WO2022012893A1 - Instrument électrochirurgical et procédé d'examen de tissu saisi au moyen de l'instrument électrochirurgical - Google Patents

Instrument électrochirurgical et procédé d'examen de tissu saisi au moyen de l'instrument électrochirurgical Download PDF

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Publication number
WO2022012893A1
WO2022012893A1 PCT/EP2021/067298 EP2021067298W WO2022012893A1 WO 2022012893 A1 WO2022012893 A1 WO 2022012893A1 EP 2021067298 W EP2021067298 W EP 2021067298W WO 2022012893 A1 WO2022012893 A1 WO 2022012893A1
Authority
WO
WIPO (PCT)
Prior art keywords
tissue
impedance
sensor electrodes
jaw
electrosurgical instrument
Prior art date
Application number
PCT/EP2021/067298
Other languages
German (de)
English (en)
Inventor
Thomas Alexander Schlebusch
Friedrich Kneule
Original Assignee
Robert Bosch Gmbh
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Robert Bosch Gmbh filed Critical Robert Bosch Gmbh
Publication of WO2022012893A1 publication Critical patent/WO2022012893A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A61B5/0538—Measuring electrical impedance or conductance of a portion of the body invasively, e.g. using a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4887—Locating particular structures in or on the body
    • A61B5/489—Blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4887—Locating particular structures in or on the body
    • A61B5/4893—Nerves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00755—Resistance or impedance

Definitions

  • the present invention relates to an electrosurgical instrument. Furthermore, the present invention relates to a method for examining tissue gripped by means of the electrosurgical instrument.
  • Electrosurgery is therefore used in this area in particular, in which the tissue is first coagulated or thermofused using a coagulation and/or thermofusion electrode before the cut.
  • the tissue is thermally heated by a high-frequency current flow and the proteins coagulate and water is expelled from the affected tissue section. This enables a reliable closure of the blood vessels before the surgical incision.
  • an electrosurgical instrument is designed as a bipolar instrument that has a coagulation and/or thermofusion electrode in both jaw parts of a jaw, then the tissue impedance can be measured integrally between the two electrodes.
  • this tissue impedance is not a meaningful measure of tissue type. Instead, it is described, for example, in WO 2009/010080 A1 that tapping a measurement voltage via sensors on coagulation and/or thermofusion electrodes for detecting the formation of vapor bubbles as a result of the increasing heating of the tissue being treated can be used.
  • the electrosurgical instrument has a jaw with two jaw parts.
  • the mouth can be opened and closed by changing the opening angle between the jaw parts.
  • Tissue to be treated can be gripped in the mouth between the jaw parts.
  • the sides of the jaw parts pointing towards the inside of the mouth are therefore each referred to as the tissue side.
  • the electrosurgical instrument is designed as a bipolar instrument. This means that at least one coagulation and/or thermofusion electrode is arranged on each jaw part on its tissue side.
  • a coagulation and/or thermofusion electrode is understood to mean an electrode which is set up for the coagulation and/or thermofusion of the tissue gripped.
  • each jaw part has exactly one coagulation and/or thermofusion electrode that is U-shaped.
  • a plurality of sensor electrodes are arranged in a distal end area of each jaw part.
  • the distal end area is understood to mean in particular an area which has a curved outer edge. If the coagulation and/or thermofusion electrode is designed as a U-shaped electrode, then the curved area of the coagulation and/or thermofusion electrode runs in this end area.
  • the sensor electrodes can be printed onto a ceramic carrier of the jaw part, in particular by means of screen printing or inkjet printing, or they can be applied to a plastic insulating body of the jaw part by means of direct laser structuring. It is also possible to insert the sensors as inserts into the ceramic carrier or into the plastic insulating body.
  • the sensor electrodes are arranged between the coagulation and/or thermofusion electrode and an outer edge of the jaw part. This arrangement of the sensor electrodes close to the edge has the advantage over an arrangement in an area surrounded by the coagulation and/or thermofusion electrode that they can be spaced far apart in order to be able to carry out an impedance analysis at different tissue depths.
  • the electrosurgical instrument has further sensor electrodes which are arranged on the tissue side outside of the end area. These additional sensor electrodes are also preferably arranged between the coagulation and/or thermofusion electrode and the outer edge of the jaw part. Even if, depending on the preparation task, it is uncertain whether tissue is actually being gripped between these additional sensor electrodes, they can still be used if necessary to subject large amounts of tissue to a complete spatial analysis.
  • an impedance of the tissue is first measured by means of sensor electrodes of only one jaw part and a characteristic tissue impedance is determined from this. This measurement is preferably repeated several times with different pairs of sensor electrodes. Due to the different distances between the different pairs, the electrical current flowing between them penetrates the gripped tissue to different depths in order to be able to determine the characteristic tissue impedance at different tissue depths. A conversion between the measured impedance and the characteristic tissue impedance can be carried out in Depending on the distance between the sensor electrodes used and on the surface of the sensor electrodes.
  • the characteristic tissue impedance is a characterizing quantity for the type of tissue grasped. This can therefore be determined from the characteristic tissue impedance, so that it can be distinguished, for example, whether connective tissue, a blood vessel or a nerve has been gripped.
  • an impedance between the jaw parts is preferably measured by means of sensor electrodes of both jaw parts.
  • An opening angle of the mouth can then be determined from this impedance and the characteristic tissue impedance. According to Ohm's law, the thickness of the tissue gripped and the opening angle of the mouth can be deduced from this.
  • one sensor electrode of each jaw part is used to conduct current and one sensor electrode of each jaw part is used to measure a voltage potential in the tissue gripped. With such a tetrapolar measurement, errors due to the contact resistance between the tissue being gripped and the sensor electrodes can be ruled out.
  • the sensor electrodes of both jaw parts can carry out an electrical impedance tomography of the tissue gripped and to draw conclusions from this about the progress of coagulation and/or thermofusion when treating the tissue using the coagulation and/or thermofusion electrodes.
  • a measuring current is impressed between two adjacent sensor electrodes and the resulting electrical potential is measured between all other pairs of sensor electrodes.
  • Current paths as well as the reciprocal recording field (reciprocal lead field) of the sensor electrodes represent a multiplied sensitivity field. Knowing the sensitivity field of each possible wiring combination of the sensor electrodes in the system, a back-projection matrix can be created, which calculates the distribution of the electrical impedance from superficial voltage measurements. This can lead to electrical inhomogeneities of the gripped tissue to be closed. In this way, a representation of the electrical impedance distribution of the cross section of the tissue gripped along the jaw and in the depth between the two jaw parts can be determined.
  • the electrosurgical instrument is preferably set up to examine grasped tissue using the method.
  • FIG. 1 schematically shows an electrosurgical instrument according to an exemplary embodiment of the invention.
  • FIG. 2 shows an isometric representation of a mouth of an electrosurgical instrument according to an exemplary embodiment of the invention.
  • FIG. 3 shows how tissue is gripped in an exemplary embodiment of the method according to the invention.
  • FIG. 4 shows how tissue is gripped in another exemplary embodiment of the method according to the invention.
  • FIG. 5 shows, in a schematic sectional illustration of a mouth, the determination of a characteristic tissue impedance in an exemplary embodiment of the method according to the invention.
  • FIGS. 6a to 6c schematically show different measurements for determining a characteristic tissue impedance in an exemplary embodiment of the method according to the invention.
  • FIG. 7 shows, in a schematic sectional illustration of a mouth, how an opening angle of the mouth can be determined in an exemplary embodiment of the method according to the invention.
  • FIG. 8 shows an isometric representation of a mouth of an electrosurgical instrument according to another exemplary embodiment of the invention.
  • FIG. 10 An electrosurgical instrument 10 in the form of coagulation and thermofusion forceps is shown in FIG. It has a handle 11 and a shaft 12, at the end of which a mouth 13 is arranged. This has two jaw parts 14, 15 which can be moved towards and away from one another in order to open and close the mouth 13. The angle a between the two jaw parts 14, 15 is the opening angle a of the jaw 13.
  • the electrosurgical instrument 10 is connected to a base unit 17 by means of a line 16.
  • the base unit 17 contains, among other things, a high-frequency generator, by means of which coagulation and thermofusion electrodes in the jaw parts 14, 15 can be supplied with electrical energy.
  • FIG. 1 The mouth of an electrosurgical instrument 10 according to a first exemplary embodiment of the invention is shown in FIG.
  • Each jaw part 14, 15 has a U-shaped coagulation and thermofusion electrode 21 on its tissue side.
  • Six sensor electrodes 30 are arranged between the coagulation and thermofusion electrode 21 and an outer edge 23 of a jaw part 15 in a distal end area 22 in which the coagulation and thermofusion electrode 21 is curved. This arrangement of coagulation and thermofusion electrode 21 and sensor electrodes 30 is provided in the other jaw part 14 in the same way.
  • Tissue 40 can be grasped by jaw 13 during an operation. As shown in FIG. 3, it is possible that only a small amount of tissue is or can be grasped by the ends 22 of the jaw parts 14,15 as shown in FIG. 4, the entire mouth 12 can be filled with tissue 40 . Even if it is uncertain how much tissue 40 is in the mouth 13, part of the tissue 40 is definitely clamped between the sensor electrodes 30 of the two jaw parts 14, 15.
  • its characteristic tissue impedance is first determined. As shown in FIG. 5, only sensor electrodes 31, 32 of one jaw part 14 are used for this purpose, while sensor electrodes 33, 34 of the other jaw part 15 remain inoperative. By a current flow 50 between the two sensor electrodes 31,
  • an impedance of the tissue 40 can be determined.
  • a characteristic tissue impedance is then calculated from the known distance between the sensor electrodes 31, 32 and their known area, and from this the type of tissue 40 gripped is inferred.
  • this measurement can be repeated with several different pairs of sensor electrodes 31, 32.
  • This makes it possible to determine the characteristic tissue impedance at different tissue depths and thus to differentiate between different tissue types. It can thus be recognized, for example, if the tissue 40 gripped consists of connective tissue on the surface, but has a nerve or a blood vessel in the deeper tissue layers.
  • the thickness of the tissue 40 gripped is determined in a further step of the method according to the invention.
  • a current flow 50 is now generated between opposite pairs of sensor electrodes 31, 33 or sensor electrodes 32, 34 of the two jaw parts 14, 15. From the impedance measured in this way and the already known specific tissue impedance, conclusions are drawn about the thickness of the tissue gripped. From this, in turn, the opening angle a of the mouth 13 can be inferred.
  • an electrical impedance tomography of the tissue 40 gripped can be performed. The electrical current can also be guided along the tissue 40 that is gripped.
  • thermofusion To monitor the progress of thermofusion, a second exemplary embodiment of electrosurgical instrument 10, which is shown in FIG are.
  • the impedance measurements are carried out in the base module 17 .
  • coaxial or triaxial cables with a voltage-following shield run in line 16 in order to compensate for parasitic cable capacitances.
  • a multiplexer is arranged in the handle 11, which simplifies the cable structure to the base module 17.

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

Abstract

L'invention concerne un instrument électrochirurgical (10), présentant une pince pourvue de deux mâchoires (14, 15), une électrode de coagulation et/ou de thermofusion (21) se trouvant sur chaque mâchoire (14, 15) appliquée sur un côté de tissu. Plusieurs électrodes détectrices (30) sont respectivement disposées dans une zone terminale distale (22) de chaque mâchoire (14, 15). Dans un procédé d'examen du tissu (40) saisi par l'instrument électrochirurgical, les électrodes détectrices (30) de seulement une mâchoire (15) permettent de mesurer l'impédance du tissu (40) et, sur cette base, de déterminer une impédance de tissu caractéristique.
PCT/EP2021/067298 2020-07-16 2021-06-24 Instrument électrochirurgical et procédé d'examen de tissu saisi au moyen de l'instrument électrochirurgical WO2022012893A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102020208935.3 2020-07-16
DE102020208935.3A DE102020208935A1 (de) 2020-07-16 2020-07-16 Elektrochirurgisches Instrument und Verfahren zur Untersuchung von mittels des elektrochirurgischen Instruments gegriffenem Gewebe

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WO2022012893A1 true WO2022012893A1 (fr) 2022-01-20

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PCT/EP2021/067298 WO2022012893A1 (fr) 2020-07-16 2021-06-24 Instrument électrochirurgical et procédé d'examen de tissu saisi au moyen de l'instrument électrochirurgical

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WO (1) WO2022012893A1 (fr)

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2023235182A1 (fr) * 2022-05-31 2023-12-07 Covidien Lp Dispositif et système de tomographie par impédance électrique

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009010080A1 (fr) 2007-07-16 2009-01-22 Stockert Ruediger Dispositif destiné à la chirurgie thermique
EP3459482A1 (fr) * 2017-09-22 2019-03-27 Covidien LP Dispositif de scellement tissulaire électrochirurgicale à revêtement anti-adhésif
WO2019186500A2 (fr) * 2018-03-30 2019-10-03 Ethicon Llc Méthode de compression de tissu à l'intérieur d'un dispositif d'agrafage et d'affichage simultané de l'emplacement du tissu dans les mâchoires

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011041488A2 (fr) 2009-09-30 2011-04-07 Mayo Foundation For Medical Education And Research Procédés et systèmes d'occlusion et de préhension tissulaire
US8439913B2 (en) 2010-04-29 2013-05-14 Covidien Lp Pressure sensing sealing plate
DE102011001372A1 (de) 2011-03-17 2012-09-20 Aesculap Ag Chirurgisches System zum Verbinden von Körpergewebe und Steuerungsverfahren für ein solches chirurgisches System
US9113904B2 (en) 2012-07-19 2015-08-25 Covidien Lp Surgical instrument with fiber bragg grating
DE102019121375A1 (de) 2019-08-07 2021-02-25 Aesculap Ag Vorrichtung und Verfahren zur Bestimmung eines Abschaltzeitpunktes eines medizinischen Instruments

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009010080A1 (fr) 2007-07-16 2009-01-22 Stockert Ruediger Dispositif destiné à la chirurgie thermique
EP3459482A1 (fr) * 2017-09-22 2019-03-27 Covidien LP Dispositif de scellement tissulaire électrochirurgicale à revêtement anti-adhésif
WO2019186500A2 (fr) * 2018-03-30 2019-10-03 Ethicon Llc Méthode de compression de tissu à l'intérieur d'un dispositif d'agrafage et d'affichage simultané de l'emplacement du tissu dans les mâchoires

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