Patent Application
20230380847
The present invention relates to an ultrasonic treatment tool device that raises a temperature of a structure such as a blood vessel to seal the structure, and a method for driving the same.
In a medical field, it is known that various treatments are performed on a subject by using an ultrasonic treatment tool that generates ultrasonic vibration. WO2019/055870A discloses an ultrasonic treatment tool comprising a pair of grip parts for gripping a structure such as a blood vessel and an ultrasound oscillator (ultrasonic transducer), and configured to transmit ultrasonic vibration through the grip parts and to perform a treatment such as sealing or incision of the blood vessel or the like. The ultrasound oscillator is composed of various devices such as a piezoelectric material, and converts supplied power into ultrasonic vibration.
In the ultrasonic treatment tool as disclosed in WO2019/055870A, there is a need to raise a temperature of the grip part in a short time to about 60° C. to 90° C., which is a denaturation temperature of a protein or the like, in order to seal the structure such as the blood vessel gripped by the grip parts. In order to raise the temperature of the grip part in a short time, each device in the ultrasound oscillator needs to be supplied with as much power as possible. Therefore, it has been required to raise the temperature of the structure in a short time by supplying a large amount of power to the ultrasound oscillator using an existing device or equipment without separately using a device for supplying a large amount of power.
An object of the present invention is to provide an ultrasonic treatment tool device capable of raising a temperature of a structure in a short time using an existing device or equipment without separately using a device for supplying a large amount of power in a case in which the temperature of the structure is raised by propagating ultrasonic waves to the structure, and a method for driving the same.
An ultrasonic treatment tool device according to an aspect of the present invention comprises: a grip part that grips a structure in a subject by a pair of gripping pieces provided at a distal end portion of the grip part; an ultrasound oscillator that is provided in at least one of the pair of the gripping pieces and emits an ultrasonic wave; and a processor configured to: drive the ultrasound oscillator such that the ultrasonic wave propagates in a first direction from one side toward the other side and propagates in a second direction opposite to the first direction in the structure; and perform a frequency fluctuation mode for driving the ultrasound oscillator by changing a frequency of the ultrasound oscillator such that a current value flowing through the ultrasound oscillator is a maximal current value.
It is preferable that in the frequency fluctuation mode, the frequency of the ultrasound oscillator is changed in a frequency range including a resonance frequency of the ultrasound oscillator. It is preferable that the processor monitors the current value of an overlapping portion between a first range showing a waveform of the current value for the ultrasonic wave in the first direction and a second range showing a waveform of the current value for the ultrasonic wave in the second direction, and performs a control to maintain the frequency of the ultrasound oscillator at which the current value of the overlapping portion is the maximal current value. It is preferable that the structure includes a blood vessel. It is preferable that the ultrasonic treatment tool device is an endoscope treatment tool that is inserted into the subject through a forceps channel of an endoscope.
A method for driving an ultrasonic treatment tool device according to an aspect of the present invention is a method for driving an ultrasonic treatment tool device including a grip part that grips a structure in a subject by a pair of gripping pieces provided at a distal end portion of the grip part, and an ultrasound oscillator that is provided in at least one of the pair of the gripping pieces and emits an ultrasonic wave, the method comprising following steps executed by a processor: driving the ultrasound oscillator such that the ultrasonic wave propagates in a first direction from one side toward the other side and propagates in a second direction opposite to the first direction in the structure; and performing a frequency fluctuation mode for driving the ultrasound oscillator by changing a frequency of the ultrasound oscillator such that a current value flowing through the ultrasound oscillator is a maximal current value. According to the present invention, it is possible to raise a temperature of a structure in a short time using an existing device or equipment without separately using a device for supplying a large amount of power in a case in which the temperature of the structure is raised by propagating ultrasonic waves to the structure.
As shown in
The endoscope 12 is optically connected to the light source device 14 and electrically connected to the processor device 15. The endoscope 12 includes an insertion part 12a to be inserted into a subject, an endoscope operating part 12b provided at a base end portion of the insertion part 12a, a bendable part 12c provided on a distal end side of the insertion part 12a, and a distal end portion 12d. By operating an angle knob 12e of the endoscope operating part 12b, the bendable part 12c is bent. As a result, the distal end portion 12d is directed in a desired direction. In addition to the angle knob 12e, a forceps port 21 (see
An observation window and an illumination window are provided on a distal end surface of the distal end portion 12d, although not shown. An image sensor (not shown) or the like is disposed on the inside of the observation window, and an optical fiber cable (not shown) is disposed on the inside of the illumination window. A signal line of the image sensor and the optical fiber cable are connected to the processor device 15 and the light source device 14, respectively.
The processor device 15 is electrically connected to the display 16 and the user interface 17. The processor device 15 performs image processing or the like on an endoscopic image captured by the image sensor and displays the processed image on the display 16. The ultrasonic treatment tool device 20 comprises an ultrasonic treatment tool 18 which is one endoscope treatment tool to be inserted into the subject through a forceps channel 23 (see
As shown in
The ultrasonic treatment tool 18 is an endoscope treatment tool to be inserted into a subject together with the insertion part 12a through the forceps channel 23. In the present embodiment, the ultrasonic treatment tool 18 is mentioned as the endoscope treatment tool to be combined with the endoscope 12, but, in practice, the present invention is not limited to this, and treatment tools such as biopsy forceps, snares, or electric scalpels are also combined with the endoscope 12.
The ultrasonic treatment tool 18 comprises a flexible sheath 31, an operation wire 32 (see
The treatment tool operating part 35 comprises an operating part main body 36 and a slider 37 that is slidably supported by the operating part main body 36. The operating part main body 36 is installed consecutively to a base end portion of the flexible sheath 31. The operating part main body 36 is provided with a finger hook portion 36A, a cylindrical portion 36B, and a connector portion 36C. The cylindrical portion 36B extends in a direction parallel to an axial direction of the flexible sheath 31. The slider 37 is engaged with the cylindrical portion 36B and slidably moves along the cylindrical portion 36B in the axial direction of the flexible sheath 31. In a case in which a patient is treated, a thumb of a user is hooked on the finger hook portion 36A, and an index finger and a middle finger of the same user are hooked on the slider 37. A base end of the operation wire 32 is fixed to the slider 37. Therefore, the operation wire 32 is pushed and pulled in the flexible sheath 31 in the axial direction with the sliding movement of the slider 37. The connector portion 36C is electrically connected to the ultrasonic driving part 19 (see
As shown in
The link mechanism 42 comprises a link plate 42A, a connecting pin 42B, and a fitting pin 42C. One end portion of the link plate 42A is connected to the pair of gripping pieces 41 via the connecting pin 42B. A position at which the pair of gripping pieces 41 is connected to the link plate 42A is a base end portion of the gripping pieces 41, which is located on a base end side with respect to the support shaft 41B. The other end portion of the link plate 42A is connected to a connecting member 32A provided at a distal end of the operation wire 32 via the fitting pin 42C. The fitting pin 42C rotatably connects the link plate 42A to the connecting member 32A.
The connecting member 32A is formed in a cylindrical shape. The connecting member 32A is partially located inside the flexible sheath 31 through a through-hole 43A formed in the support member 43. The support member 43 is formed in a substantially cylindrical shape and is fixed to a distal end of the flexible sheath 31. The support member 43 has a notch 43B notched from a distal end thereof. Since the pair of gripping pieces 41 and the link plate 42A move inside the notch 43B, the support member 43 does not hinder the movement of the gripping pieces 41 and the link plate 42A.
The link mechanism 42 converts a linear motion caused by the pushing-pulling operation of the operation wire 32 into a rotational motion, and opens and closes the gripping pieces 41. That is, in a case in which the slider 37 is pulled toward the finger hook portion 36A, the gripping pieces 41 are closed to close the grip part 33 as shown in
As shown in
The ultrasound oscillator 51 is composed of two ultrasound oscillators 51a and 51b facing each other. The ultrasound oscillator 51a is composed of a piezoelectric material 54a (also referred to as a piezoelectric element) and electrodes 56a and 57a. The piezoelectric material 54a is formed in a plate shape. The electrodes 56a and 57a are formed in a plate shape thinner than the piezoelectric material 54a, and are laminated on both surfaces of the piezoelectric material 54a. The ultrasound oscillator 51a is disposed in a parallel to the inner surface 41A of the gripping piece 41 so as to face a structure such as a blood vessel gripped by the grip part 33. In addition, a direction Dk in which the ultrasound oscillator 51 vibrates is parallel to a direction Dx in which the piezoelectric material 54a and the electrodes 56a and 57a are laminated. Then, in a case in which the structure S is gripped by the grip part 33, the ultrasonic waves emitted from the ultrasound oscillator 51a vibrate in a first direction D1 (direction from the ultrasound oscillator 51a to the ultrasound oscillator 51b) along a cross-sectional direction of the structure S, or the ultrasonic waves emitted from the ultrasound oscillator 51b vibrate in a second direction D2 (direction from the ultrasound oscillator 51b toward the ultrasound oscillator 51a) (see
The electrodes 56a and 57a are connected to a connector portion 36C (see
The acoustic matching layer 53 is provided to achieve acoustic impedance matching between a human body of a patient and the ultrasound oscillator 51. The acoustic matching layer 53 is disposed outside the ultrasound oscillator 51, and strictly speaking, the acoustic matching layer 53 is superposed on a side facing a structure gripped by the grip part 33 with respect to the ultrasound oscillator 51. That is, the acoustic matching layer 53 is provided at a position exposed from the inner surface 41A of the gripping piece 41.
Since the acoustic matching layer 53 is provided, it is possible to increase a transmittance of the ultrasonic wave. As a material of the acoustic matching layer 53, various organic materials whose acoustic impedance values are closer to that of the human body of the patient than the piezoelectric material of the ultrasound oscillator 48 can be used. Specific examples of the material of the acoustic matching layer 53 include epoxy resin, silicone rubber, polyimide, and polyethylene. In addition, the acoustic matching layer 53 is formed of a plurality of layers, and the material and the number of formed layers are appropriately selected according to a required acoustic impedance value.
The backing material layer 52 supports the ultrasound oscillator 51 from a back side (a side opposite to the acoustic matching layer 53). A backing material is made of, for example, a rigid material such as hard rubber. In addition, an air gap layer 58, that is, a gap interposed between the backing material layer 52 and the ultrasound oscillator 51 is formed between the backing material layer 52 and the ultrasound oscillator 51. Since the air gap layer 58 can reflect the ultrasonic wave by internal air, it has a function of reflecting the ultrasonic wave emitted from the back side of the ultrasound oscillator 51. Accordingly, the ultrasonic vibration can be efficiently transmitted to a structure such as a blood vessel S. Note that the present invention is not limited to this, and the backing material layer 52 may be filled with a material for reflecting the ultrasonic wave without providing the air gap layer 58.
As shown in
The ultrasonic driving part 19 comprises a signal transmitter 61, an amplifier 62, an impedance matching circuit 63, and a control unit 65. The signal transmitter 61 has a function of generating an AC voltage signal having an optional frequency and waveform, and has, for example, the same configuration and function as a known function generator. A frequency actually used while driving the ultrasound oscillator 51 is displayed on a frequency monitor 61a. It is preferable that the ultrasonic driving part 19 is provided with a current probe 71 and a current value monitor 72 composed of an oscilloscope or the like.
The ultrasonic driving part 19 stores programs related to various kinds of processing in a program memory (not shown). The control unit 65 configured by the processor executes the program in the program memory to realize the functions of the signal transmitter 61, the amplifier 62, and the impedance matching circuit 63.
The signal transmitter 61 outputs, for example, an AC voltage signal with a waveform of a sin wave. In order to supply power to a pair of the ultrasound oscillators 51a and 51b, the amplifier 62 and the impedance matching circuit 63 are provided for each of the ultrasound oscillators 51a and 51b. The signal transmitter 61 outputs AC voltage signals having the same frequency and the same waveform to the amplifiers 62, respectively. The amplifier 62 amplifies the AC voltage signal output from the signal transmitter 61 to a voltage at a level at which the ultrasound oscillators 51a and 51b can be driven. The impedance matching circuit 63 is connected in series with the amplifier 62, and can match an input impedance of the AC voltage signal output from the amplifier 62 with an impedance of the ultrasound oscillators 51a and 51b.
In a case in which a frequency fluctuation mode is set as an operation mode that can be set, the control unit 65 is provided with a frequency fluctuation mode for driving the ultrasound oscillator 51 by changing the frequency of the ultrasound oscillator 51 such that a current value flowing through the ultrasound oscillator 51a is a maximal current value in a fixed frequency range with respect to a frequency of the ultrasound oscillator 51a. It is preferable that the detection of the maximal current value in executing the frequency fluctuation mode is performed within a fixed time from a start of setting of the frequency fluctuation mode. The largest current value among the current values detected within a fixed time is defined as the maximal current value. In the middle of the treatment using the ultrasonic treatment tool 18, it is also assumed that a state of a blood vessel or the ultrasound oscillator 51 changes (for example, an influence of heating) and the optimum driving conditions of the ultrasonic treatment tool 18 change. Therefore, the frequency fluctuation mode is provided to cope with such a situation. It is preferable that the control unit 65 executes the frequency fluctuation mode in accordance with a control program for the frequency fluctuation mode.
In frequency scanning in which the frequency of the ultrasound oscillator 51 is changed, it is preferable that a resonance frequency of the ultrasound oscillator 51 is set as a center frequency and the frequency is changed within a frequency range including the center frequency. The frequency range is determined between a frequency lower limit value smaller than the center frequency and a frequency upper limit value larger than the center frequency. The current value flowing through the ultrasound oscillator 51a is preferably a current value flowing through the ultrasound oscillator 51a in a section between the impedance matching circuit 63 and the ultrasound oscillator 51a, and the current value in the section is preferably monitored by the current probe 71. In a case in which the current value flowing through the ultrasound oscillator 51a is equal to or close to the maximal current value, it is preferable to stop the frequency scanning at that timing to fix the frequency. On the other hand, in a case in which the current value flowing through the ultrasound oscillator 51a changes again from the maximal current value, it is preferable to restart the frequency scanning. A calculation method of the resonance frequency will be described below.
The ultrasonic waves emitted from the ultrasound oscillator 51a propagate in the first direction D1 from one side toward the other side in the structure S. On the other hand, the ultrasonic waves emitted from the ultrasound oscillator 51b propagate in the second direction D2 opposite to the first direction. In the current value monitor 72, the time is represented by a horizontal axis and the current value is represented by a vertical axis, and the current value at a predetermined frequency is displayed. The current value increases or decreases at fixed intervals with respect to the frequency scanning. It is considered that this is because the ultrasonic waves are strengthened or weakened by a relationship between a wavelength of the ultrasonic waves emitted from the ultrasound oscillators 51a and 51b and a distance at which the ultrasonic waves propagate. It is considered that the impedance of the piezoelectric material 54 decreases at a frequency at which the ultrasonic waves are strengthened, and as a result, the current value increases. In a case in which the propagation direction of the ultrasonic waves is only one of the first direction D1 or the second direction D2, no change in the current value occurs.
Hereinafter, a flow of a driving method in a case of actually using the ultrasonic treatment tool 18 will be described with reference to a flowchart of
Next, the control unit 65 is set to the frequency fluctuation mode, and frequency scanning is performed in which the ultrasound oscillators 51a and 51b are driven by changing the frequencies. In the frequency scanning, the current probe 71 is mounted to a probe mounting portion of the ultrasonic treatment tool 18 so that the current value flowing between the impedance matching circuit 63 and the ultrasound oscillator 51a can be measured. In addition, the current value detected by the current probe 71 is displayed on the current value monitor 72.
Subsequently, in the frequency scanning, the drive control is performed such that the current value flowing through the ultrasound oscillators 51a and 51b is the maximal current value. That is, the control unit 65 performs a control of driving the ultrasound oscillator 51 with a constant voltage and driving the ultrasound oscillators 51a and 51b by changing the frequencies of the ultrasound oscillators 51a and 51b such that a current value flowing through the ultrasound oscillators 51a and 51b is the maximal current value. The frequency range in which the frequencies of the ultrasound oscillators 51a and 51b are changed is a range including the resonance frequencies of the ultrasound oscillators 51a and 51b. Then, in a case in which the maximal current value is reached, the frequency scanning is stopped to fix the frequencies of the ultrasound oscillators 51a and 51b. Accordingly, a temperature of the structure S gripped by the grip part 33 can be raised in a short time.
Hereinafter, a relationship between the ultrasonic wave propagating to the structure S and the current value will be described in detail. In
The control unit 65 monitors the current value of the overlapping portion C, and performs a control to maintain the frequency of the ultrasound oscillator 51 at which the current value of the overlapping portion is the maximal current value. In this case, in order to detect the maximal current value, a monitoring period is preferably within a fixed time from a start of setting the frequency fluctuation mode.
Hereinafter, a method of calculating the resonance frequency will be described. As shown in
In a case in which the ultrasonic wave is emitted only from any one of the ultrasound oscillator 51a or the ultrasound oscillator 51b, the resonance condition is that “(2L×f/c)+θ” is an integer (N) (N=(2L×f/c)+θ). Therefore, in a case in which the ultrasonic wave is emitted only from any one of the ultrasound oscillator 51a or the ultrasound oscillator 51b, the resonance frequency fr in a case in which the resonance condition is satisfied can be expressed as “(c×(N−θ))/2L”.
In the above-described embodiment, a hardware structure of a processing unit that executes various kinds of processing, such as the signal transmitter 61, the amplifier 62, the impedance matching circuit 63, and the control unit 65, is various processors as shown in below. The various processors include a central processing unit (CPU) that is a general-purpose processor that executes software (programs) to function as various processing units, a graphical processing unit (GPU), a programmable logic device (PLD) that is a processor capable of changing a circuit configuration after manufacture, such as a field programmable gate array (FPGA), and an exclusive electric circuit that is a processor having a circuit configuration exclusively designed to execute various kinds of processing.
One processing unit may be configured of one of these various processors, or may be configured of a combination of two or more processors of the same type or different types (for example, a plurality of FPGAs, a combination of a CPU and an FPGA, or a combination of a CPU and a GPU). In addition, a plurality of processing units may be configured of one processor. As an example in which the plurality of processing units are configured of one processor, first, as typified by computers such as a client or a server, one processor is configured of a combination of one or more CPUs and software, and this processor functions as the plurality of processing units. Second, as typified by a system on chip (SoC) or the like, a processor that implements the functions of the entire system including the plurality of processing units by using one integrated circuit (IC) chip is used. As described above, the various processing units are configured using one or more of the various processors as a hardware structure.
Further, the hardware structure of these various processors is more specifically an electric circuit (circuitry) in a form in which circuit elements such as semiconductor elements are combined. The hardware structure of the storage unit is a storage device such as a hard disc drive (HDD) or a solid state drive (SSD).
In addition, in the above-described embodiment, the endoscope 12 to be combined with the ultrasonic treatment tool of the embodiment of the present invention is not specified, and the endoscope 12 need only comprise a forceps channel into which the treatment tool is inserted, for example, a bronchoscope, an upper gastrointestinal endoscope, or a lower gastrointestinal endoscope.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2021-019838 | Feb 2021 | JP | national |
This application is a Continuation of PCT International Application No. PCT/JP2022/001344 filed on 17 Jan. 2022, which claims priority under 35 U.S.C § 119(a) to Japanese Patent Application No. 2021-019838 filed on 10 Feb. 2021. The above application is hereby expressly incorporated by reference, in its entirety, into the present application.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2022/001344 | Jan 2022 | US |
| Child | 18447160 | US |
