JPH1094545A - Electric operation apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an electric operation apparatus which enables accurately detecting of treating state of a tissue of a living being as load. SOLUTION: An inspection signal with the frequency thereof different from that for treatment is generated by a frequency oscillator 7 for detection. The inspection signal, which is overlapped on electric energy for treatment by an output synthesization circuit 10, is supplied to an electrode for treatment while changes in the inspection signal are detected by a tissue condition detection circuit 13 to obtain biological information on a tissue of a living being to be treated based on the resulting data.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electrosurgical apparatus for performing treatment such as resection of living tissue or hemostasis using high frequency power.

[0002]

2. Description of the Related Art Generally, an electrosurgical apparatus such as an electric scalpel is used for performing a surgical operation or a medical operation such as incision of a living tissue or a treatment for coagulation and hemostasis. This electrosurgical apparatus includes a high-frequency ablation power supply (hereinafter, ablation power supply)
And a treatment tool connected to the cautery power supply. Here, the treatment tool is provided with a contact portion that comes into contact with the living tissue, and a treatment electrode is attached to the contact portion.

[0003] When the electrosurgical apparatus is used, high-frequency power (electric energy) for treatment is supplied to the treatment electrode in a state where the contact portion of the treatment tool is in contact with the treatment portion, and the living tissue is treated. It has become.

[0004]

In the above-described conventional configuration, the output setting of the high-frequency power output from the power supply for cauterization of the electrosurgical apparatus when performing a procedure such as incision of a living tissue or coagulation and hemostasis is performed. It is determined by the intuition and experience of the surgeon.
In the actual hemostasis operation in the electrosurgery, the degree of hemostasis and the coagulation quality are determined based on the output time and visual observation of the high-frequency power output from the cautery power supply. Therefore, it is difficult to optimally control the high-frequency power output from the ablation power supply, and there is a problem that it is difficult to efficiently perform ablation or coagulation / hemostatic work using the optimum high-frequency power.

[0005] Some electrosurgical devices automatically control the output of high-frequency power. However, the conditions for using electrosurgical devices differ from case to case,
A problem that the output of high-frequency power cannot be controlled with high precision because the degree of cauterization varies due to differences in the living tissue to be treated, variations in the ablation site, electrodes, and contact strength of the electrodes with the tissue. There is.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an electrosurgical apparatus capable of reliably detecting a treatment state of a living tissue as a load.

[0007]

According to the present invention, there is provided a treatment instrument having treatment means for treating a living tissue, and energy supply means for supplying treatment energy to the treatment means,
In the electrosurgical apparatus which performs the treatment of the living tissue by supplying the treatment energy to the treatment means at the time of treatment of the living tissue by the treatment means, a test output for generating a test output for examining the condition of the living tissue. Generating means, test output supply means for supplying a test output outputted from the test output generating means to the treatment means, detecting a change in the test output, and detecting the change in the test tissue based on the detected data. An electrosurgical apparatus comprising: biological information detecting means for obtaining biological information. Then, when performing a treatment such as excision or hemostasis of the living tissue, a test output for the state test of the living tissue different from the treatment energy supplied to the treatment means is generated by the test output generating means, and The change in the test output is detected by the biological information detecting means during the treatment, and the biological information of the living tissue to be treated is obtained based on the detected data.

[0008]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 shows a schematic configuration of an entire system of an electrosurgical apparatus 1 according to the present embodiment. In the electrosurgical apparatus 1 according to the present embodiment,
A high-frequency ablation power supply device (hereinafter, referred to as a power supply for ablation) 2 is provided. A monopolar treatment instrument 3, a patient electrode 4, and a foot switch 5 are connected to the cautery power supply 2, respectively. The treatment tools used in the electrosurgical device 1 of the present embodiment include a monopolar treatment tool 3 and a bipolar treatment tool. It can be used in both monopolar and bipolar cases.

The ablation power supply 2 is provided with a treatment frequency oscillator (energy supply means) 6 and a detection frequency oscillator (test output generation means) 7 as shown in FIG. Here, the treatment frequency oscillator 6 generates a high-frequency output of a frequency of treatment electric energy supplied to the treatment electrode of the monopolar treatment instrument 3, for example, about several hundred KHz. Further, the detection frequency oscillator 7 generates an inspection signal for inspecting the state of a living tissue at a frequency different from the high-frequency output for treatment, for example, a high-frequency output of about several MHz.

The output end of the treatment frequency oscillator 6 is connected to one input end of an output synthesizing circuit (test output supply means) 10 via a preamplifier 8 and a power amplifier 9 in that order. Further, the output end of the detection frequency oscillator 7 is connected to the other input end of the output synthesizing circuit 10 via the amplifier 11. The output end of the output synthesizing circuit 10 is connected to the (+) side output terminal. This output synthesizing circuit 10
Although there are various methods such as synthesis using a transformer, an addition circuit using an amplifier, and simply connecting an output, there is no particular limitation.

A voltage detection circuit 12 is connected to an output terminal of the detection frequency oscillator 7. The detection signal of the voltage detection circuit 12 is input to a tissue state detection circuit (biological information detection means) 13. Various methods are conceivable for the tissue state detection circuit 13, such as a case where only the resistance value is measured or a case where the dielectric constant is measured using phase information. There is no particular limitation in the present embodiment.

A control circuit 14 is connected to the tissue state detecting circuit 13, and a current detecting circuit 16 is connected via a filter 15. This current detection circuit 16 is connected to the (-) side output terminal.

Further, the control circuit 14 includes a power amplifier 9
Are connected, and the display unit 17 is connected. It should be noted that the voltage detection circuit 12 is configured such that when the output voltage is clear by another means (for example, when the output voltage is constant,
When the output voltage is controlled by the instruction of the control circuit, etc.)
Is no longer necessary. The current detection circuit 16
There is no particular limitation on means such as a current sensor and a shunt resistor. The detection unit is not an output terminal on the (-) side,
It may be connected to the (+) side output terminal.

The frequency of the high-frequency output for treatment is 1M
High-power circuits of less than Hz are more cost-effective and technically advantageous than those of higher frequencies. However, if the temperature is too low, the effect on the living body may occur.
A good value is about 00 kHz.

Further, the detection frequency has a β dispersion at several MHz, and at higher frequencies, the impedance of the cell membrane becomes lower. As a result, the information both inside and outside the cell is several M
Hz is included in the impedance information. However, if it is too high, the loss at the time of transmission through a cable increases, and it becomes weak to noise and the circuit becomes complicated. Therefore, about 2 to 20 MHz is preferable.

The filter 15 may be any filter that cuts the treatment frequency and allows the detection frequency to flow. In the case of the frequency relationship of the present embodiment, since the detection frequency is higher, a high-pass filter or a band-pass filter is used.

The control contents of the control circuit 14 of the present embodiment are as follows. In other words, when performing the treatment of coagulation, incision and welding with the treatment energy,
The tissue state detection circuit 13 detects whether or not those treatments have been completed. Thus, not supplying extra energy leads to a stable and safe procedure. For example, the tissue state detection circuit 13 detects whether or not the coagulation has been completed, and performs control such as display of the parameter, display of the completion of the treatment, reduction of the output, or control of the output stop. It is to be noted that it is also possible to perform advanced control such as gradually reducing the output before the treatment is completed and suppressing excessive coagulation.

Next, the operation of the electrosurgical apparatus 1 having the above configuration will be described. When performing a treatment such as excision or hemostasis of a living tissue, a test signal for a state test of the living tissue having a frequency different from the treatment frequency from the treatment frequency oscillator 6 supplied to the treatment electrode of the monopolar treatment device 3. Is generated by the detection frequency oscillator 7.

The inspection signal supplied from the detection frequency oscillator 7 is superimposed on the treatment frequency from the treatment frequency oscillator 6 by the output synthesizing circuit 10 as shown in FIG. Is supplied to the electrode. Further, a change in the test signal is detected by the tissue state detection circuit 13, and biological information of the living tissue to be treated is obtained based on the detected data.

Therefore, the present embodiment having the above configuration has the following effects. That is, an inspection signal of the load tissue state using a signal of a frequency different from the treatment frequency from the treatment frequency oscillator 6 is generated by the detection frequency oscillator 7, and the treatment frequency is different from the detection frequency. By separating the service frequencies, it becomes easier to reduce the amount of noise included in the data than detection at the same frequency.

A high-frequency output for treatment has a frequency suitable for the treatment (for example, a frequency at which high power can be obtained at a relatively low cost), and a high-frequency output for detection has a frequency suitable for the function (for example, impedance of the cell membrane). And the frequency at which the characteristics of the entire living tissue can be sufficiently obtained, or the frequency of a band with a large change when the bioimpedance changes as shown in FIG. 4A can be selected. For example, when the impedance Z of the living body changes as shown in FIG. 4A, the information on the state change of the living tissue can be detected at a frequency in a band where the change in the impedance Z is large.

Note that fs (treatment frequency) in FIG. 4A does not necessarily have to be the frequency at the intersection of the impedance Z before and after the treatment. That is, as shown in FIG. 4A, the frequency may be a frequency at a position where ΔZ is smaller than ΔZ (impedance Z after treatment−impedance Z before treatment) at fp (frequency for detection).

Further, the frequency of the detection high-frequency output as in the modified example shown in FIG. 4 (B) is changed dynamically fp ₁ ~fp _2, by obtaining a frequency characteristic at that time, a more detailed biological state It is also possible to get

Further, by performing output at the same timing, the configuration of the output control circuit 14 becomes easy. In addition, real-time detection of the state of the living tissue can be performed. further,
Since treatment and detection are performed using the same electrode of the monopolar treatment device 3, the state of the living tissue in the treatment area can be reliably detected.

The order of the output synthesizing circuit 10 and the amplifiers according to the present embodiment is merely an example, and a circuit that synthesizes at a low output stage and then amplifies to a high output is sufficiently possible. Furthermore, by incorporating means for detecting the type of the treatment tool connected to the cautery power supply 2 of the present embodiment,
Control with higher precision can be performed.

FIGS. 5A and 5B show the second embodiment of the present invention.
1 shows an embodiment of the present invention. This embodiment differs from the first embodiment in that the terminals for the treatment frequency and the detection frequency are separated on the + side.

That is, in the present embodiment, the positive electrode 22 for the high-frequency output for treatment and the positive electrode 23 for the high-frequency output for detection are arranged in proximity to the insulating member 21 of the treatment tool. The negative electrode 24 is common.

A current detection circuit 25 and a voltage detection circuit 26 are connected to the positive electrode 23 of the high-frequency output for detection. Further, the current detection circuit 25 is connected to the tissue state detection circuit 13 via a filter 27, and the voltage detection circuit 26 is connected to the tissue state detection circuit 1 via a filter 28.
3 is connected.

Therefore, the above configuration has the following effects. That is, since the treatment frequency and the detection frequency are different, separating the detection frequency makes it easier to reduce the amount of noise included in the data as compared with the detection at the same frequency.

For treatment, a frequency suitable for treatment (for example,
It is possible to select a frequency at which high output can be obtained at relatively low cost, and a frequency suitable for the function for detection (for example, a frequency at which the impedance of the cell membrane becomes low and sufficient characteristics of the whole tissue can be obtained). Become. Further, real-time tissue state detection becomes possible.

Further, in this embodiment, since the energy of the treatment frequency does not flow into the current detection circuit 25 in particular, a simple filter can be used, and the current detection circuit 25 is simplified. Can be achieved.

The + side electrode of the treatment instrument to be connected may have a separate terminal for treatment and a detection terminal in the vicinity, as in the present embodiment, corresponding to the separate terminals. , A common + side electrode 29 may be provided as shown in FIG. Therefore, a treatment instrument having a separate treatment electrode and a detection electrode and a treatment instrument having a common treatment electrode can be used.

FIG. 6 shows a third embodiment of the present invention. This embodiment has a configuration in which the treatment circuit and the detection circuit of the second embodiment are completely separated from GND.

Therefore, the above configuration has the following effects. That is, since the treatment frequency and the detection frequency are different, separating the detection frequency makes it easier to reduce the amount of noise included in the data as compared with the detection at the same frequency.

Further, for treatment, a frequency suitable for treatment (for example, a frequency at which high output can be obtained at relatively low cost)
For detection, it is possible to select a frequency suitable for the function (for example, a frequency at which the impedance of the cell membrane becomes low and sufficient characteristics of the whole tissue can be obtained). Further, real-time tissue state detection becomes possible.

Further, in the present embodiment, particularly, since the detection circuit is completely separated from the treatment circuit, the accuracy of detection is improved, and there is very little concern about noise due to the energy of the treatment frequency.

FIG. 7 shows a fourth embodiment of the present invention. In the present embodiment, the treatment frequency f ₁
It is obtained by the configuration in which the tissue condition detected at each frequency of the detection-only frequency f _2.

[0038] That is, the f ₁ filter 33 to the current detection circuit 31 in this embodiment, is provided and f ₂ filters 34, a voltage detecting circuit f ₁ filter 35 to 32 as well, for f ₂ A filter 36 is provided. The two filters ₁ and 33 for f ₁ are connected to a tissue state detecting circuit for f ₁ (biological information detecting means) 38, and the two filters 34 and 36 for f ₂ are connected to a tissue state detecting circuit for f ₂ (biological information). (Detection means) 37.

Therefore, the above configuration has the following effects. That is, since the treatment frequency and the detection frequency are different, separating the detection frequency makes it easier to reduce the amount of noise included in the data as compared with the detection at the same frequency.

Further, for treatment, a frequency suitable for treatment (for example, a frequency at which high output can be obtained relatively inexpensively) is used.
For detection, it is possible to select a frequency suitable for the function (for example, a frequency at which the impedance of the cell membrane becomes low and sufficient characteristics of the whole tissue can be obtained). Further, real-time tissue state detection becomes possible.

Further, in this embodiment, f ₁ and f ₂
Thus, control can be performed in which the detection characteristics at the respective frequencies are viewed in a complex manner. For example, the water content of the extracellular fluid in f _1, to see how the state changes, such as protein denaturation degree and the intracellular fluid in f ₂ also inclusive water content, the confirmation of a state of the state change, such as protein denaturing condition By doing so, the state of the organization can be understood more clearly.

FIGS. 8A and 8B show the fifth embodiment of the present invention.
1 shows an embodiment of the present invention. This embodiment is shown in FIG.
As shown in FIG. 1A, an electrosurgical apparatus 1 according to the first embodiment.
An adapter 41 separate from the cautery power supply 2 is interposed between the cautery power supply 2 and the monopolar treatment tool 3.
1 incorporates the electric circuit shown in FIG.

Here, the electric circuit in the adapter 41 includes an output control unit 42, a frequency oscillator 43 for detection, an output synthesizing circuit 44, a voltage detecting circuit 45, and a current detecting circuit 46.
, A filter 47, a tissue state detection circuit 48, a control circuit 49, and a display unit 50. In this embodiment, the same operation and effect as those of the first embodiment can be obtained.

FIG. 9 shows a sixth embodiment of the present invention. In the present embodiment, the detection frequency is put on the output of the treatment oscillator 61 having the coaxial output. In general, the frequency of the treatment energy of the coaxial output is higher than the microwave band (300 MHz or higher), and a lower frequency that is easy to use for detection is used for detection, but it is not particularly limited. The frequency is also arbitrary.

In this embodiment, the treatment frequency oscillator 61 is used.
Is provided with a coaxial cable 62 having one end connected thereto. A three-way connector 6 is provided in the middle of the coaxial cable 62.
3 are interposed. Further, a coaxial connector 64 is provided at the other end of the coaxial cable 62.

Further, 65 is a frequency oscillator for detection, 66 is an amplifier, 67 is a current detection circuit, 68 is a voltage detection circuit,
9 is a tissue state detection circuit, and 70 is a control circuit. In the present embodiment, a treatment probe (not shown) using a coaxial cable as a transmission cable is connected to the coaxial connector 64 after the frequency synthesis by the three-way connector 63.

Therefore, the present embodiment having the above configuration has the following effects. That is, since the treatment frequency and the detection frequency are different, separating the detection frequency makes it easier to reduce the amount of noise included in the data as compared with the detection at the same frequency.

Further, it is possible to select a frequency suitable for the treatment for the treatment and a frequency suitable for the detection for the detection (for example, a frequency at which the impedance of the cell membrane becomes low and the characteristics of the whole tissue can be sufficiently obtained). It becomes possible. Further, real-time tissue state detection becomes possible.

Further, in the present embodiment, it is possible to use the coaxial cable 62 as the output form for treatment and the feeder output as the output form for detection. In the present embodiment, the three-way connector 63 is used for frequency synthesis. However, the present invention is not particularly limited to this, and another method such as directly processing a cable to perform synthesis may be used.

FIG. 10 shows a seventh embodiment of the present invention. In the present embodiment, when the output A for treatment is intermittent, the output B for detection is output when the output for treatment is off, and the tissue state is detected.

Therefore, the above configuration has the following effects. That is, noise on the detection signal can be reduced. Further, since a natural tissue state to which no treatment energy is applied can be detected, the tissue state is not affected by the magnitude of the treatment energy.

FIG. 11 shows an eighth embodiment of the present invention. In the present embodiment, the tissue state is detected using a waveform obtained by adding the detection frequency B at the peak of the waveform A of the treatment frequency.

Therefore, the above configuration has the following effects. That is, it is possible to see the detection signal when the direction of the electric field applied to the tissue is reversed, to understand the state of polarization and the like, and to perform more sophisticated control.

FIG. 12 shows a ninth embodiment of the present invention. In the present embodiment, the tissue state is detected using a waveform in which the detection frequency B is placed near the time when the output voltage is zero in the waveform A of the treatment frequency.

Therefore, the above configuration has the following effects. That is, it is possible to perform detection that is hardly affected by the treatment energy (or the treatment electric field). further,
This is a detection during the output of the treatment energy. Even when the treatment energy is an intermittent output, it is possible to detect that the output is on.

FIGS. 13A and 13B and FIG.
Shows a tenth embodiment of the present invention. In this embodiment, a high-frequency knife 81 having an output circuit that outputs a constant current is provided with a function of reducing the output current I ₀ when the load impedance Z exceeds the upper limit Z _H or the lower limit Z _L as shown in FIG. It is a thing.

The high-frequency knife 81 of this embodiment is provided with a high-frequency oscillator 82 and a treatment tool 83. FIG. 13B shows a constant current control circuit 84 of the high-frequency knife 81 of the present embodiment, in which a resistor 85 is used as a current detector.

Therefore, the above configuration has the following effects. That is, a stable output with a constant current output can be generated only when the living body is cut or coagulated. In this case, stable output characteristics can be realized without using a complicated circuit such as impedance detection. Therefore, there is an effect of being less susceptible to the resection target, protecting the circuit at the time of electrode short-circuit, and preventing carbonization of the living body.

FIG. 15 shows an eleventh embodiment of the present invention. This embodiment uses a coil 91 instead of the resistor 85 as a current detector of the constant current control circuit 84 of the device according to the tenth embodiment. This coil 91 is connected to a constant current control circuit 84 via an LPF (low pass filter) 92. The gain is controlled to make the current constant. In the present embodiment, effects similar to those of the fourteenth embodiment can be obtained.

FIGS. 16 and 17 (A) and (B)
Shows a twelfth embodiment of the present invention. In the present embodiment, as shown in FIG. 16, a plurality of oscillation frequency sources are provided in the electrosurgical device 101, and each frequency component is set to Mi.
xing function is provided.

That is, the electric scalpel device 1 of the present embodiment
01, an adjustment knob 102 for the frequency component f ₁ of the _first oscillation frequency source, an adjustment knob 103 for the frequency component f ₂ of the second oscillation frequency source, a component display 104 for f ₁ , and f ₂
Is provided.

Further, the electric scalpel device 101 of the present embodiment
The Mixing circuit disposed therein is formed by an addition circuit 106 shown in FIG. Then, an adjustment knob 102 of f ₁ of the electric knife device 101, by adjusting the adjustment knob 103 of f _2, FIG. 17
The treatment waveform by the addition circuit 106 shown in FIG.

Therefore, with the above-described configuration, it is possible to finely adjust the waveform according to the user's request and to obtain various treatment waveforms with easy operability. Thereby, the sharpness of the electric knife device 101 can be finely adjusted.

The addition circuit 106 constituting the mixing circuit provided in the electric scalpel device 101 is the same as that shown in FIG.
In this case, the same effect as the addition circuit 106 of the twelfth embodiment can be obtained.

FIGS. 19A and 19B show a thirteenth embodiment of the present invention. In the present embodiment, a mixing circuit provided in an electrosurgical apparatus 101 according to the twelfth embodiment is configured by a multiplication circuit (AM modulation) 111. Note that FIG.
It is a characteristic view showing the frequency adjustment waveform of (A). In the case of this embodiment, the same effect as that of the addition circuit 106 of the twelfth embodiment can be obtained.

FIGS. 19C and 19D show a fourteenth embodiment of the present invention. In the present embodiment, the mixing circuit provided in the electric scalpel device 101 of the twelfth embodiment is constituted by the FM modulation circuit 112. FIG. 19D is a characteristic diagram showing the frequency adjustment waveform of FIG. 19C. In the case of this embodiment, the same effect as that of the addition circuit 106 of the twelfth embodiment can be obtained.

FIGS. 20A to 21E show a fifteenth embodiment of the present invention. This embodiment has a function of dynamically changing the frequency characteristic of a signal source when obtaining impedance Z information of a living tissue during output of the bipolar electrosurgical device shown in FIG. It is configured.

That is, the ablation power supply 121 of the electrocautery device of the present embodiment includes an oscillation source 122 for generating a high-frequency output, a pulse width generation circuit 123, a switching amplifier 124, a variable power supply 125, and a control circuit. 126,
A setting section 127 and an output transformer 128 are provided, and a voltage detection circuit 129 and a current detection circuit 13 are provided.
0 is provided. In this embodiment, a function of freely changing the high-frequency output waveform by the electric circuit is provided.

In general, even if the power value of the electric scalpel output is the same, the action on the living tissue differs due to the difference in the high-frequency output waveform. Furthermore, the detection results for obtaining information on the impedance Z when the living tissue is loaded are different. For example, FIG.
The first output waveform shown in FIG. 20 (B) and the second output waveform shown in FIG. 20 (C) have different effects on living tissue even if the output waveforms have the same area. In this case, the frequency component (spectrum) of the first output waveform shown in FIG. 20B has more harmonic components and is closer to an impulse. And FIG.
The first output waveform indicated by 0 (B) has a higher voltage peak value and is easier to discharge.

The output characteristics (output impedance) also change due to the difference in the high-frequency output waveform, and the incision and coagulation ability also change. More specifically, in the first output waveform shown in FIG.
In the second output waveform shown in (C), the cutting action becomes strong.

In the electrocautery device according to the present embodiment, as shown in FIG. 21B, the voltage and frequency are dynamically changed while the power value of the electrocautery output to the living tissue is set to a constant power. The output is controlled by the change of the output impedance Z at that time. For example, when the voltage and frequency characteristics are dynamically (easily structurally) changed with the same power (without changing the ablation energy), FIG.
The first output waveform shown in (B) and the second output waveform shown in FIG.
Is controlled so as to alternately or continuously change the output waveform. Note that FIG. 21A shows the first
FIG. 14 is a characteristic diagram showing a change state of an output waveform according to the fifth embodiment.
(B) is an output characteristic diagram, (C) is an R component current characteristic diagram,
(D) is a C component current characteristic diagram, and (E) is a characteristic diagram showing a change state of the C component current. Therefore, the above configuration has an effect that the electrical characteristics of the treatment section can be more accurately obtained.

FIGS. 22A and 22B and FIG.
(A) shows a sixteenth embodiment of the present invention. In the present embodiment, the treatment is performed with the electric scalpel energy while monitoring the state of the treatment site by ultrasonic vibration or ultrasonic acoustic impedance.
As shown in FIG. 22A, an electrosurgical device 141 of this embodiment is a surgical device used for an operation under an endoscope, and is in contact with a treatment tool 143 capable of gripping tissue and a treatment site. And an ablation power source 142, which is a controllable electric scalpel energy supply unit shown in FIG.

Here, the ablation power source 142 is provided with an ultrasonic oscillation circuit (test output generating means) 149, a high-frequency output circuit (energy supply means) 150, and a control unit 151. In addition, as shown in FIG. 22B, the treatment instrument 143 is provided with two bipolar electrodes 147 and 146 at the treatment section 145 at the distal end, and one of the ultrasonic transducers (test output supply means) 148 on one of the electrodes. A piezoelectric element is mounted.

At the time of treatment, before the electric scalpel energy is output, mechanical / acoustic impedance is detected by ultrasonic waves to check the hardness of the living tissue to be treated. continue,
The electric scalpel energy is supplied while monitoring or in a time sharing manner. Thereafter, when the impedance reaches the predetermined value, the electric knife energy is stopped or changed.

In a surgical operation (open), an operator judges a procedure by using a tactile sensation with a fingertip as information.
In endoscopic surgery, the operator cannot directly get the tactile sensation,
Assist that part.

Therefore, in the above-mentioned configuration, the state including the inside of the living tissue can be monitored and the treatment can be performed (prevention of overheating or underburning can be prevented). Further, since the ultrasonic vibration is applied at the same time, there is no sticking of the living tissue. In addition, the vibration and electric scalpel enable uniform and reliable welding (blood vessels and the like). Therefore, it is possible to control the treatment while checking the state of the treatment section.

Further, the ultrasonic vibrator 148 is connected to the treatment instrument 14.
3, the condition of the living tissue can be directly measured, and the treatment tool 14
3 can be any length.

FIG. 23 shows the structure of the sixteenth embodiment.
Modifications may be made as in the first modification shown in FIG. 24B or the second modification shown in FIG.
The same effects as in the sixth embodiment can be obtained.

Further, by providing the ultrasonic vibrator 162 as a Langevin type strong type in the handpiece portion 161 as in a third modification shown in FIG. 24B, a bipolar treatment tool capable of ultrasonic treatment is also provided. become. Further, FIG.
In (B), 163 is a vibration transmitting member of the ultrasonic vibrator 162, 164 is an operation handle for moving the holding member 165 at the tip end of the handpiece 161 in the axial direction, 16
6 is an ultrasonic oscillation circuit, and 167 is a high frequency output circuit.

FIG. 25 shows a seventeenth embodiment of the present invention. Electrosurgical device 17 of the present embodiment
1 includes a cautery power supply 172 and a hook-type treatment instrument 173.
And a return electrode plate 174. Here, the ablation power source 172 has an ultrasonic oscillation circuit (inspection output generating means) 1
75 and a high-frequency output circuit (energy supply means) 176
And a control unit 177 are provided.

The treatment instrument 173 is provided with an elongated treatment instrument main body 178. Two electrodes 179 and 180 are provided at the distal end of the treatment instrument main body 178. Here, a hook portion 181 for hooking a living tissue is formed on the first electrode 179 on the distal end side. Further, a first electrode 179 and a second electrode 180 behind the first electrode 179 are provided.
An ultrasonic vibrator (biological information detecting means) 182 for obtaining biological information of a living tissue to be treated is interposed therebetween.

Next, the operation of the above configuration will be described.
When the electrosurgical apparatus 171 of the present embodiment is used, the living tissue is cauterized by a high-frequency output while the living tissue is hooked by the hook 181 of the first electrode 179 of the treatment instrument main body 178. During this treatment, the ultrasonic oscillation circuit 175 is driven, and the ultrasonic vibration for detection output from the ultrasonic transducer 182 between the first electrode 179 and the second electrode 180 is applied to the living tissue. At this time, an ultrasonic signal reflected from the living tissue is detected by the ultrasonic transducer 182. Then, the biological information of the living tissue is obtained by the change of the ultrasonic signal detected by the ultrasonic transducer 182, and the driving of the high-frequency output circuit 176 is controlled based on the biological information to control the high-frequency output.

Therefore, in the above configuration, the first
The ultrasonic vibrator 18 is provided between the electrode 179 and the second electrode 180.
During the cauterization treatment of the living tissue by the high-frequency output,
Since the living body information of the living tissue to be treated is obtained based on the data detected by the ultrasonic transducer 182, the treatment state of the living tissue to be loaded can be reliably detected.

The present invention is not limited to the above embodiment. For example, the first to fifth embodiments and the seventh to fifteenth embodiments can be used not only for a monopolar treatment tool but also for a bipolar treatment tool. Further, it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Appendix 1) At least one or more frequencies are used as signals (test output) for detecting biological information (load tissue state) of living tissue, and at least one of the frequencies is energy for treatment. A high-frequency energy treatment device, wherein the frequency is different from the frequency output as the frequency.

(Prior Art in Additional Item 1)
Even those that have the function of detecting the tissue state, the method of detecting and seeing the voltage and current values for treatment,
It becomes necessary to process very dirty signals, which makes it difficult to perform reliable detection. In addition, an appropriate frequency is actually different between the treatment frequency and the detection frequency, but the conventional frequency is not considered from such a viewpoint.

(Purpose of Additional Item 1) Provided is a high-frequency energy treatment apparatus capable of reliably detecting a load tissue state. (Additional Item 2) A high-frequency scalpel characterized in that the output circuit is a constant current output, wherein the output current is reduced when the load impedance exceeds an upper limit or a lower limit.

(Purpose of Additional Item 2) (1) It is hard to be affected by the resection target, (2) Circuit protection at the time of electrode short-circuit,
(3) Prevention of carbonization of living body. (Additional Item 3) An electric scalpel having a plurality of oscillation frequency sources and having a function of mixing components of each frequency.

(Additional Item 4) The electric scalpel according to additional item 3, wherein the mixing circuit is an addition circuit. (Additional Item 5) The electric scalpel according to Additional Item 3, wherein the mixing circuit is a multiplication circuit. (Additional Item 6) The electric scalpel according to Additional Item 3, wherein the mixing circuit is an FM modulation circuit.

(Conventional Techniques of Supplementary Items 3 to 6) Conventionally, predetermined waveforms are preset, and it has been difficult to finely adjust waveforms as desired by the user.

(Purposes of Additional Items 3 to 6) (1) Various treatment waveforms are obtained (2) Easy operability. (Additional Item 7) A bipolar electric scalpel, which includes an oscillation source,
The amplifier, a power supply device that supplies power to the amplifier, and a detection circuit for obtaining impedance information when the tissue is used as a load, dynamically changing the voltage and frequency while maintaining the power of the tissue as constant power, A bipolar electric scalpel whose output is controlled by a change in Z at that time.

(Prior Art of Supplementary Note 7) Conventionally, there has been known a technique of detecting Z in applying electric scalpel energy and controlling the output, but the signal source at that time is a single signal. there were. In this case, only the characteristics (static characteristics) at the frequency or the voltage are known.

(Purpose of Additional Item 7) The electrical characteristics of the treatment section can be obtained more accurately. (Supplementary Item 8) A surgical apparatus used for endoscopic surgery, which includes a treatment tool capable of grasping tissue, an ultrasonic vibrator provided to be in contact with a treatment part, and a part grasping a treatment part. A surgical device comprising a controllable electric scalpel energy supply means for treating.

(Prior Art in Appendix 8) A bipolar electric scalpel that controls the electric scalpel energy while monitoring the electric impedance of the treatment section has been considered. I do not know the difference from its internal state.

(Purpose of Supplementary Item 8) To control the treatment while checking the condition of the treatment section. (Supplementary Item 9) An electrosurgical apparatus that includes a treatment tool having a treatment electrode attached to a contact portion that contacts a living tissue, supplies treatment electric energy to the treatment electrode, and performs treatment on the living tissue. In, a test signal generating means for generating a test signal for the state test of the living tissue having a frequency different from the frequency of the treatment electric energy supplied to the treatment electrode, and detecting a change in the test signal, An electrosurgical apparatus comprising: biological information detecting means for obtaining biological information of the living tissue to be treated based on the detection data.

[0095]

According to the present invention, an inspection output for inspecting the condition of the living tissue is generated by the inspection output generating means, and the inspection output is supplied to the treatment means of the treatment instrument to generate the inspection output during the treatment of the living tissue. Since the change is detected and the living body information of the living tissue to be treated is obtained by the living body information detecting means based on the detected data, the treatment state of the living tissue to be loaded can be reliably detected.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of an entire system of an electrosurgical apparatus according to a first embodiment of the present invention.

FIG. 2 is a schematic configuration diagram of a main part of the first embodiment.

FIG. 3 is a characteristic diagram showing a state in which a detection output wave is superimposed on a treatment output wave according to the first embodiment.

FIG. 4A is a characteristic diagram showing a change characteristic of a biological impedance Z according to the first embodiment, and FIG. 4B is a diagram showing a change characteristic of a biological impedance Z according to a modification of the first embodiment; Characteristic diagram.

FIG. 5A is a schematic configuration diagram of a main part of an electrosurgical apparatus according to a second embodiment of the present invention, and FIG. 5B is a schematic configuration diagram of a main part showing a modification of the second embodiment; .

FIG. 6 is a schematic configuration diagram of a main part of an electrosurgical apparatus according to a third embodiment of the present invention.

FIG. 7 is a schematic configuration diagram of a main part of an electrosurgical apparatus according to a fourth embodiment of the present invention.

FIG. 8 shows a fifth embodiment of the present invention.
(A) is a perspective view showing a connection state of an adapter of the electrosurgical device, and (B) is a schematic configuration diagram showing an electric circuit in the adapter.

FIG. 9 is a schematic configuration diagram of a main part of an electrosurgical apparatus according to a sixth embodiment of the present invention.

FIG. 10 is a schematic configuration diagram of a main part according to a seventh embodiment of the present invention.

FIG. 11 is a schematic configuration diagram of a main part according to an eighth embodiment of the present invention.

FIG. 12 is a schematic configuration diagram of a main part according to a ninth embodiment of the present invention.

FIG. 13A is a schematic configuration diagram of an electrosurgical apparatus according to a tenth embodiment of the present invention, and FIG. 13B is a schematic configuration of a main part showing a constant current output circuit according to the tenth embodiment; FIG.

FIG. 14 is a characteristic diagram for explaining a control function according to the tenth embodiment.

FIG. 15 is a schematic configuration diagram of a main part according to an eleventh embodiment of the present invention.

FIG. 16 is a perspective view of an electric scalpel device according to a twelfth embodiment of the present invention.

FIG. 17A is a schematic configuration diagram of a main part illustrating an addition circuit according to a twelfth embodiment, and FIG. 17B is a characteristic diagram illustrating a frequency adjustment waveform.

FIG. 18 is a schematic configuration diagram of a main part showing a modification of the addition circuit of the twelfth embodiment.

FIG. 19A is a schematic configuration diagram of a main part showing a multiplication circuit of an electrocautery device according to a thirteenth embodiment of the present invention;
(B) is a characteristic diagram showing the frequency adjustment waveform of (A), (C)
FIG. 21 is a schematic configuration diagram of a main part showing an FM modulation circuit of an electrosurgical apparatus according to a fourteenth embodiment of the present invention, and FIG.

FIG. 20 shows a fifteenth embodiment of the present invention, in which (A) is a schematic configuration diagram of a main part of an electrocautery device, and (B).
FIG. 4 is a characteristic diagram showing a first output waveform, and FIG. 4C is a characteristic diagram showing a second output waveform.

21A and 21B are explanatory diagrams for explaining the operation of the fifteenth embodiment, wherein FIG. 21A is a characteristic diagram showing a change state of an output waveform, FIG. 21B is an output characteristic diagram, and FIG. Characteristic diagram,
(D) is a C component current characteristic diagram, and (E) is a characteristic diagram showing a change state of the C component current.

FIG. 22 shows a sixteenth embodiment of the present invention, wherein (A) is a perspective view of an electrosurgical apparatus, and (B) is a side view of a treatment section.

FIG. 23A is a schematic configuration diagram of an electrosurgical apparatus according to a sixteenth embodiment, and FIG. 23B is a schematic configuration diagram of a first modification of the sixteenth embodiment.

FIG. 24A is a schematic configuration diagram of a second modification of the sixteenth embodiment, and FIG. 24B is a schematic configuration diagram of a third modification of the sixteenth embodiment.

FIG. 25 is a schematic configuration diagram showing an electrosurgical apparatus according to a seventeenth embodiment of the present invention.

[Explanation of symbols]

Reference Signs List 3 monopolar treatment tool 6 treatment frequency oscillator (energy supply means) 7 detection frequency oscillator (test output generation means) 10 output synthesis circuit (test output supply means) 13, 48 tissue state detection circuit (biological information detection means) 37f ₂ for tissue state detection circuit (biological information detection means) 38 f ₁ for tissue state detection circuit (biological information detection means) 81 high-frequency knife (treatment instrument) 143,173 treatment instrument 148 ultrasonic transducer (test output supplying means) 149 , 175 Ultrasonic oscillation circuit (test output generation means) 150, 176 High frequency output circuit (energy supply means)

Claims (1)

[Claims] 1. A treatment instrument having a treatment means for treating a living tissue, and an energy supply means for supplying treatment energy to the treatment means, wherein the treatment means treats the living tissue by the treatment means. In an electrosurgical apparatus that supplies the treatment energy to perform treatment on the living tissue, a test output generating unit that generates a test output for a state test of the living tissue, a test output output from the test output generating unit Test output supply means for supplying the test means to the treatment means, and biological information detecting means for detecting a change in the test output and obtaining biological information of the living tissue to be treated based on the detected data. And electrosurgical equipment.