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WO2004045436A1 - Dispositif electrochirurgical et procede pour faire fonctionner ce dispositif - Google Patents

Dispositif electrochirurgical et procede pour faire fonctionner ce dispositif Download PDF

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Publication number
WO2004045436A1
WO2004045436A1 PCT/EP2003/012789 EP0312789W WO2004045436A1 WO 2004045436 A1 WO2004045436 A1 WO 2004045436A1 EP 0312789 W EP0312789 W EP 0312789W WO 2004045436 A1 WO2004045436 A1 WO 2004045436A1
Authority
WO
WIPO (PCT)
Prior art keywords
output
instrument
poles
frequency voltage
outputs
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.)
Ceased
Application number
PCT/EP2003/012789
Other languages
German (de)
English (en)
Inventor
Valentino Remorgida
Pavel Novak
Alberto Margani
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.)
Storz Endoskop Produktions GmbH Germany
Original Assignee
Storz Endoskop Produktions GmbH Germany
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Storz Endoskop Produktions GmbH Germany filed Critical Storz Endoskop Produktions GmbH Germany
Priority to EP03772339A priority Critical patent/EP1562502A1/fr
Publication of WO2004045436A1 publication Critical patent/WO2004045436A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • 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
    • A61B18/12—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
    • A61B2018/124—Generators therefor switching the output to different electrodes, e.g. sequentially

Definitions

  • Electrosurgical device and method for operating the same
  • the invention relates to an electrosurgical device with a high frequency generator for generating high frequency voltage, with a first output connected to the high frequency generator and at least one second output connected to the high frequency generator, with an electrosurgical instrument separately at each of the first output and the second output can be connected, and both outputs can be activated simultaneously.
  • the invention further relates to a method for operating the aforementioned electrosurgical device.
  • An electrosurgical device and a method for operating the same are known from document US 4,903,696.
  • An electrosurgical device of the type mentioned at the outset is used in the context of surgical interventions for cutting and / or for coagulating tissue.
  • the high-frequency current is fed to the tissue via an active electrode provided on the connected instrument and discharged via a large-area return electrode, which is usually at ground potential and is attached to a suitable location on the patient's body.
  • a large-area return electrode which is usually at ground potential and is attached to a suitable location on the patient's body.
  • the high-frequency current flows from the active electrode to the return electrode applied to the outside of the patient's body and can thereby damage uninvolved tissue, or burns can occur on the body surface on which the return electrode rests.
  • the flow of the high-frequency current is only slightly controllable in this operating state.
  • the active electrode and the return electrode are both arranged in the body in the treatment area, usually in the immediate vicinity of one another, these two electrodes being formed on one and the same instrument, which is referred to as the bipolar instrument.
  • the bipolar instrument In the case of a grasping forceps, for example, one jaw part of the grasping forceps is the active electrode and the other jaw part is the return electrode, so that the flow of the high-frequency current is limited to the area between the jaw parts.
  • the tissue to be treated which is located between the electrodes of the instrument, is acted upon by the high-frequency current, as a result of which the use of the high-frequency current in the bipolar operating state can be controlled much better.
  • Two bipolar instruments can be connected and operated simultaneously to the electrosurgical device according to the above-mentioned document US Pat. No. 4,903,696, which has a high-frequency generator and two outputs connected to it.
  • an electrosurgical scalpel with which voltage can be cut or coagulated when exposed to a suitable radio frequency, can be connected to one output.
  • a bipolar forceps can be connected to the other output, for example a grasping forceps for coagulation. Both bipolar instruments can be activated simultaneously in this known device.
  • activatable means that the outputs can be put into operation for the simultaneous operation of the instruments connected to the outputs.
  • Both outputs of this known electrosurgical device are designed as two-pole outputs, it being possible for the high-frequency voltage to be connected between the two poles of the same output.
  • bipolar instruments Another disadvantage of such bipolar instruments is the required insulation measures between the two electrodes of the instrument, which exist in particular in electrosurgical instruments with articulated jaw parts, because the insulation measures must also be provided in the area of the joint, which is minimal for the miniaturization of such instruments -invasive surgery leads to significant constructive problems and limitations.
  • WO 01/22896 AI One approach to solving the aforementioned design problems in bipolar instruments is described in WO 01/22896 AI, in which a bipolar instrument is disclosed which has two pairs of jaw parts, one pair forming the active electrode and the other pair forming the return electrode. Because of this configuration, there are no problems with the insulation in the area of the articulated connection of the jaw parts of each pair. But also with this instrument the application angle of the instrument to the tissue is restricted.
  • the invention is therefore based on the object of specifying an electrosurgical device and a method for operating such an electrosurgical device of the type mentioned at the outset, in which the possible uses and freedom of movement when using electrosurgical instruments are improved.
  • this object is achieved with regard to the electrosurgical device mentioned at the outset in that the first output and the second output can be switched in a first operating mode in such a way that high-frequency voltage is present between the first output and the second output, so that when the two outputs are activated between the current flow is enabled for both instruments connected to the outputs.
  • the first output and the second output are accordingly switched in a first operating state in such a way that between the first output and the second output high-frequency voltage is present, so that when the two outputs are activated, a current flows between the instruments connected to the outputs.
  • an instrument can be connected to the one output, which for example forms the active electrode for tissue treatment, while an instrument can also be connected to the at least one second output, so that this is connected to this second output connected instrument forms the counter or feedback electrode to the instrument connected to the first output. If both instruments are now introduced into a treatment area in the body of a patient and brought into close proximity to one another, a current flow forms between the electrodes of the two instruments when the two outputs are activated. In other words, the two instruments connected to the device then together form a bipolar instrument.
  • the first output can be a single-pole output or an at least two-pole output, the same applies to the second output.
  • the high-frequency voltage present between the outputs can be the high-frequency voltage generated directly by the high-frequency generator or derived therefrom and changed in terms of amplitude, frequency and the like.
  • the advantage of the configuration according to the invention is, on the one hand, that the electrodes distributed over the two instruments give the surgeon a considerably greater freedom in the use and handling of the instruments, in particular the angle of use of the electrodes selected by the surgeon for the respective application, on the other hand, existing construction problems of isolation are avoided with conventional bipolar instruments. Gripping, cutting and coagulating are made possible very efficiently with the invention without changing the instruments.
  • the first output and / or the at least second output has / have at least two poles, and in a second operating mode the first output and / or the second output can be switched such that between the poles of the first Output and / or high-frequency voltage is present between the poles of the second output.
  • the first output and / or the second output has / have two poles, and if in a second operating mode the first output and / or the second output is / are switched such that between the poles of the first output and / or high-frequency voltage is present between the poles of the second output.
  • the electrosurgical device can be operated in a conventional manner in addition to the bipolar mode distributed over two instruments, in that a bipolar instrument can also be connected to the first output and / or the second output, in which case the active electrode and counter electrode are on the same Instrument are formed and the current flow in the same instrument is closed accordingly.
  • the first two-pole output for electrosurgical cutting and the second two-pole output for coagulation can be operated by, as is provided in a further preferred embodiment of the device and the method, a cutting serving on the first output and one on the second output high-frequency voltage serving for coagulation can be switched on or is switched on.
  • the first output is deactivated in the device when the at least second output is activated, or vice versa, and in the method the first output is deactivated when the at least second output is activated, or vice versa.
  • the outputs can be switched via relays in the device, the activation and deactivation can also be effected, for example, on the device or by foot switches or finger switches on the respective instrument.
  • the mutual activation and deactivation of the two outputs has the advantage that only one of the bipolar instruments is active at a time and the current flow is therefore limited to the desired instrument.
  • the device according to the invention selects an operating mode in which only one of the at least two outputs is active, and that a high-frequency voltage for coagulation and high-frequency voltage for cutting can then optionally be applied to this output.
  • the first output and / or the second output have / have at least two poles, and in a third operating mode the first and the second output can be switched such that on the one hand between the first output and the second output high frequency voltage and on the other hand between the poles of at least one of the same outputs high frequency voltage.
  • the first output and / or the second output have at least two poles, and that the first and the second output are switched in a third operating mode in such a way that high-frequency voltage is generated between the first output and the second output and on the other hand, high-frequency voltage is present between the poles of at least one of the same outputs.
  • the instrument that is connected to the poles of the output between which high-frequency voltage is present can be operated bipolar by itself, ie the circuit is closed within the same instrument, for example in the coagulation instrument, and the circuit can also between the two instruments connected to the first output and the second output.
  • the cutting current can flow between the instruments, and the instrument, which is operated bipolar per se, then forms the return electrode for the high-frequency current.
  • the surgeon has the advantage of a combination, for example bipolar coagulation, with the advantage of monopolar cutting, but without having to apply a neutral or return electrode to the patient's body surface, as in the conventional monopolar operating state, because the return electrode is now formed by one of the two instruments.
  • the outputs can be switched between the first, second or third operating mode or are switched in this way.
  • the first output and / or the at least second output have a monopolar output, to which a pole of a bipolar output of the other output is connected.
  • the further advantage of this embodiment is that the activation of the two outputs of the electrosurgical see device is not only possible via a foot switch, but also via a finger switch.
  • a high-frequency voltage used for cutting and a coagulating high-frequency voltage can be connected to the first output.
  • a high-frequency voltage used for cutting and a coagulating high-frequency voltage are preferably applied to the first output.
  • each output has a specific function, i.e. Cutting or coagulating, is preferably assigned, which makes it easier for the surgeon to work with the device.
  • the supply cables of the instruments to the outputs can be color-coded in order to avoid confusion of the two functions by the surgeon.
  • the first and / or the second output is designed for connecting a bipolar instrument.
  • a bipolar instrument is connected accordingly to the first and / or the second output.
  • the inventive design of the device and the method which preferably provides for the two outputs
  • an adapter is provided in the device for connecting a monopolar instrument to the first and / or the second output, or in the method if a monopolar is connected to the first and / or the second output instrument is connected.
  • This embodiment in particular with the aforementioned embodiment, opens up even greater freedom of movement for the device and the method according to the invention with regard to the choice of the electrosurgical instruments that can be used and the functions associated with them, such as gripping, cutting and / or coagulating, since not only bipolar instruments can be used ,
  • a circuit for monitoring the impedance is provided at at least one of the outputs.
  • the impedance is monitored at at least one of the outputs.
  • the risk of incorrect application for example by which coagulation occurs at the electrode of the instrument on which coagulation is not desired, can advantageously be reduced by the power output to the respective output is only released when the aforementioned impedance has fallen below a predetermined value, which can be determined experimentally.
  • FIG. 1 shows an electrosurgical device with two electrosurgical instruments which are connected to the device
  • FIG. 2 shows two sections of electrosurgical instruments in the area of their distal end, which can be used with the device in FIG. 1; and 3 to 6
  • an electrosurgical device provided with the general reference number 10 is shown schematically.
  • the device 10 is used for electrosurgical interventions on the human or animal body.
  • the device 10 has a high-frequency generator 12 (cf. FIGS. 3 to 6) with which a high-frequency voltage is generated for medical applications.
  • An operating mode selector switch 14 is also provided on the device 10, with which the operating modes to be described below can be set.
  • the device 10 can be used for bipolar cutting and bipolar coagulation, even using monopolar instruments, as will be described hereinafter.
  • the device 10 also has displays 16 for displaying the parameters set on the device 10, such as the power of the high-frequency current, the waveform of the generated high-frequency voltage or the flowing high-frequency current and the like.
  • the device 10 has control elements 18 for setting parameters of the high-frequency current or the high-frequency voltage.
  • the device 10 has a first output A designed as a two-pole output and a second output B also designed as a two-pole output.
  • the outputs A and B are connected to the high-frequency generator 12, as is shown in simplified form in FIGS. 3 to 6.
  • the first output A has two poles 20 and 22 and the second output B has two poles 24 and 26.
  • the poles 20 and 22 of the first output A are connected to the high-frequency generator 12 in such a way that high-frequency voltage can be applied between them, one of the poles representing the neutral conductor in the simplest case or that there is no voltage between the poles 20 and 22 in other words, have the same potential.
  • the poles 24 and 26 of the second output B are connected to the high-frequency generator 12 in such a way that there is a high-frequency voltage between them, or they are at the same potential, as will be described below.
  • a first electrosurgical instrument 28 is connected to the first output A.
  • the instrument 28 is a conventional monopolar instrument, which accordingly has only one electrode 30 at its distal end.
  • the electrode 30 is designed, for example, as a wire loop for cutting tissue.
  • the instrument 28 is connected to the output A via a cable 32 and via an adapter 34, the adapter 34 being required in order to connect the monopolar instrument 28 to the bipolar output A. Accordingly, the instrument 28 can only be activated if the two poles 20 and 22 of the output A are at the same potential. If the output A activated, the electrode 30 of the instrument 28 is accordingly subjected to high-frequency voltage or current.
  • a second electrosurgical instrument 36 is connected to the output B in FIG. 1, which in the exemplary embodiment shown is a bipolar instrument, for example a bipolar grasping instrument for grasping and coagulating tissue.
  • the instrument 36 accordingly has two electrodes 38 and 40, which are designed as jaw parts and are movable relative to one another.
  • the electrodes 38 and 40 are isolated from one another by appropriate measures.
  • the instrument 36 is connected via cables 46 and 48, which can also be designed as a common cable, to the output B or to its poles 24 and 26.
  • two instruments 28 'and 36' are shown as examples in the area of their distal ends, which can also be used together with the device 10 instead of the instruments 28 and 36.
  • the instrument 28 ' is designed as a bipolar instrument and accordingly has two electrodes 30a' and 30b ', which in the exemplary embodiment shown are designed as jaw parts of a cutting pliers for cutting tissue.
  • the instrument 36 ' is like the instrument 36 in Fig. 1, a bipolar instrument, the electrodes 38' and 40 'are formed as jaw parts for grasping tissue.
  • a monopolar instrument can also be connected to the output B, while a bipolar instrument is connected to the output A, or a monopolar instrument can be connected to both the output A and the output B.
  • the device 10 is shown in a highly schematic manner by means of a circuit diagram.
  • the circuit diagrams show various operating modes of the device 10, which can be activated with the operating mode selector switch 14, or with switches provided on the instruments 28 or 36 'used themselves.
  • the outputs A and B of the device 10 each have a monopolar output, to which a pole of a bipolar output of the respective other output is connected.
  • a high-frequency voltage used for cutting is connected to output A and a high-frequency voltage used for coagulating is connected to output B, the high-frequency voltage used for cutting and coagulating differing in the waveform, pulse duration and power of the high-frequency current.
  • the power required for cutting is higher than the power of the high-frequency current suitable for coagulation.
  • the switches A 1 and A 2 are closed.
  • the two poles 20 and 22 of output A are connected to one another and are therefore connected to the same potential, for example to “phase”, since switches A ⁇ and A 2 are connected in parallel.
  • Switch A 3 is open.
  • the output A is therefore at a uniform potential, in other words there is no high-frequency voltage between the poles 20 and 22.
  • the electrode 30 of the instrument 28 forms the active electrode and that a current flow from the Sets electrode 30 of instrument 28 to electrodes 38 and 40, which are at the same potential in this operating mode, electrodes 38 and 40 together forming the return electrode, since they are at the same potential.
  • the overall arrangement of the first instrument 28 and the second instrument 36 thus forms, so to speak, a bipolar instrument, the active electrode and return electrode of which are, however, distributed over two instruments, namely the instruments 28 and 36.
  • the instrument 28 can now be used to cut bipolar in cooperation with the electrodes 38 and 40 to be positioned close to the electrode 30, while with the electrodes 38 and 40 which are on have the same potential, can be bipolar coagulated in connection with the electrode 30.
  • the current density and the effect achieved in the tissue will depend, among other things, on the geometry of the electrodes 30, 38, 40 and on the contact area of the electrodes 30, 38, 40 with the tissue. Simply put, a small area means a high current density that is suitable for cutting, a large area a low current density that has no effect, and a medium area means an average current density that can be used for coagulation.
  • the operating mode in FIG. 3 can also be activated with two bipolar instruments or two monopolar instruments, one of which is connected to output A and the other to output B.
  • FIG. 4 shows an operating mode of the device 10 in which the output A is at a potential as a whole, in that the switches A x and A 2 are closed while the switch A 3 is open.
  • the poles 20 and 22 are at the same potential, while high-frequency voltage is present between the poles 24, 26 of the output B, in that the switches B ⁇ and B 3 are closed while the switch B 2 is open.
  • the pole 24 is at the same potential as the poles 20 and 22, while high-frequency voltage is also present between the pole 26 and the poles 20, 22.
  • bipolar coagulation can be performed with the instrument 36 connected to output B in FIG. 1, which is a bipolar instrument, while additionally with the current flow from the instrument 26 to the electrode of the instrument 36 connected to the pole 26 , so to speak mono- can be cut polar without the need for a return electrode on the patient's body as in the classic monopolar mode.
  • the operating mode in FIG. 4 can also be opened by opening switch B x and closing switch B 2 . 3 be activated to achieve this. Switching the output B from the state shown in FIG. 4 to the state shown in FIG. 3 can advantageously be effected by corresponding finger switches on the instrument 36 (not shown).
  • the surgeon can thus combine the advantage of bipolar coagulation with the advantage of bipolar cutting, but in contrast to the conventional procedure, the bipolar cutting is distributed over the electrodes of two instruments, as a result of which the insertion angle of the electrode 30 is different from conventional ones Bipolar instruments can be optimally selected.
  • FIG. 5 shows a further operating mode of the device 10, in which only the output B of the device 10 is activated, while the output A is deactivated.
  • bipolar cutting or coagulation can be carried out with the instrument 36, with the device 10 additionally being able to switch between the coagulation current and the cutting current at the output B, for example with a switch on the instrument 36 or with a foot switch.
  • FIG. 6 shows a further operating mode of the device 10, in which high-frequency voltage is switched both between the poles 20, 22 of the output A and between the poles of the output B, so that one is connected to the output A connected instrument, for example the instrument 28 'from FIG. 2, can be cut bipolar and can be bipolarly coagulated with an instrument 36 or 36' connected to the output B in FIG. 1 or 2.
  • output A is deactivated when output B is activated, and vice versa, so that the instruments 28 'and 36 or 36' can only be used alternately.
  • the device 10 also has a circuit, not shown, for monitoring the impedance at the outputs A and B, which monitors the impedance between the poles 20 and 22 or 24 and 26, in particular if this is as shown in FIGS. 3 and 4 , each have the same potential.
  • the power output of the high-frequency generator 12 at output A or at output B is only released when the impedance has fallen below a predetermined value, which was previously determined experimentally, for example.
  • the supply cables 32 or 46 and 48 color coded.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif électrochirurgical (10), comprenant un générateur haute fréquence (12) destiné à générer une tension haute fréquence, une première sortie (A) reliée au générateur haute fréquence (12), ainsi qu'au moins une deuxième sortie (B) également reliée au générateur haute fréquence (12). Des instruments électrochirurgicaux (28, 36) peuvent être raccordés séparément respectivement à la première sortie (A) et à la deuxième sortie (B), les deux sorties (A, B) pouvant être activées simultanément. Selon l'invention, la première sortie (A) et la deuxième sortie (B) peuvent être couplées dans un premier mode de fonctionnement de telle sorte qu'une tension haute fréquence soit présente entre les deux sorties (A, B) de manière à ce que, lorsque ces deux sorties (A, B) sont activées, un courant puisse circuler entre les deux instruments (28, 36 ; 28', 36') raccordés aux sorties.
PCT/EP2003/012789 2002-11-18 2003-11-15 Dispositif electrochirurgical et procede pour faire fonctionner ce dispositif Ceased WO2004045436A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP03772339A EP1562502A1 (fr) 2002-11-18 2003-11-15 Dispositif electrochirurgical et procede pour faire fonctionner ce dispositif

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE10253819.0 2002-11-18
DE2002153819 DE10253819A1 (de) 2002-11-18 2002-11-18 Elektrochirurgische Vorrichtung sowie Verfahren zum Betreiben derselben

Publications (1)

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WO2004045436A1 true WO2004045436A1 (fr) 2004-06-03

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EP (1) EP1562502A1 (fr)
DE (1) DE10253819A1 (fr)
WO (1) WO2004045436A1 (fr)

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CN105877836A (zh) * 2016-05-27 2016-08-24 厚凯(北京)医疗科技有限公司 一种外科手术能量平台系统
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US9848932B2 (en) 2006-07-28 2017-12-26 Covidien Ag Cool-tip thermocouple including two-piece hub
US9877769B2 (en) 2008-07-22 2018-01-30 Covidien Lp Electrosurgical devices, systems and methods of using the same
US9987073B2 (en) 2013-11-19 2018-06-05 Covidien Lp Electrosurgical coagulation instrument including a suction pipe and a collapsible tip
US9986984B2 (en) 2014-09-23 2018-06-05 Covidien Lp Ingress protection for electrosurgical pencil switch
EP3481315A1 (fr) * 2016-07-07 2019-05-15 Intuitive Surgical Operations, Inc. Configurations de distribution et de retour de flux électrique pour instruments de distribution de flux électrique
WO2021078969A1 (fr) * 2019-10-24 2021-04-29 Olympus Winter & Ibe Gmbh Générateur électrochirurgical
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