WO2015156156A1 - プラズマ処置システム - Google Patents
プラズマ処置システム Download PDFInfo
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- WO2015156156A1 WO2015156156A1 PCT/JP2015/059754 JP2015059754W WO2015156156A1 WO 2015156156 A1 WO2015156156 A1 WO 2015156156A1 JP 2015059754 W JP2015059754 W JP 2015059754W WO 2015156156 A1 WO2015156156 A1 WO 2015156156A1
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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
- A61B18/042—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating using additional gas becoming plasma
-
- 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
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/77—Suction-irrigation systems
- A61M1/772—Suction-irrigation systems operating alternately
-
- 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
- A61B2018/00744—Fluid flow
-
- 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
- A61B2018/00863—Fluid flow
-
- 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
- A61B18/14—Probes or electrodes therefor
- A61B2018/1472—Probes or electrodes therefor for use with liquid electrolyte, e.g. virtual electrodes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/002—Irrigation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/007—Aspiration
-
- 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
- A61B90/90—Identification means for patients or instruments, e.g. tags
- A61B90/98—Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/20—Blood composition characteristics
- A61M2230/208—Blood composition characteristics pH-value
Definitions
- the present invention relates to a plasma treatment system used together with a plasma treatment tool.
- Non-Patent Document 1 discloses a probe technique relating to a treatment tool using plasma (hereinafter referred to as a plasma treatment tool) in which an active electrode and a return electrode are arranged at the probe tip.
- This treatment tool is a bipolar treatment tool in view of the electrode configuration, and can reduce the current flowing through the living tissue as compared with the monopolar.
- a plurality of cylindrical active (titanium) electrodes disposed on the center side of the tip end surface of the probe and a plurality of return (stainless steel) electrodes disposed so as to surround them are provided. ing.
- This treatment is called cryogenic ablation and is included in the low thermal invasive treatment. Specifically, it is a treatment in which a physiological saline in which plasma is generated is brought into contact with a living tissue, and the surface of the living tissue is evaporated by the energy of the plasma.
- This low-temperature ablation treatment is suitable for, for example, tonsillectomy, and has the effect of reducing postoperative pain and swelling and complications for patients when a treatment equivalent to that of a conventional electric knife is performed. Has been.
- Patent Literature 1 proposes a surgical tool that joins grasped living tissues.
- a mechanism for supplying physiological saline to a grasping portion at the distal end while grasping a living tissue is disclosed.
- the tip of the probe is immersed in a conductive solution with high electrical conductivity, for example, physiological saline, and discharged by supplying an arbitrary high-frequency AC voltage (current) power source to the active electrode, thereby generating plasma.
- a conductive solution with high electrical conductivity for example, physiological saline
- the plasma treatment device described above uses a conductive solution such as physiological saline having a high electric conductivity (electric conductivity) when generating plasma.
- physiological saline having a high electric conductivity (electric conductivity)
- the evaporated unnecessary living tissue pieces are mixed in the physiological saline as impurities with a minute size.
- impurities are mixed in the physiological saline in this manner, characteristics such as impedance change, so that a situation where the plasma is extinguished occurs depending on conditions.
- the physiological saline In order to continue the plasma generation state stably, it is preferable to keep the physiological saline always in an environment close to the time when the plasma is generated, and supply a new pure physiological saline and a physiological salt containing impurities. It is necessary to remove (suction) water.
- a configuration is realized in which a suction port is provided along with a supply port on the probe tip side, and connected to an external pump device through a tube in the treatment tool.
- the probe of this plasma treatment tool has a supply port for supplying physiological saline and a suction port for sucking and removing physiological saline at or near the distal end surface where the electrodes (active electrode and return electrode) are arranged. It is the structure provided. With these supply port and suction port, new physiological saline is supplied to the plasma generation region, and the supplied physiological saline is continuously sucked.
- physiological saline is supplied by manually adjusting the valve provided at the supply port of the physiological saline bag suspended from the support arm and supplying an appropriate amount by its own weight. Yes.
- the manual valve adjustment does not measure the actual amount of water that is suitable for the solution from the probe during treatment, but is adjusted by visual observation or by viewing the image displayed on the display screen. And the amount of suction is not known. That is, it is not easy to control the supply amount of physiological saline to the minimum supply amount by manual operation of the valve according to the reference amount.
- the present invention provides the minimum necessary conductivity for a treatment instrument that performs treatment on a living tissue by generating a plasma near the electrode by flowing a high-frequency current through a conductive solution supplied between the two electrodes. It is an object of the present invention to provide a plasma treatment system capable of supplying and sucking a sex solution.
- a plasma treatment system includes a first electrode and a second electrode paired with the first electrode, and is supplied between the first electrode and the second electrode.
- the treatment part which treats living tissue by generating plasma in the conductive solution which immerses the 1st electrode and the 2nd electrode by the high frequency energy which, and the 1st electrode and the 2nd electrode And a predetermined ratio between a supply amount from the supply unit that supplies the conductive solution immersed between the treatment target surface layer of the living tissue and a suction amount from the suction unit that sucks the conductive solution.
- a detection unit that detects a setting unit to be set, a supply amount of the conductive solution supplied from the supply unit, and a suction amount of the conductive solution sucked into the suction unit; and detected by the detection unit Based on the supply amount and the suction amount. And a control unit for controlling the amount and the suction amount to the ratio set by the setting unit.
- a plasma treatment system including a supply / suction unit that supplies and sucks a minimum necessary amount of a conductive solution to a treatment instrument that generates a plasma in the conductive solution and performs a treatment on a living tissue. can do.
- FIG. 1 is a block diagram showing an overall configuration of a plasma treatment system including a supply suction unit.
- FIG. 2 is a cross-sectional configuration diagram showing a partial arrangement configuration of the distal end portion of the probe of the plasma treatment apparatus.
- FIG. 3 is a diagram illustrating a configuration of the supply suction unit according to the first embodiment.
- FIG. 4 is a diagram showing the amount of physiological saline supplied and sucked to the probe during treatment.
- FIG. 5 is a flowchart for explaining a treatment method in the plasma treatment system.
- FIG. 6 is a diagram illustrating an example of the ratio of the supply amount and the suction amount of physiological saline by the plasma treatment device system according to the second embodiment.
- FIG. 7 is a diagram illustrating a configuration example of a plasma treatment system according to the third embodiment.
- FIG. 8 is a diagram illustrating a configuration example of a plasma treatment system including a pH sensor according to the fourth embodiment.
- FIG. 9A is a diagram illustrating an external configuration of a distal end portion of a probe of the plasma treatment instrument according to the fourth embodiment.
- FIG. 9B is a diagram showing a cross-sectional configuration of the distal end side of the probe shown in FIG. 9A.
- FIG. 1 shows a block configuration of the entire plasma treatment system including a supply suction unit.
- the plasma treatment system 1 is used for a treatment in which plasma is generated and a living tissue to be treated is evaporated by the plasma. By excising the living tissue using plasma, thermal damage around the excised tissue becomes relatively small, and a minimally invasive treatment is realized.
- the plasma treatment system 1 is used for excision of tonsil tissue in the field of otolaryngology, for example.
- this plasma treatment system 1 may be used for excision of synovium and cartilage in the orthopedic field, and may be used for excision of an organ (particularly liver) in general laparotomy.
- the plasma treatment system 1 is roughly divided into a control unit 2 that controls the whole, a power source unit 3 that outputs radio frequency (RF) power, and physiological saline that is a conductive solution (or conductive fluid).
- RF radio frequency
- control unit 2 that controls the entire system includes a processing unit having an arithmetic processing function, and a memory that stores a processing program and preset or appropriately set numerical information, a control table, and the like. It has the same function as a personal computer. Furthermore, an input unit including an input panel for inputting and setting information, a keyboard, and the like, and a display unit 9 for displaying information related to treatment, information set or detected, and the like are provided. Further, the control unit 2 is connected to a plurality of switches 8 for performing a plasma treatment described later, for example, a water supply switch, a drain switch, a foot switch, and the like. The plurality of foot switches are switches for applying high-frequency power of different output levels to each, and are selected and operated by the operator according to the content of treatment.
- a memory for storing an ID may be provided in the plasma treatment instrument, and the ID may be read out to the control unit 2 when a cable is connected to the control unit 2.
- the control unit 2 has a plurality of plasma treatment instrument setting conditions (for example, a power supply voltage level to be supplied, a physiological saline supply amount and a suction amount, etc.) having different specifications associated with the ID. Set the stored table. With this configuration, the ID is specified when the cable is connected, the setting condition of the plasma treatment tool is selected from the table, and the apparatus system (the control unit 2 and the power supply unit 3) is set without an operator input operation.
- the power supply unit 3 outputs high-frequency energy (hereinafter referred to as high-frequency power) composed of a high-frequency current (voltage) such as a sine wave or a pulse wave.
- the power supply unit 3 has a tuning function for a reflected wave generated by a load (impedance) of an application target of high-frequency power.
- high-frequency power of a plurality of output levels is set to be selectable and can be switched by the control of the control unit 2. For example, if the required driving power differs for each type of treatment target or plasma treatment, an output level suitable for the treatment to be performed is selected and set. It is also possible to set the driving power to be supplied depending on the type of plasma treatment tool (for example, the difference in the shape of the active electrode). Further, for example, different output levels can be set according to the type of treatment such as the transpiration and coagulation mode and the coagulation mode.
- the control unit 2 reads the ID information from the treatment instrument and automatically performs the setting operation by the operator input panel.
- the output level may be set to
- the physiological saline bag 4 can use what is generally marketed.
- the plasma treatment instrument 7 is basically a disposable treatment instrument (disposable type) after use.
- the gripper 7a and the probe 7b constitute a treatment instrument body (7). It has a pen shape.
- the plasma treatment tool 7 of the present embodiment is configured to turn on the power at the time of treatment by turning the foot switch on and off as described above.
- an operation switch (hand switch) (not shown) is provided on the grip portion 7a. It may be provided to turn on / off the power supply during treatment.
- terminals 12a and 12b for taking in high-frequency power which is high-frequency energy from the power supply unit 3 are arranged at the rear end of the gripping unit 7a, and a power cable 13 is detachably connected to these terminals 12. Yes. Further, the power cable 13 is detachably connected to the power supply unit 3 by a connector 14.
- the power cable 13 is preferably an electromagnetic shield cable or the like so that high frequency does not leak to the outside and noise is not superimposed on the cable from the outside.
- the plasma treatment instrument 7 after use is an example of discarding integrally.
- the gripping portion 7a and the probe 7b are detachable separately, only the removed probe 7b is discarded. Can do.
- the treatment instrument body and the power cable 13 are separated, the power cable 13 can be reused.
- the probe 7b of the plasma treatment instrument 7 has a cylindrical shape, and at least one active electrode (first electrode) is provided in the distal end surface 7c. ) 15 and a return electrode (second electrode) 16 are juxtaposed. These electrodes 15 and 16 are electrically connected to the terminals 12a and 12b by internal wirings 17a and 17b.
- a configuration example of a so-called bipolar electrode is shown.
- the bipolar electrode in this plasma treatment is not arranged with the electrode pair outside the living body tissue to be treated like a monopolar, but arranged so that each electrode faces one surface of the living tissue inside the body cavity. Is done.
- the active electrode and the return electrode are opposed to each other at a close distance on the distal end surface of the treatment instrument, or are arranged at close positions.
- These electrodes are configured to be electrically separated by interposing a member formed of an insulating material between the electrodes. Therefore, since the generated plasma contacts only the surface of the living tissue, it acts to reduce postoperative pain, swelling, and complications for the patient.
- high frequency power is supplied in a state where the active electrode 15 and the return electrode 16 are immersed in a physiological saline that is perfused (irrigation), that is, when the switch 8 is turned on
- high frequency power is applied to the active electrode 15.
- plasma is generated between the active electrode 15 and the return electrode 16. More specifically, a high-frequency current is passed through the physiological saline existing between the two electrodes 15 and 16 to evaporate the physiological saline and create a vapor layer near the electrode 15. It is considered that plasma is generated by applying an electric field to this vapor layer.
- the living tissue can be evaporated by the action of OH radicals or the like in the plasma.
- the return electrode 16 is formed to be larger than the active electrode 15 out of the electrode surface area in which the active electrode 15 and the return electrode 16 are immersed in physiological saline. is there. This is because if the area of the return electrode 16 is smaller than that of the active electrode 15, the return electrode 16 serves as the active electrode 15, and a desired plasma may not be generated as desired.
- a plurality of supply ports 18 having a circular arc shape arranged continuously are opened at the circumferential edge portion of the distal end surface 7 c of the probe 7 b, and a suction port 19 is opened below the active electrode 15. Yes.
- the plasma treatment instrument 7 is electrically insulated so that high frequency power does not leak outside, except for the distal end surface 7c of the probe 7b.
- the wiring connected to the active electrode and the return electrode in the plasma treatment instrument 7 uses a high-frequency shielded cable that is shielded and electrically insulated from high-frequency waves.
- the arrangement position of the supply port 18 and the suction port 19 is preferably a position where the active electrode 15 and the return electrode 16 are sandwiched therebetween.
- One end of the inner tubes 20 and 21 is connected to the supply port 18 and the suction port 19 and passes through the probe 7b.
- the inner tubes 20 and 21 are detachably connected to the outer tubes 22 and 23, respectively.
- the inner tubes 20 and 21 and the outer tubes 22 and 23 may be a single tube.
- the return electrode 16 and the supply port 18 are not necessarily arranged on the distal end surface 7c, and may be arranged on the cylindrical side surface of the probe 7b. At least the supply port 18 is not particularly limited as long as it is disposed on the outer peripheral side or the gripping part 7a side than the return electrode 16 and the active electrode 15 and the return electrode 16 can be immersed in physiological saline.
- the probe 7b shown in FIG. 1 conceptually shows the tip surface 7c as a surface perpendicular to the outer peripheral surface.
- it is formed on a surface that is cut obliquely with respect to the outer peripheral surface in consideration of operability so that the operator can easily grasp the grasping portion and perform treatment.
- the distal end surface 7c of the probe 7b is formed to face the surface of the biological tissue to be treated in parallel.
- the physiological saline 40 supplied through the tube 20 is perfused from the supply port 18 to form a perfusion layer between the distal end surface 7 c of the probe 7 b and the biological tissue 41. . Further, the physiological saline is sucked from the suction port 19 and drained through the suction tube 21. At this time, the physiological saline 40 flowing out from the supply port 18 passes through the active electrode 15 and the return electrode 16 and is sucked into the suction port 19 together with the evaporated biological tissue.
- the active electrode (first electrode) 15 and the return electrode (second electrode) 16 are immersed in the perfusion layer of the physiological saline 40, when high frequency power is applied to the active electrode 15, a discharge occurs and a plasma generation region is generated. Is generated.
- One principle that is currently inferred is that the physiological saline 40 is separated into molecular sizes in the plasma generation region to generate cations with high energy, and these cations collide with living tissue (eg, large Etching phenomenon in atmospheric pressure plasma) to destroy and scrape the tissue surface and separate it from the living tissue 41 with molecular size. At the same time, the scraped tissue surface is solidified.
- the living tissue that has been scraped off and separated is suspended in the physiological saline, and is sucked into the suction port 19 together with the physiological saline 40 and discharged.
- the plasma generation condition depends on the structural specifications such as the shape of the active electrode 15 and the return electrode 16 and the distance between the electrodes, and the characteristics of the conductive solution (for example, physiological saline) to be used. ⁇ Currents are different and specific specifications are found at the time of design.
- the supply / suction unit 5 shown in FIG. 1 supplies and drains (suctions) physiological saline (conductive solution) to the plasma treatment instrument 7.
- the plasma treatment device 7 is aspirated to suck in saline containing biological tissue evaporated from the supply line 31 for supplying physiological saline to the plasma treatment device 7 and the probe 7b of the plasma treatment device 7.
- Two flow paths to the line 32 are provided.
- the supply line 31 is a line for supplying physiological saline to the plasma treatment device 7, and a supply pump (supply unit) 33, a temperature adjustment unit 34, and a supply amount sensor 35 are connected from the upstream side on the flow path, for supply.
- the tubes 39 are connected.
- the supply line 31 and the suction line 32 may be separate from the plasma treatment instrument 7.
- the supply pump 33 takes out new physiological saline from the physiological saline bag 4 and supplies the supply amount instructed to the control unit 2 to the probe 7 b of the plasma treatment instrument 7.
- the supply pump 33 is not particularly limited, a so-called roller pump that has a structure that can be easily managed and maintained in terms of hygiene and that transports the liquid inside while crushing the elastic tube by rotation of the roller is suitable.
- What supplies physiological saline is not limited to the physiological saline bag 4, It may be loaded in the container (for example, container with the scale) which can measure physiological saline at the time of manufacture. .
- a suction amount sensor (flow rate sensor) is arranged on the upstream side of the suction pump (suction unit) 36, and the physiological saline sucked from the probe 7 b through the suction tube 21 is passed by the suction pump (suction unit) 36. Measure the suction volume.
- the physiological saline sucked by the suction pump (suction unit) 36 may be stored in a container capable of being measured.
- the controller 2 detects the level of the physiological saline in the container by moving the floated float or using an optical sensor, and calculates the volume of the collected physiological saline. Or it calculates as the volume of the physiological saline from the weight of a container.
- the supply amount supplied and the suction amount sucked can be detected from the change in volume of the physiological saline.
- the temperature adjustment unit 34 cools or warms the physiological saline sent out from the supply pump 33 and adjusts the temperature to a predetermined range suitable for surgery.
- the physiological saline also has an action of cooling the probe tip including the electrodes 15 and 16.
- the supply amount sensor (detection unit) 35 is one of known flow rate sensors, detects the supply amount of physiological saline supplied to the probe 7 b, and transmits the supply value signal to the control unit 2.
- the temperature adjustment unit 34 and the supply amount sensor 35 are arranged in this order from the upstream side on the flow path. However, the supply amount sensor 35 is arranged on the upstream side to connect the temperature adjustment unit 34 to the temperature adjustment unit 34. The position may be reversed and the configuration may be more focused on the physiological saline temperature.
- the suction line 32 is arranged in the order of the suction amount sensor 38, the temperature sensor 37, and the suction pump 36 from the upstream probe 7b, and the physiological saline sucked from the probe 7b by the suction pump (suction unit) 36 is stored in the drainage tank 6.
- the suction pump 36 is connected to the plasma treatment tool 7 by the suction tube 40, and sucks the perfusion layer of physiological saline containing the living tissue perfused and evaporated at the tip of the probe 7b.
- the suction amount sensor 38 detects the suction amount of the physiological saline drained by the suction of the suction pump 36 and transmits it to the control unit 2 as a suction value signal.
- the sensors (detection units) 35 and 38 are supplied with physiological saline (conductive solution) supplied from the supply port (supply unit) 18 and physiological saline sucked into the suction port (suction unit) 19. And a signal is output to the control unit 2.
- the temperature sensor 37 detects the temperature of the physiological saline after the detection of the suction value signal, and transmits it to the control unit 2 as a temperature signal.
- the amount of physiological saline necessary for the plasma treatment is the distance L between the surface of the living tissue 41 and the distal end surface 7c of the probe 7b shown in FIG. 3 on the distal end surface 7c including both electrodes 15 and 16.
- the amount of water multiplied by the area A, and the amount of water that forms a perfusion layer at the tip of the probe 7b is M1. That is, the amount of water M1 is the amount of water defined as the distance at which the active electrode 15 comes close to the living tissue 41 without contacting the living tissue 41 and the plasma generation region comes close to the living tissue 41 when the plasma is generated. is there.
- the supply amount or the suction amount depends on the distance L from the distal end surface (tip end) 7c of the probe 7b to the surface layer of the living tissue on which the generated plasma acts, and the arrangement of the active electrode 15 and the return electrode 16. It is determined by the product with the area A of the perfusion layer formed by water (conductive solution).
- a measuring device using light irradiation may be used for the distance L.
- an arch-shaped card protruding beyond these electrodes may be provided at a position outside the active electrode 15 and the return electrode 16. This card is formed outside the plasma region, and its height is set to a distance required to generate a plasma discharge.
- the distance L is not actually measured, it is assumed that the impedance value obtained when a good plasma is generated after the start of treatment is obtained when the distance is an optimum distance.
- the impedance value is read and set as an appropriate distance reference value, and the distance between the treatment object and the electrode in the probe 7b is moved so that the impedance value detected during the subsequent treatment approaches the reference value of the distance. May be.
- set a range within the set reference value If the detected value is within the range, display a green lamp, and if it is out of the range, notify the operator with a red lamp. May be.
- the minimum required amount of water Mmin is obtained.
- This necessary minimum amount of water Mmin is set as a target amount M of the amount of water adjusted by the supply amount and the suction amount.
- the target amount M is set by the control unit 2 based on the above-described area (or immersion range) A and distance (shortest distance on which plasma acts) L. That is, the control unit 2 also functions as a setting unit. That is, the setting unit of the control unit 2 is directed from the return electrode 16 to the active electrode 15 and from a supply port (supply unit) 18 that perfuses physiological saline (conductive solution) so as to immerse the electrodes 15 and 16 together.
- FIG. 4 is a diagram showing the relationship between the amount of saline supplied and the amount of suction as a target amount M of saline water.
- the supply amount of the physiological saline according to the present embodiment is changed by supplying (feeding) physiological saline until the target amount M is reached, and then gradually increasing at the target amount M.
- the suction is started and the target amount M is maintained.
- the plasma treatment is started.
- the physiological saline in the perfusion layer formed on the probe 7b is completely sucked.
- the periods (1) and (2) shown in FIG. 4 are the supply pump drive period (4) for driving the supply pump 33 for supplying physiological saline, and the periods (2) and (3) are physiological.
- the suction pump drive period (5) for driving the suction pump 36 for sucking the saline solution is entered.
- the shared period (2) is a supply / suction period (6) in which both pumps are driven and the amount of saline perfusion layer formed at the probe tip is maintained at the target amount.
- plasma is generated on the active electrode 15 to perform plasma treatment. After the plasma is stopped, the supply pump 33 is stopped and the suction pump 36 is continuously driven to suck all the physiological saline remaining at the tip of the probe 7b, and the plasma treatment is completed.
- the control unit 2 generates physiological saline between the first and second electrodes 15 and 16 when the plasma is generated in a state where the physiological saline is interposed in the vicinity of the electrodes 15 and 16 by high-frequency energy. While the (conductive solution) is perfused, the supply pump 33 and the suction pump 36 are controlled so that the supply amount and the suction amount are substantially the same. That is, as described later, in the control unit 2, the coefficient (ratio) between the first information and the second information is 1: 1. This coefficient (ratio) is set so that the physiological saline, which is a conductive solution, has a minimum amount of water necessary for plasma generation.
- a supply pump that perfuses physiological saline (conductive solution) so as to dip both the first and second electrodes 15 and 16 from the second electrode 16 toward the first electrode 15.
- the amount of physiological saline supplied from 33 and the physiology sucked into a suction pump (suction unit) 36 that sucks and discharges the physiological saline perfused through the first and second electrodes 15 and 16.
- Detection that detects a setting unit that sets the suction amount of saline to a predetermined ratio, a supply amount of saline supplied from the supply pump 33, and a suction amount of saline that is sucked into the suction pump 36
- the control unit 2 that controls the supply amount and the suction amount to the ratio set by the setting unit based on the supply amount (water supply amount) and the suction amount detected by the detection units 35 and 38, Configure the control system.
- the control system performs feedback control by comparing the supply amount detected by the supply amount sensor 35 with the suction amount detected by the suction amount sensor 38, and the supply amount and the suction amount are predetermined target amounts M.
- the control part 2 which controls to become is provided.
- the procedure of the plasma treatment in the plasma treatment tool 7 of this embodiment is demonstrated.
- the distal end surface 7c of the plasma treatment device 7 is arranged at the close position (narrow gap) of the treatment target, the water supply switch of the switch 8 is operated, the supply pump 33 is driven, and physiological saline Stays at the tip of the probe 7b (step S1).
- the suction pump 36 is driven to be described later.
- the supply amount and the suction amount are balanced and perfused to maintain the target amount M of water (step S3).
- the surgeon operates the foot switch to apply high-frequency power from the power supply unit 3 to the active electrode 15 at the tip of the probe 7b, generate plasma, and perform a treatment to evaporate the desired living tissue (step) S4).
- the control unit 2 determines whether or not the operator has finished the treatment (step S5), that is, determines whether or not the foot switch has been turned off.
- the application is stopped to finish the plasma treatment, the plasma is extinguished, the supply pump 33 is stopped (step S6), and only the suction pump 36 is driven to complete the suction of the physiological saline perfused to the tip of the probe 7b. Then, the suction pump 36 is stopped (step S7).
- the perfusion of physiological saline may be controlled so that the target amount M is continuously maintained until the treatment is completed. Ordinarily, the perfusion is stopped and plasma is generated. Control may be performed to set the perfusion rate of the physiological saline to the target amount M immediately before every time. Further, the surgeon's foot switch may replace the water supply switch, and when the water amount reaches the target amount M, the high frequency power may be applied.
- the supply amount sensor and the suction amount sensor can use the flow rate sensor of the same specification and obtain the same value of the detection signal at the same flow rate.
- the detection signal value for the passing flow rate is defined, the comparison between the supplied water amount and the sucked water amount can be easily performed by correcting the signal value.
- the supply pump 33 is driven to supply physiological saline so that the amount of water in the perfusion layer formed on the distal end surface 7c of the probe 7b becomes the target amount M.
- the suction pump 36 is started to adjust the flow rate by sucking the same suction amount as the supply amount.
- the signal is taken and feedback control (feedback control) is repeatedly performed so that the differential signal always approaches zero.
- feedback control feedback control
- the suction amount of the suction pump is changed equally so as to synchronize.
- the target amount M is kept constant within the range in which the plasma state can be maintained
- the suction amount of the suction pump is increased in proportion.
- the flow rate of the physiological saline perfusion increases, that is, the period of staying at the tip of the probe is shortened, and the recovery of the physiological saline containing impurities (tranformed biological tissue) after the treatment can be accelerated.
- the supply amount of physiological saline supplied from the supply pump 33 to the plasma treatment instrument 7 and the suction amount recovered from the physiological saline after treatment from the plasma treatment instrument 7 are always
- the supply and suction flow rates can be adjusted independently to achieve the same amount. Therefore, the amount of water to be perfused on the tip of the probe 7b can be arbitrarily set by supplying a desired supply amount and adjusting the water amount to suck the supplied water amount, and can be adjusted to the minimum required water amount Mmin.
- the system 1 for example, almost all of the supplied physiological saline can be aspirated in the tonsillar transpiration treatment, so that the physiological saline enters the bronchus or the like without being aspirated. Aspiration can be prevented as much as possible.
- the area A can be set as appropriate.
- the area of the tip surface 7c of the probe 7b may be used as the area A as it is.
- the suction port 19 provided in the distal end surface 7c of the probe 7b of the plasma treatment instrument 7 sucks physiological saline perfused through the distal end surface 7c by the suction pump 36 and discharges it to the drain tank 6.
- the physiological saline sucked from the suction port 19 is in a state including the living tissue evaporated by the plasma.
- the living tissue is destroyed by plasma and transpiration, so that the living tissue of a minute size is in a floating state.
- a small piece of living tissue may be included.
- a threshold value (judgment value) is set in advance for the flow rate signal B, the normal water amount is supplied, and the signal value of the flow rate signal B is If it falls below the threshold, it is determined that the suction line 32 is clogged because the amount of physiological saline passing therethrough is reduced.
- the supply pump 33 can be stopped to stop the supply of physiological saline, and the plasma treatment can be stopped safely.
- an alarm function (not shown), when the supply pump 33 is stopped when the switch 8 is on, it is possible to notify the operator that an abnormality has occurred. When this notification reaches the surgeon, it is possible to call attention to an abnormal situation of the treatment tool.
- FIG. 6 shows two characteristic lines (K1, K2) based on a coefficient K which is a ratio of each of the supply amount and the suction amount of physiological saline in the first and second plasma treatment tools, and the output level of the high-frequency power. It is a figure which shows the relationship.
- the coefficient K is recorded in advance in a setting unit provided in the control unit 2, and here, a characteristic composed of a linear first-order equation is shown as an example. However, it may have a curvilinear characteristic composed of a quadratic expression or a characteristic that changes stepwise.
- the value of the coefficient K is determined experimentally according to the probe specifications (design specifications such as the tip shape, electrode shape, the diameter of the supply port and the suction port, the arrangement position, the applied high-frequency power value, etc.) in the design stage of the treatment instrument. Or it can be obtained empirically.
- the required amount of physiological saline used is different. Further, the supply amount is not necessarily equal to the suction amount.
- the suction amount (second information in the control unit 2) may be smaller than the amount (first information in the control unit 2).
- the coefficient K1 1 when the output level is P1, that is, the supply amount and the suction amount are equal. That is, in the control unit 2, the coefficient (ratio) between the first information and the second information is 1: 1. This coefficient (ratio) is set so that the physiological saline, which is a conductive solution, has a minimum amount of water necessary for plasma generation.
- the ratio information on the ratio stored in the control unit 2 is read from the output level of the high-frequency power applied to realize the plasma treatment selected by the operator or the like.
- the required supply amount and suction amount of physiological saline can be set in the supply suction unit 5.
- the ratio information detected from the supply amount and the suction amount of the physiological saline actually perfused by the probe 7b is applied to the ratio information stored in the control unit 2.
- the value of the high frequency power applied to the active electrode 15 of the probe 7b can be set.
- the output level of the high-frequency power applied to the probe of the plasma treatment device is controlled according to the supply amount and suction amount of the physiological saline at the tip of the probe. Furthermore, the ratio of the supply amount and the suction amount of physiological saline, which is a conductive solution, is set only by the operator selecting the output level of the high-frequency power corresponding to the plasma treatment with a switch or the like, and the distal end surface of the probe 7b 7c is perfused to form a perfusion layer with a minimum amount of water between the treatment target and a plasma treatment is performed.
- FIG. 7 shows a configuration example of this embodiment in which an intraoperative nerve monitoring system (Nerve Integrity Monitor system) 51 is added to the configuration of the plasma treatment device system shown in FIG.
- an intraoperative nerve monitoring system Neve Integrity Monitor system
- the intraoperative nerve monitoring system 51 is a known system.
- a monitor electrode (not shown) is attached to an innervating muscle near a living tissue to be treated during surgery, and a stimulus signal with a constant current output is sent from a stimulator (not shown) as needed. It is determined whether or not the nerve is affected by surgery or treatment based on sound or image (waveform) based on the signal obtained from the monitor electrode. Based on this judgment, the probe 7b of the plasma treatment instrument 7 is operated to confirm that the normal nerve is not damaged, and the transpiration treatment of the treatment target is performed.
- a warning signal is transmitted from the intraoperative nerve monitoring system 51 to the control unit 2 and a warning sound or a warning display is performed.
- the control unit 2 stops the application of high-frequency power from the power supply unit 3 to the probe 7b, and stops the supply pump 33 to stop the supply of physiological saline. Furthermore, the suction pump 36 is stopped after a predetermined time, and the treatment is interrupted.
- the present embodiment during the plasma treatment, when nerves that are affected by the plasma treatment are confirmed by monitoring the nerves in the vicinity of the treatment target as needed, By warning and also interrupting the plasma treatment without the operator's stop operation, it is possible to prevent thermal invasion to the nerve, so postoperative pain can be reduced.
- FIG. 8 shows a configuration example of this embodiment in which a pH (hydrogen ion concentration index) sensor having a known detection configuration is added to the configuration of the plasma treatment instrument system shown in FIG.
- FIG. 9A shows an external configuration of the distal end portion of the probe 61 (7b) of the plasma treatment device of the fourth embodiment
- FIG. 9B shows a cross-sectional configuration of the distal end side of the probe 61.
- physiological saline Generally, after plasma treatment, living tissues (such as mucous membranes and mucus) evaporated in physiological saline are mixed, so that the pH changes with respect to pure physiological saline before treatment.
- the pH change is detected, the treatment state is grasped, and the supply amount and the suction amount of the physiological saline are increased and decreased, the high frequency power is controlled with respect to the plasma generation state, and the like.
- the probe 61 has a cylindrical shape, and its tip surface is recessed in a concave shape.
- the probe 61 is formed such that four wave-shaped protrusions 61a continuously extending around the probe 61a extend. As shown in FIG. 9B, these protrusions 61a have the same length (distance) t from the tip surface to the protrusion top as the distance L described in the first embodiment defined in the plasma generation region. Is set.
- a suction port 19 is opened at the center of the distal end surface.
- the protrusion 61a has a plurality of supply ports 18 continuously open on the inner peripheral side surface.
- a ring-shaped active electrode 62 that is supported by a plurality of support columns so as to be separated from the distal end surface is provided. Further, a ring-shaped return electrode 63 is provided on the tip surface outside the support column.
- the physiological saline is perfused from the plurality of supply ports 18 toward the suction port 19 at the center of the distal end surface to form a perfusion layer similar to that of the first embodiment.
- the protrusion 61a can provide a distance between the active electrode 62 and the living tissue. This prevents high frequency energy from being input to the living tissue while the active electrode 62 is in direct contact with the living tissue.
- the protrusion 61a has a concave portion, it is possible to prevent a closed space from being formed by the probe tip surface, the protrusion 61a, and the living tissue. For this reason, it is possible to prevent the living tissue from coming into contact with the active electrode 62 by the suction through the suction port 19.
- the pH sensor may be arranged in the vicinity of the active electrode 62, but it is also assumed that the physiological saline mixed with the living tissue is not perfused on the pH sensor depending on the moving direction of the probe 61.
- a pH sensor 64 is provided so as to surround the suction tube at a position where the suction port 19 enters the inside.
- the pH of physiological saline has an acidic characteristic of about 5.5-6.
- the biological tissue for example, body fluid, blood, etc., about pH 7.4
- the pH value increases, that is, it approaches alkalinity.
- the level of the high frequency output may be increased so as to increase the plasma density.
- the control unit 2 includes a table that stores a pattern of increase / decrease in the output level of high-frequency power or increase / decrease in physiological saline depending on the degree of pH, and is preset according to the pH degree detected by the pH sensor. A pattern is selected and each control is performed.
- the pH sensor is provided at a position entering the inside from the suction port 19 so that the physiological saline containing the treated biological tissue is passed and the pH degree is measured. be able to.
- the current plasma treatment state can be grasped from this measured value, and the supply amount and suction amount of physiological saline can be increased or decreased, and high-frequency power can be controlled with respect to the plasma generation state.
- the control unit 2 sets a set value for switching the supply amount and the suction amount of the physiological saline on the treatment instrument side and the output level of the high-frequency power. You may decide on a table.
- the protrusion 61a is formed at a height capable of forming a perfusion layer having a predetermined amount of water around the distal end surface, the surgeon simply presses the distal end of the probe, and a space for treatment (plasma) Generation area) can be secured. Further, since the plasma generation region can be limited by the protrusion, even when a nerve or the like is present in the vicinity of the treatment target location, the treatment can be performed to the vicinity of the nerve.
- a treatment instrument having a pair of bipolar electrodes for supplying the high-frequency energy to the living tissue;
- a supply unit that is provided in the treatment tool and supplies a conductive solution for generating plasma from the treatment tool toward a surface layer treated by the living tissue;
- a suction part provided on the treatment instrument for sucking the conductive solution;
- a predetermined ratio is set which is a ratio between predetermined first information of the conductive solution supplied from the supply unit and predetermined second information of the conductive solution sucked into the suction unit.
- a setting section to A detection unit for detecting a supply amount of the conductive solution supplied from the supply unit, and a suction amount of the conductive solution sucked into the suction unit;
- a control unit for controlling the supply of the high-frequency energy to the living tissue based on the predetermined ratio from the ratio of the supply amount and the suction amount detected by the detection unit;
- a plasma treatment system comprising:
- the detection unit is electrically connected to and interlocked with a calculation unit that calculates the volume of the supply amount or the suction amount relative to the supply amount or the height of the liquid level in the instrument for measurement.
- the plasma treatment system according to item (1) wherein 3.
- the plasma treatment system according to (1), wherein the supply amount or the suction amount is an amount determined by a distance between a surface layer area of the living tissue to be treated and the bipolar electrode.
- the control unit is electrically connected to a first sensor that detects the presence or absence of nerve tissue below the surface of the living tissue, When there is the nerve tissue, the control unit controls to stop at least one of the supply unit, the suction unit, and the supply of the high-frequency energy, The plasma treatment according to (1) system.
- the controller is configured such that an opening provided at a distal end portion of the suction portion or a channel communicating from the opening to a proximal end portion of the treatment instrument is closed with the solution and the treatment object. Electrically connected to a second sensor for detecting information to be shown, The control unit controls that the opening is closed based on the information of the second sensor so as to stop at least one of the supply unit, the suction unit, and the supply of the high-frequency energy.
- the plasma treatment system according to (1). 6).
- a treatment instrument that treats the living tissue by providing the distal portion with a pair of bipolar electrodes that extend from the proximal end portion to the distal end portion and supply the high-frequency energy to the living tissue;
- a supply unit that is provided in the treatment tool and supplies a conductive solution from the distal end portion toward a surface layer treated by the living tissue;
- a suction portion for sucking the supplied conductive solution from the distal end portion of the treatment instrument to the proximal end portion;
- a detection unit for detecting the pH of the conductive solution sucked by the suction unit;
- a setting unit for setting a predetermined pH of the conductive solution when sucked by the suction unit;
- a temperature adjusting unit that is provided in the treatment instrument and adjusts the temperature of the conductive solution to warm or reduce the temperature of the conductive solution supplied by the supply unit; The temperature of the conductive solution obtained by the detection unit is compared with the predetermined pH threshold value of the conductive solution, and the temperature of the conductive solution
- the second control unit adds the supply amount, the suction amount, and the living tissue.
- the plasma treatment system according to item (8), wherein the application of the high-frequency energy to be supplied is controlled to be stopped.
- a control system used with a plasma treatment instrument comprising: A supply amount of the conductive solution supplied from the supply unit so as to immerse the first and second electrodes from the second electrode toward the first electrode, and the first and second electrodes.
- a control unit that controls the supply amount and the suction amount to the ratio set by the setting unit based on the supply amount and the suction amount detected by the detection unit; Control system with.
- SYMBOLS 1 Plasma treatment system, 2 ... Control part, 3 ... Power supply part, 4 ... Saline bag, 5 ... Supply suction part, 6 ... Drain tank, 7 ... Plasma treatment tool, 7a ... Grasping part, 7b ... Probe, 7c ... tip end face, 8 ... switch, 9 ... display section, 10 ... tube for suction, 12a. 12b ... terminal, 13 ... power cable, 14 ... connector, 15 ... active electrode, 16 ... return electrode, 17a. 17b ... Internal wiring, 18 ... Supply port, 19 ... Suction port, 20, 21 ... Inner tube, 22,23 ... External tube, 31 ... Supply line, 32 ... Suction line, 33 ... Supply pump, 34 ...
- Temperature adjustment unit 35 ... Supply amount sensor, 36 ... Suction pump, 37 ... Temperature sensor, 38 ... Suction amount sensor, 40 ... Saline, 41 ... Biological tissue, 51 ... Intraoperative nerve monitoring system, 61 ... Probe, 61a ... Projection, 62 ... active electrode, 63 ... return electrode, 64 ... pH sensor.
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Abstract
Description
また、把持した生体組織同士を接合する手術具が特許文献1に提案されている。この手術器具は、生体組織を把持した状態で、先端の把持部に生理食塩水を供給する機構が開示されている。
手動によるバルブ調整は、処置中のプローブから液適される実際の水量を測定しているものではなく、目視又は、表示画面に表示されている画像を観て調整しているため、実際の供給量及び吸引量は把握できていない。つまり、生理食塩水の供給量を、目分量によるバルブの手動操作で必要最小限の供給量に制御することは、容易なことではない。
そこで本発明は、2つの電極間に供給される導電性溶液に高周波電流を流すことで電極付近にプラズマを発生させて生体組織に対して処置を行う処置具に対して、必要最小限の導電性溶液を供給及び吸引可能なプラズマ処置システムを提供することを目的とする。
[第1の実施形態]
第1の実施形態について説明する。図1は、供給吸引部を含むプラズマ処置システム全体のブロック構成を示している。このプラズマ処置システム1は、プラズマを発生させ、このプラズマによって処置対象である生体組織を蒸散させる処置に用いられる。プラズマを利用した生体組織の切除により、切除組織周辺への熱損傷は比較的小さくなり、低侵襲な処置が実現される。プラズマ処置システム1は、例えば耳鼻咽喉科分野において、扁桃組織の切除術などに用いられる。また、このプラズマ処置システム1は、例えば、整形外科分野において滑膜の切除、軟骨の切除などに用いても良いし、開腹手術全般において臓器(特に肝臓)の切除などに用いても良い。
プラズマ処置具7は、基本的には、使用後使い捨てるタイプ(ディスポーザブルタイプ)の処置具であり、図1に示すように、把持部7aとプローブ7bとで処置具本体(7)を構成し、ペン型形状を成している。本実施形態のプラズマ処置具7は、処置時の電源投入を前述したフットスイッチのオン・オフにより行う構成であるが、他に、把持部7aに操作スイッチ(ハンドスイッチ)(図示せず)を設けて、処置時の電源投入のオン・オフを行ってもよい。
尚、プラズマを生体組織に近づけると、プラズマ内のOHラジカル等の作用により、生体組織を蒸散させることができる。
図1に示す供給吸引部5は、プラズマ処置具7に対して、生理食塩水(導電性溶液)の供給と排水(吸引)を行う。具体的には、プラズマ処置具7には、生理食塩水をプラズマ処置具7に供給する供給ライン31と、プラズマ処置具7のプローブ7bから蒸散された生体組織を含む生理食塩水を吸引する吸引ライン32との2つの流路が設けられている。
供給ライン31は、プラズマ処置具7に生理食塩水を供給するラインで有り、流路上で上流側から供給ポンプ(供給部)33、温度調整部34及び供給量センサ35が連設され、供給用チューブ39により連結されている。尚、供給ライン31及び吸引ライン32はプラズマ処置具7とは別体であっても良い。
生理食塩水を供給するものは、生理食塩水バッグ4に限定されるものではなく、製造時に生理食塩水の計量が可能な容器(例えば、目盛りがつけられた容器)に装填されていてもよい。一方、吸引ポンプ(吸引部)36の上流側に吸引量センサ(流量センサ)を配置して、吸引ポンプ(吸引部)36により、吸引チューブ21を通じてプローブ7bから吸引した生理食塩水を通過させて吸引量を測定する。吸引量センサ以外では、吸引ポンプ(吸引部)36により吸引した生理食塩水を計量可能な容器に収納してもよい。制御部2は、この容器内の生理食塩水の水面高さを、浮かべたフロートの移動又は、光学的センサにより検出して、回収された生理食塩水の体積として算出する。又は、容器の重量から生理食塩水の体積として算出する。これらの生理食塩水の体積の変化から供給される供給量及び吸引される吸引量を検出することができる。
供給量センサ(検出部)35は、公知な流量センサの1つであり、プローブ7bに供給される生理食塩水の供給量を検出し、その供給値信号を制御部2に送信する。尚、本実施形態では、流路上で上流側から温度調整部34と供給量センサ35の順に配置した構成例であるが、供給量センサ35を上流側に配置して、温度調整部34との位置を逆に入れ替えて、より生理食塩水の温度に重点を置いた構成であってもよい。
吸引ポンプ36は、プラズマ処置具7と吸引用チューブ40により連結され、プローブ7bの先端に灌流し蒸散された生体組織を含む生理食塩水の灌流層を吸引する。吸引量センサ38は、吸引ポンプ36の吸引により排水された生理食塩水の吸引量を検出し、吸引値信号として制御部2に送信する。
まず、プラズマ処置に必要な生理食塩水の水量は、図3に示す生体組織41の表面とプローブ7bの先端面7cとの間の距離Lに、両方の電極15,16を含む先端面7cの面積Aを掛け合わせた水量であり、プローブ7bの先端に灌流層を形成する水量をM1とする。即ち、水量M1は、プラズマ発生時に、アクティブ電極15が生体組織41には接触せずに近接して、且つプラズマ発生領域が生体組織41に近接して蒸散が行われる距離に規定された水量である。
図4に示すように、本実施形態の生理食塩水の供給量の変化は、まず目標量Mになるまで、生理食塩水を供給(送水)して増やし、その後、目標量M時点で、徐々に吸引を開始して、目標量Mを維持する。この目標量Mを維持した以降に、プラズマ処置を開始する。プラズマ処置終了後に、プローブ7bに形成されている灌流層の生理食塩水を完全に吸引する。
処置開始に当たって、まず、プラズマ処置具7の先端面7cを処置対象の近接位置(narrow gap)に配置し、スイッチ8のうちの給水スイッチを操作して、供給ポンプ33を駆動し、生理食塩水をプローブ7bの先端部に滞留する(ステップS1)。その後、滞留される水量が目標量Mに維持されているか否かを判断する(ステップS2)。水量が目標量Mに達しない場合には(NO)、生理食塩水の供給を継続し、水量が目標量Mに達した場合には(YES)、吸引ポンプ36を駆動して、後述するように生理食塩水がプローブ7bの先端面7cから溢れ出ないように、供給量と吸引量のバランスを取って灌流させて、目標量Mの水量を維持させる(ステップS3)。
なお、この実施形態では、面積Aを上述したように採用する例について説明した。面積Aは適宜に設定可能である。例えば、プローブ7bの先端面7cの面積をそのまま面積Aとしても良い。
次に、第1の実施形態の変形例について説明する。
本変形例は、前述した第1の実施形態の図1乃至図3に示したプラズマ処置システム1の構成を利用して、吸引口詰まりの検出を行う例である。
次に、第2の実施形態について説明する。
図6は、第1,2のプラズマ処置具における生理食塩水の供給量及び吸引量のそれぞれの水量の比である係数Kによる2つの特性線(K1,K2)と、高周波電力の出力レベルとの関係を示す図である。係数Kは、制御部2に設けられた設定部に予め記録されており、ここでは、直線的な1次の式からなる特性を例として示している。但し、2次の式からなる曲線的な特性、若しくは、ステップ状に変化する特性を有していてもよい。この係数Kの値は、処置具の設計段階において、プローブの仕様(先端形状や電極形状、供給口及び吸引口の口径や配置位置、印加される高周波電力値等々の設計仕様)によって、試験的又は経験的に得ることができる。
次に、第3の実施形態について説明する。
図7は、図1に示したプラズマ処置具システムの構成に、術中神経モニタリングシステム(Nerve Integrity Monitor system)51を加えた本実施形態の構成例を示している。
次に、第4の実施形態について説明する。
図8は、図1に示したプラズマ処置具システムの構成に、公知な検出構成を有するpH(水素イオン濃度指数)センサを加えた本実施形態の構成例を示している。図9Aは、第4の実施形態のプラズマ処置具のプローブ61(7b)の先端部分の外観構成を示し、図9Bは、プローブ61の先端側の断面構成を示している。
尚、突起部61aにより、アクティブ電極62と生体組織との間に距離を取ることができる。このため、アクティブ電極62が直接生体組織に接触した状態で高周波エネルギが生体組織に入力されることが防止される。また、突起部61aが凹型に形成された部分を有するので、プローブ先端面と突起部61aと生体組織とにより閉じた空間が形成されるのを防止できる。このため、吸引口19による吸引により、生体組織がアクティブ電極62に接触するのを防止できる。
1.高周波エネルギを生体組織に供給するプラズマ処置システムにおいて、
前記高周波エネルギを前記生体組織に供給する1対のバイポーラ電極を有する処置具と、
前記処置具に設けられて、前記処置具から前記生体組織の処置する表層に向けて、プラズマを発生させるための導電性溶液を供給する供給部と、
前記処置具に設けられて、前記導電性溶液を吸引する吸引部と、
前記供給部から供給される前記導電性溶液の予め決められた第1情報と、前記吸引部へ吸引される前記導電性溶液の予め決められた第2情報との割合となる所定の比率を設定する設定部と、
前記供給部から供給される前記導電性溶液の供給量と、前記吸引部へ吸引される前記導電性溶液の吸引量を検出する検出部と、
前記検出部で検出された前記供給量と前記吸引量の比率から、前記所定の比率に基づいて前記生体組織への前記高周波エネルギの供給を制御する制御部と、
を備えたプラズマ処置システム。
3.前記供給量または前記吸引量は、処置対象の前記生体組織の表層面積と前記バイポーラ電極との間の距離により決まる量であることを特徴とする(1)項に記載のプラズマ処置システム。
前記神経組織があった場合、制御部は、前記供給部、前記吸引部及び前記高周波エネルギの供給の少なくとも1つを停止するように制御することを特徴とする(1)項に記載のプラズマ処置システム。
前記制御部は、前記開口が閉塞されたことを前記第2センサの情報に基づいて、前記供給部、前記吸引部及び前記高周波エネルギの供給の少なくとも1つを停止するように制御することを特徴とする(1)に記載のプラズマ処置システム。
6.前記制御部は、前記供給量と前記吸引量の比率が1対1になるように前記供給部と前記吸引部を制御することを特徴とする(1)項に記載のプラズマ処置システム。
基端部から先端部に延出して、前記高周波エネルギを前記生体組織に供給する1対のバイポーラ電極を前記先端部に設けることによって、前記生体組織を処置する処置具と、
前記処置具に設けられて、前記先端部から前記生体組織の処置する表層に向けて、導電性溶液を供給する供給部と、
前記供給された導電性溶液を前記処置具の前記先端部から前記基端部へ吸引する吸引部と、
前記吸引部で吸引した前記導電性溶液のpHを検出する検出部と、
前記吸引部で吸引した際の前記導電性溶液の予め決められた所定のpHを設定する設定部と、
前記処置具に設けられて、前記供給部で供給される前記導電性溶液の温度の加温または減温するために前記導電性溶液の温度を調整する温度調整部と、
前記検出部で得られた前記導電性溶液のpHと、前記導電性溶液の所定のpHの閾値とを比較して、前記所定のpHに応じた前記導電性溶液の温度になるように前記温度調整部を制御する第1制御部と、
前記第1制御部によって制御された前記導電性溶液の温度から、前記生体組織への前記高周波エネルギの供給量を制御する第2制御部と、
を備えるプラズマ処置システム。
9.前記検出部は、前記先端部から前記基端部に連通する前記吸引部のチャンネル内に設けられた第1センサによって前記導電性溶液のpHを検出することを特徴とする(7)項に記載のプラズマ処置システム。
供給される高周波エネルギによりプラズマを発生させるために対を成し、前記第1の電極の周囲に配置される第2の電極と、
を具備するプラズマ処置具とともに用いられる制御システムにおいて、
前記第2の電極から前記第1の電極に向かい、前記第1,第2の電極を共に浸漬するように、供給部から供給される前記導電性溶液の供給量と、前記第1,第2の電極を灌流して吸引された前記導電性液体の吸引量とを所定の比率に設定する設定部と、
前記供給部から供給される前記導電性溶液の供給量と、前記吸引部へ吸引される前記導電性溶液の吸引量とを検出する検出部と、
前記検出部で検出された前記供給量及び前記吸引量に基づいて、前記供給量及び前記吸引量を前記設定部で設定された前記比率に制御する制御部と、
を備えた制御システム。
Claims (7)
- 第1の電極と、該第1の電極と対を成す第2の電極を有し、前記第1の電極と前記第2の電極の間に供給される高周波エネルギにより、前記第1の電極と前記第2の電極を浸漬する導電性溶液にプラズマを発生させることによって、生体組織を処置する処置部と、
前記第1の電極、前記第2の電極及び、前記生体組織の処置対象表層との間に浸漬する前記導電性溶液を供給する供給部からの供給量と、前記導電性溶液を吸引する吸引部からの吸引量と、の所定の比率を設定する設定部と、
前記供給部から供給される前記導電性溶液の供給量と、前記吸引部へ吸引される前記導電性溶液の吸引量とを検出する検出部と、
前記検出部で検出された前記供給量及び前記吸引量に基づいて、前記供給量及び前記吸引量を前記設定部で設定された前記比率に制御する制御部と、
を備えたプラズマ処置システム。 - 前記供給部から供給される供給量及び前記吸引部へ吸引される吸引量は、発生されたプラズマが作用する、前記第1の電極と前記第2の電極が設けられた前記処置具のプローブの先端部から前記生体組織の表層までの距離と、前記第1の電極と前記第2の電極の配置により前記導電性溶液が形成する灌流層の面積との積により決まる量であることを特徴とする請求項1に記載のプラズマ処置システム。
- 前記比率は、前記高周波エネルギのエネルギ量に基づいて変更可能であることを特徴とする請求項1に記載のプラズマ処置システム。
- 前記制御部は、前記高周波エネルギにより前記プラズマを発生させているとき、前記第1及び第2の電極の間に導電性溶液を灌流させながら、前記供給量と前記吸引量とを同一にすることを特徴とする請求項1に記載のプラズマ処置システム。
- 高周波エネルギからプラズマを発生させるための第1の電極と第2の電極を先端部に備えるプローブを有するプラズマ処置具と、
前記第1の電極及び前記第2の電極に高周波エネルギを供給する高周波電源と、
前記第1の電極と前記第2の電極が共に、導電性溶液内に浸漬するように、供給量センサによる所定供給量の導電性溶液を灌流する供給部と、
吸引口から前記第1,第2の電極を灌流して通過した吸引量センサによる所定吸引量の前記導電性溶液を吸引して排出する吸引部と、を有する供給吸引部と、共に用いられる制御システムであって、
前記供給量センサにより検出された供給量と、前記吸引量センサにより検出された吸引量とを比較して帰還制御し、前記供給量及び前記吸引量が前記第1の電極と前記第2の電極を共に浸漬する浸漬範囲で予め定めた目標量となるように制御する制御部を具備するプラズマ処置システム。 - 前記供給量または前記吸引量は、
発生されたプラズマが作用する、前記プローブの先端部から処置対象となる生体組織の表層までの距離と、前記第1の電極と前記第2の電極の配置により前記導電性溶液が形成する灌流層の面積との積により決まる量であることを特徴とする請求項5に記載のプラズマ処置システム。 - 前記プローブの前記吸引口の内部に入った位置に配置され、前記吸引口から吸引された処置後の導電性溶液の水素イオン濃度指数pHを検出するpHセンサを具備することを特徴とする請求項5に記載のプラズマ処置システム。
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Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH11501555A (ja) * | 1995-11-22 | 1999-02-09 | アースロケア コーポレイション | 電気外科的切断及び切除用システム及び方法 |
JP2008136843A (ja) * | 2006-12-04 | 2008-06-19 | Olympus Medical Systems Corp | 電気手術器具 |
JP2011229956A (ja) * | 2006-10-04 | 2011-11-17 | Pathway Medical Technologies Inc | 医療用カテーテル |
JP2011528950A (ja) * | 2008-07-22 | 2011-12-01 | アクシス サージカル テクノロジーズ,インク. | 組織修正デバイスおよび組織修正デバイスを使用する方法 |
JP5167443B2 (ja) * | 2011-03-17 | 2013-03-21 | オリンパスメディカルシステムズ株式会社 | 医療用送液装置 |
WO2013157408A1 (ja) * | 2012-04-20 | 2013-10-24 | オリンパスメディカルシステムズ株式会社 | 手術装置 |
Family Cites Families (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5697281A (en) * | 1991-10-09 | 1997-12-16 | Arthrocare Corporation | System and method for electrosurgical cutting and ablation |
US20050004634A1 (en) * | 1995-06-07 | 2005-01-06 | Arthrocare Corporation | Methods for electrosurgical treatment of spinal tissue |
WO2001074252A2 (en) * | 2000-03-31 | 2001-10-11 | Rita Medical Systems Inc. | Tissue biopsy and treatment apparatus and method |
US6929643B2 (en) * | 2002-04-15 | 2005-08-16 | Olympus Corporation | Resectoscope apparatus and electric operation apparatus |
US7490467B2 (en) * | 2004-06-15 | 2009-02-17 | Cummings Craig D | Gas flow enhancer for combustion engines |
US8192424B2 (en) * | 2007-01-05 | 2012-06-05 | Arthrocare Corporation | Electrosurgical system with suction control apparatus, system and method |
AU2009215404B2 (en) * | 2008-02-20 | 2014-09-18 | Mayo Foundation For Medical Education And Research | Ultrasound guided systems and methods |
US10448992B2 (en) * | 2010-10-22 | 2019-10-22 | Arthrocare Corporation | Electrosurgical system with device specific operational parameters |
US9775665B2 (en) * | 2013-03-15 | 2017-10-03 | Alan G Ellman | Fixed position RF electrode |
-
2015
- 2015-03-27 WO PCT/JP2015/059754 patent/WO2015156156A1/ja active Application Filing
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2016
- 2016-09-30 US US15/282,679 patent/US20170020594A1/en not_active Abandoned
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH11501555A (ja) * | 1995-11-22 | 1999-02-09 | アースロケア コーポレイション | 電気外科的切断及び切除用システム及び方法 |
JP2011229956A (ja) * | 2006-10-04 | 2011-11-17 | Pathway Medical Technologies Inc | 医療用カテーテル |
JP2008136843A (ja) * | 2006-12-04 | 2008-06-19 | Olympus Medical Systems Corp | 電気手術器具 |
JP2011528950A (ja) * | 2008-07-22 | 2011-12-01 | アクシス サージカル テクノロジーズ,インク. | 組織修正デバイスおよび組織修正デバイスを使用する方法 |
JP5167443B2 (ja) * | 2011-03-17 | 2013-03-21 | オリンパスメディカルシステムズ株式会社 | 医療用送液装置 |
WO2013157408A1 (ja) * | 2012-04-20 | 2013-10-24 | オリンパスメディカルシステムズ株式会社 | 手術装置 |
Non-Patent Citations (1)
Title |
---|
See also references of EP3130303A4 * |
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