JP4459814B2 - 組織をシールし、そして切断するための電極アセンブリおよび組織をシールし、そして切断することを実施するための方法 - Google Patents
組織をシールし、そして切断するための電極アセンブリおよび組織をシールし、そして切断することを実施するための方法 Download PDFInfo
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- 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
- A61B18/14—Probes or electrodes therefor
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- A61B2017/00017—Electrical control of surgical instruments
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- A61B2017/00026—Conductivity or impedance, e.g. of tissue
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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- A61B2018/00636—Sensing and controlling the application of energy
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- A61B2018/00791—Temperature
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
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Description
本出願は、「組織をシールし、そして切断するための電極アセンブリおよび組織をシールし、そして切断することを実施するための方法」と題された、2002年10月4日出願の米国仮出願第60/416,064号の利益および優先権を主張し、米国仮出願第60/416,064号の全体の内容が本明細書中で参考として援用される。
開放型電気外科用鉗子または内視鏡用電気外科用鉗子は、ホメオスタシスを実施するために、機械的な締め付け作用および電気エネルギーの両方を利用する。各々の向かい合う顎部材は、異なる電位に帯電され、その結果、この顎部材が組織をつかむ場合には、電気エネルギーは、選択的にその組織を通して伝達され得る。外科医は、上記電極間および上記組織を通して印加された電気外科用エネルギーの強度、周波数および継続時間を制御することにより、出血を焼灼し、凝固/乾燥し得、および/または単に低減しもしくは出血を遅くし得るかのいずれかである。
本開示は、脈管をシールするための器具に伴なう使用のための電極アセンブリに関する。この電極アセンブリは、一対の対向する第1の顎部材および第2の顎部材を備え、これらの部材は、その顎部材がお互いに対して間隔をあけた関係で配置される第1の位置から、その顎部材が協力してそれらの間に組織をつかむ第2の位置へ、お互いに対して可動式である。各顎部材は、電気外科用発電機(ESU)に接続される電気伝導性の組織接触表面を備え、その結果、その組織接触表面は、組織接触表面間に保持されるその組織を通して、電気外科用エネルギーを伝導することができ、シールを成し遂げる。
ここで図1Aおよび1Bに言及すれば、双極性鉗子10は、様々な外科的手順をともなう使用のために示される。鉗子10は、一般に、ハウジング20、ハンドルアセンブリ30、回転アセンブリ80、引金アセンブリ70および電極アセンブリ110を備え、これらは相互に協働して管状脈管および脈管組織400をつかみ、シールしそして分割する(図4A参照)。大多数の上記図面は、内視鏡用外科的手順に関連する使用のための双極性鉗子10を描写するが、開放型鉗子200もまた、従来の開放型外科的手順に関連する使用のために企図され、図1B中の実施例によって示され、以下に記載される。本明細書中の目的のために、内視鏡器具または開放型器具のいずれかが、本明細書中に記載される電極アセンブリとともに利用され得る。明らかに、異なる電気的接続および機械的接続ならびに電気的配慮および機械的配慮がそれぞれの特定のタイプの器具に適用されるが、しかしながら、上記電極アセンブリに関する新規な局面およびその動作特性は、一般に、上記開放型設計または内視鏡設計の両方に関して、一貫性を保つ。
Claims (14)
- 血管をシールするための器具とともに使用するための電極アセンブリであって、該電極アセンブリは、以下:
一対の対向する第一および第二の顎部材であって、該顎部材が互いに対して間隔を置いた関係で配置される第一の位置から、該顎部材がその間に組織を保持するように共同して働く第二の位置へ、互いに対して移動可能である、顎部材を備え、
各顎部材が電気伝導性の組織接触表面を含み、各組織接触表面が電気外科用エネルギー源に接続され、その結果、組織接触表面がその間に保持される組織を介して電気外科用エネルギーを伝導し得、シールを実施し、
該第一の顎部材が、該第一の組織接触表面内に誘電的に配置される電気伝導性の切断要素を含み、かつ該第二の顎部材が、そこに配置される絶縁体を含み、該絶縁体は実質的に該切断要素と対向する関係で配置され、
シールの間に該組織表面の間に隙間を生成するために、該切断要素が、該第一の組織接触表面から該第二の組織接触表面に向かって延び、かつ該切断要素および該第一の組織接触表面が、外科医により独立して作動可能であり、
該切断要素が実質的に鈍く、かつ電気外科用エネルギー供給を介してのみ組織を切断可能である、
アセンブリ。 - 切断の前にシールの質を決定するためのスマートセンサーをさらに含み、該スマートセンサーが前記組織を通る電流の低下に基づいてシールの質を決定する、請求項1または2に記載の電極アセンブリ。
- 前記スマートセンサーがシールの質を表示するための可聴の表示器を含む、請求項2に記載の電極アセンブリ。
- 前記スマートセンサーがシールの質を表示するための可視の表示器を含む、請求項2または3に記載の電極アセンブリ。
- 切断の間、前記切断要素に供給される前記電気外科用エネルギーを制御するための、種々の組織パラメーターを決定するためのスマートセンサーをさらに含む、請求項1〜4のいずれかに記載の電極アセンブリ。
- 前記組織のシールが作製された後、切断の間、前記切断要素に供給される前記電気外科用エネルギーを制御するために、前記スマートセンサーが組織の厚さ、組織の水分、組織の密度および組織のインピーダンスのうちの少なくとも一つを測定する、請求項1〜5のいずれかに記載の電極アセンブリ。
- 前記組織のシールが作製された後、切断の間、前記切断要素に供給される前記電気外科用エネルギーを制御するために、前記スマートセンサーが種々の組織パラメーターを測定できるように、前記電気外科用なエネルギー源が組織を介して較正パルスを送信し、該組織パラメーターが、組織の厚さ、組織の水分、組織の密度および組織のインピーダンスからなる群より選択される、請求項1〜6のいずれかに記載の電極アセンブリ。
- 一旦前記組織がシールされると、電気外科用エネルギーを自動的に前記切断要素に切り換えるスマートセンサーをさらに含む、請求項1〜7のいずれかに記載の電極アセンブリ。
- 切断およびシールのうちの少なくとも一つを実施するために、前記電気外科用エネルギー源からパルス様の様式で電気外科用エネルギーが伝達される、請求項1〜8のいずれかに記載の電極アセンブリ。
- シールプロセスおよび切断プロセスの両方の間に、前記電気外科用エネルギーを制御するために変動可能なレジスターを含むスマートセンサーをさらに含む、請求項1〜9のいずれかに記載の電極アセンブリ。
- 組織シールを実施するための、前記対向する第一の組織接触表面および前記対向する第二の組織接触表面にエネルギーを与えるための第一のスイッチ、ならびに組織切断を実施するための、前記切断要素および前記第二の組織接触表面にエネルギーを与えるための第二のスイッチをさらに含む、請求項1〜10のいずれかに記載の電極アセンブリ。
- 組織をシールおよび切断するためのシステムであって、該システムは、以下:
電極アセンブリであって、該アセンブリは、以下:
一対の対向する第一および第二の顎部材であって、該顎部材が互いに対して間隔をおいて配置された第一の位置から、該顎部材がその間に組織を保持するように共同して働く第二の位置へ、互いに対して移動可能であり、
各顎部材が電気伝導性の組織接触表面を含み、各組織接触表面が電気外科用エネルギー源に接続される、顎部材;
該第一の組織接触表面内に誘電的に配置された電気伝導性切断要素であって、該切断要素が、該第一の組織接触表面から該第二の組織接触表面に向かって延びる切断要素、
該第二の組織接触表面内に配置された絶縁体であって、該絶縁体が、実質的に該切断要素に対向する関係で配置される絶縁体、
を備える、電極アセンブリ;
該顎部材を組織接触表面の間に組織を保持するように作動させるための手段;
組織接触表面の間に約3kg/cm2〜16kg/cm2の間の閉鎖力を適用し、その結果、該切断要素が該第一の組織接触表面と該第二の組織接触表面との間の隙間を生成するための手段;
該第一の組織接触表面および該第二の組織接触表面にエネルギーを与え、該組織を介して電気外科用エネルギーを伝達し、組織のシールを実施するための手段;ならびに
該切断要素および該第二の組織接触表面にエネルギーを与え、該組織を介してエネルギーを伝達し、組織シールに沿って組織を効果的に切断するための手段
を備える、システム。 - 組織をシールおよび切断するための請求項12に記載のシステムであって、該システムが、組織の切断前にシールの質を決定するためのスマートセンサーをさらに備え、該スマートセンサーが前記組織を通る電流の低下に基づいてシールの質を決定する、システム。
- 組織をシールおよび切断するための請求項12または請求項13に記載のシステムであって、前記切断要素が、前記第一の組織接触表面と前記第二の組織接触表面との間に約0.001インチから約0.006インチの隙間を形成する、システム。
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US41606402P | 2002-10-04 | 2002-10-04 | |
PCT/US2003/028539 WO2004032777A1 (en) | 2002-10-04 | 2003-09-11 | Electrode assembly for sealing and cutting tissue and method for performing same |
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JP2006501939A JP2006501939A (ja) | 2006-01-19 |
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JP2009186889A Expired - Fee Related JP4944171B2 (ja) | 2002-10-04 | 2009-08-11 | 組織をシールし、そして切断するための電極アセンブリおよび組織をシールし、そして切断することを実施するための方法 |
JP2011233415A Pending JP2012045405A (ja) | 2002-10-04 | 2011-10-24 | 組織をシールし、そして切断するための電極アセンブリおよび組織をシールし、そして切断することを実施するための方法 |
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JP2011233415A Pending JP2012045405A (ja) | 2002-10-04 | 2011-10-24 | 組織をシールし、そして切断するための電極アセンブリおよび組織をシールし、そして切断することを実施するための方法 |
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JP (3) | JP4459814B2 (ja) |
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2003
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- 2003-09-11 WO PCT/US2003/028539 patent/WO2004032777A1/en active IP Right Grant
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JP2009254910A (ja) | 2009-11-05 |
JP2006501939A (ja) | 2006-01-19 |
CA2500593A1 (en) | 2004-04-22 |
WO2004032777A9 (en) | 2004-07-01 |
JP2012045405A (ja) | 2012-03-08 |
AU2008207623A1 (en) | 2008-09-25 |
DE60312348T2 (de) | 2008-01-24 |
ES2283808T3 (es) | 2007-11-01 |
AU2003270566B2 (en) | 2008-05-29 |
AU2003270566A1 (en) | 2004-05-04 |
DE60312348D1 (de) | 2007-04-19 |
JP4944171B2 (ja) | 2012-05-30 |
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