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Description  |
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FIELD OF THE ART
The present invention relates to a surgical operation method using
microwave according to which an operation of coagulation, hemostasis or
transection is performed on bio-tissue with the use of thermal energy
generated from the reaction of microwaves on the bio-tissue and an
operation, for example, on a parenchymatous organ having a great blood
content can be performed in an easy, safe and bloodless manner.
BACKGROUND OF THE INVENTION
As an operation device, there are conventionally known an electrocautery
(high frequency knife) and a laser operation device (laser knife).
The electrocautery uses a power supply with frequency of 0.3 to 10 MHz,
wavelength of 1000 to 30 m and output of 200 to 500 W, and includes a high
frequency operating electrode of the knife or tweezers type and a
nonactive electrode.
With the nonactive electrode mounted to the other part of patient body, a
high frequency current is flowed from the operating electrode to the
nonactive electrode, so that hemostasis or coagulation is performed by
cauterizing the tissue with the use of high frequency spark discharge.
Accordingly, there is the danger of the patient often getting burnt.
Moreover, the tissue is carbonizingly degenerated and thus carbonizingly
degenerated tissue comes off with the passage of time, thereby to cause
rehemorrhage which is very dangerous. Therefore, such electrocautery is
not suitable to an operation on a parenchymatous organ having a great
blood content.
Moreover, on the clinical practice, there is the danger of the patient
being injured or receiving an electric shock. There are also pointed out
that, at the stump, secondary hemorrhage after operation and cholerrhagia
after operation are observed.
On the other hand, the laser operation device uses a power supply with
wavelength of 10.6 .mu.m and output of 50 to 100 W, and includes a hand
piece of the condensing lense type. Therefore, upon each operation, the
focus of the laser beams should be adjusted. If the radiation period of
time is improperly set, such laser beams become too strong. Accordingly,
there is the danger of other tissue being easily broken.
Moreover, if there is a slight error in setting the angle of the arm for
transmitting the laser beams, the optical axis is erroneously set and the
beams are subsequently radiated in unexpected directions. It is further to
be pointed out that the arm moving range is limited to a predetermined
range in view of the laser optical axis.
Since, for performing hemostasis or coagulation, the laser operation device
utilizes thermal energy generated from the laser beams, the tissue is not
carbonizingly degenerated. However, the maximal diameter of the vessels
which are possibly made the hemostasis, is as small as 1.5 mm. Therefore,
when the blood vessels have diameters of 1.5 mm or more, it is
disadvantageously required to ligate such vessels before amputating them.
Accordingly, the laser operation device is not suitable for an emergency
operation.
Moreover, the maximal diameter of the intrahepatic bile duct which is
possibly made the coagulation closing, is as small as 1.0 mm.
After the operation has been performed with such laser device, the serum
GOT, GPT and Al-p are suddenly reduced after the third day and are
recovered as late as after one week.
Such laser operation device of this type is of large size and very
expensive.
SUMMARY OF THE INVENTION
It is an object of the present invention to provide a surgical operation
method using microwave in which microwaves are radiated to bio-tissue from
a monopolar type operating electrode disposed at the tip of a coaxial
cable for transmitting microwaves, and an operation of coagulation,
hemostasis or transection is performed on the bio-tissue with the use of
thermal energy generated from the reaction of the microwaves on the
bio-tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
The present invention will be further discussed, by way of example, with
reference to the accompanying drawings, in which:
FIG. 1 is a block diagram of a first embodiment of surgical operation
method using microwave in accordance with the present invention;
FIG. 2 is a schematic view of a second embodiment of surgical operation
method using microwave in accordance with the present invention;
FIG. 3 is a perspective view of main portions of a third embodiment of
surgical operation method using microwave in accordance with the present
invention; and
FIG. 4 is a section view of the manipulating unit in FIG. 3.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The description hereinafter will be made, in detail, of the first
embodiment of the present invention with reference to FIG. 1.
In FIG. 1, a safety device 1 mainly uses a reinforced insulating
transformer. A power supply 2 connected to the safety device 1 includes an
automatic voltage stabilizer. A microwave generator device 3 connected to
the power supply 2 is designed to give out a microwave of 2450 MHz with
the maximum output 150 W. A device for selectively limiting the output
time dependent on disease 4 is designed to set the microwave output and
radiation time to be determined dependent on the diseased organ, the state
of disease, the dimension and condition of the tissue, the part of
operation, coagulation, hemostasis and transection, etc. Namely, the
device 4 is disposed for limiting and controlling the output and
oscillation time (normally within 60 seconds) of the microwave generator
device 3, thereby to prevent an erroneous operation due to excessive
radiation, thus enabling the operation using microwaves to be performed in
a safe and secure manner.
There is disposed a microwave output fine adjuster device 5 for finely
adjusting the output of the microwave generator device 3. A microwave
output impedance matching device 6 is connected to the microwave generator
device 3. An operating hand piece 7 is connected to the impedance matching
device 6 by a coaxial cable 8. A monopolar type operating electrode 9 in
the needle form has a diameter of 0.5 mm and a length of 3.9 to 31.5 mm,
and is attached to the hand piece 7. A hand switch 10 attached to the hand
piece 7 is adapted to be turned ON when strongly grasped, and to be turned
OFF when the grasping is loosened. A normally closed-type safety foot
switch 11 is connected in series to the hand switch 10 and the primary
side of the high voltage transformer in the power supply 2. This foot
switch 11 is adapted to be turned OFF if pressed by the operator foot in
the case of emergency.
An indifferent electrode 13 is connected to the positive terminal of an
electric source of the tissue dissociation 12 and is adapted to come in
contact with tissue adjacent the part of operation. The negative terminal
of the electric source 12 is connected to the operating electrode of the
hand piece 7.
The safety device 1 is disposed to prevent a high voltage applied to the
microwave generator device 3 or a high frequency current therefrom, from
electrically injuring the operator and the patient under operation.
The power supply 2 is a rectified power supply for actuating the microwave
generator 3 in a stable manner, and can restrain sudden variations of the
microwave output caused by variations of the input commercial AC power
supply, during the operation is being performed.
The description hereinafter will discuss how the first embodiment of the
present invention is operated.
The operating electrode 9 of the hand piece 7 is inserted into or contacted
with the bio-tissue to be operated. The hand switch 10 of the hand piece 7
is turned ON. Microwaves generated by the microwave generator device 3 are
then transmitted to the operating electrode 9 through the microwave output
impedance matching device 6 and the coaxial cable 8. The microwaves are
radiated from the operating electrode 9 to the inside or the surface of
the tissue to be operated.
At this time, the bio-tissue is dielectrically heated by thermal energy
generated from the reaction of the radiated microwaves on the bio-tissue,
whereby an operation of transection coagulation or hemostasis is performed
on the tissue.
By turning ON or OFF the hand switch 10 of the hand piece 7, the radiation
of microwaves is started or stopped, respectively. When the hand switch 10
or the foot switch 11 is turned OFF, the high voltage is shut off to stop
the radiation of microwaves.
In actually performing an operation using microwaves, the microwave output
and the microwave applying period of time are selected taking the tissue
condition and the vessel sizes, etc. into account, based on the conditions
shown in the following table:
______________________________________
Microwave Applying
Organ output (W)
time (second)
______________________________________
Liver 30-60 30-60
Spleen 30-60 30-60
Ovary 20-50 20-30
Parenchymatous 50 30-60
tumor
______________________________________
It is to be noted that microwave energy is concentrated on the tissue under
operation, and therefore exerts no influence upon the tissue 15 mm or more
apart from the shaft center of the operating electrode 9. Moreover, since
the present invention does not require a nonactive electrode, no microwave
current flows in the other part of the patient body, so that no other
tissue is injured.
When the operating electrode 9 is pulled out after the completion of an
operation using microwaves made with the operating electrode 9 inserted
into the bio-tissue, moisture in the tissue around the operating electrode
9 is evaporated by dielectric heat of the microwaves and the coagulated
tissue disadvantageously sticks to the operating electrode 9. In the
embodiment of the invention, however, after the completion of the
operation, a cathodal direct current (abt. 10-15 mA) is flowed for a very
short period of time (abt. 5 seconds) from the electric source for the
tissue dissociation 12 to the operating electrode 9. Moisture is
accordingly generated on the interface between the bio-tissue and the
operating electrode 9 by eletrolysis. Therefore, the tissue coagulated by
dielectric heating of the microwaves, does not stick to the operating
electrode 9, thereby to facilitate the dissociation of the operating
electrode 9 from the bio-tissue.
The description hereinafter will discuss the second embodiment of the
surgical operation method using microwave in accordance with the present
invention, with reference to FIG. 2.
In FIG. 2, a microwave operation device main body 14 incorporates a
magnetron 15. A coaxial cable 16 comprises a core wire 17 and a shield
conductor 18. A monopolar type operating electrode 20 in the needle shape
is attached to the tip of an operating hand piece 19. This operating
electrode 20 is connected to the output intake loop of the magnetron 15
through the core wire 17. A shield metal member 21 disposed outside the
base portion of the operating electrode 20 is connected to the shield
conductor 18 of the coaxial cable 16. The shield conductor 18 is connected
to the positive electrode of the magnetron 15 and is grounded in the
operating device main body 14.
A coaxial relay device 22 incorporates a relay switch 23, of which one
contact is connected to the core wire 17 of the coaxial cable 16. An
electric source for the tissue dissociation 24 has a negative terminal
connected to the changeover terminal of the relay switch 23 and a positive
terminal connected to the shield conductor 18 of the coaxial cable 16
through the coaxial relay 22. A normally closed-type foot switch 25 is
connected to the operation device main body 14. A relay coil 26 for
actuating the relay switch 23 is connected in series to the foot switch 25
and the operation device main body 14. During the foot switch 25 is not
being actuated, a high voltage is supplied from the power supply of the
operation device main body 14 to the magnetron 15 and the relay coil 25 is
excited to connect the relay switch 23 to the open contact.
When the foot switch 25 is pressed by the operator foot to be turned OFF,
current supply to the magnetron 15 in the operation device main body 14 is
stopped and no current flows to the relay coil 26. The relay switch 23 is
then switched and the negative terminal of the electric source for the
tissue dissociation 24 is connected to the core wire 17.
A hand piece for positive electrode 27 has at the tip thereof a positive
electrode 28 to which a lead wire 29 is connected. The lead wire 29 is
also connected to the positive terminal of the electric source 24 through
the coaxial relay 22. To dissociate the operating electrode 20 from the
coagulated bio-tissue, the positive electrode 28 is adapted to come in
contact with the bio-tissue adjacent the part of operation.
The bio-tissue, in particular the diseased tissue, of a parenchymatous
organ is generally designated by numeral 30.
The description hereinafter will discuss how the second embodiment of the
present invention is operated.
The operating electrode 20 of the hand piece 19 is inserted into the part
of lesion in the bio-tissue 30. When the operation device main body 14 is
driven, microwaves generated by the magnetron 15 are transmitted to the
operating electrode 20 through the core wire 17 and radiated to the part
of lesion for 30 to 60 seconds. With the use of dielectric heat produced
at this time, hemostasis, coagulation or partial transection is performed
on the bio-tissue 30.
After the operation using microwaves has been finished, the foot switch 25
is turned OFF so that the supply of microwaves is stopped and the relay
switch 23 of the coaxial relay device 22 is switched. Then, the negative
terminal of the electric source for the tissue dissociation 24 is
connected to the operating electrode 20 through the core wire 17. When
either the positive electrode 28 of the hand piece for positive electrode
27 is contacted with the bio-tissue 30, or the shield metal member 21
disposed at the tip of the operating hand piece 19 is pressingly contacted
with the bio-tissue 30, a cathodal direct current of about 10 mA is flowed
from the electric source 24 to the operating electrode 20 for a very short
period of time (Abt. 5 seconds). Moisture is then produced on the
interface between the operating electrode 20 and the bio-tissue 30 by
electrolysis, and electroosmosis thereby to facilitate the dissociation of
the operating electrode 20 from the bio-tissue 30. Dependent on the
condition of the bio-tissue 30, the part of operation, the operation
method and other, it may be suitably judged how such dissociation is
performed, either by the contact of the positive electrode 28 with the
bio-tissue 30 or the contact of the shield metal member 21 with the
bio-tissue 30.
The description hereinafter will discuss the third embodiment of the
operation method using microwave in accordance with the present invention,
with reference to FIGS. 3 and 4.
In the third embodiment, the present invention is applied to an operation
to be performed on the organs in vivo with the use of a medical endoscope.
In FIGS. 3 and 4, with the use of a medical endoscope 31 of the
conventionally known type, the inside of the organs in vivo, in particular
the stomach, can be directly observed from the outside of the living body,
so that clinical diagnosis is made in a very easy and secure manner.
The medical endoscope 31 has a manipulating portion 32 and a detector
portion 34 which is integrally constructed with the manipulating portion
32 through a portion to be inserted in vivo 33. The detector portion 34 is
provided in the end surface thereof with a projection light guide hole, an
observation image guide hole, an air and water feed hole, a forceps hole
and other.
The manipulating portion 32 has angle knobs 35 and 36 for variously
adjusting the detector portion 34 vertically and horizontally.
The medical endoscope 34 has a light guide 37 and an eye contact portion
38. A forceps channel 39 communicates with the forceps hole in the
detector portion 34. For example, a slender forceps may be inserted into
the forceps channel 39 and the tip of the forceps is projected from the
forceps hole such that the organ and tissue in vivo can be held or pressed
by external manipulation.
A manipulating unit 40 for operation using microwaves has a hand grip 41. A
cylindrical holding member 42 passes through the head of the hand grip 41.
A slidable member 43 is slidably fitted to one side of the cylindrical
holding member 42. A finger holding portion 44 in the substantially hand
drum shape is disposed at the tip of the slidable member 43 in a unitary
construction therewith. The slidable member 43 may be slided by operating
the finger holding portion 44 with the finger of the hand which grips the
hand grip 41.
A reset coil spring 45 is disposed outside the slidable member 43 between
the hand grip 41 and the finger holding portion 44. An engagement groove
46 is formed in the outer circumference of the slidable member 43 at the
base side thereof.
A pin 47 is inserted into the head of the hand grip 41, and has a tip which
engages with the engagement groove 46 in the slidable member 43, thereby
to prevent the coil spring 45 from coming out from the slidable member 43.
A coaxial cable for transmitting microwaves 48 is extended from the
manipulating unit 40, and comprises a center conductor 49, an inner
insulating member 50, an outer conductor 51 and an outer shield 52, these
members 49, 50, 51 and 52 being concentrically disposed. The respective
base ends of the center conductor 49, the inner insulating member 50 and
the outer conductor 51 of the coaxial cable 48 are introduced in the
cylindrical holding member 42 after passing through the finger holding
portion 44 and the slidable member 43. The end of the outer conductor 51
engages with the end surface of the base portion of the slidable member
43. The center conductor 49 is slidable with respect to the inner
insulating member 50. The tip portion of the coaxial cable 48 is inserted
into the forceps channel 39 of the medical endoscope 31 and is projected
from the forceps hole of the detector unit 34 through the inserting
portion 33.
A monopolar type operating electrode 53 adapted to be projected and housed
is constructed integrally with the center conductor 49 of the coaxial
cable 48 projecting from the forceps hole.
A manipulation-side coaxial connector 54 is fitted to the other side of the
holding member 42 of the hand grip 41 and is provided at the center of the
inside thereof with a center electrode for connection 55 which is held by
a holding member 56. This center electrode 55 is connected to the center
conductor 49 of the coaxial cable 48 in the straight line form.
A coaxial cable for transmitting microwaves 57 is connected to a microwave
operation device (not shown) having a power supply, a microwave generator
device and other. A current-supply-side coaxial connector 58 is disposed
at the tip of the coaxial cable 57 and connected to the manipulation-side
coaxial connector 54. The coaxial connector 58 incorporates an electrode
to be connected and disconnected to the center electrode 55 of the
manipulation-side coaxial connector 54.
The description hereinafter will discuss how the third embodiment of the
present invention is operated.
The detector portion 34 and the inserting portion 33 of the medical
endoscope 31 are inserted in vivo. While controlling the angle knobs 35
and 36 of the manipulating portion 32, the detector portion 34 is guided
to the part of lesion in the organ in vivo, for exampl | | |
