DE4017626C2 - - Google Patents
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- Publication number
- DE4017626C2 DE4017626C2 DE4017626A DE4017626A DE4017626C2 DE 4017626 C2 DE4017626 C2 DE 4017626C2 DE 4017626 A DE4017626 A DE 4017626A DE 4017626 A DE4017626 A DE 4017626A DE 4017626 C2 DE4017626 C2 DE 4017626C2
- Authority
- DE
- Germany
- Prior art keywords
- blood vessel
- bipolar
- gripping arms
- resin adhesive
- coagulation instrument
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
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Classifications
-
- 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
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
-
- 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
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1402—Probes for open surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/282—Jaws
- A61B2017/2825—Inserts of different material in jaws
-
- 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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
-
- 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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
-
- 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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
- A61B2018/00119—Coatings on the energy applicator with metal oxide nitride
-
- 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
- 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
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/143—Needle multiple needles
-
- 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
- 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
- A61B18/14—Probes or electrodes therefor
- A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
Description
Die Erfindung geht aus von einem bipolaren Blutgefäßkoagulationsin
strument, bestehend aus einem Paar von leitfähigen Greifarmen,
die mit einer elektrischen Hochfrequenzleistungsquelle verbun
den sind, wobei ein Blutgefäß zwischen Blutgefäßhalteabschnit
ten gehalten wird, die sich an den distalen Endteilen der
Greifarme befinden.
Dieses Blutgefäßkoagulationsinstrument kann insbesondere wäh
rend chirurgischen Gehirnnervenoperationen, orthopädischen
chirurgischen Operationen und allgemeinen chirurgischen Opera
tionen zum Stoppen von Bltutungen aus Blutgefäßen verwendet wer
den.
In einem konventionellen bipolaren Blutgefäßkoagulationsinstru
ment wird Hochfrequenzstrom verwendet. Insbesondere gibt es eine
Anzahl solcher konventioneller Blutgefäßkoagulationsinstru
mente, bei denen ein Funkenstreckenverfahren angewandt wird, um
Hochfrequenz im Bereich von 0,5 bis 3 MHz zu erzeugen. Die bei
den als Elektroden (aktive und inaktive Elektrode) ausgebilde
ten Blutgefäßhalteabschnitte sind an den beiden Enden eines
Paars von Greifarmen vorgesehen, die mittels der Hand zu halten
sind. Elektrischer Strom fließt nur durch dasjenige lebende Ge
webe, das zwischen den Enden der Greifarme gehalten wird. Da
eine elektrische Schädigung bei einem Patienten nur an einem
beschränkten Teil, der koaguliert werden soll, ausgeübt wird,
kann ein Auslaufen eines Blutgefäßes vollständig gestoppt wer
den, ohne daß andere Gewebe geschädigt werden. Genauer gesagt,
wird die Blutstillungswirkung des Blutgefäßkoagulationsinstru
mentes durch Koagulieren des Blutgefäßes unter Anwenden von lo
kalisierter Erhitzung erzielt, die durch den Hochfrequenzstrom
bewirkt wird, welcher durch das lebende Gewebe fließt.
Ein bipolares Blutgefäßkoagulationsinstrument der eingangs ge
nannten gattungsgemäßen Art ist aus dem DE 86 31 723 U1 be
kannt. Bei diesem Blutgefäßkoagulationsinstrument sind die
Greifarme einschließlich der Blutgefäßhalteabschnitte derselben
jeweils durchgehend aus einem elektrisch leitfähigem Material
hergestellt, bei dem es sich, da nichts Näheres darüber ausge
sagt ist, um ein übliches Material, vermutlich rostfreien
Stahl, handelt. Titan, das leicht und korrosionswiderstandsfä
hig ist, wird derzeit auch verwendet. Da diese Greifarme, die
aus Metall hergestellt sind, eine hohe thermische Leitfähigkeit
haben, haben sie die Tendenz, Wärme leicht zu leiten. Auf Grund
dieser Tendenz wird die Wärme eines lokal erhitzten Blutgefäßes
auf die Greifarme rückübertragen. Da ein Paar von Greifarmen
vorhanden ist, nimmt die Temperatur an den vorderen Endteilen
der Greifarme allmählich zu. Das bewirkt eine Verbrennung des
Blutgefäßes zwischen den von den Enden der Greifarme gebildeten
Blutgefäßhalteabschnitten. Als Ergebnis hiervon kommt es dazu,
daß ein Teil des Blutgefäßes an den Enden der Greifarme anklebt
und anhaftet. Die hierbei wirkende Kleb- oder Haftkraft ist
größer als die Koagulationskraft des Blutgefäßes. Wenn daher
die Enden der Greifarme voneinander getrennt werden, nachdem
das Blutgefäß koaguliert worden ist, kommt es oft dazu, daß der
Koagulationsteil des Blutgefäßes abgetrennt und entfernt wird.
Das hat zur Folge, daß das Blutgefäß reißt und führt zu einem
Defekt beim Stoppen der Blutung, insbesondere führt es oft dazu,
daß ein solches Stoppen der Blutung nicht erreicht wird.
Außerdem muß die angebrannte oder verbrannte Substanz, die an
den Blutgefäßhalteabschnitten der Greifarme anklebt und anhaf
tet, abgeschabt werden, und die Blutgefäßhalteabschnitte müssen
für den nachfolgenden Gebrauch oft in mühsamer Weise gereinigt
werden. Weiterhin verursacht diese Abschab- und Schleifarbeit,
mit der die angebrannte und verbrannte Substanz von den Blutge
fäßhalteabschnitten entfernt wird, unzweckmäßige Schwierigkei
ten, nämlich insbesondere Änderungen in den Formen der Blutge
fäßhalteabschnitte und eine Verminderung in der Genauigkeit der
Blutgefäßhalteabschnitte, insbesondere hinsichtlich ihres Zu
sammenpassens und ihrer Handhabung sowie ihrer Greifgenauig
keit.
Aufgabe der Erfindung ist es, ein bipolares Blutgefäßkoagula
tionsinstrument der gattungsgemäßen Art so auszubilden, daß
damit ein vollständiges Stoppen von Blutungen ohne die Gefahr
eines Aufreißens des Blutgefäßes auf Grund eines Anklebens und
Anhaftens von angebrannten und/oder verbrannten Gewebe beim
Wegziehen des Blutgefäßkoagulationsinstruments erzielt wird.
Diese Aufgabe wird erfindungsgemäß dadurch gelöst, daß der
Blutgefäßhalteabschnitt aus einem Blutgefäßkontaktteil besteht,
welches aus einer elektrisch isolierenden gesinterten Substanz
mit einer niedrigen Wärmeleitfähigkeit hergestellt ist, und daß
das Blutgefäßkontaktteil auf seiner Oberfläche mit hervorragen
den oder freiliegenden Elektroden, die mit dem Greifarm elek
trisch verbunden sind, in einem Flächenanteil von 5% bis 60%
bezogen auf die Oberfläche des Blutgefäßkontaktteils versehen
ist.
Die elektrisch isolierende gesinterte Substanz, wie insbeson
dere Zirkondioxidkeramik, mit einer niedrigen Wärmeleitfähig
keit hat sich als äußerst wirksames Mittel zum Verhindern des
Anbrennens und Verbrennens und des Anklebens und Anhaftens von
lebenden Geweben an den Blutgefäßhalteabschnitten erwiesen, in
Verbindung mit dem es durch die auf der Oberfläche des Blutge
fäßkontaktteils hervorragenden oder freiliegenden und in be
schränktem Flächenanteil vorgesehenen Elektroden verhindert
wird, daß ein unerwünschter Temperaturanstieg bei der Benutzung
des erfindungsgemäßen Blutgefäßkoagulationsinstruments statt
findet und Wärme von einem Blutgefäß zu den Enden der Greifarme
in merklichem Umfang übertragen wird, so daß auf diese Weise
ein vollständiges Stoppen der Blutungen erzielt wird, ohne daß
die Gefahr eines Aufreißens des Blutgefäßes auf Grund eines An
klebens und Anhaftens von angebranntem und verbranntem Gewebe
beim Wegziehen des Blutgefäßkoagulationsinstruments besteht.
Weiterbildungen der Erfindung sind in den Unteransprüchen ange
geben.
Die Erfindung sei nachstehend an Hand einiger in den Figuren der
Zeichnung dargestellter, bevorzugter Ausführungsformen näher
beschrieben und erläutert; es zeigt
Fig. 1 den Gesamtaufbau einer Ausführungsform eines bipola
ren Blutgefäßkoagulationsinstruments nach der vorlie
genden Erfindung;
Fig. 2 eine gegenüber Fig. 1 vergrößerte perspektivische
Teilansicht der in Fig. 1 angedeuteten Enden A der
Greifarme des Blutgefäßkoagulationsinstruments.
Fig. 3 eine gegenüber der Fig. 2 vergrößerte Vertikal
schnitt-Seitenansicht des Endes eines Greifarms, der
das in Fig. 2 gezeigte Blutgefäßkontaktteil auf
weisr;
Fig. 4 eine gegenüber Fig. 3 vergrößerte perspektivische
Teilansicht des Endes des Greifarms einer weiterent
wickelten Ausführungsform eines Blutgefäßkoagula
tionsinstruments gemäß der Erfindung; und
Fig. 5 eine Schnittansicht eines Schnitts längs der Linie
V-V in Fig. 4.
Es sei zunächst auf Fig. 1 Bezug genommen, die den Gesamtauf
bau einer Ausführungsform eines bipolaren Blutgefäßkoagula
tionsinstruments zeigt. Ein Paar Greifarme 1 dienen dazu, ein
Blutgefäß B zu halten und zu koagulieren, um das Auslaufen von
Blut zu stoppen. Die Griffabschnitte der Greifarme 1 sind mit
einer isolierenden Beschichtung S bedeckt. Die Enden A der
Greifarme 1, die in Fig. 2 vergrößert dargestellt sind, beste
hen aus einem Paar von Blutgefäßhalteabschnitten 10, die beson
ders bevorzugt aus rostfreiem Stahl oder Titan hergestellt
sind. Die innenseitige Oberfläche des Blutgefäßhalteabschnitts
10, welche das jeweilige Blutgefäß B aktuell kontaktiert, be
steht aus einem Blutgefäßkontaktteil 10a, das aus einer elek
trisch isolierenden gesinterten Substanz hergestellt ist. Auf
dem Blutgefäßkontaktteil 10a sind freiliegende Elektroden 10b
vorgesehen, die aus leitfähigem Harzklebstoff zusammengesetzt
oder ausgebildet sind. Mit 2 ist eine Hochfrequenzleistungs
quelle bezeichnet, die dazu dient, Hochfrequenzstrom zu erzeu
gen. Die Leistung der Hochfrequenzleistungsquelle 2 wird den
Greifarmen 1 über ein flexibles Kabel 4 zugeführt und mittels
eines Fußschalters 3 ein- ausgeschaltet. Als leitfähiger
Harzklebstoff wurde in einer besonders bevorzugten Ausführungs
form des Blutgefäßkoagulationsinstruments das unter der Han
delsbezeichnung "DOTITE" vertriebene leitfähige Harz verwendet,
welches von der Firma Fujikura Chemical Co., Ltd. hergestellt
wird. Dieser leitfähige Harzklebstoff enthält Silberpulver ho
her Reinheit als leitfähigen Füllstoff und in hohem Maße wärme
widerstandsfähiges Epoxyharz. Die Eigenschaften des Klebstoffs
sind in der nachfolgenden Tabelle 1 aufgeführt.
Gehalt | |
Silberpulver, Epoxyharz, Härtungsmittel | |
Aussehen | silberweiße Paste |
Viskosität | 30 bis 50 Ns/m² (300 bis 500 Poise) (Viscotester VT-02) |
spezifisches Gewicht | 2,7 (Wichte-Prüfbecherverfahren) |
spezif. Widerstand | 5,0 × 10-4 Ω-cm oder weniger |
Adhäsionsfestigkeit | 73,58 bar (75 kg/cm²) (Zug-/Scherfestigkeit nach JIS K6850, Cu-Cu) |
Das Blutgefäßkontaktteil 10a ist aus einer elektrisch isolie
renden gesinterten Substanz (Keramik) hergestellt, wie bei
spielsweise Zirkondioxid. Die gesinterte Substanz ist in hohem
Maße korrosionswiderstandsfähig oder korrosionsfest und sehr
hart. Die Wärmeleitfähigkeit einer gesinterten Zirkondioxidsub
stanz beträgt zum Beispiel 0,0376 J·cm/cm²·sec·°C) (0,009
cal·cm/cm²·sec·°C) bei 20°C. Dieser Wert ist bei weitem kleiner
als der entsprechende Wert von 0,163 J·cm/cm²·°C (0,039
cal·cm/cm²·sec·°C) von rostfreiem Stahl und der entsprechende
Wert von 0,167 J·cm/cm²·sec·°C (0,04 cal·cm/cm²·sec·°C) von
Titan. Die Wärmeleitfähigkeit der gesinterten Zirkondioxidsub
stanz ist infolgedessen wesentlich kleiner als diejenige von
solchen Metallmaterialien. Daher wird die Wärme, die durch den
Fluß des Hochfrequenzstroms von den freiliegenden Elektroden
10b zu einem Blutgefäß erzeugt wird, bei weitem weniger durch
die Blutgefäßkontaktteile 10a, die aus der gesinterten Substanz
hergestellt sind, abgestrahlt und/oder zurückgeleitet. Dadurch
wird verhindert, daß ein Teil eines kauterisierten Blutgefäßes
an den Blutgefäßkontaktteilen 10a anhaftet und anklebt.
In der bevorzugten Ausführungsform des vorliegenden bipolaren
Blutgefäßkoagulationsinstruments sind die freiliegenden Elek
troden 10b wie eine Vielzahl von Punkten auf den Blutgefäßkon
taktteilen 10a verteilt und aus elektrisch leitfähigem Harz
klebstoff hergestellt. Im einzelnen ist eine Mehrzahl von klei
nen Durchgangslöchern 10e auf und in den isolierenden Blutge
fäßkontaktteilen 10a, die aus einer gesinterten Substanz, wie
beispielsweise Zirkondioxid, hergestellt sind, vorgesehen. In
die Durchgangslöcher 10e wird der oben erwähnte leitfähige
Harzklebstoff gefüllt, so daß in diesen Durchgangslöchern die
Elektroden 10b erzeugt werden und gleichzeitig das Blutgefäß
kontaktteil 10a, das plättchenförmig ist, in einer Ausnehmung
10d, die in dem vorderen Endteil des Blutgefäßhalteabschnitts
10 ausgebildet ist, über eine leitfähige Harzklebstoffschicht
10c befestigt wird. Überdies liegt der leitfähige Harzklebstoff
von den Durchgangslöchern 10e auf der vorderen Oberflächenseite
frei, so daß auf diese Weise die freiliegenden Elektroden 10b
wie eine Vielzahl von Punkten auf dieser Oberfläche verteilt
sind, wie besonders gut aus Fig. 4 ersichtlich ist. Der rich
tige Flächenanteil der Elektroden 10b, die über die Oberfläche
des Blutgefäßkontaktteils 10a verteilt sind, liegt im Bereich
zwischen 5% und 60%. Wenn der Flächenanteil 60% übersteigt,
wird die mechanische Festigkeit des aus Keramik hergestellten
Blutgefäßkontaktteils 10a klein; wenn der Flächenanteil gerin
ger als 5% ist, wird keine angemessene Kauterisierungs- und
Blutstillungswirkung erhalten, wie durch Experimente der Erfin
der bestätigt worden ist.
Da die freiliegenden Elektroden 10b dieser Ausführungsform, wie
oben beschrieben, wie eine Vielzahl von Punkten oder Flecken
verteilt sind, ist der elektrische Strom von dem Blutgefäßkon
taktteil 10a zu einem Blutgefäß fast gleichförmig, so daß
eine übermäßige lokale Erhitzung verhindert wird. Die Blutge
fäßkontaktteile 10a können auch unter Verwendung der freilie
genden Elektroden 10b, die aus dem leitfähigen Harzklebstoff
hergestellt sind, an den Blutgefäßhalteabschnitten 10 befestigt
werden. Dadurch wird die Produktionsleistungsfähigkeit in hohem
Maße erhöht.
Die Oberflächen der Blutgefäßkontaktteile 10a werden besonders
bevorzugt wie eine Spiegeloberfläche mit einer Oberflächenrau
higkeit von 1 Ra = 1 µm Durchschnittshöhe der Rauhigkeiten zwi
schen konkav und konvex oder 1 µm mittlere Rauhigkeit, oder
besser geschliffen und/oder poliert, so daß Substanzen, die an
gebrannt oder verbrannt sind und an den Oberflächen der Blutge
fäßkontaktteile 10a anhaften oder ankleben, leicht entfernt
werden können.
Die Vickers-Härte der Zirkondioxidkeramik beträgt 122 625 bar
(1250 kg/mm²) oder mehr, so daß sich eine bei weitem größere
Härte ergibt, als es diejenige von Metallmaterialien, wie bei
spielsweise von rostfreiem Stahl und Titan, ist. Daher kann,
selbst wenn das Gewebe eines Blutgefäßes teilweise angebrannt
oder verbrannt wird und an den Blutgefäßkontaktteilen 10a, die
aus der gesinterten Substanz hergestellt sind, fest anhaftet
oder anklebt, ein solches Gewebe leicht mit einem Messer o. dgl.
abgeschabt werden, ohne daß die Oberflächen der Blutgefäßkon
taktteile beschädigt werden. Es sei jedoch darauf hingewiesen,
daß ein solches Anbrennen oder Verbrennen sowie Anhaften oder
Ankleben von Gewebe eines Blutgefäßes bei weitem sehr viel we
niger und sehr viel seltener vorkommt als bei den oben genann
ten Blutgefäßkontaktteilen aus Metall.
Es sei nun unter Bezugnahme auf die Fig. 4 und 5 eine gegen
über der oben beschriebenen Ausführungsform weiterentwickelte
Ausführungsform des vorliegenden bipolaren Blutgefäßkoagula
tionsinstruments beschrieben und erläutert. Diese weiterentwickelte
Ausführungsform umfaßt zusätzlich eine freiliegende Elek
trode 10f, die an dem vorderen Ende des Blutgefäßkontaktteils
10a angeordnet ist. Außer einer Koagulation und Blutstillung
ist mit der freiliegenden Elektrode 10f ein Durchschneiden von
Blutgefäßen möglich. Damit sollen die nachfolgend angegebenen
Bedürfnisse erfüllt werden. Während einer Operation müssen
viele Blutgefäße in ihren Zentren blutgestillt und durchge
schnitten werden, damit der Operateur zu einem tieferen Ab
schnitt fortschreiten kann. Zu diesem Zeitpunkt ist es norma
lerweise notwendig, Operationsinstrumente zu wechseln, nämlich
von dem Blutgefäßkoagulationsinstrument zu einer Schere überzu
gehen, um den blutgestillten Abschnitt von jedem Blutgefäß
durchzuschneiden, wenn ein übliches Blutgefäßkoagulationsin
strument ohne Schneidfunktion verwendet wird. Das hat zur Folge,
daß der Operateur häufig die Operationsinstrumente wechseln
muß, nämlich von dem Blutgefäßkoagulationsinstrument zu einer
Schere und von der Schere zu einem Blutgefäßkoagulationsinstru
ment übergehen muß. Dieses Wechseln ist extrem mühsam und ver
längert die Operationszeit nicht unbeträchtlich.
Wenn die Schneidfunktion dadurch in das Blutgefäßkoagulations
instrument inkorporiert wird, daß eine Elektrode, welche sowohl
zum Koagulieren als auch zum Durchschneiden von Blutgefäßen in
der Lage ist, verwendet wird, dann kann der Operateur mit dem
Blutstillen und Durchschneiden fortfahren, während er das Blut
gefäßkoagulationsinstrument weiter in der Hand hält. Das elimi
niert die Notwendigkeit eines Wechselns, um angebrannte oder
verbrannte Gewebe zu entfernen, um das Blutgefäßkoagulationsin
strument zu reinigen, und um Blutgefäße durchzuschneiden. Als
Ergebnis hiervon wird die Operationszeit beträchtlich verkürzt.
Um die oben erwähnten Ziele und Vorteile zu erreichen, wird die
freiliegende Elektrode 10f, die an dem vordersten Ende der
Greifarme angeordnet ist, in der Form einer langgestreckten,
vorzugsweise rechteckigen, Platte ausgebildet, und zwar so, daß
sie eine Fläche hat, die weiter oder breiter als diejenige der
anderen freiliegenden Elektroden 10b ist. Der Leistungszufüh
rungsdraht 10h, der mit der Elektrode 10f verbunden ist, ist
ein anderer als der Hochfrequenzleistungszuführungsdraht 10g,
der mit den freiliegenden Elektroden 10b verbunden ist. Der
Leistungszuführungsdraht 10h ist in einer isolierenden Be
schichtung S1 eingebettet. Das Umschalten zwischen den Hochfre
quenzleistungszuführungsdraht 10g und dem Leistungszuführungs
draht 10h wird z. B. durch den Fußschalter 3 gesteuert oder be
wirkt. Für die Koagulationsarbeit wird ein Hochfrequenzstrom
mit einer sanft ansteigenden Wellenform sowohl an die freilie
genden Elektroden 10b als auch an die freiliegende Elektrode
10f angelegt. Zum Durchschneiden eines Blutgefäßes werden die
freiliegenden Elektroden 10b abgeschaltet, und ein Impulsstrom
mit einer steil ansteigenden Wellenform wird nur an die frei
liegende Elektrode 10f angelegt. Es ist wünschenswert, daß
sowohl die freiliegende Elektrode 10f als auch die freiliegen
den Elektroden 10b unter Verwendung von leitfähigem Harzkleb
stoff ausgebildet wird bzw. werden, der vorzugsweise die Eigen
schaften hat, die oben in Tabelle 1 aufgelistet sind.
Im Gegensatz zu den konventionellen bipolaren Blutgefäßkoagula
tionsinstrumenten schaltet diese hier vorgeschlagene weiterent
wickelte Ausführungsform die Notwendigkeit eines Operationsin
strumentenwechsels von einem Blutgefäßkoagulationsinstrument zu
einer Schere aus, indem ein Blutgefäß unter Verwendung der
freiliegenden Elektrode 10f nach der Koagulation durchgeschnit
ten wird. Koagulation und Durchschneiden können mittels eines
einzigen Paars von Greifarmen ausgeführt werden, wodurch eine
höhere Bequemlichkeit, Effektivität und Schnelligkeit sicherge
stellt werden.
Zusätzlich zu der oben beschriebenen bevorzugten Ausführungs
form und der vorstehend beschriebenen weiterentwickelten Aus
führungsform umfaßt das hier vorgeschlagene bipolare Blutgefäß
koagulationsinstrument die folgenden wahlweisen Ausführungsfor
men, die auch, soweit das möglich und sinnvoll ist, miteinander
und mit der bevorzugten Ausführungsform sowie mit der weiter
entwickelten Ausführungsform kombiniert werden können:
- a) An Stelle von Metall kann auch Kunststoff oder Keramik als das Material der Greifarme verwendet werden, vorausge setzt, daß innerhalb der Greifarme leitfähige Drähte oder Muster oder aufgedruckte oder in sonstiger Weise aufge brachte Leiter eingebettet sind, um elektrische Leitfähig keit vorzusehen bzw. die Elektroden mit der Hochfrequenz leistungsquelle zu verbinden.
- b) Das Blutgefäßkontaktteil ist über den Blutgefäßhalteab schnitt hinaus verlängert und über die gesamten einander zugewandten Innenflächen der Greifarme ausgebildet, um die Formung zu erleichtern.
- c) An Stelle des Anlegens von Impulsstrom mit einer steil an steigenden Wellenform an die freiliegende Elektrode für das Durchschneiden wird Hochfrequenzstrom mit hoher Strom energie zum Durchschneiden angelegt.
Das hier vorgeschlagene bipolare Blutgefäßkoagulationsinstru
ment bietet in der einen und/oder anderen seiner Ausführungs
formen insgesamt die nachstehenden Wirkungen:
- 1) Eine Blutstillung wird während der Operation sicherge stellt. Das verkürzt die Operationszeit beträchtlich.
- 2) Der Betrag an Blutung oder an Auslaufen von Blut kann ver mindert werden. Dadurch kommt es für einen Patienten zu weniger schweren Operationsschädigungen.
- 3) Der Arbeitsaufwand zum Abschaben einer an den Enden der Greifarme anhaftenden oder klebenden Substanz kann voll ständig oder doch in einem sehr hohen Maße eingespart wer den. Selbst wenn es dazu kommt, daß eine solche Substanz an den Enden der Greifarme anhaftet oder anklebt, was sehr viel weniger als bei konventionellen bipolaren Blutgefäß koagulationsinstrumenten vorkommt, kann diese Substanz leicht abgeschabt werden. Da die Enden der Greifarme sehr hart sind, bleibt ihre Form trotz eventuellen Abschabens unverändert. Dadurch wird eine hohe Genauigkeit der Greif arme, insbesondere der Form und Betätigungsgenauigkeit der Greifarme, während einer verlängerten, sehr ausgedehnten Zeitdauer sichergestellt.
- 4) Durch Verwendung von elektrisch leitfähigem Harzklebstoff, insbesondere des oben angegebenen elektrisch leitfähigen Harzklebstoffs, als Elektroden können die Elektroden leicht in komplizierten Formen ausgebildet werden, wodurch die Produktionsleistungsfähigkeit in hohem Maße verbessert wird.
- 5) Die Wärmebeanspruchung, die auf Grund des Unterschieds in den Wärmeausdehnungskoeffizienten zwischen Metall und Ke ramik erzeugt wird, insbesondere während einer Autoklaven sterilisierung, kann durch den elektrisch und thermisch leitfähigen Harzklebstoff, der Metallpulver enthält, an der Klebstoffschicht aufgenommen werden. Es wird auf diese Weise verhindert, daß die Keramik des Blutgefäßkontakt teils bricht, so daß diese Keramik eine sehr lange Ge brauchslebensdauer hat. Es ist infolgedessen eine Autokla vensterilisierung möglich, wodurch die Notwendigkeit aus geschaltet wird, eine Gassterilisierung anzuwenden. Da durch wird die Sterilisierungszeit in hohem Maße vermin dert.
- 6) Im Fall der weiterentwickelten Ausführungsform kann ein einziges Paar von Greifarmen dazu verwendet werden, Blut gefäße zu koagulieren und durchzuschneiden. Das schaltet die Notwendigkeit der Verwendung einer Schere und die Not wendigkeit eines entsprechenden Operationsinstrumenten wechsels aus, wodurch eine leichte, relativ ruhige und verkürzte Operation sichergestellt wird. Dieser Vorteil ist von hohem Wert, insbesondere im Falle einer Operation, die sich - aus sonstigen, insbesondere operationsinhären ten Gründen - über eine lange Zeit erstreckt, weil dadurch eine Menge an mühsamer Arbeit eingespart und die Opera tionszeit verkürzt werden kann.
Es sei hier noch angemerkt, daß die freiliegende Elektrode zum
wahlweisen Schneiden oder Koagulieren am vordersten Ende von
vorzugsweise jedem der beiden Greifarme vorgesehen ist. Vor
zugsweise sind zwei gleiche oder gleichartige Elektroden an den
Greifarmen vorgesehen.
Claims (8)
1. Bipolares Blutgefäßkoagulationsinstrument, bestehend
aus einem Paar von leitfähigen Greifarmen (1), die mit einer
elektrischen Hochfrequenzleistungsquelle (2) verbunden sind,
wobei ein Blutgefäß (B) zwischen Blutgefäßhalteabschnitten (10)
gehalten wird, die sich an den distalen Endteilen der Greifarme
(1) befinden, dadurch gekennzeichnet, daß der
Blutgefäßhalteabschnitt (10) aus einem Blutgefäßkontaktteil
(10a) besteht, welches aus einer elektrisch isolierenden gesin
terten Substanz mit einer niedrigen Wärmeleitfähigkeit herge
stellt ist, und daß das Blutgefäßkontaktteil (10a) auf seiner
Oberfläche mit hervorragenden oder freiliegenden Elektroden
(10b), die mit dem Greifarm (1) elektrisch verbunden sind, in
einem Flächenanteil von 5% bis 60% bezogen auf die Oberfläche
des Blutgefäßkontaktteils (10a) versehen ist.
2. Bipolares Blutgefäßkoagulationsinstrument nach An
spruch 1, dadurch gekennzeichnet, daß die
hervorragenden oder freiliegenden Elektroden (10b) aus elek
trisch leitfähigem Harzklebstoff hergestellt sind.
3. Bipolares Blutgefäßkoagulationsinstrument nach An
spruch 1 oder 2, dadurch gekennzeichnet, daß
das Blutgefäßkontaktteil (10a) plättchenförmig ist und in einer
Ausnehmung (10d) der Greifarme (1) über eine elektrisch leitfä
hige Harzklebstoffschicht (10c) angebracht und befestigt ist.
4. Bipolares Blutgefäßkoagulationsinstrument nach An
spruch 1, 2 oder 3, dadurch gekennzeichnet,
daß das Blutgefäßkontaktteil (10a) eine Mehrzahl von Durch
gangslöchern (10e) in der Richtung der Dicke des Blutgefäßkon
taktteils (10a) hat, und daß elektrisch leitfähiger Harzkleb
stoff in die Durchgangslöcher (10e) gefüllt ist.
5. Bipolares Blutgefäßkoagulationsinstrument nach einem
der Ansprüche 1 bis 4, dadurch gekennzeichnet,
daß eine hervorragende oder freiliegende langgestreckte Elek
trode (10f) an dem vordersten Ende der Greifarme (1) angeordnet
und mit einer gesonderten Leistungsquelle zum Ermöglichen eines
Durchschneidens von Blutgefäßen (B) verbindbar ist.
6. Bipolares Blutgefäßkoagulationsinstrument nach einem
der Ansprüche 1 bis 5, dadurch gekennzeichnet,
daß sich das Blutgefäßkontaktteil (10a) über die gesamten ein
ander zugewandten Innenflächen der Greifarme (1) erstreckt.
7. Bipolares Blutgefäßkoagulationsinstrument nach einem
der Ansprüche 1 bis 6, dadurch gekennzeichnet,
daß die elektrisch isolierende, gesinterte Substanz Keramik
ist, die aus irgendeiner oder mehreren der folgenden Substanzen
hergestellt ist: Zirkondioxid, Aluminiumoxid, Siliciumnitrid
und/oder Siliciumcarbid.
8. Bipolares Blutgefäßkoagulationsinstrument nach einem
der Ansprüche 1 bis 7, dadurch gekennzeichnet,
daß der elektrisch leitfähige Harzklebstoff ein auf Epoxyharz
basierender und Silverpulver hoher Reinheit enthaltender Harz
klebstoff ist.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP1140192A JP2840674B2 (ja) | 1989-05-31 | 1989-05-31 | 血管凝固止血装置 |
JP2140376A JP3010265B2 (ja) | 1990-05-30 | 1990-05-30 | 血管凝固止血装置 |
Publications (2)
Publication Number | Publication Date |
---|---|
DE4017626A1 DE4017626A1 (de) | 1990-12-06 |
DE4017626C2 true DE4017626C2 (de) | 1993-07-01 |
Family
ID=26472788
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE4017626A Granted DE4017626A1 (de) | 1989-05-31 | 1990-05-31 | Blutgefaesskoagulations-/-blutstillungs-einrichtung |
Country Status (3)
Country | Link |
---|---|
US (1) | US5151102A (de) |
DE (1) | DE4017626A1 (de) |
FR (1) | FR2647683B1 (de) |
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- 1990-05-31 FR FR9006806A patent/FR2647683B1/fr not_active Expired - Fee Related
- 1990-05-31 US US07/530,994 patent/US5151102A/en not_active Expired - Lifetime
- 1990-05-31 DE DE4017626A patent/DE4017626A1/de active Granted
Cited By (5)
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DE19652098A1 (de) * | 1996-12-14 | 1998-06-25 | Amann & Tritt Gmbh | Werkzeug |
DE19652098C2 (de) * | 1996-12-14 | 2001-04-19 | Slg Kunststoff Fabrik Und Form | Chirurgisches Instrument und Verfahren zu seiner Herstellung |
US6210411B1 (en) | 1998-05-11 | 2001-04-03 | Gebrueder Berchtold Gmbh & Co. | High frequency surgical instrument with a fluid infeed passage |
DE10224451A1 (de) * | 2002-05-29 | 2003-12-18 | Celon Ag Medical Instruments | Hochfrequenzapplikationsvorrichtung |
DE102006027150A1 (de) * | 2006-06-08 | 2007-12-13 | Celon Ag Medical Instruments | Vorrichtung zum Schneiden und Koagulieren von Gewebe |
Also Published As
Publication number | Publication date |
---|---|
FR2647683B1 (fr) | 1993-02-12 |
US5151102A (en) | 1992-09-29 |
FR2647683A1 (fr) | 1990-12-07 |
DE4017626A1 (de) | 1990-12-06 |
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