WO1997010763A1 - Energy delivery system for vessel sealing - Google Patents
Energy delivery system for vessel sealing Download PDFInfo
- Publication number
- WO1997010763A1 WO1997010763A1 PCT/IB1996/000669 IB9600669W WO9710763A1 WO 1997010763 A1 WO1997010763 A1 WO 1997010763A1 IB 9600669 W IB9600669 W IB 9600669W WO 9710763 A1 WO9710763 A1 WO 9710763A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- electrosurgical
- vessels
- power
- surgical tool
- tissues
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—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
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00026—Conductivity or impedance, e.g. of tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
-
- 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
- A61B2018/00696—Controlled or regulated parameters
- A61B2018/00702—Power or energy
-
- 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
- A61B2018/00779—Power or energy
-
- 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
- A61B2018/00869—Phase
-
- 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
-
- 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
- A61B2018/00892—Voltage
Definitions
- U.S. Patent 5, 1 51 ,1 02 discloses a blood vessel coagulation/stanching device which operates with bipolar electrosurgical energy.
- the device operates with a pair of forceps for grasping the vessel and applying electrosurgical energy. During this process, the vessel walls shrink and the tissue becomes rigid.
- This method has been unreliable and inadequate for sealing structures which are larger than approximately two millimeters in diameter.
- journal articles have disclosed methods for sealing small blood vessels using electrosurgery. An article entitled Studies on Coagulation and the Development of an Automatic Computerized Bipolar Coaoulator. J. Neurosurg., Volume 75, July 1 991 , describes a bipolar coagulator which is used to seal small blood vessels. The article states that it was not possible to safely coagulate arteries with a diameter larger than 2 to 2.5 mm.
- This invention works with a combination of pressure and controlled application of electrosurgical energy to achieve the desired result. Therefore, the system requires a tool to grasp and apply an appropriate amount of pressure to the tissue of the patient.
- pressure refers to the closure force on the vessels or other tissue that is applied by the end effectors of the tool.
- the tool must also be capable of conducting electrosurgical energy to the tissue concurrently with the application of pressure.
- Charring of the tissue can be avoided by terminating the flow of electrosurgical energy to the tissue at an appropriate time.
- One technique is to monitor the impedance of the output load on the electrosurgical generator. When the impedance reaches a certain level, preferably above one thousand ohms, the electrosurgical energy should be terminated.
- Another technique is to monitor the phase angle between the output voltage and the output current. Energy delivery to the surgical tool should be terminated preferably when the output current leads the output voltage by an angle greater than approximately fifty degrees.
- a third technique for determining when to terminate the electrosurgical energy is to monitor the output current. As the tissue desiccates, the amount of electrical current flowing through the tissue decreases. The generator may terminate the energy delivery to the surgical tool when the output current drops below approximately 200 milliamperes RMS.
- the generator is preferably capable of delivering a controlled level of high frequency electrosurgical energy.
- the output of the generator may be characterized as having an output voltage and an output current which are each regulated in the preferred embodiment.
- the generator in the present system could limit the output voltage to a value below one hundred sixty volts RMS, and most preferrably would be limited below one hundred twenty volts RMS.
- One of the reasons for limiting the output voltage is to avoid sparks and arcing which cause local high temperature zones in the tissue, and can also result in the tissue sticking to the electrodes.
- Another disadvantage of arcing is that it may result in transection of the vessel.
- the surgical tool is most preferably connected to the generator output for receiving the electrosurgical energy.
- the surgical tool may take the form of forceps, clamps, or any instrument with articulating members for grasping tissue.
- Feedback control is important because the transition points in the power curve are scheduled to occur according to the state of the tissue. In addition, it would be undesirable to apply too much energy to the tissue and thus cause charring and sticking.
- Several parameters may be monitored for purposes of feedback control. These parameters include the impedance of the tissue, the phase angle between the output voltage and output current, the level of output current flowing through the tissue, and the temperature of the tissue.
- the electrosurgical generator 1 1 must have means for automatically controlling the level of electrosurgical power delivered to the surgical tool 1 2. This can be in the form of a feedback control system. In the preferred embodiment, there are also circuits for limiting the output current and the output voltage. In one embodiment, an adjustable high voltage power supply is used to adjust an RF output stage for controlling the electrosurgical output.
- the power output of the generator 1 1 is described in terms of a power curve, and a preferred embodiment is shown in Figure 2.
- the power curve may be described in terms of several stages. The stages may be discrete, or may be approximated by a smooth continuous function.
- the electrosurgical generator 1 1 delivers output power even at impedances below approximately sixteen ohms, and holds a high power lever until the proteins in the tissue have sufficiently melted.
- the output current is allowed to increase to a maximum amplitude which is typically greater than two amperes RMS. It has been found that a high current is important for effective vessel sealing.
- the electrosurgical power is lowered to a level sufficient to desiccate the vessels and other tissues. The Iower power enables the desiccation to occur without charring the tissue.
- a final stage involves allowing the tissue to cool into its new sealed form. During this final stage, the application of electrosurgical power to the tissue is substantially terminated. After the tissue has cooled, the closure force is released. The length of time for cooling is typically less than five seconds. In the preferred embodiment, a audible tone would indicate to the surgeon that the sealing process was complete. The surgeon would thereafter release the vessel from the surgical tool 1 2. It is thought that the initial high current causes proteins in the tissue to melt.
- the electrosurgical power is held approximately constant until proteins in the vessels and other tissues have melted.
- the impedance at which this segment ends will vary in accordance with the magnitude of the RMS power.
- the maximum RMS power is approximately 1 25 Watts
- this segment will end at approximately 1 28 ohms. This is shown as the segment labeled B in Figure 2.
- a Iower power is used, such as 75 Watts, the segment may end at 256 ohms. This is shown as the segment labeled C in Figure 2.
- the phase angle between current and voltage may be used.
- the generator 1 1 includes means for substantially terminating the power delivery to the surgical tool 1 2 when the output current leads the output voltage by an angle greater than approximately fifty degrees.
Abstract
Description
Claims
Priority Applications (7)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU62378/96A AU723001B2 (en) | 1995-09-19 | 1996-07-11 | Energy delivery system for vessel sealing |
DE69621636T DE69621636T2 (en) | 1995-09-19 | 1996-07-11 | ENERGY FEEDING SYSTEM FOR SEALING VESSELS |
EP96921013A EP0862386B1 (en) | 1995-09-19 | 1996-07-11 | Energy delivery system for vessel sealing |
CA002228890A CA2228890C (en) | 1995-09-19 | 1996-07-11 | Energy delivery system for vessel sealing |
JP51251297A JP3207435B2 (en) | 1995-09-19 | 1996-07-11 | Electrosurgical energy supply system |
AT96921013T ATE218304T1 (en) | 1995-09-19 | 1996-07-11 | ENERGY SUPPLY SYSTEM FOR SEALING VESSELS |
MXPA/A/1998/001151A MXPA98001151A (en) | 1995-09-19 | 1998-02-10 | Energy supply system to close va |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/530,495 US5827271A (en) | 1995-09-19 | 1995-09-19 | Energy delivery system for vessel sealing |
US08/530,495 | 1995-09-19 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1997010763A1 true WO1997010763A1 (en) | 1997-03-27 |
Family
ID=24113828
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IB1996/000669 WO1997010763A1 (en) | 1995-09-19 | 1996-07-11 | Energy delivery system for vessel sealing |
Country Status (9)
Country | Link |
---|---|
US (1) | US5827271A (en) |
EP (1) | EP0862386B1 (en) |
JP (1) | JP3207435B2 (en) |
AT (1) | ATE218304T1 (en) |
AU (1) | AU723001B2 (en) |
CA (1) | CA2228890C (en) |
DE (1) | DE69621636T2 (en) |
ES (1) | ES2174078T3 (en) |
WO (1) | WO1997010763A1 (en) |
Cited By (268)
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EP1616529A2 (en) * | 1997-04-09 | 2006-01-18 | Sherwood Services AG | Electrosurgical generator |
EP2221017A1 (en) * | 2009-02-23 | 2010-08-25 | Covidien AG | System and method for tissue sealing |
US8066167B2 (en) | 2009-03-23 | 2011-11-29 | Ethicon Endo-Surgery, Inc. | Circular surgical stapling instrument with anvil locking system |
USD650074S1 (en) | 2010-10-01 | 2011-12-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
US8083120B2 (en) | 2008-09-18 | 2011-12-27 | Ethicon Endo-Surgery, Inc. | End effector for use with a surgical cutting and stapling instrument |
US8113410B2 (en) | 2008-02-14 | 2012-02-14 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features |
US8136712B2 (en) | 2009-12-10 | 2012-03-20 | Ethicon Endo-Surgery, Inc. | Surgical stapler with discrete staple height adjustment and tactile feedback |
US8141762B2 (en) | 2009-10-09 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical stapler comprising a staple pocket |
US8157153B2 (en) | 2006-01-31 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument with force-feedback capabilities |
US8157145B2 (en) | 2007-05-31 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with electrical feedback |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US8186560B2 (en) | 2007-03-15 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling systems and staple cartridges for deploying surgical staples with tissue compression features |
US8196796B2 (en) | 2007-06-04 | 2012-06-12 | Ethicon Endo-Surgery, Inc. | Shaft based rotary drive system for surgical instruments |
US8196795B2 (en) | 2008-02-14 | 2012-06-12 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US8205781B2 (en) | 2008-09-19 | 2012-06-26 | Ethicon Endo-Surgery, Inc. | Surgical stapler with apparatus for adjusting staple height |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8267300B2 (en) | 2009-12-30 | 2012-09-18 | Ethicon Endo-Surgery, Inc. | Dampening device for endoscopic surgical stapler |
US8308040B2 (en) | 2007-06-22 | 2012-11-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
US8317070B2 (en) | 2005-08-31 | 2012-11-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling devices that produce formed staples having different lengths |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US8322589B2 (en) | 2007-06-22 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
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Also Published As
Publication number | Publication date |
---|---|
US5827271A (en) | 1998-10-27 |
EP0862386B1 (en) | 2002-06-05 |
ES2174078T3 (en) | 2002-11-01 |
AU6237896A (en) | 1997-04-09 |
CA2228890C (en) | 2001-09-11 |
ATE218304T1 (en) | 2002-06-15 |
JPH10510460A (en) | 1998-10-13 |
EP0862386A1 (en) | 1998-09-09 |
CA2228890A1 (en) | 1997-03-27 |
AU723001B2 (en) | 2000-08-17 |
MX9801151A (en) | 1998-05-31 |
JP3207435B2 (en) | 2001-09-10 |
DE69621636T2 (en) | 2002-12-05 |
DE69621636D1 (en) | 2002-07-11 |
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