JP3207435B2 - 電気外科エネルギー供給システム - Google Patents

電気外科エネルギー供給システム

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JP3207435B2
JP3207435B2 JP51251297A JP51251297A JP3207435B2 JP 3207435 B2 JP3207435 B2 JP 3207435B2 JP 51251297 A JP51251297 A JP 51251297A JP 51251297 A JP51251297 A JP 51251297A JP 3207435 B2 JP3207435 B2 JP 3207435B2
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tissue
power
electrosurgical
surgical instrument
electrosurgical energy
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JPH10510460A (ja
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バイセ，スティーブン・ポール
ケネディ，ジェニファー・セラフィン
ルキアナウ，スティーブン・ウェイド
ライアン，トーマス・パトリック
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ヴァリーラブ・インコーポレーテッド
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00026—Conductivity or impedance, e.g. of tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00702—Power or energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00779—Power or energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00869—Phase
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00892—Voltage

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Otolaryngology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Making Paper Articles (AREA)
  • Closing Of Containers (AREA)
  • Basic Packing Technique (AREA)
  • Pressure Vessels And Lids Thereof (AREA)

Description

【発明の詳細な説明】 1.発明の分野 本発明は、血管及びその他の血管組織を封鎖するため
の医療用システムに関し、特に、患者の組織に電気外科
用エネルギーと組み合わせて圧力を加えることにより血
管および血管組織の流れを永久的に封鎖するためのシス
テムに関する。
2.発明の背景 管路、静脈、動脈、血管束あるいは血管を結さつ又は
閉塞することは多くの外科処置において非常に一般的に
行われている。大きな組織の場合は典型的には縫合によ
って封鎖される。血管の縫合が困難であったり、時間が
かかりすぎる場合には結さつクリップが用いられること
がある。クリップの配置や完全性は外科医によって注意
深くチェックされる必要がある。ステープルやクリップ
が万が一外れるようなことがあれば、望ましくない出血
を引き起こすこととなるからである。よって外科医はし
ばしば閉鎖を完全なものとするために数個のクリップや
ステープルを用いている。
血管をクリップでとめる装置の中には、クリップの固
定を助けるために電気外科エネルギーを使用するものが
ある。米国特許第5207691号は、クリップを通して組織
に電気外科エネルギーが加えられる電気外科クリップア
プリケーターを開示している。これは、電気外科エネル
ギーによってクリップと隣接する組織とが融合され、こ
の結果クリップがより確かに固定される、というもので
ある。
また、米国特許第5201900号は二つの別々な導電部を
有する双極外科クリップを開示している。この発明で
は、クリップにエネルギーを与えるために双極電気外科
器具が用いられており、クリップの一方の端子がが活性
電極に、もう一方の端子が戻り電極に接続されている。
但し、これら上記のシステムにはいづれも患者の体内
に異物を残す、という欠点が伴う。他にも組織を封鎖す
る方法は開示されているが、信頼性の問題からいづれの
方法も広く受け入れられるには至っていない。例えば、
米国特許第5151102号では双極電気外科エネルギーで作
動する血管の凝固・流出止め装置が開示されている。こ
の装置は血管を把持し、電気外科エネルギーを与えるた
めの鉗子によって操作されるものである。この処置の際
中、血管壁は縮み、組織は固くなる。また、この方法は
直径が約２ミリメーターより大きい組織を封鎖するには
信頼性に欠け、適当ではなかった。
いくつかの刊行物にも電気外科術を用いて小さな血管
を封鎖するための方法が開示されている。“凝固に関す
る研究及び自動コンピューター化双極凝固装置の開発”
（J.Neurosurg,1991年７月、第75巻）と題する論文には
小さな血管を封鎖するために使われる双極凝固装置が記
載されている。この論文によると、直径が２から2.5ミ
リより大きい動脈を安全に凝固することは不可能であっ
た、と記されている。
また、二つ目の論文は“自動制御双極電気凝固法COA
−COP"（Neurosurg.Rev.1984,pp.187〜190）と題するも
ので、この論文には血管壁の焼き焦げを避けるため血管
への電気外科電力供給を止める方法について記載されて
いる。これは電力ゼネレータの負荷のインピーダンスが
局所的最小に至った時点で電気外科電力を止めるもので
あり、この方法を神経外科手術や血管直径が小さい場合
の精密手術などに応用することがこの論文には記載され
ている。
尚、本願と同時に“血管組織封鎖圧力制御とその方
法”（名簿番号PC9200）と題する関連した特許が出願さ
れている。
発明の要約 本システムの重要な効果の一つとして、患者の体内に
いかなる異物をも残さずに患者の大きな血管を効果的に
封鎖することができるという点が挙げられる。本システ
ムによれば、直径10ミリという大きさの血管を封鎖する
ことが可能である。また、本システムのもうひとつの効
果は、外科医が封鎖の完全性を視覚的に点検することが
できる、という点である。
本発明は望ましい結果を達成するために圧力と電気外
科エネルギーを調節しながら印加することとを組みあわ
せて作用する。よって、このシステムは患者の組織を把
持し、適当な量の圧力を患者の組織に印加するための器
具を必要とする。尚ここでいう“圧力”とは器具のエン
ドエフェクタによって血管あるいはその他の組織に加え
られる閉鎖力を指している。また、この器具は組織への
圧力の印加と同時に組織に対して電気外科エネルギーを
導くことができるものでなければならない。
電気外科ゼネレータは電気外科エネルギーを生成する
ために使用される。電気外科エネルギーは自動制御シス
テムを使って特定の方法で印加されることが望ましい。
制御システムは最適な血管封鎖を行うことができる様、
電気外科ゼネレータの出力電流と出力電圧とを調整す
る。
本発明の効果の一つは、タンパク質を融かす目的で組
織に高い電流を加えることにある。高い電流は組織に与
えるその効果上、重要である。同様に、火花の発生や局
所的組織の加熱を減じるために、出力電圧が調節され
る。電圧はRMS値で160ボルトより低くおさえることが望
ましく、好ましい実施例ではRMS値で120ボルトより低く
抑えられている。
電気外科手術による血管封鎖の初期の試みが不成功に
終わった理由の一部として、比較的低い電流が加えられ
たことがあげられる。本発明では組織にRMS値で２アン
ペアを超える最大電流を流すことができる。このレベル
の出力電流は現在入手可能な多くの電気外科ゼネレータ
の設計能力よりも高いものである。
組織の焼け焦げは、適当な時点で組織への電気外科エ
ネルギーの流れを止めることによって防ぐことができ
る。この電気外科エネルギーをいつ止めるかを決定する
にはいくつかの方法がある。その一つは、電気外科ゼネ
レータの出力負荷のインピーダンスを監視することであ
る。インピーダンスが或るレベル、望ましくは1000オー
ムより高い値に達したとき、電気外科エネルギーは止め
られるべきである。
もう一つの方法としては、出力電圧と出力電流とのあ
いだの位相角を監視することがあげられる。外科器具へ
のエネルギー供給は、望ましくは出力電流が出力電圧よ
り約50度より大きな角度分だけ進んだ時に止められるべ
きである。
電気外科エネルギーの供給を止める時点を決定する３
つめの方法としては、出力電流を監視することがあげら
れる。組織が乾燥するにつれ、組織を流れる電流の量は
減少する。よって、出力電流がRMS値で約200ミリアンペ
アよりも低い値に下がった時点でゼネレータは外科器具
へのエネルギー供給をやめればよい。
電気外科エネルギーが実質的に止められてからも短時
間は患者の血管あるいは組織に対する圧力を維持するこ
とが望ましい。こうすることにより、組織が新たに封鎖
された状態で冷却されるからである。尚、組織への圧力
をゆるめるのに適当な時期を外科医に知らせるための可
聴トーン指示器がゼネレータに備わっていることが望ま
しい。外科器具へのエネルギー供給を止めた後の遅延は
最高５秒まであってかまわない。
好ましい実施例では４つの主たるステップで組織封鎖
システムを使用している。まず第１ステップでは組織に
圧力を加え、この圧力を維持する。第２ステップでは電
気外科エネルギーで組織を急速に加熱する。第３ステッ
プでは組織が焼け焦げずに乾燥するよう、組織に供給さ
れるエネルギーを弱める。そして最後の第４ステップで
は組織への電気外科エネルギー供給を止め、まだ圧力が
かかっているうちに組織が冷却されるようにする。
自動制御システムは電気外科ゼネレータの内部に設置
されていることが望ましく、その機能の一つとして自動
的に電気外科エネルギー供給のさまざまなレベルを遷移
する機能を備えている。変形実施例において、外科器具
への電力供給は不連続な、段階的レベルの供給ではな
く、そのかわりに、最初高い電流を流し、次に低いレベ
ルに遷移して組織を乾燥させ、組織のインピーダンスが
約1000オームより高いレベルにまで上昇した時に電力供
給を止める、というように滑らかな機能であって良い。
以下に述べるのは、本発明の様々な実施例の要旨であ
る。電気外科エネルギー供給システムの好ましい実施例
は患者の血管やその他の組織を封鎖するために使用され
る。このシステムは、ゼネレータ、外科用器具、及び組
織に供給される電気外科エネルギーのレベルを制御する
手段とから構成される。
ゼネレータは制御されたレベルの高周波電気外科エネ
ルギーを供給できることが望ましい。ゼネレータの出力
はいづれも好ましい実施例で調節されている出力電流と
出力電圧とを有することを特徴としてよい。本システム
のゼネレータは出力電圧をRMS値で160ボルトより低い値
に抑えることができ、この出力電圧がRMS値で120ボルト
より低く抑えられることが最も望ましい。出力電圧を制
限する理由の一つは、組織の中に局所的に高温のゾーン
をもたらしたり、組織が電極にくっついてしまう結果と
なるような火花やアークの発生を避けるためである。血
管が離断されてしまうことがある、ということもアーク
の発生のもう一つの欠点として挙げられる。
外科用器具は電気外科エネルギーを受け取るためにゼ
ネレータ出力に接続されていることが望ましい。外科用
器具は、鉗子、クランプという形体をとっていてもよい
し、組織を把持するための部材を有する器具であればい
かなる器具でもよい。
双極構造において、外科用器具の一つの部材は活性電
極に電気的に接続され、もう一つの部材が戻り電極に接
続される。かわりに、単極構造であれば、外科用器具を
ゼネレータの一方の電極だけに電気的に接続して、患者
をもう一方の電極に電気的に接続してもよい。部材が組
織を把持している間に、ゼネレータからの電気外科エネ
ルギーは組織を通して回路に流れこむ。
好ましい実施例においては外科用器具に供給される電
気外科エネルギーのレベルを制御するための手段が採用
されている。電気外科エネルギーのレベルは、血管やそ
の他の組織が外科用器具の部材によって把持されながら
封鎖される様に制御される。この電気外科電力のレベル
とはゼネレータのRMS出力を指すことができ、このRMS出
力は出力電圧、出力電流、周波数及びデューテー・サイ
クルの関数であってよい。
外科用器具には電気外科エネルギーの印加と同時に部
材間の血管やその他の組織に圧力を加えるための手段も
備えることができる。この圧力を加えるための手段は、
外科用器具の部材に対して既知のスプリング力を有する
ラッチやインデントの形体をとることができる。外科用
器具から得られる圧力にはいくつか選択できるレベルが
あってもよい。例えば、動脈や血管組織には高いレベル
の圧力を加えることが望ましく、一方、血管には低いレ
ベルの圧力を加えることが望ましい、というようにする
ことができる。
手術中、外科医は外科用器具で血管を把持し、血管に
望ましいレベルの圧力を加えるために器具上のメカニズ
ムを操作することができる。いったん圧力が血管に加え
られたなら、外科医は電気外科エネルギーを活性化して
よい。ゼネレータは指定された出力曲線に従って適切な
量の電気外科エネルギーを加える。
ゼネレータへのフィードバック制御にはいくつかの方
法がある。電力曲線における遷移点は組織の状態に従っ
て起こることとなっているので、フィードバック制御は
重要である。更に、組織に過度のエネルギーを加えてし
まって組織の焼け焦げや固着を引き起こすことは望まし
くなかろう。フィードバック制御の目的でいくつかのパ
ラメーターを監視することができる。これらのパラメー
ターには、組織のインピーダンス、出力電圧と出力電流
の間の位相角、組織を流れる出力電流のレベル、組織の
温度が含まれる。
ゼネレータには、患者の血管やその他の組織が外科用
器具の部材で把持されているときに血管や組織のインピ
ーダンスを少なくとも概算する手段が備わっていること
が望ましい。例えば、組織のインピーダンスを概算する
一つのやり方としては、インピーダンスはほとんど抵抗
性である、と仮定して出力電圧を出力電流で割って概算
する、という方法がある。長い割り算を行う必要がない
ように、インピーダンスを概算するための他の数値的技
法も利用できる。そのような概算数値技法の一例によれ
ば、出力電圧と出力電流とを適当に比較することによ
り、単なる比較とデジタル回路におけるビットシフトの
みによってインピーダンスの範囲が見積もられる。
組織のインピーダンスは組織の乾燥状態を示すインデ
ィケーターである。インピーダンスを見積もる理由の一
つは、血管や組織のインピーダンスが約1000オームより
高い値に上昇したときに電気外科エネルギーを実質的に
止めることができるよう、電気外科エネルギーのレベル
を制御することにある。本発明のある実施例において
は、インピーダンスの見積もり値が2048オームを超えた
時に外科用器具へのエネルギー供給を止めるのが適切で
あるようにすることができる。
電気外科エネルギーのレベルを制御するための好まし
い手段にはいくつかの段階が含まれている。まず第１段
階は、最初のインピーダンス中断点に達するまで血管や
その他の組織への電力供給を急速に増加するための急激
な電力供給機能である。第２段階は、血管や組織のタン
パク質が融けるまで血管や組織へのコンスタントな電力
供給を維持するための一定電力供給機能である。第３段
階は、第２のインピーダンス中断点に達するまで血管や
組織への低い電力供給を維持するための低電力供給機能
である。好ましい実施例においては、上記のある段階か
ら別の段階への遷移は外科医が更になんら入力を行うこ
となく、ゼネレータにおいて自動的に成されるものであ
る。インピーダンスの中断点は、第１の中断点が16オー
ム、第２の中断点が2048オームであることが望ましい。
患者の血管やその他の組織を封鎖する方法は、患者の
血管やその他の組織に圧力を加えるステップと、血管や
その他の組織に組織内のタンパク質を融かすに充分な第
１のレベルの電気外科エネルギーを加えるステップと、
組織を焼き焦がさず乾燥させるに充分な第２のレベルの
電気外科エネルギーを血管やその他の組織に加えるステ
ップと、血管やその組織が冷却されて新しい圧縮された
形となるに充分な時間、電気外科エネルギーを実質的に
減少させるステップと、組織にかかっている圧力をゆる
めるステップとを含む。この組織にかかっている圧力を
ゆるめるステップは、５秒以内の遅延時間のあとに行う
ことができる。更に、この遅延時間の終了後、可聴指示
を行うステップがあってもよい。
この方法における付加的ステップとして、血管やその
他の組織のインピーダンスを概算するステップがあって
もよい。尚、このステップを実行する場合には、血管や
その他の組織のインピーダンスが約1000オームより高い
値に上昇した後に第２レベルの電気外科エネルギーを止
めるための更にもう一つのステップがあってもよい。
図面の簡単な説明 図１は電気外科血管封鎖システムの概略図である。
図２は組織インピーダンスの関数として組織に供給さ
れる電気外科電力を表す電力曲線である。
発明の詳細な説明 図１には電気外科エネルギー供給システム10が示され
ている。システム10は管路、血管、動脈及び血管組織を
含む患者13の血管やその他の組織を封鎖するために使わ
れる。システム10は、電気外科ゼネレータ11、外科用器
具12、及び患者13の血管やその他の組織を効果的に封鎖
するためにゼネレータ11が外科用器具12と協力的に作動
する様、ゼネレータ11の出力を制御するための手段とか
ら構成されている。
電気外科ゼネレータ11は制御されたレベルの電気外科
出力電力を供給できるものでなければならない。出力電
力は出力電流と出力電圧とを調整することにより制御で
きる。外科用器具12は電気外科電力を受け取るためにゼ
ネレータ11と電気的に接続されている。外科用器具12に
は、患者13の血管やその他の組織を把持することのでき
る部材14あるいはエンドエフェクタが備えられている。
部材14は血管に比較的一定のレベルの圧力を加えたり維
持することも可能である。
電気外科ゼネレータ11は外科用器具12に供給される電
気外科電力のレベルを自動的に制御するための手段を有
していなければならない。この手段は、フィードバック
制御システムという形をとることができる。好ましい実
施例では、出力電流及び出力電圧を制限するための回路
も採用される。また、ある実施例では電気外科出力を制
御するためのRF出力段の調節に可調節高圧電源が用いら
れる。
ゼネレータ11の電力出力は電力出力曲線で示され、好
ましい実施例は図２に示されている通りである。電力曲
線は数段階で示すことができる。この段階は不連続な離
散的段階でもよいし、あるいは滑らかな連続関数によっ
て概算することもできる。電力曲線の第１段階では、ゼ
ネレータ11が約16オームよりも低いインピーダンスにお
いてさえ出力電力を供給し、組織中のタンパク質が実質
的に融けるまで高電力レベルを保持している。この第１
段階の間、典型的にRMS値で２アンペアよりも大きい最
大振幅まで出力電流を上げることができる。高い電流が
効果的な血管封鎖にとって重要であることは既に判明し
ている。
第１段階のあと、電気外科電力は血管やその他の組織
を乾燥させるに充分なレベルにまで下げられる。電力を
低くすることにより、組織を開き焦がさずに乾燥させる
ことが可能となる。
最後の段階では組織を冷却させて新しく封鎖された形
体とする。この最終段階の間に組織への電気外科電力の
印加は実質的に止められる。組織が冷却したあと、閉鎖
力はゆるめられる。冷却時間は典型的には５秒以内であ
る。好ましい実施例では可聴トーンが封鎖プロセスの完
了を外科医に知らせる。完了を知った外科医は外科用器
具12から血管を開放させる。
組織中のタンパク質を融かすのは最初の高電流である
と考えられる。その後組織に低い電力を供給することに
よりタンパク質は交差結合する。組織が冷却するにつ
れ、新しく交差結合した組織は血管の永久的な封鎖状態
を形成する。
外科用器具12には部材14間に複数レベルの閉鎖力を選
択的に加えるためのインデックスが含まれていてもよ
い。例えば、動脈の場合には普通の血管より大きな閉鎖
力を必要とする。動脈を封鎖するには1500グラムより大
きな閉鎖力が効果的であることがわかっている。一方、
血管の封鎖には500グラムより小さな閉鎖力が効果的で
ある。
好ましい実施例では、縮むことによって部材14に閉鎖
力をかけるバネが外科用器具12に設置されよう。上記イ
ンデックスは、インデックス上に設けられた逐次止めが
連続的に高い圧縮力をバネに加える仕掛けとなるように
機械的にバネと連結される。尚このバネは部材14が閉鎖
に対する抵抗力にあうまでは縮み始めないものとする。
好ましい実施例では、患者13の血管やその他の組織が
外科用器具12の部材14によって把持されているときに血
管やその他の組織のインピーダンスを概算するための手
段もゼネレータ11に含まれる。インピーダンスの計算に
は長い割り算とその他の長い数学的処理が必要となり得
る。電気外科ゼネレータ11の電力出力を制御する目的を
果たすに充分な、迅速なインピーダンスの概算方法とし
ては様々なものがある。例えば、出力電圧と出力電流を
比べることにより長い割り算を行うことなくインピーダ
ンスの見積もり値を求めることができる。
組織のインピーダンスからは組織の乾燥状態の指標が
得られる。インピーダンスを監視することにより、ゼネ
レータ11は組織を焼き焦がすことなく適当な量の電気エ
ネルギーを提供することができる。例えば、電力制御回
路には、血管やその他の組織のインピーダンスが約1000
オームより高くなった場合に外科用器具12への電力供給
を実質的に止めるための電力遮断機能が備えられてい
る。
図２に示されている電力制御曲線は組織インピーダン
スの関数としてのゼネレータ11の電気外科出力を表して
いる。Ａと記した部分に示されるように、低いインピー
ダンスでは出力電流を急速に増すことにより電気外科電
力が増加される。最初のインピーダンス中断点に達した
あと、電気外科電力の増加は止められる。図２では、最
初のインピーダンスの中断点を点として記している。
好ましい実施例ではこの点は典型的には20オームより低
いものである。
次に、血管やその他の組織のタンパク質が融けるまで
電気外科電力は略一定に保たれる。この一定部分が終わ
るインピーダンスはRMS電力の大きさによって異なる。
よって、最大RMS電力が約125ワットの場合、この一定部
分は約128オームで終わろう。これは図２にＢと記した
部分で示されている。一方、75ワットのようにこれより
低い電力が使われる場合、この一定部分は256オームで
終わろう。これは図２のＣと記した部分に示されてい
る。
次に、出力電力は最大値の半分以下にまで低下され
る。第２のインピーダンス中断点に達したときに、低い
電力供給は止められる。好ましい実施例では第２の中断
点は約2048オームである。
第２の中断点を決定するためにインピーダンスを利用
する代わりに、電流と電圧の間の位相角を用いてもよ
い。この変形例では、約50度より大きな角度の分だけ出
力電流が出力電圧よりも進んだ場合、外科用器具12への
電力供給を実質的に止めるための手段がゼネレータ11に
備えられている。
更に別の変形例では、出力電流がRMS値で約200ミリア
ンペアよりも低い値にまで下がった時に、ゼネレータ11
は外科用器具12への電力供給を止めるであろう。
ゼネレータ11の出力電圧は常にRMS値で160ボルトより
低くおさえておくことが望ましい。出力電圧を低く維持
するのは、組織の封鎖の失敗に至るようなアーク発生
や、アークによる局所的組織熱傷部位の発生を防ぐため
である。
患者13の血管やその他の組織を封鎖する方法は以下の
ステップから成る。まず、血管やその他の組織の内部流
路を実質的に閉鎖するに足る充分な閉鎖力を患者13の血
管やその他の組織に加える。第二に、血管やその他の組
織に第１レベルの電気外科電力を加えるが、ここではピ
ーク出力電流は２アンペアより大きく、ピーク出力電圧
がRMS値で160ボルトより小さい。第３に、第１レベルの
半分よりも小さな第２レベルにまで電気外科電力を落と
す。第４に、患者13の血管やその他の組織を焼き焦がさ
ず乾燥させるに充分な時間だけ、第２レベルの電気外科
電力を血管及びその他の組織に供給する。第５に、血管
やその他の組織が冷却されて新しい圧縮された形となる
に充分な時間だけ、電気外科電力を実質的に下げる。第
６に、組織にかかっている閉鎖力をゆるめる。
電気外科電力を下げる第５ステップは、外科用器具12
への電力を止めるか、あるいは外科用器具12への電力を
非常に低いレベルにまで下げることによって成し遂げら
れる。ある実施例では、組織13ができる限り短時間で冷
却されるよう、電気エネルギーを完全に止めることもあ
ろう。また、それに代わる実施例では、組織が冷却され
て圧縮された形となるまで組織13との閉回路を維持する
ためにゼネレータ11が約１ワットの電力を出力し続ける
こともあろう。
好ましい実施例では、血管とその他の組織を封鎖する
方法に、周期的に血管やその他の組織のインピーダンス
を概算する、というもう一つのステップを加えることが
できよう。このステップにより、ゼネレータ11の制御シ
ステムは組織のインピーダンスに従って出力電力を調節
することができるようになる。例えば、第２レベルの電
気外科電力を加えるステップは、血管やその他の組織の
インピーダンスが約1000オームより高くなった後に止め
られるであろう。
また上記の代わりとして、出力電流が約50度より大き
な角度分だけ出力電圧より進んだときに、外科用器具12
への電力供給を実質的に止めることもできる。更にこの
代わりであれば、出力電流がRMS値で約200ミリアンペア
より低くなった時点で外科用器具12への出力供給を止め
る。
好ましい実施例では、更に出力電圧をRMS値で約160ボ
ルトより低い値に抑えるステップ、及び血管やその他の
組織にかかっている閉鎖力を除去すべき時期を可聴的に
指示するステップとが加えられる。この可聴指示は電気
外科電力のレベルを実質的に下げた後、及び５秒以内の
遅延時間の後に行われる。
上記は本発明の原則の応用を記したものに過ぎず、よ
って当該技術分野に従事する者であれば本発明の精神及
び範囲から逸脱することなく多数の変形例や代わりの組
み合わせを考察できるものと考えられる。添付の請求項
はそのような変形例や代わりの組み合わせを網羅するこ
とを意図している。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ルキアナウ，スティーブン・ウェイド アメリカ合衆国コロラド州80301，ボー ルダー，バッキンガム・ロード 7339 (72)発明者 ライアン，トーマス・パトリック アメリカ合衆国コロラド州80525，フォ ート・コリンズ，パークビュー・ドライ ブ 729 (56)参考文献 特表 平６−502328（ＪＰ，Ａ) 国際公開94／24949（ＷＯ，Ａ１) 国際公開95／19148（ＷＯ，Ａ１) (58)調査した分野(Int.Cl.7，ＤＢ名) A61B 18/00 - 18/28

Claims (7)

    (57)【特許請求の範囲】
  1. 【請求項１】患者（13）の血管やその他の組織を封鎖す
    るための電気外科エネルギー供給システム（10）であっ
    て、 出力電圧と出力電流とを生成することにより制御された
    レベルの電気外科電力を供給することのできるゼネレー
    タ（11）と、 電気外科電力を受け取るためにゼネレータ（11）に電気
    的に接続されており、患者（13）の血管やその他の組織
    を把持し、電気外科電力をこの血管やその他の組織に送
    るように配置された導電部材（14）と、この導電部材
    （14）間に既知の閉鎖力を維持するための手段とを有す
    る外科用器具（12）と、 外科用器具（12）に供給される電気外科電力のレベルを
    自動的にシーケンスするためにゼネレータ（11）内に設
    けられた電力制御回路と、 から構成されること、 ゼネレータ（11）は、患者（13）の血管やその他の組織
    が外科用器具（12）の導電部材（14）によって把持され
    ている際にこの血管やその他の組織のインピーダンスを
    概算するための手段を含むこと、 上記電力制御回路は、 第１のインピーダンス中断点に至るまで血管やその他の
    組織への出力電流供給を急速に増やすための出力電流供
    給手段と、 血管やその他の組織のタンパク質が融けるまで血管やそ
    の他の組織へのコンスタントな電力供給を維持するため
    の一定電力供給手段と、 第２のインピーダンス中断点に至るまで血管やその他の
    組織への低い電力供給を維持するための低電力供給手段
    と、 を更に含むこと、 上記シークエンスには、外科用器具（12）が閉鎖力を加
    えている間に出力電流をRMS値で約２アンペアより大き
    な最大振幅にまで上げ、そのあと血管やその他の組織を
    焼き焦がさずに乾燥させるに充分なレベルにまで上記電
    気外科電力を下げ、更にこのあと外科用器具（12）への
    電気外科エネルギーの伝送を止めることが含まれるこ
    と、 を特徴とする電気外科エネルギー供給システム。
  2. 【請求項２】外科用器具（12）における上記閉鎖力を維
    持するための手段が更に導電部材（14）間に複数レベル
    の閉鎖力を選択的に加える手段を含むことを特徴とする
    請求項１記載の電気外科エネルギー供給システム。
  3. 【請求項３】上記電力制御回路が、血管やその他の組織
    のインピーダンスが約1000オームより高い値に上昇した
    ときに外科用器具（12）への電力供給を実質的に止める
    電力遮断手段を含むことを特徴とする請求項１記載の電
    気外科エネルギー供給システム。
  4. 【請求項４】上記第１のインピーダンス中断点が約16オ
    ームに在り、一方上記第２のインピーダンス中断点は約
    2048オームに在ることを特徴とする請求項１記載の電気
    外科エネルギー供給システム。
  5. 【請求項５】ゼネレータ（11）が、約50度より大きい角
    度分だけ出力電流が出力電圧より進んでいる時に外科用
    器具（12）への電力供給を実質的に止めるための手段を
    含み、あるいは、ゼネレータ（11）が、出力電圧のレベ
    ルをRMS値で約160ボルトより低く抑えるための出力電圧
    制限手段を有することを特徴とする請求項１記載の電気
    外科エネルギー供給システム。
  6. 【請求項６】ゼネレータ（11）が、出力電流がRMS値で
    約200ミリアンペアよりも低い値に下がった際に外科用
    器具（12）への電力供給を実質的に止めるための手段を
    含むことを特徴とする請求項１記載の電気外科エネルギ
    ー供給システム。
  7. 【請求項７】ゼネレータ（11）が、 外科用器具（12）への電力供給を実質的に止めるための
    手段と、 実質的に外科用器具（12）への電力供給をとめた後、組
    織にかかっている閉鎖力をゆるめるよう外科医に告げる
    ための指示器と、 を含むことを特徴とする請求項１記載の電気外科エネル
    ギー供給システム。
JP51251297A 1995-09-19 1996-07-11 電気外科エネルギー供給システム Expired - Fee Related JP3207435B2 (ja)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US08/530,495 1995-09-19
US08/530,495 US5827271A (en) 1995-09-19 1995-09-19 Energy delivery system for vessel sealing
US530,495 1995-09-19
PCT/IB1996/000669 WO1997010763A1 (en) 1995-09-19 1996-07-11 Energy delivery system for vessel sealing

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JPH10510460A JPH10510460A (ja) 1998-10-13
JP3207435B2 true JP3207435B2 (ja) 2001-09-10

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DE69621636D1 (de) 2002-07-11
CA2228890C (en) 2001-09-11
EP0862386B1 (en) 2002-06-05
EP0862386A1 (en) 1998-09-09
JPH10510460A (ja) 1998-10-13
AU6237896A (en) 1997-04-09
ES2174078T3 (es) 2002-11-01
DE69621636T2 (de) 2002-12-05
ATE218304T1 (de) 2002-06-15
MX9801151A (es) 1998-05-31
AU723001B2 (en) 2000-08-17
CA2228890A1 (en) 1997-03-27
US5827271A (en) 1998-10-27

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