JP2001120566A - Galvanosurgery apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To realize the constantly stable incisional and hemostatic effects by carrying the appropriate current output. SOLUTION: An apparatus body 2 comprises a power supply part 12 to convert the AC power inputted from a commercial power supply input part 11 into the power required in the apparatus body 2, an operation circuit 13 to be driven by the internal power from the power supply part 12, a waveform generation part 14 to generate the waveform based on the operation result operated by the operation circuit 13, a power amplification part 15 to generate and amplify the high frequency power based on the waveform generated by the waveform generation part 14 to the power from the power supply part 12 and an A/D converter 17 to A/D convert the voltage, the current or both of the high frequency power detected by a sensor circuit 16 when the high frequency power outputted from the power amplification part 15 is detected, and feed them back to the operation circuit 13.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electrosurgical apparatus, and more particularly to an electrosurgical apparatus having a high-frequency current output control section.

[0002]

2. Description of the Related Art Tumors, mucous membranes,
In many conventional electrosurgical devices which are devices for incising and coagulating polyps or tissues, the output-load characteristics shown by the solid line in FIG. 6 and the principle of the basic output circuit shown in FIG.
The output from the high-frequency power supply 101 is represented by the internal impedance of the output circuit (output circuit internal resistance 103) as indicated by the broken line due to the contact resistance (biological resistance 102) of the tissue or treatment tool to which a high-frequency current is supplied from the high-frequency power supply 101 to the living body. There is a problem that the output actually applied to the tissue is lower than the set output which is originally desired to be output in the tissue, and therefore, the size of the resected tissue, the shape of the treatment tool, the contact area In addition, the output is inappropriate due to the difference in living tissue, and the desired desired effect has not been obtained.

As for the output of a conventional electrosurgical apparatus, for example, in Japanese Patent No. 2557593, output parameters are stored digitally and the output is linearly increased with respect to a set value.

In Japanese Patent Publication No. 2671966, a voltage, a current, a load impedance, a leakage current, a spectrum component, and a crest factor are measured, and each is measured in accordance with a load in a load state (not a no-load state). Controlling parameters.

Further, in Japanese Patent Application Laid-Open No. 8-196543, only the end point of coagulation is predicted and controlled in order to coagulate a tissue purely.

[0006] However, the above-mentioned Japanese Patent No. 2557593.
The above-mentioned problem does not solve the above problem because the output is not controlled in response to a change corresponding to the impedance of the living body.

Further, Japanese Patent Publication No. 267196 mentioned above.
In No. 6, the circuit configuration is large and the cost is high,
In addition, the problem remains because proper output in a low impedance region cannot be controlled.

[0008] Furthermore, the above-mentioned Japanese Patent Application Laid-Open No. 8-196543 is not suitable for dynamic ablation and hemostasis because the output is not controlled in real time with respect to the bioelectric impedance up to that time.

[0009]

On the other hand, when the above-described high-frequency power supply 101 is used, the main control is a change in tissue, a discharge state, and a smoke generation state observed when the tissue is treated with high-frequency energy. The output setting and output time are controlled based on the experience and intuition of the operator while observing various events such as.

However, when a treatment is performed in a narrow lumen such as the inside of the stomach or the deep part of the large intestine using an endoscope, particularly a flexible endoscope, all treatments are performed in a narrow field of view like a monitor image or an endoscope image. It is very difficult to grasp the situation and take appropriate measures.
As a result, the tissue is mechanically cut with the treatment tool regardless of the damage to the deep tissue due to unnecessary output for a long time, the treatment tool sticking to the tissue, or the lack of output. Or the tissue is severely carbonized by excessive output,
There is a problem that the course of the prognosis is affected.

More specifically, for example, when the relationship between the behavior of the bioelectrical impedance and the time when a large tissue is excised is as shown in FIG. 8, the resistance at the start of the incision is 200 Ω or less, and the characteristic indicated by the solid line in FIG. Then, even if the output at the time of the incision is set to 50 W, the actual output at the start of the incision becomes 25 W or less, which is less than half, and the output is insufficient, and a spark discharge necessary for performing the incision is generated. Can not do.

As a result, after the bioimpedance is substantially constant for a long time as shown in FIG. 8, the bioimpedance starts to increase rapidly. A spark discharge occurs from the start of the ascent and incision occurs. Until then, the temperature gradually rises simply due to the Joule heat of living tissue caused by the passage of high-frequency current,
The water in the tissue evaporates, and finally, the tissue resistance at which discharge is possible is achieved, and the set output can be output, and the spark discharge is started.

However, if the time until the start of the spark discharge is long, the tissue cannot be resected, but there is a problem that tissue damage is caused by Joule heat to a deep part of the resected tissue, so that the tissue is greatly damaged.

It is also known that the high frequency voltage required to ablate tissue requires 400 peak-to-peak V or more, and carbonization starts at 600 peak-to-peak V or more. In addition, if the bioimpedance is 600Ω or more, tissue carbonization is likely to occur. Therefore, if the conventional output-bioimpedance characteristic is maintained, the output in a high impedance region may be excessive and carbonization is likely to occur.

The present invention has been made in view of the above circumstances, and it is an object of the present invention to provide an electrosurgical apparatus which can always realize a stable incision and hemostatic action by supplying an appropriate output. .

[0016]

According to a first aspect of the present invention, there is provided an electrosurgical apparatus for applying a high-frequency current to a subject via a treatment tool and performing a therapeutic treatment on the subject. A contact state detecting means for detecting information on a contact state of the treatment tool with respect to the subject; a condition signal output means for outputting detection information detected by the contact state detecting means as a condition signal; and the condition signal output. And control means for storing a control program for controlling the output state of the high-frequency current by judging a condition based on a preset setting condition by receiving the condition signal from the means.

An electrosurgical apparatus according to a second aspect of the present invention is an electrosurgical apparatus for applying a high-frequency current to a subject through a treatment tool to perform a therapeutic treatment on the subject. A contact state detecting means for detecting information on a contact state of the treatment instrument, a condition signal output means for outputting detection information detected by the contact state detecting means as a condition signal, and the condition signal from the condition signal output means. A control program that controls the output state of the high-frequency current by inputting a state signal representing the output of the high-frequency current and determining the conditions of these input signals based on preset setting conditions. And control means.

[0018]

Embodiments of the present invention will be described below with reference to the drawings.

FIGS. 1 to 5 relate to an embodiment of the present invention. FIG. 1 is a block diagram showing the configuration of an electrosurgical apparatus.
FIG. 3 is a block diagram showing the configuration of the apparatus main body of FIG. 1, and FIG.
FIG. 4 is a second flowchart for explaining the operation of the apparatus main body of FIG. 2, and FIG. 5 is a flowchart for explaining a modification of the control of FIG.

As shown in FIG. 1, an electrosurgical apparatus 1 includes an apparatus main body 2, an electric scalpel probe 4 connected to the apparatus main body 2 and treating an affected part in a living body through a treatment tool channel of an endoscope 3. A patient electrode (P plate) 5 for returning a high-frequency current from an electric scalpel probe 4 provided in contact with the patient's living body surface to the apparatus main body 2. 5
Are connected to the apparatus main body 2 by a patient electrode cord 7.

As shown in FIG. 2, the apparatus main body 2 includes a commercial power supply input section 11 for inputting power from a commercial power supply, and an AC power input from the commercial power supply input section 11 for converting power required in the apparatus main body 2 into electric power. A power supply unit 12, an arithmetic circuit 13 driven by internal power from the power supply unit 12, and an arithmetic circuit 1
3, a waveform generator 14 for generating respective waveforms such as incision, mixing, coagulation and the like based on the calculation result, and a high-frequency power based on the waveform generated by the waveform generator 14 with respect to the power from the power supply unit 12. Power amplification unit 1 that generates and amplifies
5, a sensor circuit 16 for detecting the high-frequency power output from the power amplifying unit 15 and outputting the high-frequency power to the electric scalpel probe 4 to feed back to the patient electrode 5;
6, an A / D converter 17 for A / D converting the voltage or current or both values of the high-frequency power detected by the A / D converter 6 and feeding it back to the arithmetic circuit 13. The impedance of the living body is calculated based on the signal, and the power amplifier is controlled so as to output high-frequency power corresponding to each impedance region.

The operation of the embodiment constructed as described above will be described. First, control when the living tissue is in the low impedance region will be described.

The output control is started based on the impedance data calculated by the arithmetic circuit 13 based on the signal generated by the sensor circuit 16, and as shown in FIG. Is determined to be 50 W or less, and if it is 50 W or more, a normal output control is performed in step S2 with a normal setting output.

When the set output at the time of incision is 50 W or less,
In step S3, the impedance Z of the living tissue is 250Ω.
It is determined whether it is more than or equal to 250Ω.
Performs normal output control with normal setting output. If the impedance Z of the living tissue is less than 250Ω, the impedance Z of the living tissue is 200Ω or more and 25Ω in step S4.
It is determined whether the impedance is less than 0Ω and the impedance Z of the living tissue is determined.
Is greater than or equal to 200Ω and less than 250Ω, an output 1.5 times the set output is generated in step S5.

The impedance Z of the living tissue is 20
If it is less than 0Ω, it is determined in step S6 whether the impedance Z of the living tissue is 100Ω or more and less than 200Ω, and the impedance Z of the living tissue is 100Ω or more and 200Ω or less.
If it is less than Ω, it is determined in step S7 whether the set output is less than 40 W. If the set output is less than 40 W, it is 1.5 times the set output in step S8; otherwise, it is 2 times the set output in step S9. .0 output.

If the impedance Z of the living tissue is less than 100Ω, it is determined in step S10 whether the impedance Z of the living tissue is 50Ω or more and less than 100Ω. If the impedance Z of the living tissue is 50Ω or more and less than 100Ω, the process proceeds to step S11. It is determined whether the setting output is less than 40 W, and if the setting output is less than 40 W, step S12 is performed.
3.0 times the setting output, otherwise step S
In step 13, an output that is 2.0 times the set output is generated.

Next, in step S14, it is determined whether or not the impedance Z of the living tissue is less than 50Ω. If the impedance Z of the living tissue is less than 50Ω, a circuit is formed between the distal end of the treatment tool and the metal part of the endoscope. The output is automatically stopped and a warning is issued in step S15 because there is a possibility that the high frequency energy is hardly added to the living tissue.

Next, control when the living tissue is in the high impedance region will be described.

As shown in FIG. 4, based on the bio-impedance data calculated by the arithmetic circuit 13 based on the data input from the sensor circuit 16, it is determined in step S21 whether or not the impedance Z of the living tissue is less than 700Ω.
If it is less than 700Ω, normal output control is performed with a normal set output in step S22.

Next, when the impedance Z of the living tissue is 70
If it is 0 Ω or more, it is determined in step S23 whether the bioimpedance is 700 Ω or more and less than 1000 Ω. In the region where the bioimpedance is 700 Ω or more and less than 1000 Ω, the setting output is set in step S24, for example, 50 W and the bioimpedance is 800 Ω. Output is 5
0 × 0.5 = 25 W, and the output drops as a half slope with respect to the output-bioimpedance characteristic of the conventional electric scalpel.

Further, the impedance Z of the living tissue is 1
If the impedance is not less than 000Ω, it is determined in step S25 whether or not the impedance Z of the living tissue is not less than 1000Ω and less than 1500Ω. In the region where the impedance Z of the living tissue is not less than 700Ω and less than 1000Ω, the setting output in step S26 is, for example, 50W. 50 × 0.3 = 15W and about 1
The output is attenuated with a gradient of / 3 to prevent carbonization,
It is determined whether or not the stop impedance at which the output is stopped is set to 1000Ω in step S27. If the stop impedance is set to 1000Ω, the output is stopped in step S28, and if the stop impedance is not set to 1000Ω. Determines in step S29 whether the impedance Z of the living tissue is 1500Ω or more,
When the output voltage exceeds 00Ω, the output is automatically stopped in step S28.

This eliminates the need for an output stop operation based on the operator's experience. In addition, for an operator who wishes to make the coagulation depth shallower, the operator can select a 1000Ω output stop threshold impedance.

As shown in FIG. 1, the bioimpedance between the electric scalpel probe 4 and the patient electrode 5, which is a treatment tool for binding the tissue to be resected, varies greatly.
The value cannot be specified depending on the patient and the resection site.

Further, in the conventional electrosurgical apparatus, as shown in FIG. 7, since the internal resistance of the output circuit exists in the electrosurgical apparatus, the set output is set according to the output-impedance characteristic shown by the solid line in FIG. , The value actually output fluctuates.

Further, the value of the bioresistance at the start of the treatment varies depending on the size of the resected tissue, and when the scalpel excises or stops bleeding while moving the living tissue as in a surgical operation,
The contact between the scalpel and the living tissue becomes more unstable, and it is almost impossible to specify the bioimpedance.

In the case of an endoscopic procedure, the tissue is tied up by a blunt snare wire and resected, so that the resection speed is slow and stable, so that bioimpedance can be specified relatively stably. When a tissue is ablated, it varies from around 100Ω to around 300Ω, and when a small tissue is ablated, it varies from around 300Ω to around 500Ω.

In the present embodiment, as described above, the output characteristics in the bio-impedance region required for endoscopic treatment are stabilized, and the output is sharply reduced in the high-impedance region. Produces a stable ablation effect when a small tissue is ablated and reduces the time from the start of the ablation to the actual start of spark discharge to reduce damage to the deep tissue by Joule heat, and too much tissue In the region where the impedance is low, the safety is improved by automatically stopping the output.

Further, with a simple circuit configuration (each or a combination of a current sensor, a voltage sensor, and a capacitance sensor in the sensor circuit 16), data corresponding to the impedance of the living tissue is detected, and added to the living body in a low bioimpedance region. Stable incision by optimizing the high-frequency energy that is applied and by smoothly reducing the output in areas with high bioimpedance, to prevent insufficient output due to differences in the size of the resected tissue, types of treatment tools, and tissue , Coagulation performance can be ensured, and excessive output in the high impedance area after the start of ablation is prevented. (In the low bioimpedance area, the actual output is much lower than the set output, so it corresponds to the required minimum output setting. In order to ensure the actual output, if the operator sets a high output, the organization is organized and If the bioresistance increases and the internal resistance of the output circuit becomes equal to the bioresistance value, excessive output may cause unintended results due to tissue carbonization, rapid ablation, etc. Prevention of damage to the deep tissue and prevention of bleeding due to mechanical removal of the living tissue of the operator can be performed, and the removal can be performed with purely high-frequency current.

Also, as shown in FIG. 1, only the current and / or voltage sensors are incorporated, and all the other components are controlled by software. it can.

Note that instead of the control of FIG.
3 has a corresponding waveform-voltage data table in which a waveform and an output voltage correspond to each bioimpedance region, and an actual output in each region is substantially equal to a set output by voltage control in a region of 50Ω or more and less than 250Ω. May be controlled so as to be output.

That is, as shown in FIG.
At 31, it is determined whether or not the impedance Z of the living tissue is equal to or more than 250Ω, and if it is equal to or more than 250Ω, normal output control is performed at step S32 with a normal setting output. If the impedance Z of the living tissue is less than 250Ω, the process proceeds to step S33.
And the impedance Z of the living tissue is 200Ω or more and 250Ω
It is determined whether the impedance Z is less than 2
If it is not less than 00Ω and less than 250Ω, the corresponding waveform-voltage first data table is referred to in step S34, and the corresponding waveform-
The setting output is changed in step S35 based on the voltage first data table.

The impedance Z of the living tissue is 20
If it is less than 0Ω, it is determined in step S36 whether the impedance Z of the living tissue is 100Ω or more and less than 200Ω, and the impedance Z of the living tissue is 100Ω or more and 200Ω or less.
If the value is less than Ω, the setting output is changed in step S35 based on the corresponding waveform-voltage second data table by referring to the corresponding waveform-voltage second data table in step S37.

Further, when the impedance Z of the living tissue is 1
If it is less than 00Ω, it is determined in step S38 whether the impedance Z of the living tissue is 50Ω or more and less than 100Ω, and the impedance Z of the living tissue is 50Ω or more and 100Ω or less.
If the value is less than the reference value, the corresponding waveform-voltage third data table is referred to in step S39, and the setting output is changed in step S35 based on the corresponding waveform-voltage third data table.

Next, in step S40, it is determined whether or not the impedance Z of the living tissue is less than 50Ω. If the impedance Z of the living tissue is less than 50Ω, a circuit is formed between the distal end of the treatment tool and the metal part of the endoscope. There is a possibility that almost no high-frequency energy is applied to the living tissue, and the output is automatically stopped and a warning is issued in step S41. In the control shown in FIG. 5, the same effect as in the present embodiment can be obtained.

[Supplementary note] (Supplementary note 1) A high-frequency power supply unit for generating a high-frequency current,
In an electrosurgical apparatus including a treatment tool that flows the high-frequency current through the living body in contact with a living body and a patient electrode that collects the high-frequency current, the tissue of the living body to be excised corresponds to the contact state of the treatment tool. A sensor circuit for generating an electric signal, an arithmetic circuit for calculating the appropriate high-frequency current in accordance with the signal generated by the sensor circuit, and control for sending an output generation signal to the high-frequency power amplifier in accordance with the operation result of the arithmetic circuit Part, and even if the size and condition of the resected tissue change, a stable hemostasis and incision effect can always be obtained with an appropriate output in an area lower than the predetermined impedance, and higher than the predetermined impedance An electrosurgical apparatus characterized in that unnecessary tissue carbonization and excessive discharge are prevented by forcibly reducing or stopping the output in a region.

(Appendix 2) The electrosurgical apparatus according to appendix 1, wherein the sensor circuit comprises a current sensor.

(Appendix 3) The electrosurgical apparatus according to appendix 1, wherein the sensor circuit comprises a voltage sensor.

(Additional Item 4) The electrosurgical apparatus according to additional item 1, wherein the control unit performs voltage control.

(Additional Item 5) The electrosurgical apparatus according to additional item 1, wherein the control section performs current control.

[0050]

As described above, according to the electrosurgical apparatus of the present invention, there is an effect that a stable incision and hemostatic action can always be realized by supplying an appropriate output.

[Brief description of the drawings]

FIG. 1 is a configuration diagram showing a configuration of an electrosurgical apparatus according to an embodiment of the present invention.

FIG. 2 is a block diagram showing the configuration of the apparatus main body of FIG. 1;

FIG. 3 is a first flowchart for explaining the operation of the apparatus main body of FIG. 2;

FIG. 4 is a second flowchart for explaining the operation of the apparatus main body of FIG. 2;

FIG. 5 is a flowchart illustrating a modification of the control of FIG. 3;

FIG. 6 is an equivalent circuit showing equivalent impedance including bioresistance in the electrosurgical device;

FIG. 7 is a characteristic diagram showing output characteristics of the electrosurgical device with respect to bioresistance.

FIG. 8 is a characteristic diagram showing characteristics of a current supply time to a living body by an electrosurgical apparatus and an additional impedance of the living body.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Electric surgery device 2 ... Device main body 3 ... Endoscope 4 ... Electric scalpel probe 5 ... Patient electrode 6 ... Active electrode code 7 ... Patient electrode code 11 ... Commercial power supply input unit 12 ... Power supply unit 13 ... Operation circuit 14 ... Waveform Generation unit 15 Power amplification unit 16 Sensor circuit 17 A / D converter

Claims (2)

[Claims] 1. An electrosurgical apparatus for applying a high-frequency current to a subject via a treatment tool to perform a therapeutic treatment on the subject, wherein information on a contact state of the treatment tool with the subject is detected. A contact state detecting unit, a condition signal output unit that outputs detection information detected by the contact state detecting unit as a condition signal, and the condition signal is input from the condition signal output unit to a preset setting condition. An electrosurgical apparatus comprising: a control unit configured to store a control program for controlling an output state of the high-frequency current by determining a condition based on the condition. 2. An electrosurgical apparatus that applies a high-frequency current to a subject via a treatment tool and performs a therapeutic treatment on the subject, wherein information on a contact state of the treatment tool with the subject is detected. A contact state detecting means, a condition signal output means for outputting detection information detected by the contact state detecting means as a condition signal, and the condition signal being input from the condition signal output means and an output of the high-frequency current And control means for storing a control program for controlling the output state of the high-frequency current by determining conditions of these input signals based on preset setting conditions. An electrosurgical device, characterized in that: