WO2018146729A1 - Energy applying structure and treatment tool - Google Patents

Abstract

This energy applying structure 10 includes: a treatment member 11 which is formed from a conductive material and applies thermal energy and radio frequency energy to body tissue by contacting the body tissue; a heating member 12 which has a heating pattern 152 that generates heat when energized and which heats the treatment member 11 by the heat of the heating pattern 152; and an energizing member 13 which is provided on the heating member 12, is bonded to a radio frequency wiring member C2 which serves as a current flow path for radio frequency power to be supplied to the treatment member 11, and electrically connects the radio frequency wiring member C2 and the treatment member 11.

Description

Energy imparting structure and treatment instrument

The present invention relates to an energy application structure and a treatment instrument.

2. Description of the Related Art Conventionally, there has been known a treatment instrument that is provided with an energy applying structure that applies energy to a living tissue, and that treats the living tissue (joining (or anastomosis), cutting, etc.) by applying the energy (for example, Patent Documents) 1).
The energy application structure described in Patent Document 1 is provided on each treatment surface facing each other in a pair of jaws (jaw members) that grip biological tissue. In addition, the energy application structure includes a treatment member (conductive sealing plate) made of a conductive material, and a heat generating member (heating element) disposed inside the treatment member.
A high-frequency wiring member such as a lead wire serving as a current-carrying path for high-frequency power is joined to the treatment member. Then, by supplying high-frequency power to each treatment member in each energy application structure provided in each of the pair of jaws via each high-frequency wiring member, the living tissue grasped by the pair of jaws Is applied with high frequency energy.
A heating wiring member such as a lead wire serving as a power supply path is joined to the heating member. The heat generating member generates heat by energization via the heat generating wiring member, and heats the treatment member.

JP 2008-23335 A

However, in the energy application structure described in Patent Document 1, the high-frequency wiring member is directly bonded to the treatment member. And in a treatment member, since the heat | fever tends to escape to the said high frequency wiring member in the peripheral region of the joining position of the high frequency wiring member, temperature becomes comparatively low with respect to another area | region. That is, there is a problem that it is difficult to uniformly heat the treatment member (to achieve high soaking performance).

The present invention has been made in view of the above, and an object of the present invention is to provide an energy application structure and a treatment instrument that can realize high heat equalization performance.

In order to solve the above-described problems and achieve the object, the energy application structure according to the present invention is made of a conductive material, and is a treatment for applying thermal energy and high-frequency energy to the living tissue in contact with the living tissue. A heat generating pattern that generates heat when energized, the heat generating member that heats the treatment member with the heat of the heat generating pattern, and a high-frequency power supply path that is provided on the heat generating member and supplied to the treatment member A high-frequency wiring member is joined, and includes a current-carrying member that electrically connects the high-frequency wiring member and the treatment member.

Moreover, the treatment tool according to the present invention includes the above-described energy application structure.

According to the energy applying structure and the treatment tool according to the present invention, there is an effect that high heat equalization performance can be realized.

FIG. 1 is a diagram schematically illustrating a treatment system according to the first embodiment. FIG. 2 is an enlarged view of the distal end portion of the treatment instrument. FIG. 3 is a diagram showing an energy application structure. FIG. 4 is a diagram showing an energy application structure. FIG. 5 is a diagram illustrating a positional relationship between the first and second joining positions. FIG. 6 is a diagram showing an energy application structure according to the second embodiment. FIG. 7 is a diagram showing an energy application structure according to the second embodiment. FIG. 8 is a diagram showing an energy application structure according to the third embodiment. FIG. 9 is a diagram showing an energy application structure according to the third embodiment. FIG. 10 is a diagram showing an energy application structure according to the fourth embodiment. FIG. 11 is a diagram showing an energy application structure according to the fourth embodiment. FIG. 12 is a diagram showing an energy application structure according to the fifth embodiment. FIG. 13 is a diagram showing an energy application structure according to the fifth embodiment. FIG. 14 is a diagram showing an energy application structure according to the sixth embodiment. FIG. 15 is a diagram showing an energy application structure according to the sixth embodiment. FIG. 16 is a diagram showing a positional relationship between the first and second joining positions according to the modified examples of the first to sixth embodiments.

Hereinafter, embodiments for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Furthermore, the same code | symbol is attached | subjected to the same part in description of drawing.

[Schematic configuration of treatment system]
FIG. 1 is a diagram schematically illustrating a treatment system 1 according to the first embodiment.
The treatment system 1 treats (joins (or anastomoses) and detaches, etc.) the living tissues by applying thermal energy and high frequency energy to the living tissues to be treated. As illustrated in FIG. 1, the treatment system 1 includes a treatment tool 2, a control device 3, and a foot switch 4.

[Configuration of treatment tool]
The treatment tool 2 is, for example, a linear type surgical treatment tool for performing treatment on a living tissue through the abdominal wall. As shown in FIG. 1, the treatment tool 2 includes a handle 5, a shaft 6, and a grip portion 7.
The handle 5 is a part that the surgeon holds by hand. The handle 5 is provided with an operation knob 51 as shown in FIG.
As shown in FIG. 1, the shaft 6 has a substantially cylindrical shape, and one end (right end portion in FIG. 1) is connected to the handle 5. A gripping portion 7 is attached to the other end of the shaft 6 (left end portion in FIG. 1). An opening / closing mechanism (not shown) that opens and closes the first and second jaws 8 and 8 ′ (FIG. 1) constituting the gripping portion 7 in response to the operation of the operation knob 51 by the operator is provided inside the shaft 6. ) Is provided. Further, in the shaft 6, an electric cable C (FIG. 1) connected to the control device 3 is connected to the other end side (in FIG. 1) from one end side (right end side in FIG. 1) via the handle 5. (Up to the left end side).

(Configuration of gripping part)
FIG. 2 is an enlarged view of the distal end portion of the treatment instrument 2.
The gripping part 7 is a part that grips a living tissue and treats the living tissue. As shown in FIG. 1 or 2, the grip portion 7 includes first and second jaws 8 and 8 ′.
The first and second jaws 8 and 8 'are pivotally supported on the other end (the left end portion in FIGS. 1 and 2) of the shaft 6 so as to be opened and closed in the direction of the arrow R1 (FIG. 2). The living tissue can be grasped according to the operation.
The first and second jaws 8 and 8 'are provided with energy applying structures 10 and 10', respectively, as shown in FIG.
The energy applying structures 10 and 10 ′ have the same configuration, and are different only in that the vertical posture is reversed. For this reason, below, the structure of the energy provision structure 10 is mainly demonstrated. And about energy provision structure 10 ', the same code | symbol is attached | subjected to the structure same as energy provision structure 10, and the description is abbreviate | omitted.

[Configuration of energy application structure]
3 and 4 are diagrams showing the energy application structure 10. Specifically, FIG. 3 is a perspective view of the energy applying structure 10 as viewed from below in FIG. FIG. 4 is a cross-sectional view of the energy application structure 10 cut along a vertical plane that passes through the high-frequency connection portion 131 (first through hole 133) and extends in the longitudinal direction of the energy application structure 10.
The “tip side” described below means the tip side of the gripping portion 7 and the left side in FIG. 3 or FIG. In addition, the “proximal end side” described below is the shaft 6 side of the grip portion 7 and means the right side in FIG. 3 or FIG.
The energy application structure 10 generates heat energy and high frequency energy under the control of the control device 3. As shown in FIG. 3 or FIG. 4, the energy applying structure 10 includes a treatment member 11, a heat generating member 12, and an energizing member 13.

The treatment member 11 is made of a conductive material such as copper, for example. Further, as shown in FIG. 3, the treatment member 11 has a long shape having a recess 111 on one plate surface (the upper plate surface in FIG. 3) (longitudinal direction from the distal end of the gripping portion 7 to the proximal end). (A long shape extending in the left-right direction in FIGS. 1 and 2)).
The recess 111 is located at the center in the width direction of the treatment member 11 and extends along the longitudinal direction of the treatment member 11. Moreover, the side wall part is not formed in the base end side among the side wall parts which comprise the recessed part 111. FIG. Then, the treatment member 11 supports the members 12 and 13 in the recess 111, and the recess 111 with respect to the upper surface of the first jaw 8 disposed on the lower side in FIG. 1 or 2. The other plate surface (in FIG. 3, the plate surface on the lower side in FIG. 3) is attached in a posture facing upward.

Here, in the treatment member 11, the other plate surface corresponds to the first main surface PS1 (FIGS. 2 to 4) according to the present invention. The bottom surface of the recess 111 corresponds to the second main surface PS2 (FIGS. 3 and 4) according to the present invention. Further, the bottom portion of the plate-like recess 111 having the first and second main surfaces PS1 and PS2 corresponds to the bottom surface portion 112 (FIGS. 2 to 4) according to the present invention. Further, the side wall of the recess 111 protrudes from the outer edge of the second main surface PS2 in the out-of-plane direction of the second main surface PS2, and corresponds to the side wall 113 (FIGS. 2 to 4) according to the present invention. To do.
Then, the treatment member 11 is in a state where the living tissue is gripped by the first and second jaws 8 and 8 ′, the first main surface PS1 is in contact with the living tissue, and heat energy and high frequency energy are applied to the living tissue. Give.

The heat generating member 12 has a heat generating pattern 152 that generates heat when energized, and the treatment member 11 is heated by the heat of the heat generating pattern 152. As shown in FIG. 3 or FIG. 4, the heat generating member 12 includes an insulating member 14, a wiring pattern 15, and an insulating layer 16 (FIG. 4). In FIG. 3, the insulating layer 16 is not shown for convenience of explanation.
The insulating member 14 is made of an insulating material such as alumina or aluminum nitride having a high thermal conductivity, for example, and transfers the heat of the heat generation pattern 152 to the treatment member 11. In addition, as shown in FIG. 3 or FIG. 4, the insulating member 14 is configured by a long plate (long shape extending in the longitudinal direction of the grip portion 7).
Here, in the insulating member 14, one plate surface (the plate surface on the lower side in FIGS. 3 and 4) corresponds to the third main surface PS3 (FIGS. 3 and 4) according to the present invention. In the insulating member 14, the other plate surface (the plate surface on the upper side in FIGS. 3 and 4) corresponds to the fourth main surface PS4 (FIGS. 3 and 4) according to the present invention.

The wiring pattern 15 is obtained by processing a platinum thin film, and includes a pair of heating connection portions 151 (FIG. 3) and a heating pattern 152 as shown in FIG. 3 or FIG. The wiring pattern 15 is formed by patterning a platinum thin film formed on the fourth main surface PS4 by vapor deposition, sputtering, or the like by photolithography.
The material of the wiring pattern 15 is not limited to a platinum thin film, and a conductive thin film material such as nickel or titanium may be used. Further, the wiring pattern 15 is not limited to a configuration in which a thin film is patterned on the fourth main surface PS4, and a configuration in which a thick film paste material such as ruthenium oxide is formed on the fourth main surface PS4 by a printing technique. You may adopt.

The pair of heat generating connection portions 151 are configured by a layer structure such as an adhesion layer inserted between the insulating members 14 as necessary, an adhesion layer added to the surface side, and a protective layer, as shown in FIG. , Provided at each corner portion on the distal end side and the proximal end side which are diagonal positions on the fourth main surface PS4. A pair of heat generating lead wires C1 constituting the electric cable C are joined (connected) to the pair of heat generating connecting portions 151, respectively. Hereinafter, in the pair of heat generating connection portions 151, each position where the pair of heat generating lead wires C1 are joined is referred to as a second joining position P2 (FIG. 3).
One end of the heat generation pattern 152 is connected (conducted) to one heat generation connecting portion 151, and substantially the entire surface excluding the central region ArO (see FIG. 5) in the fourth main surface PS4 while meandering from the one end. The other end is connected (conducted) to the other heat generating connecting portion 151. The heat generation pattern 152 generates heat when a voltage is applied (energized) to the pair of heat generating connection portions 151 through the pair of heat generating lead wires C1 under the control of the control device 3. That is, the heating lead C1 serves as an energization path for power supplied to the heating pattern 152, and corresponds to the heating wiring member according to the present invention.

The insulating layer 16 is made of an insulating material such as polyimide having a low thermal conductivity, for example. The insulating layer 16 is formed of a long plate (long shape extending in the longitudinal direction of the gripping portion 7) having the same width and length as the insulating member 14. The insulating layer 16 has one plate surface (the lower plate surface in FIG. 4) bonded to the fourth main surface PS4 (heat generation pattern 152). Further, in the insulating layer 16, at positions facing a pair of heat generating connection portions 151 and a high frequency connection portion 131 described later, an opening portion 161 (through the front and back surfaces and exposing these connection portions 151 and 131 to the outside is provided. 4) are formed. In FIG. 4, for convenience of explanation, only the opening 161 that faces the high-frequency connection 131 is shown among the three openings 161.

Here, in the insulating layer 16, one plate surface corresponds to the fifth main surface PS5 (FIG. 4) according to the present invention. In the insulating layer 16, the other plate surface (upper plate surface in FIG. 4) corresponds to the sixth main surface PS6 (FIG. 4) according to the present invention.
In the first embodiment, the thermal resistance of the insulating layer 16 is larger than the thermal resistance of the insulating member 14. The insulating layer 16 may be made of the same material as the insulating member 14. In this case, if the thickness dimension of the insulating layer 16 is made larger than the thickness dimension of the insulating member 14, the thermal resistance of the insulating layer 16 can be made larger than the thermal resistance of the insulating member 14. Thus, by making the thermal resistance of the insulating layer 16 larger than the thermal resistance of the insulating member 14, the heat generated in the heat generating pattern 152 can be transmitted to the insulating member 14 side.

The energizing member 13 is provided on the heat generating member 12, and a high-frequency lead C2 (FIGS. 3 and 4) constituting the electric cable C is joined to electrically connect the high-frequency lead C2 and the treatment member 11. Connecting. As shown in FIG. 3 or FIG. 4, the energizing member 13 includes a high-frequency connection portion 131, a back electrode 132, and a first through hole 133 (FIG. 4).
The high frequency connection portion 131 has a layer structure similar to that of the pair of heat generation connection portions 151, and is a pad electrode having substantially the same size as the pair of heat generation connection portions 151 as shown in FIG. The high frequency connection portion 131 is formed in the central region ArO (see FIG. 5) in the fourth main surface PS4. Then, the high frequency lead 131 is joined to the high frequency connection portion 131. Hereinafter, in the high-frequency connection portion 131, the position where the high-frequency lead wire C2 is bonded is referred to as a first bonding position P1 (FIGS. 3 and 4).

The back electrode 132 has a layer structure similar to that of the pair of heating connection portions 151 and has a long shape (the length extending in the longitudinal direction of the grip portion 7) having the same width and length as the insulating member 14. Electrode) and is formed on the third main surface PS3. The insulating member 14 is bonded to the second main surface PS2 via the back electrode 132 and the conductive bonding material 17 (FIGS. 3 and 4) provided on the entire surface of the back electrode 132. Further, the back electrode 132 is electrically connected to the treatment member 11 via the bonding material 17.
As shown in FIG. 4, the first through hole 133 is located in the central region ArO (see FIG. 5) in the fourth main surface PS4, and between the third main surface PS3 and the fourth main surface PS4. To penetrate. The first through hole 133 electrically connects the high-frequency connection part 131 and the back electrode 132. That is, the first through hole 133 corresponds to the high-frequency energization path portion according to the present invention.

[Positional relationship between the first and second joining positions]
FIG. 5 is a diagram showing the positional relationship between the first and second joining positions P1 and P2. Specifically, FIG. 5 is a view of the first and second joining positions P1 and P2 seen from above in FIG. 3 (viewed along the direction in which the treatment member 11 and the heating member 12 face each other). It is.
As shown in FIG. 5, the first bonding position P1 is set in the central area ArO of the fourth main surface PS4 and at the central position CP of the formation area ArH where the wiring pattern 15 is formed. Further, the pair of second joining positions P2 sandwiches the first joining position P1 and is spaced from the first joining position P1 by the same distance (a tip that is a diagonal position on the fourth main surface PS4). Side and base end sides).

[Configuration of control device and foot switch]
The foot switch 4 is a part operated by the operator with his / her foot. Then, according to the operation on the foot switch 4, on / off of energization from the control device 3 to the treatment instrument 2 (the heat generating connection portion 151 and the high frequency connection portion 131) is switched.
Note that the means for switching on and off is not limited to the foot switch 4, and a switch operated by hand or the like may be employed.
The control device 3 includes a CPU (Central Processing Unit) and the like, and comprehensively controls the operation of the treatment instrument 2 according to a predetermined control program. More specifically, the control device 3 applies a voltage to the pair of heating connection portions 151 via the pair of heating lead wires C1 in response to an operation of the foot switch 4 by the operator (an operation to turn on the power). Apply. The control device 3 supplies high-frequency power to the high-frequency connection portions 131 of the energy applying structures 10 and 10 ′ via the two high-frequency lead wires C <b> 2.
Here, the high-frequency lead wire C2 serves as an energization path for the high-frequency power supplied to the treatment member 11, and corresponds to the high-frequency wiring member according to the present invention.

[Action system action]
Next, operation | movement of the treatment system 1 mentioned above is demonstrated.
The surgeon holds the treatment instrument 2 by hand, and inserts the distal end portion of the treatment instrument 2 (a part of the gripping portion 7 and the shaft 6) into the abdominal cavity through the abdominal wall using, for example, a trocar. Then, the surgeon operates the operation knob 51 and grips the living tissue to be treated by the grip portion 7.
Next, the surgeon operates the foot switch 4 to turn on the power supply from the control device 3 to the treatment instrument 2. When switched on, the control device 3 applies a voltage to the pair of heating connection portions 151 via the pair of heating lead wires C1 to cause the heating pattern 152 to generate heat. Heat from the heat generation pattern 152 is transmitted to the treatment member 11 through the insulating member 14, the back electrode 132, and the bonding material 17. Then, the living tissue that is in contact with the treatment member 11 (first main surface PS1) is treated by the heat of the treatment member 11 (application of thermal energy). The control device 3 supplies high-frequency power to the high-frequency connection portions 131 of the energy applying structures 10 and 10 ′ via the two high-frequency lead wires C <b> 2. As a result, high frequency power is supplied to each treatment member 11 through the energization path of the high frequency connection portion 131, the first through hole 133, the back electrode 132, the bonding material 17, and the treatment member 11. That is, the living tissue grasped by each treatment member 11 is given high-frequency energy and treated with the high-frequency energy.
In addition, the timing which gives a thermal energy and high frequency energy to a biological tissue may be a simultaneous timing, or may be a different timing.

The energy application structure 10 (10 ′) according to the first embodiment described above has the following effects.
In the energy application structure 10 (10 ′) according to the first embodiment, the high-frequency lead wire C2 is electrically connected to the treatment member 11 via the energization member 13 provided on the heat generating member 12. That is, the high-frequency lead wire C2 is not directly joined to the treatment member 11.
The energizing member 13 can be a path for heat to escape from the treatment member 11 to the high-frequency lead wire C <b> 2, but is provided in the heat generating member 12, so that heat is transmitted from the heat generating member 12 to the treatment member 11. It will also be a route to. For this reason, it is possible to prevent heat from escaping from the treatment member 11 to the high-frequency lead wire C <b> 2 via the energization member 13.
Therefore, according to the energy imparting structure 10 (10 ′) according to the first embodiment, temperature unevenness is prevented from occurring on the first main surface PS1 of the treatment member 11, and high soaking performance is realized. There is an effect that it is possible.
In particular, the heat generating member 12 includes the insulating member 14 having a high thermal conductivity interposed between the heat generating pattern 152 and the treatment member 11. For this reason, the heat from the heat generation pattern 152 is soaked in the insulating member 14 and then transmitted to the treatment member 11. Furthermore, since the treatment member 11 is also made of a material having a high thermal conductivity, the temperature is similarly equalized in the treatment member 11 as well. Further, due to the double soaking effect in the insulating member 14 and the treatment member 11, higher soaking performance can be realized.

By the way, when the heat generation pattern 152 is uniformly formed on the surface of the insulating member 14, the temperature distribution has a temperature at which the temperature at the center position CP of the formation region ArH is highest and the temperature of the outer edge is lowest.
Therefore, in the energy application structure 10 (10 ′) according to the first embodiment, the first joining position P1 where the high-frequency lead wire C2 is joined to the energizing member 13 is set to the center position CP. That is, by setting a portion where heat is easily released to the high-frequency lead C2 and the temperature is likely to be lowered to a position where the temperature is highest in the above-described temperature distribution, the above-described temperature distribution is smoothed, and higher soaking performance is achieved. Can be realized.

By the way, as with the high-frequency lead wire C2, heat easily escapes to the pair of heat-generating lead wires C1.
In the energy application structure 10 (10 ′) according to the first embodiment, each second joining position P2 where the pair of heating lead wires C1 are joined to the heating member 12 sandwiches the first joining position P1. The first joint position P1 is set at a position separated by the same distance.
That is, by dispersing the first and second joining positions P1 and P2, the influence of heat escape to the pair of lead wires C1 for heating and the lead wire for high frequency C2 is reduced, and higher soaking performance is realized. can do.

(Embodiment 2)
Next, the second embodiment will be described.
In the following description, the same reference numerals are given to the same components as those in the first embodiment described above, and detailed description thereof will be omitted or simplified.
The energy application structure according to the second exemplary embodiment has a connection structure between the heat generation lead C1 and the heat generation pattern 152 with respect to the energy application structure 10 (10 ′) described in the first exemplary embodiment, and The connection structure between the high-frequency lead wire C2 and the back electrode 132 is different.

6 and 7 are diagrams showing an energy application structure 10A (10A ') according to the second embodiment. Specifically, FIG. 6 corresponds to FIG. In FIG. 6, unlike FIG. 3, the insulating layer 16A according to the second embodiment is illustrated. FIG. 7 is a cross-sectional view corresponding to FIG.
Here, the energy application structure 10 </ b> A according to the second embodiment corresponds to the energy application structure 10 described in the first embodiment and is provided in the first jaw 8. The energy application structure 10A ′ according to the second embodiment corresponds to the energy application structure 10 ′ described in the first embodiment and is provided in the second jaw 8 ′. And energy provision structure 10A, 10A 'has the same structure, and the points from which an up-and-down attitude | position becomes reverse are different. For this reason, the same code | symbol is attached | subjected to the same structure of energy provision structure 10A, 10A '.

In the insulating layer 16A according to the second embodiment, as shown in FIG. 6 or FIG. 7, the three openings 161 are not formed with respect to the insulating layer 16 described in the first embodiment.
Further, as shown in FIG. 6 or FIG. 7, the pair of heat generating connection portions 151A and high frequency connection portions 131A according to the second embodiment are not provided on the fourth main surface PS4 but on the sixth main surface PS6. Is formed. In addition, the arrangement positions of the pair of heating connection portions 151A and the high frequency connection portion 131A when viewed from the upper side in FIG. 6, the pair of heating connection portions 151 described in the first embodiment and The arrangement positions of the high-frequency connection portions 131 are the same. Also, the positional relationship between the pair of first joining positions P1 (FIGS. 6 and 7) and the second joining position P2 (FIG. 6) where the pair of heating lead wires C1 and the high-frequency lead wire C2 are joined is This is similar to the first embodiment described above.

The insulating layer 16A is located at each of the arrangement positions of the pair of heat generating connection portions 151A and the high frequency connection portions 131A and penetrates between the fifth main surface PS5 and the sixth main surface PS6. Three second through holes 162 are formed. In FIG. 7, only the second through-hole 162 located at the position where the high-frequency connection portion 131 </ b> A is disposed is illustrated among the three second through-holes 162.
Of these three second through-holes 162, the two second through-holes 162 located at the respective positions of the pair of heat-generating connection portions 151A are formed between the pair of heat-generating connection portions 151A and the heat generation pattern 152. Both ends are electrically connected to each other. That is, the two second through-holes 162 located at the respective arrangement positions of the pair of heat generating connection portions 151A correspond to the heat generating energization path portions according to the present invention. Further, the second through-hole 162 located at the position where the high-frequency connection portion 131A is disposed electrically connects the high-frequency connection portion 131A and the first through-hole 133.

The first through hole 133 described above and the second through hole 162 located at the position where the high frequency connecting portion 131A is disposed electrically connect the high frequency connecting portion 131A and the back electrode 132. This corresponds to the high-frequency energization path portion 133A (FIG. 7) according to the present invention. Further, the high-frequency connection portion 131, the high-frequency energization path portion 133A, and the back electrode 132 electrically connect the high-frequency lead C2 and the treatment member 11, and the energization member 13A according to the present invention (FIG. 6). , FIG. 7). Further, the insulating member 14, the insulating layer 16A, the pair of heat generating connection portions 151A, the two second through holes 162 located at the respective positions of the pair of heat generating connection portions 151A, and the heat generation pattern 152 are provided in the present invention. This corresponds to the heat generating member 12A according to FIG.

According to energy grant structure 10A (10A ') concerning this 2nd embodiment explained above, in addition to the same effect as a 1st embodiment mentioned above, there are the following effects.
By the way, when the heat generation pattern 152, the pair of heat generation connection portions 151, and the high frequency connection portion 131 are formed on the fourth main surface PS4 as in the first embodiment described above, the fourth main surface PS4. In FIG. 5, the region where the heat generation pattern 152 is provided is a heat generation region having a relatively high temperature. On the other hand, in the fourth main surface PS4, the region where the pair of heat generating connection portions 151 and the high frequency connection portion 131 are provided is a non-heat generating region having a relatively low temperature.
Here, when the pair of heat generating lead wires C1 and the high frequency lead wire C2 are joined to the pair of heat generating connecting portions 151 and the high frequency connecting portion 131, the connecting portions 151 are provided so that sufficient joining strength can be obtained. , 131 must be secured to some extent. Therefore, if an attempt is made to secure the size as much as possible, the substantial heat generation area is reduced. The heat generation area relates to the heat generation performance of the treatment tool 2. For this reason, the decrease in the heat generation area leads to a decrease in the heat generation performance of the treatment instrument 2.

In the energy application structure 10A (10A ′) according to the second embodiment, the heat generation pattern 152 is formed on the fourth main surface PS4. On the other hand, the pair of heat generating connection portions 151A and the high frequency connection portion 131A are formed on the sixth main surface PS6. That is, the heat generation pattern 152, the pair of heat generation connection portions 151A, and the high frequency connection portion 131A are formed in different layers.
For this reason, the pair of heat generating connection portions 151A and the high frequency connection portions 131A have a sufficient area on the sixth main surface PS6 so that the pair of heat generation lead wires C1 and the high frequency lead wires C2 can be joined respectively. Can be secured. On the other hand, as the heat generation pattern 152, the fourth main surface PS4 is not limited in the region provided by the pair of heat generation connection portions 151A and the high frequency connection portion 131A. It can be formed uniformly over the entire surface of PS4. Therefore, high heat generation performance can be realized while sufficiently securing the bonding strength between the pair of heat generating lead C1 and the high frequency lead C2.

(Embodiment 3)
Next, the third embodiment will be described.
In the following description, the same reference numerals are given to the same components as those in the first embodiment described above, and detailed description thereof will be omitted or simplified.
The energy application structure according to the third embodiment is different from the energy application structure 10 (10 ′) described in the first embodiment in the connection structure between the high-frequency lead C2 and the back electrode 132. .

8 and 9 are diagrams showing an energy application structure 10B (10B ') according to the third embodiment. Specifically, FIG. 8 corresponds to FIG. FIG. 9 is a cross-sectional view of the energy applying structure 10B (10B ′) taken along a vertical plane that passes through the high-frequency energizing path portion 133B and extends in the longitudinal direction of the energy applying structure 10B (10B ′).
Here, the energy application structure 10 </ b> B according to the third embodiment corresponds to the energy application structure 10 described in the first embodiment and is provided in the first jaw 8. The energy application structure 10B ′ according to the third embodiment corresponds to the energy application structure 10 ′ described in the first embodiment and is provided in the second jaw 8 ′. And energy provision structure 10B, 10B 'has the same structure, and the points from which an up-and-down attitude | position becomes reverse are different. For this reason, the same code | symbol is attached | subjected to the same structure of energy provision structure 10B, 10B '.

In the insulating member 14B according to the third embodiment, as shown in FIG. 9, the first through hole 133 is not formed with respect to the insulating member 14 described in the first embodiment.
Further, the high frequency connection portion 131B according to the third embodiment includes a connection portion main body 1311 and a first extension portion 1312 as shown in FIG. 8 or FIG.
The connection portion main body 1311 is made of the same material as the high frequency connection portion 131 described in the first embodiment, has the same shape, and is provided at the same arrangement position. The high frequency lead wire C <b> 2 is joined to the connection portion main body 1311.
The first extending portion 1312 is made of the same material as that of the connection portion main body 1311. From the base end side edge of the connection portion main body 1311, the third main surface PS3 and the fourth main surface of the insulating member 14B. This is a portion extending to the side surface S7 (FIGS. 8 and 9) on the base end side that intersects PS4.

In the third embodiment, the high frequency connecting portion 131B and the back electrode 132 are electrically connected through a high frequency energizing path portion 133B as shown in FIG. 8 or FIG.
The high-frequency energizing path portion 133B is made of a conductive material such as copper, aluminum, or carbon, and is formed on the side surface S7 by vapor deposition or the like. The high-frequency energizing path portion 133B is electrically connected to the high-frequency connection portion 131B (first extension portion 1312) and the back electrode 132, respectively.
The high frequency connecting portion 131B, the high frequency energizing path portion 133B, and the back electrode 132 described above electrically connect the high frequency lead C2 and the treatment member 11, and the energizing member 13B according to the present invention (FIG. 8 and FIG. 9). The insulating member 14B, the wiring pattern 15, and the insulating layer 16 correspond to the heat generating member 12B according to the present invention (FIGS. 8 and 9).

According to the energy provision structure 10B (10B ′) according to the third embodiment described above, the following effects can be obtained in addition to the same effects as those of the first embodiment.
Incidentally, the escape of heat from the high-frequency lead C2 depends on the cross-sectional area of the path through which the heat escapes. As in the first embodiment described above, when the first through hole 133 formed in the insulating member 14 is employed as the high-frequency energizing path portion according to the present invention, the high-frequency lead wire C2 is connected to the first through-hole 133. In order to reduce the heat escape as much as possible, it is desirable to make the first through hole 133 thinner. However, since the first through hole 133 is formed by filling a through hole formed in the insulating member 14 with a conductive member, there is a limit to the minimum size of the diameter that can be formed.
In the energy application structure 10B (10B ′) according to the third embodiment, the high-frequency energizing path portion 133B is formed on the side surface S7 of the insulating member 14B. For this reason, it becomes possible to make the high-frequency energization path portion 133B thin (small cross-sectional area), and to reduce heat escape from the high-frequency lead C2 as much as possible.

(Embodiment 4)
Next, the fourth embodiment will be described.
In the following description, the same components as those in the first and third embodiments described above are denoted by the same reference numerals, and detailed description thereof is omitted or simplified.
The energy application structure according to the fourth embodiment is different from the energy application structure 10 (10 ') described in the first embodiment in the connection structure between the high-frequency lead C2 and the treatment member 11. .

10 and 11 are diagrams showing an energy application structure 10C (10C ′) according to the fourth embodiment. Specifically, FIG. 10 corresponds to FIG. FIG. 11 is a cross-sectional view of the energy application structure 10C (10C ′) taken along a vertical plane that passes through the joint portion 134 and extends in the longitudinal direction of the energy application structure 10C (10C ′).
Here, the energy application structure 10 </ b> C according to the fourth embodiment corresponds to the energy application structure 10 described in the first embodiment and is provided in the first jaw 8. The energy application structure 10C ′ according to the fourth embodiment corresponds to the energy application structure 10 ′ described in the first embodiment and is provided in the second jaw 8 ′. The energy application structures 10C and 10C ′ have the same configuration, and are different in that the vertical posture is reversed. For this reason, the same code | symbol is attached | subjected to the same structure of energy provision structure 10C, 10C '.

In the energy application structure 10C (10C ′) according to the fourth embodiment, as illustrated in FIG. 10 or FIG. 11, the energy application structure 10B (10B ′) described in the third embodiment described above, The back electrode 132 is not formed. Then, the insulating member 14B has the third main surface in a state where the side surface S8 (FIG. 11) on the front end side intersecting the third main surface PS3 and the fourth main surface PS4 is in contact with the side wall 113. It is bonded to the second main surface PS2 via a bonding material 17 provided on the entire surface of PS3.
Further, as shown in FIG. 10 or FIG. 11, the high frequency connection portion 131C according to the fourth embodiment includes a second extension portion 1313 in addition to the connection portion main body 1311 described in the third embodiment. .
The second extending portion 1313 is made of the same material as that of the connecting portion main body 1311 and extends from the leading edge of the connecting portion main body 1311 to the side surface S8 (FIG. 11) of the insulating member 14B. .

In addition, as shown in FIG. 11, the insulating layer 16C according to the fourth embodiment has a distal end side end portion of the second extending portion 1313 with respect to the insulating layer 16 described in the third embodiment. A notch portion 163 that exposes the end portion to the outside is formed at the facing position.
In the third embodiment, the high-frequency connection part 131C (second extending part 1313) and the treatment member 11 (side wall part 113) are connected via a notch part 163 as shown in FIG. Are electrically connected at the conductive joint 134.
The high frequency connecting portion 131C and the joining portion 134 described above electrically connect the high frequency lead wire C2 and the treatment member 11 (side wall portion 113), and the energizing member 13C according to the present invention (FIGS. 10 and 10). 11). The insulating member 14B, the wiring pattern 15, and the insulating layer 16C correspond to the heat generating member 12C (FIGS. 10 and 11) according to the present invention.

According to energy grant structure 10C (10C ') concerning this 4th embodiment explained above, in addition to the same effect as the 1st and 3rd embodiments mentioned above, the following effects are produced.
By the way, when it is set as the structure which contains the 1st through-hole 133 like Embodiment 1 mentioned above and the electricity supply path | route part 133B for high frequencies like Embodiment 3 mentioned above as an electricity supply member which concerns on this invention. In production, a special processing step is required, which may increase the cost.
In the energy application structure 10C (10C ′) according to the fourth embodiment, the energization member 13C includes a high-frequency connection portion 131C and a joint portion 134. For this reason, the energization member 13C can be manufactured only by a general electric substrate manufacturing process, and the cost can be reduced.

(Embodiment 5)
Next, the fifth embodiment will be described.
In the following description, the same components as those in the first, second, and fourth embodiments described above are denoted by the same reference numerals, and detailed description thereof is omitted or simplified.
In the energy application structure according to the fifth embodiment, the connection structure of the heat generation lead C1 and the heat generation pattern 152 to the energy application structure 10C (10C ′) described in the fourth embodiment, and The connection structure between the high-frequency lead wire C2 and the back electrode 132 is different.

12 and 13 are diagrams showing an energy application structure 10D (10D ′) according to the fifth embodiment. Specifically, FIG. 12 corresponds to FIG. In FIG. 12, unlike FIG. 10, the insulating layer 16D according to the fifth embodiment is illustrated. FIG. 13 is a cross-sectional view corresponding to FIG.
Here, the energy application structure 10 </ b> D according to the fifth embodiment corresponds to the energy application structure 10 </ b> C described in the fourth embodiment and is provided in the first jaw 8. The energy application structure 10D ′ according to the fifth embodiment corresponds to the energy application structure 10C ′ described in the fourth embodiment and is provided in the second jaw 8 ′. And energy provision structure 10D, 10D 'has the same structure, and the points from which an up-and-down attitude | position becomes reverse are different. For this reason, the same code | symbol is attached | subjected to the same structure of energy provision structure 10D, 10D '.

As shown in FIG. 12 or FIG. 13, the pair of heat generating connecting portions 151D and the high frequency connecting portion 131D according to the fifth embodiment is the same as the pair of heat generating connecting portions 151 and the high frequency connecting portions described in the fourth embodiment. With respect to the connecting portion 131C, it is formed not on the fourth main surface PS4 but on the sixth main surface PS6. Note that the arrangement positions of the pair of heat generating connection portions 151D and the high frequency connection portion 131D are, as viewed from above in FIG. 12, the pair of heat generating connection portions 151 described in the fourth embodiment and It is the same as each arrangement position of the high frequency connection portion 151C. Further, the positional relationship between the pair of first joining positions P1 (FIGS. 12 and 13) and the second joining position P2 (FIG. 12) where the pair of heating lead wires C1 and the high-frequency lead wires C2 are joined is also as follows. This is the same as in the first and fourth embodiments.

In addition, in the insulating layer 16D according to the fifth embodiment, the high-frequency connection portion 131D (connection portion main body) among the three second through holes 162 with respect to the insulating layer 16A described in the second embodiment. 1311) only the second through hole 162 located at the arrangement position is not formed. The remaining two second through holes 162 electrically connect the pair of heat generating connection portions 151D and both end portions of the heat generation pattern 152, respectively, as in the second embodiment.
The high-frequency connecting portion 131D and the joining portion 134 described above electrically connect the high-frequency lead wire C2 and the treatment member 11 and correspond to the energizing member 13D (FIGS. 12 and 13) according to the present invention. . Further, the insulating member 14B, the insulating layer 16D, the pair of heat generating connection portions 151D, the two second through holes 162 located at the respective positions of the pair of heat generating connection portions 151D, and the heat generation pattern 152 are provided in the present invention. This corresponds to the heat generating member 12D (FIGS. 12 and 13).

According to the energy application structure 10D (10D ′) according to the fifth embodiment described above, the same effects as those of the first, second, and fourth embodiments described above can be obtained.

(Embodiment 6)
Next, the sixth embodiment will be described.
In the following description, the same reference numerals are given to the same components as those in the first embodiment described above, and detailed description thereof will be omitted or simplified.
In the energy application structure according to the sixth embodiment, a pair of the heating connection portion 151 and the high frequency connection portion 131 and the energy application structure 10 (10 ′) described in the first embodiment are paired. The connecting structure of the heat generating lead C1 and the high frequency lead C2 is different.

14 and 15 are diagrams showing an energy application structure 10E (10E ') according to the sixth embodiment. Specifically, FIG. 14 corresponds to FIG. FIG. 15 is a cross-sectional view corresponding to FIG.
Here, the energy application structure 10 </ b> E according to the sixth embodiment corresponds to the energy application structure 10 described in the first embodiment and is provided in the first jaw 8. Further, the energy application structure 10E ′ according to the sixth embodiment corresponds to the energy application structure 10 ′ described in the first embodiment and is provided in the second jaw 8 ′. And the energy provision structure 10E, 10E 'has the same structure, and the points from which an up-and-down attitude | position becomes reverse are different. For this reason, the same code | symbol is attached | subjected to the same structure of energy provision structure 10E, 10E '.

In the energy application structure 10E (10E ′) according to the sixth embodiment, the pair of heat generating connection portions 151 and the high frequency connection portion 131 are connected via the flexible substrate 18 as shown in FIG. A pair of heat generating lead C1 and high frequency lead C2 are electrically connected to each other.
As shown in FIG. 14 or FIG. 15, the flexible substrate 18 includes a base layer 181, a conductive layer 182, and a cover layer 183 (FIG. 15).
The base layer 181 is a long sheet made of an insulating material such as polyimide (long shape extending in the longitudinal direction from the distal end of the gripping portion 7 to the proximal end).
The conductive layer 182 is formed of a rolled copper foil, and is formed on one surface (the lower surface in FIG. 15) of the base layer 181 as shown in FIG. As shown in FIG. 14 or 15, the conductive layer 182 includes a pair of heat generating conductive lines 1821 (FIG. 14) and a high frequency conductive line 1822.

The pair of heat generating conductive lines 1821 extend on one surface of the base layer 181 from the proximal end side to the distal end side to positions facing the pair of heat generating connection portions 151. A pair of heat generating lead wires C1 are joined to each end portion on the base end side.
The high-frequency conductive line 1822 is located between the pair of heat-generating conductive lines 1821 on one surface of the base layer 181 and extends from the base end side to the distal end side to a position facing the high-frequency connection portion 131. Exists. A high-frequency lead wire C2 is joined to the proximal end.

The cover layer 183 is a sheet made of the same material as the base layer 181 and having the same shape. The cover layer 183 is bonded to one surface of the base layer 181 and covers the conductive layer 182.
In this cover layer 183, openings 1831 (FIG. 15) that expose the respective end portions to the outside at positions facing the respective end portions on the distal end side of the pair of heat generating conductive lines 1821 and the high frequency conductive lines 1822. Are formed respectively. In FIG. 15, for convenience of explanation, of the three openings 1831, only the opening 1831 facing the end on the tip side of the high-frequency conductive line 1822 is shown.
The flexible substrate 18 has a pair of heat generating connecting lines 151 and a pair of heat generating conductive lines 1821 and a high frequency conductive line 1822 through the openings 161 and 1831 with a conductive bonding material 19 (FIG. 15). And it attaches to the energy provision structure 10E (10E ') by joining to the connection part 131 for high frequency, respectively.
That is, the heat generating conductive line 1821 serves as an energization path for the power supplied to the heat generating pattern 152 and corresponds to the heat generating wiring member according to the present invention. The high-frequency conductive line 1822 serves as an energization path for high-frequency power supplied to the treatment member 11 and corresponds to the high-frequency wiring member according to the present invention.

According to the sixth embodiment described above, the following effects can be obtained in addition to the same effects as those of the first embodiment.
By the way, when the pair of heating lead C1 and the high-frequency lead C2 are joined to the pair of heating connection 151 and the high-frequency connection 131, respectively, as in the first embodiment described above, usually, 1 It is necessary to join one by one, and the joining process may be complicated.
In the sixth embodiment, the pair of heat generating lead C1 and the high frequency lead C2 are attached to the energy application structure 10E (10E ′) via the flexible substrate 18. In other words, if the flexible substrate 18 is used, the pair of heat generating conductive lines 1821 and the high frequency conductive lines 1822 with respect to the pair of heat generating connection portions 151 and the high frequency connection portions 131 of the energy application structure 10E (10E ′). Can be joined together. Therefore, the joining process can be easily performed.

(Other embodiments)
The embodiments for carrying out the present invention have been described so far, but the present invention should not be limited only by the above-described first to sixth embodiments.
FIG. 16 is a diagram showing a positional relationship between the first and second joining positions P1, P2 according to the modified examples of the first to sixth embodiments. Specifically, FIG. 16 corresponds to FIG.
In the first to sixth embodiments described above, the position of the pair of second joining positions P2 is not limited to the position described in the first to sixth embodiments. If the pair of second joining positions P2 are positions spaced by the same distance from the first joining position P1 with the first joining position P1 interposed therebetween, as shown in FIG. You may set to both sides of the width direction (up-down direction in FIG. 16) of 4th main surface PS4 with respect to P1, respectively.

The energy application structures 10 (10A to 10E) and 10 ′ (10A ′ to 10E ′) according to the first to sixth embodiments described above are configured to apply thermal energy and high frequency energy to a living tissue. However, the present invention is not limited to this, and other energy, for example, ultrasonic energy may be further applied.
In the energy application structures 10 (10A to 10E) and 10 ′ (10A ′ to 10E ′) according to the first to sixth embodiments described above, the first main surface PS1 is a flat surface. Not limited to. For example, the cross-sectional shape of the first main surface PS1 may be a convex shape, a concave shape, or a mountain shape. Furthermore, the energy application structures 10 (10A to 10E) and the energy application structures 10 ′ (10A ′ to 10E ′) may have different first cross sections on the first main surfaces PS1.
In the energy application structures 10 (10A to 10E) and 10 ′ (10A ′ to 10E ′) according to Embodiments 1 to 6 described above, both have a heat generation function. Alternatively, a configuration having a heat generating function may be used.

In the first to sixth embodiments described above, the size of the heat generating connecting portion 151 (151A, 151D), the high frequency connecting portion 131 (131A), and the connecting portion main body 1311 is the heat generating lead wire C1 (heat generating conductive wire). The line 1821) and the high-frequency lead wire C2 (high-frequency conductive line 1822) may have other sizes as long as they have an area that can be joined.
In Embodiments 2 and 5 described above, all of the heat generating connection portions 151A and 151D and the high frequency connection portions 131A and 131D are formed on the sixth main surface PS6, but this is not restrictive. For example, a configuration in which only one of the heat generating connection portions 151A and 151D and the high frequency connection portions 131A and 131D is formed on the sixth main surface PS6 and the other is formed on the fourth main surface PS4 is adopted. It doesn't matter.
In the above-described sixth embodiment, the energy applying structure 10E (10E ′) and the control device 3 are electrically connected by the electric cable C and the flexible substrate 18, but not limited thereto, only the flexible substrate 18 is provided. The energy applying structure 10E (10E ′) and the control device 3 may be electrically connected. Further, in the above-described second to fifth embodiments, a configuration using the flexible substrate 18 may be adopted as in the above-described sixth embodiment.

DESCRIPTION OF SYMBOLS 1 Treatment system 2 Treatment tool 3 Control apparatus 4 Foot switch 5 Handle 6 Shaft 7 Grip part 8,8 '1st, 2nd jaw 10,10A-10E, 10', 10A'-10E 'Energy provision structure 11 Treatment member 12, 12A to 12D Heat generating member 13, 13A to 13D Conducting member 14, 14B Insulating member 15 Wiring pattern 16, 16A, 16D Insulating layer 17 Bonding material 18 Flexible substrate 19 Bonding material 51 Operation knob 111 Recessed portion 112 Bottom surface portion 113 Side wall portion 131 , 131A to 131D High-frequency connection part 132 Back electrode 133 First through- hole 133A, 133B High-frequency energization path part 134 Joint part 151, 151A, 151D Heating connection part 152 Heat generation pattern 161 Opening part 162 Second through-hole 163 Notch 181 Base layer 182 Conductive layer 183 Cover layer 1311 Connection portion main body 1312, 1313 First and second extending portions 1821 Heat generation conductive line 1822 High frequency conductive line 1831 Opening ArH formation region ArO Central region C Electric cable C1 Heat generation lead C2 High frequency Lead wire P1, P2 First and second joining positions PS1 to PS6 First to sixth main surfaces R1 Arrow S7, S8 Side surface

Claims (12)

1. A treatment member made of a conductive material, which contacts the living tissue and applies thermal energy and high frequency energy to the living tissue;
   A heating member that generates heat when energized, and heats the treatment member with heat of the heating pattern;
   A high-frequency wiring member serving as a current-carrying path for high-frequency power supplied to the treatment member is bonded to the heat-generating member, and includes a current-carrying member that electrically connects the high-frequency wiring member and the treatment member. Energy application structure.
2. The treatment member is
   A first main surface in contact with the living tissue;
   A second main surface opposite to the first main surface;
   The heating member is
   An insulating member having a third main surface joined to the second main surface and a fourth main surface facing the third main surface and forming the heat generation pattern;
   The energizing member is
   A high-frequency connection portion formed on the fourth main surface to which the high-frequency wiring member is joined;
   A back electrode formed on the third main surface and electrically connected to the treatment member;
   The energy application structure according to claim 1, further comprising: a high-frequency energizing path portion that electrically connects the high-frequency connection portion and the back electrode.
3. The treatment member is
   A first main surface in contact with the living tissue;
   A second main surface opposite to the first main surface;
   The heating member is
   An insulating member having a third main surface joined to the second main surface, and a fourth main surface facing the third main surface and forming the heat generation pattern;
   An insulating layer having a fifth main surface joined to the heat generation pattern and a sixth main surface facing the fifth main surface;
   The energizing member is
   A high-frequency connection portion formed on the sixth main surface to which the high-frequency wiring member is joined;
   A back electrode formed on the third main surface and electrically connected to the treatment member;
   The energy application structure according to claim 1, further comprising: a high-frequency energizing path portion that electrically connects the high-frequency connection portion and the back electrode.
4. The high-frequency energization path section is
   The energy application structure according to claim 2, wherein the energy application structure is a through hole penetrating the heat generating member.
5. The high-frequency energization path part is:
   4. The energy application structure according to claim 2, wherein the energy application structure is formed on a side surface of the heat generating member intersecting the third main surface and the fourth main surface.
6. The back electrode and the second main surface are:
   The energy application structure according to any one of claims 2 to 5, wherein the energy application structures are bonded to each other with a conductive bonding material.
7. The treatment member is
   A bottom surface portion having a first main surface that contacts the living tissue and a second main surface facing the first main surface;
   A side wall portion protruding in an out-of-plane direction of the second main surface from an outer edge of the second main surface;
   The heating member is
   An insulating member having a third main surface joined to the second main surface and a fourth main surface facing the third main surface and forming the heat generation pattern;
   The energizing member is
   A high-frequency connection portion formed on the fourth main surface to which the high-frequency wiring member is joined;
   The energy application structure according to claim 1, further comprising a joint portion that electrically connects the high-frequency connection portion and the side wall portion.
8. The treatment member is
   A bottom surface portion having a first main surface that contacts the living tissue and a second main surface facing the first main surface;
   A side wall portion protruding in an out-of-plane direction of the second main surface from an outer edge of the second main surface;
   The heating member is
   An insulating member having a third main surface joined to the second main surface, and a fourth main surface facing the third main surface and forming the heat generation pattern;
   An insulating layer having a fifth main surface joined to the heat generation pattern and a sixth main surface facing the fifth main surface;
   The energizing member is
   A high-frequency connection portion formed on the sixth main surface to which the high-frequency wiring member is joined;
   The energy application structure according to claim 1, further comprising a joint portion that electrically connects the high-frequency connection portion and the side wall portion.
9. The heating member is
   A pair of heat generating connection portions formed on the sixth main surface, to which a pair of heat generating wiring members serving as energization paths for power supplied to the heat generating pattern are respectively joined;
   The energy application structure according to claim 3 or 8, further comprising a pair of heat generation path portions that electrically connect the pair of heat generation connection portions and the heat generation pattern, respectively.
10. The first joining position where the high-frequency wiring member is joined to the energizing member is:
    The center region including a center position of a region where the heat generating pattern is formed in the heat generating member when the treatment member and the heat generating member are viewed along a direction facing each other. The energy imparting structure according to claim 1.
11. In the heating member,
    A pair of heating wiring members that are energization paths for the power supplied to the heating pattern are joined,
    Each second joining position where the pair of heating wiring members are joined to the heating member,
    When the treatment member and the heat generating member are viewed along a direction in which they face each other, the first joining position is sandwiched, and the treatment member and the heat generating member are set at positions separated from the first joining position by the same distance. Item 11. The energy applying structure according to Item 10.
12. A treatment instrument comprising the energy application structure according to any one of claims 1 to 11.

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