CN1913840A - 电手术器械 - Google Patents
电手术器械 Download PDFInfo
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
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- A—HUMAN NECESSITIES
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/124—Generators therefor switching the output to different electrodes, e.g. sequentially
Abstract
一种双极电手术器械，其包括手柄(5)、与该手柄相连的本体(1)和夹爪组件(12)，该夹爪组件(12)与该本体相连并如此布置，以使得手柄的操作允许夹爪组件的相对的第一和第二夹爪(14和13)彼此相对地打开和闭合。第一夹爪(14)至少具有一个第一凝结电极，第二夹爪(13)至少具有一个第二凝结电极和通过绝缘件(17)与第二凝结电极隔离的切割电极(16)。该器械在手术位置如此操作，以使得夹爪组件(12)的夹爪(14和13)彼此相对地打开，且切割电极(16)与第一和第二凝结电极中的至少一个在手术位置与组织接触。在切割电极(16)和至少一个凝结电极之间供给射频电手术信号，并且在将夹爪(13，14)保持在其打开位置的同时移动电手术器械，以便在手术位置切割组织。
Description
技术领域
本发明涉及电手术器械、用于切割组织的电手术系统以及电手术切割组织的方法。
背景技术
电手术切割钳子是电外科手术中通常使用的工具。美国专利5,445,638为一典型的例子，其中一对夹爪被用于夹紧和凝结组织，并且随后一机械切割刀片在夹爪之间移动，以便切割组织。US 6,554,829为这种器械更为近期的型式，其仍然采用一对夹爪和一机械切割刀片。
一种替换形式的切割钳子使用了与机械切割元件相对的电手术切割元件。US 6,174,309为一种这样的例子，其中组织夹紧在夹爪之间，并且随后电手术切割电压被供给至位于夹爪之一上的切割元件。在所有这些装置中，能够被切割的组织量被在组织被切割的同时用于将其夹紧的夹爪的尺寸所限制。
发明内容
本发明试图提供一种对这些现有技术的切割装置的改进，特别是使较大数量的组织切割变得更为方便。
因此，本发明提供了一种在手术位置电手术切割组织的方法，该方法包括以下步骤：
(i)提供双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离；
(ii)在所述手术位置操作所述电手术器械，以使得所述夹爪彼此相对地打开，并且所述切割电极和所述第一和第二凝结电极中的至少一个在所述手术位置与组织接触；
(iii)在所述切割电极和所述至少一个凝结电极之间供给射频电手术信号；以及
(iv)在将所述夹爪保持在其打开位置的同时移动所述电手术器械，以便在所述手术位置切割组织。
与只有夹紧在夹爪之间的组织被切割的现有技术中的装置不同，本发明的方法移动所述器械，并且其夹爪处于“打开”位置，以便导致组织切割。优选地，该电手术器械具有纵向轴线，并且该器械沿所述轴线纵向移动，以便在手术位置切割组织。便利的是，第一夹爪具有与第二夹爪相对的内表面，并且切割电极定位在所述第一夹爪的内表面上。在一便利配置中，切割电极包括纵向延伸的导轨。
本发明的方法还允许电手术器械被用于凝结和切割组织。因此，该方法包括操作手柄以便闭合夹爪组件从而使得位于手术位置的组织夹紧在它们之间以及在第一和第二凝结电极之间供给射频电手术信号以便使夹紧在夹爪之间的组织凝结的附加步骤。在一种配置中，凝结步骤在所述器械运动以便在手术位置切割组织之后进行。这样，所述器械可以被用于控制由组织切割造成的任何流血。
可选地，该方法包括提供由第一切割射频(RF)信号和第二凝结射频(RF)信号构成的组合射频信号的步骤，所述第一射频切割信号在切割电极和至少一个凝结电极之间输送，并且第二凝结射频信号在第一和第二凝结电极之间输送。这样，所述器械能够随着组织通过器械的运动被切割同时向所述组织输送凝结信号。在一优选配置中，组合射频信号包括在第一切割射频信号和第二凝结射频信号之间不断交替的混合信号，因此所述两个信号交错或轮流使用。同样便利的是，提供用于改变混合模式的比率的调节装置，以与混合信号中的第二射频凝结信号相比改变混合信号中的第一射频切割信号。所述调节装置可由电手术器械的使用者方便地手动操作，但是可选地也可响应于来自一个或多个检测组织的参数(诸如电阻抗)的传感器的反馈被自动调节。
对于术语“射频(RF)切割信号”和“射频(RF)凝结信号”，其意味着能够分别切割或凝结组织的任何射频(RF)信号。例如，所述信号可以根据它们的电压而不同，具有较高电压的射频切割信号使得其能够切割组织，而具有较低电压的射频凝结信号使得其能够凝结而不是切割组织。另外或可选地，射频切割信号可以就其波形而非电压不同于射频凝结信号。例如，射频凝结信号可以包括用于组织切割的同一信号的更短的脉冲。
在使用术语“凝结的”或“凝结”之处，其意味着在组织切割操作之后防止流血，以及将组织内部的胶原蛋白制成粘性的以防止血液在例如切割之前流过血管的过程。该术语在此还意味着包括血管密封，其中血管壁熔合在一起，以便密封血管。
本发明还提供一种电手术系统，包括：
(i)双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离；以及
(ii)电手术发生器，其包括一个或多个射频输出功率源和控制器，该控制器可操作地控制所述发生器，从而使得其能够为所述电手术器械提供第一切割射频信号或者为所述电手术器械提供第二凝结射频信号，并且在组合模式下输送第一和第二射频信号，所述信号被供应给电手术器械，从而使得在组合模式下，切割信号在切割电极和第一和第二凝结电极中的至少一个之间输送，并且凝结射频信号在第一和第二凝结电极之间输送。
如我们的共同未审英国专利申请0305018.4中所述，该发生器可以包括单个射频源，从而使得在组合模式下，该发生器系统在输送切割和凝结信号之间不断交替。可选地，该发生器包括以不同频率工作的第一和第二射频源，从而同时输送切割和凝结信号。如上述专利申请中所述，可以设想提供用于改变组合模式的比率的调节装置，以与组合信号中的第二射频凝结信号部分相比改变组合信号中的第一射频切割信号部分。便利的是，所述调节装置可由电手术器械的使用者手动操作，但是也可设想，其可以响应于来自一个或多个检测组织的参数(诸如电阻抗)的传感器的反馈被自动调节。
本发明还提供了一种双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合；所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极；并且一切割电极安装在第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离，其中所述切割电极呈安装在所述绝缘件上的纵向导轨的形式，所述导轨从所述绝缘件伸出小于100微米的距离。
已经发现，所述导轨的尺寸对于确保有效的电手术切割来说非常重要。优选地，所述导轨从绝缘件伸出25和75微米之间、更优选为40和60微米之间、并且最优选大致为50微米的距离。优选地，所述导轨的宽度在25和75微米之间，更优选为40和60微米之间，并且最优选地大致为50微米。
根据本发明的另一方面，一种在手术位置电手术切割组织的方法包括以下步骤：
(i)提供双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离，
(ii)提供电手术发生器，其包括一个或多个射频输出功率源和控制器，该控制器可操作地控制所述发生器，从而使得其能够为所述电手术器械提供第一切割射频信号或者为所述电手术器械提供第二凝结射频信号，并且在组合模式下输送第一和第二射频信号，所述信号被供应给电手术器械，从而使得在组合模式下，切割信号在切割电极和第一和第二凝结电极中的至少一个之间输送，并且凝结射频信号在第一和第二凝结电极之间输送，
(iii)在手术位置操作所述电手术器械，以使得所述夹爪组件的夹爪彼此相对地打开，
(iv)闭合所述夹爪组件的夹爪，以使得位于目标位置的组织容纳在它们之间，
(v)从所述电手术发生器向所述电手术器械供给组合射频电手术信号，
(vi)通过所述夹爪组件向所述组织施加第一、相对低的压力，以使保持在其间的组织凝结，以及
(vii)通过所述夹爪组件向所述组织施加第二、相对较高的压力，以导致所述组织的切割。
附图说明
现在将参照附图仅以举例的方式对本发明进行进一步的描述，其中：
图1为根据本发明构造的内窥镜检查电手术器械的示意性剖视图；
图2为图1所示器械的夹爪组件的透视图；
图3为图1所示器械的本体的横截面视图；
图4为图2所示夹爪组件的端视图；
图5为图2所示夹爪组件的侧视图；
图6为与图1所示电手术器械一起使用的开关电路的电路图；
图7为在打开过程中使用并根据本发明构造的电手术器械的可选实施例的示意性侧视图；
图8为图7所示器械的夹爪之一的一部分的放大图；
图9为图7所示器械的夹爪之一的剖开端视图；以及
图10为图7所示器械的另一夹爪的剖开端视图。
具体实施方式
参考图1，一双极钳子装置包括细长管状轴1，该管状轴1具有近端2、远端3和沿管状件的整个长度延伸的管腔4。具有第一手柄6和第二手柄7的剪刀型手柄组件5位于管状件1的近端2处。第二手柄7可围绕枢销8相对于第一手柄6枢转。在已知设计的致动机构中，第二手柄7具有固定于其顶部的销9，以使得所述手柄的运动造成支撑在U形托架11中的球体10的相应运动。
钳子夹爪组件12、尤其是图2中所示的夹爪组件安装到管状件1的远端3中。夹爪组件12包括通过绝缘铆钉15可枢转地彼此连接的第一夹爪元件13和第二夹爪元件14。
夹爪元件13设置有通过陶瓷绝缘子17与其隔离的相对长但窄的切割电极16。如图3所示，三个刚性导电杆18，19和20延伸穿过管状件1的管腔4，每个导电杆覆盖有电绝缘层。杆18，19通过刚性连杆21可枢转地与相应的夹爪元件13，14相连，同时杆20通过导线24(如图5中最佳地显示)与切割电极16相连。杆18，19和20的近端从管状件1穿过球体10延伸并终止于连接器22中，借此所述装置可以与电手术发生器26相连。
如图2所示，切割电极16呈细长导轨的形式，并沿夹爪元件13的长度延伸。导轨16安装在陶瓷绝缘子17的顶部，以使得其与导电夹爪元件13绝缘。导轨16的宽度典型地为50至100微米，并且从陶瓷绝缘子17伸出大约50微米的距离。如图4中最佳地显示，当夹爪组件12处于其闭合位置时，导轨16容纳于夹爪元件14中的相应纵向凹槽23内。由绝缘材料制成的可压缩带27设置在凹槽23中。
现在将描述该装置的操作。当将要切割组织时，夹爪组件12靠近待切割组织，并且夹爪组件位于其打开位置，且所述组织定位在夹爪组件的夹隙(钳口)25中。来自电手术发生器26的切割信号经由杆20被供应给切割电极16，并且该钳子装置沿图5中所示箭头的方向纵向移动。跨接切割电极16和夹爪元件13和14中的一个或两个的组织在所述装置纵向平移时通过电手术信号切断，从而在组织中形成连续行进的纵向切割线。夹爪组件12在整个过程中保持在其打开位置，并界定出将所述组织约束于其中的夹隙25。
该装置还可以按照更传统的方式利用处于闭合位置的夹爪组件12来凝结组织。夹爪组件12被闭合，从而将组织夹紧在夹爪元件13和夹爪元件14之间。切割导轨16容纳在凹槽23中，并且没有前面描述的电手术切割信号，在位于其间的组织上没有切割作用。来自电手术发生器26的凝结信号经由杆18和19在夹爪元件13和14之间供给。这使保持在夹爪13和14之间的组织凝结。
所述装置还可以按照如我们的共同未审英国专利申请0305018.4中所描述的混合切割和凝结模式使用。图6中示出了提供这种配置的电路的例子。该电路总体上以附图标记30表示，并且可以被设置作为发生器26的输出级的一部分、作为钳子器械的一部分、或者作为位于所述发生器和器械之间的分离单元。不论采用哪种配置，输入接线31和32与发生器26的输出相连，并且输出接线33和34与杆18和19相连，并因此与夹爪元件13和14相连。输出接线35与杆20相连，并且因此与切割电极16相连。
在输入接线31和32之间存在桥接电路，其包括第一变压器36和第二变压器37。第一变压器36包括初级绕组38和次级绕组39。开关元件40设置为与初级绕组38并联。第二变压器37包括初级绕组41和次级绕组42。开关元件43设置为与初级绕组41并联。所述开关元件40和43由控制单元44控制。
第二变压器37为降压器，其中次级绕组42本身相对于跨接输出接线33和34的另一个中心抽头次级绕组45为初级绕组。隔离电容器46设置在桥接电路和输出接线35之间，并且隔离电容器47和48设置在桥接电路和输出接线33和34之间。
该电路的工作过程如下。在预定时间内，控制单元44操作开关43，以闭合并提供跨接第二变压器37的初级绕组41的短路。在该配置中，由于次级变压器37有效短路，发生器26的输出在输出接线35和两个输出接线33和34之间引导。与有效地作为电手术切割操作的回路电极的夹爪元件13和14相比，这具有利用切割电压使切割导轨16通电的作用。
在预定时间后，控制单元44工作，以打开开关43并随后闭合开关40，以提供跨接第一变压器36的初级绕组38的短路。在开关43的打开和开关40的闭合之间存在短暂的预定延迟，以确保两个开关从来不同时闭合(因为这将提供横跨发生器26的输出接线的短路)。随着开关40的闭合，第一变压器30有效地短路，并且发生器26的输出完全导向第二变压器37。第二变压器37为降压器，并且提供了输出接线33和34之间的较低电压信号。这具有利用凝结电压使第一和第二夹爪元件13和14通电的作用。
在预定时间后，控制单元44打开开关40并随后关闭开关43，从而返回到最初描述的配置状态，其中切割电压被输送至切割导轨16。通过在此处所描述的两种状态之间的不断交替，所述电路为与其相连的钳子提供了快速交替的切割和凝结信号。这样，该钳子装置能够以如上所述方式切割组织，并同时凝结组织，以便减少流血。
尽管图1至5的钳子装置被显示为内窥镜检查器械，但是如将参照图7-10所述那样，本发明也可以应用于开放器械中。该器械总体上以附图标记50表示，其包括两个利用枢销53安装以便进行枢转运动的纵向元件51和52。所述元件51的近端呈手柄部分54的形式，并且所述元件52的近端呈手柄部分55的形式。棘轮机构56设置在每个手柄部分54，55上，以用于当它们一起移动到闭合位置时将手柄部分锁定。
在枢轴53的远端，纵向元件51形成夹爪元件57，而纵向元件52形成夹爪元件58。手柄部分54和55的运动导致夹爪元件57和58打开和闭合。
参见图8和9，夹爪元件57包括整体基部59，该基部59上安装有垫片元件60，其通过夹子74固定于其上。垫片元件60包括由金属表面电极62覆盖的绝缘带61。切割电极组件63安装在沿夹爪元件57纵向延伸的凹槽64中。切割电极组件63包括典型地由陶瓷材料制成的凸出绝缘体挡块65和安装在绝缘体挡块中的另一纵向凹槽内的切割电极66。切割电极66的宽度典型地为100微米，并且从绝缘体挡块65伸出大约425微米的距离。
相对的夹爪元件58(图10中示出)也包括基部67和垫片元件68。垫片元件68也包括由金属表面电极70覆盖的绝缘带69。垫片元件68包括中心凹槽71，当夹爪元件57和58位于其闭合位置时，夹爪元件57的切割电极组件63可以容纳在所述凹槽中。在凹槽71的底部具有由诸如弹性体的弹性材料制成的带72，从而使得在夹爪元件57和58彼此抵靠而闭合时，切割电极66抵靠着所述带。安装在夹爪之一上的止动件73调节夹爪在处于闭合位置时的隔离情况。
现在将描述器械50的操作。首先，如前所述，该器械可以用于切割组织。夹爪元件57和58保持在其打开位置，并且组织在夹爪元件之间被操纵。电手术切割信号被供应给切割电极66，并且器械50纵向移动，从而随着器械前进而沿着纵向切割线切断组织。表面电极62和70作为电手术切割信号的回路电极。
在第二种技术中，组织可以利用两步法切割。夹爪元件57和58移动到其闭合位置，从而将待切割组织夹紧于它们之间。随后，在表面电极62和70之间提供第一凝结射频信号，以使得保持在夹爪元件57和58之间的组织凝结。在不松开组织的情况下，第二切割射频信号接着被供应给切割电极66，从而导致由夹爪元件57和58保持的组织被切割。
最后，在另一技术中，如参照图6所述，可以利用使用混合信号的方法凝结和/或切割组织。在该配置中，将在射频凝结信号和射频切割信号之间不断交替的信号供应给夹爪元件58，在表面电极62和70之间供给射频凝结信号，射频切割信号被供应给切割电极66，并且所述表面电极作为回路。交替的射频信号对所述组织的作用由通过夹爪元件57和58施加给组织的压力确定。器械50的使用者闭合夹爪元件57和58，以将组织夹紧在其中。当通过夹爪施加的压力处于第一、相对低的水平时，交替的射频信号的主要作用是使保持在夹爪元件57和58之间的组织凝结。当所述器械的使用者希望切断保持在夹爪元件57和58之间的组织时，使用者将由夹爪施加的压力增加到第二、相对较高的水平。在该相对较高水平的压力下，交替的射频信号的主要作用是使保持在夹爪元件57和58之间的组织被切割。这样，器械50的使用者能够仅仅通过改变由夹爪57和58施加给组织的压力在组织的凝结和切割之间切换。
此处所描述的装置可以在具有或不具有凝结过程的切割组织的切割技术中使用，其中钳子装置被移动并且其夹爪保持在打开状态，并且切割导轨在所述装置沿纵向方向移动时发生作用，以切割组织。尽管同时适用于开放和腹腔镜检查手术，这种技术在其中夹爪的过度打开和闭合将要避免或很难实现的腹腔镜检查手术中尤为有利。同样还描述了在两步法中凝结和切割组织的技术，其中组织首先凝结并随后利用保持在闭合位置的夹爪切断。一种技术利用了由夹爪施加的压力，以调节组织凝结和切割的器械作用是否是主要的。
本发明已经在此被非常详细地进行了描述，以便为本领域的技术人员提供应用该新型原理并且根据需要构造并使用这些特定部件的必要知识。然而，应当理解，本发明可以通过由特定的不同设备和装置实施，并且可以在不脱离本发明范围的情况下实现与设备和操作程序相关的各种改进。
Claims (21)
1.一种电手术系统，其包括：
(i)双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极；所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在所述第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离；以及
(ii)电手术发生器，其包括一个或多个射频输出功率源和控制器，该控制器可操作地控制所述发生器，从而使得其能够为所述电手术器械提供第一切割射频信号或者为所述电手术器械提供第二凝结射频信号，并且在组合模式下输送第一和第二射频信号，所述信号被供应给所述电手术器械，从而使得在所述组合模式下，所述切割信号在所述切割电极和所述第一和第二凝结电极中的至少一个之间输送，并且所述凝结射频信号在所述第一和第二凝结电极之间输送。
2.如权利要求1所述的系统，其特征在于，还包括用于改变所述组合模式的比率的调节装置，以与所述组合信号中的第二射频凝结信号部分相比改变所述组合信号中的第一射频切割信号部分。
3.如权利要求2所述的系统，其特征在于，所述调节装置可由所述电手术器械的使用者手动操作。
4.如权利要求2所述的系统，其特征在于，所述调节装置响应于来自一个和多个检测所述组织的参数的传感器的反馈被自动调节。
5.如权利要求4所述的系统，其特征在于，所述组织的参数为其电阻抗。
6.一种双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在所述第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离，其中所述切割电极呈安装在所述绝缘件上的纵向导轨的形式，所述导轨从所述绝缘件伸出小于100微米的距离。
7.如权利要求6所述的器械，其特征在于，所述导轨从所述绝缘件伸出25和75微米之间的距离。
8.如权利要求7所述的器械，其特征在于，所述导轨从所述绝缘件伸出40和60微米之间的距离。
9.如权利要求8所述的器械，其特征在于，所述导轨从所述绝缘件伸出大致50微米的距离。
10.如权利要求6至9中任何一项所述的器械，其特征在于，所述导轨的宽度在25和75微米之间。
11.如权利要求10所述的器械，其特征在于，所述导轨的宽度在40和60微米之间。
12.如权利要求11所述的器械，其特征在于，所述导轨的宽度大致为50微米。
13.一种在手术位置电手术切割组织的方法，其包括以下步骤：
(i)提供双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在所述第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离；
(ii)在所述手术位置操作所述电手术器械，以使得所述夹爪彼此相对地打开，并且所述切割电极和所述第一和第二凝结电极中的至少一个在所述手术位置与组织接触；
(iii)在所述切割电极和所述至少一个凝结电极之间供给射频电手术信号；以及
(iv)在将所述夹爪保持在其打开位置的同时移动所述电手术器械，以便在所述手术位置切割组织。
14.如权利要求13所述的方法，其特征在于，所述第一夹爪具有与所述第二夹爪相对的内表面，并且所述切割电极定位在所述第一夹爪的内表面上。
15.如权利要求13或14所述的方法，其特征在于，所述电手术器械具有纵向轴线，并且所述器械沿所述轴线纵向移动，以便在所述手术位置切割组织。
16.如权利要求15所述的方法，其特征在于，所述切割电极包括纵向延伸的导轨。
17.如权利要求13至16中任何一项所述的方法，其特征在于，还包括操作所述手柄以便闭合所述夹爪组件从而使得位于手术位置的组织被夹紧于它们之间以及在所述第一和第二凝结电极之间供给射频电手术信号以便使夹紧在所述夹爪之间的组织凝结的附加步骤。
18.如权利要求17所述的方法，其特征在于，所述附加步骤在所述器械运动以便在所述手术位置切割组织之后进行。
19.如权利要求13至16中任何一项所述的方法，其特征在于，还包括供给由第一切割射频信号和第二凝结射频信号构成的组合射频信号的步骤，所述第一射频切割信号在所述切割电极和所述至少一个凝结电极之间输送，并且所述第二凝结射频信号在所述第一和第二凝结电极之间输送。
20.如权利要求19所述的方法，其特征在于，所述组合射频信号包括在所述第一切割射频信号和所述第二凝结射频信号之间不断交替的信号。
21.一种在手术位置电手术切割组织的方法，该方法包括以下步骤：
(i)提供双极电手术器械，其包括手柄和夹爪组件，所述夹爪组件如此布置，以使得所述手柄的操作允许所述夹爪组件的相对的第一和第二夹爪彼此相对地打开和闭合，所述第一夹爪至少具有一个第一凝结电极，所述第二夹爪至少具有一个第二凝结电极，并且一切割电极安装在第一和第二夹爪之一上并通过绝缘件与该夹爪的凝结电极隔离，
(ii)提供电手术发生器，其包括一个或多个射频输出功率源和控制器，该控制器可操作地控制所述发生器，从而使得其能够为所述电手术器械提供第一切割射频信号或者为所述电手术器械提供第二凝结射频信号，并且在组合模式下输送第一和第二射频信号，所述信号被供应给所述电手术器械，从而使得所述在组合模式下，所述切割信号在所述切割电极和所述第一和第二凝结电极中的至少一个之间输送，并且所述凝结射频信号在所述第一和第二凝结电极之间输送，
(iii)在所述手术位置操作所述电手术器械，以使得所述夹爪组件的夹爪彼此相对地打开，
(iv)闭合所述夹爪组件的夹爪，以使得位于目标位置的组织容纳在它们之间，
(v)从所述电手术发生器向所述电手术器械供给组合射频电手术信号，
(vi)通过所述夹爪组件向所述组织施加第一、相对低的压力，以使保持在其间的组织凝结，以及
(vii)通过所述夹爪组件向所述组织施加第二、相对较高的压力，以导致所述组织的切割。
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| CN103096829A (zh) * | 2010-09-17 | 2013-05-08 | 蛇牌股份公司 | 用密封增强组合物增强的电外科组织密封 |
| CN103096829B (zh) * | 2010-09-17 | 2016-05-04 | 蛇牌股份公司 | 用密封增强组合物增强的电外科组织密封 |
| CN103764058A (zh) * | 2011-08-23 | 2014-04-30 | 蛇牌股份公司 | 电外科装置及其制造和使用方法 |
| CN106562821A (zh) * | 2015-08-21 | 2017-04-19 | 爱尔博电子医疗仪器股份有限公司 | 具有改进的控制的凝结和解剖器械 |
| CN106562821B (zh) * | 2015-08-21 | 2020-12-18 | 爱尔博电子医疗仪器股份有限公司 | 具有改进的控制的凝结和解剖器械 |
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| CN108430366A (zh) * | 2015-12-30 | 2018-08-21 | 伊西康有限责任公司 | 分阶段施加电外科和超声能量的外科器械 |
| CN108430366B (zh) * | 2015-12-30 | 2021-10-15 | 伊西康有限责任公司 | 分阶段施加电外科和超声能量的外科器械 |
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Also Published As
| Publication number | Publication date |
|---|---|
| AU2005207652A1 (en) | 2005-08-11 |
| EP1711116B1 (en) | 2010-07-28 |
| ATE475370T1 (de) | 2010-08-15 |
| US7204835B2 (en) | 2007-04-17 |
| DE602005022550D1 (de) | 2010-09-09 |
| WO2005072634A2 (en) | 2005-08-11 |
| US20050171533A1 (en) | 2005-08-04 |
| EP1711116A2 (en) | 2006-10-18 |
| US20070299439A1 (en) | 2007-12-27 |
| EP2191781A1 (en) | 2010-06-02 |
| WO2005072634A3 (en) | 2005-11-24 |
| PL1711116T3 (pl) | 2011-01-31 |
| AU2005207652B2 (en) | 2010-08-26 |
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