WO2017037907A1 - Medical treatment apparatus, method for operating medical treatment apparatus, and treatment method - Google Patents

Abstract

This medical treatment apparatus 1 includes: a pair of holding members that clamps body tissue; an energy generation unit 22 that is provided on at least one of the pair of holding members and generates energy; a distance calculation unit 321 that calculates the distance between the members of the pair of the holding members; and an energy control unit 322 that causes the energy generation unit 22 to generate energy corresponding to the distance between members.

Description

MEDICAL TREATMENT DEVICE, MEDICAL TREATMENT DEVICE OPERATING METHOD, AND TREATMENT METHOD

The present invention relates to a medical treatment apparatus, a method for operating a medical treatment apparatus, and a treatment method.

2. Description of the Related Art Conventionally, a medical treatment apparatus that treats biological tissues by applying energy (joining (or anastomosis), cutting, etc.) is known (for example, see Patent Document 1).
A medical treatment apparatus (thermal energy treatment system) described in Patent Literature 1 includes a pair of jaws that are supported so as to be openable and closable, a pair of heating resistance elements provided on the pair of jaws, and the pair of heating resistances. An energy source for supplying power to the device. The energy source performs feedback control for supplying power to the pair of heating resistance elements so that the temperature of the jaw reaches the target temperature while grasping the temperature of the jaw.

JP 2012-024576 A

By the way, in the medical treatment apparatus described in Patent Document 1, the treatment proceeds by applying energy instead of the operator's own force as compared with a treatment tool that mechanically treats a living tissue. It is difficult to get a sense. For this reason, in the medical treatment apparatus, a configuration that is set so as to complete the treatment (complete the application of energy) within a predetermined time is frequently used.
And in the medical treatment device of patent documents 1, it is the composition which performs general feedback control. For this reason, for example, when treating a first biological tissue having a relatively small thickness, the treatment does not take much time, and the treatment can be completed within the predetermined time described above. When the second biological tissue having a large thickness is treated, the treatment takes a very long time compared to the treatment of the first biological tissue, and the treatment is performed within the predetermined time described above. May not be completed.
Therefore, there is a demand for a technique that can similarly treat various biological tissues having different thicknesses.

The present invention has been made in view of the above, and provides a medical treatment apparatus, a method for operating a medical treatment apparatus, and a treatment method that can similarly treat various biological tissues having different thicknesses. The purpose is to do.

In order to solve the above-described problems and achieve the object, a medical treatment apparatus according to the present invention is provided on a pair of holding members that sandwich biological tissue and at least one of the pair of holding members. An energy generation unit that generates energy; a distance calculation unit that calculates an inter-member distance between the pair of holding members; and an energy control unit that causes the energy generation unit to generate energy corresponding to the inter-member distance. It is characterized by that.

In addition, the operating method of the medical treatment apparatus according to the present invention includes a distance calculation step of calculating a distance between the pair of holding members after the living tissue is sandwiched between the pair of holding members, and the pair of holding members. An energy applying step of applying energy corresponding to the distance between the members from at least one of the holding members to the living tissue.

The treatment method according to the present invention includes a clamping step of clamping a living tissue between a pair of holding members, a distance calculating step of calculating a distance between the pair of holding members, and the pair of holding members. An energy applying step of applying energy corresponding to the distance between the members from at least one holding member to the living tissue.

According to the medical treatment device, the operation method of the medical treatment device, and the treatment method according to the present invention, there is an effect that various biological tissues having different thicknesses can be treated similarly.

FIG. 1 is a diagram schematically showing a medical treatment apparatus according to Embodiment 1 of the present invention. FIG. 2 is a view showing a distal end portion of the treatment instrument shown in FIG. FIG. 3 is a view showing a distal end portion of the treatment instrument shown in FIG. FIG. 4 is a view showing a distal end portion of the treatment instrument shown in FIG. FIG. 5A is a diagram showing the flexible substrate shown in FIG. 3 or FIG. FIG. 5B is a diagram showing the flexible substrate shown in FIG. 3 or FIG. 4. FIG. 6A is a view for explaining opening and closing operations of the first and second holding members shown in FIGS. 1 to 4. FIG. 6B is a diagram illustrating the opening / closing operation of the first and second holding members shown in FIGS. 1 to 4. FIG. 7 is a block diagram showing a configuration of the control device shown in FIG. FIG. 8 is a diagram showing the inter-member distance calculated by the distance calculation unit shown in FIG. FIG. 9 is a flowchart showing treatment control by the control device shown in FIG. FIG. 10 is a block diagram showing a configuration of a medical treatment apparatus (control apparatus) according to Embodiment 2 of the present invention. FIG. 11 is a flowchart showing treatment control by the control device shown in FIG. FIG. 12 is a block diagram showing a configuration of a medical treatment apparatus (control apparatus) according to Embodiment 3 of the present invention. FIG. 13 is a flowchart showing treatment control by the control device shown in FIG. FIG. 14 is a block diagram showing a configuration of a medical treatment apparatus (control apparatus) according to Embodiment 4 of the present invention. FIG. 15 is a flowchart showing treatment control by the control device shown in FIG. FIG. 16 is a diagram showing a modification of the first to fourth embodiments of the present invention. FIG. 17A is a diagram illustrating the opening / closing operation of the first and second holding members in the structure shown in FIG. 16. FIG. 17B is a view for explaining the opening / closing operation of the first and second holding members in the structure shown in FIG. 16.

DETAILED DESCRIPTION Hereinafter, modes for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Furthermore, the same code | symbol is attached | subjected to the same part in description of drawing.

(Embodiment 1)
[Schematic configuration of medical treatment apparatus]
FIG. 1 is a diagram schematically showing a medical treatment apparatus 1 according to Embodiment 1 of the present invention.
The medical treatment device 1 applies energy to a living tissue to be treated, and treats the living tissue (joining (or anastomosis), cutting, etc.). As shown in FIG. 1, the medical treatment device 1 includes a treatment tool 2, a control device 3, and a foot switch 4.

[Configuration of treatment tool]
The treatment tool 2 is, for example, a linear type surgical treatment tool for performing treatment on a living tissue through the abdominal wall. As shown in FIG. 1, the treatment tool 2 includes an operation handle 5, a shaft 6, and a clamping unit 7.
The operation handle 5 is a part that the operator holds. As shown in FIG. 1, one end (the upper end in FIG. 1) is pivotally supported on the operation handle 5 so as to be rotatable in the direction of the arrow R1 or the arrow R2. An operation knob 51 that is operated in the direction is provided. The operation knob 51 is configured to return to the direction of the arrow R2 by a biasing member or the like when the operation in the direction of the arrow R1 by the operator is released.

[Shaft configuration]
2 to 4 are views showing the distal end portion of the treatment instrument 2. FIG. Specifically, FIG. 2 is a view of the distal end portion of the treatment instrument 2 as viewed from above in FIG. 3 is a cross-sectional view taken along line III-III in FIG. 2 is a line passing between the lower plate body 621 and the connecting portion 112 (slit hole 6121) in FIG. FIG. 4 is an exploded view in which the first holding member 10 and the rod 62 are removed from the shaft main body 61 from the state shown in FIG. In addition, in FIG. 4, illustration of the rotating shaft RA and the axial part 622 is abbreviate | omitted.
As shown in FIGS. 2 to 4, the shaft 6 includes a shaft main body 61, a rod 62, and a cylindrical sheath 63 (FIG. 1) that covers the outer periphery of the shaft main body 61.
2 to 4, the illustration of the sheath 63 is omitted.

The shaft main body 61 has a substantially cylindrical shape, one end connected to the operation handle 5, and the other end opens and closes the first and second holding members 10 and 20 (FIGS. 1 to 4) that constitute the holding portion 7. Support it as possible.
As shown in FIG. 3 or 4, a case 611 is disposed inside the shaft body 61.
As shown in FIG. 3 or FIG. 4, the case 611 has a cylindrical shape having a guide hole 6111 on the central axis Ax of the shaft body 61.
In addition to the guide hole 6111, the case 611 is formed with a wiring hole extending along the central axis Ax of the shaft body 61, although not specifically illustrated. The electric cable C (FIG. 1) connected to the control device 3 is connected to the other end from one end side of the shaft body 61 inside the shaft body 61 via the operation handle 5 and the wiring hole of the case 611. To the side. 3 and 4, only the heating lead C1 is illustrated among the heating leads C1 and C1 ′ constituting the electric cable C.

Further, as shown in FIGS. 2 to 4, a base portion 612 and a pair of shaft support portions 613 are provided at the other end of the shaft body 61.
The base 612 has an elongated substantially flat plate shape. The base portion 612 is integrally formed on the lower side in FIG. 3 or FIG. 4 at the other end of the shaft body 61 with the longitudinal direction along the central axis Ax and the plate surface facing up and down in FIG. 3 or FIG. Has been.
As shown in FIG. 2, in the base 612, a pair of slit holes 6121 that penetrates the front and back of the base 612 and extends along the central axis Ax are formed on both sides in the short direction.

The pair of shaft support portions 613 has a long, substantially flat plate shape. Then, the pair of shaft support portions 613 has an upper surface (the upper surface in FIG. 3 or FIG. 4) so as to sandwich the pair of slit holes 6121 with the longitudinal direction along the center axis Ax and facing each other. Are integrally formed with each other.
The pair of shaft support portions 613 have the same shape. Therefore, in the following, the shape of the upper shaft support 613 in FIG. 2 will be described.
As shown in FIG. 4, the shaft support portion 613 has a first bearing hole 6131 that penetrates the front and back of the shaft support portion 613 to the tip side (left side in FIG. 4) from the center position in the longitudinal direction of the shaft support portion 613. Is formed.
The first bearing hole 6131 is a hole through which the rotation shaft RA (FIG. 3) is inserted.
Further, as shown in FIG. 4, the shaft support portion 613 passes through the front and back of the shaft support portion 613 on the base end side (right side in FIG. 4) from the first bearing hole 6131, and extends along the center axis Ax. A first track hole 6132 extending is formed.
The first bearing hole 6131 and the first track hole 6132 described above are formed at the same height position as the center axis Ax (height position from the base 612), as shown in FIG. 3 or FIG. .

The rod 62 is disposed inside the case 611 (guide hole 6111), and moves forward and backward along the central axis Ax according to the operation of the operation knob 51 by the operator. As shown in FIGS. 2 to 4, the rod 62 includes a pair of plate bodies 621 and a shaft portion 622 (FIGS. 2 and 3).
The pair of plate bodies 621 each have an elongated flat plate shape, and are disposed inside the case 611 in a state of facing each other (opposing in the vertical direction in FIG. 2). An insertion hole 6211 (FIGS. 3 and 4) through which the shaft portion 622 is inserted passes through the front and back sides of the pair of plate bodies 621 on the front end side (the left end side in FIGS. 2 to 4). Each is formed.
The shaft portion 622 has a cylindrical shape, and is inserted into the insertion holes 6211 in the pair of plate bodies 621. Then, in a state where the shaft portion 622 is inserted into each insertion hole 6211, both ends of the shaft portion 622 are projected outward from the pair of plate bodies 621 as shown in FIG. 2. Further, both ends of the shaft portion 622 projecting outward from the pair of plate bodies 621 are the first track holes 6132 in the pair of shaft support portions 613 and the second portions in the first jaw portion 11 constituting the first holding member 10. It is inserted into the track hole 1122 (FIGS. 3 and 4).

[Configuration of clamping part]
The clamping part 7 is a part which clamps a biological tissue and treats the biological tissue (joining (or anastomosis), cutting, etc.). As shown in FIG. 3 or FIG. 4, the clamping unit 7 includes a first holding member 10 and a second holding member 20.
The first holding member 10 is disposed on the upper side in FIG. 3 or FIG. 4 with respect to the second holding member 20. As shown in FIGS. 2 to 4, the first holding member 10 includes a first jaw portion 11, a sandwiching plate 12, and a first fixing plate 13.

The first jaw portion 11 is a portion that is rotatably supported by the pair of shaft support portions 613 via the rotation axis RA. As shown in FIGS. 2 to 4, the first jaw portion 11 includes a jaw body 111 and a pair of connection portions 112.
As shown in FIG. 2, the jaw main body 111 has a long flat plate shape whose width dimension (length dimension in the short direction) is slightly smaller than the separation dimension of the pair of shaft support parts 613.

The pair of connection portions 112 are portions for connecting the first jaw portion 11 to the shaft body 61. Each of the pair of connection portions 112 has an elongated substantially flat plate shape. Then, the pair of connection portions 112 has one end side of the jaw main body 111 (FIG. 3 or FIG. 4) in a state where the longitudinal direction is along the longitudinal direction of the jaw main body 111, facing each other and orthogonal to the jaw main body 111. Are formed integrally on the middle and right end sides). Note that the distance between the pair of connection portions 112 is set to be substantially the same as the width of the jaw main body 111 as shown in FIG. Further, the pair of connection portions 112 are formed so as to have a thickness dimension slightly smaller than the width dimension of the slit hole 6121.

The pair of connection portions 112 have the same shape. Therefore, in the following, the shape of the connection portion 112 on the upper side in FIG. 2 will be described.
As shown in FIG. 3 or FIG. 4, the connection portion 112 has the front and back sides of the connection portion 112 closer to the base end side (left side in FIG. 3 or FIG. 4) than the center position in the longitudinal direction of the connection portion 112 A second bearing hole 1121 is formed therethrough.
The second bearing hole 1121 is a hole through which the rotation shaft RA (FIGS. 2 and 3) is inserted. That is, the pair of connecting portions 112 is positioned between the pair of shaft support portions 613, and the first jaw portion 11 is inserted into the shaft body 61 by inserting the rotation shaft RA into each first bearing hole 6131 and each second bearing hole 1121. With respect to (a pair of shaft support part 613), it is rotatably supported centering on rotating shaft RA.

In addition, as shown in FIG. 3 or FIG. 4, the connecting portion 112 penetrates the front and back of the connecting portion 112 to the front end side (right side in FIG. 4) from the second bearing hole 1121 and extends to the central axis Ax. A second track hole 1122 extending in the intersecting direction is formed.
Specifically, the second track hole 1122 has a shape inclined toward the upper side in FIG. 3 or FIG. 4 toward the second bearing hole 1121 along the central axis Ax. In the state shown in FIG. 3 (the first and second holding members 10 and 20 are closed), the right end of the second track hole 1122 in FIG. 3 is the same as the first track hole 6132. It is set to be a height position (a height position from the base 612). That is, in the state shown in FIG. 3, the second track hole 1122 is set such that the height position gradually increases with respect to the first track hole 6132 toward the second bearing hole 1121. . The end portion of the shaft portion 622 is inserted into the second track hole 1122.

The sandwiching plate 12 is made of, for example, a thin copper plate, and is fixed to one plate surface of the jaw body 111 (the plate surface on the lower side in FIG. 3 or FIG. 4). The sandwiching plate 12 sandwiches the living tissue with the heat transfer plate 221 constituting the second holding member 20.
The first fixing plate 13 is a member that fixes the sandwiching plate 12 to one plate surface of the jaw body 111.

As shown in FIG. 3 or FIG. 4, the second holding member 20 includes a second jaw portion 21, a thermal energy generation portion 22, and a second fixing plate 23.
The second jaw portion 21 has substantially the same shape as the jaw main body 111. And in this Embodiment 1, as shown in FIG. 3 or FIG. 4, the 2nd jaw part 21 has a longitudinal direction along the central axis Ax of the shaft main body 61, and a plate | board surface is up-down in FIG. In the state facing toward, it is integrally formed at the distal end portion of the base portion 612 (the left end portion in FIG. 3 or FIG. 4).

The thermal energy generator 22 is fixed to one plate surface of the second jaw portion 21 (the plate surface on the upper side in FIG. 3 or FIG. 4) and clamps the living tissue between the clamp plate 12. The thermal energy generation unit 22 generates thermal energy under the control of the control device 3. That is, the thermal energy generator 22 has a function as an energy generator according to the present invention. As shown in FIG. 3 or FIG. 4, the thermal energy generation unit 22 includes a heat transfer plate 221 and a flexible substrate 222.

The heat transfer plate 221 is made of, for example, a copper thin plate, and is attached to the second jaw portion 21 so that the treatment surface 2211 (FIGS. 3 and 4) as one plate surface faces the first holding member 10. The heat transfer plate 221 has the treatment surface 2211 in contact with the living tissue with the living tissue held between the first and second holding members 10 and 20, and heat from the flexible substrate 222 is applied to the living tissue. Transmit (apply energy (thermal energy) to the living tissue).

5A and 5B are diagrams showing the flexible substrate 222. FIG. Specifically, FIG. 5A is a plan view of the flexible substrate 222 shown in FIG. 3 or 4 as viewed from above in FIG. 3 or FIG. FIG. 5B is a side view of the flexible substrate 222.
A portion of the flexible substrate 222 generates heat (generates thermal energy), and functions as a sheet heater that heats the heat transfer plate 221 by the generated heat. That is, the flexible substrate 222 has a function as a heat generating member according to the present invention. As shown in FIG. 5A or 5B, the flexible substrate 222 includes a substrate 2221, a heating pattern 2222, and an insulating sheet 2223.
The substrate 2221 is a long sheet made of an insulating material such as polyimide. Note that the width dimension of the substrate 2221 (the vertical dimension in FIG. 5A) is set to be smaller than the separation dimension of the pair of connection portions 112. A part of the flexible substrate 222 is disposed between the pair of connection portions 112 in a state of being attached to the second jaw portion 21.

The heating pattern 2222 is obtained by processing a metal film formed on one surface of the substrate 2221 by bonding or vapor deposition, and is used for heating the heat transfer plate 221. As shown in FIG. 5A or 5B, the heating pattern 2222 includes a pair of lead connection portions 2222A and an electric resistance pattern 2222B.
Here, the material of the heating pattern 2222 is stainless steel, platinum, or the like.
The pair of lead connection portions 2222A extends from one end side (right end side in FIG. 5A or 5B) to the other end side (left end side in FIG. 5A or 5B) of the substrate 2221. It is provided so as to face each other. The pair of lead connecting portions 2222A are joined (connected) to the two heat generating lead wires C1 and C1 ′ constituting the electric cable C (see FIG. 3 (only the heat generating lead wire C1 is shown in FIG. 3). )).

One end of the electrical resistance pattern 2222B is connected to the one lead connecting portion 2222A, is formed along the U-shape following the outer edge shape of the substrate 2221 from the one end, and the other end is connected to the other lead wire connecting portion 2222A. . The electrical resistance pattern 2222B generates heat when voltage is applied (energized) to the pair of lead connecting portions 2222A by the control device 3 via the heating lead wires C1 and C1 ′.
And the heat-transfer plate 221 is attached to the site | part (heating | fever site | part) in which the electrical resistance pattern 2222B in the flexible substrate 222 is formed, as shown to FIG. 5B. Although not specifically shown, an adhesive sheet for bonding the heat transfer plate 221 and the flexible substrate 222 is interposed between the heat transfer plate 221 and the flexible substrate 222. This adhesive sheet is a sheet that has high thermal conductivity, withstands high temperatures, and has adhesiveness. For example, this adhesive sheet is formed by mixing ceramics with high thermal conductivity such as alumina and aluminum nitride into epoxy resin. Has been.

The insulating sheet 2223 is a long sheet made of an insulating material such as polyimide, like the substrate 2221. 5A or 5B, the insulating sheet 2223 covers the pair of lead connection portions 2222A except for a part of the pair of lead connection portions 2222A (the right end portion in FIG. 5A or 5B). It is attached as follows.
The second fixing plate 23 is a member that fixes the thermal energy generating part 22 to the second jaw part 21.

[Opening and closing operation of first and second holding members]
Next, the opening / closing operation | movement of the 1st, 2nd holding member 10 and 20 mentioned above is demonstrated.
6A and 6B are diagrams illustrating the opening / closing operation of the first and second holding members 10 and 20. Specifically, FIG. 6A is a cross-sectional view corresponding to FIG. 3 and shows a state in which the first and second holding members 10 and 20 are opened. 6B is a cross-sectional view corresponding to FIG. 3 and shows a state in which the first and second holding members 10 and 20 are closed.
FIG. 6A shows a state where the operation knob 51 is not operated by the operator. In this state, as shown in FIG. 6A, the first and second holding members 10 and 20 are in an open state.
When the operator operates the operation knob 51 in the direction of the arrow R1 (FIG. 1) from the state shown in FIG. 6A, the rod 62 moves to the operation unit 5 side (right side in FIG. 6A or 6B). By the movement of the rod 62, the shaft portion 622 moves from the left side to the right side in FIG. 6A or FIG. 6B in each first track hole 6132 and each second track hole 1122.

Here, as described above, each first track hole 6132 provided in the shaft body 61 is set so as to extend along the central axis Ax. On the other hand, each second track hole 1122 provided in the first jaw portion 11 has a height position relative to each first track hole 6132 toward the left side in FIG. 6A or 6B as described above. Is set to gradually increase.
Therefore, when the shaft portion 622 moves from the left side to the right side in FIG. 6A or FIG. 6B in each first track hole 6132 and each second track hole 1122, the edge portion of each second track hole 1122 is formed. It moves while pressing toward the upper side. Then, the first holding member 10 rotates around the rotation axis RA in the direction approaching the second holding member 20, and finally enters the state shown in FIG. 6B.

From the state shown in FIG. 6B, when the operator releases the operation knob 51 in the direction of the arrow R1 and the operation knob 51 returns in the direction of the arrow R2 (FIG. 1), In FIG. 6B, the rod 62 moves from the right side to the left side. Then, as the rod 62 moves, the first holding member 10 rotates in the direction away from the second holding member 20 around the rotation axis RA in the opposite direction to the above, and finally in FIG. 6A. It will be in the state shown. At this time, the pair of connection portions 112 are inserted through the pair of slit holes 6121.
That is, the operation knob 51 and the rod 62 are connected to the first holding member 10 and opened and closed to open and close the first and second holding members 10 and 20, and thus have a function as a power transmission unit according to the present invention. .

[Configuration of control device and foot switch]
FIG. 7 is a block diagram illustrating a configuration of the control device 3.
In FIG. 7, the main part of the present invention is mainly illustrated as the configuration of the control device 3.
The foot switch 4 is a part operated by the operator with his / her foot, and outputs an operation signal to the control device 3 in response to the operation (ON). And the control apparatus 3 starts the treatment control mentioned later according to the said operation signal.
That is, the foot switch 4 has a function as a switch according to the present invention.
Note that the means for starting the treatment control is not limited to the foot switch 4, and other switches that are operated by hand may be employed.

The control device 3 comprehensively controls the operation of the treatment instrument 2. As shown in FIG. 7, the control device 3 includes a thermal energy output unit 31 and a control unit 32.
Under the control of the control unit 32, the thermal energy output unit 31 applies (energizes) a voltage to the heating pattern 2222 via the heating lead wires C1 and C1 ′.

The control unit 32 includes a CPU (Central Processing Unit) and the like, and executes treatment control according to a predetermined control program when the foot switch 4 is turned on. As shown in FIG. 7, the control unit 32 includes a distance calculation unit 321 and an energy control unit 322.

FIG. 8 is a diagram illustrating the inter-member distance MD calculated by the distance calculation unit 321. Specifically, FIG. 8 is a cross-sectional view corresponding to FIG.
The distance calculation unit 321 inputs a signal from the position detection sensor 8 (FIG. 7).
Here, the position detection sensor 8 is disposed inside the case 611 and detects the position of the rod 62 that moves forward and backward within the case 611. In the first embodiment, a magnetic proximity sensor that magnetically detects the position of the rod 62 is employed as the position detection sensor 8. The position detection sensor 8 may be a sensor that optically detects the position of the rod 62 in addition to the magnetic proximity sensor.
As described above, the rod 62 is connected to the first holding member 10 and moves to open and close the first and second holding members 10 and 20. For this reason, there is a correlation between the position of the rod 62 and the inter-member distance MD between the first and second holding members 10 and 20 (FIG. 8, the distance between the tips of the first and second holding members 10 and 20). . In the first embodiment, the first correlation information indicating the correspondence between the position of the rod 62 and the inter-member distance MD is recorded in a memory (not shown) inside the control device 3.
The distance calculation unit 321 calculates the inter-member distance MD based on the signal from the position detection sensor 8 (position of the rod 62) and the first correlation information recorded in the memory (not shown). In other words, the distance calculation unit 321 calculates the thickness of the living tissue LT when the living tissue LT (FIG. 8) is sandwiched between the first and second holding members 10 and 20.

The energy control unit 322 controls the operation of the thermal energy output unit 31.
Specifically, the energy control unit 322, based on the inter-member distance MD calculated by the distance calculation unit 321, sets a preset target temperature (hereinafter, initial target temperature) of the heat transfer plate 221 (living tissue LT). Is corrected to generate a corrected target temperature. Then, the energy control unit 322 grasps the temperature of the heat transfer plate 221 (living tissue LT), and controls the feedback of the heating pattern 2222 so that the heat transfer plate 221 (living tissue LT) becomes the correction target temperature ( For example, PID control) is executed. That is, in the feedback control of the heat generation pattern 2222, the energy control unit 322 causes the thermal energy generation unit 22 to generate thermal energy corresponding to the member distance MD calculated by the distance calculation unit 321, and the thermal energy is transmitted to the living body. Grant to the organization LT.
In addition, about the temperature of the heat exchanger plate 221 (living tissue LT) used by feedback control, the following temperature is employable, for example.
For example, the resistance value of the heating pattern 2222 is acquired based on the voltage value and the current value supplied from the thermal energy output unit 31 to the heating pattern 2222. Then, the resistance value of the heating pattern 2222 is converted into a temperature, and the converted temperature is used as the temperature of the heat transfer plate 221 (living tissue LT).
Further, for example, a temperature sensor composed of a thermocouple, a thermistor, or the like is provided on at least one of the first and second holding members 10 and 20 (the heat transfer plate 221 and the sandwiching plate 12), and the temperature sensor detects the temperature sensor. The temperature is used as the temperature of the heat transfer plate 221 (living tissue LT).

[Operation of medical treatment device]
Next, operation | movement of the medical treatment apparatus 1 mentioned above is demonstrated.
In the following, treatment control by the control device 3 will be mainly described as the operation of the medical treatment device 1.
FIG. 9 is a flowchart showing treatment control by the control device 3.
The surgeon grasps the treatment instrument 2 and inserts the distal end portion of the treatment instrument 2 (a part of the clamping portion 7 and the shaft 6) into the abdominal cavity through the abdominal wall using, for example, a trocar. Then, the surgeon operates the operation knob 51 in the direction of the arrow R1 (FIG. 1) to clamp the living tissue LT between the first and second holding members 10 and 20 (step S1: clamping step).
Next, the surgeon operates (ON) the foot switch 4 to start treatment control by the control device 3 (step S2: Yes).

When the operation signal from the foot switch 4 is input (the foot switch 4 is turned ON) (step S2: Yes), the distance calculation unit 321 inputs the signal from the position detection sensor 8 and A position is acquired (step S3).
Subsequently, the distance calculation unit 321 determines the inter-member distance MD between the first and second holding members 10 and 20 based on the position of the rod 62 and the first correlation information recorded in the memory (not shown). Is calculated (step S4: distance detection step).

After step S4, the energy control unit 322 calculates an initial target temperature correction value CV based on the inter-member distance MD calculated in step S4 (step S5).
Specifically, in step S5, the energy control unit 322 calculates the correction value CV by the following equation (1).
CV = (PO × MD) / (λ × AR) (1)
Here, in the equation (1), “PO” means the electric power [W] applied to the heating pattern 2222 from the thermal energy output unit 31 at the time of step S5. “Λ” means the thermal conductivity [W / (m · K)] of the living tissue LT to be treated, and is, for example, a predetermined value such as 0.85 [W / (m · K)]. is there. Furthermore, “AR” means an area where the living tissue LT is in contact with the treatment surface 2211 and is a predetermined value.

After step S5, the energy control unit 322 corrects the initial target temperature IT using the correction value CV calculated in step S5 by the following equation (2) to generate a corrected target temperature CT (step S6).
CT = IT + CV (2)
Then, the energy control unit 322 grasps the temperature of the heat transfer plate 221 (living tissue LT), and controls the feedback of the heating pattern 2222 so that the heat transfer plate 221 (living tissue LT) becomes the corrected target temperature CT. (For example, PID control) is executed (step S7: energy application step). That is, in step S7, the energy control unit 322 causes the thermal energy generation unit 22 to generate thermal energy corresponding to the inter-member distance MD calculated in step S4, and applies the thermal energy to the living tissue LT.

After step S7, the energy control unit 322 determines whether or not the inter-member distance MD calculated by the distance calculation unit 321 has become 0 (step S8). That is, in step S8, the energy control unit 322 determines whether or not the thickness of the living tissue LT has become 0 due to the application of thermal energy to the living tissue LT in step S7.
If it is determined that the inter-member distance MD is not 0 (step S8: No), the energy control unit 322 sets a preset time that is set in advance from the start of feedback control in step S7. It is determined whether or not it has been exceeded (step S9).
When it is determined that the elapsed time does not exceed the set time (step S9: No), the medical treatment apparatus 1 returns to step S3.
When it is determined that the inter-member distance MD has become 0 (step S8: Yes), or when it is determined that the elapsed time has exceeded the set time (step S9: Yes), the energy control unit 322 generates thermal energy. The application of thermal energy from the unit 22 to the living tissue LT is stopped (step S10). Thereafter, the medical treatment apparatus 1 ends this control flow (treatment control).

In the medical treatment apparatus 1 according to the first embodiment described above, when the living tissue LT is sandwiched between the pair of holding members 10 and 20, the inter-member distance MD between the pair of holding members 10 and 20 is set. calculate. In other words, the medical treatment apparatus 1 calculates the thickness of the living tissue LT when the living tissue LT is sandwiched between the pair of holding members 10 and 20. And the medical treatment apparatus 1 provides the thermal energy according to the said member distance MD with respect to the biological tissue LT. For this reason, the medical treatment apparatus 1 applies relatively low thermal energy to the first living tissue when treating the first living tissue having a relatively small thickness. When treating the second living tissue, relatively high heat energy is applied to the second living tissue. That is, the treatment times for the first and second living tissues can be made substantially the same.
Therefore, according to the medical treatment apparatus 1 which concerns on this Embodiment 1, there exists an effect that it can treat similarly to the various biological tissue from which thickness differs.

Further, in the medical treatment apparatus 1 according to the first embodiment, a rod 62 that opens and closes the first and second holding members 10 and 20 by being connected to and moved by the first holding member 10 is provided. Based on the position, the inter-member distance MD is calculated. For this reason, the distance MD between members can be calculated with high accuracy.

Also, in the medical treatment apparatus 1 according to the first embodiment, calculation of the inter-member distance MD is started when the foot switch 4 is turned on (step S2: Yes) (step S4). For this reason, the calculation of the inter-member distance MD can be started at the timing of starting the treatment control, and the processing load of the control unit 32 can be reduced without calculating the inter-member distance MD unnecessarily.

Further, in the medical treatment apparatus 1 according to the first embodiment, the treatment control is terminated when the inter-member distance MD becomes 0 (step S8: Yes) (step S10). For this reason, the completion of treatment (separation) can be properly grasped, and treatment control can be appropriately terminated.

(Embodiment 2)
Next, a second embodiment of the present invention will be described.
In the following description, the same reference numerals are given to the same components as those in the first embodiment described above, and detailed description thereof will be omitted or simplified.
In the medical treatment device 1 according to Embodiment 1 described above, the inter-member distance MD is calculated based on the position of the rod 62.
In contrast, the medical treatment apparatus according to the second embodiment is configured to calculate the inter-member distance MD based on the impedance of the living tissue LT.
Hereinafter, the configuration and operation of the medical treatment apparatus according to the second embodiment will be described.

[Configuration of medical treatment device]
FIG. 10 is a block diagram showing a configuration of a medical treatment apparatus 1A (control apparatus 3A) according to Embodiment 2 of the present invention.
In the medical treatment apparatus 1A according to the second embodiment, as shown in FIG. 10, the position detection sensor 8 is omitted from the medical treatment apparatus 1 (FIG. 7) described in the first embodiment. In addition, a high frequency energy output unit 33 and a sensor 34 are added to the control device 3, and a control device 3A using a control unit 32A instead of the control unit 32 is employed.
The high-frequency energy output unit 33 is controlled between the heat transfer plate 221 and the sandwiching plate 12 (biological tissue LT) via high-frequency lead wires C2 and C2 ′ (FIG. 10) constituting the electric cable C under the control of the control unit 32A. ).
The sensor 34 detects a voltage value and a current value supplied from the high frequency energy output unit 33 to the heat transfer plate 221 and the sandwiching plate 12. Then, the sensor 34 outputs a signal corresponding to the detected voltage value and current value to the control unit 32A.

In the control unit 32A, an impedance calculation unit 323 is added to the control unit 32 (FIG. 7) described in the first embodiment.
The impedance calculation unit 323 controls the operation of the high-frequency energy output unit 33 to supply high-frequency power between the heat transfer plate 221 and the sandwiching plate 12 (living tissue LT), and also receives a signal from the sensor 34 to input high-frequency energy. The voltage value and the current value supplied to the heat transfer plate 221 and the sandwiching plate 12 from the output unit 33 are acquired. Then, the impedance calculation unit 323 calculates the impedance of the living tissue LT sandwiched between the heat transfer plate 221 and the sandwiching plate 12 based on the voltage value and the current value.

Here, there is a correlation between the impedance of the living tissue LT sandwiched between the heat transfer plate 221 and the sandwiching plate 12 and the thickness of the living tissue LT. In other words, there is a correlation between the impedance of the living tissue LT and the inter-member distance MD between the first and second holding members 10 and 20 (the heat transfer plate 221 and the sandwiching plate 12). In the second embodiment, the second correlation information indicating the correspondence between the impedance of the living tissue LT and the inter-member distance MD is recorded in a memory (not shown) inside the control device 3A.
The distance calculation unit 321 according to the second embodiment is a member based on the impedance of the living tissue LT calculated by the impedance calculation unit 323 and the second correlation information recorded in a memory (not shown). The distance MD is calculated. In other words, the distance calculation unit 321 calculates the thickness of the living tissue LT when the living tissue LT is sandwiched between the first and second holding members 10 and 20.

[Operation of medical treatment device]
Next, an operation (treatment control by the control device 3A) of the medical treatment device 1A according to the second embodiment will be described.
FIG. 11 is a flowchart showing treatment control by the control device 3A.
In the treatment control according to the second embodiment, as shown in FIG. 11, in contrast to the treatment control described in the first embodiment (FIG. 9), steps S3A and S4A are used instead of steps S3, S4 and S10. , S10A is only different.
For this reason, only steps S3A, S4A, and S10A will be described below.

The impedance calculation unit 323 controls the operation of the high-frequency energy output unit 33 when the foot switch 4 is turned on (step S2: Yes), and generates a high frequency between the heat transfer plate 221 and the sandwiching plate 12 (living tissue LT). While supplying electric power, the signal from the sensor 34 is input, and the voltage value and the current value supplied to the heat transfer plate 221 and the sandwiching plate 12 from the high frequency energy output unit 33 are acquired. And the impedance calculation part 323 calculates the impedance of the biological tissue LT currently clamped between the heat exchanger plate 221 and the clamping board 12 based on the said voltage value and electric current value (step S3A).
Subsequently, the distance calculation unit 321 determines the inter-member distance between the first and second holding members 10 and 20 based on the impedance of the living tissue LT and the second correlation information recorded in the memory (not shown). MD is calculated (step S4A: distance calculation step). Thereafter, the medical treatment apparatus 1A proceeds to Step S5.

When it is determined that the inter-member distance MD has become 0 (step S8: Yes) or when it is determined that the elapsed time has exceeded the set time (step S9: Yes), the control unit 32A has a thermal energy generation unit. The application of thermal energy from 22 to the living tissue LT is stopped, and the supply of high-frequency power between the heat transfer plate 221 and the sandwiching plate 12 (living tissue LT) is stopped (step S10A). Thereafter, the medical treatment apparatus 1A ends this control flow (treatment control).

Even when the inter-member distance MD is calculated based on the impedance of the living tissue LT as in the second embodiment described above, the same effects as those in the first embodiment described above can be obtained.

(Embodiment 3)
Next, a third embodiment of the present invention will be described.
In the following description, the same components as those in the first and second embodiments are denoted by the same reference numerals, and detailed description thereof is omitted or simplified.
In the medical treatment apparatus according to the third embodiment, the inter-member distance MD based on the position of the rod 62 described in the first embodiment (hereinafter referred to as the first inter-member distance MD1) as the inter-member distance MD. And the inter-member distance MD (hereinafter referred to as the second inter-member distance MD2) based on the impedance of the living tissue LT described in the second embodiment.
Hereinafter, the configuration and operation of the medical treatment apparatus according to the third embodiment will be described.

[Configuration of medical treatment device]
FIG. 12 is a block diagram showing a configuration of a medical treatment apparatus 1B (control apparatus 3B) according to Embodiment 3 of the present invention.
As shown in FIG. 12, the medical treatment apparatus 1B according to the third embodiment is the same as the control apparatus 3 described above with respect to the medical treatment apparatus 1 (FIG. 7) described in the first embodiment. The high frequency energy output part 33 and the sensor 34 which were demonstrated in the form 2 of this are added, and the control apparatus 3B using the control part 32B instead of the control part 32 is employ | adopted. In the control unit 32B, the impedance calculation unit 323 described in the second embodiment is added to the control unit 32 described in the first embodiment.

[Operation of medical treatment device]
Next, an operation (treatment control by the control device 3B) of the medical treatment device 1B according to the third embodiment will be described.
FIG. 13 is a flowchart showing treatment control by the control device 3B.
In the treatment control according to the third embodiment, as shown in FIG. 13, the steps S3A and S4A described in the second embodiment are compared with the treatment control (FIG. 9) described in the first embodiment. , S10A is added, and steps S11 to S15 are added.
Therefore, only steps S11 to S15 will be described below.

Step S11 is executed when the foot switch 4 is turned on (step S2: Yes).
Specifically, the impedance calculation unit 323 calculates the impedance of the living tissue LT in step S11 as in step S3A.
Subsequently, the control unit 32B determines whether or not the living tissue LT exists between the heat transfer plate 221 and the holding plate 12 based on the impedance of the living tissue LT calculated in step S11 (holds the living tissue LT). Whether or not) (step S12).

When it is determined that the living tissue LT is not sandwiched (step S12: No), the medical treatment apparatus 1B proceeds to step S10A.
On the other hand, when it is determined that the living tissue LT is sandwiched (step S12: Yes), the medical treatment apparatus 1B obtains the position of the rod 62 (step S3), and determines the position based on the position of the rod 62. The calculation of the inter-member distance MD1 (step S4), the calculation of the impedance of the living tissue LT (step S3A), and the calculation of the second inter-member distance MD2 based on the impedance of the living tissue LT (step S4A) are sequentially executed. .

Step S13 is executed after step S4A.
Specifically, in step S13, the energy control unit 322 compares the first member distance MD1 calculated in step S4 with the second member distance MD2 calculated in step S4A. It is determined whether or not the inter-member distances MD1 and MD2 are the same value.
When it is determined that the distances MD1 and MD2 between the first and second members are the same value (step S13: Yes), the energy control unit 322 is one of the distances MD1 and MD2 between the first and second members. Is determined as the inter-member distance used to calculate the correction value CV (step S14).
On the other hand, when it is determined that the distances MD1 and MD2 between the first and second members are not the same value (step S13: No), the energy control unit 322 determines the distances MD1 and MD2 between the first and second members. The larger one is determined as the inter-member distance used for calculating the correction value CV (step S15).

After step S14 or step S15, the energy control unit 322 executes step S5.
That is, when the first and second member distances MD1 and MD2 have the same value, the energy control unit 322 calculates the correction value CV by using the distance between any of the members according to Equation (1), If the distances MD1 and MD2 between the first and second members are not the same value, the correction value CV is calculated by the equation (1) using the larger distance between the members.

The medical treatment device 1B according to the third embodiment described above has the following effects in addition to the same effects as those of the first and second embodiments.
In the medical treatment apparatus 1B according to the third embodiment, based on the impedance of the living tissue LT, whether or not the living tissue LT exists between the heat transfer plate 221 and the holding plate 12 (holds the living tissue LT). Or not). When the medical treatment apparatus 1B determines that the living tissue LT is sandwiched (step S12: Yes) (when the impedance of the living tissue LT is a predetermined value), the distance between the first and second members Calculation of MD1 and MD2 is started (steps S4 and S4A). For this reason, when the living tissue LT is not sandwiched, the first and second member distances MD1 and MD2 are not calculated unnecessarily, and the processing load on the control unit 32B can be reduced.

By the way, when the living tissue LT is held between the first and second holding members 10 and 20 in a state where the living tissue LT is in contact with only a relatively small region of the treatment surface 2211 (hereinafter referred to as a first case). Therefore, the impedance of the living tissue LT cannot be calculated with high accuracy. In the first case, the second member distance MD2 based on the impedance of the living tissue LT is calculated as a relatively small member distance (a distance smaller than the first member distance MD1). . On the other hand, since the first inter-member distance MD1 is calculated based on the position of the rod 62 even in the first case, it is calculated as a highly accurate inter-member distance. In the first case, it is preferable to apply thermal energy to the living tissue LT using the highly accurate first member distance MD1.
Further, when the amount of water contained in the living tissue LT sandwiched between the first and second holding members 10 and 20 is large (hereinafter referred to as a second case), the second member based on the impedance of the living tissue LT. The inter-member distance MD2 is calculated as a relatively large inter-member distance (a distance greater than the first inter-member distance MD1). On the other hand, since the first inter-member distance MD1 is calculated based on the position of the rod 62 even in the second case, it is calculated as a highly accurate inter-member distance. In the second case, since the amount of water contained in the living tissue LT is large, it is preferable to apply more heat energy to the living tissue LT. That is, in the second case, it is preferable to apply thermal energy to the living tissue LT using the second inter-member distance MD2 corresponding to the moisture content of the living tissue LT.
In the medical treatment apparatus 1B according to the third embodiment, the first member-to-member distance MD1 based on the position of the rod 62 and the second member-to-member distance MD2 based on the impedance of the living tissue LT are calculated (steps S4 and S4A). ), When the first and second member distances MD1 and MD2 are different distances (step S13: No), the larger one of the first and second member distances MD1 and MD2 is used. (Step S15), heat energy is applied to the living tissue LT (step S5). For this reason, in the first case, it is possible to apply appropriate thermal energy to the living tissue LT using the highly accurate first member distance MD1. In the second case, the thermal energy matched to the state of the living tissue LT can be applied to the living tissue LT using the distance MD2 between the second members corresponding to the moisture content of the living tissue LT.

(Embodiment 4)
Next, a fourth embodiment of the present invention will be described.
In the following description, the same reference numerals are given to the same components as those in the second embodiment described above, and detailed description thereof will be omitted or simplified.
In the medical treatment apparatus 1A according to Embodiment 2 described above, thermal energy corresponding to the inter-member distance MD is applied to the living tissue LT.
In contrast, the medical treatment apparatus according to the fourth embodiment is configured to apply ultrasonic energy corresponding to the inter-member distance MD to the living tissue LT.
Hereinafter, the configuration and operation of the medical treatment apparatus according to the fourth embodiment will be described.

[Configuration of medical treatment device]
FIG. 14 is a block diagram showing a configuration of a medical treatment apparatus 1C (control apparatus 3C) according to Embodiment 4 of the present invention.
As shown in FIG. 14, the medical treatment apparatus 1C according to the fourth embodiment is different from the medical treatment apparatus 1A (FIG. 10) described in the second embodiment described above in that the thermal energy generation unit 22 and the heat Instead of the energy output unit 31 and the control unit 32A, an ultrasonic energy generation unit 22C, a vibrator drive unit 31C, and a control unit 32C are employed.
The ultrasonic energy generation unit 22C is supported on one plate surface (the upper plate surface in FIG. 3 or FIG. 4) of the second jaw portion 21, and clamps the living tissue LT with the sandwiching plate 12. The ultrasonic energy generation unit 22C generates ultrasonic energy under the control of the control device 3C. That is, the ultrasonic energy generator 22C has a function as an energy generator according to the present invention. As illustrated in FIG. 14, the ultrasonic energy generation unit 22 </ b> C includes a probe 223 and an ultrasonic transducer 224.

The probe 223 is a columnar body made of a conductive material and extending along the center axis Ax of the shaft 6. The probe 223 is inserted into the shaft 6 (inside the case 611) with one end side supported by the second jaw portion 21, and an ultrasonic transducer 224 is attached to the other end. The probe 223 comes into contact with the living tissue LT when the living tissue LT is held between the first and second holding members 10 and 20, and the ultrasonic vibration generated by the ultrasonic transducer 224 is applied to the living body LT. Transmit to the tissue LT (apply ultrasonic energy to the living tissue LT).
As shown in FIG. 14, a high-frequency lead C2 is joined to the probe 223. That is, the high-frequency energy output unit 33 supplies high-frequency power between the probe 223 and the sandwiching plate 12 via the high-frequency lead wires C2 and C2 ′.

The ultrasonic vibrator 224 is constituted by, for example, a piezoelectric vibrator using a piezoelectric element that expands and contracts when an AC voltage is applied. The ultrasonic vibrator 224 is connected to ultrasonic lead wires C3 and C3 ′ (FIG. 14) constituting the electric cable C, and an AC voltage is applied under the control of the control device 3C. Generates sonic vibration.
Although not specifically shown, a vibration magnifying member such as a horn for magnifying the ultrasonic vibration generated by the ultrasonic vibrator 224 is interposed between the ultrasonic vibrator 224 and the probe 223.
Here, the configuration of the ultrasonic energy generation unit 22C may be a configuration in which the probe 223 is longitudinally vibrated (vibration in the axial direction of the probe 223), or the probe 223 is laterally vibrated (in the radial direction of the probe 223). (Vibration).

The vibrator driving unit 31C applies an AC voltage to the ultrasonic vibrator 224 via the ultrasonic lead wires C3 and C3 ′ under the control of the control unit 32C.
And the energy control part 322 which comprises the control part 32C which concerns on this Embodiment 4 controls operation | movement of the vibrator drive part 31C.
Specifically, the energy control unit 322 corrects the initial target temperature IT at the tip of the probe 223 (living tissue LT) based on the second member distance MD2 based on the impedance of the living tissue LT, and generates a corrected target temperature CT. To do. Then, the energy control unit 322 detects the temperature of the tip of the probe 223 (living tissue LT) in contact with the living tissue LT, and adjusts the ultrasonic transducer so that the probe 223 (living tissue LT) becomes the correction target temperature CT. 224 feedback control (for example, PID control) is executed. That is, in the feedback control of the ultrasonic transducer 224, the energy control unit 322 causes the ultrasonic energy generation unit 22C to generate ultrasonic energy corresponding to the first member distance MD2, and transmits the ultrasonic energy to the living tissue LT. Grant.
As the temperature of the tip of the probe 223 (living tissue LT) used for feedback control, for example, the following temperature can be adopted.
The temperature of the probe 223 tip (living tissue LT) has a correlation with the resonance frequency of the probe 223. For this reason, the resonance frequency of the probe 223 is measured, the resonance frequency is converted into a temperature, and the converted temperature is used as the temperature of the tip of the probe 223 (living tissue LT).

[Operation of medical treatment device]
Next, the operation of the medical treatment apparatus 1C according to the fourth embodiment (treatment control by the control apparatus 3C) will be described.
FIG. 15 is a flowchart showing treatment control by the control device 3C.
In the treatment control according to the fourth embodiment, as shown in FIG. 15, steps S7C and S10C are adopted instead of steps S7 and S10 with respect to the treatment control (FIG. 11) described in the second embodiment. The only difference is that steps S16 and S17 are added.
Therefore, only steps S7C, S10C, S16, and S17 will be described below.

Step S16 is executed after step S6.
Specifically, in step S16, the energy control unit 322 calculates the temperature of the probe 223 tip (living tissue LT) by measuring the resonance frequency of the probe 223 and converting the resonance frequency into a temperature.
Subsequently, the energy control unit 322 causes the ultrasonic energy generation unit 22C to generate the living body based on the relationship between the corrected target temperature CT generated in step S6 and the temperature of the tip of the probe 223 (living tissue LT) calculated in step S16 (living body). Ultrasonic energy (applied to the tissue LT) (vibration speed of the probe 223) is determined (step S17). That is, in step S17, the energy control unit 322 causes the ultrasonic energy generation unit 22C to generate ultrasonic energy corresponding to the second member distance MD2 calculated in step S4A (apply to the living tissue LT). Determined as sonic energy.

After step S17, the energy control unit 322 generates the ultrasonic energy calculated in step S17 in the ultrasonic energy generation unit 22C (applies to the living tissue LT), and the tip of the probe 223 (living tissue LT) is corrected to the target temperature. Feedback control (for example, PID control) of the ultrasonic transducer 224 is executed so as to be CV (step S7C: energy application step).
In step S7C, the ultrasonic energy (vibration speed of the probe 223) applied to the living tissue LT is larger (faster) as the second member distance MD2 is larger.

When it is determined that the second inter-member distance MD2 has become 0 (step S8: Yes), or when it is determined that the elapsed time has exceeded the set time (step S9: Yes), the energy control unit 322 Then, the application of ultrasonic energy from the ultrasonic energy generator 22C to the living tissue LT is stopped, and the supply of high-frequency power between the probe 223 and the sandwiching plate 12 (living tissue LT) is stopped (step S10C). Thereafter, the medical treatment apparatus 1C ends this control flow (treatment control).

Even when the ultrasonic energy is applied to the living tissue LT as in the fourth embodiment described above, the ultrasonic energy is applied according to the distance MD2 between the second members. Therefore, the same effects as those of the second embodiment described above can be obtained.

(Other embodiments)
The embodiments for carrying out the present invention have been described so far, but the present invention should not be limited only by the above-described first to fourth embodiments.
In the first to fourth embodiments described above, the second holding member 20 is provided with the thermal energy generating unit 22 and the ultrasonic energy generating unit 22C. However, the present invention is not limited to this, and the first holding member is not the second holding member 20. 10 is provided with a thermal energy generation unit 22 and an ultrasonic energy generation unit 22C, and a configuration in which both the first and second holding members 10 and 20 are provided with a thermal energy generation unit 22 and an ultrasonic energy generation unit 22C. It doesn't matter. When the thermal energy generation unit 22 and the ultrasonic energy generation unit 22C are provided in both the first and second holding members 10 and 20, the living tissue LT is applied from both the first and second holding members 10 and 20. Since thermal energy and ultrasonic energy corresponding to the distance between the members are applied, the treatment of the living tissue LT can be performed more rapidly.

In the first to fourth embodiments described above, the thermal tissue and the ultrasonic energy corresponding to the distance between the members are applied to the living tissue LT. You may comprise so that high frequency energy may be provided. Moreover, you may comprise so that at least 2 or more energy among thermal energy according to the distance between members, ultrasonic energy, and high frequency energy may be provided to the biological tissue LT simultaneously or sequentially.

In the first to third embodiments described above, the flexible substrate 222 functioning as a sheet heater is employed as a configuration for applying thermal energy to the living tissue LT, but the present invention is not limited thereto. For example, a configuration is adopted in which a plurality of heat generating chips are provided on the heat transfer plate 221, and the heat of the plurality of heat generating chips is transmitted to the living tissue LT via the heat transfer plate 221 by energizing the plurality of heat generating chips. (For example, refer to JP2013-106909A for this technique).

By the way, when the temperature converted from the resistance value of the heating pattern 2222 is used as the temperature of the heat transfer plate 221 (living tissue LT) used in the feedback control, the temperature sensor provided on the heat transfer plate 221 or the sandwich plate 12 is used. There may be a difference between the detected temperature and the temperature. For this reason, in the first to third embodiments described above, the temperature obtained by converting the resistance value of the heating pattern 2222 is used as the temperature of the heat transfer plate 221 (living tissue LT) used for feedback control, and the heat transfer plate 221. Alternatively, different correction values CV may be calculated depending on the temperature detected by the temperature sensor provided on the sandwiching plate 12.

In the above-described first and third embodiments, the inter-member distance MD (first inter-member distance MD1) is calculated based on the position of the rod 62, but is not limited thereto. For example, the position detection sensor 8 detects the position of the operation knob 51 having a function as a power transmission unit according to the present invention, and based on the position of the operation knob 51, the inter-member distance MD (first member distance MD1). ) May be calculated.

In the first to fourth embodiments described above, the calculation of the inter-member distance is started when the foot switch 4 is turned on or when the impedance of the living tissue LT is a predetermined value (when the living tissue LT is sandwiched). However, it is not limited to this. For example, based on a signal from the position detection sensor 8, the start or stop of movement of the rod 62 or the operation knob 51 is determined. Then, when the movement of the rod 62 or the operation knob 51 is started and it is determined that the movement of the rod 62 or the operation knob 51 is stopped, the calculation of the distance between the members may be started.

FIG. 16 is a diagram showing a modification of the first to fourth embodiments of the present invention. Specifically, FIG. 16 corresponds to FIG.
In the first to fourth embodiments described above, the first and second holding members 10 and 20 are opened and closed by rotating the first holding member 10 about the rotation axis RA. However, the present invention is not limited to this. The structure shown in FIG.
In the structure shown in FIG. 16, the shapes of the pair of shaft support portions 613 and the pair of connection portions 112 described in the first to fourth embodiments are changed.
Specifically, unlike the pair of shaft support portions 613 described in Embodiments 1 to 4 described above, the pair of shaft support portions 613D shown in FIG. 16 is a long, substantially flat plate extending in the vertical direction in FIG. Each has a shape. And a pair of axial support part 613D is integrally formed in the front end side (left side in FIG. 16) in the upper surface of the base part 612 so that a pair of slit hole 6121 may be pinched | interposed.
As shown in FIG. 16, the pair of shaft support portions 613D penetrate the front and back surfaces of the shaft support portion 613D and extend from the same height position as the center axis Ax (height position from the base portion 612) to the center axis Ax. Third track holes 6133 that are orthogonal and extend upward are formed.

Also, the pair of connection portions 112D shown in FIG. 16 has a substantially flat plate shape having an L shape in plan view. And a pair of connection part 112D mutually opposes, the L-shaped one end side is along the longitudinal direction of the jaw part main body 111, respectively, and the other end side of the said L-shaped is the attitude | position which faces each below in FIG. These are integrally formed on one end side of the jaw body 111 (on the right end side in FIG. 16). The distance between the pair of connection portions 112D is set to be substantially the same as the distance between the pair of connection portions 112 described in the first embodiment (approximately the same as the width of the jaw main body 111). ing. In addition, the pair of connection portions 112D are each formed to have a thickness dimension slightly smaller than the width dimension of the slit hole 6121, like the pair of connection sections 112 described in the first embodiment.

In the pair of connection portions 112D, second bearing holes 1121 are respectively formed on one end side of the L shape, similarly to the pair of connection portions 112 described in the first embodiment.
The second bearing hole 1121 is a hole through which the rotation shaft RA is inserted, similarly to the pair of connection portions 112 described in the first embodiment. Then, both ends of the rotation shaft RA inserted through the respective second bearing holes 1121 of the pair of connection portions 112D are projected to the outside of the pair of connection portions 112D, and the third track holes 6133 in the pair of shaft support portions 613D. Is inserted into each.

Further, in the pair of connection portions 112D, fourth track holes 1123 that penetrate the front and back of the connection portion 112 and extend in the direction intersecting the central axis Ax are formed on the other end side of the L shape.
Specifically, the fourth track hole 1123 has a shape inclined toward the lower side in FIG. 16 toward the second bearing hole 1121 along the central axis Ax. Note that the right end of the fourth track hole 1123 in FIG. 16 is set to be at the same height as the second bearing hole 1121. When the first and second holding members 10 and 20 are closed (see FIG. 17B), the right end portion of the fourth track hole 1123 is the lower end portion of the third track hole 6133 in FIG. It is set to be the same height position (a height position from the base 612) as (the position through which the central axis Ax passes). Further, when the first and second holding members 10 and 20 are opened (see FIG. 17A), the left end portion of the fourth track hole 1123 is the lower end portion of the third track hole 6133 in FIG. It is set to be the same height position. Then, both ends of the shaft portion 622 are inserted into the fourth track holes 1123, respectively.

In the structure shown in FIG. 16, the first and second holding members 10 and 20 perform an opening / closing operation as described below.
17A and 17B are diagrams for explaining the opening and closing operations of the first and second holding members 10 and 20 in the structure shown in FIG. Specifically, FIG. 17A is a cross-sectional view corresponding to FIG. 6A. FIG. 17B is a cross-sectional view corresponding to FIG. 6B.
FIG. 17A shows a state where the operation knob 51 is not operated by the operator. In this state, as shown in FIG. 17A, the first and second holding members 10 and 20 are in an open state.
From the state shown in FIG. 17A, when the operator operates the operation knob 51 in the direction of the arrow R1 (FIG. 1), the rod 62 moves to the operation unit 5 side (right side in FIG. 17A or FIG. 17B). As the rod 62 moves, the shaft portion 622 moves from the left side to the right side in each of the fourth track holes 1123 in FIG. 17A or 17B.

Here, as described above, each of the fourth track holes 1123 provided in the first jaw portion 11 gradually increases in height with respect to the central axis Ax toward the left side in FIG. 17A or FIG. 17B. Is set to be low. For this reason, the shaft portion 622 presses the edge portion of each fourth track hole 1123 downward when moving inside the fourth track hole 1123 from the left side to the right side in FIG. 17A or 17B. Move while.
Further, as described above, each third track hole 6133 provided in the shaft main body 61 is set so as to extend upward from the position through which the central axis Ax passes perpendicular to the central axis Ax. For this reason, as the shaft portion 622 presses the edge portion of each fourth track hole downward, the rotation shaft RA causes the inside of each third track hole 6133 to face downward in FIG. 17A or 17B. Move. That is, the first holding member 10 moves in the direction approaching the second holding member 20 (downward in FIG. 17A or 17B), and finally enters the state shown in FIG. 17B. At this time, the pair of connection portions 112 </ b> D are inserted through the pair of slit holes 6121.

From the state shown in FIG. 17B, when the operator releases the operation knob 51 in the direction of the arrow R1, and the operation knob 51 returns in the direction of the arrow R2 (FIG. 1), In FIG. 17B, the rod 62 moves from the right side to the left side. As the rod 62 moves, the first holding member 10 moves in a direction away from the second holding member 20 (upward in FIG. 17A or FIG. 17B), and finally, The state shown in FIG. 17A is obtained.

In the above-described first to fourth embodiments and the modifications thereof, the moving direction of the rod 62 according to the operation on the operation knob 51 is shown in the above-described first to fourth embodiments and FIG. The moving direction described in the modification may be set in the opposite direction. Even when the movement direction of the rod 62 is set in the reverse direction as described above, when the operation knob 51 is operated in the direction of the arrow R1 (FIG. 1), the first and second holding members 10, It is preferable that the first and second holding members 10 and 20 be opened when the operation knob 51 returns to the direction of the arrow R2 when the operation knob 51 is in the closed state.

In the first to fourth embodiments and the modifications described above, the second holding member 20 is fixed to the shaft 6, and the first holding member 10 is configured to be closely separated from the second holding member 20. However, it is not limited to this.
For example, the first holding member 10 may be fixed to the shaft 6, and the second holding member 20 may be configured to be closely separated from the first holding member 10.
Further, for example, both the first and second holding members 10 and 20 may be configured to be movable, and the first and second holding members 10 and 20 may be opened and closed by moving both.

The flow of treatment control is not limited to the order of processing in the flowcharts (FIGS. 9, 11, 13, and 15) described in the first to fourth embodiments, and may be changed within a consistent range. I do not care. For example, with regard to steps S8 and S9, either one may be omitted, and if “Yes” is determined on the other, it may be configured to proceed to steps S10, S10A, and S10C.

DESCRIPTION OF SYMBOLS 1,1A-1C Medical treatment apparatus 2 Treatment tool 3,3A-3C Control apparatus 4 Foot switch 5 Operation handle 6 Shaft 7 Clamping part 8 Position detection sensor 10 1st holding member 11 1st jaw part 12 Clamping board 13 1st Fixed plate 20 Second holding member 21 Second jaw 22 Thermal energy generating unit 22C Ultrasonic energy generating unit 23 Second fixed plate 31 Thermal energy output unit 31C Vibrator driving unit 32, 32A to 32C Control unit 33 High frequency energy output unit 34 Sensor 51 Operation knob 61 Shaft body 62 Rod 63 Sheath 111 Jaw body 112, 112D Connection portion 221 Heat transfer plate 222 Flexible substrate 223 Probe 224 Ultrasonic transducer 321 Distance calculation portion 322 Energy control portion 323 Impedance calculation portion 611 Case 612 Base 613, 613D Shaft support 621 Plate body 622 Shaft portion 1121 Second bearing hole 1122 Second track hole 1123 Fourth track hole 2211 Treatment surface 2221 Substrate 2222 Heat generation pattern 2222A Lead connection portion 2222B Electrical resistance pattern 2223 Insulation sheet 6111 Guide hole 6121 Slit hole 6131 First Bearing hole 6132 First track hole 6133 Third track hole 6211 Insertion hole Ax Central axis C Electric cable C1, C1 'Heat generation lead C2, C2' High frequency lead C3, C3 'Ultrasonic lead LT LT Biological tissue MD (MD1, MD2) Distance between members (distance between first and second members)
R1, R2 Arrow RA Rotation axis

Claims (10)

A pair of holding members for sandwiching the living tissue;
An energy generating part that is provided on at least one of the pair of holding members and generates energy;
A distance calculating unit for calculating a distance between the pair of holding members;
An energy control unit that causes the energy generation unit to generate energy according to the distance between the members;
A medical treatment device comprising: The energy generating unit includes a heat generating member that generates thermal energy,
The medical treatment apparatus according to claim 1, wherein the energy control unit causes the energy generation unit to generate thermal energy corresponding to the distance between the members. A power transmission unit that opens and closes the pair of holding members by connecting and moving to at least one of the pair of holding members;
The medical treatment apparatus according to claim 1, wherein the distance calculation unit calculates the distance between the members based on a position of the power transmission unit. The medical treatment apparatus according to claim 3, wherein the distance calculation unit starts calculating the distance between the members when the movement of the power transmission unit stops. A switch for receiving a user operation for starting generation of the energy from the energy generation unit;
The medical treatment apparatus according to any one of claims 1 to 3, wherein the distance calculation unit starts calculating the distance between the members when the switch receives the user operation. An impedance calculation unit for calculating the impedance of the living tissue;
6. The medical treatment apparatus according to claim 1, wherein the distance calculation unit calculates the distance between the members based on the impedance. The medical treatment apparatus according to claim 6, wherein the distance calculation unit starts calculating the distance between the members when the impedance is a predetermined value. A power transmission unit that opens and closes the pair of holding members by connecting and moving to at least one of the pair of holding members;
An impedance calculation unit for calculating the impedance of the biological tissue,
The distance calculation unit calculates, as the inter-member distance, a first inter-member distance based on the position of the power transmission unit and a second inter-member distance based on the impedance;
In the case where the distance between the first members and the distance between the second members are different distances, the energy control unit has a larger member between the distance between the first members and the distance between the second members. The medical treatment apparatus according to claim 1, wherein energy corresponding to a distance is generated in the energy generation unit. A distance calculation step of calculating a distance between the pair of holding members after the living tissue is sandwiched between the pair of holding members;
An energy applying step of applying energy according to the distance between the members from at least one holding member of the pair of holding members to the living tissue;
A method for operating a medical treatment apparatus, comprising: A clamping step of clamping the living tissue with a pair of holding members;
A distance calculating step of calculating a distance between the pair of holding members;
An energy applying step of applying energy according to the distance between the members from at least one holding member of the pair of holding members to the living tissue;
A treatment method comprising the steps of:

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