FR2502935A1 - Diathermic knife for coagulating tissues - has monitoring current added to HF coagulating current in order to control end of operation as function or resistance of coagulating tissues - Google Patents

Diathermic knife for coagulating tissues - has monitoring current added to HF coagulating current in order to control end of operation as function or resistance of coagulating tissues Download PDF

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FR2502935A1
FR2502935A1 FR8106454A FR8106454A FR2502935A1 FR 2502935 A1 FR2502935 A1 FR 2502935A1 FR 8106454 A FR8106454 A FR 8106454A FR 8106454 A FR8106454 A FR 8106454A FR 2502935 A1 FR2502935 A1 FR 2502935A1
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coagulation
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance

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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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Abstract

The device is used to coagulate tissues and operates with a monitor current (ic) is applied in addition to the high frequency coagulating current. The monitoring current is very low, calibrated and clearly identifiable from the coagulating current. During the coagulation operation, the monitoring current magnitude, which is a function of the resistance of the coagulating tissues, is measured. When the magnitude of the monitoring current reaches a lower predetermined limit, the coagulation operation is automatically cut off. The diatermic knife can be mfd. as a monopolar knife comprising a thin active electrode (3) applied to the tissues to be coagulated and a large surface electrode (7) placed in contact with the patient. The device can also be manufactured as a bipolar knife comprising two thin active electrodes.

Description

Procédé et dispositif de contrôle de la coagulation de tissus à l'aide d'un courant a haute fréquence.Method and device for controlling tissue coagulation using a high frequency current

La présente invention se rapporte un procédé de con trôle de la coagulation de tissus à l'aide d'un courant à haute fréquence. The present invention relates to a method of controlling tissue coagulation using a high frequency current.

Le fonctionnement des bistouris électriques est basé sur le principe que si on applique un courant à haute fréquence au corps d'un patient, il se produit une élévation de température au niveau de chacune des électrodes d'application du courant; l'élévation de température est d'autant plus importante que la surface de contact de lfelectrode est petite. On utilise un courant à haute fréquence pour éviter toute excitation faradique qui se produirait si la fréquence était suffisamment basse pour être ressentie par le patient. The operation of the electrical lancets is based on the principle that if a high frequency current is applied to the body of a patient, a rise in temperature occurs at each of the current application electrodes; the rise in temperature is all the more important as the contact area of the electrode is small. A high frequency current is used to avoid any faradic excitation that would occur if the frequency was low enough to be felt by the patient.

Si l'une des électrodes utilisées est très fine alors que l'autre est de grande surface, l'élévation de température sera considérable au niveau de l'électrode fine et pratiquement inexistante au niveau de l'électrode de grande surface. On obtient ainsi, au niveau de l'électrode fine, un effet de coupe ou un effet de coagulation des tissus, selon la puissance appliquée. If one of the electrodes used is very fine while the other is large, the temperature rise will be considerable at the thin electrode and virtually nonexistent at the large surface electrode. Thus, at the level of the fine electrode, a cutting effect or a coagulation effect of the tissues is obtained, depending on the power applied.

Il est également possible d'obtenir un effet d'électrocoagulation en reliant les deux pôles d'un générateur de courant à haute fréquence deux électrodes fines appliquées contre le tissu å coaguler dans la zone opératoire. En géne- ral, ces deux électrodes sont constituées par les deux branches isolées d'une pince, la coagulation étant limitée à la partie des tissus qui se trouvent entre les deux becs de la pince. It is also possible to obtain an electrocoagulation effect by connecting the two poles of a high frequency current generator with two thin electrodes applied against the tissue to be coagulated in the operating zone. In general, these two electrodes are constituted by the two isolated branches of a clamp, the coagulation being limited to the part of the tissues which are between the two jaws of the clamp.

La puissance nécessaire pour ce procédé de coagulation dite "bipolaire" est nettement plus faible que celle nécessaire pour la coagulation dite "monopolaire", utilisant une électrode de grande surface dite électrode indifférente et une électrode fine dite électrode active. The power required for this so-called "bipolar" coagulation process is significantly lower than that required for so-called "monopolar" coagulation, using a large-area electrode called an indifferent electrode and a thin electrode called an active electrode.

Deux facteurs déterminent la qualité de la coagulation, savoir l'intensité du courant, d'une part, et le temps de passage du courant, d'autre part. Jusqu'S présent, l'opérateur effectue le dosage de la puissance et du temps de coagulation. Two factors determine the quality of the coagulation, namely the intensity of the current, on the one hand, and the time of passage of the current, on the other hand. Until now, the operator performs the dosing of the power and the coagulation time.

Or, en particulier des variations du temps de coagulation conduisent à des coagulations irrégulières, certaines étant trop fortes et d'autres trop faibles.In particular, variations in coagulation time lead to irregular coagulation, some being too strong and others too weak.

La présente invention a pour objet un procédé de contrôle de la coagulation aussi bien "monopolaire" que "bipolaire" à l'aide de courants à haute fréquence de manière qu'indépendam- ment de l'action de l'opérateur, toutes les coagulations soient de qualité égale et optimale. The subject of the present invention is a method of controlling both monopolar and bipolar coagulation by means of high frequency currents so that, independently of the action of the operator, all coagulation occurs. be of equal and optimal quality.

L'invention a également pour objet un dispositif pour la mise en oeuvre de ce procédé. The invention also relates to a device for implementing this method.

Suivant l'invention, on superpose au courant de coagulation à haute fréquence un très faible courant de contrôle calibré nettement identifiable par rapport au courant de coagulation. Ce courant de contrôle circule donc, comme le courant de coagulation à haute fréquence, soit entre une électrode fine dite électrode active, appliquée contre le tissu à coaguler dans la zone opératoire d'un patient et une électrode de grande surface-dite électrode indifférente en contact avec le patient en dehors de la zone opératoire, soit entre deux électrodes fines dites actives appliquées contre le tissu à coaguler dans la zone opératoire d'un patient.On mesure la variation de l'intensité de ce courant de contrôle pour déclencher l'arrêt automatique de la coagulation des que l'intensité du courant de contrôle, qui est fonction de la résistance des tissus en cours de coagulation, atteint une valeur limite inférieure prédéterminée. According to the invention, a very small calibrated control flow which is clearly identifiable with respect to the coagulation stream is superimposed on the high-frequency coagulation stream. This control current therefore circulates, like the high-frequency coagulation current, either between a thin electrode called an active electrode, applied against the tissue to be coagulated in the operating zone of a patient, and a large surface electrode-the so-called indifferent electrode. contact with the patient outside the operating zone, or between two so-called active electrodes applied against the tissue to be coagulated in the operating zone of a patient. The variation of the intensity of this control current is measured to trigger the automatic cessation of coagulation as the intensity of the control current, which is a function of the resistance of the tissues during coagulation, reaches a predetermined lower limit value.

En effet, la résistance des tissus à coaguler est faible au moment où la coagulation commence et cette résistance augmente progressivement au fur et a mesure que les tissus se dessèchent sous l'effet de l'échauffement dA au passage du courant de coagulation. Par conséquent, l'intensité du courant de contrôle superposée au courant de coagulation à haute fréquence est fonction de la résistance des tissus en cours de coagulation, ce qui permet de déclencher l'arrêt automatique de la coagulation lorsque la résistance des tissus atteint une valeur prédéterminée.Le rôle de l'opérateur se borne ainsi a déclencher le début de la coagulation, après avoir placé l'électrode active ou les électrodes actives l'endroit désiré, la coagulation s'arrêtant automatiquement dès qu'elle atteint une valeur optimale prédéterminée. Indeed, the resistance of the tissues to be coagulated is low at the moment when the coagulation begins and this resistance increases progressively as the tissues dry out under the effect of the heating of A at the passage of the coagulation stream. Consequently, the intensity of the control current superimposed on the high-frequency coagulation current is a function of the resistance of the coagulating tissues, which triggers the automatic cessation of coagulation when the tissue resistance reaches a value. The role of the operator is thus limited to triggering the start of coagulation, after having placed the active electrode or the active electrodes at the desired location, the coagulation stopping automatically as soon as it reaches a predetermined optimum value. .

Le dispositif pour la mise en oeuvre du procédé de con trôle conforme à l'invention comprend un générateur de courant de contrôle monté en parallèle avec le générateur de courant de coagulation à haute fréquence, un dispositif de mesure de l'intensité du courant de controle, monté en série avec ledit générateur de courant de contrôle, un dispositif de filtrage entre le circuit à haute fréquence et le circuit à courant continu ou basse fréquence, et un dispositif d'arrêt du générateur de courant à haute fréquence commande par ledit dispositif de mesure lorsque l'intensité du courant de contrôle atteint une valeur limite inférieure prédéterminée. The device for carrying out the control method according to the invention comprises a control current generator connected in parallel with the high frequency coagulation current generator, a device for measuring the intensity of the control current. , connected in series with said control current generator, a filtering device between the high frequency circuit and the DC or low frequency circuit, and a device for stopping the high frequency current generator controlled by said device measured when the intensity of the control current reaches a predetermined lower limit value.

En se référant au dessin annexé, on va décrire ci-après un mode de réalisation illustratif et non limitatif d'un dispositif de contrôle conforme a l'invention dans son application au contrôle de la coagulation monopolaire, l'aide d'une électrode active et d'une électrode indifférente. With reference to the appended drawing, an illustrative and nonlimiting embodiment of a control device according to the invention in its application to the control of monopolar coagulation will be described below, using an active electrode. and an indifferent electrode.

Sur le schéma de la figure unique du dessin, un géné- rateur de courant à haute fréquence 1 est relié, par l'intermédiaire d'un transformateur 2, une électrode 3 dont le conducteur d'alimentation 4 comporte une fiche 5 branchée de façon amovible sur une douille 6 reliée 8 une borne du secondaire du transformateur 2, dont l'autre borne est mise à la masse. Une électrode 7 de grande surface placée sur une table d'opération 8 est reliée par un conducteur 9 se terminant par une fiche 10, de façon amovible ê une autre douille 11 qui est mise la masse.Un patient 12 sur lequel doit être pratiqué une intervention impliquant de la chirurgie électrique (coupe de tissus par bistouri électrique) et/ou de l'électrocoagulation repose sur la table 8de manière à se trouver en bon contact avec l'électrode 7. In the diagram of the single figure of the drawing, a high-frequency current generator 1 is connected, via a transformer 2, to an electrode 3 whose feed conductor 4 comprises a plug 5 connected in such a way removable on a socket 6 connected to 8 a secondary terminal of the transformer 2, the other terminal is grounded. An electrode 7 of large surface placed on an operating table 8 is connected by a conductor 9 terminating in a plug 10, in a removable manner to another socket 11 which is fitted to the mass. A patient 12 on which a intervention involving electrical surgery (cutting of tissues by electrocautery) and / or electrocoagulation is based on the table 8 so as to be in good contact with the electrode 7.

La commande du générateur à haute fréquence 1 s'effectue, selon qu'il s'agit de couper ou de coaguler, à l'aide d'une pédale de commande de bistouri 13 ou d'une pCdale de commande de coagulation 14 reliées par deux conducteurs respectivement 15 et 16 au générateur 1. The control of the high frequency generator 1 is effected, depending on whether it is a question of cutting or coagulating, by means of a lancet control pedal 13 or a coagulation control paddle 14 connected by two conductors respectively 15 and 16 to the generator 1.

Le dispositif conforme à l'invention de contrôle de l'électrocoagulation comprend un générateur de courant de contrôle 17 monté en parallèle avec le secondaire du transformateur 2, de manière que courant ic de très faible intensité, calibré et facilement identifiable, du générateur 17 soit superposé au courant IHF du générateur 1. Un dispositif de mesure 18 de l'intensité du courant ic du générateur 17 est monté en série avec ce dernier. Un dispositif de filtrage 19 représenté comme comprenant une impédance 20 et un condensateur 21 assure la séparation des deux courants IHF et ic pour permettre une mesure précise du courant ic et éviter la destruction du dispositif de mesure 18 par le courant à haute fréquence. The device according to the invention for controlling the electrocoagulation comprises a control current generator 17 connected in parallel with the secondary of the transformer 2, so that the current ic of very low intensity, calibrated and easily identifiable, of the generator 17 is superimposed on the IHF current of the generator 1. A device 18 for measuring the intensity of the current ic of the generator 17 is connected in series with the latter. A filtering device 19 represented as comprising an impedance 20 and a capacitor 21 ensures the separation of the two currents IHF and ic to allow accurate measurement of the current ic and to avoid the destruction of the measuring device 18 by the high frequency current.

Le dispositif de mesure 18 est relié à un relais 22 actionnant un contact 23 qui commande l'ouverture et la fermeture du conducteur 16 reliant la pédale de commande de coagulation 14 au générateur de courant å haute fréquence 1. The measuring device 18 is connected to a relay 22 actuating a contact 23 which controls the opening and closing of the conductor 16 connecting the coagulation control pedal 14 to the high-frequency current generator 1.

Un interrupteur manuel 24 est monté en parallèle avec le contact 23 pour pouvoir shunter ce dernier.A manual switch 24 is mounted in parallel with the contact 23 to be able to shunt the latter.

Lorsque le générateur de courant à haute fréquence 1 est réglé sur la position bistouri (bist.) et est commandé par la pédale de commande de bistouri 13, le dispositif de contrôle conforme à l'invention comprenant le générateur de courant de contrôle 17, le dispositif de mesure 18, le relais 22 et le contact 23 n'est pas en action. Par contre, le dispositif de contrôle est mis en action automatiquement lors du réglage du générateur 1 sur la position coagulation (coag.) et lors de l'ouverture de l'interrupteur 24. When the high frequency current generator 1 is set to the scalpel position (bist.) And is controlled by the scalpel control pedal 13, the control device according to the invention comprising the control current generator 17, the measuring device 18, the relay 22 and the contact 23 is not in action. On the other hand, the control device is automatically activated when the generator 1 is set to the coagulation position (coag.) And when the switch 24 is opened.

Pour effectuer une coagulation, l'opérateur applique l'électrode 3 a l'endroit auquel il veut réaliser la coagulation et enfonce la pédale 14. Le courant IHF auquel est superposé le courant ic du générateur 17 produit ainsi un échauffement des tissus au niveau de l'extrémité de l'électrode 3, échauffement qui entrain une coagulation des tissus.  To perform a coagulation, the operator applies the electrode 3 at the place where he wants to achieve coagulation and depresses the pedal 14. The IHF current which is superimposed on the ic current of the generator 17 thus produces a heating of the tissue at the level of the end of the electrode 3, warming up which coagulates the tissues.

La résistance initialen;ent faible des tissus en contact avec l'électrode 3 augmente progressivement au fur et à mesure que les tissus coagulent, c'est-à-dire se dessèchent. Avec l'augmentation de la résistance des tissus, l'intensité du courant iC diminue. Le dispositif de mesure 18 est réglé sur un seuil d'intensité correspondant à un degré de coagulation optimal défini par une résistance déterminée des tissus. Dès que ce seuil est atteint, le dispositif de mesure 18 excite le relais 22 qui ouvre le contact 23, interrompant ainsi la commande du générateur 1, ce qui arrête la coagulation.The initial weak resistance of the tissues in contact with the electrode 3 increases progressively as the tissues coagulate, i.e., dry out. As the tissue strength increases, the intensity of the current iC decreases. The measuring device 18 is set to an intensity threshold corresponding to an optimum degree of coagulation defined by a determined resistance of the tissues. As soon as this threshold is reached, the measuring device 18 excites the relay 22 which opens the contact 23, thus interrupting the control of the generator 1, which stops the coagulation.

En fermant l'interrupteur 24, on peut mettre hors service le dispositif de contrôle, ce qui permet a l'opérateur de doser lui-même les coagulations s'il le désire. By closing the switch 24, the control device can be put out of service, which allows the operator to self-dose the coagulations if he so desires.

Le dispositif de mesure 18 est établi de manière à autoriser le fonctionnement et provoquer l'arrêt du générateur de courant a haute fréquence 1, lors de la coagulation, en fonction de trois seuils correspondant à trois résistances
R1 ( R2 < R3 et de la valeur de résistance R présentée par les tissus du patient.The measuring device 18 is set up so as to allow the operation and cause the high-frequency current generator 1 to stop, during coagulation, according to three thresholds corresponding to three resistors.
R1 (R2 <R3 and the resistance value R presented by the patient's tissues.

Si R > R3(électrode 3 non appliquée sur les tissus du patient), le dispositif de mesure 18 interdit le fonctionnement du générateur 1, même si la pédale de commande de coagulation 14 est enfoncée. If R> R3 (electrode 3 not applied to the tissues of the patient), the measuring device 18 prohibits the operation of the generator 1, even if the coagulation control pedal 14 is depressed.

Si R < R1 (électrode 3 en contact avec les tissus), le générateur 1 fonctionne lorsque la pédale 14 est actionnée. La coagulation commence et R augmente progressivement. If R <R1 (electrode 3 in contact with the tissues), the generator 1 operates when the pedal 14 is actuated. Coagulation begins and R gradually increases.

Dès que R = R2 (R2 étant le seuil de déclenchement de l'arrêt de la coagulation), le dispositif de mesure 18 arrête le générateur 1 sans que l'opérateur n'ait a relâcher la pédale 14. As soon as R = R2 (R2 being the threshold for triggering the cessation of coagulation), the measuring device 18 stops the generator 1 without the operator having to release the pedal 14.

Pour réarmer le dispositif de contrôle, l'opérateur relève ltelectrode 3 mais peut maintenir enfoncer la pédale 14; cela présente d'ailleurs l'avantage pour l'opérateur de pouvoir effectuer plusieurs coagulation en série sans relâchez la pédale, simplement en déplaçant l'électrode 3. To reset the control device, the operator returns the electrode 3 but can hold down the pedal 14; this also has the advantage for the operator to be able to perform several coagulation series without releasing the pedal, simply by moving the electrode 3.

Par contre, l'opérateur reste a tout moment maître de la coagulation qu'il peut arrêter immédiatement, s'il juge nécessaire, en relâchant la pédale 14.  On the other hand, the operator remains at all times master of the coagulation which he can stop immediately, if it deems necessary, by releasing the pedal 14.

Pour appliquer le dispositif de contrôle tel que représente et décrit à la coagulation bipolaire qui consiste à utiliser une pince à deux branches isolées dont chacune est reliée à un pôle d'un générateur de courant à haute fréquence, il suffit de relier les deux branches de la pince par deux conducteurs, directement ou indirectement, aux deux douilles 6 et 11. To apply the control device as represented and described to bipolar coagulation which consists of using a pair of insulated tweezers each of which is connected to a pole of a high-frequency current generator, it is sufficient to connect the two branches of the the clamp by two conductors, directly or indirectly, to the two sockets 6 and 11.

Seules les caractéristiques générales du dispositif de contrôle conforme à l'invention ont été décrites ci-dessus et représentées sur le dessin schématique annexé. De multiples variantes à la portée de l'homme de l'art sont concevables en ce qui concerne, par exemple, la réalisation du filtre 19, du dispositif de mesure 18 et du dispositif d'arrêt 22, 23, notamment en fonction de la nature du courant de contrôle utilisé. Ce courant peut être, par exemple un courant continu comme dans l'exemple représenté, ou encore un courant alternatif à basse fréquence, un courant alternatif ayant une fréquence nettement plus élevée que celle du courant de coagulation, ou également un courant complexe, par exemple des impulsions codées. Il suffit que ce courant soit de très faible intensité, soit calibré et soit facilement identifiable par rapport au courant de coagulation.  Only the general characteristics of the control device according to the invention have been described above and shown in the attached schematic drawing. Multiple variants within the reach of those skilled in the art are conceivable as regards, for example, the production of the filter 19, the measuring device 18 and the stop device 22, 23, in particular according to the nature of the control current used. This current may be, for example a direct current as in the example shown, or alternatively a low-frequency alternating current, an alternating current having a frequency much higher than that of the coagulation current, or also a complex current, for example encoded pulses. It is sufficient for this current to be of very low intensity, calibrated and easily identifiable with respect to the coagulation current.

Claims (2)

REVENDICATIONS 1. Procédé de contrôle de la coagulation de tissus d'un patient a l'aide d'un courant a haute fréquence fourni par un générateur dont soit un pôle est relié à une électrode fine dite électrode active appliquée contre les tissus à coaguler dans la zone opératoire du patient et l'autre à une électrode de grande surface dite électrode indifférente, en contact avec le patient en dehors de la zone opératoire, soit les deux pâles sont reliés à deux électrodes fines appliquées contre les tissus à coaguler dans la zone opératoire du patient, caractérisé par le fait qu'on superpose au courant de coagulation à haute fréquence un courant de contrôle de très faible intensité, calibré, nettement identifiable par rapport au courant de coagulation, et qu'on mesure la variation de l'intensité de ce courant de contrôle pour déclencher l'arrêt de la coagulation dès que l'intensité du courant de contrôle, qui est fonction de la résistance des tissus en cours de coagulation, atteint une valeur limite inférieure prédéterminée. 1. A method for controlling the coagulation of tissues of a patient using a high frequency current supplied by a generator of which either a pole is connected to a thin electrode called active electrode applied against the tissues to be coagulated in the operating area of the patient and the other to a large surface electrode called indifferent electrode, in contact with the patient outside the operating area, or the two blades are connected to two thin electrodes applied against the tissues to be coagulated in the operating area of the patient, characterized in that a control current of very low intensity, calibrated, clearly identifiable with respect to the coagulation current is superimposed on the high-frequency coagulation current, and that the variation in the intensity of the coagulation is measured. this control current to trigger the cessation of coagulation as soon as the intensity of the control current, which is a function of the resistance of the tissues in the course of oagulation, reaches a predetermined lower limit value. 2. Dispositif pour la mise en oeuvre du procédé suivant la revendication 1, caractérisé par le fait qu'il comprend un générateur de courant de contrôle monté en parallèle avec le générateur de courant de coagulation à haute fréquence, un dispositif de mesure de l'intensité du courant de contrôle, monté en série avec ledit générateur de courant de contrôle, un dispositif de filtrage séparant le courant de coagulation du courant de contrôle, et un dispositif d'arrêt automatique du générateur de courant de coagulation, commandé par le dispositif de mesure du courant de contrôle lorsque l'intensite de ce courant atteint une valeur limite inférieure prédéterminée.  2. Device for implementing the method according to claim 1, characterized in that it comprises a control current generator connected in parallel with the high frequency coagulation current generator, a device for measuring the intensity of the control current, connected in series with said control current generator, a filtering device separating the coagulation current from the control current, and an automatic shutdown device of the coagulation current generator, controlled by the control device. measurement of the control current when the intensity of this current reaches a predetermined lower limit value.
FR8106454A 1981-03-31 1981-03-31 METHOD AND DEVICE FOR CONTROLLING THE COAGULATION OF TISSUES USING A HIGH FREQUENCY CURRENT Expired FR2502935B1 (en)

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Cited By (248)

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Publication number Priority date Publication date Assignee Title
EP0126814A1 (en) * 1983-05-24 1984-12-05 Sien-Shih Chang Electro-surgical unit control apparatus
EP0341446A2 (en) * 1988-05-09 1989-11-15 Karl Storz GmbH & Co. High frequency generator to cut and coagulate the tissues in high frequency surgery
EP0521501A2 (en) * 1991-07-04 1993-01-07 DELMA ELEKTRO-UND MEDIZINISCHE APPARATEBAU GESELLSCHAFT mbH Electrosurgical treatment instrument
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