CN106308923A - 用于最小化神经肌肉刺激的电外科发生器 - Google Patents

用于最小化神经肌肉刺激的电外科发生器 Download PDF

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CN106308923A
CN106308923A CN201610491424.1A CN201610491424A CN106308923A CN 106308923 A CN106308923 A CN 106308923A CN 201610491424 A CN201610491424 A CN 201610491424A CN 106308923 A CN106308923 A CN 106308923A
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electrosurgery
impulse waveform
waveform
phase
electrosurgical generator
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CN106308923B (zh
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J·A·吉尔伯特
D·A·弗里克里克斯
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Nellcor Puritan Bennett LLC
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Abstract

公开了用于最小化神经肌肉刺激的电外科发生器。具体而言，公开了一种用于最小化神经肌肉刺激的***，包括转换器、逆变器和控制器。转换器被配置为输出直流波形并且包括以第一占空比操作的至少一个第一开关元件。逆变器耦合到转换器并且包括以第二占空比操作的至少一个第二开关元件。逆变器被配置为逆变DC波形，以产生电外科脉冲波形。控制器被耦合到转换器和逆变器，并且被配置为控制第一占空比来调整电外科脉冲波形的幅度和控制第二占空比来调整电外科脉冲波形的至少一个属性，以最小化神经肌肉刺激。

Description

用于最小化神经肌肉刺激的电外科发生器
技术领域
本公开内容涉及用于最小化神经肌肉刺激的电外科装置和方法。更具体而言，本公开内容涉及用于调整由电外科发生器产生的电外科波形的频率以最小化神经肌肉刺激的方法和装置。
背景技术
电外科涉及将高射频电流应用到手术部位，以切割、热方式或非热方式烧融、或者凝结组织。在单极电外科中，源或有源电极将射频交流电从电外科发生器输送到目标组织。患者返回电极被放置成远离有源电极，以将电流传导回到发生器。
在双极电外科中，返回电极和有源电极被放置成紧靠彼此，使得在两个电极之间形成电路(例如，在电外科钳子的情况下)。以这种方式，所施加的电流被限制在位于电极之间的身体组织。相应地，双极电外科一般涉及器械的使用，其中期望在位于例如钳子等的器械上的两个电极之间实现电外科能量的聚焦输送。
当产生电外科能量时，频率分量被包括在所产生的电外科波形中。如果大量的电外科能量在大约100千赫兹(kHz)或更小的低频率处出现，则电外科波形会刺激肌肉组织和/或神经。可以通过采用神经肌肉阻断剂(NMBA)来防止肌肉和神经刺激，或者这种刺激可以被用来通过利用神经肌肉刺激剂(NMSA)识别肌肉或神经。但是，使用NMSA或NMBA不是所期望的，因为这些试剂会产生过敏反应和/或会导致患者的肌肉和/或神经的不良或过度麻痹(paralysis)。因此，存在最小化NMSA和NMBA需要的电外科发生器的需求。
发明内容
本公开内容提供了一种电外科装置，其调整电外科能量的频率分量，使得大量的电外科能量在经调整的频率处出现，该频率比会刺激肌肉和神经的频率更高。这允许减少对如上所述可能潜在有害的NMSA和NMBA的需要。
在一种实施例中，用于最小化神经肌肉刺激的***包括转换器、逆变器和控制器。转换器被配置为输出直流波形并且包括以第一占空比操作的至少一个第一开关元件。逆变器被耦合到转换器并且包括以第二占空比操作的至少一个第二开关元件。逆变器被配置为逆转直流波形，以产生电外科脉冲波形。控制器被耦合到转换器和逆变器，并且被配置为控制第一占空比来调整电外科脉冲波形的幅度以及控制第二占空比来调整电外科脉冲波形的至少一个属性。
在一方面，电外科脉冲波形是单相的，以引起神经肌肉刺激，并且所述至少一个属性包括重复频率或脉宽周期中的至少一个。控制器还被配置为将单相电外科脉冲波形的重复频率调整为大于大约100kHz。在另一方面，控制器还被配置为将电外科脉冲波形的脉宽周期调整为小于大约2μs。
在另一方面，电外科脉冲波形是双相的，以减少NMBA的量，并且所述至少一个属性包括重复频率或脉宽周期中的至少一个。控制器还被配置为将双相电外科脉冲波形的重复频率调整为大于大约100kHz。在另一方面，控制器还被配置为调整双相电外科脉冲波形的每个循环的脉宽周期，使得双相电外科脉冲波形的最高振幅峰值出现在频域中从大约500kHz到大约5MHz。
在还有的另一方面，转换器是降压转换器或者逆变器是升压转换器。
在另一实施例中，一种用于控制电外科发生器以最小化神经肌肉刺激的方法，包括以第一占空比操作电外科发生器的转换器的至少一个第一开关元件来输出DC波形、以第二占空比操作电外科发生器的逆变器的至少一个第二开关元件来转换DC波形以产生电外科脉冲波形、以及控制第一占空比来调整电外科脉冲波形的幅度和控制第二占空比来调整电外科脉冲波形的至少一个属性。
在一个方面，电外科脉冲波形是单相的，以引起神经肌肉刺激，并且至少一个属性包括重复频率或脉宽周期中的至少一个。单相电外科脉冲波形的重复频率大于大约100kHz。在另一方面，脉宽周期被调整，使得单相电外科脉冲波形的最高振幅峰值出现在频域中从大约500kHz到大约5MHz。
在另一方面，电外科脉冲波形是双相的，以减少NMBA的量，并且所述至少一个属性包括重复频率或脉宽周期中的至少一个。双相电外科脉冲波形的重复频率大于大约100kHz。在另一方面，双相电外科脉冲波形的每个循环的脉宽周期被调整为小于大约2μs。
在还有的另一方面，控制第一占空比和第二占空比还包括测量组织属性或能量属性中的至少一个以及响应于组织属性或能量属性中的至少一个控制第一占空比和第二占空比。
附图说明
当结合随后的具体实施方式考虑时，本公开内容可以通过参考附图来理解，附图中：
图1是根据本公开内容的实施例的电外科***的透视图；
图2是根据本公开内容的实施例的图1的电外科发生器的正视图；
图3是根据本公开内容的实施例的图2的电外科发生器的示意性框图；
图4是根据本公开内容的实施例的图1的电外科发生器的DC-DC转换器和DC-AC逆变器的示意性框图；
图5A和图5B是根据本公开内容的实施例的、由图1的电外科发生器产生的电外科脉冲波形的图形表示；
图6A和6B是根据本公开内容的实施例的、由图1的电外科发生器产生的电外科脉冲波形的图形表示；及
图7是根据本公开内容的实施例的用于控制图1的电外科发生器的流程图。
具体实施方式
本文以下参考附图描述本公开内容的特定实施例。在以下描述中，众所周知的功能或构造没有被详细描述，以避免用不必要的细节模糊本公开内容。
根据本公开内容的发生器可以执行单极和/或双极电外科手术，包括，但不限于，切割、凝结、烧融和血管密封手术。发生器可以包括用于与各种电外科器械(例如，用于烧融的单极或多极器械(针或导管)、返回电极、双极电外科钳子、脚踏开关等)接口的多个输出。此外，发生器包括配置为产生特别适用于各种电外科模式(例如，切割、混合、凝结、热方式或非热方式烧融、止血分开术、电灼，喷涂等)和手术(例如，单极、双极、血管密封、病灶治疗、去神经等)的射频能量的电子电路***。在实施例中，发生器可以被嵌入、集成或以其它方式耦合到电外科器械，从而提供所有功能集一身的电外科装置。
图1是根据本公开内容的双极和单极电外科***10的一个说明性实施例的组件的透视图。***10可以包括具有用于治疗患者的组织的一个或多个有源电极23的一个或多个单极电外科器械20(例如，电外科切割探针、(一个或多个)烧融电极等)。电外科交流电由发生器200经由连接到发生器200的有源端子230(图3)的供给线24供应到器械20，从而允许器械20切割、凝结、热方式或非热方式烧融和/或以其它方式治疗组织。交流电通过返回电极衬垫26经由在发生器200的返回端子232(图3)处的返回线28返回到发生器200。对于单极操作，***10可以包括在使用时被放置在患者上以通过最大化与患者的整体接触面积来最小化组织损害机会的多个返回电极衬垫26。此外，发生器200和返回电极衬垫26可以被配置用于监视“组织到患者”接触，以确保其间存在足够的接触。
***10也可以包括一个或多个双极电外科器械，例如，具有用于治疗患者的组织的一个或多个电极的双极电外科钳子30。电外科钳子30包括外壳31和放置在轴32的远端处相对的钳口构件33和35。钳口构件33和35分别使一个或多个有源电极34和返回电极36放置在它们之间。有源电极34和返回电极36通过电缆38连接到发生器200，电缆38包括分别耦合到有源端子230和返回端子232的供给线24和返回线28(图3)。电外科钳子30在连接器处耦合到发生器200，连接器具有经由放置在电缆38的末端处的插头到有源端子230和返回端子232(例如，引脚)的连接，其中插头包括来自供给线24和返回线28的触点，如下面更详细描述的。
参考图2，示出了发生器200的正面240。发生器200可以是任何合适的类型(例如，电外科、微波等)并且可以包括多个连接器250-262，以适应各种类型的电外科器械(例如，电外科钳子30等)。
发生器200包括用户界面241，其具有用于向用户提供各种输出信息(例如，强度设置、治疗完成指示器等)的一个或多个显示屏幕或信息面板242、244、246。屏幕242、244、246中的每一个与对应的连接器250-262相关联。发生器200包括合适的输入控件(例如，按钮、激活器、开关、触摸屏等)，以用于控制发生器200。信息面板242、244、246的屏幕还被配置为显示用于电外科器械(例如，电外科钳子30等)的对应菜单的触摸屏。用户然后通过简单地触摸对应的菜单选项调整输入。
屏幕242控制单极输出和连接到连接器250和252的设备。连接器250被配置为耦合到单极电外科器械(例如，电外科器械20)并且连接器252被配置为耦合到脚踏开关(未示出)。脚踏开关提供附加输入(例如，复制发生器200的输入)。屏幕244控制单极和双极输出和连接到连接器256和258的设备。连接器256被配置为耦合到其它单极器械。连接器258被配置为耦合到双极器械(未示出)。
屏幕246控制由可***到连接器260和262中的电外科钳子30执行的双极密封手术。发生器200通过连接器260和262输出适于密封由电外科钳子30抓住的组织的能量。特别地，屏幕246输出允许用户输入用户定义的强度设置的用户界面。用户定义的设置可以是允许用户调整诸如功率、电流、电压、能量等一个或多个能量输送参数或者诸如能量速率限制器、密封持续时间等密封参数的任何设置。用户定义的设置被发送到控制器224，其中设置可以被保存在存储器226中。在实施例中，强度设置可以是数值尺度，例如，从一到十或从一到五。在实施例中，强度设置可以与发生器200的输出曲线相关联。强度设置可以特定于被利用的每个电外科钳子30，使得各种器械向用户提供对应于电外科钳子30的特定强度尺度。
图3示出了配置为输出电外科能量的发生器200的示意性框图。发生器200包括控制器224、电源227和射频(RF)放大器228。电源227可以是连接到AC电源(例如，线电压)的高压DC电源，并且经由引线227a和227b向RF放大器228提供高压DC电力，其中RF放大器228然后将高压DC电力转换为治疗能量(例如，电外科或微波)并且将能量输送到有源端子230。能量经由返回端子232返回到RF放大器228。有源端子230和返回端子232通过隔离变压器229耦合到RF放大器228。RF放大器228被配置为在多种模式下操作，在此期间，发生器200输出具有特定占空比、峰值电压、波峰因数等的对应的波形。可以预想，在其它实施例中，发生器200可以基于其它类型合适的电源拓扑结构。RF放大器228可以是非谐振RF放大器。如本文所使用的，非谐振RF放大器表示在RF逆变器和负载之间没有放置任何调谐组件(即，导体、电容器等)的放大器。
控制器224包括操作上连接到存储器226的处理器225，其中存储器226可以包括临时类型存储器(例如，RAM)和/或非临时类型存储器(例如，闪存介质、盘介质等)。处理器225包括操作上连接到电源227和/或RF放大器228，从而允许处理器225根据开放和/或闭合控制环路方案控制发生器200的输出的输出端口。闭合环路控制方案是反馈控制环路，其中多个传感器测量多种组织和能量属性(例如，组织阻抗、组织温度、输出功率、电流和/或电压等)，并且向控制器224提供反馈。控制器224然后控制分别调整DC和/或电源的电源227和/或RF放大器228。本领域技术人员将理解，处理器225可以利用适于执行本文描述的计算和/或指令集的任何逻辑处理器(例如，控制电路)替代，包括但不限于，现场可编程门阵列、数字信号处理器及其组合。
根据本公开内容的发生器200包括多个传感器280，例如，RF电流传感器280a和RF电压传感器280b。发生器200的各种组件，即，RF放大器228、RF电流传感器280a和电压传感器280b，可以放置在印刷电路板(PCB)上。RF电流传感器280a耦合到有源端子230并且提供由RF放大器228供给的RF电流的测量。RF电压传感器280b耦合到有源端子230和返回端子232并且提供由RF放大器228供给的RF电压的测量。在实施例中，RF电流传感器280a和电压传感器280b可以耦合到将有源和返回端子230和232分别互连到RF放大器228的有源引线228a和返回引线228b。
RF电流传感器280a和电压传感器280b分别向控制器224提供感测到的RF电压和电流信号，其中控制器224然后可以响应于感测到的RF电压和电流信号调整电源227和/或RF放大器228的输出。控制器224也接收来自发生器200的输入控件、器械20和/或电外科钳子30的输入信号。控制器224利用输入信号调整由发生器200输出的功率和/或在其上执行其它控制功能。
参考图4中示出的示意图，发生器200包括DC-DC降压转换器101、DC-AC升压转换器102、电感器103、变压器104和控制器224。在实施例中，DC-AC升压转换器102是RF放大器228a、228b中的每一个的一部分。相应地，为简单起见，本文下面只讨论RF放大器228a、228b中的一个。在示例性实施例中，诸如电源227的DC电压源Vg连接到DC-DC降压转换器101。此外，电感器103在DC-DC降压转换器101和DC-AC升压转换器102之间电耦合。DC-AC升压转换器102的输出将功率发送到变压器104的初级绕组，其穿过变压器104的次级绕组到负载Z(例如，被处理的组织)。
DC-DC降压转换器101包括开关元件101a并且DC-AC升压转换器102包括以H-桥拓扑结构布置的多个开关元件102a-102d。在实施例中，DC-AC升压转换器102可以根据任何合适的拓扑结构来配置，包括但不限于，半桥式、全桥式、推挽式等。合适的开关元件包括电压控制的器件，诸如晶体管、场效应晶体管(FET)、其组合等。在示例性实施例中，控制器224分别与DC-DC降压转换器101和DC-AC升压转换器102两者，具体而言与开关元件101a和102a-102d通信。控制器224被配置为将可以是脉宽调制信号的控制信号输出到开关元件101a和102a-102d，如在由Johnson等人于2013年12月4日提交的、标题为CONSTANT POWERINVERTER WITH CREST FACTOR CONTROL、公开为US 2014/0254221的共同未决申请中进一步详细描述的，该申请的全部内容通过引用被结合于此。特别地，控制器224被配置为控制提供给DC-DC降压转换器101的开关元件101a的控制信号的占空比d1和提供给DC-AC升压转换器102的开关元件102a-102d的控制信号的占空比d2。此外，控制器224被配置为测量发生器200的功率特性，并且至少部分地基于测得的功率特性控制发生器200。测得的功率特性的例子包括通过电感器103的电流和在DC-AC升压转换器102的输出处的电压。在示例性实施例中，控制器224通过基于电感器电流和用于每个循环的非线性载波控制电流的比较产生占空比d1来控制降压变换器101。
在实施例中，发生器200可以产生如在图5A-图6B中所示出的大致方形的电外科脉冲波形。根据本公开内容的非谐振RF放大器228被配置为由于其非谐振拓扑结构产生方波，而不是由RF放大器228中不存在的谐振网络产生的正弦波形。图5A-图6B的电外科脉冲波形根据本公开内容的实施例由发生器200的RF放大器228在不同的重复频率和/或不同的脉宽频率产生。
图5A和图5B两者都示出了具有小于大约20kHz的低重复频率的电外科脉冲波形。特别地，图5A示出了单相电外科脉冲波形520和530，并且图5B示出了双相电外科脉冲波形560a-570b。由于单相电外科脉冲波形520和530包括DC分量，因此单相电外科脉冲波形520和530可以用来刺激肌肉和神经或者充当NMSA来在电外科手术期间识别和定位神经和肌肉，并且双相电外科脉冲波形560a-570b可以用来减少NMSA和NMBA的量。因此，单相电外科脉冲波形可以消除对NMSA的需要。
纵向轴505表示电压的振幅并且横向轴510表示时间。重复时间Tr指示电外科脉冲波形的一个完整循环的重复的持续时间。即，单相电外科脉冲波形520的一个循环包括一个脉冲并且双相电外科脉冲波形的一个循环包括两个脉冲560a和560b，其中一个脉冲(例如，脉冲560a)是向上的，而另一个(例如，脉冲560b)是向下的。重复频率fr是等效于重复时间Tr的频率。脉宽周期Tw指示电外科脉冲波形为开启或保持电压的持续时间，并且脉宽频率fw是等效于脉宽周期Tw的频率。
电外科脉冲波形由发生器200根据控制信号d1和d2产生。控制信号d1控制电外科脉冲波形的幅度。具体而言，控制信号d1控制到转换器101的PWM信号的占空比。因此，如果电外科脉冲波形的幅度低于预期，则控制信号d1增大PWM信号的占空比。相反，如果电外科脉冲波形的幅度高于预期，则控制信号d1减小PWM信号的占空比。
控制信号d2控制PWM控制信号的占空比以及PWM控制信号的其它特性。在实施例中，控制信号d2可以控制开关102a-102d的切换频率和每个开关102a-102d保持其状态的持续时间。切换频率与重复频率fr相关并且持续时间与脉宽周期Tw相关。
如在图5A和图5B中所示，重复频率fr小于大约20kHz并且脉宽周期Tw大于大约5微秒(μs)。与5μs的脉宽周期相关的频率是200kHz。因此，电外科能量在小于大约20kHz的低频率处出现得比在大约200kHz的高频率处更多。
在期望定位或刺激神经和肌肉期间的电外科手术期间，已经采用了NMSA。由于肌肉或神经在低频处被刺激，因此肌肉和神经也可以通过利用其中更多能量出现在低频(例如，低于大约100kHz的频率)处的单相或双相电外科脉冲波形来识别或刺激。以这种方式，单相电外科脉冲波形可以消除对用单独的NMSA来定位神经或刺激肌肉的需要，因为单相电外科脉冲波形具有DC分量，并且双相电外科脉冲波形可以用来减少NMSA和NMBA的量。
图6A和图6B示出了在大于大约100kHz的频率处具有更多能量的电外科脉冲波形，其避免了肌肉和神经刺激；从而减少了对NMBA的需要。图6A示出了单相电外科脉冲波形620并且图6B示出了双相电外科脉冲波形660a-660b。在图6A和6B两者中，重复频率fr大于大约100kHz并且脉宽周期Tw小于大约1μs。脉宽周期是向上和向下脉冲的完全循环的周期。在实施例中，重复频率fr可以从大约100kHz到大约500kHz，并且脉宽周期Tw可以被调整为从大约0.2μs到大约2μs，使得在其能谱中的最高振幅峰值出现在频域中从大约500kHz到大约5MHz。
电外科能量出现在大于大约100kHz的重复频率fr处，并且因此电外科脉冲波形不引起神经和/或肌肉刺激。双相电外科脉冲波形可以充当中断肌肉和神经元之间的通信的中断信号，使得对NMBA的需要被减少。
在实施例中，脉宽周期Tw可以被调整以提供足够的能量来获得期望的治疗效果或用途。此外，转换器101和逆变器102被控制，以在期望的频率提供足够能量的电外科波形。
图7示出了根据本公开内容的实施例的说明用于控制图1的电外科发生器200的方法700的流程图。方法700可以在电外科发生器200的软件和/或硬件中体现。在实施例中，控制器224被配置为根据本公开内容控制电外科发生器200的操作和电外科波形的产生。在还有的实施例中，软件可以包括存储在存储器224中并且可由微处理器225执行的指令。
方法700开始于步骤710，其中以第一占空比操作转换器101的至少一个开关元件来输出DC波形，并且转换器101基于第一占空比产生具有期望幅度的DC功率。在步骤720中，DC波形的振幅被测量，并且在步骤730中，发生器200确定测得的振幅是否在预定的范围之内。
在实施例中，测得的振幅可以是基于电外科操作的模式(例如，分别为恒定电压限制模式、恒定电流限制模式、恒定功率模式)的电流、电压或功率的振幅。在另一种实施例中，电外科操作的模式可以确定预定范围。在还有的实施例中，用于恒定电压限制模式的预定范围可以具有与用于恒定电流限制模式的预定范围不同的幅度。
当在步骤730中确定测得的振幅不在预定范围之内时，用于转换器101的第一占空比在步骤740中被调整。在实施例中，当测得的振幅高于预定范围时，占空比被降低，使得测得的振幅被相应地降低。相反，当测得的振幅低于预定范围时，占空比被升高，使得测得的振幅被相应地增加。
当在步骤730中确定测得的振幅在预定范围之内时，在步骤750中以第二占空比操作逆变器102的至少一个第二开关元件，以将DC波形转换为电外科脉冲波形。电外科脉冲波形的能量在若干个频率处分布，这可以通过重复速率和脉宽频率来控制或调整。在实施例中，控制信号(例如，PWM信号)可以用来调整电外科脉冲波形的重复频率和脉宽频率，以获得如以上关于图5A-6B所描述的期望的波形。
在步骤760中，确定电外科脉冲波形的重复频率是否小于第一阈值。如在图6A和6B中所示，重复频率可以大于大约100kHz，使得电外科脉冲波形可以不刺激肌肉和/或神经。当重复频率小于第一阈值时，PWM信号被调整，使得重复频率高于步骤790的第一阈值。
当确定重复频率高于步骤760中的第一阈值时，还在步骤770确定电外科脉冲波形是否是双相的。
如在步骤770中，在当电外科脉冲波形被确定为是双相的情况下，还如在步骤780中确定脉宽周期是否低于第二阈值。脉宽周期可以指示足够的电外科能量被提供用于操作的电外科模式。具体而言，脉宽周期越低，利用每个电外科脉冲波形输送的电外科能量越低。在实施例中，等效于脉宽周期的频率被调整为大于重复频率，并且同样，等效于第二阈值的频率被编程为大于第一阈值。在实施例中，重复频率可以从大约100kHz到大约500kHz，并且脉宽周期可以被调整，使得在其能谱中的最高振幅峰值出现在频域中从大约500kHz到大约5MHz。
当在步骤780确定脉宽周期大于第二阈值时，PWM信号在步骤790被调整，使得脉宽周期变得小于或等于第二阈值。以这种方式，PWM信号通过执行步骤760-790进行调整，直到重复频率高于第一阈值并且脉宽周期小于第二阈值。
通过增加重复频率和/或减小脉宽周期，电外科波形的占空比被降低。相反，通过减小重复频率和/或增加脉宽周期，电外科波形的占空比被增加。
当在步骤780中确定脉宽周期小于第二阈值时，方法700结束。以这种方式，电外科脉冲波形可以引起肌肉和神经的刺激，以便减少NMSA的量，并且可以通过控制电外科脉冲波形的频率减少NMSA或NMBA的量。
虽然已经在附图中示出和/或在本文描述了本公开内容的几种实施例，但是本公开内容不是要限定于此，因为本公开内容旨在范围上如本领域将允许的一样广泛而且本说明书要照此理解。因此，以上描述不应当认为是限制，而仅仅作为特定实施例的示例。在所附权利要求的范围与精神内，本领域技术人员将可以构想其它的修改。

Claims (17)

1.一种用于最小化神经肌肉刺激的电外科发生器，包括：
转换器，配置为输出DC波形，该转换器包括以第一占空比操作的至少一个第一开关元件；
逆变器，耦合到转换器并且包括以第二占空比操作的至少一个第二开关元件，该逆变器被配置为逆变DC波形，以产生电外科脉冲波形；及
控制器，耦合到转换器和逆变器并且配置为控制第一占空比来调整电外科脉冲波形的幅度和控制第二占空比来调整电外科脉冲波形的至少一个属性。
2.如权利要求1所述的电外科发生器，其中电外科脉冲波形是单相的，以引起神经肌肉刺激，及
其中所述至少一个属性包括重复频率或脉宽周期中的至少一个。
3.如权利要求2所述的电外科发生器，其中控制器被配置为将单相电外科脉冲波形的重复频率调整为大于大约100kHz。
4.如权利要求2所述的电外科发生器，其中控制器被配置为将电外科脉冲波形的脉宽周期调整为小于大约2μs。
5.如权利要求1所述的电外科发生器，其中电外科脉冲波形是双相的，以减少神经肌肉阻断剂的量，及
其中所述至少一个属性包括重复频率或脉宽周期中的至少一个。
6.如权利要求5所述的电外科发生器，其中控制器被配置为将双相电外科脉冲波形的重复频率调整为大于大约100kHz。
7.如权利要求5所述的电外科发生器，其中控制器被配置为调整双相电外科脉冲波形的每个循环的脉宽周期，使得双相电外科脉冲波形的最高振幅峰值出现在频域中从大约500kHz至大约5MHz。
8.如权利要求1所述的电外科发生器，其中转换器是降压转换器。
9.如权利要求1所述的电外科发生器，其中逆变器是升压转换器。
10.一种用于控制电外科发生器以最小化神经肌肉刺激的方法，该方法包括：
以第一占空比操作电外科发生器的转换器的至少一个第一开关元件来输出DC波形；
以第二占空比操作电外科发生器的逆变器的至少一个第二开关元件来转换DC波形，以产生电外科脉冲波形；及
控制第一占空比来调整电外科脉冲波形的幅度和控制第二占空比来调整电外科脉冲波形的至少一个属性。
11.如权利要求10所述的方法，其中电外科脉冲波形是单相的，及
其中所述至少一个属性包括重复频率或脉宽周期中的至少一个。
12.如权利要求11所述的方法，将单相电外科脉冲波形的重复频率调整为大于大约100kHz。
13.如权利要求11所述的方法，调整单相电外科脉冲波形的每个脉冲的脉宽周期，使得单相电外科脉冲波形的最高振幅峰值出现在频域中从大约500kHz到大约5MHz。
14.如权利要求10所述的方法，其中电外科脉冲波形是双相的，及
其中所述至少一个属性包括重复频率或脉宽周期中的至少一个。
15.如权利要求14所述的方法，还包括将双相电外科脉冲波形的重复频率调整为大于大约100kHz。
16.如权利要求14所述的方法，还包括将双相电外科脉冲波形的每个循环的脉宽周期调整为小于大约2μs。
17.如权利要求10所述的方法，其中控制第一占空比和第二占空比还包括：
测量组织属性或能量属性中的至少一个；及
响应于组织属性或能量属性中的至少一个控制第一占空比和第二占空比。
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