JP2003126112A - Surgical equipment - Google Patents

Abstract

(57) [Summary] [PROBLEMS] To reduce the entire operation time by eliminating the need to hold a holding unit such as an electrosurgical device and a suction device used together with an electrostimulation device used during surgery, and to reduce the number of operators during surgery. Provided is a surgical device capable of reducing a burden on a patient. An electric scalpel device control unit (27) for supplying electricity for coagulating or incising a predetermined tissue of a subject, and an electric signal applied to the predetermined tissue of the subject or an electric signal from the predetermined tissue of the subject. The electrical stimulator control unit 25 to be detected
A switch 22b for connecting to one holding unit held by the operator and switching the function of the holding unit is provided.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical device used during surgery.

[0002]

2. Description of the Related Art Conventionally, as a device used during surgery,
An electric scalpel device, a suction device, etc. are mentioned. The electric scalpel device is a device used for performing coagulation for stopping bleeding or burning hard tissue (dura etc.) during surgery. Among the electrosurgical units, what is called a bipolar is a tweezers-like instrument with a pair of small electrodes at the tip, and a voltage is applied between the electrodes, and a liquid containing electrolyte is generally supplied from a hole provided near the tip. Physiological saline)
Give out. An electric current flows through this liquid to generate heat, and the heat causes solidification and incision. An electric scalpel device called a monopolar is composed of a large electrode that is constantly in contact with the patient and one small electrode that is inserted into the surgical field. By applying a voltage between these electrodes, the inserted small electrode Incision and coagulation are performed by generating Joule heat in the surroundings. In addition, these instruments are also used as instruments for holding or ablating tissue.

A suction device is a low pressure (usually "vacuum") device.
It is a device used to aspirate and remove tissue, blood, washing water, etc. from the tip of a tube (suction tube) that is kept in the so called. In addition, there is an instrument called a probe, which is inserted into the tissue to check the response.
Additionally, pieces of cotton cloth may be used to cut brain tissue. By holding a piece of cotton cloth with tweezers and rubbing the brain tissue, only the brain tissue is incised without cutting the blood vessel. In addition, for the purpose of elucidating brain functions, etc., studies have been conducted to determine whether or not the nerve tissue is the efferent nerve and to which part it is connected by electrically stimulating the brain tissue, spinal cord, and peripheral nerve. ing. When performing this electrical stimulation, a device (hereinafter, referred to as an electrical stimulation device) including a stimulation electrode that is a portion to which electrical stimulation is applied and a detection electrode that detects the applied electrical stimulation is used.

[0004]

However, these surgical devices may be used in combination with each other.
At this time, the following problems occurred. (1) Since the surgical devices such as the electric scalpel device and the suction device used during the operation are separate devices, the part (holding part) held by the operator is also configured separately. In the case of using this electric stimulator, it is necessary to change the holding part (which may be frequently performed depending on the type of surgery), which imposes a great burden on the operator and the patient. In particular, when using an electric stimulator, it is necessary to bring a part of the holding part into contact with the tissue of the subject with a very delicate balance of forces, and it is very difficult to carry it with another device. On the other hand, if the examination by the electric stimulator is omitted when necessary, an important nerve may be injured. (2) In the conventional electrical stimulator, whether the electrical signal detected by the detection electrodes accurately transmits nerves (in the present specification, this is referred to as "whether tissues contacting each electrode are nerve-connected to each other"). I didn't know in detail. ”). For this reason,
Applying the conventional electrical stimulator as a surgical device as it is during a surgery in which there is a time limit due to various factors (physical strength of the patient, etc.) imposes a great burden on the operator.

(3) Further, the conventional electric stimulator is attached so as to be adhered to the subject, and the electrodes are not covered with the insulating member. However, in surgery, the operator needs to hold the electrode by hand, and in the case of such an uncoated electrode, an electric signal for stimulating the subject is applied to the operator, and Noise may be mixed into the detected electric signal. Therefore, it is an object of the present invention to solve the above problems and provide a surgical apparatus that can reduce the burden on the operator and the patient when the electric stimulator is used during surgery.

[0006]

In order to solve the above-mentioned problems, the invention according to claim 1 provides an electrosurgical knife device control means for supplying electricity for coagulating or incising a predetermined tissue of a subject, At least two control means of an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the specimen and an electric signal detection control means for detecting an electric signal from the predetermined tissue of the subject; Two
It is characterized in that it is provided with a holding portion connected to one control means and held by an operator, and a switching means for switching which of the at least two control means is to be used. Further, the invention according to claim 9 is a suction device control means for sucking a predetermined tissue of a subject by a suction tube, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject, And at least two control means of the electric signal detection control means for detecting an electric signal from a predetermined tissue of the subject, a holding part connected to the at least two control means and held by an operator, Switching means for switching which of the two control means is to be used.

According to a twelfth aspect of the present invention, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject, and an electric signal for detecting the electric signal from the predetermined tissue of the subject. At least one control means of the signal detection control means, and a son connected to the at least one control means and inserted into a predetermined tissue of the subject to check the response. . According to a thirteenth aspect of the present invention, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject, and an electric signal detection control for detecting the electric signal from the predetermined tissue of the subject. It is characterized by comprising at least one control means of the means, and conductive tweezers connected to the at least one control means for holding a predetermined member. According to a fifteenth aspect of the present invention, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject and an electric signal detection control for detecting the electric signal from the predetermined tissue of the subject. Means, neural connection detection for detecting, based on the generated electrical signal and the detected electrical signal, whether the tissue stimulated by the electrical signal and the tissue in which the electrical signal is detected are neurally connected And means.

According to the eighteenth aspect of the present invention, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject, and an electric signal for detecting the electric signal from the predetermined tissue of the subject. At least one control means of the signal detection control means, and a holding portion having a conductive member connected to the at least one control means and an insulating member for insulating an operator from the conductive member. It is characterized by Further, the invention according to claim 19 is an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of a subject, and an electric signal detection control for detecting an electric signal from the predetermined tissue of the subject. Means and display control means for displaying the waveform of the generated electric signal and the waveform of the detected electric signal on the same screen.

[0009]

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, a first embodiment according to the present invention will be described in detail with reference to FIGS. FIG. 1 is an external view of a holding portion of the surgical operating apparatus according to the present embodiment. First, the holding portion 10 of the present embodiment is roughly divided and includes an electrode 11a, an electrode 11b, and an insulating support portion 19 that integrally supports these electrodes.
Each of the electrodes 11a and 11b has a structure in which a conductive member whose central portion is bent is covered with an insulating cover 12, and a non-slip portion 15 is provided on the support portion 19 side from the central portion. The operator holds the holding portion 10 by gripping the anti-slip portion 15. The insulator cover 12 is for preventing the operator from being applied with an electrical signal for stimulation and for preventing noise from being mixed into the detected electrical signal. Also, the insulator cover 12
Is the tip 1 of the electrode that needs to contact the tissue of the subject.
3 and the support portion 19 are not provided inside. That is, in the tip portion 13, the conductive member is exposed, and in the support portion 19, the support portion 19 itself plays a role of an insulator cover.

Further, in one electrode (the electrode 11b in the present embodiment), when the present device is used as an electric scalpel device, water supply used for introducing the above-mentioned physiological saline into the subject. A pipe 16 is provided. One end of the water supply pipe 16 is provided in the tip portion 13 as the water supply port 14,
The other end has a water supply tank 21 to be described later via the support portion 19.
Connected to. In addition, an insulating member (not shown) for keeping the electrodes 11a and 11b in an insulated state is provided in the supporting portion 19, and this insulating member is used when the operator brings the electrodes close to each other. It also has a function as a so-called elastic member that generates a stress to. As a result, in a so-called steady state in which the operator does not apply a force in a direction approaching the respective electrodes, the electrodes are kept at a predetermined distance. The conductive members of the electrodes 11a and 11b are connected to the electric wires, and the connecting cord 1
It is electrically connected to a later-described surgical apparatus main body 23 via 7.

An LED 18 is provided on the supporting portion 19 as an example of a light emitting member. The LED 18 is also electrically connected to the surgical apparatus main body 23 via the connecting cord 17 similarly to the conductive member of each electrode. This LED
Is, for example, lit in red when the holding unit 10 is used as an electric knife, green when used as a stimulation electrode, and yellow when used as a detection electrode (specifically, LEDs for emitting respective colors of red, green, and yellow are provided, and the LEDs may be configured to emit light by appropriately flowing an electric current to each LED, or each color is issued by a predetermined electric signal. LEs
If it is not connected to the surgical apparatus main body 23, the light is turned off. Next, the configuration of the entire surgical operating apparatus according to the present embodiment will be described with reference to FIG. 2, which is a block diagram of the surgical operating apparatus. The main components of the surgical apparatus according to the present embodiment are the surgical apparatus main body 23 connected to the holding unit 10, the water supply tank 21 connected to the water supply pipe, and the stimulation electrode for generating an electrical signal for stimulation. 24, a monitor 28 that indicates the state of the detected electric signal as a waveform, and various switches (foot switches in the present embodiment) 22a and 22b. The operation of the various switches will be briefly described. The switch 22a applies a predetermined voltage between the electrodes provided on the holding unit 10 when the device is used as an electric knife device. At the same time, a physiological saline solution is delivered from the water supply port 14, and when the device is used as an electric stimulator, an electrode provided on the holding part 10 or a stimulus provided on a part other than the holding part 10. It has a function of determining the timing of generating an electrical signal for stimulation from the electrode 24. The switch 22b is used to sequentially select whether the holding unit 10 is used as an electric knife, a stimulation electrode, or a detection electrode.

The surgical device main body 23 is an electric scalpel device control unit 2 used when the present device is used as an electric scalpel device.
7. It mainly includes an electric stimulator control unit 25 used when the present apparatus is used as an electric stimulator and a main body control unit 26 for switching these. The electric scalpel device control unit 27 includes the main body control unit 26 and each electrode 11 of the holding unit 10.
a, 11b and the water supply tank 21, and each electrode 11a, based on a control signal from the main body control unit 26.
A predetermined voltage is applied between 11b and the water tank 2
1 to deliver the physiological saline solution. In addition, the electric stimulator control unit 25 includes the main body control unit 26 and each electrode 1 of the holding unit 10.
It is connected to 1a and 11b. The electric stimulator control unit 25 will be described later in detail. The stimulating electrode 24 is provided separately from the holding unit 10 shown in FIG. 1, and is used to generate an electric signal for stimulation when the holding unit 10 is used as a detection electrode. Is used for.

The monitor 28 is connected to the main body controller 26 and displays both the stimulation electrical signal and the detected electrical signal as a waveform. Next, the electric stimulation device control unit 25 will be described with reference to FIG. 3 which is a block diagram. Electrical stimulation device control unit 2 of the present embodiment
5 is mainly composed of an electric signal generation control unit 32 and an electric signal detection control unit 31. Electric signal generation controller 32
Applies a voltage of a predetermined magnitude to the subject, and controls a predetermined device to generate an electrical signal for stimulation. The main body control unit 26, the stimulation electrode 24, and the holding unit 1
0 electrodes 11a and 11b, respectively.
Further, the electric signal detection control unit 31 detects the electric signal applied by the stimulation electrode or the electric signal generated by the subject performing a predetermined action (moving a finger or the like) from a predetermined portion. The electrodes 11 of the main body control unit 26 and the holding unit 10 are for controlling a predetermined device.
It is connected to a and 11b.

Next, the operation of the surgical operating apparatus according to the present embodiment when the holding section 10 is used for the following three purposes will be described. (1) When used as an electric scalpel First, the case where the present surgical device is used as an electric scalpel device will be described. Note that, here, as an initial state at the time of starting this operation, the operator is holding the holding unit 10, and the holding unit 10 is selected to be used as a detection electrode. To do. When the operator confirms this initial state with the LED 18 provided in the holding unit 10 (it emits yellow light representing the detection electrode in the initial state), the holding unit 10 is depressed by stepping on the switch 22b once. Switch the usage status of. (Note that the switch 22
Every time b is turned on, an electrosurgical knife → stimulation electrode → detection electrode →
The electric knife is repeatedly selected, and the emission color of the LED 18 is changed from red to green to yellow to red at any time. As a result, the signal from the switch 22b is input to the main body control unit 26 of the surgical apparatus main body 23, and the control signals are sent to the electrosurgical knife device control unit 27 and the electrostimulator control unit 25, respectively. When the electrical stimulator control unit 25 receives this control signal, the electrodes 11a and 11b are in an insulated state. In addition, the operation of the stimulation electrode 24 connected to the electric stimulator control unit 25 is stopped.

On the other hand, the electric scalpel device control unit 27 performs a safety check for applying a predetermined voltage (voltage suitable for coagulation or incision of tissue) between the electrodes 11a and 11b. Here, the "safety check" is a concept indicating an operation performed for ensuring safety, and is, for example, an operation such as automatically checking the insulation between the electrodes 11a and 11b. (However, this "safety check" does not necessarily have to be performed, and the time required for the "safety check" is infinitely short.) For example, as a result of this safety check, each electrode 11a, 11b
When it is detected that there is a short circuit between them, a warning sound or the like is generated. Note that this "safety check" automatically ends. When the operator confirms that the emission color of the LED 18 is red, each electrode 1 of the holding unit 10 shown in FIG.
The tips 13 of 1a and 11b are brought into contact with the tissue to be coagulated and incised. In this state, the operator turns on the switch 22a. As a result, the signal from the switch 22a is input to the main body control unit 26, and the electric scalpel device control unit 2
A predetermined voltage is applied between the electrodes 11a and 11b of the holding unit 10 from 7 and a physiological saline solution is delivered from the water supply tank 21 and is provided at the tip portion 13 of the electrode 11b via the water supply pipe 16. The water is ejected from the water supply port 14 into the tissue of the subject. An electric current flows through the jetted liquid to generate heat, and the heat causes tissue coagulation and incision.

The above is the description of the operation when the holding portion 10 is used as an electric knife. (2) When Used as Stimulation Electrode Next, the operation when the holding unit 10 is switched from the case where it is used as an electric knife to the case where it is used as a stimulation electrode will be described. The operator, while holding the holding unit 10 shown in FIG. 1 in his hand, confirms the current state (here, red) with the LED 18 and operates the holding unit 10 as a stimulating electrode, as described above. For,
The switch 22b is turned on again. As a result, the signal from the switch 22b is input to the main body control unit 26, and the control signals are sent to the electrosurgical knife device control unit 27 and the electrostimulator control unit 25, respectively. As a result, the electric scalpel device control unit 27 is stopped. Further, the main body control device 2
By the control signal from 6, the emission color of the LED 18 changes from red to green. Further, according to the control signal from the main body control unit 26, the electric signal detection control unit 31 (shown in FIG. 3) provided in the electric stimulator control unit 25 is in a stopped state (the holding unit 10 is used as an electric knife). If it is in the stopped state, the stopped state is maintained in this case). On the other hand, the electric signal generation control unit 32 performs a safety inspection for applying a predetermined electric signal. Note that the "safety check" here is also a concept showing an operation performed for ensuring safety, as in the above, and here, for example, whether an abnormal voltage is applied between the electrodes is checked. It is an action. For example, if an abnormality occurs during use as an electric scalpel and a predetermined voltage used for the electric scalpel is continuously applied between the electrodes, using this electrode as a stimulating electrode will damage the tissue. (However, this does not mean that these measures are essential for safety.) Assuming such a case, if an abnormal voltage is applied between the electrodes during this safety check, a warning will be issued. Sound or the like may be generated. After the safety inspection, the electrodes 11a and 11b of the holding unit 10 are electrically short-circuited (they were in an insulating state when the electric knife was used). In addition to this, the "safety check" includes simply grounding each electrode without checking the voltage between the electrodes (either one may be good) or the like.

Further, the stimulation electrode 24 is kept in a stopped state as in the case of using the electric scalpel. In this state, when the operator confirms that the color of light emitted from the LED 18 is green, each electrode 11 of the holder 10 shown in FIG.
The tips 13 of a and 11b are brought into contact with, for example, a part of brain tissue. When the operator turns on the switch 22a in this state, the signal from the switch 22a is transmitted to the main body control unit 26.
And the electrical signal generation controller 32 generates an electrical signal for stimulation. The generated electric signal is applied to the electrodes 11a,
It is delivered to the tissue of the subject via 11b. Since the electrodes 11a and 11b are in a short circuit state in the electrostimulator control unit 25, the electrodes 11a and 11b are short-circuited.
It is possible to generate an electric signal from either of the electrodes. (By the way, when the holding part 10 was used as an electric knife, a predetermined voltage was applied between the electrodes.) The voltage of this electrical signal for stimulation (the voltage between the electrode and the ground) is as described above. It is smaller than the voltage between the electrodes of the electric knife.

As described above, when an electrical signal for stimulation is applied to the brain tissue, each part of the subject in which the nerve connected to the brain tissue exists is reacted. Specifically, this reaction is, for example, a slight spasm (a jerk in the arm, etc.). In this way, the operator can confirm that the brain tissue to which the electric signal has been applied is
During surgery, it is possible to know to which part of the subject the nerve is connected, so that important nerves can be protected. The above is the description of the operation when the holding unit 10 is used as a stimulation electrode. (3) When used as a detection electrode Further, a case where the holding unit 10 is used as a detection electrode by switching from the case where it is used as a stimulation electrode as described above will be described. The operator is
While holding the holding unit 10 shown in FIG. 2 in the hand, the current state (here, green) is confirmed by the LED 18 and the switch 22b is turned on again in order to operate the holding unit 10 as a detection electrode, as described above. Turn it on. As a result, the signal from the switch 22b is input to the main body control unit 26, and the control signals are sent to the electrosurgical knife device control unit 27 and the electrostimulator control unit 25, respectively. As a result, the electric knife device control unit 27 is brought into a stopped state (maintaining the stopped state in this example). The emission color of the LED 18 changes from green to yellow according to a control signal from the main body control device 26.

Further, in response to a control signal from the main body control unit 26, the electric signal generation control unit 32 provided in the electric stimulator control unit 25 is in a state of being electrically insulated from the electrodes 11a and 11b of the holding unit 10. Become. That is, no electric signal is transmitted from the electrodes 11a and 11b. In addition, the electric signal generation control unit 32 causes the holding unit 10 to receive the same control signal.
Stimulation electrode 24, which is provided separately from the above, performs a safety check for applying a predetermined electric signal. Note that the "safety check" here is a concept indicating an operation performed for ensuring safety, as in the above, and here, for example, the stimulation electrode 24 is used.
Is an operation such as checking whether or not is properly connected to the electric signal generation control unit 32. For example, here, the stimulation electrode 24
Is not connected, the monitor 28 displays "External stimulation electrode is not connected". This allows the operator to confirm that no electrical signal is emitted from the stimulation electrode 24. In actual use, as will be described later, without emitting an electric signal from the stimulation electrode 24,
Since it is possible to detect electrical signals, the operator
In this way, the stimulating electrode 24 provided in addition to the holding unit 10
It is important to know whether or not an electrical signal is emitted from. It should be noted that even if the stimulation electrode 24 is properly connected, it is possible to set such that the stimulation electrical signal is not generated. Further, it may be configured such that a warning sound is emitted when it is detected that the connection is not properly made although the electric signal is set to be generated from the stimulation electrode 24.

On the other hand, the electric signal detection control section 31 receives the control signal from the main body control section 26, and the electrodes 1 of the holding section 10 are controlled.
Perform a safety check to detect electrical signals at 1a or 11b. In addition, as for the "safety check" here, as in the above, it is a concept that shows the operation performed for ensuring safety,
Here, the operation is, for example, to check whether an abnormal voltage is applied between the electrodes. As described above, it is effective when an abnormality occurs during use as an electrosurgical unit (in this example, after use as a stimulation electrode, this is not the case). In addition, the holding unit 10
The respective electrodes 11a and 11b are electrically short-circuited (maintaining the short-circuited state in this example). In this state, the operator
When it is confirmed that the ED18 has a yellow emission color, as shown in FIG.
The tip portion 13 of each of the electrodes 11a and 11b of the holding portion 10 shown in FIG. Further, the stimulation electrode 24 is previously attached to a predetermined part of the subject, for example, an arm or the like by using an adhesive member such as tape, or is brought into direct contact with the brain tissue.

The operator turns on the switch 22a in this state.
When set to N, the signal from the switch 22a is input to the main body control unit 26, and the electric signal generation control unit 32 generates an electric signal for stimulation. The generated electric signal is sent to a predetermined part of the subject through the stimulation electrode 24. Further, the electric signal detection control unit 31 detects the sent electric signal. Since the electrodes 11a and 11b are in a short-circuited state, an electric signal can be detected by either of the electrodes 11a and 11b. In this way, when an electric signal for stimulation is applied to a predetermined region of the subject, the electric signal is detected from the brain tissue nerve-connected to the region. The detected electric signal is displayed on the monitor 28 together with the transmitted electric signal. Nerve is typically 1 m
It has a transmission rate of about / sec, and thus there is a delay before an electric signal applied from the stimulation electrode 24 passes through the nerve and is detected by the detection electrodes (here, the electrodes 11a and 11b). On the other hand, the electric signal leaked from the stimulation electrode 24 into the tissue reaches the detection electrode in a much shorter time. That is,
The electrical signal detected after a delay time corresponding to the distance between these electrodes is the stimulus actually transmitted through the nerve.

An example of the graph displayed on the monitor 28 is shown in FIG. In this graph, the horizontal axis is time,
The vertical axis represents the magnitude of the voltage of the electric signal. Thus, the time t _a of the first voltage peak value close in time to the stimulating electrical signal, the electrical signal that has leaked into the tissue indicates the time until the detection, in time to the stimulating electrical signal The time t _b at the distant second voltage peak value indicates the time until the electric signal transmitted through the nerve is detected. That is, by observing the voltage peak value at time t _b, it is possible to know whether or not the region to which the stimulation electrode 24 is connected and the brain tissue with which the electrode 11a or 11b is in contact are neurally connected. (If the region to which the stimulation electrode 24 is connected and the brain tissue contacted by the electrode 11a or 11b are not neurally connected, the second voltage peak value at time t _b is very small or peak. However, although the second voltage peak value is sometimes neurally connected,
When it is small (or when it is buried in noise etc.)
Therefore, in order to overcome this problem, the surgical apparatus main body 23 may be provided with the following two means (or any one means).

Noise is removed by detecting the electrical signal with the stimulating electrode 24 a plurality of times and averaging the obtained electrical signals. (Averaging Means) The averaging means operates a high-frequency filter on the electric signal from which noise has been removed, and the electric signal leaked into the tissue (because the transmission paths are disjointed, a relatively low-frequency signal is included. Are removed) to enhance the electrical signals transmitted through the nerves. (Low-frequency signal removing means) As described above, the operator observes the electric signal detected by the detection electrode as a waveform to determine whether or not the tissues in contact with each electrode are neurally connected to each other. . Further, it is possible to detect an electric signal even when the stimulation electrode 24 is not used. This is because the electric signal can be generated by moving a predetermined part of the subject. That is, the operator, the subject or another assistant different from the operator moves a predetermined part of the subject,
It is possible to detect the electrical signal generated thereby. The detection of the electric signal is the same as above.

In this way, the operator can know during operation the brain tissue to which the part of the subject to which the electric signal is applied (or moved) is neurally connected. It is possible to protect important nerves. The above is the description of the operation when the holding unit 10 is used as the detection electrode. In the surgical operating apparatus according to the present embodiment, the holding unit held by the operator in the hand shares the three functions of the electric scalpel, the stimulation electrode, and the detection electrode,
It is possible to eliminate the need to change the holding portion during the operation, shorten the entire operation time, and reduce the burden on the operator and the patient. Further, when the function of the holding unit is switched, the holding unit is provided with a display means for displaying which function is selected, so that the operator can maintain the tip of the holding unit in the observation field of view, for example. , It is possible to confirm the selected functions at the same time, and it is very effective from the viewpoint of safety. Further, since the display means can be identified by the emission color, the operator can confirm the selected function even when the viewpoint is concentrated on the tip.
(Display of characters and the like is difficult if the viewpoint is not concentrated even if it is in the observation visual field, but color recognition is sufficiently possible if it is in the observation visual field.) Further, the present embodiment Then, any of the timing of supplying electricity to the electrode from the electric knife device control unit 27, the timing of generating the electric signal from the electric signal generation control unit 32, and the timing of detecting the electric signal by the electric signal detection control unit 31 Since the common switch (the switch 22a in the present embodiment) is used for the determination, the number of switches can be reduced as compared with the case of providing a switch for generating each timing for each function.
As a result, malfunction can be prevented. (If there are many switches, there is a risk that the wrong switch will be pressed.) In addition, in the present embodiment, each time a function is switched, a "safety check" is performed according to each function. Also, high safety can be secured.

In the present embodiment, a case has been described in which the holder can be used as an electric knife, a stimulation electrode, and a detection electrode. However, it is possible to use any two of these functions. It may be configured. In particular, if one of the stimulating electrode and the detecting electrode and the function as an electric knife are provided, the tissue inspection and treatment can be performed as one operation, which is very useful. Also, when using the holding part as an electric knife,
In particular, since a high voltage is required as compared with other functions, it is in use (in this embodiment, the switch 22a is used for safety assurance).
A mechanism may be provided for notifying the operator (e.g., emitting a predetermined sound) while pressing. That is, when the operator uses the holding part as an electric knife, higher safety can be ensured by performing three operations of checking the emission color of the LED, pressing the switch, and checking the sound. . Further, in the present embodiment, the electric scalpel device has been described as a bipolar device having a pair of small electrodes at its tip, but it can be applied to a monopolar device.

The second embodiment according to the present invention will be described below in detail with reference to the drawings. FIG. 5 is an external view of a holding portion of the surgical operating apparatus according to the present embodiment. The holding unit 50 of the present embodiment is mainly configured to include an elastic suction tube 53 made of a pipe-shaped conductive member. In addition, the operator attaches the suction pipe 5 to the suction pipe 53.
3 Adjustment hole 5 that can adjust the suction force from the suction port at the tip
6 is provided, and the operator performs a predetermined treatment by holding the vicinity of the hole 56 in his hand. Further, a connection portion 52 is provided at the other end of the suction pipe 53, and inside the connection portion 52, a suction pipe for moving the suctioned substance of the subject sucked from the suction pipe 53 to a suction tank 62 described later. 55
And a suction tube 53 are connected. In addition, the outer peripheral portion of the suction pipe 53 is electrically connected to the electric wire in the connecting cord 51. Moreover, the LED 18 is provided in the connecting portion 52 as in the first embodiment, and is electrically connected to the surgical apparatus main body 23 via the connecting cord 51. As an example, the LED 18 lights up red when the holding unit 50 is used as a suction tube, green when the holding unit 50 is used as a stimulation electrode, and yellow when the holding unit 50 is used as a detection electrode.

In the present embodiment as well, as in the first embodiment, the portion directly contacted by the operator may be covered with the insulating cover. Here, the portion directly contacted by the operator is the vicinity of the hole 56. Next, the overall configuration of the surgical operating apparatus according to the present embodiment will be described with reference to FIG. 6, which is a block diagram of the surgical operating apparatus. The same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted. The surgical apparatus according to the present embodiment has a first configuration as a first configuration.
Unlike the above embodiment, a suction tank 62 connected to the suction pipe 55 and a suction device control section 61 for adjusting the pressure of the suction tank 62 and the like are provided in the surgical apparatus main body 23. The suction tank 62 is a tank for storing the above-mentioned suction substance, and the inside of the tank is normally maintained at a low pressure. Next, regarding the operation of the surgical operating apparatus according to the present embodiment, only the suction operation different from that of the first embodiment will be described. As in the case of using the electric knife in the first embodiment, the switch 22b is used to switch to the use as the suction tube. Further, in this state, the holding unit 50
When is used as a suction tube, the switch 22a is used as in the first embodiment. Switch 22a is ON
In this case, the suction tube 53 is insulated from the surgical apparatus main body 23.

In this state, the operator closes the hole 56 provided in the suction tube 53 with his / her finger, and the suction tube 5 is
The suction force at the suction port 3 is adjusted. The hole 56
When is not blocked by the finger, there is almost no suction force at the suction port. When the hole 56 is closed to a certain extent or more, a predetermined tissue of the subject is sucked from the suction pipe 53 due to the difference between the pressure inside the suction tank 62 and the pressure inside the subject that is conducted through the suction pipe 53. The suctioned substance is accumulated in the suction tank 62. In addition, the operation of "safety check" is the same as that of the first embodiment when switching to the suction operation in this embodiment, and the suction operation is performed when switching to the electric signal generating operation or the electric signal detecting operation. This includes checking whether any operation is being performed. Note that other operations are the same as those in the first embodiment, and therefore omitted here.
In the surgical apparatus according to the present embodiment, the holding unit 50 held by the operator in his / her hand shares the three functions of the suction tube, the stimulation electrode, and the detection electrode, so that the holding unit 50 can be operated during the operation.
It is possible to minimize the number of holding operations, shorten the entire operation time, and reduce the burden on the operator and the patient. With regard to other effects, the configuration common to the first embodiment has at least the same effect.

The first modification of the present invention will be described below with reference to FIG. FIG. 7 is an external view of the holding portion of the surgical operating apparatus according to the present embodiment. Since the surgical apparatus main body 23, the monitor 28, the stimulation electrode 24, and the like are the same as those in the first embodiment, description thereof will be omitted here. The holding unit 70 in this modification is configured as a son. Incidentally, the son in this modification is an instrument for examining the response by inserting it into a tissue like the conventional son, and also has a function as a stimulation electrode or a detection electrode unlike the conventional son. ing. Explaining a specific configuration, the holding unit 70 of the present modified example includes a son body 75 and a support portion 74 that supports one end of the son body 75.
Is mainly equipped with. Further, the son body 75 has a structure in which the insulating cover 72 covers the central portion of a rod-shaped conductive member. The operator holds the holding portion 70 by gripping the insulating cover 72. Also, the insulator cover 7
2 is for preventing an electric signal for stimulation from being applied to the operator and for preventing noise from being mixed in the detected electric signal. Further, the insulator cover 72 is not provided in the tip portion 73 and the support portion 74 of the electrode that need to contact the tissue of the subject. That is, the tip 73
The conductive member is exposed, and in the support portion 74, the support portion 74 itself plays a role of an insulator cover.

Further, the conductive member of the son body 75 is connected to an electric wire and electrically connected to the surgical apparatus body 23 via the connecting cord 71. Next, regarding the operation of the surgical operating apparatus according to the present modification, only the operation of checking the response of the tissue by the holding unit 70 different from that of the first embodiment will be described. As in the case of using the electric knife in the first embodiment, the switch 22b is used to switch the use to the son. Further, when the holding unit 70 is used in this state, the switch 22a is used as in the first embodiment. When the switch 22a is ON,
The holding part 70 is insulated from the surgical apparatus main body 23. In this state, the operator inserts the distal end portion 73 of the holding portion 70 into the tissue to check the response. "Safety check"
The operation described above can also be applied to this modification. Further, other operations are the same as those in the first embodiment, and therefore omitted here. In the surgical operating apparatus according to the present embodiment, the holding unit held by the operator in the hand has a function as an electrode of the electrical stimulator and also a function as a son to check the response by inserting into the tissue. It is possible to eliminate the need to change the holding portion during the operation, shorten the entire operation time, and reduce the burden on the operator and the patient. With regard to other effects, the configuration common to the first embodiment has at least the same effect.

A second modification of the present invention will be described below with reference to FIG. FIG. 8 is an external view of the holding portion of the surgical operating apparatus according to the present embodiment. Since the surgical apparatus main body 23, the monitor 28, the stimulation electrode 24, and the like are the same as those in the first embodiment, description thereof will be omitted here. The holding portion in this modification is configured as tweezers 80. Note that the tweezers 80 in the present modified example is a device that holds a predetermined member such as a cotton cloth piece, like the conventional tweezers, and also has a function as a stimulation electrode or a detection electrode, unlike the conventional tweezers. There is. Explaining a specific configuration of the tweezers 80, the tweezers 80 mainly include the tweezer body 86.
And a support portion 83 that supports one end of the tweezers main body 86. In addition, the tweezers body 86 includes a conductive member whose central portion is bent and which is covered with an insulator 82.
And a non-slip portion 85 is provided on the support portion 83 side from the central portion. The operator
By grasping this non-slip portion 85, the tweezers 8
Holds 0. Further, the insulator cover 82 is, as described above, for preventing the operator from being applied with an electrical signal for stimulation and for preventing noise from being mixed into the detected electrical signal. Moreover, the insulator cover 82 is not provided in the tip portion 87 and the support portion 83 of the electrode that need to contact the tissue of the subject. That is, the tip 87
In, the conductive member is exposed, and in the support portion 83, the support portion 83 itself plays a role of an insulator cover.

The conductive member of the tweezers body 86 is
It is connected to an electric wire and electrically connected to the surgical apparatus main body 23 via the connecting cord 71. In addition, the tweezers 80 of the present modification is the same as the electric knife of the first embodiment,
The main differences are that the conductive members are short-circuited in advance within the support portion 83 and that the cotton cloth piece 84 is held by the tweezers 80. Here, a piece of cotton cloth 8
4 is similar to a conventional piece of cotton cloth, incising brain tissue,
Unlike the conventional cotton cloth piece, it also has a function as a stimulation electrode or a detection electrode. Specifically, the cotton cloth piece 84 in the present modification has a surface on one end side of the cloth body covered with a conductive member, and through this conductive member, it can operate as a stimulation electrode or a detection electrode. become. next,
Regarding the operation of the surgical operating apparatus according to the present modification, only the incision operation of the brain tissue by the tweezers 80 and the cotton cloth piece 84 different from that of the first embodiment will be described.

Similar to the case of using the electric knife in the first embodiment, the switch to the use as the tweezers is performed by using the switch 22b. Then, by turning on the switch 22a, the tweezers 80 is insulated from the surgical apparatus main body 23. In this state, the operator rubs the cloth portion of the cotton cloth piece 84 held by the tweezers 80 on the brain tissue and incises only the brain tissue without cutting the blood vessel. The other operations are the same as those in the first embodiment and the first modification, and therefore the description thereof is omitted here. In the surgical apparatus according to the present embodiment, the holding portion held by the operator in the hand has a function as tweezers for holding a predetermined member in addition to a function as an electrode of the electric stimulator, so that the holding section can be held during surgery. It is possible to eliminate the need to switch parts, shorten the entire operation time, and reduce the burden on the operator and the patient. With regard to other effects, the configuration common to the first embodiment has at least the same effect.

The third embodiment of the present invention will be described in detail below with reference to the drawings. FIG. 9 is an external view of the holding portion of the surgical operating apparatus according to the present embodiment. In addition,
The present embodiment mainly relates to the delay time between the stimulation electric signal and the detected electric signal, and in order to simplify the explanation, only the case where the holding portion functions as the detection electrode will be described. Holding unit 90 of the present embodiment
Is a detection electrode 93 mainly made of a conductive member, and a support portion 9 made of an insulating member provided on the detection electrode 93.
2, the operator performs an operation by gripping the support 92 with his / her hand. In addition, in the support portion 92, the detection electrode 93 is electrically connected to the electric wire in the connection cord 91. Next, the overall configuration of the surgical operating apparatus according to the present embodiment will be described with reference to FIG. 10, which is a block diagram of the surgical operating apparatus. The same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted.

The surgical apparatus according to the present embodiment is different from the surgical apparatus according to the first embodiment mainly in the configuration inside the electric stimulator control unit 25 and in having a speaker 101. It should be noted that the speaker 101 includes the electrical stimulation device control unit 25.
Is connected to, and emits a predetermined sound in a predetermined state (specifically described later). Further, the difference in the configuration inside the electrostimulator control unit 25 is, specifically, as shown in FIG. 11 which is a block diagram of the electrostimulator control unit 25, the electric signal generation control unit 32 and the electric signal detection control. The point is that the section 31 is provided with the nerve connection detecting section 111. The nerve connection detecting unit 111 automatically detects whether or not the tissues in contact with the electrodes 93 and 24 are connected to each other. Next, the operation of the surgical operating apparatus according to the present embodiment will be described with reference to FIGS. 11 and 12. Note that FIG. 12 is an example of a graph displayed on the monitor 28. The operator brings the detection electrode 93 in the holding unit 90 into contact with a predetermined tissue of the subject, attaches the stimulation electrode 24 to a predetermined site of the subject, and then switches the electricity from the stimulation electrode 24 by the switch 22a. Send a signal.

As described with reference to FIG. 4 in the first embodiment, there is a delay in the electric signal that reaches the detection electrode 93 from the stimulation electrode 24 through the nerve. On the other hand, the electric signal leaked into the tissue without passing through the nerve reaches the detection electrode 93 in a much shorter time. In the present embodiment, the electrical signal generated by the stimulation electrode 24 and the electrical signal detected by the detection electrode 93 are stored in a predetermined storage device (memory or the like) and then input to the nerve connection detection unit 111. It In the nerve connection detection unit 111, the stimulation electrode 2
From the time when the electric signal is generated from No. 4, the electric signal detected by the detection electrode 93 has a predetermined threshold voltage value Vth.
Find the time (t ₁ ) until the above. Regarding the detected electric signal, as in the first embodiment,
The high frequency filter may be operated by performing averaging in a plurality of detections. Next, the minimum delay time t _th predicted based on this time t ₁ is calculated. Specifically, t _th
= T ₁ + t _α . Note that here, t _α is a predetermined time that is obtained in advance by experiments or the like.

Next, after a lapse of a predetermined time t _th , a predetermined signal is issued when the detected electric signal has a voltage equal to or higher than a predetermined threshold voltage value Vth. 12
In, the time t ₂ is the time to generate this signal.
That is, the nerve connection detecting unit 111 determines, for a predetermined period of time, from the electrical signal emitted from the stimulation electrode 24 (or only the signal indicating that the electrical signal is emitted) and the electrical signal detected by the detection electrode 93. The t _th is calculated, and after the lapse of the predetermined time t _th , it is detected whether or not there is a signal having a predetermined voltage Vth or more. Nerve connection detector 1
If 11 detects that this signal is present,
A signal is sent to the speaker 101 and a predetermined sound is output to the speaker 1.
01, the operator can recognize the state of the nerve connection by recognizing this sound. The description of the same operation as that of the first embodiment will be omitted. In the surgical operating apparatus according to the present embodiment, whether or not the tissue contacting the detection electrode with the site of the subject to which the stimulation electrode is attached is nerve-connected from the generated electric signal and the detected electric signal. Is automatically detected and the result is notified to the operator, so that the operator does not need to read the presence / absence of the nerve connection from the waveform displayed on the monitor, and the operator can concentrate on the examination.

Since the predetermined time for detecting the nerve connection is calculated from the applied electric signal or the signal indicating that the electric signal is emitted and the detected electric signal, the stimulation electrode and The nerve connection can be accurately detected regardless of the distance between the detection electrodes. This is because, if the distance between the stimulating electrode and the detecting electrode is different, the electrical signals transmitted through the nerves will also be detected at different times. However, it is excluded from the present invention that a predetermined value (which may be arbitrarily changed by the operator) stored in advance is used instead of calculating the predetermined time t _th which is a reference for detecting the nerve connection. Not something to do. In addition, by using a speaker that emits a predetermined sound as the notification means, it is possible to recognize whether or not the tissue contacted with the detection electrode and the site where the stimulation electrode is attached are neurally connected only by the sound from the speaker. The operator can perform an inspection without moving the observation field of view, and high safety is ensured.

Further, in the present embodiment, the configuration for automatically detecting whether or not the nerve connection has been made, but in addition to this, a configuration for semi-automatically detecting by a predetermined value input by the operator Is also good. Specifically, the operator numerically inputs (or selects) the expected delay time or the distance itself between the electrodes according to the distance between the stimulation electrode 24 and the detection electrode 93. The estimated delay time input by the operator or the estimated delay time automatically calculated according to the input distance between the electrodes is set as the above-mentioned threshold voltage value Vth, and the nerve is connected in the surgical apparatus main body 23. Automatically detect whether or not there is. This makes it possible to detect semi-automatically whether or not the nerve is connected even when the time t ₁ cannot be obtained due to a short distance between the electrodes or a problem such as the performance of the electronic circuit. Is possible. Although the respective embodiments and modified examples of the present invention have been described above, the present invention may be used in various combinations of the above-described embodiments and modified examples, and further within the scope of the invention. Deformation is also possible.

[0040]

As described in detail above, according to the present invention, it is possible to reduce the burden on the operator and the patient when the electric stimulator is used during surgery.

[Brief description of drawings]

FIG. 1 is an external view of a holding portion of a surgical operating apparatus according to a first embodiment of the present invention.

FIG. 2 is a block diagram of the surgical operating apparatus according to the first embodiment of the present invention.

FIG. 3 is a block diagram of an electric stimulator control unit according to the first embodiment of the present invention.

FIG. 4 is a graph of a waveform of an electric signal according to the first embodiment of the present invention.

FIG. 5 is an external view of a holding portion of a surgical device according to a second embodiment of the present invention.

FIG. 6 is a block diagram of a surgical operating apparatus according to a second embodiment of the present invention.

FIG. 7 shows a first modification of the present invention.

FIG. 8 shows a second modification of the present invention.

FIG. 9 is an external view of a holding portion of a surgical device according to a third embodiment of the present invention.

FIG. 10 is a block diagram of a surgical operating apparatus according to a third embodiment of the present invention.

FIG. 11 is a block diagram of an electric stimulator control unit according to a third embodiment of the present invention.

FIG. 12 is a graph of a waveform of an electric signal according to the third embodiment of the present invention.

[Explanation of symbols]

10 Holder 11 electrodes 12 Insulator cover 13 Tip 14 water outlet 15 Anti-slip part 16 Water pipe 17 Connection code 18 LED 19 Support 21 Water tank 22 Various switches 23 Surgical device body 24 Stimulation electrode 25 Electric Stimulator Control Unit 26 Main unit controller 27 Electric knife device control unit 28 monitors 31 Electric signal detection controller 32 Electric signal generation controller 50 holding part 51 Connection cord 52 Connection 53 Suction tube 55 Suction pipe 56 holes 61 Suction device control unit 62 Suction tank 70 holding unit 71 Connection cord 72 Insulator cover 73 Tip 74 Support 75 son body 80 tweezers 81 Connection cord 82 Insulator cover 83 Support 84 Cotton cloth piece 85 Anti-slip part 86 tweezers body 90 Hold 91 Connection cord 92 Support 93 Detection electrode 101 speaker 111 Neural connection detector

─────────────────────────────────────────────────── ─── Continuation of front page (51) Int.Cl. ⁷ Identification code FI theme coat (reference) A61N 1/36 F term (reference) 4C027 AA04 BB05 CC00 DD03 EE01 HH03 HH04 HH06 4C053 BB13 BB35 JJ21 4C060 KK03 KK04 KK05 KK09 KK10 KK15 KK22 KK50 MM24

Claims (19)

[Claims] 1. An electric scalpel device control means for supplying electricity for coagulating or incising a predetermined tissue of a subject, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject, And at least two control means of the electric signal detection control means for detecting an electric signal from a predetermined tissue of the subject, a holding part connected to the at least two control means and held by an operator, And a switching means for switching which of the two control means is to be used. 2. The at least two control means include the electrosurgical knife device control means.
The described surgical device. 3. The surgical apparatus according to claim 2, wherein the holding unit has a display unit that displays which control device has been selected by the switching unit. 4. The surgical apparatus according to claim 3, wherein the display means has a light emitting means capable of identifying which control device is selected by the switching means by a light emission color. 5. The surgical apparatus according to claim 3, further comprising an informing unit for informing an operator only when the electric knife device control unit is selected by the switching unit. 6. A first switch for determining a timing of supplying the electricity from the electric knife device control means, and a timing of generating the electric signal from the electric signal generation control means, or the electric signal detection. The surgical apparatus according to claim 2, wherein the second switch that determines the timing at which the electric signal is detected by the control unit is a common switch. 7. The surgical apparatus according to claim 2, further comprising an inspection means for performing a safety inspection when the control means used by the switching means is switched. 8. The inspection means for performing the safety inspection is characterized in that the holding part is grounded for a predetermined time when the electric knife device control means is switched to another control means by the switching means. The surgical apparatus according to claim 7. 9. A suction device control means for sucking a predetermined tissue of a subject with a suction tube, an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject, and a predetermined body of the subject. At least two control means of the electric signal detection control means for detecting an electric signal from the tissue, a holding part connected to the at least two control means for holding by an operator, and the at least two control means And a switching means for switching which control means to be used. 10. The surgical apparatus according to claim 9, wherein the at least two control means include the suction device control means. 11. The suction tube has a conductive member, and an electric signal is applied to a predetermined tissue of a subject via the conductive member, or an electric signal is detected from a predetermined tissue of the subject. The surgical apparatus according to claim 10, wherein: 12. At least one of an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of a subject and an electric signal detection control means for detecting an electric signal from a predetermined tissue of the subject. A surgical apparatus comprising: a control unit; and a son connected to the at least one control unit, the probe being inserted into a predetermined tissue of a subject to check the response. 13. At least one of an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of a subject and an electric signal detection control means for detecting an electric signal from a predetermined tissue of the subject. A surgical apparatus comprising: control means; and conductive tweezers connected to the at least one control means and holding a predetermined member. 14. The operation according to claim 13, wherein the predetermined member held by the tweezers is a cotton cloth piece for cutting tissue, and the cotton cloth piece has a conductive member on its surface. apparatus. 15. An electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of a subject, an electric signal detection control means for detecting an electric signal from a predetermined tissue of the subject, and the generated electric signal. A tissue stimulated by the electric signal based on the electric signal and the detected electric signal; and a nerve connection detecting means for detecting whether or not the tissue in which the electric signal is detected has a nerve connection. A surgical device characterized by the above. 16. The nerve connection detecting means records at least one of a waveform of an electrical signal that stimulates a predetermined tissue of the subject and a generation time of the electrical signal, and a waveform of the detected electrical signal. Recording means for recording, at least one of the waveform of the generated electrical signal and the generation time of the electrical signal, the time calculation means for calculating a predetermined time based on the waveform of the detected electrical signal, ,
16. The surgical apparatus according to claim 15, further comprising: a determining unit that determines whether or not the electric signal having a predetermined value or more is detected after the calculated predetermined time has elapsed. 17. The surgical apparatus according to claim 16, further comprising sound notification means for notifying the operator by sound when the determination means determines that the electrical signal is equal to or higher than a predetermined value. 18. At least one of an electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of the subject and an electric signal detection control means for detecting an electric signal from the predetermined tissue of the subject. A surgical apparatus comprising: a control unit; and a holding unit having a conductive member connected to the at least one control unit and an insulating member for insulating an operator from the conductive member. 19. An electric signal generation control means for generating an electric signal for stimulating a predetermined tissue of a subject, an electric signal detection control means for detecting an electric signal from a predetermined tissue of the subject, and the generated electric signal. And a display control means for displaying the waveform of the electric signal and the detected waveform of the electric signal on the same screen.