CN1222065A - Under water treatment - Google Patents
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- CN1222065A CN1222065A CN 97195575 CN97195575A CN1222065A CN 1222065 A CN1222065 A CN 1222065A CN 97195575 CN97195575 CN 97195575 CN 97195575 A CN97195575 A CN 97195575A CN 1222065 A CN1222065 A CN 1222065A
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Abstract
An electrosurgical instument, which is used for the treatment of tissue in the presence of an electrically-conductive fluid medium, comprises an instrument shaft (10), and an electrode assembly (12) at one end of the shaft. The electrode assembly (12) comprises a tissue treatment electrode (14) and a return electrode (18) which is electrically insulated from the tissue treatment electrode by means of an insulation member (16). The tissue treatment electrode (14) has an exposed end for treating tissue, and the return electrode (18) has a fluid contact surface which is spaced from the tissue treatment electrode in such a manner as to define, in use, a conductive fluid path that completes an electrical circuit between the tissue treatment electrode and the return electrode. The electrode assembly (12) is provided with a plurality of apertures (14a) in the region of the tissue treatment electrode (14), through which apertures vapour bubbles and/or particulate material can be aspirated from the region surrounding the tissue treatment electrode.
Description
The present invention relates to a kind of electrosurgical equipment, be used for the tissue treatment under the conductive fluid medium situation, also relate to the electrosurgical equipment that comprises this apparatus, and used electrode unit in this kind apparatus.
Endoscope's electrosurgery is generally used for treating endoceliac tissue, and generally is to carry out under the situation that the expansion medium is arranged.When inflating medium is liquid, usually it is called electrosurgery under water, when meaning electrosurgery, this term has one or more electrosurgical equipments that are immersed in the processing electrode in the liquid in the operative site employing, and biological tissue is obtained medical treatment.When carrying out endoscopic surgical in the bigger dilatancy body cavity of potential volume, liquid medium is not suitable for wherein, just like the situation in abdominal speculum surgery or gastrointestinal surgery is such usually, all adopts gas medium usually.
Surgery normally adopts endoscopic technique to implement under water, and wherein endoscope itself can be provided with a conduit (being commonly referred to active channel), and using is the path of electrode.In addition, endoscope can be equipped to especially the device that (as resectoscope) includes installing electrodes, perhaps can under about endoscope's situation at an angle, the device by a split-inlet be introduced in the body cavity by described electrode--be commonly called the triangle technology.Can give segmentation again to these technical modification by surgery's specialty, plant these technology a kind of or its all has the provide access special advantage of path of particular body cavity.Can enter under the situation of body cavity by natural opening, the general endoscopies that adopt with a plurality of indispensable operation paths, those are called as the endoscope of resectoscope,--as lead to the cervical canal of endometrial cavity, perhaps lead to the urethra of prostate and bladder.Be called as metroscope by being used for the specially designed endoscope of endometrial cavity, comprise cystoscope, urethroscope and resectoscope for being used for the endoscope that urethra designs.Prostatic transurethral resection operation process or vaporizastion are called as TURP and EVAP respectively.When not having the natural human body opening that can pass through for endoscope, just adopt said triangle technology usually.The triangle technology is normally used in the process of endoscopic surgical under water such as articular cavity such as knee joint and shoulders.Endoscope used in these processes is commonly called arthroscope.
Usually adopt one pole apparatus or bipolar instruments to carry out electrosurgery.Adopt monopolar electrosurgical, an active electrode is used for field of operation, general-conductor back flow plate is anchored on patient's the skin simultaneously.Adopt this layout, electric current flows to the external reflux plate from the tissue of active electrode by the patient.Because the patient is equivalent to the live part of circuit, the value of input power just must bigger (being generally 150 to 250 watts), hinder the restriction of electric current with the compensation patient tissue, and, under the Electrosurgical under water situation, because liquid medium shows as the event of incomplete conduction because of the existence of blood or other body fluid, consumed energy.Because there is the cause of tissue heating in described back flow plate place, make and adopt monopolar arrangement and use bigger power still dangerous, promptly may cause serious skin burn.Also there is the risk that capacitive character couples between apparatus and patient tissue in inlet point place at body cavity.
Adopt bipolar electrosurgical, pair of electrodes (active electrode and return electrode) is used to simultaneously the operating position of organizing.Because two electrodes approaching relatively, make the electric current of radio frequency be restricted to zone between the electrode, so from the viewpoint of safety, this advantage that is furnished with., the direct and two interelectrode distance dependents of effective depth, and must use under the situation of minimum electrode, the interior interval of electrode becomes very little, thereby has just limited the effect to tissue, has also limited the power of exporting.Further the observation of operating position is covered in the interval regular meeting between spaced electrode, and for guaranteeing that two electrodes contact with the correct of tissue, also needs to change operation process.
Many remodeling that design substantially about bipolar probe are arranged.US Patent specification US4 for example, 706,667 have described a kind of basic design, promptly with regard to the cut meaning, the ratio of return electrode and active electrode contact area greater than 7: 1 less than 20: 1.This sphere of action is only relevant with the profile of cut electrode.When bipolar instruments is used for evaporation or hemopexis, the contact area ratio of described two electrodes is reduced to is bordering on 1: 1, to adapt to the different electric stress that the contact position exists between tissue and each electrode.
Can utilize such as the moistening described tissue of common saline solution class conducting solution, thus guarantee described return electrode and the tissue between electric interlock.Along with realize two interelectrode circuit by described tissue, guaranteed to make surgical effect to be restricted to needle electrode or active electrode place.One of significant limitation that adopts this design is described pin is imbedded in the described tissue fully, so that return electrode is realized described circuit.Another problem is directed problem, and ideal vertical contact has less change even work angle is about tissue surface, also can change the ratio of described contact area, makes influence to performing the operation may take place under tissue and situation that return electrode contacts.
Cavity expands to provide to improving visualization and enters the space of operating position, to improve visualization and to be able to operating apparatus.In the body cavity of small size, this is special needs for expand cavity under higher pressure, replaces gas more commonly used with liquid, and this is because optical characteristics is better, and because it washes blood away from the position of operating.
Adopt nonconducting liquid (glycine) as flushing liquor or as inflating medium for the decline of avoiding electric conductivity, existing electrosurgery under water is achieved such as 1.5%.Use glycine under isosmoticity concentration, the infiltration in the blood changes under having endovascular Absorption situation to avoid.In operating process, because liquid comprehensively penetrates in the circulation and goes, vein is cut off, comprising the dilution that may cause serum sodium, this may cause being called as water intoxication.
The applicant finds, in endoscope's electrosurgery, can adopt conventional liquid medium under water, replaces nonconducting non-electrolytic solution as common saline solution.Do not considering electrosurgery, perhaps adopting non-electrical tissue effect, under the situation as laser therapy, common saline solution is a preferred inflating medium in the endoscopic surgical under water.Though common saline solution (0.9%w/v, electric conductivity 150mmol/l) is more slightly larger than most people soma, but its advantage is, lowers physiological effect by absorbing or oozing out percolation from the operating position, and can avoid the so-called water intoxication effect of nonconducting non-electrolytic solution.
Carbon dioxide is first-selected gas expansion medium, and this at first is because its non-toxic nature and higher water solublity.
Inflating medium is in the endoscopic procedures of gas therein, and the applicant finds, can use gaseous conductor (as argon) to replace carbon dioxide.When argon is excited to discharge condition, it becomes conduction, and is used in the monopolar electrosurgical of endoscope and routine, by under situation about adopting such as high-tension electricities such as jet or flash of light operation output, in between described tissue and apparatus, provide conductive path, as the method that strengthens the two distance.Used high pressure causes that to enter the described penetrance of electrosurgical effect of organizing very low in this application, makes this method only be applicable to many little angiorrbagias of control.This makes surgeon can use the hemorrhage of the method for " smearing " fast Kechuang damaging the spleen and stomach prevention outside multi-section position, to replace that electrosurgery is used for each bleeding part.By a hollow surgical instruments feed argon, simultaneously, argon is crossed above the single electrode that is exposed to the apparatus end as air communication.This just produces argon in the operating position denseer and facilitate the expansible zone of body cavity.Since to apparatus away from the Capacitance Coupled of operating position part or directly connect often in the outside in the operator visual field because to the danger of pathological tissues outside the visual field so, in endoscopic surgical, do not wish to have high pressure one pole electrosurgical to export.
The applicant has developed bipolar instruments, is applicable to the electrosurgery under water that adopts conducting liquid or gas medium.This being used for comprises at the electrosurgical equipment of conductive fluid medium situation undertissue treatment: have the implement body of handle and apparatus footstalk, and at the electrode assemblie of described footstalk one end.Described electrode assemblie comprises tissue treatment (effectively) electrode that is exposed to the apparatus least significant end, with a return electrode, it and described tissue treatment electrodes electric insulation, and a liquid contact surface arranged, this face leaves certain interval with tissue treatment electrodes as follows, promptly determine the conductor fluid path in use, this path is realized the circuit between described tissue treatment electrodes and return electrode.When using this apparatus, tissue treatment electrodes is used tissue place to be disposed, on the other hand, being placed near the tissue treatment electrodes bared end has the return electrode of a segment distance usually with described tissue one segment distance to be arranged, and it is used for finishing the electrosurgical current loop by described tissue and liquid medium and tissue treatment electrodes.In the description of our European patent application EP 96918786.1 this electrosurgical equipment has been described.
The electrode structure of this apparatus that combines with conductive fluid medium has greatly been avoided the problem of one pole or bipolar electrosurgical aspect.Particularly, the level of input power is significantly less than and adopts the general required power (being generally 100 watts) of monopolar configuration.In addition,, compare, the degree of depth of effect is improved with the dipolar configuration of routine because its interelectrode interval is bigger.
Our international monopoly GB96/01472 description has been described a kind of bipolar electrosurgical instrument that has been poured, and can be used for getting through the environment that is filled with air or gas.This kind apparatus comprises an inner passage, and being used for when using this apparatus, provides a conductor fluid path to the tissue treatment electrodes bared end conductor fluid (being generally saline solution) of packing into, in order to connect the circuit to return electrode.This apparatus also comprises a fluidic inner passage that is used to remove tissue treatment electrodes bared end zone.When described fluid is a liquid, during such as saline solution, the pressure of liquid can cause indirect tissue injury, so need remove it.This class apparatus is intended to be used to get through the environment that is filled with air or gas at first, and is not suitable for and needs the expansible electrosurgical procedure of body cavity.
Yet, in such as endoscopic surgical, when the body cavity volume hour, such as the knee place,, also can only provide the 50-60ml perfusion fluid even seam crossing is bigger, this just may produce following problems, promptly
(1) the most close heated liquid in the place of contact electrode of organizing may cause incidental tissue injury;
(2) generation that is organized the tissue of contact electrode vaporization may cause that multiple eyes can observable problem;
(3) soft tissue that is present in the seaming position trends towards moving around seam, makes to be difficult to add to active electrode, with this soft tissue of vaporizing.
A kind of endoscope electrode can its short (100-140mm) be a feature, and has the rigidity that working diameter reaches 5mm.Can adopt described triangle technology to be introduced into articular cavity by acupuncture otch (with or without sleeve pipe).Kind electrode is so that its mode that moves between 9 o ' clock positions and 3 o ' clock positions about endoscope's pattern and moving.So, always make tissue to be disposed about the nearly very little operating angle of being coupling of electrode.Therefore, endoscope's electrode need with this and described tissue near the concordance that becomes the angle to remain valid.Tissue to be disposed, as meniscal cartilage, normally fine and close, and resistance is higher.Endoscope's electrode need be adjusted output and voltage as follows, promptly with the relevant mode of the speed of effectively seeking that can compare with its used at that time mechanically cutting device (though adopting the electrode littler than exsector chip size for improving inlet) of the kind of waiting to dispose tissue, electrode size and endoscope.
The object of the present invention is to provide the improved electrosurgical equipment of a kind of this class.
The invention provides a kind of electrosurgical equipment, be used for the tissue treatment under the conductive fluid medium situation, described apparatus comprises an apparatus footstalk, with electrode assemblie at this apparatus footstalk one end, described electrode assemblie comprises a tissue treatment electrodes and a return electrode, the latter is by an insulating part and described tissue treatment electrodes electric insulation, described tissue treatment electrodes has in order to dispose the exposed distal ends of tissue, and described return electrode has a liquid contact surface, this face leaves certain interval with tissue treatment electrodes as follows, promptly in use determine the conductor fluid path, this path is realized the circuit between described tissue treatment electrodes and return electrode, in the tissue treatment electrodes zone a plurality of apertures are set wherein for described electrode assemblie, can make steam bubble and/or predetermined substance pass through these apertures by the regional sucking-off around tissue treatment electrodes.
In a kind of preferred embodiment, described apparatus also comprises a pump, with so that the end portion of described apparatus footstalk is born pressure below atmospheric pressure, thereby in use by regional suck out vapour bubble and/or the predetermined substance of described aperture around the tissue treatment electrodes.
It is favourable starting described pump in a looping fashion, thereby material is sucked out with pulse mode.Also can make described pump only be given energy so that be activated during tissue vaporisation with other substitute mode in tissue treatment electrodes.
Described apparatus preferably also comprises a RF generator, and it has the bipolar system outfan that links to each other with tissue treatment electrodes and return electrode.In this case, can control described pump by the voltage output characteristics of RF generator.
During use, make return electrode and tissue treatment electrodes spaced apart, make it unlikely contact tissue to be disposed, and circuit is always finished by conducting liquid, and be not only by interelectrode puncture.In fact, this layout makes that the puncture between each adjacent part of described electrode assemblie is avoided, thereby guaranteed to make tissue treatment electrodes to be enclosed in the steam capsule, the tissue that consequently enters this steam capsule becomes the preferred path that makes electric current flow back into return electrode through conducting liquid.
Electrosurgical equipment of the present invention also is used to dissection, excision, evaporation, dehydration and the blood coagulation organized and the combination of these functions.It has special application in arthroscopic surgery, as on being applicable to the human synovial that includes, but is not limited to they are used for that generic operation of spinal column and when endoscopic procedure of being implemented on other asynovia joint and percutaneous operation, the combination of these functions special applications in the arthroscope operation.The process of arthroscope operation can comprise: the part or the complete resection that comprise the meniscus of knee joint of meniscus capsule; The disconnection of kneed outside retinaculum musculorum peroneorum; Front and back excision of ligamentum cruciatum or leaving over of they; The maxillary lip cleft seaming and cutting of shoulder joint remove, acromion shaping, bursa excision and acromion decompression down; The osteoarticular excision of the restriction upper jaw; When being applied to any Synovial joint of health, synovectomy, cartilage debridement, cartilage are shaped, the debridement of separation, fracture and the tendon of intraarticular adhesion; Joint capsule thermic shrinkage when being used for human body respectively connected the recurrence dislocation, subluxation in joint or repeated stress damage and dispose; For similar purpose, approaching in the prominent prolipase (disc prolipase) of dish is handled or as the dissection in the part spinal fusion (dissecotomy) by back or front to cervical region, chest and lumbar spinal column or any other [; The excision of pathological tissues; And stasis.
Apparatus of the present invention also is used to dissection, excision, evaporation, dehydration and the blood coagulation organized, and the combination of these functions special applications in urology department endoscope (urethroscopy, cystoscopy, Ureteroscopy and nephroscopy) and percutaneous operation.The urology department process can comprise: prostatic electricity evaporation (EVAP), and other modification that generally is referred to as prostate transurethral resection (TURP) process, no matter the latter comprises that benign lesion also or malignant change, by percutaneous or to carry out prostatic matter through the total length approach partly cut, but be not limited thereto; When the urinary tract tumor may occur as former or secondary tumor, and when their occurring Anywhere from renal pelvis to outside urethral orifice in urinary tract, to their transurethral resection or percutaneous excision; To the narrow separation that may occur at pelviureteral junction (PUJ), ureter, ureteric orifice, neck of bladder or urethra place; The rectification of ureterocele; The shrinkage of diverticulum of bladder; As the gauged bladder forming process that is suitable for draining kakergasia; Pelvic floor thermic shrinkage when the rectification that neck of bladder descends is disposed; The excision of pathological tissues; And stasis.
Adopt operation process of the present invention to comprise: by an artificial conduit (sleeve pipe), perhaps by a natural conduit, electrode assemblie is directed to surgery location, described natural conduit can be organizes body cavity or space, or form with modus operandi.In operating process, can use liquid to be expanded in described body cavity or space, perhaps can stay open naturally by organizational structure.Operative site is immersed in the continuous conduction flow of liquid such as common salt aqueous solution, common salt aqueous solution is full of and the distending cavity, perhaps at the environment that forms a regional perfusion around the electrode assemblie end in the inflating cavity mode.Dabbling liquid is sucked out, to remove because of the formed product of the effect of RF energy, fragment of tissue or blood from operative site.Described process can comprise by endoscope or use direct visualization device to observe described position simultaneously.A kind of dabbling bipolar system electrosurgical unit has been described in the description of our international patent application GB96/01472.
In described apparatus end portion, making the bared end of tissue treatment electrodes is favourable along the opening extending transversely that is provided in the insulating part, and the liquid contact surface of return electrode covers the insulating part in the described open region.
In preferred embodiment first, an independent helical form filament constitutes described tissue treatment electrodes, and described each hole-shaped is formed in the described insulating part, and each aperture is positioned at around it, and contiguous it.The diameter of described filament is preferably in 0.05mm in the 1.0mm scope.
In addition, also can constitute described tissue treatment electrodes by a flat board with holes, each dull and stereotyped aperture constitutes that such the hole--steam bubble and/or predetermined substance can be sucked out by them.Can make the outer surface of described flat board form the recessed portion that is close to described aperture.These recessed portions are collected the steam capsule, thereby reduce the vaporization energy threshold value of apparatus.
The alloy of available tungsten or tungsten or platinum is made described tissue treatment electrodes.
Described apparatus preferably also comprises the pipe that is positioned at the apparatus footstalk, uses so that each aperture is connected with pump.This pipe can be the pipe of multi-cavity, and in this case, it limits a plurality of passages, and the diameter of each passage equals the diameter of each aperture in the tissue treatment electrodes zone at least.In addition, this apparatus also comprises a filter at the end of described pipe.
The present invention also provides a kind of electrode unit, is used for the tissue treatment under the conductive fluid medium situation, and described electrode unit comprises a footstalk, at the one end end fitting that is used to link instrument handle is arranged; The other end at described footstalk is installed an electrode assemblie, and this electrode assemblie comprises tissue treatment electrodes and return electrode, and return electrode is by an insulating part and tissue treatment electrodes electric insulation; Described tissue treatment electrodes has bared end, is used for disposing tissue; Described return electrode has liquid contact surface, this face leaves certain interval with tissue treatment electrodes as follows, promptly stipulate the path of conductor fluid in use, between tissue treatment electrodes and return electrode, form circuit, a plurality of apertures are set wherein in the tissue treatment electrodes zone, for described electrode assemblie, steam bubble and/or predetermined substance are sucked out from the zone around the tissue treatment electrodes by these apertures.
The present invention also provides a kind of electrosurgical equipment, and it comprises radio-frequency signal generator and be used for the electrosurgical equipment of tissue treatment under the conductive fluid medium situation; Described apparatus comprises the apparatus axis handle and at the electrode assemblie of this footstalk one end; Described electrode assemblie comprises tissue treatment electrodes and return electrode, and return electrode is by an insulating part and tissue treatment electrodes electric insulation; Described tissue treatment electrodes has bared end, is used for disposing tissue; Described return electrode has liquid contact surface, this face leaves certain interval with tissue treatment electrodes as follows, promptly limit the path of conductor fluid in use, between tissue treatment electrodes and return electrode, form circuit, and described radio-frequency signal generator has the bipolar outfan that links to each other with each electrode, a plurality of apertures are set wherein in the tissue treatment electrodes zone, for described electrode assemblie, steam bubble and/or predetermined substance are sucked out from the zone around the tissue treatment electrodes by these apertures.
Describe the present invention hereinafter with reference to accompanying drawing in detail by enumerating embodiment, wherein:
Fig. 1 is the figure of expression according to the electrosurgical unit of the present invention's formation;
Fig. 2 is the graphic formula side view according to the electrode unit of first kind of form of the present invention's formation;
Fig. 3 is the partial enlarged view of first kind of electrode unit form seeing along the direction of Fig. 2 arrow A;
Fig. 4-the 6th, the graphic formula side view of the electrode unit of second, third that constitutes according to the present invention and the 4th kind of form;
With reference to each figure, Fig. 1 represents a kind of electrosurgical unit, and it comprises generator 1, has output socket 2, for apparatus, provides radio frequency (RF) output through line 4 in handle 3.Can perhaps realize the startup of generator 1 by foot switch unit 5 through the control connection (not shown) in the described line 4 by handle 3, described unit 5 separates the rear portion of linking generator 1 by foot switch line 6.In illustrated embodiment, there are two foot switch 5a and 5b in foot switch unit 5, is respectively applied for dewatering type and the evaporation mode of selecting generator 1.Button 7a and 7b are arranged on the front panel of generator, be respectively applied for the size of setting dehydration and evaporation power, and by display 8 indications.Button 9a is set as converting means, in order between dewatering type and evaporation mode, to select.
Handle 3 is by adorning a demountable electrode unit E, than electrode unit E1 as will be described below to E4.
Fig. 2 represents the electrode unit E1 of first kind of form, be used for detachably being fastened to the handle 3 of electrosurgical equipment, this electrode unit comprises footstalk 10, and it constitutes by a rustless steel or with copper or half flexible pipe made of the electric clad phynox of gold, has electrode assemblie 12 in its end.The other end (not shown) of this footstalk 10 is provided for mechanically reaching the mechanism that electric mode is linked electrode unit E1 on handle 3.
Radio-frequency signal generator 1 (not shown among Fig. 2) provides the electrosurgical electric current for electrode assemblie 12.Generator 1 comprises the device of the output that change provides, to adapt to the need of different electrosurgical.Described generator can be just like described in the description of our European patent application EP 96304558.8 like that.
Electrode unit E1 comprises effectively (tissue treatment) electrode 14, and it is made of the narrow meshed plate of arc of the alloy manufacturing of tungsten or tungsten or platinum.Active electrode 14 is made into a plurality of aperture 14a, and the regional 14b of active electrode 14 is specified to cup-shaped recessed portion (see figure 3) near each aperture.Active electrode 14 links to each other with RF generator 1 through an isolated center copper conductor (not shown).Ceramic insulation sleeve 16 surrounds described central conductor, and active electrode 14 is extending transversely in breach 16a.Politef, polyolefin, polyester or ETFE surround the contiguous return electrode 18 of described footstalk proximal part.Return electrode 18 forms the elongated portion 18a of cap shape, and it and breach 16a relatively stretch on the whole surface of sleeve 16.So, the maximum combined that the operating angle that electrode unit E1 can be very little provides and organizes, it is called as the side action electrode.
This electrosurgical unit is used in particular for quick separate tissue, wherein one of problem may be when adopting the arthroscope electrode structure to make tissue by sharp separation, when especially in less joint space, operating, the amount of the steam bubble that is produced as the tissue vaporisation end product.These steam bubbles do not see Chu, and may interrupt at the application site of tissue, so that the circuit between active electrode and the return electrode involving of becoming and be subjected to that conducting liquid exists.The irregular active electrode that is filament shape, scopiform or coil spring shape addresses this problem with same method, just like described in our description of international patent application GB97/00065 like that, their reduce vaporization threshold value.Another advantage of these electrode forms bubble that the bubble ratio of being given birth to given birth to by solid state electrode that is to vaporize is little.Just like the scopiform electrode 14 of this electrosurgical unit is irregularly shaped the same, it be also advantageous in that product as tissue vaporization, produce less steam bubble.But, as owing to adopt the result of the caused low vaporization power threshold of electrode unit E1, the generation of these steam bubbles further is reduced.Compare with the result of the cap shape elongated portion 18a of the return electrode 18 that stretches at active electrode 14 backs, this is an improvement.This has reduced peeling off between active electrode 14 and the return electrode 18, thereby has reduced the electric field of active electrode and the threshold power of vaporization.This has just improved the speed that is organized in vaporization under the lower-wattage, and this is needed for given active electrode zone, therefore, has also just reduced the generation of steam bubble.Because along the cause of the cap shape elongated portion 18a of active electrode 14 whole length extending, so, also keep bigger electrode size although reduce peeling off of electrode.
In order further to reduce the problem of steam bubble generation, the suction pump (not shown) is set for electrode unit E1, it can remove steam bubble through the footstalk of the apparatus aperture 14a by active electrode 14.This has strengthened the eliminating of steam bubble from the operating position, and this is particularly advantageous in the process that corrodes chorista.Suction pump is controlled, so that pass through the voltage output characteristics balance of the flow of bubble of electrode 14 to RF generator 1, in order to avoid too cool off active electrode, the result has increased its vaporization power threshold.The thermal mass of active electrode 14 with holes is lower than the thermal mass of solid-state form active electrode, and this helps to obtain the steam capsule fast again around active electrode, and this has just disintegrated the sub-cooled of being followed.No matter because of the caused liquid stream of the swabbing action of suction pump, the cup-shaped recessed portion of active electrode 14 helps to keep the steam capsule by keeping saline solution.The accumulative saline solution of institute absorbs energy, thereby is better than being vaporized because of the saline solution that aspirates in the caused liquid stream.
The intensity of electrode assemblie 12 also is important in arthroscopic surgery, and this is because the surgeon tends to electrode assemblie with being cooling controller, also because wait to dispose tissue, the particularly tight character of bone and cartilage.Cap shape elongated portion 18a stretches the mechanical strength that has increased electrode assemblie 12 because of it on ceramic insulation sleeve pipe 16, thereby has lowered the risk of ceramic fracture and potential insulation breakdown.
Electrode unit E1 mainly is intended to be used for arthroscopic surgery, and this need be by the chorista apace of vaporizing.During use, electrosurgical unit is controlled, and so that electrode assemblie 12 is introduced selected operating position (in kneed slit), makes electrode 14 contact tissue to be disposed, and immerses in the saline solution with described tissue and electrode assemblie.
Electrode unit E1 also is very effective remove the saline solution that is heated (expanding liquid) in articular cavity in the middle of.The risk of thermally-expansible liquid mainly occurs in the process that energy is used for reaching the vaporization threshold value.In case reach threshold value, then the requirement decline 30-50% of energy.
Swabbing action by active electrode 14 will be removed the saline solution that is heated in body cavity, and eliminate all overheated risks by under the condition that is not reached of vaporization threshold value, starting for a long time, the breaking of the steam capsule that is produced around cooling effect and the active electrode with the described vaporization threshold value of increase.Therefore, can produce vicious cycle in the scope of the more suctions that added to by electrode 14, many more for reaching vaporization threshold value energy needed, the risk of being heated is just big more.The other factors of influence vaporization threshold value is to reflux and the effective ratio of contact area, and the separation of insulator between two electrodes 14 and 18.Therefore, the size of active electrode 14 and separating of insulator are reduced in order to reach the needed minima of described function, so that the influence of payment swabbing action aspect increase vaporization power threshold.
The description of our international patent application GB97/00065 has disclosed and has helped to collect the steam capsule by the design of adopting active electrode in the endoscope, and by separating the method that prevents to cool off various control such as the position vaporization threshold value of using active electrode with the perfusion stream that provides by each passage.The electrode with holes 14 of Fig. 2 makes the people recall these holes more and is bored in and leaves inboard outside, and this electrode both had been provided with suction socket 14a, is provided with again to make the steam capsule be collected in wherein regional 14b, in order to reduce the vaporization power threshold.
The method of another kind of or additional reduction vaporization power threshold is that pulsation real estate light soy sauce is inhaled pressure, thereby can obtain described threshold value between each pulse.These pulses can be synchronous with the output characteristics of RF generator 1, is (even there is the obstruction of suction channel in this) for reasons of safety both, also during keeping the steam capsule, provide energy pulse, and clean the tissue that all stop up each aperture 14a in the active electrode 14 at active electrode.
A kind of known method is aspirated by a kind of tissue of machinery device of nibbling in endoscopic surgical, can make the soft device that is present in the slit, joint, as fat pad under the kneecap, when it progressively " by biting off " time, be maintained at position in the tooth plate of nibbling by suction.
For top each former thereby speech that has provided, the tissue that is attracted to the active electrode 14 of electrode unit E1 has less influence, promptly attaches to the reduction that tissue will cause the vaporization power threshold of depending on the active electrode.Adherent tissue will be evaporated apace, and the little tissue particles that produces in evaporation process also will be aspirated from site of action.
Because its separating rate and flanking effect structure as the EVAP technology, are used with resectoscope, this electrode unit E1 also has the advantage of Urology Surgery aspect.The resectoscope electrode unit is difficult to be introduced into, because in advance it is installed in the endoscope, by the operation sheath that per urethra is introduced into, arrives the passage of the apparatus of having assembled.The most proximal end of this electrode unit is linked to each other with activation member, and electrically contact with described resectoscope and to be one.In this way, electrode unit E1 is retracted, after this by start the moving area of mechanical defined by manipulation.Assembled in advance when being used as electrode unit E1, the size of end is not subjected to the restriction of operating walk way size, and is operated the restriction of sheath diameter, and this sheath can reach 10mm.The part of this diameter is accounted for by the support lead of counter electrode unit E1, and described lead is bent an angle about the pattern of endoscope downwards to the end of operation usually, makes their unlikely obstruction visualization or its operations.The length of electrode 14 can be at 3mm in the 4mm scope, and width is in 2mm to 3mm scope, and for the given Urology Surgery that must remove average 20-30 gram prostata tissue, this size is necessary.
Because the water storage effect of bladder, and endoscope is installed, so that from the end of following observation active electrode 14, along with bubble flows out and is focused into blister from endoscope, the problem that produces bubble in vaporescence will be less than the problem during endoscope's urology department.However, use electrode unit E1 obviously to reduce bubble and generate the probability that causes problem.
Though electrode unit E1 mainly is intended to the vaporization that is used to organize, also it can be used for drying, the drying of Synovial membrane especially, or be used for the separately combination of muscle.In this case,, use foot switch 5a or button 7a, RF generator 1 is started, to set in order to the required power level of drying in case electrode assemblie 12 is introduced chosen operating position.Generator 1 provides enough RF energy with counter electrode assembly 12 thereupon, is in its boiling point basically with near the saline solution the retainer belt pore electrode 14, and does not form the steam capsule around this electrode.So, can be by cross over surperficial traveling electrode 14 these apparatuses of manipulation of waiting to dispose tissue by the mode of " smearing " to a side from a side.
Also electrode unit 14 can be used to produce blended energy output.By between dry and vaporization power level, substituting the output of RF generator 1 automatically,, can realize this point so that under the vaporization mode, can produce more stasis.Therefore, the speed of separate tissue is lowered, but when excision or separating blood vessel organizational structure, increasing of stasis is useful.In addition, under the level of vaporization power, can make RF generator 1 be output as pulsation, and start unlike the periodic under the drying mode.Along with the formation that reduces bubble and organize pyrogenic risk, to compare with what happens under described evaporation mode, this will produce rodent tissue vaporisation seldom.
Fig. 4 to 6 expression electrode unit E2 is to E4, and they are improved forms of electrode unit E1.Therefore, same reference number will be used to similar parts, and will only describe various improvement in detail.So the active electrode 14 of electrode unit E2 is for being installed in the helical spring electrode in the breach 16a.Helical spring electrode 14 is made by the alloy of tungsten or tungsten or platinum, and its near-end links to each other with RF generator 1 through an isolated center copper conductor (not shown).But, electrode unit E2 is provided with the aperture 16b that is formed in the ceramic insulation sleeve 16, and these apertures 16b all is positioned at around the active electrode 14, and near this electrode.These apertures 16b constitutes steam bubble, tissue to be removed and the suction path of fragment, thereby has increased the generation of steam bubble at effective surface electrode, and has comprised the vaporization threshold property, also guarantees the saline solution that suction preferably is heated simultaneously.The position adequate closure of these apertures 16b active electrode 14, guaranteed that all tissues that are evaporated are inhaled in this apparatus basically, be discharged from by the swabbing action of suction pump footstalk 10 again by this apparatus.According to the improved form of present embodiment, the adjacent loop of described helical spring electrode can limit additional aperture, to help the suction of steam bubble, carbon granule and fragment of tissue.
The electrode unit E3 of Fig. 5 has " eraser shape " active electrode 14, is similar to the active electrode of Fig. 2 and Fig. 3.Apparatus footstalk 10 has an a plurality of lumen 22, determines many suction channels 24.Active electrode 14 links to each other with RF generator 1 by isolated copper conductor 26.The advantage of present embodiment is, if a saline solution has hindered one or more passage 24, steam still can be sucked by remaining open to the outside world passage 24.In this case, the chamber thorax of every passage 24 need not narrower than the aperture 14a in the active electrode 14, thereby can avoid because of the place's of being applied special fragment of generation of tissue passage being stopped up.
The electrode unit E4 of Fig. 6 has an independent lumen 22, and its end is provided with monolithic filter 28.Filter 28 prevents from because of the place's of being applied special fragment of generation of tissue lumen 22 to be stopped up.In addition, filter 28 is in the end of lumen 22 is integrally formed with insulating sleeve 16.Have, filter 28 can comprise a grid that the smaller perforations size is arranged again, and in order to there to be solid matter to be deposited under the situation on the filter, allows evaporate to discharge according to qualifications.In this case, will be convenient to the extraction of gaseous material, and immediate single chamber suction tube 22 will be constituted can stand high vacuum pressure because of the following fact, and unlikely breaking.Here also be that active electrode 14 is linked to each other with RF generator 1 by an isolated copper conductor 26.
Among the electrode unit E1 to E4 each all has bonus, i.e. convective flow in the saline solution around the restriction of swabbing action in the active electrode 14 scopes electrode assemblie 12.When reaching required power threshold, it is relevant with the energy expenditure of active electrode 14 and flow behavior on every side thereof to vaporize, and described power threshold is relevant with the maximum of convection rate.Therefore, the inhibition of convection current just makes power threshold reduce, and this helps it and can use more cheap RF generator, and avoids such as apparatus internal consumption and catastrophic active electrode problems of excessive heat.In case the vaporization beginning, it also helps the control of described generator.In our description of international patent application GB97/00065, the importance of vaporization power threshold obtains more detailed discussion.
Another of these electrode units is also advantageous in that during use, active electrode 14 faces down, thereby makes the saline solution that is heated rise to return electrode 18.This causes reducing of entire circuit impedance, thereby the heat loss in the saline solution path is reduced.
Will be understood that and to make various improvement to the various embodiments described above.For example, the tube chamber 22 of Fig. 5 and Fig. 6 embodiment can be used for the electrode assemblie 12 of Fig. 4, promptly adopt the embodiment of insulating sleeve with holes.It also is possible making insulating sleeve 16 with among the embodiment of silicone rubber (as the siloxanes polyurethane), glass or thermoplastic each.
Used term " pump " in this description should be interpreted as comprising the steered vacuum source that all are suitable.
Claims (29)
1. electrosurgical equipment, be used for the tissue treatment under the conductive fluid medium situation, described apparatus comprises an apparatus footstalk, with electrode assemblie at this apparatus footstalk one end, described electrode assemblie comprises a tissue treatment electrodes and a return electrode, the latter is by an insulating part and described tissue treatment electrodes electric insulation, described tissue treatment electrodes has in order to dispose the exposed distal ends of tissue, and described return electrode has a liquid contact surface, this face leaves certain interval with tissue treatment electrodes as follows, promptly in use determine the conductor fluid path, this path is realized the circuit between described tissue treatment electrodes and return electrode, in the tissue treatment electrodes zone a plurality of apertures are set wherein for described electrode assemblie, can make steam bubble and/or predetermined substance pass through these apertures by the regional sucking-off around tissue treatment electrodes.
2. electrosurgical equipment as claimed in claim 1, it is characterized in that, also comprise a pump, with so that the end portion of described apparatus footstalk is born pressure below atmospheric pressure, thereby in use by regional suck out vapour bubble and/or the predetermined substance of described aperture around the tissue treatment electrodes.
3. an electrosurgical equipment as claimed in claim 2 is characterized in that, described pump starts in a looping fashion, thereby material is sucked out with pulse mode.
4. one kind as claim 2 or 3 described electrosurgical equipments, it is characterized in that, described pump only is activated when tissue treatment electrodes is given energy in order to tissue vaporization.
5. one kind as each described electrosurgical equipment of claim 2 to 4, it is characterized in that also comprise a RF generator, it has the bipolar system outfan that links to each other with tissue treatment electrodes and return electrode.
6. an electrosurgical equipment as claimed in claim 5 is characterized in that, it is controlled that described pump is pressed the voltage output characteristics of RF generator.
7. one kind as each described electrosurgical equipment of claim 1 to 6, it is characterized in that, in described apparatus end portion, the bared end that makes described tissue treatment electrodes is along the opening extending transversely that is provided in the insulating part, and the liquid contact surface of return electrode covers the insulating part in the described open region.
8. an electrosurgical equipment as claimed in claim 7 is characterized in that, an independent helical form filament constitutes described tissue treatment electrodes.
9. an electrosurgical equipment as claimed in claim 8 is characterized in that, described hole-shaped is formed in the described insulating part, and these apertures are positioned at around the described tissue treatment electrodes, and near it.
10. an electrosurgical equipment as claimed in claim 8 or 9 is characterized in that the diameter of described filament is in 0.05mm to 1.0mm scope.
11. an electrosurgical equipment as claimed in claim 7 is characterized in that, a flat board with holes constitutes described tissue treatment electrodes, and each dull and stereotyped aperture constitutes such hole, and steam bubble and/or predetermined substance can be sucked out by them.
12. an electrosurgical equipment as claimed in claim 11 is characterized in that, the appearance of described flat board and form the recessed portion of contiguous described aperture.
13. one kind as claim 1 to 12 each described electrosurgical equipments, it is characterized in that described tissue treatment electrodes is made by tungsten.
14. one kind as each described electrosurgical equipment of claim 1 to 12, it is characterized in that described tissue treatment electrodes is made by the alloy of tungsten or platinum.
15. one kind as claim 2, or each described electrosurgical equipment when being subordinated to claim 2 of claim 3 to 14, it is characterized in that, also comprises the pipe that is positioned at the apparatus footstalk, with so that each aperture be connected with described pump.
16. an electrosurgical equipment as claimed in claim 15 is characterized in that, described pipe is the pipe of multi-cavity.
17. an electrosurgical equipment as claimed in claim 16 is characterized in that the pipe of described multi-cavity limits a plurality of passages, the diameter of each passage equals the diameter of each aperture in the tissue treatment electrodes zone at least.
18. an electrosurgical equipment as claimed in claim 15 is characterized in that, also comprises a filter at the end of described pipe.
19. an electrode unit is used for the tissue treatment under the conductive fluid medium situation, described electrode unit comprises a footstalk, at the one end end fitting that is used to link instrument handle is arranged; The other end at described footstalk is installed an electrode assemblie, and this electrode assemblie comprises tissue treatment electrodes and return electrode, and return electrode is by an insulating part and tissue treatment electrodes electric insulation; Described tissue treatment electrodes has bared end, is used for disposing tissue; Described return electrode has liquid contact surface, this face leaves certain interval with tissue treatment electrodes as follows, promptly stipulate the path of conductor fluid in use, between tissue treatment electrodes and return electrode, form circuit, a plurality of apertures are set wherein in the tissue treatment electrodes zone, for described electrode assemblie, steam bubble and/or predetermined substance are sucked out from the zone around the tissue treatment electrodes by these apertures.
20. one kind as claim 19 described electrode units, it is characterized in that, also comprise a pump, with so that the end portion of described apparatus footstalk is born pressure below atmospheric pressure, thereby in use by regional suck out vapour bubble and/or the predetermined substance of described aperture around the tissue treatment electrodes.
21. an electrode unit as claimed in claim 20 is characterized in that described pump starts in a looping fashion, thereby material is sucked out with pulse mode.
22. one kind as claim 20 or 21 described electrode units, it is characterized in that, described pump only is activated when tissue treatment electrodes is given energy in order to tissue vaporization.
23. one kind as each described electrode unit of claim 20 to 22, it is characterized in that also comprise a RF generator, it has the bipolar system outfan that links to each other with tissue treatment electrodes and return electrode.
24. an electrode unit as claimed in claim 23 is characterized in that, it is controlled that described pump is pressed the voltage output characteristics of RF generator.
25. an electrosurgical equipment, it comprises radio-frequency signal generator and be used for the electrosurgical equipment of tissue treatment under the conductive fluid medium situation; Described apparatus comprises the apparatus axis handle and at the electrode assemblie of this footstalk one end; Described electrode assemblie comprises tissue treatment electrodes and return electrode, and return electrode is by an insulating part and tissue treatment electrodes electric insulation; Described tissue treatment electrodes has bared end, is used for disposing tissue; Described return electrode has liquid contact surface, this face leaves certain interval with tissue treatment electrodes as follows, promptly limit the path of conductor fluid in use, between tissue treatment electrodes and return electrode, form circuit, and described radio-frequency signal generator has the bipolar outfan that links to each other with each electrode, a plurality of apertures are set wherein in the tissue treatment electrodes zone, for described electrode assemblie, steam bubble and/or predetermined substance are sucked out from the zone around the tissue treatment electrodes by these apertures.
26. electrosurgical equipment as claimed in claim 25, it is characterized in that, also comprise a pump, use, thereby in use steep and/or predetermined substance from the regional suck out vapour around the tissue treatment electrodes by described aperture so that the end portion of described apparatus footstalk is born pressure below atmospheric pressure.
27. electrosurgical equipment as claimed in claim 26 is characterized in that described pump starts in a looping fashion, thereby material is sucked out with pulse mode.
28. one kind as claim 26 or 27 described electrosurgical equipment, it is characterized in that, described pump only is activated when tissue treatment electrodes is given energy in order to tissue vaporization.
29. an electrosurgical equipment as claimed in claim 28 is characterized in that, it is controlled that described pump is pressed the voltage output characteristics of RF generator.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN 97195575 CN1222065A (en) | 1996-06-20 | 1997-06-17 | Under water treatment |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GB9612993.7 | 1996-06-20 | ||
| CN 97195575 CN1222065A (en) | 1996-06-20 | 1997-06-17 | Under water treatment |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN1222065A true CN1222065A (en) | 1999-07-07 |
Family
ID=5179244
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN 97195575 Pending CN1222065A (en) | 1996-06-20 | 1997-06-17 | Under water treatment |
Country Status (1)
| Country | Link |
|---|---|
| CN (1) | CN1222065A (en) |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN103932780A (en) * | 2013-01-17 | 2014-07-23 | 亚瑟罗凯尔公司 | Systems and methods for turbinate reduction |
| CN104161588A (en) * | 2013-05-17 | 2014-11-26 | 佳乐医疗设备有限公司 | Electrosurgical instrument and system |
| CN104334107A (en) * | 2012-06-01 | 2015-02-04 | 奥林巴斯医疗株式会社 | Energy-using treatment tool |
| CN104546124A (en) * | 2013-10-15 | 2015-04-29 | 佳乐医疗设备有限公司 | Electrosurgical electrode and instrument |
| CN105188586A (en) * | 2013-03-07 | 2015-12-23 | 亚瑟罗凯尔公司 | Electrosurgical systems and methods |
| US9788882B2 (en) | 2011-09-08 | 2017-10-17 | Arthrocare Corporation | Plasma bipolar forceps |
| CN107438411A (en) * | 2015-02-18 | 2017-12-05 | 美敦力施美德公司 | The tissue wound-cleaning device realized by RF energy |
| US11197714B2 (en) | 2015-02-18 | 2021-12-14 | Medtronic Xomed, Inc. | Electrode assembly for RF energy enabled tissue debridement device |
| US11737812B2 (en) | 2012-06-12 | 2023-08-29 | Medtronic Advanced Energy Llc | Debridement device and method |
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- 1997-06-17 CN CN 97195575 patent/CN1222065A/en active Pending
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US9788882B2 (en) | 2011-09-08 | 2017-10-17 | Arthrocare Corporation | Plasma bipolar forceps |
| CN104334107A (en) * | 2012-06-01 | 2015-02-04 | 奥林巴斯医疗株式会社 | Energy-using treatment tool |
| US11737812B2 (en) | 2012-06-12 | 2023-08-29 | Medtronic Advanced Energy Llc | Debridement device and method |
| CN103932780A (en) * | 2013-01-17 | 2014-07-23 | 亚瑟罗凯尔公司 | Systems and methods for turbinate reduction |
| CN107242902B (en) * | 2013-01-17 | 2020-05-12 | 亚瑟罗凯尔公司 | Systems and methods for turbinate reduction |
| CN107242902A (en) * | 2013-01-17 | 2017-10-13 | 亚瑟罗凯尔公司 | The system and method reduced for concha |
| CN105188586A (en) * | 2013-03-07 | 2015-12-23 | 亚瑟罗凯尔公司 | Electrosurgical systems and methods |
| US10004554B2 (en) | 2013-05-17 | 2018-06-26 | Gyrus Medical Limited | Electrosurgical instrument and system |
| CN104161588B (en) * | 2013-05-17 | 2018-05-25 | 佳乐医疗设备有限公司 | electrosurgical tool and system |
| CN104161588A (en) * | 2013-05-17 | 2014-11-26 | 佳乐医疗设备有限公司 | Electrosurgical instrument and system |
| CN104546124A (en) * | 2013-10-15 | 2015-04-29 | 佳乐医疗设备有限公司 | Electrosurgical electrode and instrument |
| CN107438411A (en) * | 2015-02-18 | 2017-12-05 | 美敦力施美德公司 | The tissue wound-cleaning device realized by RF energy |
| US11197714B2 (en) | 2015-02-18 | 2021-12-14 | Medtronic Xomed, Inc. | Electrode assembly for RF energy enabled tissue debridement device |
| US11207130B2 (en) | 2015-02-18 | 2021-12-28 | Medtronic Xomed, Inc. | RF energy enabled tissue debridement device |
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