JP7228283B2 - 電気手術装置及び方法 - Google Patents
電気手術装置及び方法 Download PDFInfo
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Description
1つ以上の粘膜下層の組織変質または変性させることを実行する)ためにも使用してよい。
達構造を有し、アプリケータは治療部位で生体組織に沿って回転可能な放射構造を備える。
または変形可能な支持体(例えば、カップ状または凹所のあるハウジング)を含んでよい。搬送構造は、例えば環状リングを使用して器具コード上に留められ得る。他の例で、搬送構造は器具コードに付着し得る、またはそれと一体に形成され得る。
ト106の遠位端から延在する単一の可撓軸112内に結合することである。
エネルギー(例えば赤外線)を送達するまたは生体組織の他の熱的効果を励起するように配置されるアプリケータと、に分けることができる。マイクロ波エネルギーを利用するアプリケータ構造に関する議論から開始し、それは図2~図14に記載されている。
度説明しない。スリーブ及び膨張チャネルは見やすさを考えて省略した。アプリケータ250は「溝付き」ラジエータとして構成される。複数の導電要素252はバルーンスキン210上に作成される。例えば導電要素252は、バルーンの外側の金属被覆領域または断片でもよい。導電要素252は、同軸ケーブル206の外部導体に電気的に接続し得る。導電要素252は、マイクロ波エネルギーの供給を制限するのに役立つ。図3に示す実施形態で、マイクロ波エネルギーは導電要素252の間の間隙(溝)から送達される。このように治療の所望のパターンは、導電要素252の形状及び位置を適切に構成することによって得ることができる。例えばバルーンの片側は、マイクロ波エネルギーからGI管側面を遮蔽するために金属被覆され得る。金属被覆した部分は、それが膨張する際バルーンと共に拡張することができる。例えば導電要素252は、金属被覆した可撓性ポリマー層から形成されてよい。
で同軸ケーブル206の内部導体212は、膨張性容積303を画定する拡張可能な内側表面304上の導電性被覆に接続している。内側表面303は、誘電体材料層302によって外側表面305から分離される。外側層305は、その上に形成される1つ以上の導電要素306を有し得る。これらの導電要素306は、放射状アンテナ(例えば放射状パッチなど)として作用するために特定の寸法にされ得る。
8Cに示す装置は、スリーブ202に対してハウジング332の長手方向の移動を生じさせることによってGI管生体組織の長手方向片を切除するのに好適であり得る。他の例では、例えば組織の周囲片の治療を可能にするために、放射回転盤の回転軸は異なることができる。
在するスリーブ202に摺動可能に載置されてよい、または単独で器具チャネルに載置されてよい。マイクロ波エネルギーを伝送する同軸ケーブル206は、カテーテルの長さに沿って延在する。同軸ケーブルの遠位端は可撓性誘電体材料シート384(例えば、Rogers Corporation製Rflex(登録商標))で終端する。長手方向溝385はカテーテル382の側面に形成される。溝がカテーテル382の外側に露出するように、可撓性誘電体シート384がそれを通して通過できるように、溝は特定の寸法にされる。可撓性誘電体シート384は、カテーテル382内で含まれるコイル状構成と、溝385を通過してカテーテル382の円周の一部または全体の周囲に位置する展開(または広げた)構成との間のカテーテル軸周囲を回転可能であり得る。
一連の導電性材料を有し、それは適切なワイヤまたは配線414によって同軸ケーブル206の内部導体に接続している。各細片410の前面に、一連の導電性パッチ412は形成される。導電性パッチ412は、上述のものと類似のやり方で放射素子として機能するように構成される。
2内に載置される摺動可能な制御ロッドの操作によってこの開孔を通ってハウジング内に引き入れられることができる。一例で制御ロッドは同軸ケーブル206であることができる。
い場合がある。実際にいくつかの構造のレイアップ構造、複雑さ及びそれに伴う大きさを考慮すると、その近位端から一般的なGI可撓性ビデオ内視鏡の器具チャネルを通ってそれらを供給することは可能でない場合がある。本明細書の開示は、このようなアプリケータ構造の導入及び制御の多くの代替手段を想到する。このような構造の例は図17~図20に関連して後述する。これらの着想が任意のGI経口法または経直腸法の適用可能性を見いだし得、そこで可撓性内視鏡及び視覚化が必要とされ、遠位アプリケータ構造は可撓性GI内視鏡の器具(または操作)チャネルによる導入を防ぐためであることを理解すべきである。
載置した壁である。ポケット618は、器具コード600周辺の全部またはその一部の周囲に延在し得る。ポケットの外側形状は、導入を補助するために滑らか及び整合であり得る。アプリケータ612はポケット616内に置かれて、近位接続のために操作チャネル604を通って後退するように入れられるプローブ606に接続した。アプリケータの操作及び回収は図17に関する上述のものと同じである。
きるスリーブを備え得る。あるいは可撓性イントロデューサーは、アプリケータに付随する供給ラインが取り付けられることできる可撓性ロッドまたは針を備え得る。可撓性イントロデューサーは操作可能であり得、例えばその長さに沿って延在する1つ以上の制御ワイヤを有し得る。イントロデューサーは、アプリケータとは別にまたはそれと一体化して形成され得る。
[1]Cherrington,et al.13th World Congress on Insulin Resistance,Diabetes & Cardiovascular Disease.Los Angeles,Calif.,USA,December 2015。
Claims (14)
- 十二指腸の粘膜組織を切除するように構成される電気手術器具であって、前記器具が、
患者に対して外部に位置するジェネレーターから前記患者の十二指腸内に位置する治療部位にマイクロ波エネルギーを伝送するための可撓性の同軸ケーブルと、
前記可撓性の同軸ケーブルの遠位端に位置するアプリケータであって、前記アプリケータが、前記同軸ケーブルから前記マイクロ波エネルギーを受け取って、前記治療部位の生体組織内に受け取った前記マイクロ波エネルギーを送達するために接続されるエネルギー送達構造を備える可撓性誘電体基板を有する、前記アプリケータと、を備え、
前記アプリケータが、前記治療領域の十二指腸の粘膜組織と接触するように前記エネルギー送達構造を移動させるために前記可撓性誘電体基板上に配置した径方向に拡張可能な部分を含み、前記径方向は前記同軸ケーブルの中心軸に垂直な横方向に対応し、
前記エネルギー送達構造が、
その第1表面上に形成される導電層であって、前記同軸ケーブルの内部導体に電気的に接続する前記導電層と、
その第2表面上に形成される複数の導電要素と、を有し、
前記複数の導電要素が電気的に接地され、前記エネルギー送達構造によって受け取られる前記マイクロ波エネルギーの放射素子として作用するために特定の寸法にされる、前記電気手術器具。 - 前記可撓性誘電体基板がシートの形状であり、前記複数の導電要素が前記シート上の2次元の配列に配置される、請求項1に記載の電気手術器具。
- 前記アプリケータは、前記同軸ケーブルが通って延在するカテーテルを備え、前記カテーテルは、遠位側面に形成された長手方向の溝を有し、前記シートが前記カテーテルの外側に露出されるよう、前記溝は前記シートが通過できるように寸法決めされる、請求項2に記載の電気手術器具。
- 前記シートは、前記カテーテル内に前記シートが収容されたコイル状構成と、前記シートが前記溝を通過し、前記カテーテルの円周の一部または全体の周りに位置する展開構成との間で、前記カテーテルの軸周囲を回転可能である、請求項3に記載の電気手術器具。
- 前記シートは、前記展開構成にあるときに前記カテーテルの本体の周りに優先的に巻きつくように、曲がった状態で予め成形される、請求項4に記載の電気手術器具。
- 前記複数の導電要素は、前記展開構成にあるときに前記シートの外側を向く表面に配置される、請求項4または5に記載の電気手術器具。
- 前記アプリケータは、前記同軸ケーブルの周りに取り付けられたスリーブを備え、前記シートが前記スリーブの遠位の口を通過するように、前記スリーブおよび前記同軸ケーブルは、互いに対して摺動可能である、請求項2に記載の電気手術器具。
- 前記シートは、前記シートに巻かれた構成を取らせるように、近位方向に向かって幅が狭くなり前記口と係合する湾曲面を有する、請求項7に記載の電気手術器具。
- 前記可撓性誘電体基板が1つ以上の細片の形状であり、前記複数の導電要素が前記細片に沿って並んで配置される、請求項1に記載の電気手術器具。
- 前記1つ以上の細片が、展開時に径方向外向きに屈曲するように配置された、複数の展開可能な長手方向に配置された可撓性細片を含む、請求項9に記載の電気手術器具。
- 前記1つ以上の細片が、伸縮自在なループの形状をとる細片を含む、請求項9に記載の電気手術器具。
- 前記1つ以上の細片が、螺旋コイルの形状をとる細片を含む、請求項9に記載の電気手術器具。
- 十二指腸の粘膜組織を切除するための電気手術装置であって、前記装置が、
患者の十二指腸内に位置する治療部位に前記患者へ挿入するための器具コードを有する手術スコープ装置と、
マイクロ波エネルギーを供給するためのジェネレーターと、
請求項1から請求項12のいずれか1項に記載の電気手術器具と、を含み、
前記可撓性の同軸ケーブルがその近位端で前記ジェネレーターに接続され、
前記可撓性の同軸ケーブル及び前記アプリケータが前記治療部位に前記器具コードと共に挿入可能である、前記電気手術装置。 - 前記器具コードがそれを通して延在する長手方向の器具チャネルを有し、前記可撓性の同軸ケーブル及び前記アプリケータが前記器具チャネルに摺動可能に載置されるために特定の寸法にされる、請求項13に記載の電気手術装置。
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