WO2019163137A1 - Treatment device and method for operating treatment device - Google Patents

Abstract

A treatment device 1 includes: a pair of holding members 8, 9 that holds a target site to be joined on a biological tissue; an energy application part 82 that is provided on at least one of the pair of holding members 8, 9 and applies energy to the target site; and a control part 34 that controls at least one of energy output from the energy application part 82 and compressive load applied to the target site by the pair of holding members 8, 9. The control part 34 calculates an elasticity index value which is an index of elasticity of the target site held by the pair of holding members 8, 9, and after the elasticity index value reaches extremal values, increases the energy output and/or the compressive load to a level higher than before the extremal values were reached.

Description

TREATMENT DEVICE AND METHOD OF OPERATING TREATMENT DEVICE

The present invention relates to a treatment device and a method for operating the treatment device.

2. Description of the Related Art Conventionally, there has been known a treatment apparatus that cuts while joining a target part by applying energy to a part (hereinafter, referred to as a target part) to be joined and incised in living tissue (for example, Patent Document 1). reference).
In the treatment apparatus described in Patent Document 1, ultrasonic energy is used as energy to be applied to the target site. And in the said treatment apparatus, the elastic modulus of the said target part is detected, providing ultrasonic energy to a target part. Further, in the treatment apparatus, when the elastic coefficient increases by a certain value or more from the elastic coefficient at the start of application of ultrasonic energy, the target portion is joined by increasing the output of the ultrasonic energy. Incision.

JP 2006-288431 A

By the way, when the temperature of the living tissue gradually increases, the first process in which elasticity increases due to protein denaturation and dehydration, the second process to shrink by further protein denaturation, the third process to soften, and the protein The state is sequentially shifted to each state of the fourth process to be decomposed.
According to the applicant's research, it has been confirmed that the optimal timing for incising the target site while joining the target site is the third process.
However, in the treatment apparatus described in Patent Document 1, when the elastic coefficient of the target portion increases by a certain amount or more from the elastic coefficient at the start of application of ultrasonic energy, the output of the ultrasonic energy is increased. The incision is made while joining the target parts. That is, in the treatment apparatus described in Patent Document 1, when the state of the target site is not the third process but the first and second processes, the target site is incised while being joined. For this reason, there exists a problem that it is difficult to obtain desired joining strength.

The present invention has been made in view of the above, and an object of the present invention is to provide a treatment apparatus and an operation method of the treatment apparatus that can improve the bonding strength of the target part.

In order to solve the above-described problems and achieve the object, a treatment apparatus according to the present invention includes a pair of gripping members that grip a target site to be joined in living tissue, and at least one gripping member of the pair of gripping members. An energy applying unit that provides energy to the target site, and a control unit that controls at least one of an energy output from the energy applying unit and a compressive load applied to the target site from the pair of gripping members. And the control unit calculates an elasticity index value that is an index of elasticity of the target portion gripped by the pair of gripping members, and outputs the energy after the elasticity index value becomes an extreme value. And at least one of the compressive load is increased more than before the extreme value.

The operating method of the treatment apparatus according to the present invention is an operating method of the treatment apparatus including a pair of gripping members for gripping a target site to be joined in living tissue, and the target site is gripped by the pair of gripping members. A step of applying energy to the target site from at least one gripping member of the pair of gripping members, a step of calculating an elasticity index value serving as an index of elasticity of the target site, and the elasticity index After the value becomes an extreme value, a step of increasing at least one of the output of energy applied to the target site and the compressive load applied to the target site from the pair of gripping members from before reaching the extreme value With.

According to the treatment device and the operation method of the treatment device according to the present invention, there is an effect that the bonding strength of the target part can be improved.

FIG. 1 is a diagram showing a treatment apparatus according to the first embodiment. FIG. 2 is a block diagram illustrating a configuration of the control device. FIG. 3 is a flowchart showing a method for operating the treatment apparatus. FIG. 4 is a diagram illustrating an example of temperature characteristics of a living tissue. FIG. 5 is a diagram for explaining an operating method of the treatment apparatus. FIG. 6 is a block diagram showing the configuration of the treatment apparatus according to the second embodiment. FIG. 7 is a flowchart showing a method for operating the treatment apparatus. FIG. 8 is a diagram for explaining an operating method of the treatment apparatus. FIG. 9 is a block diagram showing the configuration of the treatment apparatus according to the third embodiment. FIG. 10 is a flowchart showing a method for operating the treatment apparatus. FIG. 11 is a diagram for explaining an operating method of the treatment apparatus. FIG. 12 is a block diagram showing the configuration of the treatment apparatus according to the fourth embodiment. FIG. 13 is a flowchart showing an operation method of the treatment apparatus. FIG. 14 is a diagram for explaining an operating method of the treatment apparatus.

Hereinafter, embodiments for carrying out the present invention (hereinafter, 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 treatment device]
FIG. 1 is a diagram showing a treatment apparatus 1 according to the first embodiment.
The treatment device 1 applies energy to a site to be treated in a living tissue such as a blood vessel (hereinafter referred to as a target site) and treats the target site. Here, the said treatment means joining and incision of an object part, for example. As shown in FIG. 1, the 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 treating a target site through the abdominal wall. As shown in FIG. 1, the treatment tool 2 includes a handle 5, a shaft 6, and a grip portion 7.
The handle 5 is a part that the surgeon holds by hand. The handle 5 is provided with an operation knob 51 as shown in FIG.
The shaft 6 has a substantially cylindrical shape, and one end is connected to the handle 5 (FIG. 1). In addition, a grip portion 7 is attached to the other end of the shaft 6. Inside the shaft 6, an electric cable C (FIG. 1) connected to the control device 3 is disposed from one end side to the other end side via the handle 5.
Then, inside the handle 5 and the shaft 6 described above, a drive unit 10 (see FIG. 2) that drives the first and second gripping members 8 and 9 constituting the gripping unit 7 under the control of the control device 3. Is provided. The drive unit 10 includes an opening / closing mechanism 11, a motor 12, and second and third sensors 13 and 14.

The opening / closing mechanism 11 is a mechanism that opens and closes the first and second gripping members 8 and 9 according to the operation of the operation knob 51 by the operator.
The motor 12 is connected to the opening / closing mechanism 11 and operates the opening / closing mechanism 11 under the control of the control device 3 when the target part is held by the first and second holding members 8, 9. The compression load applied to the target part from the first and second gripping members 8 and 9 is changed.
The second sensor 13 is a pressure sensor or the like, and detects a pressure given from a movable part in the opening / closing mechanism 11 or a pressure given from a movable part in the motor 12. Then, the second sensor 13 outputs a signal corresponding to the detected pressure to the control unit 34.
The third sensor 14 is a rotary encoder, a linear encoder, or the like, and detects a displacement amount of the movable part in the opening / closing mechanism 11 or a displacement amount of the movable part in the motor 12.

(Configuration of gripping part)
The gripping part 7 is a part that treats the target part while holding the target part. As shown in FIG. 1, the grip portion 7 includes a first grip member 8 and a second grip member 9.
The first and second grasping members 8 and 9 are configured to be openable and closable in the direction of the arrow R1 (FIG. 1) according to the operation of the operation knob 51 by the operator.
Specifically, as shown in FIG. 1, the first gripping member 8 is rotatably supported at the other end of the shaft 6. On the other hand, the second gripping member 9 is fixed to the other end of the shaft 6. That is, in the first embodiment, the first gripping member 8 can be opened and closed with respect to the second gripping member 9 according to the operation of the operation knob 51 by the operator. For example, when the operation knob 51 moves in the direction of the arrow R2 (FIG. 1), the first gripping member 8 rotates in the direction approaching the second gripping member 9. Further, when the operation knob 51 moves in the direction of the arrow R3 (FIG. 1) opposite to the arrow R2, the first gripping member 8 rotates in a direction away from the second gripping member 9.

In addition, as a structure which opens and closes in the 1st, 2nd holding members 8 and 9, it is not restricted to the structure mentioned above. For example, the first gripping member 8 may be fixed to the other end of the shaft 6, and the second gripping member 9 may be rotatably supported on the other end of the shaft 6. That is, the second gripping member 9 can be opened and closed with respect to the first gripping member 8. Further, both the first and second gripping members 8 and 9 may be rotatably supported on the other end of the shaft 6. That is, the first and second gripping members 8 and 9 can be opened and closed by rotating.

The first gripping member 8 corresponds to the gripping member according to the present invention. The first holding member 8 is disposed on the upper side in FIG. 1 with respect to the second holding member 9. The first gripping member 8 includes a first jaw 81 and an energy application unit 82.
As shown in FIG. 1, the first jaw 81 includes a shaft support portion 811 that is supported on the other end of the shaft 6 and a support plate 812 that is connected to the shaft support portion 811. Depending on the operation, it opens and closes in the direction of arrow R1.

The energy applying unit 82 applies high-frequency energy and heat energy to the target site under the control of the control device 3. As shown in FIG. 1, the energy applying unit 82 includes a heat transfer plate 821 and a heat generating sheet 822, and the heat generating sheet 822 and the heat transfer on the plate surface of the support plate 812 facing the second holding member 9. The plates 821 are stacked in this order.
The heat transfer plate 821 is, for example, a copper thin plate.
In this heat transfer plate 821, the lower plate surface in FIG. 1 is the first treatment surface that comes into contact with the target site when the target site is gripped by the first and second gripping members 8 and 9. It functions as 820. The heat transfer plate 821 transmits heat from the heat generating sheet 822 to the target site. That is, the heat transfer plate 821 gives thermal energy to the target part. Further, the heat transfer plate 821 is joined with a high-frequency lead wire C1 (see FIG. 2) constituting the electric cable C. The heat transfer plate 821 is supplied with high frequency power from the control device 3 to the probe 92 to be described later via the high frequency lead wires C1 and C1 ′ (see FIG. 2). To apply high frequency energy. That is, the heat transfer plate 821 also functions as a high frequency electrode.

The heat generating sheet 822 is a sheet heater, for example, and functions as a heat generator. Although not specifically shown, the heat generating sheet 822 is obtained by forming an electric resistance pattern on a sheet-like substrate made of an insulating material such as polyimide by vapor deposition or the like.
The electrical resistance pattern is formed, for example, along a U shape that follows the outer edge shape of the heat generating sheet 822, and heat generating leads C2 and C2 ′ (see FIG. 2) constituting the electric cable C are joined to both ends, respectively. . The electrical resistance pattern generates heat when a voltage is applied from the control device 3 via the heating lead wires C2 and C2 ′.

Although not shown in FIG. 1, an adhesive sheet for adhering the heat generating sheet 822 to the heat transfer plate 821 is interposed between the heat transfer plate 821 and the heat generating sheet 822. This adhesive sheet is a sheet having high thermal conductivity, withstands high temperatures, and has adhesiveness. For example, the adhesive sheet is formed by mixing an epoxy resin with a ceramic having high thermal conductivity such as alumina or aluminum nitride. Has been.

The second gripping member 9 corresponds to a gripping member according to the present invention. As shown in FIG. 1, the second gripping member 9 includes a second jaw 91 and a probe 92.
The second jaw 91 is fixed to the other end of the shaft 6 and has a shape extending along the axial direction of the shaft 6.
The probe 92 is made of a conductive material, and is fixed on a surface of the second jaw 91 that faces the first gripping member 8.
In this probe 92, the upper surface in FIG. 1 functions as a second treatment surface 920 that comes into contact with the target site when the target site is gripped by the first and second gripping members 8 and 9. To do. The probe 92 is joined to a high-frequency lead C1 ′ constituting the electric cable C. The probe 92 supplies high-frequency energy to the target part by supplying high-frequency power from the control device 3 to the heat transfer plate 821 via the high-frequency lead wires C1 and C1 ′. That is, the probe 92 functions as a high frequency electrode.

[Configuration of control device and foot switch]
FIG. 2 is a block diagram illustrating a configuration of the control device 3.
In FIG. 2, 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 a surgeon with a foot, and outputs an operation signal to the control device 3 by turning on the switch according to the operation. And the control apparatus 3 starts the control mentioned later according to the said operation signal. Note that the means for starting the control is not limited to the foot switch 4 and may be a switch operated by hand.

The control device 3 comprehensively controls the operation of the treatment instrument 2. As shown in FIG. 2, the control device 3 includes a high-frequency energy output unit 31, a first sensor 32, a thermal energy output unit 33, and a control unit 34.
The high frequency energy output unit 31 supplies high frequency power between the heat transfer plate 821 and the probe 92 via the high frequency lead wires C1 and C1 ′ under the control of the control unit 34.
The first sensor 32 detects a voltage value and a current value supplied from the high frequency energy output unit 31 to the heat transfer plate 821 and the probe 92. Then, the first sensor 32 outputs a signal corresponding to the detected voltage value and current value to the control unit 34.
The thermal energy output unit 33 applies a voltage to the heating sheet 822 via the heating lead wires C2 and C2 ′ under the control of the control unit 34.

The control unit 34 is, for example, a CPU (Central Processing Unit), an FPGA (Field-Programmable Gate Array), or the like. When the foot switch 4 is turned on, the control unit 34 operates the treatment tool 2 according to a predetermined control program. Control. As shown in FIG. 2, the control unit 34 includes an impedance calculation unit 341, a load calculation unit 342, an index value calculation unit 343, and an operation control unit 344.
The impedance calculation unit 341 calculates the impedance of the target part when high frequency energy is applied to the target part based on the voltage value and the current value detected by the first sensor 32.
Based on the pressure detected by the second sensor 13, the load calculation unit 342 calculates a compression load applied to the target part from the first and second gripping members 8 and 9.
The index value calculation unit 343 calculates an elasticity index value that is an index of elasticity of the target portion gripped by the first and second gripping members 8 and 9. In the first embodiment, the index value calculation unit 343 calculates the distance between the first and second gripping members 8 and 9 as an elastic index value based on the displacement amount detected by the third sensor 14. . The distance between the first and second gripping members 8 and 9 means the distance between the first and second treatment surfaces 820 and 920.

As illustrated in FIG. 2, the operation control unit 344 includes an energy control unit 345 and a motor control unit 346.
The energy control unit 345 includes the high-frequency energy output unit 31 and the energy control unit 345 according to the operation signal from the foot switch 4, the impedance of the target part calculated by the impedance calculation unit 341, and the elasticity index value calculated by the index value calculation unit 343. The operation of the thermal energy output unit 33 is controlled. That is, the energy control unit 345 controls the timing for applying the high frequency energy and the thermal energy to the target part.
The motor control unit 346 controls the operation of the motor 12 with reference to the compression load calculated by the load calculation unit 342 according to the operation signal from the foot switch 4, thereby controlling the compression load to be constant.

[Method of operating the treatment device]
Next, the operation method of the treatment apparatus 1 mentioned above is demonstrated.
FIG. 3 is a flowchart showing an operation method of the treatment apparatus 1.
The surgeon holds the treatment instrument 2 by hand, and inserts the grasping portion 7 and a part of the shaft 6 which are the distal end portion of the treatment instrument 2 into the abdominal cavity through the abdominal wall using, for example, a trocar. Then, the operator operates the operation knob 51 to open and close the first and second holding members 8 and 9, thereby holding the target site with the first and second holding members 8 and 9. Thereafter, the surgeon turns on the foot switch 4 (step S1: Yes). And the control apparatus 3 starts the control shown below.

First, the motor control unit 346 controls the operation of the motor 12 and starts control to make the compression load applied to the target part from the first and second gripping members 8 and 9 constant (step S2).
The energy control unit 345 drives the high frequency energy output unit 31 and the thermal energy output unit 33, supplies high frequency power from the high frequency energy output unit 31 to the heat transfer plate 821 and the probe 92, and the thermal energy output unit. The energization from 33 to the heat generating sheet 822 is started (step S3). Thereby, application of high frequency energy and thermal energy to the target part is started.

Furthermore, the impedance calculator 341 starts calculating the impedance of the target part based on the voltage value and the current value detected by the first sensor 32 (step S4).
Further, the index value calculation unit 343 starts calculating the distance between the first and second gripping members 8 and 9 based on the displacement detected by the third sensor 14 (step S5). In the first embodiment, the compression load applied to the target part from the first and second gripping members 8 and 9 is controlled to be constant after step S2. For this reason, the distance between the 1st, 2nd holding members 8 and 9 also changes as the elasticity in an object part changes. That is, the distance between the first and second gripping members 8 and 9 corresponds to an elasticity index value that is an index of elasticity of the target part.
In FIG. 3, for the convenience of explanation, steps S2 to S5 are sequentially executed. However, actually, steps S2 to S5 are executed substantially simultaneously.

After step S5, the energy control unit 345 constantly monitors whether or not the elasticity index value calculated by the index value calculation unit 343 has reached the maximum value (step S6).
If it is determined that the elasticity index value has reached the maximum value (step S6: Yes), the energy control unit 345 determines whether or not the impedance of the target portion detected by the impedance calculation unit 341 has reached a predetermined impedance. Monitoring is always performed (step S7).
When it is determined that the impedance of the target part has reached the predetermined impedance (step S7: Yes), the energy control unit 345 has the elasticity index value detected by the index value calculation unit 343 decreased at a predetermined decrease rate. Is constantly monitored (step S8).

When it is determined that the elasticity index value has decreased at a predetermined decrease rate (step S8), the energy control unit 345 controls the operation of the high-frequency energy output unit 31, and the heat transfer plate 821 is controlled from the high-frequency energy output unit 31. And the high frequency electric power supplied to the probe 92 is decreased (step S9). As a result, the output of the high-frequency energy that has been applied to the target region after step S3 decreases after step S9.
Moreover, the energy control part 345 controls the operation | movement of the thermal energy output part 33, and increases the electric power supplied from the said thermal energy output part 33 to the heat generating sheet 822 (step S10). As a result, the output of heat energy that has been applied to the target site after step S3 increases after step S10. That is, the thermal energy corresponds to the energy according to the present invention.
Here, the energy control unit 345 increases the increase rate of the power supplied from the thermal energy output unit 33 to the heat generating sheet 822 as the decrease rate of the elasticity index value after decreasing at the predetermined decrease rate in step S10. To do.
In FIG. 3, for the sake of convenience of explanation, step S10 is executed after step S9. However, in practice, steps S9 and S10 are executed substantially simultaneously.

After step S10, the energy control unit 345 constantly monitors whether or not a predetermined time has elapsed since the output of thermal energy was increased in step S10 (step S11).
If it is determined that a predetermined time has elapsed since the increase in the output of thermal energy (step S11: Yes), the energy control unit 345 stops driving the high-frequency energy output unit 31 and the thermal energy output unit 33, respectively. (Step S12). Thereby, the application of the high frequency energy and the thermal energy to the target part is completed.
The target site is treated by the above control.

FIG. 4 is a diagram illustrating an example of temperature characteristics of a living tissue. Specifically, FIG. 4 is a diagram in which the temperature [° C.] is the horizontal axis and the elasticity [Pa] of the living tissue is the vertical axis.
Here, the living tissue has the temperature characteristics shown in FIG.
Specifically, when the temperature gradually increases, the living tissue sequentially shifts to the first to fourth processes P1 to P4.
The first process P1 occurs in a temperature range of about 40 ° C. to 90 ° C. shown in FIG. In the first process P1, the biological tissue undergoes protein denaturation and dehydration, and its elasticity increases dramatically.

The second process P2 occurs in a temperature range of about 90 ° C. to 200 ° C. shown in FIG. In the second process P2, the biological tissue is hardened and contracted by further denaturation and dehydration of the protein, and the elasticity is slightly increased.
The third process P3 occurs in a temperature range of about 200 ° C. to 260 ° C. shown in FIG. In the third process P3, the biological tissue is softened after the moisture in the interior is exhausted, and the elasticity is drastically reduced.
The fourth process P4 occurs in the temperature range of about 260 ° C. to 300 ° C. shown in FIG. In the fourth process P4, protein is degraded in the living tissue.

In the third process P3, the biological tissue is softened as described above. Then, in a state where the target part is softened, it is possible to make an incision while reliably joining the target part as compared with a state where the target part is cured. As described above, in the third process P3, the elasticity of the living tissue is dramatically reduced. Therefore, in the first embodiment, based on the impedance of the target part and the distance between the first and second gripping members 8 and 9 that are the elasticity index values, the state of the target part is determined by the third process P3. It is determined whether or not the target site is in the third process P3, and the target site is incised while being joined.

FIG. 5 is a diagram for explaining an operating method of the treatment apparatus 1. Specifically, in FIG. 5 (a), the behavior of the impedance of the target part after step S2 is shown by a curve CL1, and the behavior of the distance between the first and second gripping members 8 and 9, which are elastic index values, is a curve. This is indicated by CL2. FIG. 5B is a time chart showing the high frequency power supplied from the high frequency energy output unit 31 to the heat transfer plate 821 and the probe 92 after step S2. FIG. 5C is a time chart showing electric power supplied from the thermal energy output unit 33 to the heat generating sheet 822 after step S2.

When the application of high frequency energy and thermal energy to the target part is started in step S3, the impedance of the target part exhibits the following behavior.
In the initial time zone from the energy application start T ₀ to the time T ₁ , the impedance of the target portion gradually decreases as shown by a curve CL1 in FIG. This is because the cell membrane destruction of the target site occurs due to the application of high-frequency energy and thermal energy, and the extracellular matrix is extracted from the target site. In other words, the initial time zone is a time zone in which the extracellular matrix is extracted from the target site and the viscosity of the target site is lowered, that is, the target site is softened. The impedance of the target site is the minimum value Im1 and since time T ₁ after the impedance of the target site, gradually increases. This is due to the evaporation of moisture in the target part due to the application of high-frequency energy and thermal energy to the target part. In other words, the time T ₁ and later, extracellular matrix no longer extracted from the target site, the viscosity of the target site by water in the target site evaporates becomes higher, i.e., the target site is solidified It is time to go. Then, the impedance of the target site, after reaching a predetermined impedance Im2 at time T _2, saturates. That is, the predetermined impedance Im2 corresponds to the upper limit value in the impedance of the target part.

On the other hand, when application of high-frequency energy and thermal energy to the target site is started in step S3, the distance between the first and second gripping members 8 and 9 exhibits the following behavior.
First, the distance between the second gripping members 8 and 9, as indicated by the curve CL2 in FIG. 5 (a), giving start _{T 0} after the energy, gradually increased, reaching a maximum value Gp1. This is because the cell membrane is destroyed at the target site, and the extracellular matrix is extracted from the target site, thereby increasing the elasticity of the target site. The maximum value Gp1 corresponds to the extreme value according to the present invention. Further, the maximum value Gp1 and since time T ₃ after, the distance is gradually decreased. This is due to the evaporation of moisture in the target part due to the application of high-frequency energy and thermal energy to the target part. Then, the distance at time T _4, decreases in the default rate of decrease. That is, first, the distance between the second gripping member 8, 9, at time T _4, decreases at a lower reduction rate than the decrease rate in the time period between time T _{3 ~} time T _4. This is due to the fact that the water in the target part is lost and the target part is softened. The predetermined reduction rate corresponds to the predetermined fluctuation rate according to the present invention.

The time zone from the energy application start T ₀ to the time T ₄ described above means that the state of the target part is the first and second processes P1 and P2. The time T ₄ after, it means that the target site conditions are beginning to transition to the third process P3.
Then, in the first embodiment, as shown in FIG. 5 (b), at time _{T 4} (step S8: Yes), it reduces the output of high-frequency energy to be applied to the target site (step S9). Further, as shown in FIG. 5 (c), at time T ₄ (step S8: Yes), by increasing the output of the heat energy to be applied to the target site (step S10), and while bonding the target site incision doing. In step S10, as the rate of decrease in the distance between the first and second gripping members 8 and 9 after decreasing at a predetermined rate of decrease is smaller, the rate of increase in the output of thermal energy applied to the target site is increased. doing. In FIG. 5A and FIG. 5C, the case where the rate of decrease in the distance between the first and second gripping members 8 and 9 after decreasing at the predetermined rate of decrease is shown by a solid line, and the case where it is small It is indicated by a one-dot chain line.

According to the first embodiment described above, the following effects are obtained.
In the treatment apparatus 1 according to the first embodiment, after the elasticity index value reaches the maximum value Gp1, when the elasticity index value decreases at a predetermined decrease rate, the output of thermal energy applied to the target site is increased. In this way, an incision is made while joining the target sites.
Therefore, according to the treatment apparatus 1 according to the first embodiment, when the state of the target part is the third process P3, the target part can be incised while being joined, and a desired joint strength can be obtained. Can do.

Incidentally, the timing of reduction in the default rate of decrease in elastic index value, despite of sites state is not the third process P3, for example, prior to the time T _4, anomalously may occur.
In the treatment apparatus 1 according to the first embodiment, after the impedance of the target region reaches the predetermined impedance Im2, when the elasticity index value decreases at a predetermined decrease rate, the output of the thermal energy applied to the target region is Increasing. Here, according to the research by the present applicant, it is confirmed that the third process P3 is transferred after the impedance of the target portion reaches the predetermined impedance Im2. That is, since the irregularly generated timing described above can be excluded, it is possible to accurately determine whether or not the state of the target part is the third process P3.

By the way, even if the state of the target part is the third process P3, the elasticity may be different depending on the type of the biological tissue.
In the treatment apparatus 1 according to the first embodiment, the rate of increase in the output of thermal energy is increased as the rate of decrease in the elasticity index value after the rate of decrease in the elasticity index value is decreased. In other words, in the case where the state of the target part is the third process P3, the increase rate of the output of thermal energy is increased as the target part is harder. In other words, any type of living tissue can be incised while obtaining similar joint strength.

Further, in the treatment apparatus 1 according to the first embodiment, the first and second gripping members 8 and 9 are controlled to have a constant compression load applied to the target site, while the elasticity change in the target site is changed to the first. , The distance between the second gripping members 8 and 9 is detected. For this reason, it is possible to easily calculate an elasticity index value that is an index of elasticity of the target portion, based on the distance between the first and second gripping members 8 and 9.

(Embodiment 2)
Next, the second embodiment 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.
FIG. 6 is a block diagram showing a configuration of the treatment apparatus 1A according to the second embodiment. FIG. 7 is a flowchart showing an operation method of the treatment apparatus 1A.
In the treatment apparatus 1 according to the first embodiment described above, the first and second gripping members 8 and 9 are controlled to have a constant compression load applied to the target part, while the elastic change in the target part is changed to the first and second. Detection is based on the distance between the second gripping members 8 and 9. Then, the treatment apparatus 1 determines whether or not the state of the target part is the third process P3 based on the distance.
On the other hand, in the treatment apparatus 1A according to the second embodiment, the change in elasticity at the target site is controlled from the target site while the distance between the first and second gripping members 8 and 9A is controlled to be constant. Detected by pressure applied to the first and second gripping members 8 and 9A. Then, the treatment apparatus 1A determines whether or not the state of the target part is the third process P3 based on the pressure.

Specifically, the treatment apparatus 1A employs a second gripping member 9A in which a pressure sensor 93 is added to the second gripping member 9 described in the first embodiment, as shown in FIG. Yes. The second gripping member 9A corresponds to the gripping member according to the present invention.
The pressure sensor 93 is provided between the second jaw 91 and the probe 92 and detects the pressure applied to the probe 92 from the target site. Then, the pressure sensor 93 outputs a signal corresponding to the detected pressure to the control unit 34A.

In addition, as shown in FIG. 6, the treatment apparatus 1A employs a drive unit 10A in which the second sensor 13 is omitted from the drive unit 10 described in the first embodiment.
Furthermore, the treatment apparatus 1A employs a control apparatus 3A equipped with a control unit 34A having a function different from that of the control unit 34 described in the first embodiment. Here, in addition to the impedance calculation unit 341 described in the first embodiment, the control unit 34A includes an index value calculation unit 343A, an operation control unit 344A having an energy control unit 345A and a motor control unit 346A, and a distance calculation. Part 347.
Hereinafter, functions of the index value calculation unit 343A, the energy control unit 345A, the motor control unit 346A, and the distance calculation unit 347 will be described with reference to FIG.

In the operating method of the treatment apparatus 1A according to the second embodiment, as shown in FIG. 7, the steps S2, S3 and S3 are different from the operating method (FIG. 3) of the treatment apparatus 1 described in the first embodiment. Steps S2A, S3A, S5A to S12A are employed instead of S5 to S12, and step S13 is added. Therefore, only steps S2A, S3A, S5A to S12A, and S13 will be described below.

Step S2A is executed after the foot switch 4 is turned on (step S1: Yes).
Specifically, the distance calculation unit 347, like the index value calculation unit 343 described in the first embodiment, is based on the displacement amount detected by the third sensor 14, and the first and second grips. The distance between the members 8 and 9A is calculated. Then, the motor control unit 346A controls the operation of the motor 12 with reference to the distance between the first and second gripping members 8 and 9A calculated by the distance calculation unit 347, thereby controlling the distance to be constant. (Step S2A).
The energy control unit 345A drives the high-frequency energy output unit 31 and starts supplying high-frequency power from the high-frequency energy output unit 31 to the heat transfer plate 821 and the probe 92 (step S3A). That is, in step S3A, no thermal energy is applied to the target part as compared to step S3 described in the first embodiment.

Further, the index value calculation unit 343A starts calculating the elasticity index value based on the pressure detected by the pressure sensor 93 in step S5A. In the second embodiment, after step S2A, the distance between the first and second gripping members 8 and 9A is controlled to be constant. For this reason, as the elasticity in the target part changes, the pressure applied from the target part to the first and second gripping members 8 and 9 also changes. That is, the pressure detected by the pressure sensor 93 corresponds to an elasticity index value that is an index of elasticity of the target part.
In FIG. 7, for convenience of description, steps S2A, S3A, S4, and S5A are sequentially executed. However, in practice, steps S2A, S3A, S4, and S5A are executed substantially simultaneously. is there.

After step S5A, the energy control unit 345A monitors whether or not the elasticity index value has reached the maximum value (step S6A) and the impedance of the target part, as in steps S6 to S9 described in the first embodiment. (Step S7A), whether or not the elasticity index value has decreased at a predetermined reduction rate (step S8A), and the output of the high frequency energy applied to the target site The reduction (step S9A) is sequentially executed.
In step S <b> 10 </ b> A, the energy control unit 345 </ b> A drives the thermal energy output unit 33 and starts energization from the thermal energy output unit 33 to the heat generating sheet 822. That is, since heat energy is not applied to the target part after step S3A, the output of the heat energy is increased after step S10A. Here, in step S10A, as in step S10 described in the first embodiment, the energy control unit 345A outputs the thermal energy output as the decrease rate of the elastic index value after decreasing at the predetermined decrease rate is smaller. The power supplied from the unit 33 to the heat generating sheet 822 is increased.

Further, in step S13, the motor control unit 346A controls the operation of the motor 12 to increase the compression load applied to the target part from the first and second gripping members 8 and 9. As a result, the compressive load applied to the target part from the first and second gripping members 8 and 9 increases after step S13 than before the execution of step S13.
In FIG. 7, for the convenience of explanation, steps S9A, S10A, and S13 are sequentially executed. However, in practice, steps S9A, S10A, and S13 are executed substantially simultaneously.

After step S13, the energy control unit 345A monitors whether or not a predetermined time has passed (step S11A), and stops driving the energy output units 31 and 33 (step S11 and S12). S12A) are executed sequentially.

FIG. 8 is a diagram for explaining an operating method of the treatment apparatus 1A. Specifically, in FIG. 8A, the impedance behavior of the target part after step S2A is indicated by a curve CL1, and the pressure applied to the first and second gripping members 8, 9A from the target part which is an elastic index value. Is shown by a curve CL3. FIG. 8B is a time chart showing the high frequency power supplied from the high frequency energy output unit 31 to the heat transfer plate 821 and the probe 92 after step S2A. FIG. 8C is a time chart showing the electric power supplied from the thermal energy output unit 33 to the heat generating sheet 822 after step S2A. FIG. 8D is a time chart showing the compressive load applied to the target part from the first and second gripping members 8 and 9A after step S2A. In FIG. 8D, for convenience of explanation, the compression load is constant in the time period from the energy application start T ₀ to the time T ₄ . Actually, since the distance between the first and second gripping members 8 and 9A is controlled to be constant after step S2A, the compressive load varies in the time zone.

When application of high-frequency energy to the target part is started in step S3A, the impedance of the target part exhibits the same behavior as that of the first embodiment described above, as indicated by the curve CL1 in FIG.
On the other hand, when application of high-frequency energy to the target part is started in step S3A, the pressure applied from the target part to the first and second gripping members 8 and 9A exhibits the following behavior.
First from the target site, pressure applied to the second gripping member 8,9A, as indicated by the curve CL3 in FIG. 8 (a), the energy imparted start _{T 0} later, gradually increased, the maximum value Pr1 Reach. This is because the elasticity of the target region has increased due to thermal denaturation of the extracellular matrix or the like by applying high frequency energy to the target region. Note that the maximum value Pr1 corresponds to the extreme value according to the present invention. Further, the maximum value Pr1 and since time T ₃ after, the pressure is gradually reduced. This is because the tissue of the target site is gelled. Moreover, the time the impedance becomes minimum value Im1 T ₁ after the target site, the pressure is gradually increased. This is due to the fact that most of the water in the target site has evaporated and the elasticity of the target site has increased. Then, the pressure at time T _4, decreases in the default rate of decrease. That is, the first from the target site, pressure applied to the second gripping member 8,9A at time T _4, decreases at a lower reduction rate than the decrease rate in between times T _{3 ~} time T _4. This is due to the fact that the target part is softened. The predetermined reduction rate corresponds to the predetermined fluctuation rate according to the present invention.

The time zone from the energy application start T ₀ to the time T ₄ described above means that the state of the target part is the first and second processes P1 and P2. The time T ₄ after, it means that the target site conditions are beginning to transition to the third process P3.
Then, in the second embodiment, as shown in FIG. 8 (b), at time _{T 4} (step S8A: Yes), it reduces the output of high-frequency energy to be applied to the target site (step S9A). Further, as shown in FIG. 5 (c) and FIG. 5 (d), the at time _{T 4} (step S8A: Yes), the thermal energy applied to the target site (step S10A), the first and second hold By increasing the compression load applied to the target part from the members 8 and 9A (step S13), the target part is incised while being joined. In steps S10A and S13, the smaller the rate of decrease in the pressure applied to the first and second gripping members 8 and 9A from the target site after the decrease at the predetermined rate, the smaller the amount of heat energy applied to the target site. While increasing the output, the increasing rate of the compressive load applied to the target part from the first and second gripping members 8 and 9A is increased. 8 (a), 8 (c), and 8 (d), the rate of decrease in pressure applied to the first and second gripping members 8 and 9A from the target portion after being decreased at a predetermined rate of decrease. A large case is indicated by a solid line, and a small case is indicated by a one-dot chain line.

As in the second embodiment described above, the distance between the first and second gripping members 8 and 9A is controlled to be constant, and given to the first and second gripping members 8 and 9A from the target portion. Even when it is determined whether or not the state of the target region is the third process P3 based on the applied pressure, the same effects as those of the first embodiment described above can be obtained.
Further, in the treatment apparatus 1A according to the second embodiment, after the elasticity index value reaches the maximum value Pr1, when the elasticity index value decreases at a predetermined decrease rate, the first and second gripping members 8 are used. , 9A, the compression load applied to the target part is increased. For this reason, in the case where the state of the target part is the third process P3, when the incision is performed while joining the target part, the target part is compressed, so that a desired joint strength can be effectively obtained. .
Furthermore, in the treatment apparatus 1A according to the second embodiment, the smaller the decrease rate of the elasticity index value after the elasticity index value decreases at a predetermined decrease rate, the smaller the first and second gripping members 8, 9A. Increase the rate of increase in compressive load applied to the target area. In other words, when the state of the target part is the third process P3, the increase rate of the compressive load is increased as the target part is harder. In other words, any type of living tissue can be incised while obtaining similar joint strength.

(Embodiment 3)
Next, the third embodiment 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.
FIG. 9 is a block diagram showing a configuration of the treatment apparatus 1B according to the third embodiment. FIG. 10 is a flowchart showing an operation method of the treatment apparatus 1B.
In the treatment apparatus 1 according to the first embodiment described above, the first and second gripping members 8 and 9 are controlled to have a constant compression load applied to the target part, while the elastic change in the target part is changed to the first and second. Detection is based on the distance between the second gripping members 8 and 9. Then, the treatment apparatus 1 determines whether or not the state of the target part is the third process P3 based on the distance.
On the other hand, in the treatment apparatus 1B according to the third embodiment, the distance between the first and second gripping members 8 and 9 is controlled to be constant, and the second gripping member 9 is set to a constant amount at a constant period. While oscillating, a change in elasticity in the target region is detected by a control amount necessary for oscillating a certain amount at the certain period. Then, the treatment apparatus 1B determines whether or not the state of the target part is the third process P3 based on the control amount.

Specifically, in the treatment apparatus 1B, as shown in FIG. 9, a drive unit 10B in which a vibration unit 15 and a fourth sensor 16 are added to the drive unit 10A described in the second embodiment is employed. Yes.
The vibration unit 15 is configured using a motor, a piezoelectric element, or the like, and vibrates the second gripping member 9 according to a control amount output from the control unit 34B. Here, as the direction of the vibration, the rotation direction about the central axis along the extending direction of the second gripping member 9, the in-plane direction of the second treatment surface 920, or the second treatment surface 920 is provided. The normal direction and the like can be exemplified.
The fourth sensor 16 is configured using a piezoelectric element or the like, and detects the vibration state of the second gripping member 9. That is, the fourth sensor 16 corresponds to a vibration state detection unit according to the present invention. And the 4th sensor 16 outputs the signal according to the detected vibration state to the control part 34B.

In addition, the treatment apparatus 1B employs a control device 3B equipped with a control unit 34B having a function different from that of the control unit 34A described in the second embodiment. Here, in addition to the impedance calculation unit 341 and the distance calculation unit 347 described in the second embodiment, the control unit 34B includes the index value calculation unit 343B and the operation control unit 344A described in the second embodiment. An operation control unit 344B to which a vibration control unit 348 is added is provided.
Hereinafter, functions of the index value calculation unit 343B and the vibration control unit 348 will be described with reference to FIG.

In the operation method of the treatment apparatus 1B according to the third embodiment, as shown in FIG. 10, instead of the step S5A, the operation method (FIG. 7) of the treatment apparatus 1A described in the second embodiment described above. Step S5B is adopted, step S14 is added, and step S13 is omitted. For this reason, only steps S5B and S14 will be described below.

In step S <b> 14, the vibration control unit 348 controls the operation of the vibration unit 15 while referring to the vibration state detected by the fourth sensor 16, thereby vibrating the second gripping member 9 by a certain amount at a certain period. Control to start. Here, as the fixed amount of vibration in the fixed period, for example, when the target part is grasped in a width of 2 mm, a vibration of 0.02 mm at 1 Hz can be exemplified.

Further, the index value calculation unit 343 starts calculating the elastic index value based on the control amount output from the vibration control unit 348 to the vibration unit 15 in step S5B (step S5B). In the third embodiment, after step S14, the second gripping member 9 is vibrated by a certain amount at a certain period. For this reason, the control amount output from the vibration control unit 348 to the vibration unit 15 also changes as the elasticity in the target region changes. For example, when the elasticity of the target part is high, that is, when the target part is hard, in order to vibrate the second gripping member 9 by a constant amount at a constant period, it is necessary to make the control amount relatively large. is there. On the other hand, when the elasticity of the target part is low, that is, when the target part is soft, a relatively small control amount is sufficient to vibrate the second gripping member 9 by a constant amount at a constant period. That is, the control amount output from the vibration control unit 348 to the vibration unit 15 corresponds to an elasticity index value that is an index of elasticity of the target part. Thereafter, the control device 3B proceeds to step S6A.
In FIG. 10, for convenience of explanation, steps S2A, S3A, S4, S14, and S5B are sequentially executed. However, in practice, steps S2A, S3A, S4, S14, and S5B are executed substantially simultaneously. It is what is done.

FIG. 11 is a diagram for explaining an operating method of the treatment apparatus 1B. Specifically, in FIG. 11A, the behavior of the impedance of the target part after step S2A is indicated by a curve CL1, and the behavior of the controlled variable output from the vibration control unit 348 to the vibration unit 15 as an elastic index value is a curve. This is indicated by CL4. FIG. 11B is a time chart showing high-frequency power supplied from the high-frequency energy output unit 31 to the heat transfer plate 821 and the probe 92 after step S2A. FIG. 11C is a time chart showing the electric power supplied from the thermal energy output unit 33 to the heat generating sheet 822 after step S2A.

When the application of high-frequency energy to the target part is started in step S3A, the impedance of the target part exhibits the same behavior as in the first and second embodiments as shown by the curve CL1 in FIG.
On the other hand, when the application of high-frequency energy to the target part is started in step S3A, the control amount output from the vibration control unit 348 to the vibration unit 15 is the energy application start T as shown by the curve CL4 in FIG. _{After 0,} it gradually increases and reaches a maximum value CV1. This is because the elasticity of the target region has increased due to thermal denaturation of the extracellular matrix or the like by applying high frequency energy to the target region. The maximum value CV1 corresponds to the extreme value according to the present invention. The time became the maximum value CV1 T ₃ later, the control amount is gradually reduced. This is because the tissue of the target site is gelled. Furthermore, the impedance of the target site is the minimum value Im1 and since time T ₁ and later, the control amount is gradually increased. This is due to the fact that most of the water in the target site has evaporated and the elasticity of the target site has increased. Then, the control amount at time T _4, decreases in the default rate of decrease. That is, the control value output to the vibrating section 15 from the vibration control unit 348, at time T _4, decreases at a lower reduction rate than the decrease rate in the time period between time T _{3 ~} time T _4. This is due to the fact that the target part is softened. The predetermined reduction rate corresponds to the predetermined fluctuation rate according to the present invention.

The time zone from the energy application start T ₀ to the time T ₄ described above means that the state of the target part is the first and second processes P1 and P2. The time T ₄ after, it means that the target site conditions are beginning to transition to the third process P3.
Then, in the third embodiment, as shown in FIG. 11 (b), at time _{T 4} (step S8A: Yes), it reduces the output of high-frequency energy to be applied to the target site (step S9A). Further, as shown in FIG. 11 (c), at time _{T 4} (step S8A: Yes), by applying thermal energy (step S10A) the target site, and dissected while joining the target site. In step S10A, the smaller the rate of decrease of the control amount output from the vibration control unit 348 to the vibration unit 15 after the decrease at the predetermined decrease rate, the greater the output of the thermal energy applied to the target site. . In FIG. 11A and FIG. 11C, the case where the rate of decrease of the controlled variable output from the vibration control unit 348 to the vibrating unit 15 after being reduced at the predetermined rate of reduction is shown by a solid line, and the case where it is small is shown. It is indicated by a one-dot chain line.

As in the third embodiment described above, the distance between the first and second gripping members 8 and 9 is controlled to be constant, and the second gripping member 9 is vibrated by a constant amount at a constant period. Even when it is determined whether or not the state of the target portion is the third process P3 based on the control amount necessary to vibrate a constant amount at a constant period, the same as in the first and second embodiments described above The effect of.

(Embodiment 4)
Next, the fourth embodiment 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.
FIG. 12 is a block diagram showing a configuration of the treatment apparatus 1C according to the fourth embodiment. FIG. 13 is a flowchart showing an operation method of the treatment apparatus 1C.
In the treatment apparatus 1 according to Embodiment 1 described above, the impedance of the target part is used to accurately determine whether or not the state of the target part is the third process P3.
On the other hand, in the treatment apparatus 1C according to the fourth embodiment, in order to accurately determine whether or not the state of the target part is the third process P3, the target part is used instead of the impedance of the target part. Use the temperature of.

Specifically, in the treatment apparatus 1C, as shown in FIG. 12, a counter plate 94 and a heat generating sheet 95 are mounted on the second gripping member 9 described in the first embodiment, instead of the probe 92. The second gripping member 9C is employed. The second gripping member 9C corresponds to the gripping member according to the present invention. Hereinafter, in order to identify the heat generating sheets 822 and 95, the heat generating sheet 822 is referred to as a first heat generating sheet 822, and the heat generating sheet 95 is referred to as a second heat generating sheet 95.
The counter plate 94 and the second heat generating sheet 95 have the same configuration as that of the energy applying unit 82, and the second heat generating sheet 95 and the counter plate are disposed on the surface of the second jaw 91 that faces the first gripping member 8. The plates 94 are stacked in this order. The opposing plate 94 comes into contact with the target site when the target site is gripped by the first and second gripping members 8 and 9C.
Here, temperature detection lead wires C3 and C3 ′ (FIG. 12) constituting the electric cable C are joined to both ends of the electric resistance pattern constituting the second heat generating sheet 95, respectively.

Further, in the treatment device 1C, as shown in FIG. 12, the control device 3C in which the thermal energy output unit 35 is mounted instead of the high-frequency energy output unit 31 with respect to the control device 3 described in the first embodiment. Is adopted. Hereinafter, in order to identify the thermal energy output units 33 and 35, the thermal energy output unit 33 is referred to as a first thermal energy output unit 33, and the thermal energy output unit 35 is referred to as a second thermal energy output unit 35. It describes.
The second thermal energy output unit 35 has the same configuration as the first thermal energy output unit 33. The second thermal energy output unit 35 applies a voltage to the second heat generating sheet 95 via the temperature detection lead wires C3 and C3 ′ under the control of the control unit 34C. In addition, the said voltage is a voltage of the grade which does not contribute to the temperature rise of an object part.

Further, in the control device 3C, as shown in FIG. 12, a fifth sensor 36 is employed instead of the first sensor 32 described in the first embodiment.
The fifth sensor 36 detects a voltage value and a current value supplied from the second thermal energy output unit 35 to the second heat generating sheet 95. Then, the fifth sensor 36 outputs a signal corresponding to the detected voltage value and current value to the control unit 34C.

In addition, as shown in FIG. 12, the control device 3C employs a control unit 34C having a function different from that of the control unit 34 described in the first embodiment. Here, in addition to the load calculation unit 342 and the index value calculation unit 343 described in the first embodiment, the control unit 34C includes the energy control unit 345C and the motor control unit 346 described in the first embodiment. An operation control unit 344C and a temperature calculation unit 349.
Hereinafter, functions of the energy control unit 345C and the temperature calculation unit 349 will be described with reference to FIG.

In the operating method of the treatment apparatus 1C according to the fourth embodiment, as shown in FIG. 13, steps S3, S4 and S4 are performed with respect to the operating method (FIG. 3) of the treatment apparatus 1 described in the first embodiment. Steps S3C, S4C, S6C to S8C, and S10C to S12C are employed instead of S6 to S8 and S10 to S12, and step S9 is omitted. Therefore, only steps S3C, S4C, S6C to S8C, and S10C to S12C will be described below.

In step S3C, the energy control unit 345C drives the first thermal energy output unit 33 and starts energization from the first thermal energy output unit 33 to the first heat generating sheet 822. Thereby, application of thermal energy to the target part is started.
Further, the energy control unit 345C drives the second thermal energy output unit 35 and starts energization from the second thermal energy output unit 35 to the second heat generating sheet 95. Here, as described above, the voltage applied to the second heat generating sheet 95 is a voltage that does not contribute to the temperature increase of the target portion. And the temperature calculation part 349 starts the calculation of the temperature of an object site | part in step S4C. The calculation method of the temperature of the target part is executed as follows.
The temperature calculation unit 349 calculates the resistance value of the electrical resistance pattern constituting the second heat generating sheet 95 based on the current value and the voltage value detected by the fifth sensor 36. Further, the temperature calculation unit 349 refers to resistance temperature characteristic information that is stored in a memory (not shown) and indicates the relationship between the resistance value and the temperature in the electric resistance pattern, and converts the calculated resistance value into a temperature. Then, the temperature calculation unit 349 calculates the converted temperature as the temperature of the target part.
In FIG. 13, for the convenience of explanation, steps S2, S3C, S4C, and S5 are sequentially executed. However, actually, steps S2, S3C, S4C, and S5 are executed substantially simultaneously. is there.

After step S5, the energy control unit 345C performs monitoring (step S6C) as to whether or not the elasticity index value has reached the maximum value, similarly to step S6 described in the first embodiment.
When it is determined that the elasticity index value has reached the maximum value (step S6C: Yes), the energy control unit 345C determines whether or not the temperature of the target portion calculated by the temperature calculation unit 349 has reached a predetermined temperature. Monitoring is always performed (step S7C).
When it is determined that the temperature of the target part has reached the predetermined temperature (step S7C: Yes), the energy control unit performs the elasticity index similarly to steps S8 and S10 to S12 described in the first embodiment. Monitoring whether or not the value has decreased at a predetermined reduction rate (step S8C), increase in output of thermal energy applied to the target site (step S10C), monitoring whether or not a predetermined time has passed (step S11C), And stop of the drive of the 1st thermal energy output part 33 (Step S12C) is performed one by one.

FIG. 14 is a diagram for explaining an operating method of the treatment apparatus 1C. Specifically, in FIG. 14A, the behavior of the temperature of the target part after step S2 is indicated by a curve CL5, and the behavior of the distance between the first and second gripping members 8 and 9C, which are elastic index values, is a curve. This is indicated by CL2. FIG. 14B is a time chart showing the power supplied from the first thermal energy output unit 33 to the first heat generating sheet 822 after step S2.

When the application of thermal energy to the target part is started in step S3C, the distance between the first and second gripping members 8 and 9C is the same as that of the first embodiment described above as shown by the curve CL2 in FIG. Shows similar behavior.
On the other hand, when application of thermal energy to the target part is started in step S3C, the temperature of the target part exhibits the following behavior.
Temperature of sites, as shown by curve CL5 in FIG. 14 (a), the energy imparted start _{T 0} later, gradually increased, first, the distance maximum value between the second gripping member 8,9C Gp1 at time _{T 1} became reaches a maximum value Te1. The time became the maximum value Te1 T ₁ and later, the temperature of the target site, after once decreased, the time distance between the first, second gripping member 8,9C decreases the default rate of decrease in T Before ₄ , the temperature Te2 reaches about 200 ° C. The temperature Te2 of about 200 ° C. corresponds to a predetermined temperature according to the present invention. Here, according to the study by the present applicant, it is confirmed that the third process P3 is transferred after the temperature of the target part reaches a predetermined temperature Te2 of about 200 ° C. That is, by determining whether or not the temperature of the target part has reached the predetermined temperature Te2 (step S7C), the elasticity index value is decreased by a predetermined value even though the state of the target part is not the third process P3. Excludes anomalous timing that declines at a rate.

The time zone from the energy application start T ₀ to the time T ₄ described above means that the state of the target part is the first and second processes P1 and P2. The time T ₄ after, it means that the target site conditions are beginning to transition to the third process P3.
Then, in the fourth embodiment, as shown in FIG. 14 (b), at time _{T 4:} by (step S8C Yes) to increase the output of heat energy to be applied to the target site (step S10C), the target An incision is made while joining the parts. In step S10C, the rate of increase in the output of thermal energy applied to the target site increases as the rate of decrease in the distance between the first and second gripping members 8, 9C after decreasing at the predetermined rate of decrease is small. doing. In FIG. 14A and FIG. 14B, the case where the rate of decrease in the distance between the first and second gripping members 8 and 9C after decreasing at the predetermined rate of decrease is shown by a solid line, and the case where it is small is shown. It is indicated by a one-dot chain line.

As in the fourth embodiment described above, the temperature of the target part is used instead of the impedance of the target part in order to accurately determine whether or not the state of the target part is the third process P3. Even if it is a case, there exists an effect similar to Embodiment 1 mentioned above.

(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 Embodiments 1 to 4 described above, heat energy is used as the energy according to the present invention. However, the present invention is not limited to this, and high frequency energy or ultrasonic energy may be used. That is, the present invention includes a configuration that increases the output of high-frequency energy or ultrasonic energy when the state of the target part is the third process P3.

In the first to fourth embodiments described above, when the elasticity index value changes at a predetermined fluctuation rate after the elasticity index value becomes an extreme value, at least one of the output of energy applied to the target site and the compressive load. However, the present invention is not limited to this. For example, when a threshold value of an elasticity index value is provided in order to detect that the state of the target site is the third process P3, and the elasticity index value becomes an extreme value and then falls below the threshold value, the target site It is good also as a structure which increases at least one of the output of the energy provided to and compression load.

In the first to fourth embodiments described above, the energy applying unit according to the present invention is provided only on the first gripping member 8, but the present invention is not limited to this. As long as at least one of thermal energy, high-frequency energy, and ultrasonic energy can be applied to the target site, both the first and second gripping members 8 and 9 (9A and 9C) can be used. You may provide the energy provision part which concerns on invention.

In the first, third, and fourth embodiments described above, when the state of the target part is the third process P3, the compression load applied to the target part from the first and second gripping members 8 and 9 (9A, 9C) You may employ | adopt the structure which increases this. In the first to fourth embodiments described above, when the output of the thermal energy applied to the target part is constant and the state of the target part is the third process P3, the first and second gripping members You may employ | adopt the structure which increases the compressive load given to an object site | part from 8, 9 (9A, 9C).

In Embodiment 2 described above, at time T _4, but to impart thermal energy to a target site, as in Embodiment 1 and 4 of the embodiment described above, from time T ₀ to the target site thermal You may start giving energy. In the first embodiment described above, similarly to the third embodiments described above, it may be adopted a configuration for starting the application of heat energy from the time T ₄ to the target site.

In the above-described third embodiment, the second gripping member 9 is vibrated by a certain amount at a constant period, and a change in elasticity in the target region is detected by a control amount necessary to vibrate the constant amount at the certain period. However, it is not limited to this. For example, a pressure sensor is provided on the first gripping member 8. The pressure sensor detects a pressure at which displacement due to vibration of the second gripping member 9 is transmitted to the first gripping member via the target portion. For example, when the target part is softened, the response of vibration transmission via the target part is worse and the detected pressure is lower than when the target part is hardened. That is, the pressure may be used as the elasticity index value.
In the fourth embodiment described above, as in the second embodiment described above, the change in elasticity at the target site is controlled from the target site while the distance between the first and second gripping members 8 and 9C is controlled to be constant. You may detect with the pressure given to the 1st, 2nd holding members 8 and 9C.

Further, the flow showing the operation method of the treatment devices 1, 1A to 1C is not limited to the order of processing in the flowcharts (FIGS. 3, 7, 10, and 13) described in the first to fourth embodiments. It does not matter if it is changed within a consistent range.

DESCRIPTION OF SYMBOLS 1,1A-1C Treatment apparatus 2 Treatment tool 3, 3A-3C Control apparatus 4 Foot switch 5 Handle 6 Shaft 7 Gripping part 8 1st holding member 9, 9A, 9C 2nd holding member 10, 10A, 10B Drive part DESCRIPTION OF SYMBOLS 11 Opening / closing mechanism 12 Motor 13 2nd sensor 14 3rd sensor 15 Vibration part 16 4th sensor 31 High frequency energy output part 32 1st sensor 33 Thermal energy output part (1st thermal energy output part)
34, 34A to 34C Control unit 35 Second thermal energy output unit 36 Fifth sensor 51 Operation knob 81 First jaw 82 Energy application unit 91 Second jaw 92 Probe 93 Pressure sensor 94 Opposing plate 95 Second heat generation Seat 341 Impedance calculation unit 342 Load calculation unit 343, 343A, 343B Index value calculation unit 344, 344A to 344C Operation control unit 345, 345A, 345C Energy control unit 346, 346A Motor control unit 347 Distance calculation unit 348 Vibration control unit 349 Temperature Calculation unit 811 Shaft support unit 812 Support plate 820 First treatment surface 821 Heat transfer plate 822 Heat generation sheet (first heat generation sheet)
920 Second treatment surface C Electric cable C1, C1 ′ High frequency lead C2, C2 ′ Heat generation lead C3, C3 ′ Temperature detection lead CL1 to CL5 Curve CV1 Maximum value Gp1 Maximum value Im1 Minimum value Im2 Default Impedance P1 First process P2 Second process P3 Third process P4 Fourth process Pr1 Maximum value R1 to R3 Arrow T ₀ to T ₄ hours Te1 Maximum value Te2 Default temperature

Claims (9)

A pair of gripping members for gripping the target site of bonding in the living tissue;
An energy applying unit that is provided on at least one gripping member of the pair of gripping members and applies energy to the target portion;
A control unit for controlling at least one of an output of energy from the energy application unit and a compressive load applied to the target part from the pair of gripping members;
The controller is
After calculating an elasticity index value that is an index of elasticity of the target portion gripped by the pair of gripping members, and after the elasticity index value becomes an extreme value, at least one of the output of the energy and the compression load is calculated. A treatment device that increases more than before reaching the extreme value. The controller is
After the elasticity index value becomes an extreme value, when the elasticity index value fluctuates at a predetermined fluctuation rate, at least one of the energy output and the compression load is increased more than before the extreme value. The treatment device according to claim 1. The controller is
When the impedance of the target part is calculated and the elasticity index value fluctuates at the predetermined fluctuation rate after the impedance of the target part reaches a predetermined impedance, at least the output of the energy and the compression load The treatment apparatus according to claim 2, wherein one is increased from that before the extreme value is reached. The controller is
When the temperature of the target part is calculated and the elasticity index value fluctuates at the predetermined fluctuation rate after the temperature of the target part reaches a predetermined temperature, at least the output of the energy and the compression load The treatment apparatus according to claim 2, wherein one is increased from that before the extreme value is reached. The controller is
The increase rate of at least one of the output of the energy and the compressive load is increased as the change rate of the elasticity indicator value after the change of the elasticity indicator value at the predetermined change rate is smaller. The treatment device according to any one of the above. The controller is
6. The compression load is calculated, the compression load is controlled to be constant based on the calculation result of the compression load, and the distance between the pair of gripping members is calculated as the elasticity index value. The treatment device according to one. The controller is
The distance between the pair of gripping members is calculated, the distance is controlled to be constant based on the calculation result of the distance, and the pressure applied from the target part to the pair of gripping members is calculated as the elasticity index value. The treatment device according to any one of claims 1 to 5. A vibration unit that vibrates one gripping member of the pair of gripping members according to a control amount output from the control unit;
A vibration state detection unit that detects a vibration state of the one gripping member;
The controller is
Based on the detection result by the vibration state detection unit, the control amount for vibrating the one gripping member by a constant amount at a constant period is output to the vibration unit, and the output control amount is calculated as the elasticity index value. The treatment device according to any one of claims 1 to 5. An operation method of a treatment apparatus provided with a pair of grasping members for grasping a target site of bonding in a living tissue,
After the target site is gripped by the pair of gripping members, applying energy to the target site from at least one gripping member of the pair of gripping members;
Calculating an elasticity index value that is an index of elasticity of the target region;
After the elasticity index value becomes an extreme value, at least one of the output of energy applied to the target site and the compressive load applied to the target site from the pair of gripping members is more than before the extreme value. And a method for operating the treatment device.

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