JPH08317934A - 適応性電極を有する電気外科手術用止血装置 - Google Patents

適応性電極を有する電気外科手術用止血装置

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Publication number
JPH08317934A
JPH08317934A JP8123859A JP12385996A JPH08317934A JP H08317934 A JPH08317934 A JP H08317934A JP 8123859 A JP8123859 A JP 8123859A JP 12385996 A JP12385996 A JP 12385996A JP H08317934 A JPH08317934 A JP H08317934A
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Prior art keywords
electrode
tissue
end effector
electrosurgical
potential
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JP8123859A
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JP3857354B2 (ja
Inventor
Dale R Schulze
デール・アール・シュルツ
William D Fox
ウィリアム・ディー・フォックス
David Yates
デビッド・イェイツ
Anil Nalagatla
アニル・ナラガトラ
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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    • A61B18/12Surgical 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
    • A61B18/1206Generators therefor
    • AHUMAN NECESSITIES
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    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B18/1442Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A61B18/1447Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod wherein sliding surfaces cause opening/closing of the end effectors
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    • A61B17/115Staplers for performing anastomosis in a single operation
    • AHUMAN NECESSITIES
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    • A61B17/115Staplers for performing anastomosis in a single operation
    • A61B17/1155Circular staplers comprising a plurality of staples
    • AHUMAN NECESSITIES
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    • A61B18/12Surgical 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
    • AHUMAN NECESSITIES
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    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
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    • AHUMAN NECESSITIES
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    • A61B2017/07214Stapler heads
    • AHUMAN NECESSITIES
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    • A61B2018/00345Vascular system
    • A61B2018/00404Blood vessels other than those in or around the heart
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Abstract

(57)【要約】 【課題】 末端効果器により係合する組織の種類、厚
み、インピーダンスまたはその他のパラメータに適合す
るように前記末端効果器の電極を設定することにより組
織処理エネルギーの効率を最適化する電気外科装置を提
供すること。 【解決手段】 インピーダンス、厚み、圧縮性、密度、
空乏性、その他が変化する組織の焼灼および/または融
着のための特に内視鏡手術で用いる電気外科装置を提供
する。本装置は異なる電位の2個の電極を提供し、一方
の電極は他方の電極に対して移動可能にして電極間の距
離を変化させ、これによりジェネレータに呈示される組
織インピーダンスを変化させる。電極間距離は自動的に
またはユーザ制御の装置で変化させられる。

Description

【発明の詳細な説明】
【0001】
【発明の属する技術分野】本発明は外科手術、特に内視
鏡手術の際に用いる焼灼、凝集および/または組織融着
のための電気外科装置に関する。
【0002】
【従来の技術】組織の切開・切断を要する外科手術では
切開部位の出血が見られることがある。出血抑制に各種
技術が応用され、例えば縫合、欠陥へのクリップ適用、
ホチキス止め、および電気焼灼およびその他の組織加熱
技術等がさまざまな度合で成功している。組織接合また
は溶着、組織修復および創傷封止の進歩により以前なら
不可能または危険が大きすぎた外科手術でも施術できる
ようになってきた。
【0003】手術用ホチキス装置は組織縫合、接合、近
置に用いられており、組織切開との組み合せで止血を提
供している。このような装置は、例えば線型および円形
の切開およびステープル止め装置を含む。典型的には線
型カッターは平行なステープル(ホチキス針)列を有
し、カッター手段のスロットがステープル列の間を移動
する。この種の手術用ホチキス装置は組織を固定して切
開を改善し、組織層を接合し、カッター手段が平行な列
の間を切開するので周辺組織層に平行なステープル列を
装着することにより止血を提供する。
【0004】電気凝固装置は組織および血管を加熱して
凝固または焼灼を起すことにより止血の改善を行なうた
めに用いられてきた。単極装置は切開または焼灼装置に
接続した1本の電極と、通常患者の体表に接着される離
れた帰還電極とを用いる。最近では双極装置が用いられ
るが、これは一般に装置の組織処理部分の2本の電極の
間にある組織に焼灼電流が限定されることによる。
【0005】双極鉗子は各種処置での切開および/また
は凝固に使用されている。一般に、双極鉗子は2極の間
に組織を挟み、挟んだ組織に通電するが、幾つかの欠点
を有し、その幾つかとしては組織が菲薄な場合に極間に
電弧が発生する、または鉗子の両極が接触した場合に鉗
子が短絡する傾向が含まれる。凝固用に鉗子を使用する
のも技術への依存が大きく、また鉗子は同時に広い組織
部分を焼灼するのには適していない。さらに、鉗子は熱
拡散領域が発生する、すなわち鉗子表面で摘出するまた
は係合することで限定された部分の外側に熱が放散され
る傾向にある。
【0006】電気外科装置で高周波エネルギーを使用す
る場合、インピーダンス負荷が存在する特定ジェネレー
タの出力特性に対して最高または最適なエネルギー供給
が得られる組織インピーダンスの最適範囲が存在する。
【0007】一般に、最適範囲は供給源と負荷のインピ
ーダンスが適合する場合に供給源から負荷への電力の移
動が最大になるという原理に関連する。さらに任意のジ
ェネレータが出力する電力は、インピーダンス負荷すな
わち組織が供給源インピーダンスから離れると予測可能
な率で任意のジェネレータの電力出力が減少する。
【0008】最適範囲は、ジェネレータからの電力伝達
が意図した結果すなわちよく制御された凝固、焼灼、ま
たは組織溶着を実現するのに充分な負荷インピーダンス
の範囲として本明細書で定義する。最適範囲は用途によ
って、またはジェネレータによって変化することがあ
る。
【0009】組織インピーダンスは、組織の種類、水分
含量、組織状態(すなわち凝固しているかまたは凝固し
ていないか)、組織の厚み、組織圧迫量、組織に流れる
電流の流路の寸法と長さ、組織に適用するエネルギー周
波数を含む多数のパラメータによって変化すると言われ
ている。
【0010】さらに、任意の組織領域または容積で、組
織が加熱され凝固が始まると、組織インピーダンスが変
化し、組織のインピーダンスモデルが動的に変化するの
で、凝固電流が組織に供給されるとその組織領域または
容積を流れる電流パターンに影響を与える。また組織の
厚みも、例えば水分が蒸気または水蒸気として逸脱する
と電気装置で摘出した組織の体積が減少することから、
電気外科的処置により典型的に変化すると言われてい
る。特定の末端効果器の構成により、この特定の末端効
果器で組織厚みが組織に適用する電流径路の長さおよび
/または圧力の量に影響を与える場合組織のインピーダ
ンスモデルにさらに変数を提供することがある。
【0011】
【発明が解決しようとする課題】つまり、多数の組織種
類および多種厚みにおいて、例えば筋肉組織または血管
組織領域、インピーダンスの高い、低い、または組み合
された組織において、効果的に凝固を提供できる電気装
置を提供することが望まれる。止血は本明細書におい
て、一般に凝固、焼灼および/または組織接合または溶
着を含めた出血を止めることを表わすために用いる。
【0012】さらに組織を処理することで変化するイン
ピーダンスおよび/または組織厚みに適応し、ジェネレ
ータに呈示されるインピーダンスが最適範囲に収まるよ
うな装置を提供することが望ましい。
【0013】したがって本発明の目的は、末端効果器に
より係合する組織の種類、厚み、インピーダンスまたは
その他のパラメータに適合するように前記末端効果器の
電極を設定することにより組織処理エネルギーの効率を
最適化する電気外科装置を提供することである。
【0014】
【課題を解決するための手段】したがって、本発明の1
つの実施例は、組織を把持するまたは挟持する装置の対
向極または電極の間の距離を調整できるような調整自在
な装置を提供する。この装置は組織の厚み、多様な種類
の組織または装置の適用を補償するのに適している。
【0015】また、本発明の実施例は組織を凝固してい
る時のインピーダンスおよび組織厚の変化に動的または
連続的に対応して組織へエネルギーが効率的に供給され
るようにする装置を提供する。本装置は処理中に連続的
または一定間隔で調整することができる。
【0016】好適実施例において調整手段は自動または
ユーザが作動させる機械的装置で有り得る。本装置は例
えば外科用ホチキス装置、クリップ適用具、縫合装置等
の組織締結装置等の治療用電気外科エネルギーを用いる
各種器具で使用できる。例えば切開器具、線型または円
形切開兼ホチキス止め装置等の他の末端効果器構成を用
いることもできる。
【0017】本発明の上記およびその他の目的は以下に
添付の図面の詳細な説明を本発明の詳細な説明と組み合
せて熟読することでより良く理解されよう。
【0018】
【発明の実施の形態】ここで図1から図4、図8から図
17を参照すると、本発明の装置が図示してある。図5
から図7は類似の電気外科的エネルギーの供給および作
動機構を使用し得る別の実施例の末端効果器を示す。
【0019】内視鏡圧締兼切開装置10はハウジング1
6が貫通して延在する内腔を有する鞘30と鞘30の遠
位端から延出する末端効果器15に接続するように図示
してある。末端効果器15はインターフェース面を有す
る第1と第2の顎部材32、34を含む。顎部材32は
顎部材34に移動可能に固定されている。ハウジング1
6は顎部材32、34を閉じるためのクランプ用引き金
12と、高周波エネルギーを作動させるための電気スイ
ッチ59に接続してある高周波スイッチ戻り止めアーム
58および電気スイッチ接点67a、67bと、切開要
素11を組織内に進めるための作動引金14を有する。
【0020】顎部材32は顎部材32の長手方向に延在
するナイフチャネル29を形成するU字状電極52を含
む。ポリフェニレンオキサイドなどの高分子材料で形成
するのが好ましい絶縁体31で電極51を被覆する。顎
部材32は電極51と絶縁体31から成るインターフェ
ース面である内面33を有する。内面33は実質的に顎
部材34のインターフェース面である内面35に対向す
る。
【0021】顎部材34は、内面35の一部を形成しま
た内面35の切れ込みを構成する絶縁体36と、切れ込
み39に挿入されるスプリング電極52を含む。電極5
1、52は導体例えば手術用ステンレス鋼等から構成さ
れる。スプリング電極52は内面に形成された絶縁層5
2aも含む。
【0022】電極51は双極組織処置または治療システ
ムの第1の極として作用する。顎32、34を互いに閉
じると電極51は絶縁体52aによってスプリング電極
52から電気的に絶縁されて電極51とスプリング電極
52の不用意な接触による短絡を防止する。スプリング
電極52は双極処置または治療システムの第2の治療電
極として作用し、電極52は電極51に電気的に対向す
る。
【0023】スプリング電極52は顎部材34の切れ込
み39内部で近位から遠位へ長手方向に延在し、切れ込
みに沿って長手方向に延在し電極バー27、28を形成
するフラップ23、24を有するV字状の本体22を含
む。本体22の内側表面22aは絶縁体52aで絶縁さ
れるが、バー27、28は露出している。絶縁体は例え
ばポリフェニレンオキサイド等の絶縁ポリマーから形成
できる。スプリング電極52は閉じたV字状の方向にバ
イアスがかかる。
【0024】菲薄組織を顎部材32、34で係合した場
合(図3)、肉厚組織(図4)を係合した場合ほど圧縮
力が大きくならないのでフラップ23、24は互いに閉
じようとする。肉厚の組織を係合した場合、インターフ
ェース面である内面33、35の間の圧縮力はさらに大
きく、フラップ23、24を互いに離れるようにひろげ
ようとする。つまり、菲薄組織を係合した場合の電極バ
ー27、28と電極51の間の距離は肉厚組織を係合し
た場合より小さい。
【0025】好適実施例において本装置は腸間膜組織等
の比較的薄くさらに圧縮可能なまたは脂肪性組織、また
は比較的厚いかまたはもっと緻密な組織例えば筋組織ま
たは付属器等に使用する。本明細書で用いている圧縮性
は任意の力をかけた時に寸法的に組織を圧縮する能力を
表わす。一般に、脂肪組織では筋肉または付属器組織よ
り高インピーダンス、低密度で高圧縮性を有しやすい。
電極は対向する表面上に配置して予想される組織の種類
に適応させる。菲薄な腸間膜組織を係合する場合、電流
の径路または電極間の距離を短くして電極の相対インピ
ーダンスを減少させるが、肉厚の筋肉または付属器組織
では距離を増加させ電極つまりはジェネレータに現れる
相対インピーダンスを増加させる。このように、本実施
例では適応電極が2種類の違う組織のあいだの負荷イン
ピーダンスの差を低減している。
【0026】スプリング電極52は組織を電気外科的エ
ネルギーで処置する場合の組織厚の変化と圧縮に連続適
応するように配置する。典型的には、組織は処置を行な
うと菲薄になる。また組織は凝固するとインピーダンス
が増加する傾向にある。スプリング電極は組織が薄くな
るかまたはさらに圧縮されると閉じたV字状の位置に向
かって移動し、これによって電流の径路を短縮して、組
織のインピーダンスを下げ、および/または組織と電極
51、52との電気的接触が確実に行なわれ続けるよう
にする。
【0027】末端効果器の別の実施例が図5から図7に
図示してある。顎部材132はポリフェニレンオキサイ
ド等のポリマーから形成されるのが好ましい絶縁体13
1を含む。顎部材132は長手方向に貫通して延在する
ナイフチャネル129を含む。顎部材132は顎部材1
34の内側表面と実質的に対面する内面33を含む。
【0028】顎部材134はカートリッジ123を受け
入れるのに適したチャネル122を含む。チャネル12
2は顎部材134の外周を形成するU字状の電極151
を含む。交換自在なカートリッジ123はチャネル12
2に挿入する。カートリッジ123は絶縁体139と、
表面135の一部を含み圧縮うね156を形成する実質
的に平行なバー電極127、128を形成するU字状電
極152とを含む。U字状電極152は絶縁体139に
より包囲される。
【0029】カートリッジ123は特定種類の組織、厚
み、および/または別の用途に適合した別の電極構造を
有するカートリッジと相互交換できる。図6は比較的厚
い付属器組織に係合する図5の末端効果器を示す。カー
トリッジ123は狭いU字状の電極152を有する。バ
ー127、128は電極152のうね156から距離D
1にある。図7は比較的薄い腸間膜組織に係合する末端
効果器を示す。末端効果器は、うね156aを形成する
広いU字状の電極152aを有する別のカートリッジ1
23aを含む。バー127a、128aは電極152a
の電極151からD1>D2となるような距離D2にあ
る。カートリッジ123、123aは予想される組織の
厚み、圧縮性、密度、組成または特定の装置用途によっ
て選択できる。電極151、152または152aは電
極51、52と同様の方法でエネルギー源に接続でき
る。
【0030】図1から図4、図8から図17を参照する
と、鞘30は絶縁材量から形成され内腔を貫通する封止
管38を有する。チャネル保持具37aは封止管38の
遠位端から延出し遠位端側で封止管38の残りを通って
延出するチャネル37に固定されて顎部材34を形成す
る。チャネル37は封止管38から遠位側に延出する顎
部材34を含む。
【0031】ハウジング16は封止管38を前進させて
組織を間に係合しつつ顎部材32、34が互いに閉じる
ようにするための圧締引金12を有する。圧締引金12
の回転により、封止管38が鞘30と同軸的に顎部材3
2のカム表面32aの上まで前進して、顎部材32、3
4の間に載置した組織に顎部材32、34を閉じるよう
になっている。
【0032】チャネル保持具37aはチャネル37内部
で駆動軸41の同軸的な移動を案内する。駆動軸41は
詳細に後述するような作動引金14の回転により前進す
る。駆動軸41はこれの遠位端でブロック43に固定し
てある。ブロック43は切開手段11に固定してあり、
これを駆動軸41が末端効果器15にブロック43を使
って前進させる。顎部材32はチャネル37を使って顎
部材34に固定される。
【0033】駆動軸41が切開要素11を前進させる
と、切開要素11はバー27、28の間にあるナイフチ
ャネル29を前進させて顎部材32、34によって係合
した組織を切断する。組織を電気外科的に処置した時点
でこれを行なうのが好ましい。つまり、切開線はバー電
極27、28が形成する凝固線の中線である。
【0034】ハウジング16の遠位端に配置したノブ4
4は、封止管38、チャネル保持具37a、チャネル3
7、末端効果器15を回転させるが、これらは直接また
は間接にノブ44に接続してあるので、ノブ44を使っ
て末端効果器の顎32、34の回転移動を行なうことが
できる。ノブ44は封止管38の切り込み38aに嵌合
し係合する楔(図示していない)を含む。封止管38は
ハウジング16に近位端で嵌合する。
【0035】電気エネルギーは後述するような接続、ま
たは本明細書の参照に含まれる米国特許出願番号08/
095,797号に開示されているようなその他の接続
手段を介してジェネレータ70から電極51、52に供
給する。ジェネレータ70はハウジング16に配置して
ある高周波スイッチ59によりユーザが制御する。これ
以外にも、ユーザ制御の足踏みペダルを用いることがで
きる。
【0036】線19a、19bはそれぞれ装置本体16
に延出し、電極51、52へエネルギーを供給する。線
19a、19bはそれぞれ低インピーダンスの接触要素
20a、20bに接続され、接触要素20a、20bは
それぞれ線材47a、47bに接続される。線材47
a、47bは遠位端48a、48bで露出している。線
材47a、47bはチャネル保持具37aの近位端に配
置した接触リング49aと接触リング49bに向かって
折り曲げてあり、それぞれ接触リング49a、49bと
電気的に接触するようにしてある。
【0037】線19aは封止管を通って電極51まで延
在する線40aに接続してある接触リング49aに接触
する第1の線材47aを使って電極51へ電流を供給す
る。線19bは封止管を通って電極52まで延在する線
40bに接続してある接触リング49bに接触する第2
の線材47bを経由して電極52まで電流を供給する。
【0038】接触リング49a、49bによってリング
49a、リング49bと、線材47a、47bの間の接
触を維持しながらノブ44を回転させることができる。
リング49aはリング49bから電気的に絶縁される。
配線40a、40bは封止管38に嵌合するチャネル保
持具37aに嵌合するシール45を貫通して延在する。
【0039】圧締引金12はヨーク66の歯66bと移
動自在に係合するギアの歯12aを含むヨーク66は遠
位端が封止管38に結合してある。圧締引金12を作動
させると、ギアの歯12aがヨーク66の歯66bと係
合してヨーク66を遠位方向に前進させる。封止管38
は顎部材32のカム表面32aの上に前進すると顎部材
32、34を閉じる。
【0040】高周波スイッチ59を回転させて治療電極
51、52に供給する高周波エネルギーを断続させる。
高周波スイッチ59を回転させるとスイッチ59の戻り
止め突起59aが戻り止めアーム58の戻り止め突起5
8aに引っ掛り元の位置まで高周波スイッチ59を手動
で回転して戻さない限りスイッチ59で高周波エネルギ
ーが停止しないようにしている。高周波エネルギーは組
織のインピーダンス帰還量に応じて等電気的に停止させ
ることもできる。
【0041】スイッチ59は移動自在な接点67aと固
定接点67bとを有する。移動自在な接点67aはスイ
ッチ59により回転してスイッチが投入された時に固定
接点67bに接触する。
【0042】解除ボタン60の押し棒60aがヨーク6
6の近位端にあるヨーク66隣接ステップ押し棒の近位
端に係合する。ヨーク66が圧締引金12により前進さ
れると、押し棒60aがヨーク66の近位端の後ろに回
り込み、これによってヨーク66は押しボタンを押すま
で引き込まれないようになる。つまり顎部材32、34
はユーザが顎32、34を解除ボタン60で解除するま
で閉じた位置に留まる。
【0043】スイッチ59はヨーク66の近位端のすぐ
上に配置されるフィンガ59cを含む。解除ボタン60
の押し棒60aはフィンガ59cの間に係合する。高周
波スイッチ59は、ヨーク66が遠位方向に前進してス
イッチ59のフィンガ59cがヨーク66の近位端の後
ろに回転できるようにならないと起動できない、すなわ
ち前転できない。
【0044】スイッチ59は作動ラック53の溝53a
に係合する下フック59bも含む。作動ラック53は作
動トリガ15のギアの歯14aと係合するギアの歯53
bを含む。作動ラック53は遠位端でピニオンギア54
に結合しこれが駆動軸41に係合する。
【0045】作動引金14を引くと、作動ラック53が
遠位側へ前進してピニオン54を回転させ、ピニオンが
遠位側に駆動軸41を前進させ、切開要素11を作動さ
せ、末端効果器15に係合した組織を切開する。
【0046】但し作動ラック53は高周波スイッチの下
フック59bが作動ラック53の溝53aから分離する
まで前進できない。これは高周波スイッチ59を作動し
た場合にだけ行なわれる。
【0047】以上のように、本発明で説明した装置は、
顎部材32、34が閉じられるまで高周波エネルギーの
適用またはメス作動を防止するための閉鎖装置または装
置群を含む。閉鎖装置では正しい手順にしたがう、すな
わち顎を閉じてから高周波エネルギーを適用し、その後
で切開要素を作動させることが必要とされる。これは戻
り止めのついた高周波スイッチも提供しているので、高
周波エネルギーはスイッチ59が手動で解除されるか、
または高周波エネルギーが例えばジェネレータ70への
電気フィードバック制御信号によって遮断されるまで連
続的に適用される。
【0048】圧締引金12と作動引金14はインターロ
ック式になっておりスプリング57は機械的に両方の引
金12、14に結合してある。
【0049】咬み合せた顎部材32、34の間に組織を
係合し、高周波エネルギーを適用した場合、ハウジング
16に配置した作動引金14を作動して切開要素11を
係合組織を通るように前進させ組織を切開することがで
きる。
【0050】特定の実施例に関連して幾つかの本発明の
変化を説明した。本質的に、本発明は止血またはその他
の電気外科的な組織効果が所望の場合に多くの用途で使
用することができる。例えば、本明細書で説明した装置
は組織を切開するための機構および/またはホチキス止
めまたはその他の締結具を適用するための機構を含むこ
とができる。例えば本明細書で参照に含めてある米国特
許出願番号第095,797号および096,154号
を参照されたい。以上のように、本発明には以下の請求
の範囲とその等価によって定義される発明の範囲を逸脱
することなく各種の変化および変更を行ない得ることが
当業者には理解されよう。
【0051】本発明の好適な態様は以下に示すように提
供される。 1.請求項1に記載の電気外科装置において、前記第1
の電極は前記第1の位置から前記第2の位置へ前記第2
の電極に対して移動可能であることを特徴とする電気外
科装置。 2.態様1に記載の電気外科装置において、前記第1の
電極は電気外科的エネルギーを組織に適用することで移
動可能であることを特徴とする電気外科装置。 3.請求項1に記載の電気外科装置において、前記第1
の電極は前記表面に係合した組織のパラメータにしたが
って前記第2の電極からの距離が適応可能であることを
特徴とする電気外科装置。 4.態様3に記載の電気外科装置において、前記パラメ
ータが組織の組成であることを特徴とする電気外科装
置。 5.態様3に記載の電気外科装置において、前記パラメ
ータが組織の厚みであることを特徴とする電気外科装
置。 6.態様3に記載の電気外科装置において、前記パラメ
ータが組織の種類であることを特徴とする電気外科装
置。 7.態様3に記載の電気外科装置において、前記パラメ
ータが組織の圧縮性であることを特徴とする電気外科装
置。 8.態様3に記載の電気外科装置において、前記パラメ
ータが組織密度であることを特徴とする電気外科装置。 9.態様3に記載の電気外科装置において、前記第1の
電極は電気外科的エネルギーを前記組織に適用すること
で前記第1と第2の位置の間に連続的に適応できること
を特徴とする電気外科装置。 10.請求項1に記載の電気外科装置において、前記第
1の電極はスプリングを含むことを特徴とする電気外科
装置。
【0052】11.請求項2に記載の電気外科装置にお
いて、前記カートリッジは所定の用途で使用するのに適
し、複数のカートリッジの中から選択自在であることを
特徴とする電気外科装置。 12.請求項2に記載の電気外科装置において、前記カ
ートリッジは所定の組織パラメータを有する組織で使用
するのに適し、複数のカートリッジの中から選択自在で
あることを特徴とする電気外科装置。 13.態様12に記載の電気外科装置において、前記組
織パラメータが電気インピーダンスであることを特徴と
する電気外科装置。 14.態様12に記載の電気外科装置において、前記組
織パラメータが組織の組成であることを特徴とする電気
外科装置。 15.態様12に記載の電気外科装置において、前記組
織パラメータが組織の圧縮性であることを特徴とする電
気外科装置。 16.態様12に記載の電気外科装置において、前記組
織パラメータが組織密度であることを特徴とする電気外
科装置。 17.態様12に記載の電気外科装置において、前記組
織パラメータが組織厚みであることを特徴とする電気外
科装置。
【0053】
【発明の効果】以上のように、本発明によれば、末端効
果器により係合する組織の種類、厚み、インピーダンス
またはその他のパラメータに適合するように前記末端効
果器の電極を設定することにより組織処理エネルギーの
効率を最適化することができる。
【図面の簡単な説明】
【図1】本発明の1つの実施例による内視鏡電気外科的
圧締兼凝固装置の斜視図である。
【図2】図1の圧締装置の下顎の底部だけを取り出した
略図である。
【図3】比較的菲薄な組織に係合する図1の装置の遠位
端の正面断面図である。
【図4】図3の組織より比較的厚い組織と係合する図1
の装置の遠位端の正面断面図である。
【図5】本発明の圧締装置の別の実施例の部分断面部分
拡大斜視図である。
【図6】末端効果器に比較的厚い組織のためのカートリ
ッジを挿入した状態を示す図5の装置の正面断面図であ
る。
【図7】図6より比較的薄い組織のためのカートリッジ
を取り付けた状態を示す図5の装置の正面断面図であ
る。
【図8】図1の装置の近位把持部の分解斜視図である。
【図9】図1の装置の中間部および遠位部の分解斜視図
である。
【図10】図1の装置の第1の開き位置での近位把持部
の側面図であり、左側面把持カバーと線材を除去して図
示したものである。
【図11】左側面把持部の内側の側面図であり、本発明
で使用する線材とコネクタの位置を示す。
【図12】本発明の装置の中間部の長手方向断面図であ
る。
【図13】中間部の近位端の側面図であり、線材からそ
れぞれの接触位置への接続を示す。
【図14】本発明の装置の中間部の近位端の拡大断面図
である。
【図15】図14の線15−15に沿って見た横断方向
の断面図である。
【図16】線材がそれぞれの接触位置で接触した状態を
示す斜視図である。
【図17】図16の端面図であり、線材がそれぞれの接
触位置へ線材の圧力をかけられるようにするわずかな曲
げを示す。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ウィリアム・ディー・フォックス アメリカ合衆国、45157 オハイオ州、ニ ュー・リッチモンド、ジェット・ヒル・ロ ード 2606 (72)発明者 デビッド・イェイツ アメリカ合衆国、45069 オハイオ州、ウ エスト・チェスター、ギャルウェイ・コー ト 7534 (72)発明者 アニル・ナラガトラ アメリカ合衆国、45249 オハイオ州、シ ンシナティ、グリーン−アーバース・レー ン 4203

Claims (3)

    【特許請求の範囲】
  1. 【請求項1】 電気外科エネルギーを受け取ることがで
    きるようにした末端効果器を有する電気外科装置であっ
    て、前記末端効果器は組織を間に係合することができる
    第1および第2の相対向するインターフェース面と、 第1の電位の第1の電極と、 前記第1の電位とは異なる第2の電位の第2の電極とを
    含み、前記第1および第2の電極は電気外科エネルギー
    を受け取るように配置され、 前記第1の電極は前記第1のインターフェース面に配置
    され、前記第2の電極は前記第1と第2のインターフェ
    ース面の少なくとも一方に配置され、 前記第1の電極は前記第2の電極から前記第1のインタ
    ーフェース面上での第1の距離にある第1の位置と、前
    記第2の電極から前記第1のインターフェース面上での
    第2の距離にある第2の位置をとることを特徴とする電
    気外科装置。
  2. 【請求項2】 電気外科エネルギーを受け取ることがで
    きる末端効果器を有する電気外科装置であって、前記末
    端効果器は間に組織を係合することができる第1および
    第2の相対向するインターフェース面と、 第1の電位の第1の電極と、 前記第1の電位とは異なる電位の電位の第2の電極とを
    含み、前記第1および第2の電極は電気外科エネルギー
    を受け取るように配置され、 前記インターフェース面の少なくとも一部を形成し、前
    記第1の電極を含む着脱自在なカートリッジをさらに含
    み、前記第1の電極は前記インターフェース面の前記一
    部に配置され前記第2の電極は前記インターフェース面
    の少なくとも一方に配置されることを特徴とする電気外
    科装置。
  3. 【請求項3】 第1および第2の相互交換自在なカート
    リッジを含み、電気外科エネルギーを受け取ることがで
    きる末端効果器を含む電気外科装置であって、前記末端
    効果器は間に組織を係合することができる、第1および
    第2の相対向するインターフェース面を含み、前記相互
    交換自在なカートリッジのそれぞれは前記末端効果器に
    挿入自在にして前記インターフェース面の少なくとも一
    部を形成し、前記カートリッジのそれぞれは第1の電位
    の第1の電極を含み、挿入したカートリッジの前記第1
    の電極は前記インターフェース面の前記一部に配置され
    ることと、 前記第1の電位とは異なる第2の電位の第2の電極をさ
    らに含み、前記挿入したカートリッジの前記第1の電極
    および前記第2の電極は電気外科エネルギーを受け取る
    ように構成してあり、前記第2の電極は前記インターフ
    ェース面の少なくとも一方に配置されることと、 前記第1のカートリッジの前記第1の電極は前記第1の
    カートリッジが前記末端効果器に挿入されたとき前記第
    2の電極から第1の距離に位置することと、前記第2の
    カートリッジの前記第1の前記第1の電極は前記第2の
    カートリッジを前記末端効果器に挿入したとき前記第2
    の電極から第2の距離に位置することを特徴とする電気
    外科装置。
JP12385996A 1995-04-12 1996-04-11 適応性電極を有する電気外科手術用止血装置 Expired - Lifetime JP3857354B2 (ja)

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US08/421,353 US5693051A (en) 1993-07-22 1995-04-12 Electrosurgical hemostatic device with adaptive electrodes
US421353 1995-04-12

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JPH08317934A true JPH08317934A (ja) 1996-12-03
JP3857354B2 JP3857354B2 (ja) 2006-12-13

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EP (1) EP0737446B1 (ja)
JP (1) JP3857354B2 (ja)
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EP0737446A1 (en) 1996-10-16
US5876401A (en) 1999-03-02
DE69625267T2 (de) 2003-11-06
US5693051A (en) 1997-12-02
ES2188721T3 (es) 2003-07-01
CA2173827C (en) 2007-03-13
JP3857354B2 (ja) 2006-12-13
AU694333B2 (en) 1998-07-16
EP0737446B1 (en) 2002-12-11
DE69625267D1 (de) 2003-01-23
CA2173827A1 (en) 1996-10-13
AU5061296A (en) 1996-10-24

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