Patent Application
20190298432
The exemplary embodiments relate to an energy treatment instrument for treating a treatment target using heat.
The related art discloses an energy treatment instrument for treating a treatment target such as a biological tissue to be grasped between a pair of grasping pieces. In this energy treatment instrument, heat generated in a heat generating element and high-frequency current are applied to a treatment target grasped between a pair of grasping pieces. The treatment target is coagulated and/or incised by the heat and the high-frequency current.
According to one aspect of the exemplary embodiments, an energy treatment instrument includes a first grasping piece, a second grasping piece configured to open and close with respect to the first grasping piece, a first opposing face that faces the second grasping piece on an outer surface of the first grasping piece, a second opposing face that faces the first grasping piece on an outer surface of the second grasping piece, a heat generator that contains at least a metal component and that is configured to generate heat by a current flowing, and a base plate that is provided in the first grasping piece, the base plate being formed of ceramics having electrical insulation properties, and the base plate being configured to transfer the heat generated by the heat generator, the heat generator being fixed to the base plate in close contact.
Advantages of the exemplary embodiments will be set forth in the description which follows, and in part will be obvious from the description. The advantages of the exemplary embodiments may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.
The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate exemplary embodiments, and together with the general description given above and the detailed description of the embodiments given below, serve to explain the principles of the exemplary embodiments.
A first embodiment will be described with reference to
The energy treatment instrument 1 comprises a housing 4 that is holdable, a shaft 5 connected to the distal portion of the housing 4, and an end effector 6 provided at a distal end portion of the shaft 5. One end of a cable 7 is connected to the housing 4. The other end of the cable 7 is separably connected to a power supply unit 3. The power supply unit 3 includes a first energy output source 8, a second energy output source 9, and a control unit 10. The first energy output source 8 includes a conversion circuit or the like configured to convert electric power from a battery power source or an outlet power source into electric energy (DC power or AC power) to be supplied to a heat generating element (heat source) to be described later, and outputs the converted electric energy. The second energy output source 9 includes a conversion circuit or the like configured to convert electric power from a battery power source or an outlet power source into electric energy (high-frequency power) to be supplied to an electrode to be described later, and outputs the converted electric energy. The control unit 10 includes an integrated circuit or processor including a CPU (Central Processing Unit), an ASIC (Application Specific Integrated Circuit), an FPGA (Field Programmable Gate Array), or the like, and also includes a storage medium.
An operation button 19 as an energy operation input unit is attached to the housing 4. By depressing the operation button 19, an operation (signal) is input to the power supply unit 3 for outputting electric energy from the first energy output source 8 and/or the second energy output source 9 to the energy treatment instrument 1. Instead of or in addition to the operation button 19, a foot switch or the like separate from the energy treatment instrument 1 may be provided as an energy operation input unit.
In the housing 4, a grip (fixed handle) 11 is provided, and a handle (movable handle) 12 is rotatably attached. As the handle 12 rotates relative to the housing 4, the handle 12 opens or closes with respect to the grip 11. In the present embodiment, the handle 12 is located in a distal side of the grip 11 and moves substantially parallel to the longitudinal axis C in an opening or closing operation with respect to the grip 11. However, the handle 12 is not limited to this embodiment. For example, in one embodiment, the handle 12 may be located in a proximal side of the grip 11. In another embodiment, the handle 12 may be located on the side opposite the grip 11 with respect to the longitudinal axis C, and the direction of movement in the opening or closing movement with respect to the grip 11 may intersect (perpendicular to) the longitudinal axis C.
The shaft 5 extends along the longitudinal axis C. Further, the end effector 6 comprises a first grasping piece 13 and a second grasping piece 14 (jaw) which opens and closes relative to the first grasping piece 13. The outer surface of the first grasping piece 13 comprises a first opposing face 16 which faces the second grasping piece 14. The outer surface of the second grasping piece 14 has a second opposing face 17 which faces the first opposing face 16 of the first grasping piece 13. The handle 12 and the second grasping piece 14 are connected via a movable member 18 that extends along the longitudinal axis C inside the shaft 5. By opening or closing the handle 12, which is an opening/closing operation input portion, with respect to the grip 11, the movable member 18 moves along the longitudinal axis C with respect to the shaft 5 and the housing 4, so that the pair of grasping pieces 13 and 14 open or close. By closing the grasping pieces 13 and 14, a living tissue such as a blood vessel is grasped as a treatment target between the first grasping piece 13 and the second grasping piece 14. In the state where the grasping pieces 13 and 14 are closed, the grasping pieces 13 and 14 are extended along the longitudinal direction. In the present embodiment, the first grasping piece 13 is fixed to the shaft 5 and the second grasping piece 14 is pivotally attached to the distal end portion of the shaft 5.
The opening and closing directions of the end effector 6 intersect (perpendicular to) the longitudinal axis C. Of the opening and closing directions of the end effector 6, the direction in which the second grasping piece 14 opens with respect to the first grasping piece 13 is defined as an opening direction of the second grasping piece 14 (the direction of the arrow Yl in
The configuration can be such that the first grasping piece 13 and the second grasping piece 14 are provided at the distal end portion of the shaft 5 and the first grasping piece 13 and the second grasping piece 14 can be opened and closed. For example, in one embodiment, the first grasping piece 13 is integrally formed with the shaft 5. The second grasping piece 14 is then pivotally attached to the distal end portion of the shaft 5. In another embodiment, both the first grasping piece 13 and the second grasping piece 14 are pivotally attached to the distal end portion of the shaft 5.
On a side of the base 41 facing the second grasping piece 14, a heat generating portion (heat generating unit) 30 is fixed. The heat generating portion 30 includes a substrate member (heat transfer member/base plate) 43. The substrate member (heat transfer member/base plate) 43 is attached to the support surface 42 of the base 41. The substrate member 43 is formed of a member having a thermal conductivity higher than that of the base 41. That is, the base 41 has a lower thermal conductivity than the substrate member 43. As the substrate member 43, for example, ceramics such as aluminum nitride is used. Furthermore, the substrate member 43 preferably has electrical insulation properties.
The substrate member 43 has a substrate facing surface 47 that faces the second grasping piece 14 side. In the present embodiment, the first opposing face 16 is formed by the substrate facing surface 47. The substrate facing surface 47 is inclined in the width direction of the first grasping piece 13 so that the substrate facing surface 47 incline toward the second grasping piece 14 side from the outside toward the center in the width direction. Therefore, a protruding portion 44 protruding toward the second grasping piece 14 side is formed in the central portion in the width direction of the first opposing face 16.
The substrate member 43 has a bottom surface 45 that faces the side opposite to the substrate facing surface 47. The bottom surface 45 is a surface that faces away from the first opposing face 16. The bottom surface 45 is in contact with the support surface 42 of the base 41 from the side of the second grasping piece 14.
Further, the heat generating portion 30 includes a heat generating element (heat source) 40. The heat generating element 40 is provided between the support surface 42 of the base 41 and the bottom surface 45 of the substrate member 43. The heat generating element (heat generator) 40 is fixed to the bottom surface 45 of the substrate member 43 so as to be in close contact from the back surface 20 side. As the heat generating element 40, for example, a metal coating such as gold, silver, copper, platinum or the like is used. Thus, the heat generating element 40 contains a metal component. As the metal coating, platinum is particularly preferable. The heat generating element 40 is formed on the bottom surface 45 by, for example, sputtering. Further, the metal wire formed of the metal described above may be disposed on the bottom surface 45 of the substrate member 43 as the heat generating element 40.
As described above, since the heat generating element 40 is formed of a metal, the heat generating element 40 is formed of a material having a high electric conductivity (that is, having a low electric resistance) as compared with the base 41 and the substrate member 43. Therefore, each of the base 41 and the substrate member 43 has a lower electric conductivity (higher electric resistance) than the heat generating element 40. Note that the heat generating element 40 may be in close contact with the support surface 42 of the base 41 or an appropriate space may be provided between the heat generating element 40 and the support surface 42 of the base 41.
The heat generating element 40 is electrically connected to the first energy output source 8 of the power supply unit 3 via an electrical path (not shown) extending through the inside of the first grasping piece 13, the inside of the shaft 5, the inside of the housing 4 and the inside of the cable 7. By supplying electric energy (DC power or AC power) from the power supply unit 3 to the heat generating element (heat source) 40 via this electrical path, heat is generated in the heat generating element 40. The heat generated in the heat generating element 40 is transferred to the substrate member 43 via the bottom surface 45. In other words, in the heat generating element 40, heat is generated as a current flows, and the generated heat is directly transferred from the heat generating element 40 to the substrate member 43. The heat transferred to the substrate member 43 is transferred to the substrate facing surface 47 forming the first opposing face 16 via the interior of the substrate member 43. The base 41 has a lower thermal conductivity than the heat generating element 40 and the substrate member 43. For this reason, the heat generated by the heat generating element 40 is not easily transferred to the base 41.
The bottom surface 45 of the substrate member 43 is coated with an insulating coating 50. The insulating coating 50 is a thin film having electrical insulation properties. As the insulating coating 50, for example, a ceramic coating or a heat-resistant resin such as PEEK, LCP, fluorine resin, parylene or the like is used. The insulating coating 50 is provided between the substrate member 43 and the heat generating element 40. Therefore, electrical insulation properties between the heat generating element 40 and the substrate member 43 are further improved. Therefore, the current flowing through the heat generating element 40 is prevented from flowing into the substrate member 43 even at a higher voltage (electric energy). If the insulating coating 50 is not provided, it is preferable that the substrate member 43 has electrical insulation properties. Further, in the present embodiment, the base 41 has electrical insulation properties. Therefore, the base 41 and the heat generating element 40 are electrically insulated from each other even if the insulating coating 50 is not provided. Thus, the current flowing through the heat generating element 40 is prevented from flowing into the base 41.
As long as one or more heat generating elements 40 are arranged on the bottom surface 45 of the substrate member 43, the number of heat generating elements 40, the extension pattern of heat generating elements 40, and the like are not limited.
The substrate facing surface 47 of the substrate member 43 forming the first opposing face 16 is coated with a conductive coating 49 along the longitudinal direction. The conductive film 49 is provided on the outer surface of the substrate member 43. The conductive coating 49 is a thin film formed of a coating material having water repellency and electrical conductivity. The conductive coating 49 is formed of a material having a thermal conductivity higher than that of the base 41. As the conductive coating 49, for example, metal plating, a mixture material of a fluororesin and a metal powder (Ag, Ni, etc.), or the like is used. In the present embodiment, the conductive film 49 is in close contact with all of the substrate facing surface 47 of the substrate member 43 forming the first opposing face 16 from the second grasping piece 14 side.
The conductive coating 49 is electrically connected to the second energy output source 9 of the power supply unit 3 via an electrical path (not shown) extending through the inside of the first grasping piece 13, the inside of the shaft 5, the inside of the housing 4 and the inside of the cable 7. The conductive coating 49 functions as a (first) electrode by supply of electric energy (high frequency power) from the second energy output source 9. Here, the substrate member 43 and the base 41 have electrical insulation properties. Therefore, the electric energy from the second energy output source 9 is not supplied (transferred) to the substrate member 43 and the base 41.
The second grasping piece 14 includes a support member 31. The support member 31 extends in the longitudinal direction. The support member 31 has electrical insulation properties. As the support member 31, for example, a heat-resistant resin such as PTFE (polytetrafluoroethylene) is used. On the outer surface of the second grasping piece 14, the support member 31 forms a back surface 21, which faces away from the second opposing face 17. The back surface 21 is exposed to the outside in the second grasping piece 14.
A conductive member (an electrical conductive member) 36 is fixed to a side of the first grasping piece 13 of the support member 31. The conductive member 36 is fixed to the support member 31 from the side of the first grasping piece 13. The conductive member 36 extends along the extending direction of the second grasping piece 14 from the proximal end portion to the distal end portion of the second grasping piece 14. The conductive member 36 is formed of a material having electrical conductivity such as metal. The conductive member 36 has an electrode surface 37 facing the first grasping piece 13 side. The electrode surface 37 forms a part of the outer surface of the second grasping piece 14. In addition, the electrode surface 37 forms a part of the second opposing face 17.
The conductive member 36 is electrically connected to the second energy output source 9 of the power supply unit 3 via an electrical path (not shown) extending through the inside of the second grasping piece 14, the inside of the shaft 5, the inside of the housing 4 and the inside of the cable 7. The conductive member 36 functions as a (second) electrode different from the first electrode provided in the first grasping piece 13 by supply of electric energy (high frequency power) from the second energy output source 9. Here, the support member 31 has electrical insulation properties. Therefore, the electric energy from the second energy output source 9 is not supplied (transferred) to the support member 31.
The support member 31 has a protruding portion 35 protruding toward the first grasping piece 13 side through the gap in the conductive member 36. The protruding portion 35 is exposed to the outside through the electrode surface 37 of the conductive member 36. The second opposing face 17 is formed by the electrode surface 37 of the conductive member 36 and the protruding portion 35 of the base 41. The protruding portion 35 is provided in the central portion of the second opposing face 17 in the width direction.
The electrode surface 37 is positioned on both outer sides of the protruding portion 35 in the width direction. The electrode surface 37 is formed so as to incline toward the first grasping piece 13 side from the center toward the outside in the width direction. The electrode surface 37 is a slope (inclined surface) inclined with respect to the width direction.
When the first grasping piece 13 and the second grasping piece 14 are closed in a state in which a treatment target is not placed between the first grasping piece 13 and the second grasping piece 14, the protruding portion 44 of the first opposing face 16 is brought into contact with the protruding portion 35 of the second opposing face 17. At this time, the first opposing face 16 and the electrode surface 37 of the second opposing face 17 are not in contact with each other. Therefore, the conductive coating 49 provided on the substrate facing surface 47 is not brought into contact with the conductive member 36. Therefore, a short circuit due to contact between the conductive film 49 which is the first electrode and the conductive member 36 which is the second electrode is prevented.
The inclination angle of the second opposing face 17 with respect to the width direction is set to be smaller than the inclination angle of the first opposing face 16 with respect to the width direction. That is, the inclination angles are set such that the incised treatment target between the first opposing face 16 and the second opposing face 17 can easily move outward from the central portion in the width direction.
Next, effects and advantages of the energy treatment instrument 1 of the present embodiment will be described with reference to
In addition, by performing the operation input at the energy operation input unit (the operation button 19), electric energy (high-frequency power) is supplied from the second energy output source 9 to each of the conductive film 49 which is the first electrode and the conductive member 36 which is the second electrode. By supplying electric energy to each of the conductive coating 49 and the conductive member 36, a high-frequency current flows between the first opposing face 16 and the electrode surface 37 of the second opposing face 17 through the grasped living tissue M. As a result, the high-frequency current is applied to the living tissue M grasped between the first opposing face 16 and the second opposing face 17. That is, the high-frequency energy is supplied to the part between the first opposing face 16 and the second opposing face 17. By applying the high-frequency current, coagulation of the grasped living tissue M is promoted. As described above, the first opposing face 16 and the second opposing face 17 serve as treatment surfaces for treating the grasped treatment target.
Here, the heat generated by the heat generating element 40 is applied to the living tissue M grasped by the first opposing face 16 via the substrate facing surface 47 of the substrate member 43. Therefore, the substrate member 43 forms a portion that applies heat to the treatment target on the first opposing face 16. In the present embodiment, the heat generating element 40 is directly attached to the substrate member 43 without any other member interposed therebetween. Therefore, the heat from the heat generating element 40 is directly transferred to the member forming the portion that applies heat to the living tissue M in the first opposing face 16. For this reason, the heat path formed between the heat generating element 40 and the substrate member 43 is shorter in comparison with the case where another member is present between the heat generating element 40 and the substrate member 43. Furthermore, the heat from the heat generating element 40 is transferred to the substrate facing surface 47 via only the substrate member 43. Therefore, in comparison with the case where another member is present between the heat generating element 40 and the substrate member 43 in the heat transfer path, the loss of thermal energy at the boundary portion between the members is reduced. As a result, the heat can be efficiently transferred from the heat generating element 40 to the portion that applies heat in the first opposing face 16 and to the treatment target.
In the case where the portion that applies heat to the living tissue grasped by the first opposing face 16 is formed by another member different from the substrate member 43, warpage or breakage may occur at the boundary portion between the substrate member 43 and the other member due to a difference in thermal expansion coefficient between the members. In the present embodiment, the portion that applies heat on the first opposing face 16 is formed by the substrate member 43 to which heat from the heat generating element 40 is directly transferred. Therefore, in the heat transfer path from the heat generating element 40 to the first opposing face 16, there is no boundary portion between the substrate member 43 and the other member. For this reason, the heat generated by the heat generating element 40 is transferred from the bottom surface 45 of the substrate member 43 to the first opposing face 16 (substrate facing surface 47) without any other member interposed therebetween. As a result, in comparison with a case where a portion that applies heat in the first opposing face 16 is formed by a member different from the substrate member 43, warpage or breakage due to a difference in coefficient of thermal expansion between members at the boundary portion between the members is prevented. As a result, the efficiency of transferring the heat generated by the heat generating element to the treatment target (opposing face) is prevented from being lowered, and the treatment performance of the energy treatment instrument 1 is secured.
In this modification, the support surface 42 of the base 41 is formed in a planar shape and is provided in the central portion of the base 41 in the width direction. Further, the base 41 is provided with inclined surface portions 62 provided on both outer sides of the support surface 42. The heat generating portion 30 including the substrate member 43 and the heat generating element 40 is fixed to the support surface 42 from the side of the second grasping piece 14. The support surface 42 is sandwiched between the inclined surface portions 62 from both outer ends in the width direction. The inclined surface portions 62 are formed so that the outermost ends in the width direction are closer to the back surface 20 than the ends in the center in the width direction. That is, the inclined surface portions 62 are slopes (inclined surfaces) inclined with respect to the width direction. The inclined surface portions 62 form a part of the first opposing face 16. In the present modification, the first opposing face 16 is formed by the substrate facing surface 47 of the substrate member 43 and the inclined surface portions 62 of the base 41. That is, the inclined surface portions 62 of the base 41 form a portion of the first opposing face 16 other than the portion formed by the substrate facing surface 47 of the substrate member 43.
Also in this modification, the first opposing face 16 (the substrate facing surface 47 and the inclined surface portions 62) is coated with a conductive coating (an electrical conductive coating) 49.
In this modification, the central portion in the width direction of the first opposing face 16 is formed by the substrate facing surface 47 of the substrate member 43. The side portions located on both outer sides of the central portion of the first opposing face 16 are formed by the inclined surface portions 62 of the base 41. Here, the base 41 has a lower thermal conductivity than the substrate member 43. For this reason, the heat generated by the heat generating element (heat source) 40 is intensively transferred to the central portion formed by the substrate member 43. That is, the portion where heat is intensively transferred on the first opposing face 16 is limited to the central portion formed by the substrate member 43. Since the portion where heat is intensively transferred on the first opposing face 16 is limited to the central portion, the heat is prevented from being transferred to the portion located in the side portions of the living tissue. As a result, heat invasion to an unintended part is reduced. In addition, since the portion where heat is intensively transferred on the first opposing face 16 is limited to the central portion, the residual heat on the side surfaces of the first grasping piece 13 is reduced.
As a second modification of the first embodiment, as shown in
As described above, in the present modification, heat is applied to the grasped living tissue at the central portion of the first opposing face 16, and a high-frequency current is applied to the side portion. In this way, by adjusting the portion coated with the conductive coating 49 on the first opposing face 16, the portion that applies heat to the grasped living tissue and the portion that applies a high-frequency current can be adjusted to appropriate positions.
In this modification, a high-frequency current is applied to a living tissue grasped between the grasping pieces 13 and 14 at the central portion of the first opposing face 16 in the width direction. Further, the heat generated by the heat generating element 40 is intensively transferred to the central portion formed by the substrate facing surface 47. Therefore, at the central portion of the first opposing face 16, both heat and high-frequency current can be applied to the grasped living tissue.
Furthermore, in this modification, the conductive coating 49 is provided at the boundary between the substrate facing surface 47 and the inclined surface portion 62 on the first opposing face 16. Therefore, water or the like is prevented from entering a part between the substrate member 43 and the base 41 through the boundary between the substrate facing surface 47 and the inclined surface portion 62.
Further, the configuration of the present embodiment is also applicable to an energy treatment instrument that does not apply a high-frequency current to a grasped living tissue. In this case, as shown in
In the above-described embodiment and the like, the protruding portion 44 may not be provided on the first opposing face 16. That is, the first opposing face 16 does not necessarily protrude toward the second grasping piece 14 side.
In the above-described embodiment and the like, the heat generating element (heat source) 40 is provided only in the first grasping piece 13, but it may be provided in both the first grasping piece 13 and the second grasping piece 14. In this case, a configuration similar to the first grasping piece 13 is also applied to the second grasping piece 14.
Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the exemplary embodiments in their broader aspects are not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concepts.
This is a Continuation Application of PCT Application No. PCT/JP2016/084323, filed Nov. 18, 2016, the entire contents of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2016/084323 | Nov 2016 | US |
| Child | 16414923 | US |
