JPH07171163A - 外科用電気止血装置 - Google Patents

外科用電気止血装置

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Publication number
JPH07171163A
JPH07171163A JP6190177A JP19017794A JPH07171163A JP H07171163 A JPH07171163 A JP H07171163A JP 6190177 A JP6190177 A JP 6190177A JP 19017794 A JP19017794 A JP 19017794A JP H07171163 A JPH07171163 A JP H07171163A
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JP
Japan
Prior art keywords
pole
tissue
interface surface
jaw
surgical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
JP6190177A
Other languages
English (en)
Inventor
David C Yates
デビット・シー・ヤッツ
Jesse J Kuhns
ジェシー・ジェイ・クーンズ
Steven H Mersch
スティーブン・エイチ・マーシュ
Martin Madden
マーティン・マッデン
Richard P Nuchols
リチャード・ピー・ニュコルス
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Ethicon Inc
Original Assignee
Ethicon Inc
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Publication date
Application filed by Ethicon Inc filed Critical Ethicon Inc
Publication of JPH07171163A publication Critical patent/JPH07171163A/ja
Pending legal-status Critical Current

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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
    • 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
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B17/07207—Surgical 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
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    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes 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
    • A61B18/1447—Probes 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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    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
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Abstract

(57)【要約】 【目的】 種々のインピーダンス，厚さ，脈管質の組織
を効果的に止血できる外科用電気装置を提供する。 【構成】 種々のインピーダンス，厚さ，脈管質の組織
を焼灼及び／又は溶接するのに用いられ、特に内視鏡処
置のための外科用電気装置。この装置は、第一のインタ
ーフェイス面３３にある二極エネルギー源の第一のポー
ル５２と、第二のインターフェイス面３５の間で、組織
を圧縮する。第二のポール１８は２つのインターフェイ
ス面３３，３５のうちの１つにある。好ましくは、第二
のポール１８は第一のポール５２と同じインターフェイ
ス面３３にあり、絶縁体５５が２つのポール５２，１８
を電気的に分離する。好ましくは、切開器具と共に使用
され、止血ラインは、切開ラインに添って無周波エネル
ギーを用いて形成される。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】この発明は、外科処置、特に内視
鏡処置において、焼灼，凝固及び／又は組織溶接に用い
る外科用電気装置に関するものである。
【０００２】
【従来の技術】組織の切開を伴う外科処置では、切開部
で出血する。外科医が出血を制御する手段を有する前
は、血液が過剰に損失するため多くの外科処置を達成す
るのは非常に困難であった。内視鏡手術や復腔鏡手術で
は止血はさらに重要である。出血を制御できないのな
ら、復腔鏡処置は中止し、出血を制御するために、患者
の体に切開手術をしなければならない。
【０００３】従って、成功の度合いは様々であるが、出
血制御のために種々の技術が用いられてきた。例えば、
単極，二極電気焼灼器等の発熱技術の他、縫合、血管で
のクリップの使用，ステープルがある。組織結合，修復
や損傷閉塞においても進歩したためかつては危険で不可
能であった外科処置が可能となった。
【０００４】先ず初めに、縫合が、止血や組織結合のた
めの主な手段の一つであった。他の止血，組織修復手段
が導入される前は、外科医は患者の組織を縫い合わすの
に多くの時間を費やしていた。
【０００５】外科用クリップが、高度に血管化した組織
を切開するときに血管を閉じる手段として導入された。
しかしながら、処置によっては、外科用クリップは扱い
ずらい。血管を同定しなければならない。その後に、ク
リップは、同定された各血管の意図する切開の両側に個
々に用いなくてはならない。特に血管が脂肪組織に囲ま
れている場合は血管を見つけることも難しい。
【０００６】外科用ステープラは組織を合わせて固定す
る時間を減らせる。種々のタイプの外科用ステープラが
ある。ステープラは組織結合のために用いられ組織切開
と共に止血する。この装置は例えば線状又は円状切開器
具とステープル器具を有する。一般的には、線状切開器
具にはステープルの平行な列があり、ステープルの列の
間に切開手段が入る隙間がある。この種の外科用ステー
プラは切開しやすいように組織を固定し、切開手段がス
テープルの平行列の間を切るときステープルの平行列を
周りの組織の層に留めて組織の層を合わせ止血する。こ
の種の切開ステープル装置は、筋肉や腸等の肉質組織の
処置、特に腸切除処置で、効果的に用いられる。円状切
開及びステープル器具は例えば管状器官を再結合する吻
合術で効果的に用いられる。しかし、腸間膜や付属器等
の高度に血管化された組織の切開を含む処置において
は、切削ステープル装置は最適とはいえず止血に問題を
有する傾向があった。
【０００７】電気焼灼装置はまた止血にも使用されてい
る。単極装置は、切開又は焼灼器具に連結する１電極
と、通常は患者に接続する離れた帰路電極を使用する。
最近は、焼灼電流を器具の２つの電極間の組織にほぼ限
定するため、二極器具が使用されている。
【０００８】二極鉗子は種々の処置で切開及び／又は凝
固のために使用されている。例えば、フォロピーオ管を
密封するとき、二極鉗子は滅菌処置に使用される。一般
に、二極鉗子は、組織を２つのポール間で掴み、電流を
掴んだ組織に流す。しかし、二極鉗子は欠点を有してお
り、それら欠点の幾つかは、組織が薄いとき電流がポー
ル間でアークしたり、また、鉗子のポールが接触して鉗
子が短絡することである。凝固のための鉗子を使用する
のは非常に限定されていて、また、鉗子は組織の広い面
積を同時に焼灼できない。
【０００９】２つのはさみの刃が２つの電極として機能
し剪断面は絶縁されている二極はさみが、開示されてい
る。凝固電流が電流路を通って組織に伝わると、この装
置は機械的に組織を切る。二極はさみもまた非常に用途
に依存する技術である。
【００１０】
【発明が解決しようとする課題】以上述べたように、従
来の止血装置は、高度に血管化された組織では止血が不
十分であり、また薄い組織ではアークや短絡の恐れがあ
る等の問題点があった。さらに、組織の広い面積を止血
できない等の問題点があった。
【００１１】この発明は上記のような問題点を解消する
ためになされたもので、肉質組織，管組織面，高い，低
い又はその組合せのインピーダンスを有する組織等の種
々の種類と厚さの組織において、効果的に止血できる外
科用電気止血装置を提供することを目的とする。ここで
「止血」は、凝固，焼灼及び／又は組織結合又は溶接等
によって、一般に出血を止めることを、意味する。
【００１２】本発明の他の目的は、従来の装置よりも、
比較的広い組織の面積または線を同時に焼灼又は溶接で
きる二極止血装置を提供することである。本発明の他の
目的は、長形又は棒状電極を有する二極電気焼灼器を提
供することである。
【００１３】本発明の他の目的は、組織を切る切開手段
の切開路の隣に凝固ラインを形成する切開手段を提供す
ることである。
【００１４】本発明の他の目的は、切開路に添って組織
溶接又は焼灼する電気焼灼手段を有する切開ステープル
装置を提供することである。
【００１５】
【課題を解決するための手段及び作用】本発明の上述の
目的及び他の目的は、間に組織を入れる顎の相対するイ
ンターフェイス面と、その相対する面の１つ又は両方に
ある２つの電気的に反対のポール（極）を含む末端効果
器を有する外科用電気ステープル装置で説明される。ポ
ールは絶縁物質で互いに分離されるか、ポールが相対す
るインターフェイス面にあるときはインターフェイス面
上で互いに向き合わないように互いにずらす。
【００１６】一実施例の外科用電気器具は、第一のイン
ターフェイス面と第二のインターフェイス面の間の圧縮
ゾーンにある組織を圧縮し、圧縮ゾーンを通して電気エ
ネルギーを与える。第一のインターフェイス面は、圧縮
ゾーンで圧縮された組織を調整する二極エネルギー源の
第一のポールと、第一のポールと電気的に分離され同一
又は相反するインターフェイス面に第二のポールがあ
る。ここで「電気的に分離されたポール」は、末端効果
器で絶縁物質で互いに分離された電極及び／又は相対す
る面で互いにずらされた電極を意味する。
【００１７】一実施例では、圧縮ゾーンは、１つのイン
ターフェイス面上で圧縮隆起により形成される域であ
り、他のインターフェイス面に対して組織を圧縮する。
また、両方のインターフェイス面に圧縮隆起があっても
よい。凝固ゾーンは、第一の及び第二のポール，第一の
ポールを第二のポールから分離する絶縁体によって形成
される。１つのインターフェイス面にある第二のポール
は、同じインターフェイス面の絶縁体の隣、又は相対す
る面の絶縁体を向こうにある。この配列により２つのポ
ールは電気的に分離され、電流が第一と第二のポールの
間の路を流れ組織の所望の区域を横切れるようになる。
【００１８】組織圧縮は、インピーダンスの違いの原因
となる組織の構造の違いを少なくすることによって、組
織インピーダンスを標準化すると考えられる。また、圧
縮は、特に血管に流れる場合は、血流を止め、吸込み装
置として機能し血液を絞り出す。従って、圧縮は、エネ
ルギー伝達速度を血流によるエネルギーの消失速度より
大きくして、幾分組織への伝達を最適化する。２つのポ
ール間を流れる電流が確実に圧縮ゾーンに流れるため
に、ポールを形成する電極の配置が重要である。また、
器具において、相対するポールが互いに絶縁又は分離し
ているので、ポールが短絡したり二極器具に共通する電
気的にアークすることなく、組織を圧縮できる。
【００１９】従って、このように電極を配置し組織を圧
縮すると、より効果的に焼灼でき、幅広い範囲の組織イ
ンピーダンス，厚さ，脈管質で止血できる。
【００２０】好ましくは、圧縮は過剰の圧縮により組織
が破壊されないように調整される。顎の間の隙間は、器
具の用途や器具を使用する組織の厚みによって、変える
ことができる。
【００２１】他の一実施例では、第一のポールは第一の
顎の第一のインターフェイス面にあり、第二のポールは
インターフェイス面ではないが第一のポールと同じ顎に
ある。
【００２２】本発明は、また、切開ライン又は切開路に
添った又は横の組織のライン又は路を、凝固できる装置
を提供する。一実施例では、第一のポールは長形の電極
からなる。長形の電極は隣の絶縁体と共に隆起を形成
し、焼灼すべき組織を圧縮する。第二のポールは、絶縁
体の隣で第一のポールの反対側にある。
【００２３】他の一実施例では、組織を切開する切開手
段が装置に取り込まれ、その装置は止血ラインを切開手
段の路の隣に形成する。もちろん、焼灼又は溶接の前，
間，後のいつでも切開はできる。この実施例の変更とし
て、ステープル手段を切開路の片側又は両側に設けるこ
とができる。
【００２４】他の一実施例では、指示手段が、組織が所
望又は所定の程度まで焼灼されたことを使用者に通知す
る。
【００２５】他の一実施例では、切開手段の作動即ち機
械的切開の前に、凝固が完了する。指示手段を使用する
ときは、組織が焼灼されると、切開手段が作動し、ステ
ープル列が組織に適合している間平行バー間を切る。
【００２６】他の一実施例では、線状切開機構ステープ
ラと同様に、止血装置が線状カッターに取り込まれる。
この実施例では、止血装置は、１つのポールを形成する
２つの平行な結合した長形電極バー及び切開手段がバー
間に入る隙間からなる。さらに止血するために、１以上
のステープル列を、隙間とバーの各側に取り付けてもよ
い。作用機構は、組織を２つの顎間で締める。好ましく
は無線周波数エネルギーの電気エネルギーを圧縮組織に
かけ、２つの平行バーに添った血管を焼灼する。
【００２７】他の一実施例では、異常なインピーダンス
や所定の域から外れる他の電気因子の検出手段を有す
る。例えば、検出手段は、器具が良好な凝固が期待でき
る範囲外のインピーダンスを示す組織に使用されたこと
を示すために、使用できる。また、他の器具の異状を検
出するために使用できる。例えば、インターフェイスエ
レクトロニクスにおける組織の最初の正常範囲のインピ
ーダンスと比較する事によって、異常な状態を検出でき
る。これは無線周波エネルギーをかける最初の数ミリ秒
で感知でき、有効なエネルギー治療量ではない。警告機
構も、インピーダンスが範囲から外れたことを使用者に
警告するために、使用できる。器具の配置を変えても、
同じ測定基準が適用され、組織インピーダンスが再度範
囲から外れると使用者は再度警告される。この工程は、
正常なインピーダンス範囲を満足させ良好な凝固が期待
できるまで、続けられる。
【００２８】同様に、他の一実施例では、イントラルミ
ナルステープラと同様な、組織溶接焼灼切開装置を提供
する。好ましくは、ポールは、絶縁体によって分離され
た２つの同心円電極に形成される。ポールを形成する電
極は、ステーブラカートリッジ又はアンビルのいずれか
に配置できる。
【００２９】本発明の上記及び他の目的は、以下の実施
例と図面によって更に理解できるであろう。
【００３０】
【実施例】以下、本発明を添付の図面と共に詳細に説明
する。図１〜９に本発明の好ましい一実施例を示す。図
１及び図２に示すように、内視鏡電気焼灼線状切開ステ
ープル器具１０は、軸３０に結合した本体１６及び軸３
０の遠位端２１から延びる効果器５０を有する。軸３０
は中に延びている管を有する。軸３０は絶縁物質から形
成され、管に延びている導電性鞘３８を有する。鞘３８
の中に延びている溝３９は、溝３９内の駆動手段４４の
同軸の動きを誘導する。この実施例では、駆動手段４４
は本体１６と結合する発射引金１４を含み、発射引金１
４は可撓性発射ロッド４０に連結し、発射ロッド４０は
駆動ロッド４１に連結し、駆動ロッド４１はブロック４
３に連結している。ブロック４３は切開手段１１とステ
ープル駆動楔１３に連結し、駆動手段４４はステープル
駆動楔１３をブロック４３によって末端効果器５０の中
へ進める。
【００３１】末端効果器５０は２つの顎３２，３４から
なる。末端効果器５０は顎３４によって溝３９に固定さ
れる。顎３２は顎３４に運動可能に取り付けられる。本
体１６は、顎３２，３４を閉じるための掴み引金１２を
有し、引金１２は鞘３８の近位端に連結している閉じ台
４５を長手方向に進める。閉じ台４５は鞘３８を軸３０
内で同軸的に進める。鞘３８は顎３２のカム面２７の上
を進み、顎３２，３４は顎間にある組織上で閉じる。以
下に詳細に述べるように、閉じ台４５はまたスイッチと
して作用し、電気エネルギーを末端効果器５０に伝える
回路を閉じる。
【００３２】図３〜９に拡大された末端効果器５０を示
す。図３は顎３２，３４が締め付けていない状態を示
し、図４は締め付けて発射してない状態を示し、図５は
締め付けて発射している状態を示している。図６に示す
ように、顎３２は、アンビル１８，顎３２に対して長手
方向に延びるＵ形第一のポール５２（図７，９）及び第
一のポール５２の外側を囲むＵ形絶縁物質５５からな
る。顎３２の内面３３は、顎３４の内面３５に面する。
内面３３は、２つの電気的に繋がる電極バー５３，５４
からなり、大体内面３３の長さに添って延びている第一
のポール５２を含み、電極バー５３，５４はアルミニウ
ムから形成される。電極バー５３，５４は第一のポール
の中央を長手方向に延びているナイフ溝４２により離さ
れ、Ｕ形を形成する。バーの表面は平らな片状であり組
織に接する表面の面積を増やしている。ステープル端を
受けるアンビル１８上の２組のポケット３６，３７は、
内面３３に添って、バー５３，５４の外側の横に延びて
いる。電極バー５３，５４と絶縁物質５５は、内面３３
のアンビル部３３ａに対して外へ延びている隆起５６を
形成する。アンビル１８は導電性物質で形成され第一の
ポールと電気的に反対の第二のポールとして機能する。
アンビル１８は第一のポール５２とＵ形絶縁物質５５に
よって分離されている。
【００３３】顎３４はカートリッジ溝２２とカートリッ
ジ２３からなる。カートリッジ２３は、楔１３用トラッ
ク２５，ナイフ溝２６，一連の駆動体２４及びステープ
ル１００からなる。ナイフ溝２６はカートリッジ２３の
中央を長手方向に延び（図８）、駆動体２４はトラック
２５に延び、ステープル１００は２組の平行な２列に配
置している。組織が顎３２，３４の間に係合したとき、
引金１４によって駆動手段４４は作動発射し、切開手段
１１と楔１３を係合した組織内に進め、組織をステープ
ルで留め切る。発射機構１４が作動すると、楔１３がト
ラック２５の中を前進し、駆動体２４をステープル１０
０の方に動かし、それによってステープル１００が組織
を通ってアンビルポケット３６，３７に入る。
【００３４】図３，７，９に示されるように、ギャップ
ピン２９は内面３３のアンビル１８の先端方向にある。
図８に示されるように、ギャップピン２９は、カートリ
ッジ２３の内面３５に形成されるギャップ２８の中へ入
る。ギャップ２８とギャップピン２９は、ステープル１
００とポケット３６，３７が整列しナイフ溝４２，２６
が互いに整列するように作用する。
【００３５】図２に示されるように、本体１６の遠位端
にあるノブ１５は、ノブ１５に直接又は間接に連結して
いる軸３０，鞘３８，溝３９及び末端効果器５０を回
し、末端効果器の顎３２，３４の回転方向の配置に使用
できる。
【００３６】二極エネルギーが、本体１６内に延びてい
るワイヤ１９，２０を介して、外科用発電機６０から末
端効果器５０に与えられる。発電機６０は足踏スイッチ
６５によって使用者が制御できる。
【００３７】電流エネルギーを第一のポールに供給する
ワイヤ１９は、ワイヤや他の電気接触手段６１を介し
て、閉じ台４５の遠位端にあり第一のポールに繋がる接
触子６２に連結している。反対の極の電流を運ぶワイヤ
２０は、ワイヤや他の電気接触手段６６を介して、閉じ
台４５の遠位端にあり接触子６２から電気的に分離して
いるディスク接触子６７に連結している。
【００３８】第一のポールに連結し本体１６の遠位端に
あるディスク接触子６３は、ワイヤや他の接触手段６４
と電気的に繋がっている。接触手段６４は、溝３９を通
って、顎３２まで延びて第一のポール５２に接触する。
ディスク接触子６３はノブ１５の回転を阻害しないが、
ディスク接触子６３と接触手段６４の間の接触は維持さ
れる。接触手段６４は鞘３８から電気的に絶縁される。
【００３９】掴み引金１２が作動すると、閉じ台４５は
遠位方向に動き、接触子６２はディスク接触子６３と電
気的に繋がり、第二のポール５１に連結するディスク接
触子６７は導電性鞘３８と電気的に繋がる。鞘３８は、
帰路電極として機能する導電性アンビル１８のカム面２
７の上を動く。従って、掴み引金１２が閉じるときのみ
電気回路が閉じる。
【００４０】操作では、末端効果器５０を組織の切られ
る部位に配置する。解放ボタン７０を押すと、ボタンス
プリング７１が解放され閉じ台４５が近位方向に動き、
顎３２，３４が開く。その後、組織を顎３２，３４の夫
々のインターフェイス内面３３，３５の間に置く（図
３）。掴み引金１２を握り締め、鞘３８をカム面２７上
に動かし、顎３２，３４が閉じ（図４）、同時に上記の
電気回路が閉じる。ギャップピン２９は、アンビル１８
をカートリッジ２３と略平行に保持させる。共に隆起５
６を形成する電極バー５３，５４と絶縁物質５５が、顎
３４の内面３５に対して組織を圧縮する。約０．０１２
インチ〜０．０２２インチの隙間が圧縮ゾーンの顎間に
ある。その後、使用者は、足踏スイッチ６５等のスイッ
チによって、発電機６０から無線周波エネルギーをかけ
る。電流が、圧縮された組織を通って、第一のポール５
２即ちバー５３，５４と第二のポール５１即ちアンビル
１８の間に流れる。
【００４１】好ましくは、二極エネルギー源は、約３０
０ｋＨｚから３ＭＨｚの無線周波数エネルギーを提供す
る低インピーダンス源である。好ましくは、組織に流れ
る電流は０．１から１．５アンペアであり、電圧は３０
から２００ボルトＲＭＳである。
【００４２】十分な焼灼が成され無線周波エネルギーを
止めてもよいことを示すために、可聴、可視、触知又は
他のフィードバックシステムを使用できる。この様なフ
ィードバックシステムの例を以下に説明する。無線周波
エネルギーが止まった後、発射引金１４によって切開手
段１１は前進しステープル１００は発射する。ピボット
１４ａの周りにレバーアームとして機能する発射引金１
４を回転させて、発射させる。駆動手段４４は切開手段
１１と楔１３を前進させる（図５）。図６に示されるよ
うに、切開手段１１はバー５３，５４間の焼灼された組
織を切る。従って、切開ラインは、バー電極によって形
成される凝固ラインの横である。同時に、楔１３は駆動
体２４をステープル１００の方へ前進させ、ステープル
１００を組織を通ってアンビル１８のポケット３６，３
７の中へ発射させる。切開手段が組織を切ると、ステー
プル１００は、２つの長手方向の２列の状態で、切開手
段１１の各側に入る。
【００４３】線状ステープルの操作はこの技術分野では
既知であり、例えば米国特許第 4,608,981号，第 4,63
3,874号，米国特許出願第07/917,636号に記載されてい
る。
【００４４】一実施例では、二列のステープルを一列に
置き換えて、カートリッジを多発射ステープル機能とす
る。現在使用されている腹腔鏡ステープル切開装置で
は、単発射置換可能カートリッジが使用されている。よ
り良く止血するために、このタイプのステープラは、２
列のステープルが一列のステープルを使用することによ
り、かつて２列のステープルが占めていた空間に、ステ
ープルを積み重ねることが可能となり、多発射ステープ
ル機能が得られる。他の実施例では、ステープルは必要
とされず、電流が必要な止血をする。
【００４５】本発明の好ましい実施例は、所望又は所定
の程度まで凝固がなされた時を示すように設計されたフ
ィードバックシステムを有する。特に、凝固ゾーンが使
用者に見えないときに有効である。特定の実施例では、
凝固の程度を示す電気因子を測定する。
【００４６】フィードバックシステムは、凝固の程度を
示す凝固ゾーンの又は近くの組織の特性を測定してもよ
い。電気エネルギーがかかる組織の電気インピーダンス
も、凝固を示すために使用できる。一般にエネルギーが
組織にかかると、インピーダンスは初めは低下し、その
後凝固が発生するにつれ増加する。組織の経時的電気イ
ンピーダンスと凝固の関係は、バエルフォーズ(Vaellfo
rs),ベルティル(Bertil), ベルダール(Bergdahl), ジョ
ーン(Bjoern)「オートマティカリィ コントロールド
バイポラー エレクトロコアギュレーション(Automatic
ally controlled Bipolar Electrocoagulation) 」（ニ
ューロシュグ(Neurosurg) Rev.187〜190頁、１９８４
年）に記載されている。乾燥するとインピーダンスは増
加する。高電圧の過剰印加による組織の炭化及び／又は
器具への焼付きは、組織インピーダンス特性に基づくフ
ィードバックシステムによって防ぐことができる。凝固
を示す組織特性の他の例は、温度や光反射率である。
【００４７】図１０は、本発明の好ましい実施例に含ま
れるフィードバックシステムを示すフローチャートであ
る。初めに、エネルギーが組織にかかる。次に、組織に
印加されたシステム電流と電圧が測定される。インピー
ダンス値が計算され、記憶される。例えばインピーダン
ス，インピーダンス変化及び／又はインピーダンス変化
率等を含むインピーダンスの関数に基づき、所望の凝固
が発生したか否か測定する。所定又は所望の程度まで凝
固が発生すると、指示手段がエネルギーを止めるよう指
示する。このような指示手段は、例えば可視光，可聴音
又は触知指示器を用いる。フィードバック手段は発電機
もまた制御でき、所定のインピーダンスレベルでエネル
ギーを止める。他の実施例では、インピーダンスレベル
によってトーンが変化する連続した可聴音を出す。さら
に、インピーダンスが通常の最小以下及び／又は最大以
上であるとき、エラーや装置の誤操作を示すエラー指示
手段を設けてもよい。
【００４８】図１１〜図１４は末端効果器の他の形態を
示す。図１１では、第一のポール１５２と第二のポール
１５１は共にアンビル１１８を有する同じ顎１３２にあ
る。Ｕ形第一のポール１５２はナイフ溝１４２を形成す
る。Ｕ形絶縁体１５５は面１３３を除き第一のポール１
５２を囲み、第二のポール１５１から電気的に分離す
る。圧縮隆起１５６は、不導電性物質からなるカートリ
ッジに形成される。隆起１５６は第一のポール１５２と
絶縁体１５５に対して組織を圧縮し、組織圧縮ゾーンを
形成する。
【００４９】図１２では、第一のポール２５２と第二の
ポール２５１は共にアンビル２１８を有する同じ顎２３
２にある。第一のポール２５２と第二のポール２５１は
それぞれナイフ溝２４２の両側にある。絶縁体２５５は
面２３３を除いてポール２５１，２５２を囲み、ポール
２５１，２５２を互いに電気的に分離する。圧縮隆起２
５６は、不導電性物質からなるカートリッジに形成され
る。隆起２５６はポール２５１，２５２と絶縁体２５５
に対して組織を圧縮し、組織圧縮ゾーンを形成する。
【００５０】図１３では、第二のポール３５１はアンビ
ル３１８を有する顎３３２にあり、第一のポール３５２
はカートリッジ３２３にある。Ｕ形第一のポール３５２
はナイフ溝３２６を形成し、絶縁体３５５ａによって囲
まれる。Ｕ形絶縁体３５５ｂは顎３３２にナイフ溝３４
２を形成する。絶縁体３５５ｂを除いて、顎は導電性物
質からなり、第二のポール３５１を形成する。第一のポ
ール３５２と絶縁体３５５ａは圧縮隆起３５６を形成
し、隆起３５６は顎３３２の面３３３に対して組織を圧
縮し、圧縮ゾーンを形成する。絶縁体３５５ｂは、顎３
３２，３３４が閉じるときポール３５１，３５２が接触
しないだけの十分な幅を有する。
【００５１】図１４では、第一のポール４５２と第二の
ポール４５１は共にカートリッジ４２３を有する顎４３
４にある。第一のポール４５２と第二のポール４５１は
それぞれ両側にあり、カートリッジ４２３を通るナイフ
溝４２６を形成する。絶縁体４５５ａは面４３５を除い
てポール４５１，４５２を囲み、ポール４５１，４５２
を互いに電気的に分離する。圧縮隆起４５６はカートリ
ッジ４２３に形成され、顎４３２の面４３３にある絶縁
体４５５ｂに対して組織を圧縮して、圧縮ゾーンを形成
する。
【００５２】図１５は他の実施例を示す。第一及び第二
のポール５５１，５５２とナイフ溝５４２は、第一の及
び第二のポール５５１，５５２それぞれがナイフ溝５４
２の長さに沿った電気的に接続している一連のスタガー
電極からなり、スタガー電極の間には絶縁物質がある以
外は、図１２と同様の形に配置される。
【００５３】図１６は、図１５と同様にスタガー電極を
示しているが、第一のポール電極６５２と第二のポール
電極６５１はナイフ溝６４２の長さに添ってナイフ溝６
４２の両側で互い違いになっている。
【００５４】図１７，１８は他の実施例を示し、第一の
ポールと第二のポール７５１，７５２はそれぞれスタガ
ー電極からなる。この実施例では、第一のポール７５２
は、ナイフ溝７２６の各側に添って部分的に配置してい
て、カートリッジ７２３に形成される圧縮隆起７５６に
ある。第二のポール７５１は、顎７３２の面７３３にあ
るナイフ溝７４２の各側に部分的に配置している。図１
８に示されるように、ポール７５１，７５２は垂直に並
んでいるが、図１７に示されるように、顎７３２，７３
４が閉じるとポールが絶縁体７５５ａ，７５５ｂにより
互いに電気的に分離されるようにずれている。
【００５５】図１９は末端効果器の他の実施例を示す。
第一のポール８５２と第二のポール８５１は共にアンビ
ル８１８を有する顎８３２にある。第一のポール８５２
は、インターフェイス面８３３に有り圧縮ゾーンで組織
を圧縮するための隆起８５６を形成する。第二のポール
８５１は、インターフェイス面８３３上でなくアンビル
８１８の側にある。
【００５６】図２０，２１は、本発明のステープル手段
を有する円状カッターを示す。図２０はインターフェイ
ス面９３３を有するステープラカートリッジ９００を示
す。２列のステープル開口９０１は面９３２の外周付近
に乱して配置される。ステープル開口９０１を通ってス
テープルは組織の中に入る。第一のポール９５２は面９
３３の内周を囲んでいる。絶縁体９５５は、第一のポー
ル９５２を、ステープル開口の周りの、面９３３の部位
９３３ａから電気的に分離している。ステープル開口部
位９３３ａは導電物質から形成され、第二のポールとし
て機能する。円状切開ナイフ９１１は、面９３３の内周
の中の方に放射状にカートリッジ９００の窪みに置かれ
る。
【００５７】図２１はアンビル９１８を示し、アンビル
９１８は、ステープルを受けるポケット９３７，第一の
ポール９５２に対して組織を圧縮する圧縮隆起９５６及
びカートリッジの絶縁体９５５を有する。円状カッター
は米国特許第 5,104,025号に記載されている円状ステー
プラと同様に作用する。ステープルや切開する前に、組
織溶接電流を、第一のポール９５２とステープル開口部
位９３３ａを通して組織に送ることもできる。
【００５８】他の実施例では、円状カッターはステープ
ルなしで使用できる。電流はポールを通して送られ、組
織を溶融し凝固する。その後、ナイフを前進させ吻合等
の方法で組織を切る。
【００５９】内視鏡切開及びステープルを含む特別の実
施例を用いて本発明の幾つかの形態を説明した。しか
し、本発明は止血が求められる多くの用途に使用でき
る。従って、当業者は、特許請求の範囲とその均等範囲
によって定義される本発明の範囲から離れることなく、
本発明に種々の変更を加えることが可能である。
【００６０】本発明の具体的な実施態様は、次の通りで
ある。 （１）前記第二のポールは前記第一のポールと同じイン
ターフェイス面にある請求項１記載の外科用電気装置。 （２）前記第二のポールは前記第一のポールと異なるイ
ンターフェイス面にある請求項１記載の外科用電気装
置。 （３）前記第二のインターフェイス面の一部は、組織を
前記インターフェイス面間で圧縮するための組織圧縮ゾ
ーンを形成する隆起を含む請求項１記載の外科用電気装
置。 （４）前記第一のポールと前記第二のポールの間を流れ
る電流が前記圧縮ゾーンに凝固を形成する上記実施態様
（３）記載の外科用電気装置。 （５）前記第一のインターフェイス面の一部は、前記第
二のインターフェイス面の前記隆起と共に前記組織圧縮
ゾーンを形成する隆起を含む上記実施態様（３）記載の
外科用電気装置。 （６）前記第一のポールが前記第一のインターフェイス
面にあり、前記第二のインターフェイス面にある前記隆
起が前記第一のポールに対して組織を圧縮する上記実施
態様（３）記載の外科用電気装置。 （７）前記隆起が前記第一のポールからなり絶縁体が前
記第一のポールと前記第二のポールを電気的に分離する
上記実施態様（３）記載の外科用電気装置。
【００６１】（８）少なくとも１つの前記ポールは、前
記第一及び第二のインターフェイス面の少なくとも１つ
の面上の一連の電気的に繋っているスタガー電極からな
る請求項１記載の外科用電気装置。 （９）前記少なくとも１つのポールは、前記電気的に反
対のポールに対して平行に配置されてる上記実施態様
（８）記載の外科用電気装置。 （１０）前記第一のポールは一連の第一電極からなり、
前記第二のポールは一連の第二電極からなり、前記第一
のインターフェイス面において、前記第一電極は前記第
二電極と互い違いである上記実施態様（８）記載の外科
用電気装置。 （１１）前記第一のポールは前記第一のインターフェイ
ス面で前記一連の第一スタガー電極からなり、前記第二
のポールは前記第二のインターフェイス面で前記一連の
第二スタガー電極からなる上記実施態様（８）記載の外
科用電気装置。
【００６２】（１２）前記第一のポールは長形電極を含
む請求項１記載の外科用電気装置。 （１３）前記装置は組織を溶接する請求項１記載の外科
用電気装置。 （１４）さらに、末端効果器に連結する切開要素を有
し、前記切開要素は前記末端効果器に係合される組織を
切開ラインで切る請求項１記載の外科用電気装置。 （１５）さらに前記インターフェイス面によって係合さ
れる組織をステープルで留めるステープル手段を有する
請求項１記載の外科用電気装置。 （１６）前記末端効果器は前記切開ラインの横で止血す
る上記実施態様（１４）記載の外科用電気装置。 （１７）さらに前記切開ラインの横にステープルを留め
るステープル手段を有する上記実施態様（１４）記載の
外科用電気装置。 （１８）前記切開要素は切開路で可動で、前記切開ライ
ンを形成する上記実施態様（１４）記載の外科用電気装
置。 （１９）前記第一のポールは第一及び第二の電極を有
し、前記切開要素が前記第一及び第二の電極の間を動く
上記実施態様（１４）記載の外科用電気装置。 （２０）前記第一及び第二の電極はそれぞれ、電気的に
繋がっている平行長形バー電極からなり、前記末端効果
器はさらに前記切開要素を受ける隙間を有し前記切開要
素は前記バー電極間で隙間を動く上記実施態様（１９）
記載の外科用電気装置。
【００６３】（２１）前記ステープル手段は少なくとも
１つのステープルの平行列及び、前記切開手段が前記少
なくとも１つのステープル列間を動けるカートリッジの
中を長手方向に延びる隙間を有し、前記第二のインター
フェイス面を形成するカートリッジ、前記インターフェ
イス面間の組織をステープルで留める駆動手段、及び前
記第一のインターフェイス面の一部を形成し、前記ステ
ープルを受け形成するアンビル、を有する上記実施態様
（１５）記載の外科用電気装置。 （２２）前記切開手段が平行列間を切ると、前記駆動手
段が組織をステープルで留める上記実施態様（２１）記
載の外科用電気装置。 （２３）前記第二のポールは前記アンビルに含まれる上
記実施態様（２１）記載の外科用電気装置。 （２４）前記カートリッジは絶縁物質から形成される上
記実施態様（２１）記載の外科用電気装置。 （２５）前記第二のポールは前記カートリッジにより形
成される前記第二のインターフェイス面に含まれる上記
実施態様（２３）記載の外科用電気装置。 （２６）前記切開手段が前進する前に、二極エネルギー
がかかる上記実施態様（２１）記載の外科用電気装置。 （２７）前記切開ラインがほぼ円形である上記実施態様
（１４）記載の外科用電気装置。 （２８）前記第一のポールが大体円形であり、前記第一
のインターフェイス面の外周に配置され、前記切開ライ
ンが前記第一のポールの内方向に放射状にある上記実施
態様（２７）記載の外科用電気装置。
【００６４】（２９）前記ステープル手段を管腔を再結
合するために使用する上記実施態様（１５）記載の外科
用電気装置。 （３０）前記ステープル手段はカートリッジの外周付近
にステープルを有するカートリッジ、前記ステープルの
内方向に放射状に組織を切るための切開手段、前記イン
ターフェイス面間の組織をステープルで留める駆動手
段、及び前記第一のインターフェイス面の一部を形成
し、前記ステープルを受け形成するアンビル、を有する
上記実施態様（１５）記載の外科用電気装置。 （３１）前記切開手段が組織を切ると、前記駆動手段が
組織をステープルで留める上記実施態様（３０）記載の
外科用電気装置。 （３２）前記第二のポールは前記アンビルに含まれる上
記実施態様（３０）記載の外科用電気装置。 （３３）前記カートリッジは絶縁物質から形成される上
記実施態様（３０）記載の外科用電気装置。 （３４）前記第二のポールは前記カートリッジにより形
成される前記第二のインターフェイス面に含まれる上記
実施態様（３２）記載の外科用電気装置。 （３５）前記切開手段が組織を切る前に、二極エネルギ
ーがかかる上記実施態様（３０）記載の外科用電気装
置。
【００６５】（３６）さらに、範囲から外れた電気因子
を検出する手段を有する請求項１記載の外科用電気装
置。 （３７）さらに、組織が所定の程度まで焼灼された時を
測定するフィードバック手段を有する請求項１記載の外
科用電気装置。 （３８）前記フィードバック手段は、組織の電気因子の
測定に基づいて、組織が所定の程度の焼灼がなされた時
を測定する上記実施態様（３７）記載の外科用電気装
置。 （３９）前記フィードバック手段は、凝固ゾーンの組織
の１以上の特性の測定に基づいて、所望の程度の焼灼が
なされた時を測定する上記実施態様（３７）記載の外科
用電気装置。 （４０）前記組織の特性が組織インピーダンスである上
記実施態様（３９）記載の外科用電気装置。
【００６６】（４１）さらに、組織が所定の程度まで焼
灼されたことを使用者に伝える指示手段を有する請求項
１記載の外科用電気装置。 （４２）前記指示手段が可聴シグナルを用いる上記実施
態様（４１）記載の外科用電気装置。 （４３）前記指示手段が可視シグナルを用いる上記実施
態様（４１）記載の外科用電気装置。 （４４）前記指示手段が触知フィードバックを用いる上
記実施態様（４１）記載の外科用電気装置。
【００６７】（４５）前記ポールの両方が前記第一のイ
ンターフェイス面に含まれる請求項３記載の外科用電気
装置。 （４６）前記第一のポールが前記第一のインターフェイ
ス面に含まれ、前記第二のポールが前記第一のインター
フェイス面外に含まれる請求項３記載の外科用電気装
置。
【００６８】
【発明の効果】以上のように、本発明によれば、インピ
ーダンス，厚さ，脈管化等の種々の組織に効果的に止血
できる効果がある。
【図面の簡単な説明】
【図１】本発明の一実施例による内視鏡電気焼灼線状ス
テープル切開器具の側面図である。
【図２】図１の器具の側断面図である。
【図３】図１の器具の遠位端の開いた状態の部分断面図
である。
【図４】図１の器具の遠位端の閉じて発射してない状態
の部分断面図である。
【図５】図１の器具の遠位端の閉じて発射する状態の部
分断面図である。
【図６】線６−６についての図４の器具の遠位端の断面
図である。
【図７】図１の器具のアンビル顎の底面図である。
【図８】図１の器具のカートリッジの平面図である。
【図９】線９−９についての図７の顎の側断面図であ
る。
【図１０】本発明のフィードバックシステムを示すフロ
ーチャート図である。
【図１１】本発明の他の実施例の末端効果器の断面図で
ある。
【図１２】本発明の他の実施例の末端効果器の断面図で
ある。
【図１３】本発明の他の実施例の末端効果器の断面図で
ある。
【図１４】本発明の他の実施例の末端効果器の断面図で
ある。
【図１５】本発明の他の実施例のアンビルの底面図であ
る。
【図１６】本発明の他の実施例のアンビルの底面図であ
る。
【図１７】本発明の他の実施例の遠位端の断面図であ
る。
【図１８】図１７の末端効果器の断面図である。
【図１９】本発明の他の実施例の末端効果器の断面図で
ある。
【図２０】本発明の円状カッターのカートリッジの平面
図である。
【図２１】本発明の円状カッターのアンビルの底面図で
ある。
【符号の説明】
１０ 外科用電気装置 １２ 掴み引金 ３２ 第一の顎 ３３ 第一のインターフェイス面 ３４ 第二の顎 ３５ 第二のインターフェイス面 ４４ 駆動手段 ５０ 末端効果器 ５２ 第一のポール ５１ 第二のポール
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ジェシー・ジェイ・クーンズ アメリカ合衆国、45220 オハイオ州、シ ンシナティ、リッドル・ロード 683 (72)発明者 スティーブン・エイチ・マーシュ アメリカ合衆国、45237 オハイオ州、ジ ャーマンタウン、ウィーバー・ロード 7347 (72)発明者 マーティン・マッデン アメリカ合衆国、45140 オハイオ州、ラ ブランド、サドルブルック・コート 6631 (72)発明者 リチャード・ピー・ニュコルス アメリカ合衆国、45140 オハイオ州、ラ ブランド、ジョージタウン・ロード 1560

Claims (3)

    【特許請求の範囲】
  1. 【請求項１】 末端効果器を有する外科用電気装置にお
    いて、前記間末端効果器は、 第一及び第二のインターフェイス面の間に組織を係合
    し、末端効果器はその中で二極エネルギーを受ける、対
    向する第一及び第二のインターフェイス面、及び二極エ
    ネルギーを伝えることができ、電気的に相反する電極か
    らなる、電気的に分離されてる第一及び第二のポール、
    を有し、 前記各ポールは前記インターフェイス面にあり、前記二
    極エネルギーは組織を通って前記ポール間に伝わる、外
    科用電気装置。
  2. 【請求項２】 ハンドル、 前記ハンドルに連結する作動手段、 前記作動手段の遠位端に連結する末端効果器、 電気エネルギーを二極エネルギー源から前記末端効果器
    に伝える伝達手段からなり、 前記末端効果器は、 第一のインターフェイス面、 第二のインターフェイス面、 前記インターフェイス面の少なくとも一つの面にある第
    一のポール、 前記インターフェイス面の少なくとも一つの面にある第
    二のポール、及び前記第一のポールを前記第二のポール
    から電気的に分離させる絶縁体、からなり、 前記作動手段は前記末端効果器を作動させ、組織を前記
    第一のインターフェイス面と前記第二のインターフェイ
    ス面の間に係合させ、 前記第一のポールと前記第二のポールは、前記伝達手段
    から供給される電気エネルギーを、前記第一のポールと
    前記第二のポールに隣接する組織を通って伝えることが
    できる電気的に相反する電極である、外科用電気装置。
  3. 【請求項３】 第一のインターフェイス面を有する第一
    の顎と第二のインターフェイス面を有する第二の顎の間
    に組織を係合する第一の顎及び第二の顎、及び二極エネ
    ルギーを伝えることができ、電気的に相反する電極から
    なる、電気的に分離されてる第一及び第二のポール、を
    有し、 各ポールは前記第一の顎に含まれ、前記ポールの少なく
    とも１つは前記第一のインターフェイス面に含まれる、
    末端効果器を有する外科用電気装置。
JP6190177A 1993-07-22 1994-07-21 外科用電気止血装置 Pending JPH07171163A (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US095797 1993-07-22
US08/095,797 US5403312A (en) 1993-07-22 1993-07-22 Electrosurgical hemostatic device

Related Child Applications (1)

Application Number Title Priority Date Filing Date
JP2004228318A Division JP2005021703A (ja) 1993-07-22 2004-08-04 外科用電気止血装置

Publications (1)

Publication Number Publication Date
JPH07171163A true JPH07171163A (ja) 1995-07-11

Family

ID=22253627

Family Applications (2)

Application Number Title Priority Date Filing Date
JP6190177A Pending JPH07171163A (ja) 1993-07-22 1994-07-21 外科用電気止血装置
JP2004228318A Pending JP2005021703A (ja) 1993-07-22 2004-08-04 外科用電気止血装置

Family Applications After (1)

Application Number Title Priority Date Filing Date
JP2004228318A Pending JP2005021703A (ja) 1993-07-22 2004-08-04 外科用電気止血装置

Country Status (9)

Country Link
US (2) US5403312A (ja)
EP (1) EP0640317B1 (ja)
JP (2) JPH07171163A (ja)
AT (1) ATE184467T1 (ja)
AU (1) AU687405B2 (ja)
CA (1) CA2128450C (ja)
DE (1) DE69420650T2 (ja)
ES (1) ES2136168T3 (ja)
GR (1) GR940100336A (ja)

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AU687405B2 (en) 1998-02-26
ES2136168T3 (es) 1999-11-16
EP0640317B1 (en) 1999-09-15
DE69420650D1 (de) 1999-10-21
CA2128450C (en) 1996-05-28
US5403312A (en) 1995-04-04
AU6862294A (en) 1995-02-02
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US5833690A (en) 1998-11-10
ATE184467T1 (de) 1999-10-15
EP0640317A1 (en) 1995-03-01
CA2128450A1 (en) 1995-01-23

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