WO2019123520A1 - Control device and treatment system - Google Patents

Abstract

In the present invention, a high-frequency control unit outputs, to an end effector, first electric energy with a voltage waveform for generating discharge from the end effector. In a state where the first electric energy is outputted with the voltage waveform for generating the discharge, by control of the output of second electric energy to an ultrasonic transducer, a signal control unit performs control for oscillating the end effector with an oscillation frequency and an amplitude at which the end effector is not brought into contact with a to-be-treated object, thereby concentrating the discharge from the end effector in the traveling direction of the end effector.

Description

Control device and treatment system

The present invention relates to a control device used together with a treatment tool, and a treatment system including the control device.

US2013 / 0123820A1 discloses a treatment tool including an end effector and an ultrasonic transducer, and a treatment system including a return electrode separate from the treatment tool. In the treatment using this treatment system, the first electric energy (high frequency power) is supplied to the end effector and the return electrode, and at the same time the second electric energy is supplied to the ultrasonic transducer as a drive signal. Then, the end effector is brought into contact with a treatment target such as a living tissue. At this time, by supplying the first electrical energy to the end effector and the return electrode, a high frequency voltage is applied between the end effector and the return electrode, and a high frequency current is applied to the treatment target. Further, by supplying the second electric energy to the ultrasonic transducer, ultrasonic vibration is generated by the ultrasonic transducer, and the generated ultrasonic vibration is transmitted to the end effector. Then, in the state where the end effector vibrates by ultrasonic vibration, the treatment object is cut at the same time as coagulation by applying a high frequency current from the end effector to the treatment object.

As in US2013 / 0123820A1, in the treatment of applying a high frequency current to the treatment subject while vibrating the end effector by ultrasonic vibration and incising the treatment subject simultaneously with coagulation, the incision site is uniformly coagulated, and It is required that the heat invasion from the incised site to the surrounding site is reduced in the tissue.

The object of the present invention is to apply a high-frequency current to the treatment subject while vibrating the end effector, and in the treatment to incise the treatment subject simultaneously with coagulation, the incision site is uniformly coagulated and the incision site It is an object of the present invention to provide a control device and a treatment system in which heat invasion from the patient to the surrounding area is reduced.

In order to achieve the above object, according to an aspect of the present invention, there is provided an end effector to which a high frequency voltage is applied between a first electrode and a return electrode by supplying a first electric energy, and a second electric energy as a drive signal. A control device including: an ultrasonic transducer that generates ultrasonic vibration and transmits the generated ultrasonic vibration to the end effector by being supplied; A high-frequency control unit that causes the end effector to output the first electrical energy in a voltage waveform that generates a discharge from the treatment target, and a state in which the first electrical energy is output in the voltage waveform that generates the discharge Control of the output of the second electrical energy to the ultrasonic transducer to By controlling vibrating the end effector amplitude and frequency of vibration does not contact the motor, and a signal control unit for concentrating the traveling direction of the end effector of the discharge from the end effector.

FIG. 1 is a schematic view showing a treatment system according to the first embodiment. FIG. 2 is a block diagram schematically showing a configuration for supplying electrical energy to the treatment device according to the first embodiment. FIG. 3 is a schematic diagram showing an example of voltage waveforms of output voltages to the end effector and the return electrode in the first embodiment. FIG. 4 is a flowchart showing processing performed by the processor in controlling output of electrical energy to the treatment tool in the first embodiment. FIG. 5 is a schematic view showing an example of treatment in which an end effector according to the first embodiment is vibrated by ultrasonic vibration and the treatment object is cut simultaneously with coagulation by discharge from the end effector. FIG. 6 is a schematic view showing a system in which the amount of sticking of the treatment target to the end effector, the amount of force acting on the end effector from the treatment target, and the range where the discharge occurs are verified. FIG. 7 is a diagram showing an example of measurement results in verification of the adhesion amount to the end effector and the average load acting on the housing. FIG. 8A is a view showing an example of the calculation result in the verification of the discharge area from the end effector. FIG. 8B is a diagram showing an example of an image generated by superimposing images taken at a plurality of times from the start of the incision of the treatment target to the end in the verification. FIG. 9 is a diagram illustrating an example of a detection result in verification of a change with time in impedance of the electrical path of the first electrical energy. FIG. 10 is a diagram showing an example of measurement results in verification of time until discharge occurs from the end effector. FIG. 11 is a flowchart showing processing performed by the processor in controlling output of electrical energy to the treatment tool in the first modification. FIG. 12 is a flowchart showing processing performed by the processor in controlling output of electrical energy to the treatment tool in the second modification.

First Embodiment
A first embodiment of the present invention will be described with reference to FIGS. 1 to 5.

FIG. 1 is a view showing a treatment system 1 of the present embodiment. As shown in FIG. 1, the treatment system 1 includes a treatment tool 2 and a power supply 3. The treatment tool 2 includes a cylindrical shaft 4, a holdable housing 5, and an end effector 6. The housing 5 is connected to one side of the shaft 4 in a direction along the central axis of the shaft 4. Further, in the present embodiment, the central axis of the housing 5 is coaxial or substantially coaxial with the central axis of the shaft 4. Here, the side where the housing 5 is positioned with respect to the shaft 4 in the direction along the central axis of the shaft 4 is taken as the proximal side, and the side opposite to the proximal side is taken as the distal side. One end of the cable 7 is connected to the proximal end of the housing 5. The other end of the cable 7 is detachably connected to the power supply 3.

Further, in the treatment tool 2, the rod member 8 is extended from the inside of the housing 5 through the inside of the shaft 4 toward the distal end side. The end effector 6 is formed of a portion of the rod member 8. In the present embodiment, the rod member 8 projects from the distal end of the shaft 4 to the distal end side, and the end effector 6 is formed by the projecting portion from the shaft 4 in the rod member 8. In the present embodiment, the rod member 8 is formed of a material having high vibration transferability, such as a titanium alloy. In addition, the end effector 6 has conductivity. The end effector 6 is formed into an appropriate shape, and can use a high-frequency current as treatment energy to cut and solidify a treatment target such as a living tissue.

The housing 5 is provided with an operation button 11 as an operation member. The operation button 11 can input an operation of supplying electric energy to the treatment instrument 2 as described later. In one embodiment, a foot switch or the like separate from the treatment tool 2 can input an operation for supplying electric energy to the treatment tool 2 in place of the operation button 11 or in addition to the operation button 11 It may be provided as an operation member. Further, the treatment system 1 is provided with a return electrode 12 separate from the treatment instrument 2. The return electrode plate 12 is separably connected to the power supply 3 via the cable 13.

FIG. 2 is a diagram showing a configuration for supplying electrical energy to the treatment instrument 2. As shown in FIG. 2, the power supply device 3 includes a processor (controller) 15 and a storage medium 16. The processor 15 is formed of an integrated circuit or circuitry including a central processing unit (CPU), an application specific integrated circuit (ASIC) or a field programmable gate array (FPGA). Only one processor 15 may be provided in the power supply 3, or a plurality of processors 15 may be provided in the power supply 3. In the present embodiment, the processor 15 constitutes at least a part of a control device that controls the treatment system 1. The processing in the processor 15 is performed in accordance with a program stored in the processor 15 or the storage medium 16. The storage medium 16 stores a processing program used by the processor 15 and parameters, functions, tables, and the like used in operations of the processor 15.

The processor 15 determines whether an operation input is performed with the operation button (operation member) 11, that is, whether the operation input with the operation button 11 is ON or OFF. In one embodiment, a switch (not shown) corresponding to the operation button 11 is provided inside the housing 5, and the switch is switched between ON and OFF corresponding to the operation of the operation button 11. The processor 15 determines whether an operation input is performed with the operation button 11 based on whether the switch is ON or OFF.

The power supply device 3 includes an output source (high frequency output source) 21. The output source (high frequency power supply) 21 includes a waveform generator, a conversion circuit, a relay circuit, a transformer, and the like to form a drive circuit (high frequency drive circuit). The output source 21 can convert power from a battery power source or a wall outlet power source into high frequency power (high frequency electrical energy), which is first electrical energy, and can output the first electrical energy. The power source 21 is electrically connected to the end effector 6 via the electrical path 22 and is also electrically connected to the return electrode 12 via the electrical path 23. The electrical path 22 extends, for example, through the interior of the cable 7 and the electrical path 23 extends, for example, through the interior of the cable 13.

The first electrical energy output from the output source 21 is supplied to the end effector 6 and the return electrode 12 via the electrical paths 22 and 23. By supplying the first electrical energy (high frequency power) to the end effector 6 and the return electrode plate 12, a high frequency voltage (voltage) is applied between the end effector 6 and the return electrode plate 12, and the end effector 6 and the return electrode plate 12 functions as an electrode. As a result, it becomes possible to flow a high frequency current between the end effector 6 and the return electrode plate 12, and it becomes possible to apply a high frequency current to a living tissue or the like. The processor 15 includes a high frequency control unit 28, and the processor 15 functions as the high frequency control unit 28. When the operation input is performed by the operation button 11, the high frequency control unit 28 controls the output from the output source 21 and controls the supply of the first electrical energy to the end effector 6 and the return electrode plate 12. The return electrode plate 12 has a much larger surface area than the end effector 6. Therefore, in the state where the high frequency current is applied to the treatment target, the current density of the high frequency current becomes high between the end effector 6 and the treatment target, and the high frequency current is concentrated between the end effector 6 and the treatment target. Then, the return electrode plate 12 serves as a return electrode for recovering the high frequency current applied to the treatment target.

Further, the power supply device 3 is provided with a current detection circuit 25, a voltage detection circuit 26, and an A / D converter 27. The current detection circuit 25 detects the output current I from the output source 21 to the end effector 6 and the return electrode plate 12, and the voltage detection circuit 26 detects the output voltage V to the end effector 6 and the return electrode plate 12. The A / D converter 27 digital-signals an analog signal indicating the current value of the output current I detected by the current detection circuit 25 and an analog signal indicating the voltage value of the output voltage V detected by the voltage detection circuit 26. And transmit the converted digital signal to the processor 15. Thus, the processor 15 obtains information on the output current I and the output voltage V from the output source 21.

The processor 15 also determines the impedance Z of the circuit through which the high frequency current (output current I) flows, that is, the impedance Z of the electrical path of the first electrical energy, based on the output current I and the output voltage V from the output source 21. ,calculate. The impedance Z changes corresponding to the impedance between the end effector 6 and the return electrode 12. In one embodiment, processor 15 calculates output power P from output source 21 based on output current I and output voltage V from output source 21. The high frequency control unit 28 of the processor 15 controls the output of the first electric energy from the output source 21 to the end effector 6 and the return electrode plate 12 based on the output current I, the output voltage V, the impedance Z, the output power P, etc. Do.

The treatment instrument 2 is provided with an ultrasonic transducer 18. The ultrasonic transducer 18 is connected to the rod member 8 inside the housing 5. Further, the power supply device 3 includes an output source (signal output source) 31. The output source (ultrasonic power source) 31 includes a waveform generator, a conversion circuit, a relay circuit, a transformer, and the like to form a drive circuit (ultrasonic drive circuit). The output source 31 can convert power from a battery power source or a wall outlet power source into second electrical energy different from the first electrical energy, and can output second electrical energy. The output source 31 is connected to the ultrasonic transducer 18 via the electrical paths 32 and 33. Each of the electrical paths 32, 33 extends, for example, through the interior of the cable 7.

The second electrical energy output from the output source 31 is supplied to the ultrasonic transducer 18 via the electrical paths 32 and 33. That is, a drive signal for driving the ultrasonic transducer 18 is supplied to the ultrasonic transducer 18 as second electric energy. At this time, AC power of a frequency with a predetermined frequency range is supplied to the ultrasonic transducer 18 as the second electric energy. The processor 15 includes a signal control unit 38, and the processor 15 functions as the signal control unit 38. When the operation input is performed by the operation button 11, the signal control unit 38 controls the output from the output source 31 and controls the supply of the second electric energy to the ultrasonic transducer 18.

By supplying the second electric energy (AC power) to the ultrasonic transducer 18, the ultrasonic transducer 18 converts the electric energy into vibration energy by a piezoelectric element (not shown) or the like, and the ultrasonic vibration is obtained. Generate The ultrasonic vibration generated by the ultrasonic transducer 18 is transmitted to the end effector 6 via the rod member 8. By transmitting the ultrasonic vibration to the end effector 6, the end effector 6 vibrates. At this time, the rod member 8 including the end effector 6 vibrates at a vibration frequency having a predetermined frequency range, and in the present embodiment, the vibration direction of the rod member 8 is parallel or substantially parallel to the central axis of the shaft 4 Become.

Further, the power supply device 3 is provided with a current detection circuit 35, a voltage detection circuit 36, and an A / D converter 37. The current detection circuit 35 detects an output current I ′ from the output source 31 to the ultrasonic transducer 18, and the voltage detection circuit 36 detects an output voltage V ′ to the ultrasonic transducer 18. The A / D converter 37 includes an analog signal indicating the current value of the output current I ′ detected by the current detection circuit 35 and an analog signal indicating the voltage value of the output voltage V ′ detected by the voltage detection circuit 36. The digital signal is converted, and the converted digital signal is transmitted to the processor 15. Thus, the processor 15 obtains information on the output current I ′ and the output voltage V ′ from the output source 31.

Also, the processor 15 generates an impedance Z ′ of a circuit through which the output current I ′ flows based on the output current I ′ and the output voltage V ′ from the output source 31, that is, an impedance Z ′ of the electrical path of the second electrical energy. Calculate The impedance Z ′ changes corresponding to the impedance of the ultrasonic transducer 18. The impedance of the ultrasonic transducer 18 changes corresponding to the load acting on the vibrator including the ultrasonic transducer 18 and the rod member 8, and changes corresponding to the amount of force acting on the end effector 6 from the treatment object etc. . Therefore, the impedance Z ′ changes in response to the load acting on the vibrator and the amount of force acting on the end effector 6.

Further, the processor 15 calculates the output power P ′ from the output source 31 based on the output current I ′ and the output voltage V ′ from the output source 31. The signal control unit 38 of the processor 15 outputs the second electric energy from the output source 41 to the ultrasonic transducer 18 based on the output current I ′, the output voltage V ′, the impedance Z ′, the output power P ′, and the like. Control. In one embodiment, the signal control unit 38 performs PLL control (Phase Locked Loop control) in a state where the phase difference between the output current I ′ and the output voltage V ′ disappears.

Further, in the present embodiment, the touch screen 17 is provided in the power supply device 3. The touch screen 17 functions as, for example, an input unit that can input settings related to the output from each of the output sources 21 and 31, such as the output level of each of the output sources 21 and 31. The touch screen 17 also outputs, for example, the output current I from the output source 21 and the output voltage V, and the output current I ′ from the output source 31 and the output from the output sources 21 and 31 such as the output voltage V ′. It also functions as a display unit that displays information related to

Next, the control device formed of the processor 15 of the present embodiment and the operation and effects of the treatment system 1 will be described. The treatment system 1 of the present embodiment is used, for example, for treatment in which a solid organ such as a liver is cut at the same time as coagulation as a treatment target. When performing treatment using the treatment system 1, the operator places the return electrode plate 12 on a subject such as a human body and holds the housing 5. Then, the end effector 6 is inserted into a body cavity such as the abdominal cavity, and the end effector 6 is brought close to the living tissue to be treated. Then, in a state in which the end effector 6 is in proximity to the living tissue, an operation input is performed on the operation button 9. When the operation input on the operation button 9 is turned on, the processor 15 causes the power supply device 3 to output electrical energy as described later. Then, in a state where electric energy is output from the power supply device 3, the operator performs treatment while moving the end effector 6 close to the treatment target. At this time, the operator moves the end effector 6 in the direction intersecting with the central axis of the shaft 4 or moves it to the distal end side. In the treatment, after switching the operation input on the operation button 9 to ON, the operator may cause the end effector 6 to approach the living tissue.

When the operation input at the operation button 9 is turned on, the high frequency control unit 28 of the processor 15 outputs the first electric energy to the end effector 6 and the return electrode plate 12 with a voltage waveform that satisfies the conditions described later. Thus, a high frequency voltage is applied between the end effector 6 and the return electrode plate 12. Further, when the operation input on the operation button 9 is turned on, the signal control unit 38 of the processor 15 causes the ultrasonic transducer 18 to output the second electric energy as a drive signal. As a result, ultrasonic vibration is generated by the ultrasonic transducer 18, and the generated ultrasonic vibration is transmitted to the end effector 6. As described above, the high-frequency voltage is applied between the end effector 6 and the return electrode plate 12, and the ultrasonic vibration is transmitted to the end effector 6, thereby vibrating the end effector 6. A high frequency current is given as treatment energy from 6 to the treatment subject. That is, the treatment for applying the high frequency current to the treatment target is performed while vibrating the end effector 6.

FIG. 3 shows an example of the voltage waveform of the output voltage V to the end effector 6 and the return electrode plate 12. In FIG. 3, the horizontal axis indicates time t based on the start of output of the first electrical energy, and the vertical axis indicates the output voltage V. In the example of FIG. 3, the first electrical energy is output intermittently with time, and the first electrical energy is output intermittently. Therefore, the voltage waveform of the output voltage V is a burst wave. Further, in the voltage waveform, the crest factor (CF) of the output voltage V is 5 or more. Here, the crest factor is a value obtained by dividing the maximum value (peak value) of the output voltage V by the effective value (RMS) of the output voltage V. Further, when intermittent output of the first electric energy is performed as in the example of FIG. 3, in the calculation of the crest factor of the voltage waveform, the output voltage throughout the period in which the output is performed and the period in which the output is not performed The effective value of V is used.

When the first electric energy is output to the end effector 6 and the return electrode plate 12 in a voltage waveform having a crest factor of 5 or more, predetermined conditions such as the impedance between the end effector 6 and the return electrode plate 12 becoming high to some extent By filling, it is understood that discharge occurs between the end effector 6 and the living tissue. Therefore, the high frequency control unit 28 causes the end effector 6 and the return electrode plate 12 to output the first electric energy with a voltage waveform that generates a discharge from the end effector 6 to the treatment target. The voltage waveform of the output voltage V does not have to be a burst wave shown in the figure, and may be a continuous wave as long as the crest factor is 5 or more. In this case, the first electrical energy is output to the end effector 6 and the return electrode plate 12 continuously over time. Also, in one embodiment, the output power P to the end effector 6 and the return electrode plate 12 is about 30 W to 70 W.

Further, in the present embodiment, the signal control unit 38 of the processor 15 adjusts the frequency of the output of the second electrical energy so that the vibration frequency f of the end effector 6 falls within the predetermined frequency range. In one embodiment, the frequency at the output of the second electrical energy is adjusted such that the end effector 6 vibrates at a certain oscillation frequency f of 45 kHz to 49 kHz. Further, in the present embodiment, the frequency at the output of the second electrical energy is controlled such that the vibration frequency f of the end effector 6 is maintained within a predetermined frequency range with time. In one embodiment, the frequency at the output of the second electrical energy is controlled such that the vibration frequency f of the end effector 6 is maintained constant or substantially constant with time around 47 kHz.

In one embodiment, the signal control unit 38 controls the output of the second electrical energy by, for example, constant current control that makes the current value of the output current I ′ constant or substantially constant with time. In constant current control, a detection signal for the output current I ′ detected by the current detection circuit 35 is A / D converted by the A / D converter 37 and transmitted to the processor 15 including a CPU or an FPGA. In the touch screen 17 or the like, the operator selects an output setting, and the processor 15 sets a target value I′ref for achieving the selected output setting for the current value of the output current I ′. Then, the processor 15 compares the detection signal from the current detection circuit 35 with the signal indicating the set target value I′ref, and controls the output current I ′ to a state in which it matches the set target value I′ref. Here, the amplitude including the full amplitude A and the half amplitude of the end effector 6 due to the ultrasonic vibration changes corresponding to the magnitude of the output current I ′, and the larger the output current I ′, the more the amplitude of the end effector 6 large. Therefore, when constant current control is performed on the output of the second electrical energy, the amplitude including the full amplitude A and the half amplitude of the end effector 6 is maintained constant or substantially constant with time. Here, the total amplitude A is a value from the peak value of the vibration to the peak value, and the half amplitude is a value from the central value of the vibration to the peak value. Then, the total amplitude A is twice as large as one amplitude. Further, the vibration velocity は of the end effector 6 due to ultrasonic vibration changes corresponding to the product of the amplitude of the end effector 6 and the vibration frequency f, and the larger the product of the amplitude of the end effector 6 and the vibration frequency f, Vibration speed ν is large. Therefore, when constant current control is performed on the output of the second electrical energy and the vibration frequency f of the end effector 6 is maintained constant or substantially constant with time, the vibration velocity ν of the end effector 6 is It is kept consistent or substantially constant over time.

Further, in the present embodiment, the signal control unit 38 controls the output of the second electrical energy to obtain the product of the total amplitude A and the vibration frequency f in the end effector 6, and in the present embodiment, the end effector 6 The product of the total amplitude and the vibration frequency at the vibrating tip of the tip of the tip is 2.4 m (meter) · Hz (hertz) or more. Here, when the vibration frequency f of the end effector 6 due to ultrasonic vibration is 47 kHz, the total amplitude A is 50 μm or more (that is, the half amplitude is 25 μm or more) in order to make the product 2.4 m · Hz or more. There is a need to. In one embodiment, the vibration frequency f is maintained constant or substantially constant with time at about 47 kHz, and the total amplitude A of the end effector 6 is maintained constant or substantially constant with a target total amplitude Aref of 50 μm or more To control the output of the second electrical energy. In this case, the target value I'ref of the current value of the output current I 'corresponding to the target full amplitude Aref is set, and the current value of the output current I' is made constant or substantially constant with the set target value I'ref. Constant current control is performed to maintain a constant.

From the viewpoint of the strength and the like of the rod member 8, it is preferable that the vibration velocity は of the end effector 6 is not excessively high. Therefore, the product of the total amplitude A and the vibration frequency f in the end effector 6 is preferably 7.1 mHz or less, and more preferably 5.6 mHz. For this reason, in the embodiment in which the vibration frequency f is maintained at approximately 47 kHz with a constant or substantially constant over time, the total amplitude A of the end effector 6 is constant or substantially constant with time at a target total amplitude Aref of 50 μm to 150 μm. Preferably, the output of the second electrical energy is controlled while being maintained at. Then, it is more preferable that the output of the second electrical energy be controlled in a state where the total amplitude A of the end effector 6 is maintained constant or substantially constant with time at a target total amplitude Aref of 50 μm to 120 μm.

FIG. 4 is a flowchart showing processing performed by the processor 15 in controlling the output of electrical energy to the treatment tool 2. As shown in FIG. 4, the processor 15 determines whether or not an operation has been input using an operation member such as the operation button 11, that is, whether the operation input on the operation member is ON or OFF (S 101). If an operation has not been input (S101-No), the process returns to S101. That is, the processor 15 stands by until an operation to supply the electrical energy to the treatment device 2 is input. When the operation is input by the operation member (S101-Yes), the high frequency control unit 28 of the processor 15 starts the output of the first electric energy, that is, the HF (high-frequency) output (S102). Further, the signal control unit 38 of the processor 15 starts the output of the second electric energy, that is, the signal output (S103).

When the output of the first electrical energy is started, the high frequency controller 28 outputs the first electrical energy with a voltage waveform having a crest factor of 5 or more (CF ≧ 5) (S104). In addition, when the output of the second electrical energy is started, the signal control unit 38 determines that the product (A · f) of the total amplitude A and the vibration frequency f in the end effector 6 becomes 2.4 m · Hz or more In the state, control the output of the second electrical energy. (S105). At this time, in one embodiment, when the output of the second electrical energy is started, the signal control unit 38 sets a target for achieving the output setting selected on the touch screen 17 or the like for the current value of the output current I ′. Set the value I'ref. Then, the output of the second electric energy is controlled by the above-described constant current control in which the current value of the output current I 'is maintained constant or substantially constant with time with the set target value I'ref. For example, when the vibration frequency f of the end effector 6 is maintained over time at about 47 kHz, the total amplitude A of the end effector 6 becomes constant or substantially constant over time at a target total amplitude Aref of 50 μm or more. The target value I'ref for the current value of the output current I 'is set, and the above-described constant current control is performed.

Then, the processor 15 determines whether the operation input with the operation button 11 or the like is stopped, that is, whether the operation input with the operation button 11 is switched from ON to OFF (S106). When the operation input is stopped (S106-Yes), the high frequency control unit 28 stops the output of the first electric energy (HF output) (S107). Then, the signal control unit 38 stops the output (signal output) of the second electrical energy (S108). On the other hand, when the operation input with the operation button 11 is continued (S106-No), the process returns to S104, and the processes after S104 are sequentially performed. Therefore, the output control of the first electric energy described above and the output control of the second electric energy described above are continued.

Since the processing as described above is performed by the processor 15, in the present embodiment, in the state where the treatment is performed, the product of the total amplitude A and the vibration frequency f is 2.4 m · Hz or more. Vibrate at the vibration velocity な る, and apply a high frequency current to the treatment object. Here, the impedance between the end effector 6 and the return electrode 12 at the start of and immediately after the start of the output of the first electrical energy, ie, at the start of application of the high frequency current to the treatment object and immediately thereafter, ie, the The impedance Z of the electrical path of electrical energy of 1 is low. For this reason, even if the first electrical energy is output with a voltage waveform having a crest factor of 5 or more, discharge from the end effector 6 to the treatment target is less likely to occur. Therefore, while the impedance Z is low, the high frequency current applied from the end effector 6 flows through the treatment object, and the treatment object is cut at the same time as coagulation due to Joule heat caused by the high frequency current.

Then, when a while has passed from the start of the output of the first electric energy, that is, the start of the application of the high frequency current to the treatment target, the impedance Z starts to increase with time. Then, when the impedance Z rises to a certain degree, the first electric energy is output with a voltage waveform with a crest factor of 5 or more, so that a discharge is generated from the end effector 6 toward the treatment target, and the discharge is treated by the discharge. A high frequency current is applied. Therefore, when the impedance Z rises to a certain degree, the discharge cauterizes the treatment subject, and the treatment subject is incised simultaneously with coagulation.

Further, in the present embodiment, as described above, the output of the second electrical energy is controlled such that the product of the total amplitude A and the vibration frequency f in the end effector 6 is 2.4 m · Hz or more. . Here, in a state in which the high-frequency current is applied from the end effector 6 to the treatment target, when the product of the total amplitude A and the vibration frequency f in the end effector 6 is 2.4 m · Hz or more, the end effector by the operator Although depending on the progressing speed of 6, it is understood that it becomes difficult for the end effector 6 to abut on the treatment object. That is, when the vibration speed of the end effector 6 increases until the product of the total amplitude A and the vibration frequency f in the end effector 6 becomes 2.4 m · Hz or more, the amount of force hardly acts on the end effector 6 from the treatment target It is understood that. Therefore, in the present embodiment, the signal control unit 38 of the processor 15 controls the output of the second electrical energy in the state where the first electrical energy is output in the above-described voltage waveform, thereby making the treatment target. Control is performed to vibrate the end effector 6 with an amplitude (full amplitude A) and an oscillation frequency f that do not cause the end effector 6 to abut. In addition, in the state where the above-mentioned control in which the end effector 6 is not brought into contact with the treatment object with respect to the vibration of the end effector 6 is performed, the end effector 6 is not always in contact with the treatment object. That is, even in the state where the above-described control is performed in which the end effector 6 is not in contact with the treatment target, the end effector 6 periodically contacts the treatment target (tissue) by ultrasonic vibration. However, since the contact of the end effector 6 with the treatment object is instantaneous, it is understood that the end effector 6 hardly contacts the treatment object. Therefore, it is understood that the amount of force acting on the end effector 6 becomes zero or almost zero.

FIG. 5 illustrates an example of treatment in which the end effector 6 is vibrated by ultrasonic vibration and the discharge from the end effector 6 simultaneously incises the treatment target 50 at the same time as coagulation. In the example of FIG. 5, the treatment is performed by the operator while moving the end effector 6 in the direction of the arrow X1. That is, in the example of FIG. 5, the traveling direction of the end effector 6 intersects (perpendicularly or substantially perpendicular) to the central axis of the shaft 4 and intersects (perpendicular or approximately) to the vibration direction of the end effector 6 Vertical).

As shown in FIG. 5, when performing dissection simultaneously with coagulation of the treatment target 50 by discharge from the end effector 6 while moving the end effector 6, in the opposite side to the advancing direction with respect to the end effector 6 The treatment target 50 has already been cauterized by electric discharge, and has already been coagulated and cut in the region located and in the region adjacent to both sides of the end effector 6 in the direction crossing (perpendicular or nearly perpendicular) to the advancing direction . Therefore, in the region opposite to the advancing direction with respect to the end effector 6 and in the region adjacent to both sides of the end effector 6 with respect to the direction crossing the advancing direction, the coagulation layer 51 Exposed to the surface. Therefore, in the region opposite to the direction of movement with respect to the end effector 6, and in the region adjacent to both sides of the end effector 6 with respect to the direction crossing the direction of movement, the non-cauterized portion 52 is not cauterized , And is not exposed to the surface of the treatment target 50. Further, in the region positioned on the side of the direction of movement with respect to the end effector 6, the non-cauterized non-cautery portion 52 is exposed on the surface of the treatment target 50.

Further, in the present embodiment, since the output of the second electrical energy is controlled so that the product of the total amplitude A and the vibration frequency f in the end effector 6 is 2.4 m · Hz or more, as described above It is understood that the end effector 6 does not abut or hardly abuts on the treatment target 50. Therefore, it is understood that the amount of force acting on the end effector 6 is zero or almost zero. When the end effector 6 abuts or hardly abuts on the treatment target 50, an area located on the opposite side to the advancing direction with respect to the end effector 6 and an end in a direction intersecting the advancing direction In the regions adjacent to both sides of the effector 6, sticking of the coagulation layer 51 of the treatment target 50 to the end effector 6 is prevented, and peeling of the coagulation layer 51 is prevented. Therefore, in the region opposite to the advancing direction with respect to the end effector 6 and in the region adjacent to both sides of the end effector 6 with respect to the direction intersecting with the advancing direction, Exposure is prevented.

Here, in the treatment target 50, the solidified layer 51 cauterized by the electric discharge has a higher electrical impedance than the non-cauterized portion 52 not cauterized. In addition, the discharge from the end effector 6 tends to occur toward the point where the impedance is low. Therefore, in the end effector 6, discharge tends to occur toward the non-cautery portion 52 as compared to the solidified layer 51. In the present embodiment, since the treatment is performed as described above, the non-cautery portion 52 of the treatment target 50 is exposed only in the region located on the side of the movement direction of the end effector 6. The coagulation layer 51 of the treatment target 50 is exposed in the area opposite to the advancing direction with respect to the end effector 6 and in the area adjacent to both sides of the end effector 6 with respect to the direction intersecting the advancing direction. Do. Therefore, the discharge from the end effector 6 is concentrated in the traveling direction, and the discharge from the end effector 6 is less likely to occur in the direction opposite to the traveling direction and in the direction intersecting the traveling direction.

By the discharge from the end effector 6 being concentrated in the traveling direction, in the treatment target 50, the region located on the traveling direction side with respect to the end effector 6 is appropriately cut by the discharge. In addition, since the discharge from the end effector 6 in the direction opposite to the traveling direction and in the direction intersecting the traveling direction is less likely to occur, the incised region of the treatment target 50 is the end effector 6 The cautery is cauterized only once at the time of dissection by discharge in the forward direction. That is, at the incised site of the treatment target 50, it is effectively prevented that the same site is cauterized a plurality of times by the discharge. Thereby, the coagulation layer 51 is uniformly formed on the surface of the treatment target 50 at the site cut by the discharge. Therefore, the incision site of the treatment target 50 is appropriately coagulated and appropriately stopped. In addition, since it becomes difficult for the discharge from the end effector 6 in the direction opposite to the traveling direction and in the direction intersecting the traveling direction to occur, the heat invasion from the incised site to the peripheral site is reduced. Be done.

Further, in the present embodiment, as described above, the high-frequency current is applied from the end effector 6 to the treatment target in a state where the product of the total amplitude A and the vibration frequency f in the end effector 6 is 2.4 m · Hz or more. Be done. Since the end effector 6 vibrates as described above, the time from the start of application of the high frequency current to the treatment target until the impedance Z rises to such an extent that a discharge occurs is shortened. As a result, the time from the start of application of the high-frequency current to the treatment target until the discharge occurs becomes short. By shortening the time until the discharge occurs, the heat invasion due to Joule heat from the incision site to the surrounding site is reduced.

In the present embodiment, by controlling the outputs of the first electric energy and the second electric energy as described above, the high-frequency current is applied to the treatment target while vibrating the end effector 6, and the treatment target is coagulated. In the simultaneous incision procedure, the incision site is uniformly solidified, and the heat invasion from the incision site to the surrounding site is reduced.

(Verification related to the embodiment)
Here, the operation and the effect by controlling the output of the first electric energy and the second electric energy as in the above-described embodiment were verified. First, in the treatment in which the treatment object is simultaneously cut and coagulated by the high frequency current, the amount of sticking of the treatment object to the end effector 6, the amount of force acting on the end effector 6 from the treatment object, and the range where the discharge occurs are verified. The FIG. 6 shows a system in which the amount of application of the treatment subject to the end effector 6, the amount of force acting on the end effector 6 from the treatment subject, and the range where the discharge occurs are verified.

As shown in FIG. 6, in the system used for verification, the motorized stage 61 is disposed on the table table 60. Then, the plate 62 is fixed on the motorized stage 61, and the treatment target 63 such as a living tissue is disposed on the plate 62. Further, in the system used for verification, the stand No. 65 is fixed to the table base 60. Then, a force gauge 66 is installed on the stand base 65, and the treatment instrument 2 is supported by the stand base 65. At this time, the treatment tool 2 is supported in a state where the end effector 6 side is vertically lower. Also, the force gauge 66 is attached to the housing 5. In the verification, in the system of FIG. 6, the motorized stage 61 is moved relative to the treatment instrument 2 and the table base 60 in the direction of the arrow X2. That is, the motorized stage 61 is moved in a direction (vertical or substantially perpendicular) intersecting with the central axis of the shaft 4 (end effector 6). Then, while moving the treatment target 63 in the direction of the arrow X2 together with the motorized stage 61, a high frequency current is applied to the treatment target 63 from the end effector 6, and the treatment target 63 is incised simultaneously with coagulation. In the verification, the motorized stage 61 and the treatment target 63 were moved at 0.4 cm / s. The dimension L1 of the treatment target 63 in the movement direction (the direction of the arrow X2) was 3 cm, and the treatment target 63 was incised by the high frequency current applied from the end effector 6 over the entire length of the dimension L1.

Further, in the verification, the first electric energy is output to the end effector 6 and the return electrode plate 12 in a state where the voltage waveform becomes a burst wave having a crest factor of 5 or more, and output power P to the end effector 6 and the return electrode 12 Was 40W. Then, the vibration state of the end effector 6 was changed to perform verification. In the verification, in the state where the total amplitude A of the end effector 6, that is, the total amplitude at the vibration antinode of the tip of the end effector 6 is 25 μm, 50 μm, 75 μm and 100 μm, respectively, The amount α and the average load σ acting on the housing 5 were measured.

Here, the sticking amount α was calculated by subtracting the weight of the treatment tool 2 before the treatment object 63 is incised from the weight of the treatment tool 2 after the treatment object 63 is incised. Further, the load acting on the housing 5 was measured by the force gauge 66, and the average value of the measured loads was taken as the average load σ. In the verification, in the state where the end effector 6 is vibrating, the vibration frequency f of the end effector 6 is set to 46 kHz or more and 48 kHz or less at any total amplitude A. Therefore, assuming that the vibration frequency f of the end effector 6 is 47 kHz, which is the center value of the frequency range, the product of the total amplitude A and the vibration frequency f is as follows when the total amplitude A is 25 μm, 50 μm, 75 μm and 100 μm. , 1.2 m Hz, 2.4 m Hz, 3.5 m Hz and 4.7 m Hz respectively.

FIG. 7 shows an example of the measurement result of the sticking amount α to the end effector 6 and the average load σ acting on the housing 5. In FIG. 7, the horizontal axis indicates the total amplitude A of the end effector 6, the left vertical axis indicates the sticking amount α, and the right vertical axis indicates the average load σ. Moreover, in FIG. 7, the measurement result of the amount of sticking (alpha) is shown by a bar graph, and the measurement result of average load (sigma) is shown by a broken line graph. As shown in FIG. 7, in the verification, in the state where the total amplitude A of the end effector 6 is 25 μm, the sticking amount α is larger than 2.5 mg. On the other hand, in the state where the total amplitude A of the end effector 6 is 50 μm, 75 μm and 100 μm, the sticking amount α is smaller than 1.0 mg. Therefore, when the vibration frequency is about 47 kHz and the total amplitude A is 50 μm or more, that is, the end effector 6 vibrates with the product of the total amplitude A and the vibration frequency f being 2.4 m · Hz or more It was confirmed that the end effector 6 was hardly attached to the treatment target.

Further, in the verification, in a state where the total amplitude A of the end effector 6 is 25 μm, the average load σ is larger than 0.05N. On the other hand, in each of the states in which the total amplitude A of the end effector 6 is 50 μm, 75 μm and 100 μm, the average load α is zero or almost zero. Here, in a state in which the treatment target 63 is incised simultaneously with the coagulation by the high frequency current, the load acting on the housing 5 changes corresponding to the amount of force acting on the end effector 6 from the treatment target 63. The larger the amount of force acting on the end effector 6, the larger. When the amount of force acting on the end effector 6 from the treatment target 63 is zero or substantially zero, the load acting on the housing 5 becomes zero or substantially zero. Therefore, when the total amplitude A of the end effector 6 is 50 μm, 75 μm and 100 μm, respectively, the end effector 6 does not abut on the treatment target 63, and the amount of force acting on the end effector 6 from the treatment target 63 is zero or approximately It is understood that it becomes zero. From the above, when the vibration frequency is about 47 kHz and the total amplitude A is 50 μm or more, that is, the end effector 6 vibrates with the product of the total amplitude A and the vibration frequency f being 2.4 m · Hz or more In this case, it was confirmed that the treatment subject 63 exerts little or no force on the end effector 6.

In the verification, the high-speed camera 67 captured a state in which the end effector 6 incised the treatment target 63 simultaneously with coagulation. Then, images taken at a plurality of times from the start to the end of the incision of the treatment target 63 were superimposed, and pixels of the discharge point from the end effector 6 in the superimposed image were calculated. And the pixel of the discharge part calculated was made into discharge area Y. FIG. In the verification, from the start of the incision of the treatment target 63 in the state that the total amplitude A of the end effector 6, that is, the total amplitude at the vibrating tip of the end effector 6 becomes 25 μm, 50 μm, 75 μm and 100 μm, respectively. Images taken at a plurality of times until the end were superimposed, and an superimposed image was generated. Further, in the verification, the discharge area Y was calculated in each of the states in which the total amplitude A of the end effector 6 is 25 μm, 50 μm, 75 μm and 100 μm.

FIG. 8A shows an example of the calculation result of the discharge area Y from the end effector 6. Moreover, in FIG. 8B, an example of the image produced | generated by superimposing the image | photographed image in several time from the start of the incision of the process target 63 to completion | finish is shown. In FIG. 8A, the horizontal axis represents the product of the total amplitude A and the vibration frequency f in the end effector 6, and the vertical axis represents the discharge area Y. Moreover, in FIG. 8A, the calculation result of the discharge area Y is shown by a broken line graph. Also, in FIG. 8B, when the total amplitude A is 25 μm, 50 μm, 75 μm and 100 μm, that is, the product of the total amplitude A and the oscillation frequency f is 1.2 m · Hz, 2.4 m · Hz, 3.5 m · The generated images are shown for each of Hz and 4.7 m Hz. Then, in FIG. 8B, in any of the images, the end effector 6 travels in the direction indicated by the arrow X3, that is, downward in the drawing. In FIGS. 8A and 8B, the product of the total amplitude A and the vibration frequency f is calculated with the vibration frequency f of 47 kHz in any state.

As shown in FIG. 8A, in the verification, the discharge area Y is larger than 2000 pixels in a state where the product of the total amplitude A and the vibration frequency f in the end effector 6 is 1.2 m · Hz. On the other hand, when the product of the total amplitude A and the vibration frequency f at the end effector 6 is 2.4 mHz, 2.5mHz and 4.7mHz respectively, the discharge area Y is 1200 pixels or more It became smaller. Further, as shown in FIG. 8B, in a state where the product of the total amplitude A and the vibration frequency f in the end effector 6 is 1.2 m · Hz, discharge occurs in the traveling direction of the end effector 6, The discharge was also generated from the end effector 6 in the direction intersecting with the traveling direction. On the other hand, in each of the states in which the product of the total amplitude A and the vibration frequency f at the end effector 6 is 2.4 mHz, 3.5mHz and 4.7mHz, the direction crosses the traveling direction The discharge from the end effector 6 hardly generated toward the end effector 6, and the discharge points from the end effector 6 were concentrated in the traveling direction of the end effector 6. Therefore, when the vibration frequency is about 47 kHz and the total amplitude A is 50 μm or more, that is, the end effector 6 vibrates with the product of the total amplitude A and the vibration frequency f being 2.4 m · Hz or more It was confirmed that the discharge from the end effector 6 was concentrated in the traveling direction.

Further, in another verification, the end effector 6 is brought close to a treatment target such as a living tissue, and a high-frequency current is applied from the end effector 6 to the treatment target to cut the treatment target simultaneously with coagulation. Also in this verification, the first electric energy is output to the end effector 6 and the return electrode plate 12 in a state where the voltage waveform becomes a burst wave having a crest factor of 5 or more, and the output power P to the end effector 6 and the return electrode 12 is , 40W. Then, the verification was performed by changing whether or not the end effector 6 is vibrated. In the verification, the impedance Z of the electrical path of the first electric energy is detected while the end effector 6 does not vibrate, that is, the total amplitude A of the end effector 6 becomes zero, and The time η from the start of application to the occurrence of discharge was measured. The impedance Z was detected while the total amplitude A of the end effector 6, that is, the total amplitude at the tip of the end effector 6 was 50 μm, and the time η until the discharge occurred was measured. In the verification, the vibration frequency f of the end effector 6 is set to 46 kHz or more and 48 kHz or less.

FIG. 9 shows the detection result of the change in impedance Z with time, and FIG. 10 shows the measurement result of time η until the discharge occurs. In FIG. 9, the horizontal axis indicates time t with reference to the start of output of the first electrical energy, and the vertical axis indicates impedance Z. Further, in FIG. 9, the change with time of the impedance Z with the end effector 6 not vibrating is indicated by a broken line, and the change with time of the impedance Z with a total amplitude A of the end effector 6 of 50 μm is obtained. Indicated by a solid line. In FIG. 10, the horizontal axis indicates the total amplitude A, and the vertical axis indicates the time η. And in FIG. 10, time (eta) until discharge generate | occur | produces is shown with a bar graph. In the verification, the impedance Z increases to some extent from the start of the increase of the impedance Z in either the state in which the end effector 6 does not vibrate or the state in which the total amplitude A of the end effector 6 is 50 μm. When the impedance Z reaches the predetermined value Za, a discharge is generated from the end effector 6. Also, in either state, when the increase of the impedance Z starts, the impedance Z instantaneously reaches the predetermined value Za, and a discharge occurs.

As shown in FIG. 9, in the verification, it took time T1 from the start of application of the high frequency current to the treatment object to the start of the increase in impedance Z over time in a state where the end effector 6 is not vibrating. Then, in a state where the total amplitude A of the end effector 6 is 50 μm, a time T2 shorter than the time T1 is required from the start of application of the high frequency current to the treatment object until the impedance Z starts to increase over time. Here, the time T1 was about 2 s, and the time T2 was about 0.5 s. From this verification, in the state in which the total amplitude A of the end effector 6 is 50 μm, the time required for the impedance Z to rise to such an extent that discharge is generated from the end effector 6 is compared to the state where the end effector 6 does not vibrate, It is understood that it becomes short.

Further, in the verification, as shown in FIG. 10, in the state where the end effector 6 is not vibrating, the time η from the start of application of the high frequency current to the treatment object to the generation of the discharge became about 2s. On the other hand, in the state where the total amplitude A in the end effector 6 is 50 μm, the time η until the discharge occurs is about 0.5 s. Therefore, when the vibration frequency is about 47 kHz and the total amplitude A is 50 μm or more, that is, the end effector 6 vibrates with the product of the total amplitude A and the vibration frequency f being 2.4 m · Hz or more It has been confirmed that the time until the discharge from the end effector 6 occurs becomes short.

(Modification)
In the first modified example shown in FIG. 11, the processor 15 performs the processes of S101 to S108 in the output control of the electrical energy to the treatment instrument 2 as in the above-described embodiment and the like. However, in this modification, when the operation input with the operation button 11 is continued in S106 (S106-No), the signal control unit 38 of the processor 15 determines the impedance Z of the electrical path of the first electrical energy. It acquires (S109). At this time, the impedance Z is calculated based on the output current I and the output voltage V to the end effector 6 and the return electrode plate 12. Then, the signal control unit 38 determines whether the impedance Z is equal to or less than the threshold Zth (S110). If the impedance Z is larger than the threshold Zth (S110-No), the process returns to S104, and the processes after S104 are sequentially performed. On the other hand, if the impedance Z is less than or equal to the threshold Zth (S110-Yes), the signal control unit 38 determines whether the duration γ in which the impedance Z is less than or equal to the threshold Zth is longer than a predetermined time γref (S111). ). If the continuation time γ is less than or equal to the predetermined time γref (S111-No), the process returns to S104, and the processes after S104 are sequentially performed.

On the other hand, if the duration time γ is longer than the predetermined time γref, the signal control unit 38 increases the output of the second electrical energy to the ultrasonic transducer 18, that is, the signal output (S112). Then, the process returns to S104, and the processes after S104 are sequentially performed. At this time, for example, in an embodiment in which the output of the second electrical energy is controlled by constant current control in which the current value of the output current I 'is made constant or substantially constant with time, the processor 15 including a CPU etc. For the current value of the current I ', the target value I'ref is increased. Then, the processor 15 performs constant current control to maintain the current value of the output current I ′ constant or substantially constant over time with the increased target value I′ref, thereby increasing the target value I′ref. , The output current I ′ to the ultrasonic transducer 18 is increased, and the output of the second electrical energy is increased. As a result, the total amplitude A (amplitude) of the end effector 6 is increased compared to before the target value I'ref is increased. In addition, after raising the target value I'ref, the total amplitude A of the end effector 6 becomes constant or substantially constant with time at the target total amplitude Aref which is larger than before increasing the target value I'ref. Maintained. As described above, in the present modification, when the impedance Z is maintained at or below the threshold value Zth for longer than the predetermined time γref, the signal control unit 38 increases the output of the second electrical energy to Increase the vibration speed.

Here, in a state in which a force is applied to the end effector 6 from the treatment object or the like, it takes time until the impedance Z starts to increase with time. In this modification, in the treatment in which the treatment target is simultaneously cut and coagulated by the high frequency current, the processor 15 raises the output of the second electric energy when the low impedance state continues for a longer time than the predetermined time. The vibration velocity of the end effector 6 is increased. For this reason, even when the treatment is performed in a state where the end effector 6 exerts a force amount from the treatment target or the like, such as a state in which the end effector 6 is in contact with the treatment target, the vibration speed of the end effector 6 is increased. By doing this, it becomes difficult for the force to act on the end effector 6 from the treatment target. Therefore, in the present modification, in the treatment in which the treatment object is incised simultaneously with the coagulation by the high frequency current, a state in which the amount of force from the treatment object to the end effector 6 becomes zero or substantially zero is more easily formed. For this reason, the effect mentioned above is promoted more.

Further, in the second modified example shown in FIG. 12, instead of performing the processing of S109 to S111 in the first modified example, the signal control unit 38 of the processor 15 determines the impedance Z ′ of the electrical path of the second electrical energy. Is acquired (S113). At this time, the impedance Z ′ is calculated based on the output current I ′ and the output voltage V ′ to the ultrasonic transducer 18. Then, the signal control unit 38 determines whether the impedance Z ′ is larger than the threshold Z′th (S114). If the impedance Z ′ is equal to or less than the threshold Z′th (S114-No), the process returns to S104, and the processes after S104 are sequentially performed. On the other hand, when the impedance Z ′ is larger than the threshold Z′th (S114-Yes), the signal control unit 38 increases the output of the second electric energy to the ultrasonic transducer 18, that is, the signal output (S112). . Then, the process returns to S104, and the processes after S104 are sequentially performed. Therefore, in the present modification, when the impedance Z ′ is larger than the threshold Z′th, the signal control unit 38 increases the output of the second electrical energy to increase the vibration velocity of the end effector 6.

Here, in a state in which an amount of force is applied to the end effector 6 from the treatment object or the like, such as a state in which the end effector 6 is in contact with the treatment object, the force acts on the vibrator including the ultrasonic transducer 18 and the rod member 8 The load increases. For this reason, the impedance of the ultrasonic transducer 18 becomes large, and the impedance Z 'becomes large. In this modification, in the treatment in which the treatment object is simultaneously cut and coagulated by the high frequency current, when the impedance Z ′ is high, the processor 15 increases the output of the second electric energy to increase the vibration speed of the end effector 6 Let For this reason, even when the treatment is performed in a state in which the force is applied to the end effector 6 from the treatment object or the like, the force is applied to the end effector 6 from the treatment object by increasing the vibration speed of the end effector 6 It becomes difficult to do. Therefore, also in the present modification, as in the first modification, in the treatment in which the treatment target is incised simultaneously with the coagulation by the high frequency current, the state in which the amount of force from the treatment target to the end effector 6 becomes zero or nearly zero is more It becomes easy to form. For this reason, the effect mentioned above is promoted more.

Moreover, in the above-mentioned embodiment etc., although the power supply device 3 is provided only one, the power supply device which outputs 1st electrical energy and the power supply device which outputs 2nd electrical energy are separate bodies in a certain modification. is there. In this case, the above-described output source 21, current detection circuit 25, voltage detection circuit 26, and A / D converter 27 are provided in the power supply device that outputs the first electrical energy. Then, the power supply device that outputs the second electrical energy is provided with the above-described output source 31, current detection circuit 35, voltage detection circuit 36, and A / D converter 37. Also, each of the power supply devices is provided with a storage medium and one or more processors. And the control apparatus which controls the treatment system 1 is formed of one or more processors provided in each of a power supply device, and the process mentioned above is performed.

In another variation, the treatment tool 2 is provided with one or more processors that perform the above-described process, and the control device that controls the treatment system 1 is formed by the one or more processors provided in the treatment tool 2. Be done.

The present invention is not limited to the above embodiment, and can be variously modified in the implementation stage without departing from the scope of the invention. In addition, the embodiments may be implemented in combination as appropriate as possible, in which case the combined effect is obtained. Furthermore, the above embodiments include inventions of various stages, and various inventions can be extracted by an appropriate combination of a plurality of disclosed configuration requirements.

Claims (6)

By supplying the first electrical energy, an end effector to which a high frequency voltage is applied between the electrode and the return electrode, and a second electrical energy as a drive signal are generated to generate ultrasonic vibrations. A control device including: an ultrasonic transducer for transmitting the generated ultrasonic vibration to the end effector;
A high frequency control unit that causes the end effector to output the first electrical energy with a voltage waveform that generates a discharge from the end effector to the treatment target;
In the state where the first electrical energy is output in the voltage waveform that generates the discharge, the end effector is placed on the treatment target by controlling the output of the second electrical energy to the ultrasonic transducer. A signal control unit that causes the discharge from the end effector to concentrate in the traveling direction of the end effector by performing control to vibrate the end effector with an amplitude and vibration frequency that are not in contact;
Control device equipped with. The signal control unit controls the output of the second electrical energy in a state in which the first electrical energy is output in the voltage waveform that generates the discharge, so that the entire amplitude of the end effector The control device according to claim 1, wherein the product of the vibration frequency and the vibration frequency is 2.4 m · Hz or more. The signal control unit acquires an impedance of an electrical path of the first electrical energy in a state where the first electrical energy is output in the voltage waveform that causes the discharge;
The signal control unit increases the output of the second electrical energy to increase the vibration velocity of the end effector when the impedance is maintained at or below a threshold for longer than a predetermined time.
The control device of claim 1. The signal control unit acquires an impedance of an electrical path of the second electrical energy in a state where the first electrical energy is output in the voltage waveform that causes the discharge;
The signal control unit increases the output of the second electrical energy to increase the vibration velocity of the end effector when the impedance is larger than a threshold.
The control device of claim 1. The control device according to claim 1, wherein the high frequency control unit causes the end effector to output the first electric energy with a voltage waveform having a crest factor of 5 or more as the voltage waveform for generating the discharge. The control device according to claim 1;
The treatment tool comprising the end effector and the ultrasonic transducer;
Treatment system.

Images