This invention relates to an electrosurgical system including a bipolar electrosurgical instrument for use in the treatment of tissue.
Both monopolar and bipolar electrosurgery are well-established techniques. In monopolar electrosurgery, an electrosurgical instrument has a single electrode and a patient return plate is attached to the patient well away from the electrosurgical instrument. The electrosurgical current flows from the electrode through the patient to the return plate.
In bipolar electrosurgery, the electrosurgical instrument includes spaced first and second electrodes, and there is no patient return plate. The current flows from one electrode through the patient to the other, and so the current flow is kept to a much more localised area.
Both monopolar and bipolar electrosurgery are known to have certain advantages and disadvantages. Monopolar electrosurgery is known to produce very effective tissue coagulation, but there is always the danger of stray current paths causing the unwanted treatment of tissue spaced from the monopolar electrode. Burns to the patient in the area of the return plate have also been known. Bipolar electrosurgery is generally considered to be a safer option, as the current is constrained within a smaller area, but it is sometimes difficult to obtain as thorough a coagulation effect with a bipolar instrument.
For this reason perhaps, there have been previous attempts to provide the option of either monopolar or bipolar electrosurgery from a single generator. The prior art is full of examples of generators in which both a monopolar and a bipolar instrument can be connected to the generator, with some form of switch to select which one of the instruments is to be activated at any one time. Examples include U.S. Pat. Nos. 4,171,700, 4,244,371, 4,559,943, 5,951,545 and 6,113,596. U.S. Pat. No. 5,472,442 is different in that a single instrument can be used in either a monopolar or bipolar mode, but once again a choice must be made as to which one of monopolar or bipolar modes is to be activated at any one time.
The present invention attempts to provide an easy to use electrosurgical system enjoying the benefits of both monopolar and bipolar electrosurgery. Accordingly, an electrosurgical system is provided including a generator for generating radio frequency (RF) power, an electrosurgical instrument including at least first and second bipolar electrodes carried on the instrument, and a monopolar patient return electrode separate from the instrument, wherein the generator comprises at least one source of RF power and a plurality of outputs connected to the electrodes, the generator being adapted to operate in a first supply state in which an RF output waveform is delivered between the first and second bipolar electrodes via the output lines, and in a second supply state in which an RF output waveform is delivered between (a) at least one of the first and second bipolar electrodes and (b) the monopolar patient return electrode via the output lines, which operation, in at least one mode of the generator, includes continuously alternating between the first supply state and the second supply state whereby combined bipolar and monopolar RF energy delivery is obtained.
The generator effectively delivers an RF waveform in both the first and second supply states. In one arrangement, the generator includes first and second sources of radio frequency (RF) power, the first source being connected to deliver an RF waveform in the first supply state, and the second source being connected to deliver an RF waveform in the second supply state. In a preferred generator, a feeding means is adapted to supply an RF waveform between the bipolar electrodes simultaneously with an RF waveform being supplied between one bipolar electrode and the patient return electrode. Alternatively, the feeding means is adapted to supply RF waveforms from at least one of the first and second sources discontinuously, with one or both of the sources being switched in and out of connection with the electrodes. In one arrangement, the feeding means is adapted to switch in and out the connection of the first source to deliver the RF waveform in the first supply state discontinuously.
In accordance with the invention, the feeding means is adapted to alternate between the first and second supply states, either with or without gaps therebetween. In this arrangement there is a regular switching between the first supply state, in which the RF waveform is supplied “bipolar” mode, and the second supply state, in which the RF waveform is supplied in “monopolar” mode. As the regular switching between the first and second states takes place at a high frequency, typically between 5 and 100 Hz, the overall effect is a blend of monopolar and bipolar electrosurgery delivered substantially simultaneously.
The “first duty cycle” is defined as that part of the overall signal that is delivered in the first supply state. Similarly, the “second duty cycle” is defined as that part of the overall signal that is delivered in the second supply state. In general terms, the first duty cycle is the proportion of the signal that is delivered in the “bipolar” mode, and the second duty cycle is the proportion of the signal that is delivered in the “monopolar” mode. If a single source is provided and switched between the electrodes, then a first duty cycle of 30% would see the waveform delivered in bipolar mode for 30% of the time and in monopolar mode for 70% of the time (if there were no gaps between the various parts of the signals). A first duty cycle of 30% and a second duty cycle of 50% would see a gap between the bipolar and monopolar parts of the signal, the gap constituting 20% of the overall cycle.
In one convenient arrangement, both the first and second duty cycles are constant at 50%, thereby providing equal periods for both bipolar and monopolar modes. In an alternative arrangement, at least one duty cycle is not constant, and there is adjustment means, operable by the user of the electrosurgical system, for changing at least one duty cycle. Typically, the adjustment means is operable by the user of the electrosurgical system to change the at least one duty cycle between a plurality of preset settings. In this way, the user can select various settings for the duty cycle, for example mostly bipolar, mostly monopolar, equal amounts of bipolar and monopolar etc. If desired, the user could be permitted to use the electrosurgical instrument entirely in bipolar or monopolar mode, if required.
Alternatively, the electrosurgical system includes means for measuring a parameter associated with the electrosurgical procedure, the controller adjusting at least one duty cycle automatically in response to the measured parameter. In this way, the electrosurgical system adjusts itself dynamically in response to different operating conditions, selecting greater or lesser proportions of the bipolar and monopolar modes respectively, as required for effective operation. Conveniently, the measured parameter is the impedance measured between two of the electrodes. This could be the impedance between the two bipolar electrodes, or alternatively one of the bipolar electrodes and the patient return plate. Thus, when the measured impedance is low, indicating a relatively fluid surgical environment associated with bleeding tissue, the electrosurgical system could increase the proportion of the monopolar signal applied to the tissue, as this is recognized as providing effective coagulating power. Conversely, when the measured impedance is higher, indicating a relatively dry surgical environment, the electrosurgical system could increase the proportion of bipolar signal applied to the tissue, in order to maximise patient safety.
In another convenient arrangement, the feeding means operates such that at least one duty cycle varies according to a predetermined progression. This provides a dynamically changing electrosurgical signal, without the user selecting different operating settings, or the system performing dynamic measurement of operating parameters. For example, experience could show that the most effective tissue coagulating waveform for a particular tissue or vessel type is a particular combination of bipolar and monopolar signals, changing over time. This could be preprogrammed into the electrosurgical generator, such that it is automatically performed without the need for any additional intervention from the user. Conceivably, the predetermined progression is such that at least one duty cycle increases or alternatively decreases with time. Alternatively, the feeding means operates such that there is a first period during which the duty cycle is constant, followed by a second period in which at least one duty cycle varies according to a predetermined progression. Different predetermined progressions of duty cycle may be appropriate for different types of tissue, or for different surgical procedures, as will be readily established by users of the electrosurgical system.
The monopolar patient return electrode is described as being separate from the instrument. This is to say that the monopolar patient return electrode is designed to be attached to the patient at a location remote from the area where the instrument is in contact with the patient. Conceivably, the patient return electrode could still be supplied together with the electrosurgical instrument, and may even be physically attached thereto, for example by means of a long cord or tie. The description of the monopolar patient return electrode as being “separate” refers to its remote location on the patient, as opposed to any lack of connection with the electrosurgical instrument.
Conceivably, a characteristic of the RF waveform is different during the first duty cycle as compared to the second duty cycle. For example, the power of the RF waveform may be different during the bipolar mode as compared with the power during the monopolar mode. Similarly, the voltage of the RF waveform, the current of the RF waveform, or the frequency of the RF waveform could be different for the bipolar signals as opposed to the monopolar signals.
The electrosurgical system according to the present invention is primarily concerned with the effective coagulation of tissue, but the electrosurgical system can also be employed to cut or vaporise tissue. In a convenient arrangement, the electrosurgical instrument includes at least a third electrode, and the generator is adapted, in an alternative mode of operation, to supply a cutting RF waveform between the third electrode and one or both of the first and second electrodes. Thus, the instrument can be employed to cut or vaporise tissue, and then coagulate tissue in either a bipolar or monopolar mode, or a combination of bipolar and monopolar modes.
The invention further resides in an electrosurgical generator for generating radio frequency power, the generator including a bipolar output for an electrosurgical instrument including at least two output lines for bipolar electrodes carried on the instrument, and a monopolar output for a monopolar patient return electrode separate from the instrument; the generator comprising one source of radio frequency (RF) power, and having a first supply state in which the RF waveform is supplied to the bipolar output between the two output lines, and a second supply state in which the RF waveform is supplied between one or both of the two output lines of the bipolar output and the monopolar output, and a controller operable to control the generator such that, in at least one mode of the generator, a feeding means is adapted to alternate between the first and second supply states to produce an alternating signal.
The invention will be described in more detail, by way of example only, with reference to the accompanying drawings.
In the drawings:
a to 7d are schematic cross-sectional views showing the effect on tissue of different modes of operation of the electrosurgical system of
a to 8e are schematic diagrams showing different outputs of the electrosurgical system of
a and 10b are schematic diagrams showing further different outputs of the electrosurgical system of
a to 11c are schematic diagrams showing further different outputs of the electrosurgical system of
Referring to
Referring to
The operation of the electrosurgical system of
Alternatively or additionally, a feeding means is provided, adapted to switch in and out the connection of the second source to deliver the RF waveform in the second supply state discontinuously. In this way, the generator can supply a number of different signals, including but not limited to the following;
i) simultaneous continuous signals from the first and second sources;
ii) a continuous signal from the first source, with an intermittent signal from the second source;
iii) a continuous signal from the second source, with an intermittent signal from the first source;
iv) alternate signals from the first and second sources, in a continuously alternating fashion; and
v) intermittent signals from both the first and second sources, with gaps therebetween.
In this embodiment the switching is carried out by optional switching circuits 6 and 7 as the feeding means. Switching circuit 6 allows the signal from power source 1 to be optionally switched between connected and unconnected conditions with respect to output lines 4A and 4B. Similarly, switching circuit 7 allows the signal from power source 2 to be optionally switched between connected and unconnected conditions with respect to output lines 4B and 13. In this way, various combinations of simultaneous or sequential bipolar and monopolar signals can be applied to the tissue 8, as will be further described in more detail with respect to
Switches S1 and S2 operate in tandem.
a to 7d shown the tissue effect achieved in the tissue 8 in the region of the electrodes 3A and 3B using different proportions of bipolar and monopolar energy.
a to 8e show different arrangements for the timings for the switches S1 and S2. In the figures, the switches are in the positions shown in
In
In
a to 11c show schematic diagrams, similar to that of
The arrangements of
When the user intends the instrument to coagulate tissue, the electrosurgical generator supplies an RF waveform between the electrodes 3A and 3B as well as the patient return plate (not shown in
Those skilled in the art will appreciate that variations on the precise examples given herein can be made without departing from the scope of the present invention. For example, a range of different arrangements for varying the duty cycle, in addition to those described herein, could be readily derived depending on the tissue to be treated, the surgical procedure under consideration, or even the particular preference of each individual surgeon. Any of the embodiments discussed herein can be employed with or without an additional cutting electrode.
Number | Date | Country | Kind |
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0708783.6 | May 2007 | GB | national |
Number | Date | Country | |
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60924961 | Jun 2007 | US |