JPH08229050A - 電気外科的装置、電気外科的方法、組織の電気外科的処理方法、及び電気外科的インピーダンスフィードバック制御装置 - Google Patents

電気外科的装置、電気外科的方法、組織の電気外科的処理方法、及び電気外科的インピーダンスフィードバック制御装置

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Publication number
JPH08229050A
JPH08229050A JP7349056A JP34905695A JPH08229050A JP H08229050 A JPH08229050 A JP H08229050A JP 7349056 A JP7349056 A JP 7349056A JP 34905695 A JP34905695 A JP 34905695A JP H08229050 A JPH08229050 A JP H08229050A
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tissue
impedance
electrodes
energy
therapeutic
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JP3857345B2 (ja
Inventor
Warren P Williamson
ウォーレン・ピー・ウィリアムソン
David C Yates
デビッド・シー・イェイツ
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
    • A61B18/14—Probes or electrodes therefor
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    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods
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Abstract

(57)【要約】 【課題】 組織のインピーダンス等を測定してその特性
を判定し、特に組織の凝固終了時点を判定すること。 【解決手段】 治療用電極で処理前、処理中、又は処理
後に、組織の１つ以上の電気的パラメータを測定する照
会電極を含む電気外科的装置であって、被測定パラメー
タは組織の凝固の完了等の組織の特性判定に用いられ、
例えば、被測定組織特性を表す信号に応じた電気外科的
エネルギーの伝達制御信号が与えられ、この制御信号
は、ＲＦエネルギーを完全にシャットオフにするか、ま
たは治療用電極を介して組織に伝達されるエネルギーの
レベル、周波数、その他を調節する。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】この発明は電気外科的組織処
理に関し、特に、電気外科的装置により処理されている
組織のインピーダンスを測定することにより、組織の電
気外科的処理を制御する電気外科的装置、電気外科的方
法、組織の電気外科的処理方法、及び電気外科的インピ
ーダンスフィードバック制御装置に関するものである。
【０００２】
【従来の技術】電気外科的器具は例えば、切断、凝固、
組織の溶接、切除、及び解剖のために使用される。その
ような器具に高周波（ＲＦ）レンジの治療用電気外科的
エネルギーを供給するために電気外科的ジェネレータが
用いられる。通常そのようなジェネレータは電圧及び／
又は電流を調整して選択された範囲のパワーレベルが伝
達され最大パワーレベルを越えないようにする制御を含
む。
【０００３】そのような電気外科的器具を用いる場合、
主要な制御は、組織がＲＦエネルギーで処理されるとき
組織に何が起きているかの観察に応答する外科医の経験
によって行われる。しばしば、特に内視鏡検査の処置に
対して、外科医は組織に何が起きているかを容易には見
ることができない。また、ＲＦエネルギーによる組織の
性質の変化は非常に迅速に起きる。この結果、生じるか
もしれないいくつかの問題は組織の焦げ、組織の外科器
具の電極への固着、熱放散、及び組織の過剰な処理又は
処理不足を生じるということである。
【０００４】ＲＦエネルギーが組織に加わると組織のイ
ンピーダンスが変わることが認識されている。組織のイ
ンピーダンスが変わるとき組織に伝達されるパワーを制
御する試みがなされてきた。例えば、一定のパワー又は
電圧レベルを維持するために組織のインピーダンスが用
いられてきた。また、組織のインピーダンス、とりわけ
ＲＦパワーが加えられる時の組織のインピーダンスの微
分商は、初期パワーレベルを決定するため及びインピー
ダンスの微分商がプリセットされた値に到達するとＲＦ
パワーを切り替えてオフにするために用いられてきた。
【０００５】
【発明が解決しようとする課題】これらの制御に関する
議論にもかかわらず、組織への電気外科的エネルギーの
伝達及び／又はいつ組織の処理が最適のレベルに到達し
たかの決定の制御において、改良が引き続き要求されて
いる。
【０００６】特に、組織におけるインピーダンス及びイ
ンピーダンス変化を測定して組織の特性を判定するこ
と、特に様々な組織のインピーダンス又はある範囲の組
織のインピーダンスに対して凝固の終了点を判定するた
めの装置及び方法を提供するという要求がある。
【０００７】
【課題を解決するための手段】この発明は、組織を治療
用電極で処理前、処理中に又は処理後に、組織の１つ以
上の電気的パラメータを測定する照会電極を含む電気外
科的装置を提供する。これらの測定された組織のパラメ
ータは、例えば、組織のタイプ、組織のインピーダンス
特性、組織処理の状態、組織の凝固の完了、その他、様
々な組織の特性の判定に用いられる。この発明の１態様
により、測定された組織の特性を表す信号が提供され
る。１実施例において、測定された組織の特性に応じて
電気外科的エネルギーの伝達を制御する制御信号が与え
られる。この制御信号は、ＲＦエネルギーを完全にシャ
ットオフにするか、または治療用電極を介して組織に伝
達されるエネルギーのレベル、周波数、その他を調節す
る。
【０００８】好ましい実施例においては、照会電極が用
いられて組織のインピーダンスを測定する。しかしなが
ら、様々な他の電気的パラメータが測定され又は用いら
れて組織の特性を判定する。
【０００９】１実施例において、この発明は電気外科的
器具の末端効果器の組織に接触する面に連絡（即ち、そ
こに配置され、その上に配置され、そこに重ねられ、そ
こに接着され、その他）している電気的に反対の照会電
極の間に配置された組織のインピーダンスをモニタする
インピーダンスモニタ装置及び／又は方法を提供する。
この器具は更に、末端効果器に関係付けられている、電
気的に反対の治療用電極を備えている。この治療用電極
は、これに接触している組織を処理するために治療用の
電気外科的エネルギーを伝達するようになっている。
【００１０】この発明により、好ましくは電気的エネル
ギーが組織に伝達されたとき、連続的又は周期的に組織
のインピーダンスを測定する組織インピーダンスモニタ
が提供される。この発明により、電気外科的エネルギー
で処理する前、処理中、又は処理後に、組織のインピー
ダンスに基づいて、組織の特性が判定される。好ましい
実施例において、モニタされた組織のインピーダンス
は、電気外科的エネルギーが組織に伝達されるとき時間
にわたり予想される組織のインピーダンスの振る舞いの
モデルに基づいて、組織の状態を判定するのに用いられ
る。これを以下に、より詳細に記載する。組織の状態を
表す信号がユーザ又は器具のコントローラに与えられ
る。この装置はまた、処理が完了したとき電気的エネル
ギーを自動的にオフにするスイッチを含んでもよい。
【００１１】知られた組織のインピーダンスモデルによ
れば、組織のインピーダンスは電気的エネルギーが与え
られると最初に低下し、次いで凝固が起こると再び上昇
し始める。この知られた組織の振る舞いに基づいて、こ
の発明の好ましい実施例においては、組織の処理が完了
する点が選択される。
【００１２】１実施例において、最小インピーダンスの
値、即ちエネルギーが印加されるときのインピーダンス
がその最低値であるとき、が確定される。次いで、所望
の組織の効果をもたらす予測されるインピーダンス値
が、確定された最小インピーダンスの選ばれた関数を計
算することにより決定される。測定されたインピーダン
スが、例えば。凝固、組織の溶接、又はジアテルミーの
レベル、といった所望の結果のためのインピーダンス値
のレベルにまで上昇すると、器具はそのような事情のた
めの応答を表す。この発明は、好ましくは、組織のタイ
プ、面積及び／又は体積によって変化する、予想される
組織のインピーダンスの範囲のための条件が検出される
ように適合されている。
【００１３】好ましい実施例において、所望の組織の状
態とは凝固が完了するときである。この点に到達する
と、フィードバック信号が制御ユニット又はユーザに与
えられ、そのときエネルギーの供給はオフに切り替えら
れる。フィードバック信号は、例えば、ユーザへの視
覚、聴覚又は触覚信号でよく、及び／又は制御ユニット
に指令を与えて組織に供給されるエネルギーを自動的に
オフに切り替えてもよい。
【００１４】この発明の１態様によれば、外科的処置中
に組織を凝固させるための電気外科的装置が提供され
る。この装置は、その間で凝固させるべき組織を係合す
るために互いに対して移動可能な第１及び第２の要素を
含む末端効果器を備えている。第１及び第２の要素の各
々は対向し組織に接触する面を備えている。第１及び第
２の要素の少なくとも１つは、電気的に反対の治療用ポ
ールに関係付けられている第１の治療用電極を含んでい
る。第１の治療用電極は、凝固させるべく係合された組
織と接触するように配置されている。照会電極は第１の
ポールに対応する少なくとも１つの照会電極と、電気的
に反対の第２のポールに対応する少なくとも１つの照会
電極とを備えている。好ましくは、組織が係合させられ
ると、両照会電極が凝固させるべき組織と接触する。照
会電極は好ましくは、所望の情報に依存して戦略的な位
置におけるインピーダンスを測定するように配置されて
いる。例えば、その電極はインターフェースするか対向
し、組織を係合している面の周辺に配置してもよい。パ
ワー制御信号に応答するパワーコントローラはＲＦエネ
ルギーを第１及び／又は第２の要素の電極に接触してい
る組織に供給する。
【００１５】インピーダンス測定回路は、エネルギーを
照会電極に伝達する電気回路に接続されている。インピ
ーダンス測定回路は照会電極の間の組織のインピーダン
スを測定する。制御信号をジェネレータに供給して治療
用電極への出力を制御するフィードバック回路が、イン
ピーダンス測定回路に接続されている。
【００１６】好ましい実施例においては、ジェネレータ
への制御信号は、測定されたインピーダンス値に基づい
て、治療用電極への出力を制御する。フィードバック回
路は、最小インピーダンス値を決定しその最小インピー
ダンス値を保持する第１の装置を含んでいる。第２の装
置は第１の装置に接続されたスレショルド決定回路であ
る。スレショルド決定回路は、スレショルドインピーダ
ンス値を保持された最小インピーダンス値の関数として
決定する。
【００１７】スレショルド決定回路は、最小インピーダ
ンスの関数を決定するためのアナログ装置又は、入力さ
れた最小インピーダンス値に基づいてスレショルドイン
ピーダンス値を決定する、例えば、ルックアップテーブ
ルを含むディジタル回路を備えている。
【００１８】スレショルド値が決定されると、第１の比
較器は測定されたインピーダンス値をスレショルドイン
ピーダンス値と比較して、パワーコントローラへのパワ
ーコントロール信号を発生し、測定されたインピーダン
ス値がスレショルドインピーダンス値を越えたときに組
織に伝達される治療用ＲＦエネルギー制御する。
【００１９】パワーコントローラは、選択的にＲＦエネ
ルギーを器具に供給して、第１及び第２の要素の間に配
置された組織を凝固させる少なくとも１つの電気的スイ
ッチを含んでもよい。
【００２０】パワーコントローラは、例えば、測定され
たインピーダンス値がスレショルドインピーダンス値を
越えたとき、のような多数の条件下で、組織に供給され
るパワーを選択的にオフに切り替えてもよい。
【００２１】この器具はモノポーラ又はマルチポーラ
（即ち、測定されたときの波形でエネルギーを任意のポ
ールから他の任意のポールに位相関係を持ちながら供給
する２つ以上の治療用電極を含む）でよいが、末端効果
器は好ましくは、２つの電気的に反対の治療用ポールに
対応する、２つの電気的に反対の治療用電極を含んでい
る。
【００２２】好ましいバイポーラ装置においては、各照
会及び治療用電極は対向する組織に接触する面の一方又
は両方の上に配置されている。第１及び第２の電気的に
反対の照会電極の各々は、１つ以上の組織の接触する照
会電極を備え、第１及び第２の治療用電極の各々は１つ
以上の組織の接触する治療用電極を備えている。治療用
電極は電気外科的装置の遠端点に配置されており、第１
及び第２の要素が互いに閉じて組織を係合すると、電気
的に反対の治療用電極は、係合された組織の部分の間
の、同一面上又は対向面上のいずれかに配置される。
【００２３】照会電極は電気外科的装置の遠端点に配置
されており、第１及び第２の要素が互いに閉じて組織を
係合すると、電気的に反対の照会電極は、係合された組
織の部分の間の、同一面上又は対向面上のいずれかに配
置される。インピーダンスモニタ回路は、低い電圧のＲ
Ｆエネルギーが照会電極を通して組織に伝達されると、
照会電極の間の組織のインピーダンスをモニタする。照
会電極を介して伝達されるＲＦエネルギーの周波数は、
治療用電極を介して伝達されるエネルギーの周波数と異
ならせて、電気的な相互作用を減少させることが好まし
い。
【００２４】１つの好ましい実施例においては、第１の
ポールに対応する治療用電極の各々は、インターフェー
ス面に関して、第２のポールに対応する治療用電極の各
々からオフセットされている。換言すれば、治療用電極
は互いにオフセットされており、それによりそれらはイ
ンターフェース面上で正反対には互いに対向しないか、
又は同一面上で互いに分離され絶縁されている。
【００２５】好ましい実施例において、電気外科的器具
は、第１のインターフェース面と第２のインターフェー
ス面との間の圧縮ゾーンにおいて組織を圧縮し、その圧
縮ゾーンを通じて治療用電気エネルギーを印加する。よ
り好ましくは、圧縮ゾーンとは、組織を他方のインター
フェース面に対して圧縮するインターフェース面の１つ
の上の圧縮用隆起部により決まる領域である。これに替
えて、又はこれに追加して、両インターフェース面の上
に圧縮用隆起部が存在してもよい。照会電極は、圧縮ゾ
ーン内で、圧縮ゾーンに隣接して離れて、末端効果器上
の遠端点又は近端点に、その他、器具の応用に依存し
て、圧縮ゾーンの横の外側に配置してもよい。
【００２６】１実施例において、末端効果器は切断要素
を含む。この切断要素は、凝固位置において又はその近
くで組織を切断するように配置されている。好ましく
は、凝固は、あらゆる機械的又は他の切断の前又は凝固
位置において又はその回りで完了する。照会電極がこう
して配置されるので、インピーダンスセンサは凝固又は
焼灼が切断位置において生じたときを判定できる。次い
で、切断要素が使用されて凝固した組織又は組織の凝固
の２つのゾーンの間を切断する。
【００２７】他の実施例において、治療用及び照会電極
は、リニアな切断用の機械的ステープラに類似のリニア
カッターに取り込まれる。この実施例においては、器具
は好ましくは、１つの治療用ポールに結合している２つ
の実質的に平行で伸張した治療用電極棒と、切断手段が
その棒の間を走行するためのスロットとを備えている。
オプションとして、ステープルの１つ以上の列を棒のス
ロットの外側の各側の上に設けて、治療過程での組織の
機械的な安全等を確保するようにしてもよい。
【００２８】好ましい実施例の動作において、組織は器
具の２つの要素の間にクランプされ、ＲＦエネルギーの
形の電気エネルギーが圧縮された組織に供給されて、２
つの実質的に平行な棒に沿って組織を凝固又は焼灼す
る。同時に、好ましくはより低い電圧で異なるＲＦ周波
数の電気的エネルギーが照会電極に供給されてその間の
組織のインピーダンスを感知する。この特定の電極形態
を持つ装置のインピーダンスのモデルに基づいて、最小
インピーダンスの適当な関数がインピーダンスフィード
バック回路に取り込まれて適当なスレショルドインピー
ダンスレベルを決定する。警報機構が用いられてインピ
ーダンスがスレショルドインピーダンスレベルの範囲外
又それを越えるとユーザに警告を与える。また、警告信
号は制御回路又はパワーコントローラに伝達されて、Ｒ
Ｆエネルギーをオフに切り替えるか、又は、ジェネレー
タの出力レベル、周波数、波形、その他、治療用電極を
介して伝達されるものを調整する。
【００２９】この発明の他の態様によれば、組織の電気
外科的処理方法が提供される。好ましくは、この方法
は、電気外科的器具の末端効果器に関係付けられた１つ
以上の組織照会電極を介して、電気外科的に処理される
べき組織にＲＦエネルギーを印加する段階と、器具の末
端効果器に関係付けられた電気的に反対の照会電極の間
の組織のインピーダンスを測定する段階と、組織の測定
されたインピーダンスを表すインピーダンス信号を発生
する段階と、そしてこのインピーダンス信号に応答して
治療用電極を介して組織に印加されるＲＦエネルギーを
制御する段階とを備えている。
【００３０】治療用電極を介して組織に印加されるＲＦ
エネルギーを制御する段階は、最小インピーダンス値を
決定し保持する段階と、最小インピーダンス値の関数に
基づいてスレショルドインピーダンス値を決定する段階
と、測定されたインピーダンス値をスレショルドインピ
ーダンス値と比較する段階と、測定されたインピーダン
ス値がスレショルドインピーダンス値を越えた状態でコ
ントローラを制御し又はそのパワーをオフに切り替える
制御信号を発生する段階とを備えている。
【００３１】この発明の更に他の態様によれば、外科的
処理の間、組織を電気外科的に処理する方法は、第１及
び第２の組織係合用表面を備える末端効果器を有する電
気外科的器具を用意し、この場合前記第１及び第２の組
織係合用表面の少なくとも１つはその上に、電気外科的
システムの第１のポールに関係付けられた組織に接触す
る治療用電極を含ませ、前記第１及び第２の組織係合用
表面の少なくとも１つはその上に、電気外科的治療シス
テムの第２のポールに関係付けられた組織に接触する治
療用電極を含ませ、前記第１及び第２の組織係合用表面
の少なくとも１つはその上に、インピーダンス感知シス
テムの第１のポールに関係付けられた組織に接触する第
１の照会電極と、インピーダンス感知システムの第２の
ポールに関係付けられた組織に接触する第２の照会電極
とを含ませる段階と、前記第１及び第２の組織係合表面
の間に、処理されるべき組織を係合する段階と、前記第
１及び第２の組織に接触する治療用電極に供給されるＲ
Ｆエネルギーを選択的に制御してその間に配置された組
織を凝固させる段階と、処理された組織のインピーダン
スを前記第１及び第２の照会電極で測定する段階と、組
織の処理が完了するときのスレショルドインピーダンス
を設定する段階と、測定されたインピーダンス値を前記
スレショルドインピーダンス値と比較する段階と、そし
て測定されたインピーダンス値が前記スレショルドイン
ピーダンス値に到達するか越えるという条件で、前記第
１及び第２の治療用電極に結合したＲＦエネルギーを制
御又はオフに切り替える段階とを備えている。
【００３２】この発明の他の目的及び利益は以下の記
載、添付の図面及び特許請求の範囲から明らかである。
【００３３】
【発明の実施の形態】この発明は概略的には、モノポー
ラ、バイポーラ及びマルチポーラ、及び通常のものと内
視鏡の両方の様々な電気外科的器具に適用可能である
が、以下では内視鏡、バイポーラ、リニアな切断及びス
テープリング器具に関して記載する。
【００３４】リニアな切断及びステープリング用器具は
この技術において知られており、例えば、米国特許第
４,６０８,９８１号、第４，６３３，８７４号、及び参
考のためにここに取り込んだ米国特許出願シリアル番号
第０７／９１７，６３６号において議論されている。
【００３５】組織の処理前、処理中、又は処理後のある
時間における組織のインピーダンスを決定するために、
照会電極が好ましく使用される。しかしながら、電流又
は電圧の伝達、位相シフト、及び組織の周波数応答のモ
ニタといった他の使用も考えられる。
【００３６】１実施例において、照会電極を用いるイン
ピーダンスモニタ装置は、組織がある特別の位置で所望
の度合いにまで処理された時を判定する。この処理は、
過剰な熱の放散、組織の固着、焼け又は焦げが生じる前
で、組織が焼灼した時点で完了することが好ましい。電
気外科的エネルギーで加熱されている時の組織のインピ
ーダンスは、一般に特性組織インピーダンス曲線に従
う。インピーダンス曲線に従って、一般にインピーダン
スは減少して、最小値に達し、次いで凝固と組織の乾燥
が起こると上昇する。特性曲線上のあるインピーダンス
又はある範囲のインピーダンスで、凝固は予測可能に生
じる。
【００３７】図２３は、図１から図２０に示した電気外
科的装置を用いて電気外科的エネルギーを加えている間
の時間の、組織のインピーダンスの変化を示す特性イン
ピーダンス曲線である。この発明は曲線上で凝固が起き
たスレショルドインピーダンスＺTARGETの点１４６を決
定する。このインピーダンスは曲線上の最低インピーダ
ンスＺMINの点１４５、すなわち、インピーダンスの低
下が停止し、上昇し始める時に基づいている。最低イン
ピーダンスの関数ｆ（ＺMINi）は凝固が起きるおよその
点、ＺTARGETを予測するために用いられる。
【００３８】図１から図１８において、インピーダンス
フィードバック装置とともに用いられるこの発明の装置
が示されている。図１から図４において、内腔がその中
を伸びている鞘３０と鞘３０の遠端点から伸びている末
端効果器１５とに結合されたハウジング１６を有する内
視鏡のリニアな切断及びステープリング装置１０が示さ
れている。末端効果器１５は、互いに面と向かう顎部材
３２，３４からなる第１及び第２要素を備えている。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１６は、顎部材３２，３４を閉じるクランプ用
引き金１２と、ＲＦスイッチ戻り止めアーム５８（図５
参照）と、ＲＦエネルギーをオンにする電気的スイッチ
５９に接続された電気的スイッチ接点６７ａ，６７ｂ
（図５）と、切断要素１１を組織に進入させる点火用引
き金１４と、ステープル１７（図１７）を適用するため
のくさび１３とを有している。図１においては顎部材３
２，３４はクランプされていない位置にあり、図２にお
いては電気外科的エネルギーを加える前及び切断とステ
ープリングをする前のクランプされた位置にあり、図３
においては電気外科的エネルギーを加えた後で切断とス
テープリングをする前のクランプされた位置にあり、図
４においては切断とステープリングをした後のクランプ
された位置にある状態が示されている。
【００３９】顎部材３２は、図１７に示されるように、
金床（以下アンビル称する）１８と、顎部材３２の長手
方向に沿って伸びているＵ字形治療用電極３９と、Ｕ字
形治療用電極３９の外側をとりまくＵ字形絶縁部材３１
とを備えている。顎部材３２は顎部材３４の内面３５に
実質的に面している内面３３を有している。Ｕ字形治療
用電極３９は、第１のポールを形成し且つ実質的に内面
３３の長手方向に沿ってその上に配置され伸びている２
つの電気的連絡用電極棒２７，２８を備えている。Ｕ字
形治療用電極３９はアルミニウム又は外科用のグレード
のステンレススティールといった導体でできている。電
気的連絡用電極棒２７，２８はＵ字形治療用電極３９の
中央を通って縦方向に伸びているナイフチャネル２９に
より分離されている。Ｕ字形治療用電極３９の各側に一
列のステープルを形成するために、ステープルの端部を
受け入れるアンビル１８上に配置されたポケット３６
が、電気的連絡用電極棒２７，２８の長手方向の外側に
沿う内面３３に沿って配置されている。
【００４０】電気的連絡用電極棒２７，２８及び絶縁部
材３１は内面３３のアンビル部３３ａに対して外側に伸
びる隆起部５６を形成している。Ｕ字形治療用電極３９
はバイポーラ組織処理又は治療システムの第１ポールと
して働く。アンビル１８は導電性材料でできていてバイ
ポーラ組織処理又は治療システムの第２ポールとして働
く。アンビルはＵ字形治療用電極３９と電気的に反対で
ある。アンビル１８はＵ字形絶縁部材３１によりＵ字形
治療用電極３９から電気的に分離されている。
【００４１】顎部材３４はカートリッジチャネル２２と
カートリッジチャネル２２の中に解放可能に挿入された
カートリッジ２３を備えている。カートリッジ２３はく
さび１３のためのトラック２５と、カートリッジ２３の
中心を通って縦方向に伸びるナイフチャネル２６と、２
組の列にそれぞれ配置されたトラック２５及びステープ
ル１７の中に伸びる一連のドライバ２４とを備えてい
る。
【００４２】顎部材３４はさらに、カートリッジ２３上
に配置され且つカートリッジチャネル２２から絶縁材料
により分離されている第１の照会電極５１と、ナイフチ
ャネル２６によって決められる平面の第１の照会電極５
１と反対側の横のカートリッジチャネル２２上に配置さ
れ且つカートリッジチャネル２２から絶縁材料により分
離されている第２の照会電極５２とを備えている。第１
の照会電極５１及び第２の照会電極５２は表面３５の横
側面周辺に向かって配置されており、それにより、係合
している組織の部分全体を横切る組織のインピーダンス
が測定される。第１の照会電極５１及び第２の照会電極
５２は又、カートリッジ２２により決められる平面から
へこんでおり、それにより顎部材３２，３４が閉じても
第１の照会電極５１及び第２の照会電極５２がアンビル
１８に接触しないようになっている。
【００４３】鞘３０は絶縁材料でできておりその管腔を
通って伸びている導電性の封止官３８を有している（図
１及び図２）。好ましい実施例において、封止官３８は
顎封止管及び電気的接点として働く。チャネルリテイナ
３７ａ（図５、図７、図９、図１０、図１１）が封止官
３８の近端点から伸びており、且つ封止官３８の残りを
通って遠方に伸びて顎部材３４を形成しているチャネル
３７に確保されている。
【００４４】ハウジング１６は封止官３８を前進させ
て、組織をその間に係合している顎部材３２，３４を互
いの方向に閉じさせるクランプ用引き金１２を有してい
る。クランプ用引き金１２を回転すると、封止官３８は
顎部材３２のキャミング面３２ａ（図１）にわたって鞘
３０を通って同軸的に前進して、顎部材３２、３４の間
にある組織上で顎部材３２、３４を閉じさせる。
【００４５】チャネルリテイナ３７ａはチャネル３７内
でドライブロッド４１（図５から図１１）の同軸的移動
をガイドする。以下に、より詳細に記載するように、ド
ライブロッド４１は点火用引き金１４の回転により前進
する。ドライブロッド４１はその遠端点でブロック４３
に結合されている。ブロック４３は、切断要素１１及び
ステープルドライブ用くさび１３に結合されている。ド
ライブロッド４１はブロック４３によりその切断要素１
１及びステープルドライブ用くさび１３を末端効果器１
５内に前進させる。
【００４６】ドライブロッド４１が切断要素１１を前進
させると、切断要素１１は電気的連絡用電極棒２７，２
８の間のナイフチャネル２６を通って前進し、顎部材３
２、３４に係合されている組織が焼灼されたときにその
組織を切断する。こうして、電気的連絡用電極棒２７，
２８により形成された凝固ラインに対して、切断ライン
は中間となる。ドライブロッド４１は同時にブロック４
３を前進させてくさび１３を前進させ、くさび１３はド
ライバ２４をステープル１７の中にドライブしてステー
プル１７を組織を通して発射させ且つアンビル１８のポ
ケット３６の中にドライブする。ステープル１７は切断
要素１１が組織を切断するとき、切断要素１１の各側の
上の単一の縦列内に適用される。
【００４７】ハウジング１６の遠端点上に配置されたノ
ブ４４は、ノブ４４に直接的又は間接的に結合している
封止官３８、チャネルリテイナ３７ａ、及び末端効果器
１５を回転させ、それによりノブ４４は顎部材３２、３
４の末端効果器１５の回転的配置のために使用される。
ノブ４４は封止官３８の刻み目３８ａにフィットし且つ
係合するペグ（図示せず）を含んでいる。封止官３８は
その近端点でハウジング１６にフィットしている。
【００４８】電気外科的ジェネレータ７０、９０（図
１、図２１、図２２）から電気的エネルギーが、以下に
記載するようなコネクタ又は、例えば、米国特許出願シ
リアル番号台０８／０９５，７９７号に記載の接続手段
を介して、電極３９、アンビル１８、第１の照会電極５
１、１５１（図１９）又は２５１（図２０）に供給され
る。電気外科的ジェネレータ７０、９０は、ハウジング
１６に配置されたＲＦ電気的スイッチ５９によりユーザ
により制御される。
【００４９】ワイヤ１９ａ、１９ｂ、１９ｃ、及び１９
ｄ（図１、図５、図８）が装置のハウジング１６内に伸
びており、Ｕ字形治療用電極３９、アンビル１８、第１
の照会電極５１、及び第２の照会電極５２にそれぞれエ
ネルギーを伝達する。ワイヤ１９ａ、１９ｂは低インピ
ーダンスコンタクト要素２０ａ、２０ｂにそれぞれ接続
されている。線細工ばね４７ａ、４７ｂがそれらの遠端
点で露出している。線細工ばね４７ａ、４７ｂはチャネ
ルリテイナ３７ａの近端点に配置されている封止官３８
及びコンタクトリング４９ｂに向かってそれぞれバイア
スされており、それにより封止官３８及びコンタクトリ
ング４９ｂにそれぞれ接触させられている（図１４）。
ワイヤ１９ａ、１９ｂはハウジング１６内でリボンワイ
ヤ５０の形で伸びている（図１３）。リボンワイヤ５０
はコンタクトフィンガ４２ｃ、４２ｄを有するコンタク
トブロック４１に接続されている。コンタクトブロック
４１はハウジング１６に確保されている。ワイヤ１９ｃ
はコンタクトフィンガ４２ｃに電気的に接触しており、
ワイヤ１９ｄはコンタクトフィンガ４２ｄに電気的に接
触している。コンタクトフィンガ４２ｃ、４２ｄは、チ
ャネルリテイナ３７ａの近端点に配置されているコンタ
クトリング４９ｃ、４９ｄに向けてそれぞれバイアスさ
れており、それによりコンタクトリング４９ｃ、４９ｄ
にそれぞれ電気的に接触している。
【００５０】封止官３８が顎部材３２、３４を閉じる時
に、ワイヤ１９ａは線細工ばね４７ａによってアンビル
１８に電気的に接触する。線細工ばね４７ａはこの時封
止官３８に電気的に接触する。封止官３８はこの時アン
ビル１８に電気的に接触する。
【００５１】ワイヤ１９ｃはリボンワイヤ５０を介して
第１の照会電極５１の電流を伝達しコンタクトブロック
４１の第１のスプリングコンタクトフィンガー４２ｃに
接続されている。第１のスプリングコンタクトフィンガ
ー４２ｃはコンタクトリング４９ｃと電気的に接触する
ようにコンタクトリング４９ｃに対してバイアスされて
いる。コンタクトリング４９ｃは封止管３８を介して電
極５１まで伸びているワイヤ４０ｃに接触している。
【００５２】ワイヤ１９ｄはリボンワイヤ５０を介して
第２の照会電極５２に電流を伝達しコンタクトブロック
４１の第２のスプリングコンタクトフィンガー４２ｄに
接続されている。第２のスプリングコンタクトフィンガ
ー４２ｄはコンタクトリング４９ｄと電気的に接触する
ようにコンタクトリング４９ｄに対してバイアスされて
いる。コンタクトリング４９ｄは封止管３８を介して電
極５２まで伸びているワイヤ４０ｄに接触している。
【００５３】封止管３８、リングコンタクト４９ｂ、４
９ｃ、４９ｄ及びワイヤフォーム４７ａ、４７ｂと第１
のスプリングコンタクトフィンガー４２ｃ、第２のスプ
リングコンタクトフィンガー４２ｄとの間がそれぞれ接
触している間は、封止管３８及びリングコンタクト４９
ｂ、４９ｃ、及び４９ｄはノブ４４の回転を可能にす
る。リングコンタクト４９ｂ、４９ｃ、４９ｄは互いに
電気的に絶縁されており、且つ封止管３８からも電気的
に絶縁されている。
【００５４】ワイヤ４０ａ−ｄはチャネルリテイナ３７
ａにフィットしているシール４５を介して伸びており、
チャネルリテイナ３７ａは封止管３８にフィットしてい
る。
【００５５】図５において、クランプ用トリガ１２は歯
車１２ａを有しており、歯車１２ａはヨーク６６の歯６
６ｂに可動的に係合している。ヨーク６６はその遠端点
上で封止管３８に結合している。クランプ用引き金１２
が駆動されると、歯車１２ａはヨーク６６内の歯６６ｂ
に係合してヨーク６６を遠方に前進させる。封止管３８
はキャミング面３２ａにわたり前進するとき顎３２、３
４を閉じる。
【００５６】図１から図５において、ＲＦスイッチ５９
の回転よりＲＦエネルギーがスイッチオンし、治療用及
び照会電極に供給される。ＲＦスイッチ５９が回転する
と、ＲＦスイッチ５９がその元の位置に手動により回転
して戻されない限り、戻り止め突起５９ａが戻り止めア
ーム５８上の戻り止め突起５８ａの下にフックする。Ｒ
Ｆエネルギーはまた、下記のように電気的にオフにでき
る。
【００５７】スイッチ５９は可動接点６７ａと固定接点
６７ｂを有する（図７）。スイッチがオンになると可動
接点６７ａはＲＦスイッチ５９とともに回転して固定接
点６７ｂに接触する。
【００５８】解放ボタン６０の出っ張り部６０ａはヨー
ク６６の近端点上の階段状の出っ張り部６６ａに隣接す
るヨーク６６の近端点に係合している。ヨーク６６がク
ランプ用引き金１２により前進させられると、出っ張り
部６０ａはヨーク６６の近端点の後ろの下方に回転し、
それにより解放ボタン６０を押すまではヨーク６６が元
に戻る（リトラクトする）のを防止する。こうして、ユ
ーザが解放ボタン６０により顎３２、３４を解放するま
では顎３２、３４は閉じている。
【００５９】スイッチ５９はヨーク６６の近端点のすぐ
上にあるフィンガー５９ｃを含んでいる。解放ボタン６
０の出っ張り部６０ａはフィンガー５９ｃの間にフィッ
トする。ヨーク６６が遠くに前進させられてＲＦスイッ
チ５９のフィンガー５９ｃがヨーク６６の近端点の後ろ
で自由に回転するまでは、ＲＦスイッチ５９は駆動、即
ち正方向に回転させることはできない。
【００６０】ＲＦスイッチ５９はまた点火ラック５３の
溝５３ａに係合する下側フック５９ｂを含んでいる。点
火ラック５３は点火引き金１４の歯車１４ａに係合する
歯車５３ｂを含んでいる。点火ラック５３はその遠端点
状で歯車５４に結合しており、歯車５４は駆動ロッド４
１に係合している。
【００６１】点火引き金１４が引かれると、点火ラック
５３は遠方に前進させられてピニオン５４を回転させ、
ピニオン５４は駆動ロッド４１を遠方に前進させて切断
要素１１を前進させ、ステープル１７を末端効果器１５
により係合している組織の中にドライブする。
【００６２】しかしながら、点火ラック５３は、ＲＦス
イッチ５９の下側フック５９ｂが点火ラック５３の溝５
３ａからはずれないかぎり、前進することができない。
これはＲＦスイッチ５９が駆動された時にのみ生じる。
【００６３】こうして、ここに記載した装置は、顎３
２、３４が閉じられるまでは、ＲＦエネルギー、ステー
プル又はナイフの駆動の適用を防止する少なくとも１つ
のロックアウト装置を含む。ロックアウト装置は図１か
ら図４に示されるように適切なシーケンスに従うことが
要求される。即ち、顎が閉じた後にＲＦエネルギーが加
えられ、次いでステープルと切断要素の適用がある。ま
た、ＲＦスイッチは戻り止めされているので、ＲＦスイ
ッチ５９が手動で解放されるか、電気外科的ジェネレー
タ７０，９０への帰還制御信号によりＲＦエネルギーが
オフに切り替えられるまで、ＲＦエネルギーは連続的に
供給される。
【００６４】閉鎖クランプ用引き金１２及び点火引き金
１４はインターロックされており、スプリング５７は両
引き金１２、１４に機械的に結合されている。組織がク
ランプされた顎部材３２、３４の間に係合され、ＲＦエ
ネルギーが加えられると、ハウジング１６上に配置され
ている点火引き金１４を駆動して係合された組織を通し
て切断要素１１を前進させ、組織を切断することができ
る。同時に、点火引き金１４が駆動されると、くさび１
３がトラック２５を通して前進させられて、ドライバ２
４をステープル１７に向けて移動させ，それによりステ
ープル１７を組織を通してアンビルポケット３６の中に
ドライブする。
【００６５】図１９はこの発明の他の実施例による末端
効果器を示す。この実施例においては、末端効果器は、
照会電極の配置を除き、図１７に付いて記載したものと
同一である。第１の照会電極は、一対の電極１５１であ
り、ナイフチャネル２６の反対側の上のカートリッジチ
ャネル２２上に配置され表面３５の側部周辺に向かって
いる。第２の照会電極及び第２の治療用電極は同じであ
りアンビル１８を備えている。
【００６６】図２０はこの発明の更に他の実施例による
末端効果器を示す。この実施例においては、照会電極は
一対の電極２５１であり、アンビル１８上に配置されて
おり且つ絶縁部材１８ａによりアンビル１８から電気的
に分離されている。第１の照会電極２５１はナイフチャ
ネル２９の互いに反対側に配置されている。第２の照会
電極は一対の電極２５２であり、カートリッジチャネル
２２の上に配置されており、且つ絶縁部材によりカート
リッジチャネル２２から電気的に分離されている。第２
の照会電極２５２はナイフチャネル２９の互いに反対側
に配置されている。第１の照会電極２５１は装置周辺側
で対応する第２照会電極に直接的に対向しており、それ
によりモニタされるインピーダンスは、組織の凝固が装
置の中央から進む時、典型的に加熱される周辺部におけ
る組織に基づいている。
【００６７】３つの異なる特定の電極形態を図１７、１
９及び２０に示したが、なかんずく組織のモニタが望ま
れる処理の位置またはステージによって、この発明によ
り照会電極及び治療用電極の多くの位置が可能であるこ
とを理解すべきである。更に、１つ以上の照会電極が１
つ以上の処理電極でジェネレータへの導通パスを分け合
うことができる。
【００６８】図２１を参照すると、この発明のインピー
ダンスモニタ装置（インピーダンス測定回路）２１０の
アナログ装置の実施例の概略的ブロック図が示されてい
る。このインピーダンスモニタ装置は凝固が完了した時
を判定する。
【００６９】装置１０は処理されるべき組織を係合する
ように位置づけられる。次いで、適切に位置づけられる
と、ＲＦエネルギーが組織に供給される。
【００７０】第１の電気外科的ジェネレータ７０は、治
療用電極であるＵ字形治療用電極３９及びアンビル１８
を介して、装置１０の末端効果器１５により係合された
組織にＲＦエネルギーを供給する。好ましくは、約３０
０Ｋｈｚから３Ｍｈｚの基本周波数の正弦波の３０から
２００ボルトＲＭＳで約０．１から４．０アンペアの電
流が、アンビル１８とＵ字形治療用電極３９を介して供
給される。第２の電気外科的ジェネレータ９０は、その
周波数範囲の上の範囲内の異なる基本周波数で好ましく
は２ボルト以下の電圧と約１ｍＡから１００ｍＡの電流
で第１の照会電極５１及び第２の照会電極５２に電気的
エネルギーを供給する。
【００７１】第１の電気外科的ジェネレータ７０及び第
２の電気外科的ジェネレータ９０はハウジング１６に配
置された、ユーザにより操作される電気的スイッチ５９
によりオンになる。これに替えて、第２の電気外科的ジ
ェネレータ９０は治療用信号から独立にオンに切り替え
ることもできる。
【００７２】ユーザにより操作される電気的スイッチ５
９（図２２）はコントローラ７９のＲＦ制御入力端子に
信号を与えて、治療用エネルギー信号をオンにする。コ
ントローラ７９の出力１２９はアナログスイッチ１３０
（図２１）に接続されている。出力１２９がアナログス
イッチ１３０に「ＲＦオン」信号を与えると、アナログ
スイッチ１３０を介してアナログ乗算器７５に接続され
ている発振器７２は知られた周波数の電圧をアナログ乗
算器７５に印加する。アナログ乗算器７５の出力はドラ
イバ７６に接続されており、ドライバ７６はＲＦ増幅器
７１の入力に接続されている。第１のＲＦ増幅信号は、
電気外科的ジェネレータ７０によって、回路８０に供給
される。回路８０は、装置１０により処理されるべき組
織５５を含む、装置１０の第１の治療用電極であるＵ字
形治療用電極３９と第２の治療用電極であるアンビル１
８とに接続されている。第２の電気外科的ジェネレータ
９０は第１の照会電極５１及び第２の照会電極５２に第
２の電気信号を供給する。発振器９１は治療用の発振器
７２の出力信号とは異なる周波数の電圧をＲＦ増幅器９
２に印加し、ＲＦ増幅器９２は第１の照会電極５１及び
第２の照会電極５２に、より低い電圧信号を与える。
【００７３】治療用電極に接続されているインピーダン
スセンサは、治療用電極であるアンビル１８及びＵ字形
治療用電極３９を介して組織に伝達された電流及び電圧
を検出する電圧・電流センサ８１を含む。電圧・電流セ
ンサ８１は、治療用電極における電気外科的ジェネレー
タ７０の出力と直列に低インピーダンス電流変換器８２
を含み、治療用電極における電気外科的ジェネレータ７
０の出力と並列に高インピーダンス電圧変換器８３を含
んでいる。好ましくは、電流変換器８２は、例えば、
１：２０の巻き線比と変換器の二次側に並列な５０オー
ムの抵抗を有している。好ましくは、電圧変換器８３
は、例えば、２０：１の巻き線比と変換器の二次側に並
列な１Ｋオームの抵抗を有している。
【００７４】電流変換器８２の出力はＲＭＳコンバータ
８４に接続されている。ＲＭＳコンバータ８４は検出し
た電流をＤＣ信号に変換して、アンビル１８とＵ字形治
療用電極３９の間を流れる電流ＲＭＳであるＩTRMSを出
力８６に供給する。電圧変換器８３の出力はＲＭＳコン
バータ８５に接続されている。ＲＭＳコンバータ８５は
電圧をＤＣ信号に変換して、治療用電極であるアンビル
１８とＵ字形治療用電極３９の間の電圧ＲＭＳであるＶ
TRMSを出力８７に与える。ここで、照会信号が組織の治
療用信号より極めて低い電圧である場合、ＶTRMS及びＩ
TRMSを決定する時に照会信号をフィルタにより除去する
必要がないことに着目すべきである。
【００７５】次いで、治療用電極において測定されたイ
ンピーダンスＺTが、測定されたＩT RMS及びＶTRMSから
計算される。出力８６及び８７におけるＩTRM及びSＶ
TRMSはアナログドライバ８８に供給される。アナログド
ライバ８８はＩTRMSによってＶTRMSをドライブして測定
されたインピーダンスＺTを表す出力信号８９を出力す
る。
【００７６】好ましい実施例によれば、ジェネレータの
エネルギーの出力を負荷インピーダンスに基づいて制御
する制御装置が提供される。この実施例においては、治
療用電極におけるインピーダンス、すなわち組織のイン
ピーダンスが好ましく用いられる。しかしながら、他の
実施例において、照会電極におけるインピーダンスをジ
ェネレータの出力を制御するために用いてもよい。この
目的のためには、電流、電圧センス回路（図示せず）に
より測定された治療用電極における被測定インピーダン
スを用いても、これに替えて照会電極におけるインピー
ダンスを用いてもよい。治療用電極又は照会電極のいず
れかのインピーダンスは、ジェネレータ、装置、及び／
又はアプリケーションの特定のシステム負荷曲線に基づ
いて、好ましいエネルギーレベル、例えば、電圧、電流
又はパワーレベルを決定するために用いられる。制御装
置は次いで、測定されたインピーダンスに対する実際の
エネルギーレベルを所望のエネルギーレベルと比較し、
その間の差によってジェネレータの出力を調整して、好
ましくはその間の差を最小化する。
【００７７】そのような制御装置における特定のシステ
ム負荷曲線は、装置の性能を最適化するインピーダンス
の範囲に対する電圧、電流又はパワーを反映しているこ
とが好ましい。
【００７８】この負荷曲線の必要条件は様々な形態でよ
く、例えば、連続でも階段状でも良い。この負荷曲線
は、ジェネレータと共に使用する特定の装置、又はジェ
ネレータの特定の電気外科的アプリケーションに応じて
変化する。例えば、ここに記載したような装置を用いる
１実施例においては、異なるエネルギーが要求される。
即ち、最初は組織のインピーダンスは低い範囲、例えば
およそ２０から１００オームにある。この低い範囲で
は、組織の凝固を開始するためには十分なパワーを与え
るための電流が要求される。第２のインピーダンスの中
間範囲、例えば１００から５００オームでは、凝固プロ
セスを維持するために十分なパワーが要求される。凝固
の完了に向けて生じる高インピーダンスの第３の範囲、
例えばおよそ５００オーム以上では、スパークと組織の
粘着を防止するために電圧は制限されることが要求され
る。こうして、この実施例におけるシステム負荷曲線
は、ジェネレータの固有の特性と特定のインピーダンス
のための最適パワーが伝達される電圧出力との両方を、
所定の装置及びアプリケーションのための特定のパワー
の要求と共に反映する。
【００７９】電気外科的ジェネレータ７０はサーボルー
プ制御装置を含んでいる。インピーダンス信号８９及び
電圧ＶTRMS信号８７は、ファンクションフィッティング
装置６１とエラー増幅器６２を備える制御装置を介して
電気外科的ジェネレータ７０にフイードバックされる。
この制御装置は電気外科的ジェネレータ７０を制御し
て、特定負荷曲線にフィットする負荷インピーダンスに
基づいて所望の範囲内の電圧を発生させる。
【００８０】信号線８９上のインピーダンスはファンク
ションフィッティング装置６１に与えられる。ファンク
ションフィッティング装置６１の出力６４は入力された
信号線８９上のインピーダンスに基づく所望の電圧を表
す。この所望の電圧の機能は、特定の、所定負荷曲線を
生成するために電気外科的ジェネレータ７０に要求され
る電圧である。出力６４における所望の電圧は実際の電
圧と共にエラー増幅器６２に供給される。エラー増幅器
６２の出力６５は、ダイオード７７を介してアナログ乗
算器７５に供給されるエラー電圧を表す。
【００８１】これに替えて、電流、パワー又は他のエネ
ルギーパラメータを用いて電気外科的ジェネレータ７０
の出力を制御してもよい。この場合、目標物のインピー
ダンスに対応する信号がファンクションフィッティング
装置６１に入力される。ファンクションフィッティング
装置６１は所望の電流、パワー又は他のエネルギーパラ
メータを出力する。このパラメータは次いで測定された
電流、パワー又は他のエネルギーパラメータと比較され
る。
【００８２】ダイオード７７はアナログ乗算器７５の最
初の四半動作を保証する。アナログ乗算器７５は発振器
７２の振幅変調器として機能して出力６５における大き
いエラー電圧がＲＦ増幅器７１からの大きい出力をもた
らすようにする。また、出力６５における小さなエラー
電圧はＲＦ増幅器７１からの小さいＲＦ出力をもたら
す。こうして、電気外科的ジェネレータ７０は、所望の
曲線が得られように電圧に基づく閉じたループのサーボ
システムとして働く。電圧以外の電気的パラメータが用
いられる場合、ファンクションフィッティング装置６１
は好ましくはその代替エネルギーパラメータにおける差
を反映した信号を出力する。
【００８３】他の実施例（図示せず）において、照会電
極に伝達されたエネルギーに関連するインピーダンス又
は他のエネルギーパラメータを用いてサーボループを介
してジェネレータを制御してもよい。
【００８４】図２２に示される電気外科的ジェネレータ
９０は、照会信号を第１の照会電極５１及び第２の照会
電極５２に供給する。この信号は、治療用信号とは独立
にオンになり且つオンに維持される。照会信号は低電圧
であり組織の処理を行わないので、照会信号はオンに維
持しておいてもよい。第１の照会電極５１及び第２の照
会電極５２に接続されているインピーダンスセンサは、
第１の照会電極５１及び第２の照会電極５２を介して組
織に供給される電流及び電圧を感知する電圧及び電流セ
ンサ９３を含んでいる。電圧及び電流センサ９３は電気
外科的ジェネレータ９０と直列の低インピーダンス電流
変換器９４と、照会電極への電気外科的ジェネレータ９
０の出力の両端に並列に接続された高インピーダンス電
圧変換器９５とを含んでいる。
【００８５】電圧変換器９４の出力は、治療用信号の周
波数又はその周辺の周波数をフィルタにより除去する一
方で、照会信号の周波数又はその周辺の周波数を通過さ
せるように設けられた帯域通過フィルタ１１１に接続さ
れている。帯域通過フィルタ１１１の出力はＲＭＳコン
バータ１１２に接続されている。ＲＭＳコンバータ１１
２は感知した電流をＤＣ信号に変換して、２つの照会電
極５１、５２の間を流れる電流ＲＭＳであるＩQRMSを表
す出力を与える。電圧変換器９５の出力は、治療用信号
の周波数又はその周辺の周波数をフィルタにより除去す
る一方で、照会信号の周波数又はその周辺の周波数を通
過させるように設けられた帯域通過フィルタ１１３に接
続されている。帯域通過フィルタ１１３の出力はＲＭＳ
コンバータ１１４に接続されている。ＲＭＳコンバータ
１１４は感知した電圧をＤＣ信号に変換して、照会電極
５１、５２の間の電圧ＲＭＳであるＶQRMSを表す出力を
与える。
【００８６】出力１１５及び１１６はアナログデバイダ
８８と類似のアナログデバイダ１１７に供給される。ア
ナログデバイダ１１７はＩQRMSによってＶQRMSを割り算
して、第１の照会電極５１及び第２の照会電極５２にお
ける測定されたインピーダンスＺａを表す出力信号１１
８を出力する。
【００８７】第１の照会電極５１及び第２の照会電極５
２を用いて凝固の完了の検出を開始させるために、最小
量の電流が治療用電極であるアンビル１８及びＵ字形治
療用電極３９に供給されなくてはならない。ＲＭＳコン
バータ８４の出力８６のＩTR MS（図２１）は比較器１１
９に入力され、比較器１１９の出力は凝固完了回路１２
０内のピーク検出器９７をイネーブルにする。治療用電
極に供給される最小より大きい電流により凝固完了回路
が以下に記載のように動作を開始する。ＩQRMS，ＶQRMS
及び測定されたインピーダンスＺａから、インピーダン
ス感知装置は凝固が完了したかどうかを判断する。
【００８８】凝固完了状態は次のようにして判定され
る。まず、最小インピーダンスＺMINが決定される。次
いで、凝固が完了する目標インピーダンスＺTARGETが最
小インピーダンスＺMINの関数として計算される。初期
インピーダンス、最小インピーダンスＺMIN、目標イン
ピーダンスＺTARGET、インピーダンス曲線の勾配、及び
完了までの時間は、与えられたアプリケーション及び／
又は装置によって変化するが、最小インピーダンスＺ
MINの関数ｆ（ＺMIN）と相互に関係する傾向にある。使
用される装置及び／又は実際の所望の結果に依存して、
最小インピーダンスＺMINの実際の関数は変化する。こ
の実施例においては、ｆ（ＺMIN）はリニアで、ｆ（Ｚ
MIN）＝０．２ＺMIN＋５００である。この関数は制限さ
れている。即ち、ＺMINが５６０オームより大であれ
ば、ＺTARGETはＺMIN＋５０オームである。ｆ（ＺMIN）
は異なる関数であってもよい。それは連続、非連続、リ
ニア、ノンリニア、区分的近似、及び／又はルックアッ
プテーブルの形式でもよい。ｆ（ＺMI N）はまた、異な
る値に制限されてもよい。
【００８９】インピーダンス信号１１８は組織が凝固し
たことを以下のようにして判定する。まず測定されたイ
ンピーダンスＺａが最小インピーダンスＺMINかどうか
を判定する。インピーダンス信号線１１８上のインピー
ダンスＺａはゲインオフセットインバータ９６によって
反転され且つオフセットされる。ゲインオフセットイン
バータ９６の出力はピーク検出器９７に接続されてい
る。ゲインオフセットインバータ９６の出力１０２は測
定されたインピーダンスＺａを反転し且つオフセットし
た値、即ち（−Ｚａ＋ｋ）を表す。ＺMINは遭遇する
（−Ｚａ＋ｋ）の値のうちの最高オフセットによって表
されることになる。
【００９０】最小スレショルド電流が治療用電極である
Ｕ字形治療用電極３９及びアンビル１８に供給される
と、ピーク検出器９７は比較器１１９の出力によってイ
ネーブルにされる。これにより、ピーク検出器９７は測
定されたインピーダンスＺａの最大値、即ちＺMIN、を
反転し且つオフセットした値を検出し保持する。ＺMIN
が発生すると、ピーク検出器９７の出力１０３は（−Ｚ
MIN＋ｋ）を表す。
【００９１】最小インピーダンスＺMINが決定される
と、その関数ｆ（ＺMIN）が計算されて、処理（凝固）
が完了する時のインピーダンスである目標インピーダン
スＺTARG ETが出力される。ピーク検出器９７の出力１０
３は、ｆ（ＺMIN）を計算して目標インピーダンスＺ
TARGETを決定するスレショルド決定回路９８に接続され
ている。スレショルド決定回路の出力９９は測定された
インピーダンスＺａがＺMINに等しい時のＺTARGETを表
す。
【００９２】Ｚとｆ（ＺMIN）の間で連続的な比較が行
われる。ここで、最小インピーダンスＺMINが検出され
るまで関数ｆ（ＺMIN）は連続的に計算されることに着
目すべきである。この比較は最小インピーダンスＺMIN
が決定されるまでは測定されたインピーダンスＺａと関
数ｆ（ＺMIN）の間で連続的に行われる。しかしなが
ら、組織の処理の間はｆ（Ｚａ）は測定されたインピー
ダンスＺａより大きくて早期の凝固完了信号は発生しな
いと予想されるので、これは重大な結論ではない。
【００９３】測定されたインピーダンスＺａが目標イン
ピーダンスＺTARGET以下の場合、ＲＦエネルギーは連続
的に供給され凝固完了信号が発生し受け取られるまでは
上記したステップが行われる。測定されたインピーダン
スＺａが目標インピーダンスＺTARGET以上であれば、凝
固が完了したことを表す信号がコントローラに与えられ
て凝固が完了する。この実施例においても、ピーク検出
器９７を介してＺMINの決定を調節するために、測定さ
れたインピーダンスＺａは反転され且つシフトされてい
ることに着目される。このパラグラフにおいて言及され
ているインピーダンス値とは実際のインピーダンス値で
ある。
【００９４】スレショルド決定回路９８の出力９９であ
るＺTARGETは比較器としてのオペアンプ１００の非反転
入力１０１に入力される。ゲインオフセットインバータ
９６の出力１０２はオペアンプ１００の反転入力１０４
に接続されている。オペアンプ１００は、オペアンプ１
００の反転入力１０４に入力される値を示す（−Ｚａ＋
ｋ）と、（−ＺMIN＋ｋ）の関数として計算された値を
表す目標インピーダンスＺTARGETとを比較する。（−Ｚ
ａ＋ｋ）が目標インピーダンスＺTARGET以下であれば、
オペアンプ１００の出力１０５は正である。即ち、測定
されたインピーダンスＺａが関数ｆ（ＺMIN）より大き
いと、凝固完了信号がオペアンプ１００の出力１０５に
現れる。
【００９５】出力１０５における信号は凝固完了条件が
存在するかどうかを表し、コントローラ７９に与えられ
る。凝固完了条件が存在すると、コントローラによりＲ
Ｆエネルギーが自動的にオフになる。
【００９６】コントローラ７９は以下の論理を有する。 表１ スイッチ（１３０） ＣＣ（１２５） ＲＦオン（１２９） ０ ０ ０ ０ １ ０ １ １ １ １ １ ０
【００９７】動作において、装置１０の末端効果器１５
は組織が処理されるべき場所に配置される。次いで、顎
部材３２、３４が開かれて、組織が顎部材３２、３４の
互いに向き合っているそれぞれの内側表面３３、３５間
に配置される。次に、クランプ用引き金１２が絞られて
顎部材３２、３４が閉じ、対向する表面３３、３５の間
で組織を配置し且つ圧縮する。組織が顎部材３２、３４
の間に適切に配置されると、ユーザはユーザにより駆動
される電気的スイッチ５９を用いて電気外科的ジェネレ
ータ７０、９０からＲＦエネルギーを与える。
【００９８】共に隆起部５６を形成している、電気的連
絡用電極棒２７，２８及び絶縁部材３１は、顎部材３４
の内側表面に向けて組織を圧縮する。Ｕ字形治療用電極
３９、即ち電気的連絡用電極棒２７，２８と、電気的に
反対の電極、即ちアンビル１８との間で、圧縮された組
織を電流が流れる。第１の照会電極５１及び第２の照会
電極５２の間で、上記電流の周波数とは異なる周波数の
電流が流れる。
【００９９】上記したようにして、凝固完了条件が判定
されて治療用電極へのＲＦエネルギーがオフになるま
で、第１の照会電極５１及び第２の照会電極５２により
インピーダンスが測定される。
【０１００】凝固完了状態が示されると、点火用引き金
１４が駆動されて切断要素１１をナイフチャネル２６を
通して前進させ、電気的連絡用電極棒２７，２８の間に
係合されている組織の焼灼された部分を切断する。同時
に、点火用引き金１４はトラック２５を通してくさび１
３を前進させ、且つアンビル１８のポケット３６の中に
前進させて、ステープル１７を発射する。こうして、切
断線は電気的連絡用電極棒２７，２８により形成された
凝固線に対して中間線となり、ステープル１７は、切断
要素１１が組織を切断する時の切断要素１１の各側の上
の縦方向の単一列の中に適用される。
【０１０１】１実施例において、カートリッジは、現在
使用されている腹壁鏡のステープリング内のカートリッ
ジの通常の二重列のステープル及び切断装置とは対照的
に、単一のステープル列を有することによりマルチファ
イヤステープリングが可能になる。よりよい止血を行う
ために、各平行列に二重列のステープルを与えるこのタ
イプのステープラが設計されていた。二重列のステープ
ルを収容するのに必要なスペースの大きさのために、積
み重ねられたステープルを持つ再点火可能なカートリッ
ジは好ましくなっかった。ステープルを積み重ねる追加
のスペースが必要となるからである。マルチファイヤス
テープリングの実施例では、単一の列のステープルが用
いられる。単一の列のステープルを用いると、ステープ
ルの第２の列により予め占められていたスペースにステ
ープルを積み重ねることができ、マルチファイヤを可能
にする。
【０１０２】上述した好ましい実施例は円形のステープ
ラを含んでもよい。円形ステープラの動作はこの技術に
おいて知られており、例えば、米国特許第５，１０４，
０２５号に記載されている。記載した実施例の変形によ
り、管内の（イントラルミナルな）ステープラに類似の
組織の溶接、焼灼、及び切断装置を提供できる。この実
施例においては、１９９３年７月２２日出願の、米国特
許出願シリアル番号第０８／０９５，７９７号に記載さ
れている装置に類似の装置が提供される。電極は絶縁対
で分離された２つの同心円電極の形に形成されている。
この電極は、圧縮用隆起部を形成し且つインターフェー
ス面のいずれかの上にある絶縁体の半径方向内側又は半
径方向外側に配置されている。円形切断装置のステープ
リングの実施例の電極はステープラのカートリッジ又は
アンビルの上に配置されている。
【０１０３】この発明の具体的な実施態様は以下の通り
である。 １）前記治療用電極の各々は前記第１及び第２のインタ
ーフェース面の少なくとも１つの上に配置されている、
請求項２記載の電気外科的装置。 ２）前記照会電極の各々は前記第１及び第２のインター
フェース面の少なくとも１つの上に配置されている、請
求項２記載の電気外科的装置。 ３）前記第１及び第２のインターフェース面の少なくと
も１つは、前記第１及び第２のインターフェース面の間
に組織圧縮ゾーンを形成する隆起部を含み、前記末端効
果器は更に前記インターフェース面と前記隆起部を二分
する平面を備えており、前記照会電極は前記平面に関し
て圧縮用の前記隆起部と反対の横側の上に配置されてい
る、請求項２記載の電気外科的装置。 ４）前記治療用電極は、電流が前記第１及び第２の治療
用ポールの間を流れると前記組織圧縮ゾーンにおいて電
気外科的組織処理がなされるように配置されている、実
施態様３に記載の電気外科的装置。 ５）前記第１及び第２の治療用電極の１つは前記第１及
び第２の感知用ポールの電位と同じである、請求項２記
載の電気外科的装置。 ６）前記末端効果器に結合された切断要素を更に備え、
前記切断要素は前記末端効果器に係合された組織を、切
断線を介してドライブするようになっている、請求項２
記載の電気外科的装置。 ７）前記照会電極は前記切断線の対向する側の上に配置
されている、実施態様６に記載の電気外科的装置。 ８）前記照会電極はインターフェース面の周囲の上に配
置されてその周囲において係合されている組織のインピ
ーダンスを測定するようになっている、請求項２記載の
電気外科的装置。 ９）前記電気的パラメータは前記組織に供給される電流
である、請求項２記載の電気外科的装置。 １０）前記電気的パラメータは前記組織に印加される電
圧である、請求項２記載の電気外科的装置。
【０１０４】１１）前記電気的パラメータは組織のイン
ピーダンスである、請求項２記載の電気外科的装置。 １２）前記電気的パラメータは前記組織に供給される電
圧及び電流であり、それにより前記照会電極の間の組織
のインピーダンスを決定できる、請求項２記載の電気外
科的装置。 １３）前記治療用電極の各々は前記第１及び第２のイン
ターフェース面の少なくとも１つの上に配置されてい
る、請求項３記載の電気外科的装置。 １４）前記第１及び第２の前記照会電極の各々は前記第
１及び第２のインターフェース面の少なくとも１つの上
に配置されている、請求項３記載の電気外科的装置。 １５）前記組織の効果は凝固完了状態である、請求項４
記載の方法。 １６）前記電気的パラメータは組織のインピーダンスで
ある、請求項４記載の方法。 １７）電気外科的エネルギーを前記治療用電極に供給す
るように配置されたエネルギー源を更に備え、前記エネ
ルギー源は前記制御信号に応答して前記エネルギーを前
記治療用電極に供給するようにした、請求項５記載の電
気外科的装置。 １８）前記インピーダンス測定回路は、最小インピーダ
ンス値を決定するための第１の装置と、前記第１の装置
に接続されており、前記目標インピーダンス値を前記最
小インピーダンス値の関数として決定する目標決定装置
と、測定されたインピーダンスを前記目標インピーダン
スと比較して、前記測定されたインピーダンス値が前記
目標インピーダンス値を越えたかどうかを表す信号を発
生する第１の比較装置とを備えた、請求項５記載の電気
外科的装置。 １９）前記末端効果器は、組織をその間に係合するため
の互いに相対的に移動可能な第１及び第２の要素を備
え、前記第１の治療用電極は前記第１及び第２の要素の
少なくとも１つの上に配置されている、請求項５記載の
電気外科的装置。 ２０）前記第２の治療用電極は前記第１及び第２の要素
の少なくとも１つの上に配置されている、実施態様１９
に記載の電気外科的装置。
【０１０５】２１）前記第１及び第２の照会電極は前記
第１及び第２の要素のいずれか１つ又は両方の上に配置
されており、前記インピーダンス測定回路は前記第１及
び第２の照会電極の間で且つ前記第１及び第２の要素の
間に係合されている組織のインピーダンスを測定するよ
うに適合されている、実施態様１９に記載の電気外科的
装置。 ２２）前記１つ以上の第１の治療用電極の各々は、前記
インターフェース面に関して前記１つ以上の第２の治療
用電極からオフセットされている、実施態様２１に記載
の電気外科的装置。 ２３）前記第１及び第２の要素は、電気外科的に処理さ
れるべき組織を係合するための第１及び第２のインター
フェース面を備えており、前記第１の治療用ポールは、
前記第１及び第２のインターフェース面の少なくとも１
つの上に配置された１つ以上の第１の治療用電極を備え
ており、前記第２の治療用ポールは、前記第１及び第２
のインターフェース面の少なくとも１つの上に配置され
た１つ以上の第２の治療用電極を備えている、実施態様
１９に記載の電気外科的装置。 ２４）前記１以上の第１の治療用電極は、前記インター
フェース面に関して前記１つ以上の第２の治療用電極か
らオフセットされている、実施態様２３に記載の電気外
科的装置。 ２５）更に、前記末端効果器に含まれる、組織に接触し
対向する表面を用意し、前記表面の間に処理されるべき
組織を係合している前記表面はその間に処理されるべき
組織を係合するために移動可能であり、前記照会電極及
び前記１つ以上の治療用電極は前記表面のいずれか１つ
または両方に関係付けられている、請求項７記載の方
法。
【０１０６】
【発明の効果】以上の記載から明らかなように、この発
明によれば、上記したインピーダンスフィードバックシ
ステムは、十分な焼灼が起きた時を示すのに使用され
る。凝固が完了すると、コントローラによりユーザに信
号が与えられるか、あるいはコントローラは自動的にＲ
Ｆエネルギーをオフにする。他の信号も同様に装置のユ
ーザに与えることができる。例えば、測定されたインピ
ーダンスに対応する音をユーザに与えてインピーダンス
の変化を聴覚によりモニタすることもできる。以上に記
載されたこの発明及び特定の詳細及び実施の方法は例示
として示した。しかし、記載した基本原理の多数の変
形、修正、拡張が この発明の精神及び範囲を逸脱する
ことなく可能であることは、当業者に容易に理解でき
る。
【０１０７】この装置及び／又は方法は、モノポーラ、
バイポーラ及びマルティポーラの形態を含む電気外科的
装置の様々なタイプに使用することを意図している。凝
固の完了又は他の組織の特性又は状態を判定するため
に、多数の異なるインピーダンスフィードバックシステ
ムがやはり使用できる。照会電極は、処理を通じて、連
続的に、周期的に、あるいは所定の又はユーザが開始し
た特定の時間に、励起してもよい。インピーダンスフィ
ードバックシステムは実際の装置内と共に、別のユニッ
トとして及び／又はエネルギー源又はジェネレータとし
て、一部又は全体に含ませることができる。
【図面の簡単な説明】
【図１】この発明の１実施例の内視鏡用電気外科的器具
の斜視図である。
【図２】切断又はステープリングの前の閉じてクランプ
された状態で示される、図１の実施例の側面図である。
【図３】ＲＦエネルギーが組織に加わる時が示される図
２の実施例の側面図である。
【図４】ＲＦエネルギーが加わった後で組織がステープ
ルされ且つ切断された後が示される図３と類似の側面図
である。
【図５】図１の装置のハンドル部の近傍の分解斜視図で
ある。
【図６】図１の装置の中間及び遠位部の分解斜視図であ
る。
【図７】左側のハンドルカバー及びバネが除かれた状態
で示される、図１の装置の第１の、オープン位置にある
ハンドル部の近傍の側面図である。
【図８】この発明で用いられるバネ及びコネクタの位置
を示す左側のハンドル部の内側の側面図である。
【図９】装置の中間部の縦断面図である。
【図１０】それぞれのコンタクト部へのバネのコンタク
トを示す中間部の近端部の側面図である。
【図１１】装置の中間部の近端部の拡大側面図である。
【図１２】図１１の線図１２−図１２に沿った横断面図
である。
【図１３】それぞれのコンタクト部にコンタクトしてい
るバネを示す斜視図である。
【図１４】バネのそれぞれのコンタクト部への圧力印加
を可能にするバネにおけるわずかなバイアスを示す図１
２のエンドビューを示す図である。
【図１５】閉じてクランプされた状態で示される、図１
の装置の遠端点の縦断面図である。
【図１６】図１４の遠端点の一部拡大断面図である。
【図１７】図１５の線図１７−図１７に沿った縦断面図
である。
【図１８】図１５の線図１８−図１８に沿った縦断面図
である。
【図１９】この発明の他の実施例の装置の遠端点の前断
面図である。
【図２０】この発明の他の実施例の装置の遠端点の前断
面図である。
【図２１】図１の装置において用いられるコントローラ
のアナログの実施例の概略ブロック図である。
【図２２】図１の装置において用いられるコントローラ
のアナログの実施例の概略ブロック図である。
【図２３】図１に示した電気外科的装置を用いて組織に
電気外科的エネルギーを加えている間のインピーダンス
の変化を示す特性曲線を示す図である。
【符号の説明】
１０ カッティング及びステープリング装置（外科用器
具） １１ 切断要素 １５ 末端効果器 １８ アンビル（治療用電極） ３２ 顎部材（組織処理部） ３４ 顎部材（組織処理部） ３５ 内面（インターフェース面） ３９ Ｕ字形治療用電極（治療用電極、第１のポール） ５１ 第１の照会電極（感知用ポール） ５２ 第２の照会電極（感知用ポール） ５６ 隆起部 ９６ ゲインオフセットインバータ ９７ ピーク検出器 １００ オペアンプ（第１の比較装置） ２１０ インピーダンスモニタ装置
フロントページの続き (72)発明者 デビッド・シー・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

Claims (9)

    【特許請求の範囲】
  1. 【請求項１】 処理すべき組織をその間に係合するよう
    に適合された第１及び第２の対向するインターフェース
    面を備えている末端効果器を含む組織処理部を有する外
    科用器具と、 エネルギー源から電気外科的エネルギーを受け取るよう
    に適合されており、且つその間で電気的エネルギーを導
    通することができ、組織に接触する第１及び第２の治療
    用電極を含み、前記第１及び第２の治療用電極の少なく
    とも１つは前記第１及び第２のインターフェース面の少
    なくとも１つに関係付けられている、第１及び第２の治
    療用ポールと、 エネルギー源から電気外科的エネルギーを受け取るよう
    に適合されており、且つその間で電気的エネルギーを導
    通することができ、組織に接触する第１及び第２の照会
    電極を含み、前記第１及び第２の照会電極の少なくとも
    １つは前記第１及び第２のインターフェース面の少なく
    とも１つに関係付けられている、第１及び第２の照会ポ
    ールと、を備えた、外科的処理中に組織を処理する電気
    外科的装置。
  2. 【請求項２】 末端効果器を有し、前記末端効果器は、 その間に組織を係合させることができる第１及び第２の
    対向するインターフェース面であって、前記末端効果器
    が前記インターフェース面内の電気外科的エネルギーを
    受け取ることができるようにしたものと、 その間で電気外科的エネルギーを導通することができ、
    電気的に反対の治療用電極を含み、電気的に分離された
    第１及び第２の治療用ポールと、そして、 その間で電気外科的エネルギーを導通することができ、
    電気的に反対の照会電極を含み、電気的に分離された第
    １及び第２の感知用ポールとを備え、 前記治療用電極の少なくとも１つは、前記第１及び第２
    のインターフェース面の少なくとも１つの上に配置され
    て、それにより前記治療用ポールの間で前記インターフ
    ェース面により係合されている組織を通して電気外科的
    エネルギーを通過させて、組織を電気外科的に処理する
    ことができ、 前記照会電極の少なくとも１つは、前記第１及び第２の
    インターフェース面の少なくとも１つの上に配置され
    て、それにより前記感知用ポールの間で前記インターフ
    ェース面により係合されている組織を通して感知用の電
    気外科的エネルギーを通過させて、前記感知用ポールの
    間で前記組織の電気的パラメータを測定できるようにし
    た、電気外科的装置。
  3. 【請求項３】 末端効果器を有し、前記末端効果器は、 その間に組織を係合させることができる第１及び第２の
    対向するインターフェース面であって、前記末端効果器
    が前記インターフェース面内の電気外科的エネルギーを
    受け取ることができるようにしたものと、 その間で電気外科的エネルギーを導通することができ、
    電気的に反対の治療用電極を含み、電気的に分離された
    第１及び第２の治療用ポールと、そして、 その間で電気外科的エネルギーを導通することができ、
    電気的に反対の照会電極を含み、電気的に分離された第
    １及び第２の感知用ポールとを備え、 前記治療用電極の少なくとも１つは、前記第１及び第２
    のインターフェース面の少なくとも１つの上に配置され
    て、それにより前記治療用ポールの間で前記インターフ
    ェース面により係合されている組織を通して電気外科的
    エネルギーを通過させて、組織を電気外科的に処理する
    ことができ、 前記照会電極の少なくとも１つは、前記第１及び第２の
    インターフェース面の少なくとも１つの上に配置され
    て、それにより前記感知用ポールの間で前記インターフ
    ェース面により係合されている組織を通して感知用の電
    気外科的エネルギーを通過させて、前記感知用ポールの
    間に伝達された前記感知用電気外科的エネルギーの電気
    的パラメータを測定できるようにした、電気外科的装
    置。
  4. 【請求項４】 末端効果器と、 その間に組織を係合させることができる第１及び第２の
    対向するインターフェース面であって、前記末端効果器
    が前記インターフェース面内の電気外科的エネルギーを
    受け取ることができるようにしたものと、 その間で電気外科的エネルギーを導通することができ、
    電気的に反対の治療用電極を含み、電気的に分離された
    第１及び第２の治療用ポールと、そして、 その間で電気外科的エネルギーを導通することができ、
    電気的に反対の照会電極を含み、電気的に分離された第
    １及び第２の感知用ポールとを備え、 前記治療用電極の各々及び前記第１及び第２の照会電極
    の各々は、前記第１及び第２のインターフェース面の１
    つの上に配置されている末端効果器を有する電気外科的
    装置を用意する段階と、 組織を前記インターフェース面の間に係合させる段階
    と、 治療用電気外科的エネルギーを前記治療用電極の間の前
    記組織に供給する段階と、 組織の効果が生じた時を決定する段階と、 前記組織の効果を表す信号を供給する段階とを備える、
    電気外科的方法。
  5. 【請求項５】 処理すべき組織を係合するように適合さ
    れた末端効果器を含む組織処理部を有する外科用器具
    と、 エネルギー源から電気外科的エネルギーを受け取るよう
    に適合されており、且つその間で電気的エネルギーを導
    通することができ、組織に接触する第１及び第２の治療
    用電極を含み、前記第１及び第２の治療用電極の少なく
    とも１つは前記外科用器具の前記組織処理部に関係付け
    られている、第１及び第２の治療用ポールと、 エネルギー源から電気外科的エネルギーを受け取るよう
    に適合されており、且つその間で電気的エネルギーを導
    通することができ、組織に接触する第１及び第２の照会
    電極を含み、前記第１及び第２の照会電極の少なくとも
    １つは前記外科用器具の前記組織処理部に関係付けられ
    ている、第１及び第２の照会ポールと、 前記治療用電極に供給されるＲＦエネルギーを制御する
    エネルギー制御信号と、 前記照会電極に接続されており、前記末端効果器により
    係合されている組織のインピーダンスを測定するインピ
    ーダンス測定回路とを備え、 前記インピーダンス測定回路は、前記照会電極の間の前
    記組織が処理電極により治療用エネルギーで処理される
    とき、前記照会電極の間の組織の最小インピーダンスを
    測定し、組織の所望の状態が達成されたときの、前記最
    小インピーダンスの関数である目標インピーダンスを決
    定し、前記照会電極の間の組織の測定されたインピーダ
    ンス値を目標インピーダンス値と比較し、前記測定され
    たインピーダンス値が前記目標インピーダンス値を越え
    たとき前記制御信号を調整するように適合されている、
    外科的処理中に組織を処理する電気外科的装置。
  6. 【請求項６】 １つ以上の組織処理用電極と電気的に反
    対の照会電極とを備えた末端効果器を含む電気外科的器
    具を用意する段階と、 電気外科的に処理されるべき組織に、前記１つ以上の組
    織処理用電極を通して、感知用電気外科的エネルギーを
    供給する段階と、 前記照会電極の間の組織の電気的パラメータを測定する
    段階と、 前記照会電極の間の組織の測定された電気的パラメータ
    を表す信号を発生する段階と、 前記測定された電気的パラメータから治療用の目標とな
    る電気的パラメータを決定する段階と、 続いて測定された電気的パラメータを前記目標値と比較
    する段階と、 制御信号を生成して、前記測定された電気的パラメータ
    に応答して前記電気外科的器具へのＲＦエネルギーを制
    御し、前記目標値に到達する段階と、 前記１つ以上の治療用電極を通して組織に与えられるエ
    ネルギーを、前記制御信号に応じて制御する段階とを備
    える、組織の電気外科的処理方法。
  7. 【請求項７】 １つ以上の組織処理用電極と電気的に反
    対の照会電極とを備えた末端効果器を含む電気外科的器
    具を用意する段階と、 電気外科的に処理されるべき組織に、前記１つ以上の組
    織処理用電極を通して、感知用電気外科的エネルギーを
    供給する段階と、 前記照会電極の間の組織のインピーダンスを測定する段
    階と、 前記照会電極の間の組織の測定されたインピーダンス値
    を表すインピーダンス信号を発生する段階と、 前記インピーダンス信号から代表的最小インピーダンス
    を測定する段階と、 最小インピーダンス値の関数としての代表的目標インピ
    ーダンス値を決定する段階と、 続いて測定されたインピーダンス信号を前記目標インピ
    ーダンス値と比較する段階と、 制御信号を生成して、前記目標インピーダンス値を越え
    る前記測定されたインピーダンスに応答して前記電気外
    科的器具へのＲＦエネルギーを制御する段階と、 前記１つ以上の治療用電極を通して組織に与えられるエ
    ネルギーを、前記制御信号に応じて制御する段階と、を
    備える、組織の電気外科的処理方法。
  8. 【請求項８】 第１及び第２の組織係合用表面を備える
    末端効果器を有する電気外科的器具を用意し、この場合
    前記第１及び第２の組織係合用表面の少なくとも１つは
    その上に、電気外科的治療システムの第１のポールに関
    係付けられた組織に接触する治療用電極を含ませ、前記
    第１及び第２の組織係合用表面の少なくとも１つはその
    上に、電気外科的治療システムの第２のポールに関係付
    けられた組織に接触する治療用電極を含ませ、前記第１
    及び第２の組織係合用表面の少なくとも１つはその上
    に、インピーダンス感知システムの第１のポールに関係
    付けられた組織に接触する第１の照会電極と、インピー
    ダンス感知システムの第２のポールに関係付けられた組
    織に接触する第２の照会電極とを含ませる段階と、 前記第１及び第２の組織係合表面の間に、処理されるべ
    き組織を係合する段階と、 前記第１及び第２の組織に接触する治療用電極に供給さ
    れるＲＦエネルギーを選択的に制御してその間に配置さ
    れた組織を処理する段階と、 前記第１及び第２の照会電極の間の処理された組織のイ
    ンピーダンスを前記第１及び第２の照会電極で測定する
    段階と、 組織の処理が完了するときのスレショルドインピーダン
    スを設定する段階と、 測定されたインピーダンス値を前記スレショルドインピ
    ーダンス値と比較する段階と、そして、 測定されたインピーダンス値が前記スレショルドインピ
    ーダンス値に到達するか越えるという条件で、前記第１
    及び第２の治療用電極に結合したＲＦエネルギーを制御
    又はオフに切り替える段階とを備える、電気外科的な組
    織の処理方法。
  9. 【請求項９】 エネルギー源から、外科用器具の組織処
    理部に連絡している１つ以上の治療用電極に供給される
    電気外科的エネルギーを制御するエネルギー制御信号
    と、 前記外科用器具の組織処理部に連絡している組織に接触
    する照会電極と、前記外科用器具の組織処理部に連絡し
    ている１つ以上の治療用電極に治療用電気外科的エネル
    ギーを供給するように配置されたエネルギー源とに、接
    続されるようになっているインピーダンス測定回路と、
    を備え、 前記インピーダンス測定回路は前記外科用器具の組織処
    理部により係合された組織のインピーダンスを測定する
    ようになっており、 前記インピーダンス測定回路は、 最小インピーダンス値を決定する第１の装置と、 前記第１の装置に接続され、前記最小インピーダンス値
    の関数としての目標インピーダンスを決定する目標決定
    装置と、 測定されたインピーダンス値を前記目標インピーダンス
    値と比較し、前記測定されたインピーダンス値が前記目
    標インピーダンス値を越えたかどうかを示す信号を発生
    する第１の比較装置と、 を備えた、電気外科的インピーダンスフィードバック制
    御装置。
JP34905695A 1994-12-22 1995-12-21 電気外科的装置及び電気外科的インピーダンスフィードバック制御装置 Expired - Lifetime JP3857345B2 (ja)

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CA2165714A1 (en) 1996-06-23
DE69530747D1 (de) 2003-06-18
DE69534437D1 (de) 2005-10-13
EP0717967A3 (en) 1996-08-14
EP0717967A2 (en) 1996-06-26
EP1157666A1 (en) 2001-11-28
JP3857345B2 (ja) 2006-12-13
DE69530747T2 (de) 2004-03-25
AU701320B2 (en) 1999-01-28
DE69534437T2 (de) 2006-06-22
AU4026495A (en) 1996-06-27

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