組織への熱侵襲を効果的に抑制することができる。 Further, in the medical treatment apparatus 1 according to the first embodiment, the second highest reached temperature of the first energy generating parts 82, 82 'at the time of generation of the high frequency energy from the first energy generating parts 82, 82'. First energy generating unit 82, 82 'and second energy generating unit 83 such that the maximum temperature reached by second energy generating unit 83, 83' when generating high frequency energy from energy generating unit 83, 83 'becomes higher. , 83 'to generate high frequency energy.
For this reason, it is possible to effectively suppress heat invasion to normal tissue outside the living tissue LT (region ArO).
（実施の形態１の変形例）
　上述した実施の形態１では、生体組織（領域ＡｒＯ）の仮接合の終了タイミングを生体組織ＬＴ（領域ＡｒＯ）のインピーダンスに基づいて判断していたが、これに限られず、生体組織（領域ＡｒＩ）の本接合時と同様に、仮接合の開始からの時間に基づいて判断しても構わない。同様に、生体組織（領域ＡｒＩ）の本接合の終了タイミングについても、生体組織（領域ＡｒＯ）の仮接合時と同様に、領域ＡｒＩのインピーダンスに基づいて判断しても構わない。 (Modification of Embodiment 1)
In the first embodiment described above, the end timing of temporary joining of the living tissue (region ArO) is determined based on the impedance of the living tissue LT (region ArO). However, the present invention is not limited thereto. Living tissue (region ArI) As in the case of the final bonding, the determination may be made based on the time from the start of the temporary bonding. Similarly, the termination timing of the main junction of the living tissue (region ArI) may be determined based on the impedance of the region ArI, as in the temporary joining of the living tissue (region ArO).
　上述した実施の形態１では、生体組織ＬＴ（領域ＡｒＯ）のインピーダンスが最低値ＶＬとなった場合に、生体組織ＬＴ（領域ＡｒＯ）の仮接合を終了していたが、これに限られない。生体組織ＬＴ（領域ＡｒＯ）のインピーダンスが最低値ＶＬとなった時間Ｔ１の後（例えば、時間Ｔ１から仮接合を開始した時点での初期値ＶＩ（図９）に戻った時間Ｔ２（図９）までの間）であれば、いずれのタイミングで生体組織ＬＴ（領域ＡｒＯ）の仮接合を終了しても構わない。 In the first embodiment described above, although the temporary joining of the living tissue LT (region ArO) is ended when the impedance of the living tissue LT (region ArO) becomes the lowest value VL, the present invention is not limited thereto. After time T1 when the impedance of the living tissue LT (area ArO) becomes the lowest value VL (for example, time T2 (FIG. 9) returned to initial value VI (FIG. 9) when temporary joining is started from time T1 The temporary joining of the living tissue LT (region ArO) may be terminated at any timing as long as
　上述した実施の形態１では、スイッチ３２を設けることにより、生体組織ＬＴに対して、第１エネルギ発生部８２，８２´にて発生した高周波エネルギ、及び第２エネルギ発生部８３，８３´にて発生した高周波エネルギを同時に付与することができない構成としていたが、これに限られず、スイッチ３２を省略し、同時に付与することができる構成としても構わない。すなわち、第１エネルギ発生部８２，８２´にて発生した高周波エネルギ、及び第２エネルギ発生部８３，８３´にて発生した高周波エネルギが生体組織ＬＴに対して同時に付与される期間があっても構わない。 In the first embodiment described above, by providing the switch 32, the high-frequency energy generated in the first energy generating unit 82, 82 'and the second energy generating unit 83, 83' are applied to the living tissue LT. Although the configuration has been described in which the generated high frequency energy can not be simultaneously applied, the present invention is not limited to this. The switch 32 may be omitted and the configuration may be simultaneously applied. That is, even if there is a period in which the high-frequency energy generated by the first energy generating unit 82, 82 'and the high-frequency energy generated by the second energy generating unit 83, 83' are simultaneously applied to the living tissue LT. I do not care.
（実施の形態２）
　次に、本発明の実施の形態２について説明する。
　以下の説明では、上述した実施の形態１と同様の構成には同一符号を付し、その詳細な説明は省略または簡略化する。
　上述した実施の形態１に係る医療用処置装置１では、生体組織ＬＴの仮接合及び本接合の双方に高周波エネルギを利用していた。
　これに対して本実施の形態２に係る医療用処置装置では、生体組織ＬＴの仮接合に熱エネルギを利用し、生体組織ＬＴの本接合に高周波エネルギを利用している。
　以下、本実施の形態２に係る第１保持部材、第２保持部材、及び制御装置の構成を説明する。 Second Embodiment
Next, a second embodiment of the present invention will be described.
In the following description, the same components as those in the first embodiment described above are denoted by the same reference numerals, and the detailed description thereof is omitted or simplified.
In the medical treatment apparatus 1 according to the first embodiment described above, high frequency energy is used for both temporary bonding and main bonding of the living tissue LT.
On the other hand, in the medical treatment apparatus according to the second embodiment, thermal energy is used for temporary bonding of the living tissue LT, and high frequency energy is used for main bonding of the living tissue LT.
The configurations of the first holding member, the second holding member, and the control device according to the second embodiment will be described below.
　〔第１保持部材の構成〕
　図１０及び図１１は、本発明の実施の形態２に係る医療用処置装置１Ａ（エネルギ処置具２Ａ）を構成する第１保持部材８Ａを示す図である。具体的に、図１０及び図１１は、図３及び図４にそれぞれ対応した図である。
　第１保持部材８Ａは、図１０及び図１１に示すように、上述した実施の形態１で説明した第１保持部材８（図３，図４）と同様に第１顎部８１及び第２エネルギ発生部８３を備えるとともに、第１エネルギ発生部８２の代わりに第１エネルギ発生部８２Ａを採用している。 [Configuration of First Holding Member]
FIG.10 and FIG.11 is a figure which shows 1st holding member 8A which comprises the medical treatment apparatus 1A (energy treatment tool 2A) which concerns on Embodiment 2 of this invention. Specifically, FIGS. 10 and 11 correspond to FIGS. 3 and 4, respectively.
As shown in FIGS. 10 and 11, the first holding member 8A has the first jaw 81 and the second energy similarly to the first holding member 8 (FIGS. 3 and 4) described in the first embodiment. A generator 83 is provided, and a first energy generator 82A is employed instead of the first energy generator 82.
　第１エネルギ発生部８２Ａは、上述した第１エネルギ発生部８２と同様の形状（第１周囲領域ＡｒＳと同一の平面形状（略Ｕ字形状））を有し、第１周囲領域ＡｒＳに固定されている。そして、第１エネルギ発生部８２Ａは、制御装置３Ａ（図１２参照）による制御の下、熱エネルギを発生する。
　本実施の形態２では、第１エネルギ発生部８２Ａは、具体的な図示は省略したが、当該第１エネルギ発生部８２Ａと同様の略Ｕ字形状を有する抵抗体（発熱源）が絶縁性材料にて被覆された構成（例えば、セラミックヒータ等）を有する。そして、第１エネルギ発生部８２Ａは、電気ケーブルＣを構成する第１発熱用リード線Ｃ３，Ｃ４（図１２参照）が抵抗体（図示略）の両端部に接合され、第１発熱用リード線Ｃ３，Ｃ４を介して制御装置３Ａにより電圧が印加（通電）されることにより、発熱する（熱エネルギを発生する）。 The first energy generating unit 82A has the same shape as that of the first energy generating unit 82 described above (the same planar shape (substantially U-shaped) as the first surrounding area ArS), and is fixed to the first surrounding area ArS. ing. Then, the first energy generating unit 82A generates thermal energy under the control of the control device 3A (see FIG. 12).
In the second embodiment, although the first energy generating unit 82A is not specifically illustrated, a resistor (heat generating source) having a substantially U shape similar to that of the first energy generating unit 82A is an insulating material. (E.g., a ceramic heater). In the first energy generating unit 82A, the first heat generating lead wires C3 and C4 (see FIG. 12) constituting the electrical cable C are joined to both ends of the resistor (not shown), and the first heat generating lead wire As a voltage is applied (energized) by the control device 3A via C3 and C4, heat is generated (heat energy is generated).
　〔第２保持部材の構成〕
　本実施の形態２に係る第２保持部材８Ａ´は、第１保持部材８Ａと同一の構成及び形状を有する。図１０及び図１１では、第２保持部材８Ａ´の構成を示す符号として、第１保持部材８Ａと同一の構成については、当該第１保持部材８Ａの構成を示す符号に「´」を付加し、当該第１保持部材８Ａの構成を示す符号にかっこ付きで併記している。
　すなわち、第２保持部材８Ａ´は、図１０及び図１１に示すように、上述した実施の形態１で説明した第２保持部材８´と同様に第２顎部８１´及び第２エネルギ発生部８３´を備えるとともに、第１エネルギ発生部８２Ａと同様の第１エネルギ発生部８２Ａ´を備える。
　第１エネルギ発生部８２Ａ´は、電気ケーブルＣを構成する第２発熱用リード線Ｃ３´，Ｃ４´（図１２参照）が抵抗体（図示略）の両端部に接合され、第２発熱用リード線Ｃ３´，Ｃ４´を介して制御装置３Ａにより電圧が印加（通電）されることにより、発熱する（熱エネルギを発生する）。
　なお、本実施の形態２では、第１エネルギ発生部８２Ａ´は、後述するように、生体組織ＬＴ（領域ＡｒＯ）の熱伝導率を検出するために用いられる。 [Configuration of Second Holding Member]
The second holding member 8A ′ according to the second embodiment has the same configuration and shape as the first holding member 8A. In FIG. 10 and FIG. 11, as a code | symbol which shows the structure of 2nd holding member 8A ', about structure same as 1st holding member 8A, "'" is added to the code | symbol which shows the structure of the said 1st holding member 8A. The reference numeral indicating the configuration of the first holding member 8A is shown in parentheses.
That is, as shown in FIG. 10 and FIG. 11, the second holding member 8A ′ is the second jaw 81 ′ and the second energy generating portion as in the second holding member 8 ′ described in the first embodiment. The first energy generating unit 82A 'is provided in the same manner as the first energy generating unit 82A.
In the first energy generating unit 82A ', the second heat generating lead wires C3' and C4 '(see FIG. 12) constituting the electric cable C are joined to both ends of the resistor (not shown), and the second heat generating lead As a voltage is applied (energized) by the control device 3A through the lines C3 'and C4', heat is generated (heat energy is generated).
In the second embodiment, the first energy generation unit 82A ′ is used to detect the thermal conductivity of the living tissue LT (region ArO) as described later.
　〔制御装置の構成〕
　図１２は、本発明の実施の形態２に係る制御装置３Ａの構成を示すブロック図である。
　本実施の形態２に係る制御装置３Ａは、図１２に示すように、上述した実施の形態１で説明した制御装置３（図６）に対して、スイッチ３２が省略され、熱エネルギ出力部３５及び第２センサ３６が追加されるとともに、制御部３４の一部の機能を変更した制御部３４Ａが採用されている。
　なお、スイッチ３２が省略されたことに伴い、本実施の形態２に係る高周波エネルギ出力部３１は、第２高周波用リード線Ｃ２，Ｃ２´を介して、第２エネルギ発生部８３，８３´のみに電気的に接続されている。 [Configuration of control device]
FIG. 12 is a block diagram showing a configuration of a control device 3A according to Embodiment 2 of the present invention.
In the control device 3A according to the second embodiment, as shown in FIG. 12, the switch 32 is omitted from the control device 3 (FIG. 6) described in the first embodiment described above, and the thermal energy output unit 35 And a second sensor 36 is added, and a control unit 34A in which some functions of the control unit 34 are changed is adopted.
Since the switch 32 is omitted, the high frequency energy output unit 31 according to the second embodiment only includes the second energy generation unit 83, 83 'via the second high frequency lead wires C2, C2'. Are connected electrically.
　熱エネルギ出力部３５は、制御部３４Ａによる制御の下、発熱用リード線Ｃ３，Ｃ４，Ｃ３´，Ｃ４´を介して第１エネルギ発生部８２Ａ，８２Ａ´に電圧を印加（通電）する。
　第２センサ３６は、熱エネルギ出力部３５から第１エネルギ発生部８２Ａ´に供給されている電圧値及び電流値を検出する。そして、第２センサ３６は、検出した電圧値及び電流値に応じた信号を制御部３４Ａに出力する。 The thermal energy output unit 35 applies (energizes) a voltage to the first energy generation units 82A and 82A 'through the heating lead wires C3, C4, C3' and C4 'under the control of the control unit 34A.
The second sensor 36 detects the voltage value and the current value supplied from the thermal energy output unit 35 to the first energy generation unit 82A ′. Then, the second sensor 36 outputs a signal corresponding to the detected voltage value and current value to the control unit 34A.
　制御部３４Ａは、図１２に示すように、上述した実施の形態１で説明した制御部３４（図６）に対して、インピーダンス算出部３４２の代わりに熱伝導率算出部３４３が採用されているとともに、エネルギ制御部３４１の代わりにエネルギ制御部３４１Ａが採用されている。
　エネルギ制御部３４１Ａは、熱エネルギ出力部３５を駆動し、熱エネルギ出力部３５から第１エネルギ発生部８２Ａに電圧を印加させる（熱エネルギを発生させる）。同時に、エネルギ制御部３４１Ａは、熱エネルギ出力部３５から第１エネルギ発生部８２Ａ´に熱伝導率の検出用の電圧を印加させる。また、エネルギ制御部３４１Ａは、熱伝導率算出部３４３にて算出された熱伝導率に基づいて、熱エネルギ出力部３５の駆動を停止して高周波エネルギ出力部３１を駆動し、高周波エネルギ出力部３１から第２エネルギ出力部８３，８３´に高周波電力を供給させる（高周波エネルギを発生させる）。 As shown in FIG. 12, the control unit 34A employs a thermal conductivity calculation unit 343 instead of the impedance calculation unit 342 in the control unit 34 (FIG. 6) described in the first embodiment described above. In addition, an energy control unit 341A is employed instead of the energy control unit 341.
The energy control unit 341A drives the thermal energy output unit 35, and applies a voltage from the thermal energy output unit 35 to the first energy generation unit 82A (generates thermal energy). At the same time, the energy control unit 341A applies a voltage for detecting the thermal conductivity from the thermal energy output unit 35 to the first energy generation unit 82A '. In addition, the energy control unit 341A stops the drive of the thermal energy output unit 35 and drives the high frequency energy output unit 31 based on the thermal conductivity calculated by the thermal conductivity calculation unit 343, and the high frequency energy output unit The high frequency power is supplied to the second energy output unit 83, 83 'from 31 (the high frequency energy is generated).
　ここで、エネルギ制御部３４１Ａは、上述した実施の形態１と同様に、第１エネルギ発生部８２Ａからの熱エネルギの発生時での第１エネルギ発生部８２Ａの最高到達温度より第２エネルギ発生部８３，８３´からの高周波エネルギの発生時での第２エネルギ発生部８３，８３´の最高到達温度が高くなるように第１エネルギ発生部８２Ａ及び第２エネルギ発生部８３，８３´に熱エネルギ及び高周波エネルギをそれぞれ発生させる。 Here, as in the first embodiment described above, the energy control unit 341A generates a second energy generation unit based on the highest temperature reached by the first energy generation unit 82A when the thermal energy is generated from the first energy generation unit 82A. Thermal energy of the first energy generating unit 82A and the second energy generating unit 83, 83 'so that the maximum temperature reached by the second energy generating unit 83, 83' at the time of generation of high frequency energy from 83, 83 'becomes higher. And generate high frequency energy respectively.
　熱伝導率算出部３４３は、第２センサ３６にて検出された電圧値及び電流値に基づいて、第１エネルギ発生部８２Ａから生体組織ＬＴ（領域ＡｒＯ）に対して熱エネルギが付与されている際での第１エネルギ発生部８２Ａ´の抵抗値の変化（温度の変化）を算出し、当該抵抗値の変化に基づいて、生体組織ＬＴ（領域ＡｒＯ）の熱伝導率を算出する。 The thermal conductivity calculation unit 343 applies thermal energy to the living tissue LT (area ArO) from the first energy generation unit 82A based on the voltage value and the current value detected by the second sensor 36. The change (change in temperature) of the resistance value of the first energy generation unit 82A 'at that time is calculated, and the thermal conductivity of the living tissue LT (region ArO) is calculated based on the change in the resistance value.
　〔接合制御〕
　次に、本実施の形態２に係る接合制御について説明する。
　図１３は、本発明の実施の形態２に係る接合制御を示すフローチャートである。
　本実施の形態２に係る接合制御では、図１３に示すように、上述した実施の形態１で説明した接合制御（図７）に対して、第１エネルギ発生部８２，８２´及びインピーダンス算出部３４２に関連するステップＳＳ３～Ｓ６の代わりに、ステップＳ３Ａ～Ｓ６Ａが採用されている。以下、ステップＳ３Ａ～Ｓ６Ａのみ説明する。 [Joint control]
Next, bonding control according to the second embodiment will be described.
FIG. 13 is a flowchart showing bonding control according to the second embodiment of the present invention.
In the bonding control according to the second embodiment, as shown in FIG. 13, with respect to the bonding control (FIG. 7) described in the first embodiment described above, the first energy generating unit 82, 82 'and the impedance calculating unit Steps S3A to S6A are employed instead of steps SS3 to S6 related to 342. Hereinafter, only steps S3A to S6A will be described.
　エネルギ制御部３４１Ａは、フットスイッチ４がＯＮになると（ステップＳ２：Ｙｅｓ）、熱エネルギ出力部３５を駆動し、熱エネルギ出力部３５から第１エネルギ発生部８２Ａへの電圧の印加を開始（生体組織ＬＴ（領域ＡｒＯ（図８））に対する熱エネルギの付与を開始）する（ステップＳ３Ａ：第１エネルギ付与ステップ）。すなわち、ステップＳ３Ａでは、上述した実施の形態１で説明したステップＳ３と同様に、生体組織ＬＴの仮接合を開始している。また、ステップＳ３Ａと同時に、エネルギ制御部３４１Ａは、熱エネルギ出力部３５から第１エネルギ発生部８２Ａ´に熱伝導率の検出用の電圧を印加させる。
　ステップＳ３Ａの後、熱伝導率算出部３４３は、第２センサ３６にて検出された電圧値及び電流値に基づいて、生体組織ＬＴ（領域ＡｒＯ）の熱伝導率の算出を開始する（ステップＳ４Ａ）。 When the foot switch 4 is turned on (step S2: Yes), the energy control unit 341A drives the thermal energy output unit 35, and starts applying a voltage from the thermal energy output unit 35 to the first energy generation unit 82A (living body The application of thermal energy to the tissue LT (area ArO (FIG. 8)) is started (step S3A: first energy application step). That is, in step S3A, temporary joining of the living tissue LT is started as in step S3 described in the first embodiment described above. At the same time as step S3A, the energy control unit 341A applies a voltage for detecting the thermal conductivity from the thermal energy output unit 35 to the first energy generation unit 82A '.
After step S3A, the thermal conductivity calculation unit 343 starts calculation of the thermal conductivity of the living tissue LT (region ArO) based on the voltage value and the current value detected by the second sensor 36 (step S4A). ).
　熱エネルギの付与により生体組織ＬＴ内の水分が減少（蒸発）していく（生体組織ＬＴが凝固していく）と、当該生体組織ＬＴの熱伝導率は、上昇していく。すなわち、生体組織ＬＴの熱伝導率が所定の値を超えた時点で、生体組織ＬＴの仮接合が完了したか否かを判断することができる。
　このため、ステップＳ４Ａの後、エネルギ制御部３４１Ａは、熱伝導率算出部３４３にて算出された熱伝導率が所定の値を超えたか否かを常時、監視する（ステップＳ５Ａ）。
　熱伝導率が所定の値を超えたと判断した場合（ステップＳ５Ａ：Ｙｅｓ）には、エネルギ制御部３４１Ａは、生体組織ＬＴの仮接合（第１エネルギ発生部８２Ａから生体組織ＬＴ（領域ＡｒＯ）への熱エネルギの付与）を終了し（ステップＳ６Ａ）、ステップＳ７に移行する。 As the moisture in the living tissue LT is reduced (evaporated) by the application of the thermal energy (the living tissue LT is solidified), the thermal conductivity of the living tissue LT is increased. That is, when the thermal conductivity of the living tissue LT exceeds a predetermined value, it can be determined whether temporary joining of the living tissue LT is completed.
Therefore, after step S4A, the energy control unit 341A constantly monitors whether the thermal conductivity calculated by the thermal conductivity calculation unit 343 exceeds a predetermined value (step S5A).
If it is determined that the thermal conductivity exceeds the predetermined value (step S5A: Yes), the energy control unit 341A proceeds from temporary joining of the living tissue LT (from the first energy generation unit 82A to the living tissue LT (area ArO) Application of the thermal energy (step S6A), and the process proceeds to step S7.
　以上説明した本実施の形態２に係る医療用処置装置１Ａによれば、上述した実施の形態１と同様の効果の他、以下の効果がある。
　本実施の形態２では、第１エネルギ発生部８２Ａ（８２Ａ´）は、セラミックヒータ等により構成され絶縁性が確保されている。このため、第１エネルギ発生部８２Ａ（８２Ａ´）と第２エネルギ発生部８３（８３´）とが電気的にショートし難い構成を実現することができる。また、第１エネルギ発生部８２Ａ（８２Ａ´）と第２エネルギ発生部８３（８３´）との間の距離を比較的に近距離にすることができるため、第１保持部材８Ａ（第２保持部材８Ａ´）の小型化を図ることができる。 The medical treatment apparatus 1A according to the second embodiment described above has the following effects in addition to the effects similar to the first embodiment described above.
In the second embodiment, the first energy generating unit 82A (82A ') is formed of a ceramic heater or the like to ensure insulation. For this reason, it is possible to realize a configuration in which the first energy generation unit 82A (82A ') and the second energy generation unit 83 (83') are less likely to electrically short. In addition, since the distance between the first energy generating unit 82A (82A ') and the second energy generating unit 83 (83') can be relatively short, the first holding member 8A (second holding The members 8A ') can be miniaturized.
（その他の実施形態）
　ここまで、本発明を実施するための形態を説明してきたが、本発明は上述した実施の形態１，２によってのみ限定されるべきものではない。
　図１４Ａないし図１４Ｃは、本発明の実施の形態１，２の変形例１を示す図である。具体的に、図１４Ａ及び図１４Ｂは、図３に対応した図であり、本実施の形態１の変形例（第１挟持面を平坦状にした変形例）を示す図である。図１４Ｃは、図３に対応した図であり、本実施の形態２の変形例（第１挟持面を平坦状にした変形例）を示す図である。
　上述した実施の形態１，２では、第１顎部８１は、突出部８１１１を有していた。すなわち、第１挟持面８１１は、段差を有する凸形状を有していた。しかしながら、第１挟持面８１１としては、これに限られない。 (Other embodiments)
Although the modes for carrying out the present invention have been described above, the present invention is not to be limited only by the first and second embodiments described above.
14A to 14C are diagrams showing a first modification of the first and second embodiments of the present invention. Specifically, FIG. 14A and FIG. 14B correspond to FIG. 3 and show a modified example of the first embodiment (a modified example in which the first holding surface is flat). FIG. 14C is a view corresponding to FIG. 3 and showing a modified example of the second embodiment (a modified example in which the first holding surface is flat).
In the first and second embodiments described above, the first jaw 81 has the protrusion 8111. That is, the first holding surface 811 had a convex shape having a step. However, the first holding surface 811 is not limited to this.
　例えば、上述した実施の形態１において、第１保持部材８（第２保持部材８´）の代わりに、図１４Ａ及び図１４Ｂに示した第１保持部材８Ｂ，８Ｃ（第２保持部材８Ｂ´，８Ｃ´）を採用しても構わない。
　第１保持部材８Ｂは、図１４Ａに示すように、上述した実施の形態１で説明した第１保持部材８に対して、第１顎部８１と形状が異なる第１顎部８１Ｂを採用している。
　具体的に、第１顎部８１Ｂは、上述した実施の形態１で説明した第１顎部８１に対して、突出部８１１１が省略されている。すなわち、第１顎部８１Ｂの第１挟持面８１１Ｂは、平坦状に構成されている。
　このように構成した場合であっても、第１エネルギ発生部８２と第２エネルギ発生部８３との平面的に見た場合（図２中、上方側から見た場合）での位置関係は、上述した実施の形態１で説明した位置関係と同一である。すなわち、第２エネルギ発生部８３は、第１挟持面８１１Ｂにおける中心位置ＣＰを含む領域である第１領域Ａｒ１Ｂ（平面的に見た場合に上述した実施の形態１で説明した第１領域Ａｒ１と同一の領域）を包含する第１包含領域ＡｒＣＢ（平面的に見た場合に上述した実施の形態１で説明した領域ＡｒＣと同一の領域）と同一の平面形状（略矩形形状）を有し、当該第１包含領域ＡｒＣＢに固定される。また、第１エネルギ発生部８２は、第１挟持面８１１Ｂにおける第１領域Ａｒ１Ｂを囲む第１周囲領域ＡｒＳＢ（平面的に見た場合に上述した実施の形態１で説明した領域ＡｒＳと同一の領域）と同一の平面形状（略Ｕ字形状）を有し、当該第１周囲領域ＡｒＳＢに固定される。
　この際、第１エネルギ発生部８２と第２エネルギ発生部８３との間には、図１４Ａに示すように、空気層（隙間）が介在しているため、第１エネルギ発生部８２と第２エネルギ発生部８３との間でのショートを回避することができる。
　なお、第２保持部材８Ｂ´は、第１保持部材８Ａと同一の構成及び形状を有する。図１４Ａでは、第２保持部材８Ｂ´の構成を示す符号として、第１保持部材８Ｂと同一の構成については、当該第１保持部材８Ｂの構成を示す符号に「´」を付加し、当該第１保持部材８Ｂの構成を示す符号にかっこ付きで併記している。
　すなわち、第２保持部材８Ｂ´は、図１４Ａに示すように、上述した実施の形態１で説明した第２保持部材８´に対して、第２顎部８１´の代わりに、上述した第１顎部８１Ｂと同様の第２顎部８１Ｂ´（第２挟持面８１１Ｂ´を含む）を採用している。
　ここで、領域Ａｒ１Ｂ´は、第１挟持面８１１Ｂ及び第２挟持面８１１Ｂ´を互いに対向させた状態で、第１挟持面８１１Ｂの第１領域Ａｒ１Ｂを当該第２挟持面８１１Ｂ´に投影した領域であり、本発明に係る第２領域に相当する。以下、領域Ａｒ１Ｂ´を第２領域Ａｒ１Ｂ´と記載する。また、領域ＡｒＣＢ´は、第２領域Ａｒ１Ｂ´を包含する領域であり、本発明に係る第２包含領域に相当する。以下、領域ＡｒＣＢ´を第２包含領域ＡｒＣＢ´と記載する。さらに、領域ＡｒＳＢ´は、第２領域Ａｒ１Ｂ´を囲む領域であり、本発明に係る第２周囲領域に相当する。以下、領域ＡｒＳＢ´を第２周囲領域と記載する。なお、本変形例１では、第２包含領域ＡｒＣＢ´及び第２周囲領域ＡｒＳＢ´は、第１挟持面８１１Ｂ及び第２挟持面８１１Ｂ´を互いに対向させた状態で、第１挟持面８１１Ｂの第１包含領域ＡｒＣＢ及び第１周囲領域ＡｒＳＢを当該第２挟持面８１１Ｂ´にそれぞれ投影した領域である。 For example, in Embodiment 1 described above, instead of the first holding member 8 (second holding member 8 '), the first holding members 8B and 8C (second holding members 8B', shown in FIGS. 14A and 14B). You may adopt 8C ').
As shown in FIG. 14A, the first holding member 8B adopts a first jaw 81B having a shape different from that of the first jaw 81 in addition to the first holding member 8 described in the first embodiment. There is.
Specifically, in the first jaw 81B, the protrusion 8111 is omitted from the first jaw 81 described in the first embodiment described above. That is, the first holding surface 811B of the first jaw 81B is configured to be flat.
Even in the case of this configuration, the positional relationship between the first energy generating unit 82 and the second energy generating unit 83 in plan view (when viewed from the upper side in FIG. 2) is It is the same as the positional relationship described in the first embodiment described above. That is, the second energy generation unit 83 is a first region Ar1B that is a region including the center position CP in the first holding surface 811B (the first region Ar1 described in the first embodiment when viewed in a plan view) Having the same planar shape (substantially rectangular shape) as the first inclusion region ArCB (the same region as the region ArC described in the first embodiment when viewed in plan view) including the same region), It is fixed to the first inclusion area ArCB. In addition, the first energy generation unit 82 is a first surrounding area ArSB surrounding the first area Ar1B in the first holding surface 811B (the same area as the area ArS described in the first embodiment when viewed in plan) And has the same planar shape (substantially U-shaped), and is fixed to the first surrounding area ArSB.
At this time, as shown in FIG. 14A, an air layer (a gap) is interposed between the first energy generation unit 82 and the second energy generation unit 83, and thus the first energy generation unit 82 and the second energy generation unit 82 A short circuit with the energy generating unit 83 can be avoided.
The second holding member 8B 'has the same configuration and shape as the first holding member 8A. In FIG. 14A, as a symbol indicating the configuration of the second holding member 8B ′, “′ ′ ′ is added to the symbol indicating the configuration of the first holding member 8B for the same configuration as the first holding member 8B, and (1) The reference numeral indicating the configuration of the holding member 8B is shown in parentheses.
That is, as shown in FIG. 14A, the second holding member 8B ′ is the first holding member described above in place of the second jaw 81 ′ with respect to the second holding member 8 ′ described in the first embodiment. A second jaw 81B '(including a second holding surface 811B') similar to the jaw 81B is employed.
Here, the area Ar1B ′ is an area obtained by projecting the first area Ar1B of the first holding surface 811B onto the second holding surface 811B ′ with the first holding surface 811B and the second holding surface 811B ′ facing each other. And corresponds to a second area according to the present invention. Hereinafter, the region Ar1B 'will be referred to as a second region Ar1B'. The region ArCB ′ is a region including the second region Ar1B ′ and corresponds to a second inclusion region according to the present invention. Hereinafter, the region ArCB ′ is described as a second inclusion region ArCB ′. Furthermore, the area ArSB ′ is an area surrounding the second area Ar1B ′, and corresponds to a second surrounding area according to the present invention. Hereinafter, the region ArSB ′ is referred to as a second surrounding region. In the first modification, the second inclusion region ArCB ′ and the second peripheral region ArSB ′ are configured such that the first sandwiching surface 811B and the second sandwiching surface 811B ′ are opposed to each other. (1) An area obtained by projecting the inclusion area ArCB and the first surrounding area ArSB onto the second sandwiching surface 811 B ′.
　第１保持部材８Ｃは、図１４Ｂに示すように、上述した第１保持部材８Ｂに対して、第１顎部８１Ｂの代わりに、第１顎部８１Ｃを採用した点が異なる。
　第１顎部８１Ｃは、上述した第１顎部８１Ｂに対して、第１エネルギ発生部８２と第２エネルギ発生部８３との隙間を埋めるように突出部８１１３を設けた点が異なる。
　なお、第２保持部材８Ｃ´は、第１保持部材８Ｃと同一の構成及び形状を有する。図１４Ｂでは、第２保持部材８Ｃ´の構成を示す符号として、第１保持部材８Ｃと同一の構成については、当該第１保持部材８Ｃの構成を示す符号に「´」を付加し、当該第１保持部材８Ｃの構成を示す符号にかっこ付きで併記している。
　すなわち、第２保持部材８Ｃ´は、図１４Ｂに示すように、上述した実施の形態１で説明した第２保持部材８´に対して、第２顎部８１´の代わりに、上述した第１顎部８１Ｃと同様の第２顎部８１Ｃ´（突出部８１１３´を含む）を採用している。 The first holding member 8C differs from the above-described first holding member 8B in that a first jaw 81C is employed instead of the first jaw 81B, as shown in FIG. 14B.
The first jaw 81C is different from the above-described first jaw 81B in that a projection 8113 is provided to fill the gap between the first energy generator 82 and the second energy generator 83.
The second holding member 8C 'has the same configuration and shape as the first holding member 8C. In FIG. 14B, as a symbol indicating the configuration of the second holding member 8C ′, “′ ′” is added to the symbol indicating the configuration of the first holding member 8C for the same configuration as the first holding member 8C, and (1) The reference numeral indicating the configuration of the holding member 8C is shown in parentheses.
That is, as shown in FIG. 14B, the second holding member 8C ′ is the first holding member described above in place of the second jaw 81 ′ with respect to the second holding member 8 ′ described in the first embodiment. A second jaw 81C '(including the protrusion 8113') similar to the jaw 81C is employed.
　また、例えば、上述した実施の形態２において、第１保持部材８Ａ（第２保持部材８Ａ´）の代わりに、図１４Ｃに示した第１保持部材８Ｄ（第２保持部材８Ｄ´）を採用しても構わない。
　第１保持部材８Ｄは、図１４Ｃに示すように、上述した実施の形態２で説明した第１保持部材８Ａに対して、第１顎部８１の代わりに上述した第１顎部８１Ｂを採用した点が異なる。
　この際、第１エネルギ発生部８２Ａは、セラミックヒータ等により構成され絶縁性が確保されている。このため、図１４Ｃに示すように、第１エネルギ発生部８２Ａと第２エネルギ発生部８３との間に隙間がないように第１エネルギ発生部８２Ａと第２エネルギ発生部８３とを配置しても構わない。なお、図１４Ｃでは、当該隙間を埋めるために第２エネルギ発生部８３のサイズを大きくしているが、これに限られず、当該隙間を埋めるために第１エネルギ発生部８２Ａのサイズを大きくしても構わない。
　なお、第２保持部材８Ｄ´は、第１保持部材８Ｄと同一の構成及び形状を有する。図１４Ｃでは、第２保持部材８Ｄ´の構成を示す符号として、第１保持部材８Ｄと同一の構成については、当該第１保持部材８Ｄの構成を示す符号に「´」を付加し、当該第１保持部材８Ｄの構成を示す符号にかっこ付きで併記している。
　すなわち、第２保持部材８Ｄ´は、図１４Ｃに示すように、上述した実施の形態２で説明した第２保持部材８Ａ´に対して、第２顎部８１´の代わりに、上述した第１顎部８１Ｂと同様の第２顎部８１Ｂ´を採用している。 Also, for example, in the second embodiment described above, instead of the first holding member 8A (second holding member 8A '), the first holding member 8D (second holding member 8D') shown in FIG. 14C is adopted. It does not matter.
As shown in FIG. 14C, the first holding member 8D adopts the first jaw 81B described above in place of the first jaw 81 with respect to the first holding member 8A described in the second embodiment described above. The point is different.
Under the present circumstances, the 1st energy generation part 82A is constituted by a ceramic heater etc., and insulation is secured. Therefore, as shown in FIG. 14C, the first energy generating unit 82A and the second energy generating unit 83 are disposed such that there is no gap between the first energy generating unit 82A and the second energy generating unit 83. I don't care. In FIG. 14C, the size of the second energy generating unit 83 is increased to fill the gap, but the present invention is not limited to this, and the size of the first energy generating unit 82A may be increased to fill the gap. I don't care.
The second holding member 8D 'has the same configuration and shape as the first holding member 8D. In FIG. 14C, as a symbol indicating the configuration of the second holding member 8D ′, “′ ′ ′ is added to the symbol indicating the configuration of the first holding member 8D for the same configuration as the first holding member 8D, and 1 indicates in parentheses the reference numeral indicating the configuration of the holding member 8D.
That is, as shown in FIG. 14C, the second holding member 8D ′ is the first holding member described above in place of the second jaw 81 ′ with respect to the second holding member 8A ′ described in the second embodiment. A second jaw 81B 'similar to the jaw 81B is employed.
　上述した実施の形態１，２及び変形例１（図１４Ａ～図１４Ｃ）では、第１エネルギ発生部８２，８２Ａ（８２´，８２Ａ´）と第２エネルギ発生部８３（８３´）とが同一の厚み寸法となるように設定されていたが、これに限られない。例えば、第２エネルギ発生部８３（８３´）の厚み寸法が第１エネルギ発生部８２，８２Ａ（８２´，８２Ａ´）の厚み寸法よりも大きくなるように設定しても構わない。 In the first and second embodiments and the first modification (FIGS. 14A to 14C) described above, the first energy generation units 82 and 82A (82 'and 82A') and the second energy generation unit 83 (83 ') are the same. Although it was set so that it might become the thickness dimension of, it is not restricted to this. For example, the thickness dimension of the second energy generating unit 83 (83 ') may be set to be larger than the thickness dimension of the first energy generating units 82, 82A (82', 82A ').
　図１５Ａ及び図１５Ｂは、本発明の実施の形態１，２の変形例２を示す図である。具体的に、図１５Ａは、図４に対応した図であり、本変形例２に係る第１保持部材８Ｅを示す図である。図１５Ｂは、本変形例２に係る第２保持部材８Ｅ´を示す図である。
　上述した実施の形態１，２及び変形例１（図１４Ａ～図１４Ｃ）では、第１保持部材８（８Ａ～８Ｄ）と第２保持部材８´（８Ａ´～８Ｄ´）とが同一の構成及び形状を有していたが、これに限られない。
　例えば、変形例１（図１４Ａ～図１４Ｃ）に示したように第１挟持面８１１及び第２挟持面８１１´の双方を平坦状に構成した構成に限られず、一方のみを平坦状に構成した構成を採用しても構わない。 15A and 15B are diagrams showing a second modification of the first and second embodiments of the present invention. Concretely, FIG. 15A is a figure corresponding to FIG. 4, and is a figure which shows the 1st holding member 8E which concerns on this modification 2. As shown in FIG. FIG. 15B is a view showing a second holding member 8E ′ according to the second modification.
In the first and second embodiments and the first modification (FIGS. 14A to 14C) described above, the first holding member 8 (8A to 8D) and the second holding member 8 '(8A' to 8D ') have the same configuration. And although it had a shape, it is not restricted to this.
For example, as shown in the first modification (FIGS. 14A to 14C), both the first holding surface 811 and the second holding surface 811 'are not limited to the flat configuration, but only one of them is flat. The configuration may be adopted.
　また、上述した実施の形態１，２及び変形例１では、第１エネルギ発生部８２（８２Ａ）と第２エネルギ発生部８３とが同一の第１挟持面８１１に設けられていた（第１エネルギ発生部８２´（８２Ａ´）と第２エネルギ発生部８３´とが同一の第２挟持面８１１´に設けられていた）が、これに限られず、例えば、図１５Ａ及び図１５Ｂに示すように、異なる挟持面にそれぞれ設けた構成を採用しても構わない。
　具体的に、図１５Ａに示した第１保持部材８Ｅは、上述した変形例１で説明した第１顎部８１Ｂと、第１エネルギ発生部８２Ｅとを備える。
　第１エネルギ発生部８２Ｅは、上述した実施の形態２で説明した第１エネルギ発生部８２Ａと同様に、セラミックヒータ等で構成され、熱エネルギを発生する。そして、第１エネルギ発生部８２Ｅは、図１５Ａに示すように、第１挟持面８１１Ｂにおける第１周囲領域ＡｒＳＢと同一の平面形状（略Ｕ字形状）を有し、当該第１周囲領域ＡｒＳＢに固定される。
　また、図１５Ｂに示した第２保持部材８Ｅ´は、上述した変形例１で説明した第２顎部８１Ｂ´と、第２エネルギ発生部８３Ｅとを備える。
　第２エネルギ発生部８３Ｅは、上述した第１エネルギ発生部８２Ｅと同様に、セラミックヒータ等で構成され、熱エネルギを発生する。そして、第２エネルギ発生部８３Ｅは、図１５Ｂに示すように、第２挟持面８１１Ｂ´の略全体を占める領域ＡｒＣＥ´と同一の平面形状（略矩形状）を有し、当該領域ＡｒＣＥ´に固定される。なお、領域ＡｒＣＥ´は、第２領域Ａｒ１Ｂ´を包含する領域であり、本発明に係る第２包含領域に相当する。以下、領域ＡｒＣＥ´を第２包含領域ＡｒＣＥ´と記載する。
　すなわち、第２エネルギ発生部８３Ｅが配置される第２包含領域ＡｒＣＥ´としては、第２領域Ａｒ１Ｂ´を包含していればよく、図１５Ｂに示すように、第２周囲領域ＡｒＳＢ´まで広がった領域としても構わない。 In the first and second embodiments and the first modification described above, the first energy generating unit 82 (82A) and the second energy generating unit 83 are provided on the same first sandwiching surface 811 (first energy The generation unit 82 '(82A') and the second energy generation unit 83 'are provided on the same second holding surface 811'), but not limited to this, for example, as shown in FIGS. 15A and 15B. You may employ | adopt the structure each provided in the different clamping surface.
Specifically, the first holding member 8E shown in FIG. 15A includes the first jaw 81B and the first energy generator 82E described in the first modification.
Similar to the first energy generating unit 82A described in the second embodiment, the first energy generating unit 82E is configured of a ceramic heater or the like, and generates thermal energy. Then, as shown in FIG. 15A, the first energy generation unit 82E has the same planar shape (substantially U-shape) as the first surrounding area ArSB in the first holding surface 811B, and It is fixed.
Moreover, 2nd holding member 8E 'shown to FIG. 15B is provided with 2nd jaw part 81 B' and the 2nd energy generation part 83E which were demonstrated by the modification 1 mentioned above.
Similar to the first energy generating unit 82E described above, the second energy generating unit 83E includes a ceramic heater or the like, and generates heat energy. Then, as shown in FIG. 15B, the second energy generation unit 83E has the same planar shape (substantially rectangular shape) as the area ArCE ′ which occupies substantially the entire second sandwiching surface 811B ′, and the second energy generation unit 83E It is fixed. The region ArCE ′ is a region including the second region Ar1B ′ and corresponds to a second inclusion region according to the present invention. Hereinafter, the area ArCE 'is described as a second inclusion area ArCE'.
That is, the second inclusion region ArCE 'in which the second energy generation unit 83E is disposed only needs to include the second region Ar1B', and as shown in FIG. 15B, it extends to the second surrounding region ArSB '. It does not matter as an area.
　上述した実施の形態１，２及び変形例１，２では、本発明に係る第１領域（第２領域）として、第１挟持面８１１，８１１Ｂ（第２挟持面８１１´，８１１Ｂ´）の中心位置ＣＰを含む第１領域Ａｒ１，Ａｒ１Ｂ（第２領域Ａｒ１´，Ａｒ１Ｂ´）を採用していたが、これに限られず、中心位置を含まない他の領域を第１領域（第２領域）としても構わない。 In Embodiments 1 and 2 and Modifications 1 and 2 described above, the center of the first sandwiching surfaces 811 and 811 B (second sandwiching surfaces 811 ′ and 811 B ′) as the first region (second region) according to the present invention. Although the first regions Ar1 and Ar1B (second regions Ar1 ′ and Ar1B ′) including the position CP are employed, the present invention is not limited thereto, and other regions not including the center position may be used as the first region (second region). I don't care.
　上述した実施の形態１，２及び変形例１，２では、生体組織ＬＴを仮接合及び本接合するエネルギとして高周波エネルギや熱エネルギを採用していたが、これに限られず、超音波エネルギを採用しても構わない。この際、上述した実施の形態２のように高周波エネルギまたは熱エネルギと超音波エネルギとの種類の異なる２つのエネルギを組み合わせてもよく、あるいは、上述した実施の形態１のように超音波エネルギの一種類のエネルギのみを採用しても構わない。また、生体組織ＬＴを仮接合するエネルギとしては、高周波エネルギ、熱エネルギ、及び超音波エネルギのうちいずれのエネルギでもよく、生体組織ＬＴを本接合するエネルギも同様に、高周波エネルギ、熱エネルギ、及び超音波エネルギのうちいずれのエネルギでも構わない。 In Embodiments 1 and 2 and Modifications 1 and 2 described above, high frequency energy and thermal energy are adopted as energy for temporarily joining and main joining living tissue LT, but the invention is not limited thereto, and ultrasonic energy is adopted. It does not matter. At this time, two types of different types of high frequency energy or thermal energy and ultrasonic energy may be combined as in the second embodiment described above, or as in the first embodiment described above, ultrasonic energy Only one kind of energy may be adopted. The energy for temporarily joining the living tissue LT may be any of radio frequency energy, thermal energy, and ultrasonic energy, and the energy for main joining the living tissue LT is similarly high frequency energy, thermal energy, and Any energy of ultrasonic energy may be used.
　上述した実施の形態１，２及び変形例１，２では、生体組織ＬＴのインピーダンス、時間、及び熱伝導率に基づいて、生体組織ＬＴの本接合を開始（仮接合を終了）していたが、これに限られない。例えば、生体組織ＬＴの硬さ、厚さ、または温度等の物性値に基づいて、生体組織ＬＴの本接合を開始（仮接合を終了）しても構わない。 In Embodiments 1 and 2 and Modifications 1 and 2 described above, main bonding of living tissue LT is started (termination of temporary bonding is completed) based on the impedance, time, and thermal conductivity of living tissue LT. Not limited to this. For example, main bonding of the living tissue LT may be started (termination of temporary bonding may be completed) based on physical properties such as hardness, thickness, or temperature of the living tissue LT.
　また、接合制御のフローは、上述した実施の形態１，２及び変形例１，２で説明したフローチャート（図７，図１３）における処理の順序に限られず、矛盾のない範囲で変更しても構わない。 Further, the flow of bonding control is not limited to the order of the processing in the flowcharts (FIG. 7, FIG. 13) described in the first and second embodiments and the first and second modifications, and I do not care.
　１，１Ａ　医療用処置装置
　２，２Ａ　エネルギ処置具
　３，３Ａ　制御装置
　４　フットスイッチ
　５　ハンドル
　６　シャフト
　７　挟持部
　８，８Ａ～８Ｅ　第１保持部材
　８´，８Ａ´～８Ｄ´，８Ｅ´　第２保持部材
　３１　高周波エネルギ出力部
　３２　スイッチ
　３３　第１センサ
　３４，３４Ａ　制御部
　３５　熱エネルギ出力部
　３６　第２センサ
　５１　操作ノブ
　８１，８１Ｂ，８１Ｃ　第１顎部
　８１´，８１Ｂ´　第２顎部
　８２，８２´，８２Ａ，８２Ａ´，８２Ｅ　第１エネルギ発生部
　８３，８３´，８３Ｅ　第２エネルギ発生部
　３４１，３４１Ａ　エネルギ制御部
　３４２　インピーダンス算出部
　３４３　熱伝導率算出部
　８１１，８１１Ｂ　第１挟持面
　８１１´８１１Ｂ´　第２挟持面
　８１１１，８１１１´，８１１３　突出部
　８１１２　Ｕ字部分
　Ａｒ１，Ａｒ１Ｂ　第１領域
　Ａｒ１´，Ａｒ１Ｂ´　第２領域
　ＡｒＣ，ＡｒＣＢ　第１包含領域
　ＡｒＣ´，ＡｒＣＢ´，ＡｒＣＥ´　第２包含領域
　ＡｒＳ，ＡｒＳＢ　第１周囲領域
　ＡｒＳ´，ＡｒＳＢ´　第２周囲領域
　ＡｒＯ，ＡｒＩ　領域
　Ｃ　電気ケーブル
　Ｃ１，Ｃ１´　第１高周波用リード線
　Ｃ２，Ｃ２´　第２高周波用リード線
　Ｃ３，Ｃ４　第１発熱用リード線
　Ｃ３´，Ｃ４´　第２発熱用リード線
　ＣＰ，ＣＰ´　中心位置
　ＬＴ　生体組織
　Ｒ１　矢印
　Ｔ１，Ｔ２　時間
　ＶＩ　初期値
　ＶＬ　最低値 1, 1A medical treatment device 2, 2A energy treatment tool 3, 3A control device 4 foot switch 5 handle 6 shaft 7 pinching portion 8, 8A to 8E first holding member 8 ', 8A' to 8D ', 8E' second Holding member 31 high frequency energy output unit 32 switch 33 first sensor 34, 34A control unit 35 thermal energy output unit 36 second sensor 51 operation knob 81, 81B, 81C first jaw 81 ', 81B' second jaw 82, 82 ', 82A, 82A', 82E first energy generation unit 83, 83 ', 83E second energy generation unit 341, 341A energy control unit 342 impedance calculation unit 343 thermal conductivity calculation unit 811, 811B first sandwiching surface 811' 811 B ′ second holding surface 8111, 8111 ′, 8113 protrusion 8112 U-shaped portion Ar1, Ar1 B first region r1 ', Ar1B' second area ArC, ArCB first inclusion area ArC ', ArCB', ArCE 'second inclusion area ArS, ArSB first surrounding area ArS', ArSB 'second surrounding area ArO, ArI area C electrical cable C1, C1 'first high frequency lead wire C2, C2' second high frequency lead wire C3, C4 first heat generation lead wire C3 ', C4' second heat generation lead wire CP, CP 'center position LT living tissue R1 Arrow T1, T2 Time VI Initial value VL Lowest value

Claims (11)

  1. 　第１挟持面を有する第１保持部材と、前記第１挟持面に対向して当該第１挟持面との間で生体組織を挟持する第２挟持面を有する第２保持部材と、を備えたエネルギ処置具であって、
    　前記第１挟持面は、第１領域を囲む領域である第１周囲領域と、前記第１領域を包含する領域である第１包含領域と、を有し、
    　前記第２挟持面は、前記第１挟持面及び前記第２挟持面を互いに対向させた状態で、前記第１領域を前記第２挟持面に投影した第２領域を囲む領域である第２周囲領域と、前記第２領域を包含する領域である第２包含領域と、を有し、
    　当該エネルギ処置具は、
    　前記第１周囲領域と、前記第２周囲領域とのうち少なくとも一方からエネルギを発生する第１エネルギ発生部と、
    　前記第１包含領域と、前記第２包含領域とのうち少なくとも一方からエネルギを発生する第２エネルギ発生部と、を備える、
    ことを特徴とするエネルギ処置具。     A first holding member having a first holding surface, and a second holding member having a second holding surface for holding a living tissue between the first holding surface and the first holding surface. Energy treatment tool,
    The first sandwiching surface has a first surrounding area which is an area surrounding the first area, and a first inclusion area which is an area including the first area,
    The second surrounding surface is a region surrounding a second region obtained by projecting the first region onto the second sandwiching surface, with the first sandwiching surface and the second sandwiching surface facing each other, with the second sandwiching surface being in a state in which the first sandwiching surface and the second sandwiching surface are opposed to each other. A region and a second inclusion region which is a region including the second region,
    The energy treatment tool is
    A first energy generating unit generating energy from at least one of the first peripheral region and the second peripheral region;
    And a second energy generation unit that generates energy from at least one of the first inclusion region and the second inclusion region.
    An energy treatment tool characterized by the above.
  2. 　前記第１領域は、前記第１挟持面における中心位置を含む領域であり、
    　前記第２領域は、前記第２挟持面における中心位置を含む領域である
    ことを特徴とする請求項１に記載のエネルギ処置具。     The first area is an area including a center position of the first holding surface,
    The energy treatment tool according to claim 1, wherein the second area is an area including a center position of the second holding surface.
  3. 　前記第１包含領域は、前記第１周囲領域に対して突出している
    ことを特徴とする請求項１または２に記載のエネルギ処置具。     The energy treatment device according to claim 1, wherein the first inclusion area protrudes with respect to the first surrounding area.
  4. 　前記第２包含領域は、前記第２周囲領域に対して突出している
    ことを特徴とする請求項３に記載のエネルギ処置具。     The energy treatment device according to claim 3, wherein the second inclusion area protrudes relative to the second surrounding area.
  5. 　前記第１エネルギ発生部及び前記第２エネルギ発生部の一方は、熱エネルギを発生し、
    　前記第１エネルギ発生部及び前記第２エネルギ発生部の他方は、高周波エネルギを発生する
    ことを特徴とする請求項１～４のいずれか一つに記載のエネルギ処置具。     One of the first energy generating unit and the second energy generating unit generates thermal energy,
    The energy treatment tool according to any one of claims 1 to 4, wherein the other of the first energy generation unit and the second energy generation unit generates high frequency energy.
  6. 　請求項１～５のいずれか一つに記載のエネルギ処置具と、
    　前記第１エネルギ発生部と前記第２エネルギ発生部とにエネルギを発生させるエネルギ制御部と、を備える
    ことを特徴とする医療用処置装置。     The energy treatment tool according to any one of claims 1 to 5.
    A medical treatment apparatus comprising: an energy control unit configured to generate energy in the first energy generation unit and the second energy generation unit.
  7. 　前記エネルギ制御部は、前記第１エネルギ発生部にエネルギの発生を開始させた後、前記第２エネルギ発生部にエネルギの発生を開始させる
    ことを特徴とする請求項６に記載の医療用処置装置。     The medical treatment apparatus according to claim 6, wherein the energy control unit causes the second energy generation unit to start energy generation after the first energy generation unit starts the energy generation. .
  8. 　前記生体組織のインピーダンスを検出するインピーダンス検出部をさらに備え、
    　前記エネルギ制御部は、前記第１エネルギ発生部にて発生したエネルギが前記生体組織に付与されている際に前記インピーダンス検出部にて検出された前記インピーダンスに基づいて、前記第２エネルギ発生部にエネルギの発生を開始させる
    ことを特徴とする請求項７に記載の医療用処置装置。     It further comprises an impedance detection unit for detecting the impedance of the living tissue,
    The energy control unit controls the second energy generation unit based on the impedance detected by the impedance detection unit when the energy generated by the first energy generation unit is applied to the living tissue. The medical treatment apparatus according to claim 7, wherein generation of energy is started.
  9. 　前記エネルギ制御部は、前記第１エネルギ発生部からのエネルギの発生時での当該第１エネルギ発生部の最高到達温度より前記第２エネルギ発生部からのエネルギの発生時での当該第２エネルギ発生部の最高到達温度が高くなるように前記第１エネルギ発生部と前記第２エネルギ発生部とにエネルギを発生させる
    ことを特徴とする請求項６～８のいずれか一つに記載の医療用処置装置。     The energy control unit is configured to generate the second energy at the time of generation of energy from the second energy generation unit based on the highest reached temperature of the first energy generation unit at the time of generation of energy from the first energy generation unit The medical treatment according to any one of claims 6 to 8, wherein energy is generated in the first energy generation part and the second energy generation part so that the highest reached temperature of the part becomes high. apparatus.
  10. 　第１挟持面を有する第１保持部材と第２挟持面を有する第２保持部材との間に生体組織が挟持された後、前記第１挟持面における第１周囲領域と、前記第２挟持面における第２周囲領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第１エネルギ付与ステップと、
    　前記第１エネルギ付与ステップが開始された後、前記第１挟持面における第１包含領域と、前記第２挟持面における第２包含領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第２エネルギ付与ステップと、を備え、
    　前記第１周囲領域は、前記第１挟持面における第１領域を囲む領域であり、
    　前記第２周囲領域は、前記第１挟持面及び前記第２挟持面を互いに対向させた状態で、前記第１領域を前記第２挟持面に投影した第２領域を囲む領域であり、
    　前記第１包含領域は、前記第１領域を包含する領域であり、
    　前記第２包含領域は、前記第２領域を包含する領域である
    ことを特徴とする医療用処置装置の作動方法。     After living tissue is sandwiched between a first holding member having a first holding surface and a second holding member having a second holding surface, a first peripheral region of the first holding surface, and the second holding surface Applying energy to the living tissue from at least one of the second surrounding regions in
    After the first energy applying step is started, energy is applied to the living tissue from at least one of a first inclusion region in the first holding surface and a second inclusion region in the second holding surface. Providing an energy applying step;
    The first surrounding area is an area surrounding a first area in the first holding surface,
    The second surrounding area is an area surrounding a second area obtained by projecting the first area onto the second holding surface, with the first holding surface and the second holding surface facing each other,
    The first inclusion region is a region including the first region,
    A method of operating a medical treatment apparatus, wherein the second inclusion area is an area including the second area.
  11. 　第１挟持面を有する第１保持部材と第２挟持面を有する第２保持部材とで生体組織を挟持する挟持ステップと、
    　前記第１挟持面における第１周囲領域と、前記第２挟持面における第２周囲領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第１エネルギ付与ステップと、
    　前記第１エネルギ付与ステップが開始された後、前記第１挟持面における第１包含領域と、前記第２挟持面における第２包含領域とのうち少なくとも一方から前記生体組織にエネルギを付与する第２エネルギ付与ステップと、を備え、
    　前記第１周囲領域は、前記第１挟持面における第１領域を囲む領域であり、
    　前記第２周囲領域は、前記第１挟持面及び前記第２挟持面を互いに対向させた状態で、前記第１領域を前記第２挟持面に投影した第２領域を囲む領域であり、
    　前記第１包含領域は、前記第１領域を包含する領域であり、
    　前記第２包含領域は、前記第２領域を包含する領域である
    ことを特徴とする治療方法。     A sandwiching step of sandwiching a living tissue with a first holding member having a first holding surface and a second holding member having a second holding surface;
    A first energy applying step of applying energy to the living tissue from at least one of a first peripheral region of the first clamping surface and a second peripheral region of the second clamping surface;
    After the first energy applying step is started, energy is applied to the living tissue from at least one of a first inclusion region in the first holding surface and a second inclusion region in the second holding surface. Providing an energy applying step;
    The first surrounding area is an area surrounding a first area in the first holding surface,
    The second surrounding area is an area surrounding a second area obtained by projecting the first area onto the second holding surface, with the first holding surface and the second holding surface facing each other,
    The first inclusion region is a region including the first region,
    The treatment method, wherein the second inclusion area is an area including the second area.
PCT/JP2015/080621 2015-10-29 2015-10-29 Energy treatment tool, medical treatment device, medical treatment device operating method, and treatment method WO2017072924A1 (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003245285A (en) * 2002-01-23 2003-09-02 Ethicon Endo Surgery Inc Feedback light apparatus and method for use with electrosurgical instrument
WO2014141530A1 (en) * 2013-03-12 2014-09-18 オリンパスメディカルシステムズ株式会社 Treatment device and treatment method
WO2015159607A1 (en) * 2014-04-18 2015-10-22 オリンパス株式会社 Therapeutic treatment device

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003245285A (en) * 2002-01-23 2003-09-02 Ethicon Endo Surgery Inc Feedback light apparatus and method for use with electrosurgical instrument
WO2014141530A1 (en) * 2013-03-12 2014-09-18 オリンパスメディカルシステムズ株式会社 Treatment device and treatment method
WO2015159607A1 (en) * 2014-04-18 2015-10-22 オリンパス株式会社 Therapeutic treatment device

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