JP2014121341A - Treatment system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment system that can facilitate a technique for incising a tissue.SOLUTION: A treatment system comprises: a high-frequency incision forceps 2; a high-frequency power supply device 30 that is electrically connected to the high-frequency incision forceps 2 and supplies high-frequency current to the high-frequency incision forceps 2: and a return electrode 33 that is electrically connected to the high-frequency power supply device 30, can be attached to a body surface of a living body and receives the high-frequency current supplied to the high-frequency incision forceps 2. The high-frequency incision forceps 2 includes: a first forceps member 6 that has an incision electrode 12; and a second forceps member 13 that has a sensing electrode 17 capable of coming into contact with the incision electrode 12. The high-frequency power supply device 30 includes: a measuring unit 31 that is electrically connected to the sensing electrode 17 and measures impedance between the sensing electrode 17 and the incision electrode 12; and a current control unit 32 that controls the high-frequency current to be supplied to the incision electrode 12, on the basis of the impedance measured by the measuring unit 31.

Description

  The present invention relates to a treatment system for incising living tissue.

2. Description of the Related Art Conventionally, as examples of medical treatment tools for incising a living tissue, a sharp blade such as a scalpel or a scalpel, a treatment system for incising the living tissue by cauterizing, and the like are known.
As an example of a treatment system that can incise and cauterize a living tissue, Patent Document 1 discloses a high-frequency treatment instrument having an electrode for energizing a living tissue with a high-frequency current. According to the high-frequency treatment tool described in Patent Document 1, the tissue can be incised by bringing the electrode into contact with a living tissue and applying a high-frequency current to the tissue.

JP 2004-321660 A

  However, the high-frequency treatment instrument described in Patent Document 1 does not have means for detecting that a living tissue has been incised. For this reason, there is a problem that the user who operates the high-frequency treatment instrument has to visually confirm that the tissue has been incised using, for example, an endoscope or the like, and the procedure becomes complicated.

  The present invention has been made in view of the above-described circumstances, and an object thereof is to provide a treatment system capable of easily performing a procedure for incising a tissue.

In order to solve the above problems, the present invention proposes the following means.
The treatment system of the present invention is a treatment system for incising a living tissue, a high-frequency incision forceps for incising the tissue using high-frequency current, and the high-frequency incision forceps electrically connected to the high-frequency incision forceps. A high-frequency power supply for supplying to the incision forceps, and a counter electrode that is electrically connected to the high-frequency power supply and attachable to the body surface of the living body, and receives the high-frequency current supplied to the high-frequency incision forceps. The high-frequency incision forceps includes a first forceps member having an incision electrode and a second forceps member having a sensing electrode that can contact the incision electrode, and the high-frequency power supply device Are electrically connected to the sensing electrode and measure the impedance between the sensing electrode and the incision electrode, and the measurement unit measures the impedance. A treatment system and having a current control unit for controlling the high frequency current supplied to the incising electrode on the basis of the impedances.

  The measurement unit may repeatedly measure the impedance, and the current control unit may stop outputting the high-frequency current to the incision electrode when the impedance measured in the measurement unit changes.

  The measurement unit repeatedly measures the impedance, and the current control unit cuts the tissue with a high-frequency current that is output to the cutting electrode when the impedance measured by the measurement unit changes. The incision wave may be switched to a coagulation wave for coagulating the tissue.

  The measurement unit repeatedly measures the impedance, and the current control unit coagulates the tissue with a high-frequency current output to the incision electrode when the impedance measured in the measurement unit changes. It is possible to switch from a coagulation wave for cutting to a cutting wave for cutting the tissue.

  The first forceps member includes a ridge extending in the longitudinal direction, a pair of inclined surfaces having a first angle, and a first inclined surface provided on both sides in the width direction of the ridge, and the first A pair of inclined surfaces having a second formed angle greater than an angle formed by the second inclined surfaces provided on both sides in the width direction of the first inclined surface, and the ridge portion has conductivity and It preferably functions as an incision electrode.

  According to the treatment system of the present invention, since the incision state of the tissue can be detected by the measurement unit measuring the impedance between the sensing electrode and the incision electrode, a procedure for incising the tissue is facilitated.

It is a mimetic diagram showing the treatment system of one embodiment of the present invention. It is A arrow directional view of FIG. It is sectional drawing in the BB line of FIG. It is a figure for demonstrating the manufacturing process of the 1st forceps member in the treatment system. It is a block diagram of the treatment system. It is a flowchart for demonstrating the operation | movement at the time of use of the treatment system. It is a figure for demonstrating the operation | movement at the time of use of the treatment system. It is a figure for demonstrating the operation | movement at the time of use of the treatment system. It is a flowchart for demonstrating the operation | movement at the time of use of the treatment system of the modification of the embodiment.

A treatment system 1 according to an embodiment of the present invention will be described. FIG. 1 is a schematic diagram showing a treatment system 1 according to an embodiment of the present invention. FIG. 2 is a view taken in the direction of arrow A in FIG. 3 is a cross-sectional view taken along line BB in FIG.
The treatment system 1 of the present invention is a system for performing a treatment for incising a living tissue. In addition, the treatment system 1 of the present embodiment is inserted into a treatment instrument channel of an endoscope and can be used with an endoscope.

  As shown in FIG. 1, the treatment system 1 includes a high-frequency incision forceps 2 that incises a living tissue using a high-frequency current, a high-frequency power source device 30 that is electrically connected to the high-frequency incision forceps 2, and a high-frequency power source device 30. And a counter electrode plate 33 electrically connected to the monopolar system.

The high-frequency incision forceps 2 includes a long cylindrical insertion portion 3 that can be inserted into a treatment instrument channel of an endoscope, a treatment portion 4 disposed at the distal end of the insertion portion 3, and a proximal end of the insertion portion 3. And an arranged operation unit 20.
As shown in FIGS. 1 and 2, the treatment section 4 includes a pair of forceps members 5 (a first forceps member 6 and a second forceps member 13) that can be opened and closed, and a first forceps member 6 and a second forceps member 13. And a support portion 18 that supports the opening and closing operation.

  As shown in FIG. 3, the first forceps member 6 has a conductive first forceps body 7 and a first insulating coating 8 provided on a part of the outer surface of the first forceps body 7. . The first forceps member 6 includes a ridge 9 extending in the longitudinal direction, a first slope 10 having a first angle θ1 provided on both sides of the ridge 9 in the width direction, and both sides of the first slope 10 in the width direction. And a second slope 11 provided on the surface.

FIG. 4 is a view for explaining a manufacturing process of the first forceps member 6 in the treatment system 1.
As shown in FIGS. 3 and 4, the first insulating coating 8 is removed from a part of the first forceps body 7 (see FIG. 4) in which the ridge portion 9 and the first inclined surface 10 are provided with the first insulating coating 8. (See FIG. 3). As a result, as shown in FIG. 3, the ridge 9 and the first slope 10 are in a state where the conductor is exposed to the outside, and the high-frequency current supplied from the high-frequency power supply device 30 is passed through the living tissue. It functions as the incision electrode 12.
As shown in FIG. 1, the incision electrode 12 is connected to a current control unit 32 of the high-frequency power supply device 30 through a first wiring 23 inserted into the insertion unit 3.
The second slope 11 is a set of slopes having a second angle θ2 that is larger than the first angle θ1. The second inclined surface 11 is configured such that a high-frequency current is not supplied even when it is in contact with the tissue by covering the first forceps body 7 with the first insulating coating 8.

  In the present embodiment, the ridge 9 and the first slope 10 are formed by scraping off the first insulating coating 8 in accordance with the inclination angle of the first slope 10. In the present embodiment, the first forceps member 6 is provided with a ridge portion 9 and a first inclined surface 10 protruding from the second inclined surface 11 toward the second forceps member 13. For this reason, the first insulating coating 8 provided on the second inclined surface 11 is not scraped in the step of scraping off the first insulating coating 8 at the position of the first inclined surface 10.

  As shown in FIGS. 2 and 3, the second forceps member 13 includes a conductive second forceps main body 14 and a second insulating coating 15 provided on a part of the outer surface of the second forceps main body 14. doing. The second forceps member 13 includes a serrated forceps surface 16 directed toward the first forceps member 6 and a sensing electrode 17 provided at the tip of the forceps surface 16.

  The sensing electrode 17 is formed by removing the second insulating coating 15 from a part of the second forceps body 14 provided with the second insulating coating 15. The sensing electrode 17 is an electrode (see FIG. 7) that comes into contact with the tissue when the treatment section 4 is used to cut the tissue. As shown in FIG. 1, the sensing electrode 17 is connected to the measurement unit 31 of the high-frequency power supply device 30 via the second wiring 24 inserted into the insertion unit 3.

As shown in FIGS. 1 and 2, the support portion 18 is a substantially cylindrical member that is connected to the distal end of the insertion portion 3 and has a slit into which the forceps member 5 is inserted. A rotation shaft member 19 that rotatably connects the first forceps member 6 and the second forceps member 13 is fixed to the tip of the support portion 18.
The support portion 18 is provided to be rotatable with respect to the insertion portion 3 around the central axis of the insertion portion 3. For this reason, the first forceps member 6 and the second forceps member 13 connected to the support portion 18 via the rotation shaft member 19 can be rotated around the central axis of the insertion portion 3 together with the support portion 18. .
The first forceps member 6 and the second forceps member 13 connected to the rotation shaft member 19 are opened and closed by rotating around the central axis of the rotation shaft member 19.

  As shown in FIG. 1, the operation unit 20 includes a cylindrical main body 21, a rod-shaped rotation operation body 25 connected to the main body 21 so as to be rotatable about the axis of the main body 21, and a rotation operation body 25. And a slider 29 attached to the rotary operation body 25 so as to be movable back and forth in the longitudinal axis direction.

  Inside the main body 21, an operation wire 22 for opening and closing the forceps member 5, a first wiring 23 for supplying a high-frequency current to the first forceps member 6, and sensing of the second forceps member 13 A second wiring 24 connected to the working electrode 17 is arranged.

In the rotary operation body 25, the operation wire 22, the first wiring 23, and the second wiring 24 are disposed inside, and the operation wire 22, the first wiring 23, and the second wiring 24 are integrated with the main body 21. Can be rotated.
As shown in FIG. 1, the rotary operation body 25 includes a first terminal portion 26 for connecting the first wiring 23 to the current control unit 32 of the high frequency power supply device 30, and a measurement unit 31 of the high frequency power supply device 30. A second terminal portion 27 for connecting the second wiring 24 is provided.
Furthermore, a ring-shaped finger hooking portion 28 is formed at the proximal end of the rotary operation body 25 so that a user who uses the high-frequency incision forceps 2 hooks his / her finger.

  The slider 29 is formed with a recessed outer surface so that a user using the high-frequency incision forceps 2 can place a finger. The proximal end of the operation wire 22 is fixed to the slider 29. When the slider 29 is moved in the longitudinal axis direction of the rotary operation body 25 by the user's operation, the operation wire 22 moves back and forth in the insertion portion 3 in the central axis direction of the operation wire 22.

FIG. 5 is a block diagram of the treatment system 1.
As shown in FIG. 5, the high frequency power supply device 30 is a device for supplying a high frequency current to the high frequency incision forceps 2, and includes a measurement unit 31 electrically connected to the sensing electrode 17, the measurement unit 31, and the incision. A current control unit 32 electrically connected to the electrode 12 and a counter electrode plate 33 connected to the current control unit 32 are included.

  The measurement unit 31 is a circuit that measures the impedance between the sensing electrode 17 and the incision electrode 12 and outputs the magnitude of the impedance to the current control unit 32.

The current control unit 32 is a circuit that controls the high-frequency current supplied to the incision electrode 12 based on the impedance measured by the measurement unit 31. In the current control unit 32, a value slightly larger than the magnitude of the impedance when the forceps member 5 does not sandwich tissue and the forceps member 5 is in a closed state is stored as a set value. The current control unit 32 stops the output of the high-frequency current to the incision electrode 12 when the impedance measured by the measurement unit 31 becomes lower than the set value.
The current control unit 32 is connected to an input device 34 such as a foot switch (not shown). When the user of the treatment system 1 operates the input device 34, the energization state of the high-frequency current can be switched.

  The counter electrode plate 33 is an electrode that can be attached to the body surface of a living body and receives a high-frequency current supplied to the high-frequency incision forceps 2. The high-frequency current supplied to the cutting electrode 12 of the high-frequency cutting forceps 2 flows to the counter electrode plate 33 through the patient's body.

  The operation of the treatment system 1 having the above-described configuration will be described together with the operation when the treatment system 1 is used. FIG. 6 is a flowchart for explaining an operation when the treatment system 1 is used. FIG. 7 and FIG. 8 are diagrams for explaining an operation when the treatment system 1 is used.

  A user using the treatment system 1 inserts the insertion portion 3 of the high-frequency incision forceps 2 into, for example, a treatment instrument channel of an endoscope, and guides the treatment portion 4 to a tissue to be incised. Subsequently, as shown in FIG. 7, a tissue (indicated by reference symbol T in FIG. 7) to be incised is grasped using the forceps member 5 of the treatment section 4. At this time, the position of the forceps member 5 is adjusted and arranged so that the ridge portion 9 of the first forceps member 6 is positioned on the planned line for incision.

Next, the operation of incising the tissue grasped by the forceps member 5 will be described step by step.
Step S1 is a step of waiting for an input of incision start by the user (see FIG. 6).
In step S1, when the user inputs an incision start for starting an incision of tissue by operating the input device 34 such as a foot switch, the process proceeds to step S2. If there is no input of incision start by a foot switch or the like, step S1 is performed again to wait for input to start incision.
This ends step S1.

Step S2 is a step of starting measurement of impedance between the incision electrode 12 and the sensing electrode 17 (see FIG. 6).
In step S <b> 2, based on the input operation performed by the input device 34, the measurement unit 31 starts measuring the impedance between the incision electrode 12 and the sensing electrode 17. Further, the measurement unit 31 starts an operation of outputting the measured impedance magnitude to the current control unit 32. In the measurement unit 31, the impedance between the incision electrode 12 and the sensing electrode 17 is repeatedly measured at a predetermined time interval.
Step S2 is complete | finished now and it progresses to step S3.

Step S3 is a step of starting output of an incision wave for incising the tissue (see FIG. 6).
In step S <b> 3, the current control unit 32 generates a high-frequency current (incision wave) having a predetermined waveform that can incise the tissue and supplies the generated high-frequency current to the incision electrode 12. Thereby, the tissue grasped by the forceps member 5 is incised along the planned line. As the tissue incision progresses, the first forceps member 6 and the second forceps member 13 gradually approach each other. As a result, when the tissue incision progresses, the distance between the incision electrode 12 and the sensing electrode 17 becomes short, and the impedance between the incision electrode 12 and the sensing electrode 17 decreases. Also in step S3, the measurement unit 31 repeatedly measures the impedance between the incision electrode 12 and the sensing electrode 17.
Step S3 is complete | finished now and it progresses to step S4.

Step S4 is a step in which the process branches based on the magnitude of the impedance measured by the measurement unit 31 (see FIG. 6).
In step S <b> 4, the current control unit 32 compares the magnitude of the impedance output from the measurement unit 31 with the set value stored in the current control unit 32. When the magnitude of the impedance output from the measurement unit 31 is greater than or equal to the set value, step S4 is performed again.
As shown in FIG. 8, when the tissue is incised, the incision electrode 12 and the sensing electrode 17 are close to each other without sandwiching the tissue. For this reason, the magnitude | size of the impedance measured in the measurement part 31 (refer FIG. 5) becomes a magnitude | size smaller than a setting value. In the current control unit 32, when the magnitude of the impedance output from the measurement unit 31 is less than the set value, step S4 ends, and the process proceeds to step S5.

Step S5 is a step of stopping the output of the incision wave (see FIG. 6).
In step S <b> 5, the current control unit 32 stops the output of the high frequency current to the incision electrode 12. Thereby, energization of the high-frequency current to the tissue is stopped.
This ends step S5, and the series of steps for incising the tissue ends.

At the time when Step S5 is started, the tissue is incised, and the high frequency current is automatically stopped by the current control unit 32 in Step S5 after the tissue is incised.
The user who uses the treatment system 1 can perform the series of steps S1 to S5 in the same manner for other parts of the tissue as necessary, and cut the tissue.
Thereafter, the high-frequency incision forceps 2 and the endoscope are removed from the patient's body to complete a series of procedures.

As described above, according to the treatment system 1 of the present invention, the incision state of the tissue can be detected by the measurement unit 31 measuring the impedance between the sensing electrode 17 and the incision electrode 12, so that the tissue is incised. The technique to do becomes easy.
Moreover, since the user of the treatment system 1 can save time and labor for determining the tissue incision state, the burden on the user can be reduced.

  For example, when a tissue is incised using an endoscope, the incision site may not be sufficiently visible in the field of view of the endoscope. In such a case, it may be difficult for the user to grasp from the endoscopic image that the incision has been properly completed. In the present embodiment, even when the incision state cannot be sufficiently grasped by the endoscopic image, the supply of the high-frequency current can be stopped when the incision is properly completed. As a result, it is possible to reduce the possibility that the high-frequency current is excessively applied to the tissue or the amount of high-frequency current supplied is insufficient.

  Further, the relationship between the angles formed by the first inclined surface 10 and the second inclined surface 11 (the first formed angle θ1 and the second formed angle θ2) formed on the first forceps member 6 is the first formed angle. θ1 is configured to be smaller than the second angle θ2. For this reason, the contact area between the incision electrode 12 and the tissue can be reduced, and the current can be rapidly incised by increasing the current density of the high-frequency current to be passed through the tissue.

(Modification)
Next, a modified example of the treatment system 1 described in the above embodiment will be described.
The treatment system 1A of the present modification is different in that a current control unit 32A different from the control unit described in the above embodiment is provided in the high frequency power supply device 30 (see FIG. 1).
The current control unit 32A can generate a high-frequency current (coagulation wave) having a predetermined waveform for coagulating the tissue in addition to the incision wave, and can switch between the incision wave and the coagulation wave and output it to the incision electrode 12. it can. The current control unit 32A has a timer circuit that measures the output time of the coagulation wave, and can stop the output of the coagulation wave when the time during which the coagulation wave is output exceeds a specified time. Note that the length of the specified time used in the timer circuit can be appropriately changed.

  The operation of the treatment system 1A of the present modification will be described together with the operation during use of the treatment system 1A. FIG. 9 is a flowchart for explaining an operation at the time of use of the treatment system 1A according to the modification of the embodiment. In addition, the same code | symbol is attached | subjected to the step in which the operation | movement same as the operation | movement demonstrated in the above-mentioned embodiment is performed, and the overlapping description is abbreviate | omitted.

When the treatment system 1A is used, steps S1 to S5 described in the above embodiment are performed.
When step S5 ends, the process proceeds to step S6.

Step S6 is a step of starting output of a coagulation wave for coagulating the vicinity of the incision site in the incised tissue.
In step S <b> 6, the current control unit 32 </ b> A (see FIG. 5) generates a high-frequency current (coagulation wave) having a predetermined waveform for coagulating the tissue and supplies it to the incision electrode 12. Thereby, the cut surface portion of the incised tissue is solidified.
Step S6 is completed now and it progresses to Step S7.

Step S7 is a step of branching the process by measuring the time for outputting the coagulation wave.
In step S7, the coagulation wave output time is measured by the timer circuit of the current control unit 32A, and when the coagulation wave output time is less than the specified time, the current control unit 32A repeats step S7. If the output time of the coagulation wave is equal to or longer than the specified time, step S7 ends and the process proceeds to step S8.

Step S8 is a step of stopping the output of the coagulation wave.
In step S8, the current control unit 32A stops the output of the coagulation wave to the incision electrode 12.
This ends step S8, and a series of steps for incising the tissue and coagulating the incised portion is completed.

Thus, in this modification, the measurement unit 31 repeatedly measures the impedance between the incision electrode 12 and the sensing electrode 17. Then, the current control unit 32A switches from the incision wave to the coagulation wave when the impedance measured by the measurement unit 31 becomes less than the set value.
For this reason, since the tissue incision and the tissue coagulation can be performed automatically and continuously simply by closing the forceps member 5, bleeding from the incised portion of the tissue can be minimized.
Further, even when the incision state cannot be sufficiently grasped by the endoscopic image, the incision portion can be solidified after the incision is properly completed. For this reason, it is not necessary to look for the incision portion while viewing the endoscopic image in order to coagulate the tissue, and the procedure can be rapidly advanced.

As mentioned above, although embodiment of this invention was explained in full detail with reference to drawings, the concrete structure is not restricted to this embodiment, The design change etc. of the range which does not deviate from the summary of this invention are included.
For example, the current control unit 32A described in the above embodiment coagulates the tissue with the high-frequency current output to the incision electrode 12 when the impedance measured by the measurement unit 31 changes beyond a predetermined value. The clotting wave may be switched to an incision wave for incising the tissue. In this case, it is possible to automatically and continuously perform a procedure for incising the tissue after the tissue around the planned incision portion is coagulated in advance. For this reason, an incision can be made without bleeding even when bleeding is assumed in advance when the planned incision portion is incised.
Further, the constituent elements shown in the above-described embodiments and modifications can be combined as appropriate.

DESCRIPTION OF SYMBOLS 1 Treatment system 2 High frequency incision forceps 3 Insertion part 4 Treatment part 5 Forceps member 6 First forceps member 9 Edge part 10 1st slope 11 2nd slope 12 Cutting electrode 13 2nd forceps member 17 Sensing electrode 20 Operation part 30 High frequency power supply Device 31 Measuring unit 32 Current control unit 33 Counter electrode

Claims (5)

A treatment system for incising living tissue,
A high-frequency incision forceps for incising the tissue using a high-frequency current;
A high-frequency power supply device that is electrically connected to the high-frequency incision forceps and supplies the high-frequency current to the high-frequency incision forceps;
A counter electrode that is electrically connected to the high-frequency power supply and attachable to the body surface of the living body, and receives a high-frequency current supplied to the high-frequency incision forceps;
With
The high frequency incision forceps
A first forceps member with an incision electrode;
A second forceps member comprising a sensing electrode capable of contacting the incision electrode;
Have
The high frequency power supply device
A measurement unit that is electrically connected to the sensing electrode and measures impedance between the sensing electrode and the incision electrode;
A current control unit for controlling a high-frequency current supplied to the incision electrode based on the impedance measured in the measurement unit;
A treatment system comprising: The treatment system according to claim 1,
The measurement unit repeatedly measures the impedance,
The treatment system according to claim 1, wherein the current control unit stops the output of the high-frequency current to the incision electrode when the impedance measured in the measurement unit changes. The treatment system according to claim 1,
The measurement unit repeatedly measures the impedance,
The current control unit generates a high-frequency current to be output to the incision electrode when the impedance measured in the measurement unit changes, and a coagulation wave for coagulating the tissue from an incision wave for incising the tissue. A treatment system characterized by switching to The treatment system according to claim 1,
The measurement unit repeatedly measures the impedance,
The current control unit generates a high-frequency current to be output to the incision electrode when the impedance measured in the measurement unit changes, and an incision wave for incising the tissue from a coagulation wave for coagulating the tissue. A treatment system characterized by switching to The treatment system according to any one of claims 1 to 4,
The first forceps member is
A ridge extending in the longitudinal direction;
A set of slopes having a first angle, the first slopes provided on both sides in the width direction of the ridge,
A pair of inclined surfaces having a second formed angle larger than the first formed angle and provided on both sides in the width direction of the first inclined surface;
Have
The treatment system characterized in that the ridge portion has conductivity and functions as the incision electrode.

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