DE1139927B - High-frequency surgical device - Google Patents
High-frequency surgical deviceInfo
- Publication number
- DE1139927B DE1139927B DEL37861A DEL0037861A DE1139927B DE 1139927 B DE1139927 B DE 1139927B DE L37861 A DEL37861 A DE L37861A DE L0037861 A DEL0037861 A DE L0037861A DE 1139927 B DE1139927 B DE 1139927B
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- Prior art keywords
- electrode
- parts
- surgical device
- frequency
- inactive
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B18/1233—Generators therefor with circuits for assuring patient safety
-
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/16—Indifferent or passive electrodes for grounding
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Otolaryngology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Plasma & Fusion (AREA)
- Physics & Mathematics (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Description
Hochfrequenz-Chirurgiegerät Hochfrequenz-Chirurgiegeräte enthalten einen Hochfrequenzgenerator, dessen eine Ausgangsklemme durch eine großflächige, »in aktive« Elektrode mit dem Patienten verbunden wird, während die andere, aktive Elektrode zum Schneiden oder Koagulieren dient. Die Stromdichte an der inaktiven Elektrode muß so niedrig gehalten werden, daß keine Rötungen oder Verbrennungen auftreten können. Sie besteht im allgemeinen aus großflächigen Metallteilen, z. B. einem Drahtnetz, auf das der Patient gelegt wird; es sind auch manschettenartige Elektroden bekannt, die an Gliedmaßen angelegt werden können.High frequency surgical device High frequency surgical devices included a high-frequency generator, one output terminal of which is connected to a large, "In active" electrode is connected to the patient while the other, active one Electrode is used for cutting or coagulation. The current density at the inactive Electrode must be kept low enough to prevent redness or burns may occur. It generally consists of large metal parts, e.g. B. a wire mesh on which the patient is placed; there are also cuff-like ones Known electrodes that can be applied to limbs.
Um die Gefahr von Verbrennungen an der inaktiven Elektrode auszuschalten, ist bei einem bekannten Hochfrequenz-Chirurgiegerät ein Gleichstromhilfskreis vorgesehen, der zwischen die aktive Elektrode und die inaktive Elektrode geschaltet ist und den Hochfrequenzgenerator selbsttätig abschaltet, wenn der Widerstand zwischen dem Körper des Patienten und der in aktiven Elektrode einen bestimmten Wert überschreitet. Da der Widerstand zwischen der aktiven Elektrode und dem Körper des Patienten in weiten Grenzen schwanken kann, ist ein zuverlässiges Arbeiten mit der bekannten Anordnung nicht zu erreichen. Außerdem kann der Hochfrequenzgenerator bei abgehobener aktiver Elektrode nicht eingeschaltet werden, und der Generator schaltet sich automatisch auch bei jedem kurzzeitigen Abheben der aktiven Elektrode aus. To avoid the risk of burns on the inactive electrode, a DC auxiliary circuit is provided in a known high-frequency surgical device, which is connected between the active electrode and the inactive electrode and the high-frequency generator switches off automatically when the resistance between the Body of the patient and the active electrode exceeds a certain value. Since the resistance between the active electrode and the patient's body is in can fluctuate widely, reliable work with the known Arrangement cannot be achieved. In addition, the high-frequency generator can be used when lifted active electrode cannot be switched on and the generator switches off automatically also with every brief lifting of the active electrode.
Es ist ferner bekannt, bei Hochfrequenz-Chirurgiegeräten mehrere in aktive Elektroden zu verwenden. It is also known to have several in high-frequency surgical devices to use in active electrodes.
Es ist schließlich auch noch bekannt, Hochfrequenz-Chirurgiegeräte mit einer Alarmvorrichtung zu versehen, die den Betriebszustand des Hochfrequenzgenerators anzeigt.Finally, it is also known high frequency surgical equipment to be provided with an alarm device that monitors the operating status of the high-frequency generator indicates.
Durch die Erfindung sollen die Nachteile der bekannten Anordnungen vermieden werden. Insbesondere soll ein Hochfrequenz-Chirurgiegerät angegeben werden, bei dem Verbrennungen durch die inaktive Elektrode mit Sicherheit vermieden werden, ohne daß dadurch das Arbeiten mit der aktiven Elektrode in irgendeiner Weise beeinträchtigt wird. The invention is intended to address the disadvantages of the known arrangements be avoided. In particular, a high-frequency surgical device should be specified, in which burns from the inactive electrode can be avoided with certainty, without thereby affecting the work with the active electrode in any way will.
Ein Hochfrequenz-Chirurgiegerät mit einem Hochfrequenzgenerator, einer kleinflächigen, aktiven Elektrode und einer großflächigen, inaktiven Elektrode in Form von zwei oder mehr Elektrodenteilen ist gemäß der Erfindung dadurch gekennzeichnet, daß die Teile der inaktiven Elektrode in einen Gleichstromhilfskreis eingeschaltet sind, der über den zwischen den Teilen der in aktiven Elektrode liegenden Körper des Patienten geschlossen wird und eine Schaltungsanordnung enthält, die anspricht, wenn der Widerstand in dem zwischen den Elektrodenteilen gelegenen Teil des Hilfsstromkreises einen bestimmten Grenzwert überschreitet, und den Hochfrequenzgenerator abschaltet und/oder eine Alarmanlage auslöst. A high-frequency surgical device with a high-frequency generator, a small-area, active electrode and a large-area, inactive electrode in the form of two or more electrode parts is characterized according to the invention, that the parts of the inactive electrode switched into a DC auxiliary circuit over the body lying between the parts of the active electrode of the patient is closed and contains circuitry that responds if the resistance is in the part of the auxiliary circuit located between the electrode parts exceeds a certain limit and switches off the high-frequency generator and / or triggers an alarm system.
Bei einer Weiterbildung der Erfindung ist eine Schaltungsanordnung vorgesehen, die auch anspricht, wenn der Widerstand zwischen den Teilen der inaktiven Elektrode einen bestimmten unteren Grenzwert unterschreitet. In a further development of the invention, there is a circuit arrangement provided, which also responds when the resistance between the parts of the inactive Electrode falls below a certain lower limit value.
Das Gerät gemäß der Erfindung bietet also sowohl gegen zu kleine Kontaktflächen und hohe Übergangswiderstände Sicherheit, als auch gegen einen Kurzschluß von Elektrodenteilen' durch die die Anlage funktionsunfähig würde. The device according to the invention thus offers both against too small Contact surfaces and high contact resistance security, as well as against a short circuit of electrode parts' which would make the system inoperable.
Die Erfindung soll nun an Hand der Zeichnungen näher erläutert werden, dabei bedeutet Fig. 1 eine schematische Darstellung eines Hochfrequenz-Chirurgiegerätes gemäß der Erfindung, Fig. 2 ein Ersatzschaltbild zur Erläuterung der Wirkungsweise der Anordnung nach Fig. 1, Fig. 3 eine weitere Ausführungsform der Erfindung, Fig. 4 eine Elektrodenanordnung gemäß der Erfindung. The invention will now be explained in more detail with reference to the drawings, FIG. 1 is a schematic representation of a high-frequency surgical device according to the invention, FIG. 2 is an equivalent circuit diagram to explain the mode of operation the arrangement according to FIG. 1, FIG. 3 shows a further embodiment of the invention, FIG. 4 shows an electrode arrangement according to the invention.
Das in Fig. 1 schematisch dargestellte Hochfrequenz-Chirurgiegerät enthält in bekannter Weise einen Hochfrequenzgenerator 1, der über eine flexible Leitung 2 mit einem Operationshandgrifl 3 verbunden sein kann. Die zweite Ausgangsklemme des Hochfrequenz-Chirurgiegerätes ist über eine Leitung 4 mit einer großflächigen, in aktiven Elektrode verbunden, die hier aus zwei Teilen 5 und 6 besteht. Auf der inaktiven Elektrode 5, 6 ruht der Körper 7 des Patienten. Die Elektrode 5 ist gleichstrommäßig durch eine mit einem Kondensator 9 überbrückte Gleichspannungsquelle 8 mit Masse verbunden; die Gleichspan- nungsquelle 8 ist hier beispielsweise als Grätz-Gleichrichter dargestellt. Die andere Elektrode 6 ist gleichstrommäßig durch einen Kondensator 10 von Masse getrennt. Die Anordnung soll so getroffen sein, daß die einzige Verbindung zwischen den beiden Elektroden 5 und 6 durch den Körper 7 des Patienten gebildet wird. Die Elektrode 6 ist über eine Hochfrequenzdrossel 11 mit dem Gitter einer Röhre 12 verbunden, das über einen Gitterableitwiderstand 13 mit Masse verbunden ist. Der Gitterableitwiderstand 13 ist durch einen Kondensator 14 überbrückt, der zur Beseitigung von Spuren von Hochfrequenz dient und verhältnismäßig klein bemessen ist, um das Ansprechen der Röhre 12 nicht zu verzögern. The high-frequency surgical device shown schematically in FIG. 1 contains in a known manner a high-frequency generator 1, which has a flexible Line 2 can be connected to an operation handle 3. The second output terminal of the high-frequency surgical device is via a line 4 with a large, connected in active electrode, which here consists of two parts 5 and 6. On the Inactive electrode 5, 6, the patient's body 7 rests. The electrode 5 is direct current by a DC voltage source 8 bridged with a capacitor 9 to ground tied together; the DC voltage Voltage source 8 is here for example shown as a Grätz rectifier. The other electrode 6 is direct current separated from ground by a capacitor 10. The arrangement should be made in such a way that that the only connection between the two electrodes 5 and 6 is through the body 7 of the patient is formed. The electrode 6 is via a high frequency choke 11 connected to the grid of a tube 12, which via a grid bleeder resistor 13 is connected to ground. The grid bleeder resistor 13 is through a capacitor 14 bridged, which is used to remove traces of high frequency and relatively is made small so as not to delay the response of the tube 12.
Die Röhre 12 ist normalerweise gesperrt, beispielsweise durch eine positive Vorspannung an der Kathode, die durch einen Spannungsteiler geliefert wird, der aus dem Kathodenwiderstand 15 und einem zwischen Kathode und der Anodenspannungsquelle + B geschalteten Widerstand 16 bestehen kann. Im Anodenkreis der Röhre 12 liegt ein Relais 17, das einen Arbeitskontakt 18 und/oder einen Ruhekontakt 19 trägt. The tube 12 is normally blocked, for example by a positive bias on the cathode, which is supplied by a voltage divider, that of the cathode resistor 15 and one between the cathode and the anode voltage source + B switched resistor 16 can exist. In the anode circle of the tube 12 lies a relay 17 which carries a normally open contact 18 and / or a normally closed contact 19.
Die Arbeitsweise der Schaltung soll an Hand von Fig. 2 erklärt werden. Der Widerstand 7' des Patienten zwischen den Elektroden 5 und 6 bildet mit dem Gitterableitwiderstand 13 einen Spannungsteiler für die von der der Einfachheit halber als Batterie gezeichneten Stromquelle 8'. Die Stromquelle 8' ist so gepolt, daß das Gitter der Röhre 12 eine positive Vorspannung über den Widerstand 7' erhält. Die Schaltungsparameter sind nun so gewählt, daß die Röhre erst dann zu leiten beginnt, wenn der Widerstand 7' zwischen den Elektroden 5 und 6 unterhalb eines bestimmten Wertes liegt, der in der Praxis größenordnungsmäßig etwa 10 kOhm beträgt. The mode of operation of the circuit will be explained with reference to FIG. The resistance 7 'of the patient between the electrodes 5 and 6 forms with the grid bleeder resistance 13 shows a voltage divider for those drawn as a battery for the sake of simplicity Power source 8 '. The power source 8 'is polarized so that the grid of the tube 12 a receives positive bias across the resistor 7 '. The circuit parameters are now chosen so that the tube only begins to conduct when the resistor 7 ' between the electrodes 5 and 6 is below a certain value, which in in practice is of the order of magnitude of about 10 kOhm.
Das Relais 17 in Fig. 1 trägt einen Arbeitskontakt 18, der im geöffneten Zustand den Hochfrequenzgenerator außer Betrieb setzt, beispielsweise über ein in die Stromzuleitung des Hochfrequenzgenerators geschaltetes Schaltschütz. An Stelle des Arbeitskontaktes 18 oder zusätzlich zu diesem kann ein Ruhekontakt 19 vorgesehen sein, der eine Alarmeinrichtung 20 betätigt, wenn er geschlossen ist. Durch diese Schaltungsanordnung wird bewirkt, daß auch beim Ausfall der Spannungsquelle 8 oder einer Unterbrechung einer Leitung in dem Stromkreis zum Gitter der Röhre 12 die Hochfrequenz abgeschaltet bzw. The relay 17 in Fig. 1 carries a normally open contact 18, which is open State puts the high-frequency generator out of operation, for example via an in the power supply of the high-frequency generator switched contactor. Instead of of the normally open contact 18 or in addition to this, a normally closed contact 19 can be provided which operates an alarm device 20 when it is closed. Through this Circuit arrangement is effected that even if the voltage source 8 or fails an interruption of a line in the circuit to the grid of the tube 12 the High frequency switched off or
Alarm gegeben wird.Alarm is given.
Die in Fig. 1 dargestellte Sicherheitsanordnung kann jedoch nicht ansprechen, wenn die Elektroden 5 und 6 unerwünschterweise kurz geschlossen sind, beispielsweise durch irgendein Metallteil, ein chirurgisches Instrument, einen Isolationsfehler u. dgl. Gemäß einer Weiterbildung der Erfindung sind daher Maßnahmen vorgesehen, die Sicherheitseinrichtung auch dann ansprechen zu lassen, wenn der Widerstand zwischen den Elektroden 5 und 6 unterhalb eines bestimmten Wertes fällt. Dieser untere Grenzwert kann zwischen einigen Ohm und einigen Hundert Ohm liegen. However, the safety arrangement shown in FIG. 1 cannot respond when electrodes 5 and 6 are undesirably short-circuited, for example due to some metal part, a surgical instrument, an insulation fault and the like. According to a further development of the invention, measures are therefore provided to allow the safety device to respond even if the resistance is between the electrodes 5 and 6 falls below a certain value. This lower limit can be between a few ohms and a few hundred ohms.
Bei der in Fig. 3 dargestellten Ausführungsform der Erfindung besteht die inaktive Elektrode aus zwei Manschetten 5' und 6', die um einen Arm oder ein Bein oder auch um zwei verschiedene Gliedmaßen des Patienten gelegt werden können. Die Manschette 5' ist direkt geerdet, d. h. mit der masseseitigen Klemme des der Einfacheit halber hier nicht dar- gestellten Hochfrequenzgenerators verbunden. Die Manschette 6' liegt wieder über einen Kondensator 10 an Masse. Sie ist außerdem über eine Hochfrequenzdrossel 11, eine Spannungsquelle 21 und eine erste Arbeitswicklung eines Relais 22 mit dem Gitter einer Röhre 12 verbunden. Die Röhre 12 ist im übrigen wie bei dem in Fig. 1 dargestellten Ausführungsbeispiel geschaltet. Im Anodenkreis liegt ebenfalls die Arbeitswicklung eines Relais, die hier eine zweite Arbeitswicklung des Relais 22 ist. Die beiden Arbeitswicklungen sind so geschaltet, daß sie einander entgegenwirken. Im übrigen entspricht das Relais 22 dem Relais 17 in Fig. 1. In the embodiment of the invention shown in FIG. 3 the inactive electrode consists of two cuffs 5 'and 6', which are around an arm or a Leg or around two different limbs of the patient can be placed. The cuff 5 'is directly earthed, i. H. with the earth-side terminal of the For the sake of simplicity not connected high-frequency generator. the Cuff 6 'is again connected to ground via a capacitor 10. She is also Via a high-frequency choke 11, a voltage source 21 and a first working winding a relay 22 is connected to the grid of a tube 12. The tube 12 is otherwise switched as in the embodiment shown in FIG. In the anode circle is also the working winding of a relay, which here is a second working winding of relay 22 is. The two working windings are connected so that they are mutually exclusive counteract. Otherwise, relay 22 corresponds to relay 17 in FIG. 1.
Die in Fig. 3 dargestellte Schaltung arbeitet folgendermaßen: Ist der Widerstand zwischen den Manschetten 5' und 6' sehr groß, so ist die Röhre 12 infolge der positiven Spannung an der Kathode gesperrt, und das Relais 22 spricht nicht an. Bei einem bestimmten, mittleren Widerstand zwischen den Elektroden 5' und 6' wird das Gitter der Röhre 12 durch die Spannungsquelle 21 positiv vorgespannt, und die Röhre leitet. Das Relais 22 zieht an, und das Hochfrequenz-Chirurgiegerät ist betriebsbereit. The circuit shown in Fig. 3 operates as follows: Actual the resistance between the cuffs 5 'and 6' is very great, so the tube 12 is blocked due to the positive voltage at the cathode, and the relay 22 speaks not on. At a certain average resistance between the electrodes 5 ' and 6 'the grid of the tube 12 is positively biased by the voltage source 21, and conducts the tube. The relay 22 picks up, and so does the high-frequency surgical device is ready for use.
Wenn die Elektroden 5' und 6' kurz geschlossen werden, fließt ein verhältnismäßig großer Strom durch die erste Relaiswicklung, die in einem Stromkreis liegt, der aus der Stromquelle 21, der Drossel 11, den Elektroden6' und 5', dem Gitterwiderstand 13 und der ersten Relaiswicklung besteht. Da die erste Relaiswicklung im umgekehrten Sinn geschaltet ist wie die im Anodenkreis der Röhre 12 liegende zweite Relaiswicklung, wird die durch den Anodenstrom der Röhre 12 verursachte Erregung kompensiert, und das Relais fällt wieder ab. Als Relais 22 wird hier vorteilhaft ein polarisiertes Relais verwendet. If the electrodes 5 'and 6' are short-circuited, flows in relatively large current through the first relay winding, which is in a circuit is from the power source 21, the choke 11, the electrodes 6 'and 5', the Grid resistor 13 and the first relay winding consists. As the first relay winding is connected in the opposite sense as that lying in the anode circuit of the tube 12 second relay winding, is the excitation caused by the anode current of the tube 12 compensated, and the relay drops out again. As a relay 22 is advantageous here uses a polarized relay.
Die in Fig. 3 dargestellte Schaltung besitzt also die Eigenschaft, daß sie das Hochfrequenz-Chirurgiegerät abschaltet und/oder Alarm auslöst, wenn der Widerstand zwischen den Elektroden 5' und 6' einen bestimmten ersten Wert überschreitet oder einen bestimmten kleineren, zweiten Wert unterschreitet. Die Ansprechgrenzen können beispielsweise bei 10 bzw. The circuit shown in Fig. 3 thus has the property that it switches off the high-frequency surgical device and / or triggers an alarm when the resistance between the electrodes 5 'and 6' exceeds a certain first value or falls below a certain smaller, second value. The response limits can, for example, at 10 or
1 kOhm liegen.1 kOhm.
Selbstverständlich gibt es eine große Anzahl von anderen Schaltungsanordnungen, die dasselbe leisten, wie die in Fig. 1 und 3 dargestellten. Es können beispielsweise Glimmschaltröhren oder direkt empfindliche Relais verwendet werden, an Stelle des einen Relais 22 in Fig. 3 können auch zwei getrennte Relais vorhanden sein. Of course there are a large number of other circuit arrangements which do the same as those shown in FIGS. For example Glow contact tubes or directly sensitive relays can be used instead of the a relay 22 in Fig. 3, two separate relays can also be present.
Die Elektrode selbst kann mechanisch aus einem Stück, das mehrere elektrisch getrennte Teile umfaßt, bestehen, es können aber auch völlig getrennte und unabhängig applizierbare Elektroden verwendet werden. The electrode itself can be mechanically made from one piece, which is several includes electrically separate parts exist, but it can also be completely separate and independently applicable electrodes can be used.
Fig. 4 zeigt ein Ausführungsbeispiel einer mechanisch zusammenhängenden Elektrode, die zwei elektrisch getrennte Teile umfassen. Die eigentlichenElektroden 5", 6" bestehen aus zwei Stücken eines flexiblen Drahtnetzes, die jeweils in einer Art von Einschlagtuch 23, 24 aus einer Plastikfolie liegen, die die Oberseiten der Drahtnetze frei läßt. Auf den Oberseiten liegen Zellstoff- oder Gazekissen, die, um einen guten Kontakt zu gewährleisten, mit Kochsalz getränkt sind. Die beiden Elektrodenanordnungen sind durch eine Reihe von Isolierstoffstreifen 27 verbunden. Die Isolierteile zwischen den Elektrodenteilen, also beispielsweise die Streifen 27, sind vorzugsweise mit einem Antinetzmittel imprägniert. Auf die in Fig. 4 dargestellte Elektrodenanordnung kann beispielsweise der Körper des Patienten gelegt werden, oder sie kann bei entsprechend kleinerer Ausbildung als Manschette verwendet werden. Fig. 4 shows an embodiment of a mechanically coherent Electrode comprising two electrically separated parts. The actual electrodes 5 ", 6" consist of two pieces of flexible wire mesh, each in a Kind of wrapping cloth 23, 24 are made of a plastic film covering the tops of the Leaves wire nets free. On the top there are cellulose or gauze pillows that, to ensure good contact, are soaked with table salt. The two Electrode assemblies are connected by a series of strips of insulating material 27. The insulating parts between the electrode parts, for example the strips 27, are preferred impregnated with an anti-wetting agent. on the electrode arrangement shown in Fig. 4 can, for example, the body of the Patients are placed, or they can be with correspondingly smaller training than Cuff can be used.
Claims (6)
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DEL37861A DE1139927B (en) | 1961-01-03 | 1961-01-03 | High-frequency surgical device |
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DEL37861A DE1139927B (en) | 1961-01-03 | 1961-01-03 | High-frequency surgical device |
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