U.S. patent number 3,601,126 [Application Number 04/789,716] was granted by the patent office on 1971-08-24 for high frequency electrosurgical apparatus.
This patent grant is currently assigned to Electro Medical Systems. Invention is credited to Jerry R. Estes.
United States Patent |
3,601,126 |
Estes |
August 24, 1971 |
HIGH FREQUENCY ELECTROSURGICAL APPARATUS
Abstract
Electrosurgical apparatus including electrodes powered by high
frequency electric current, wherein the amplitude of the current
flowing through the circuit is monitored and compared with a
reference amplitude so that the current source can be regulated to
transmit power of a desired amplitude. Further, the waveform of the
current can be selectively switched from a sinusoidal waveform to a
pulsed waveform. Also, there is provided an indifferent or return
electrode whose conductivity controls the operation of the power
source.
Inventors: |
Estes; Jerry R. (N/A, CO) |
Assignee: |
Systems; Electro Medical
(CO)
|
Family
ID: |
25148473 |
Appl.
No.: |
04/789,716 |
Filed: |
January 8, 1969 |
Current U.S.
Class: |
606/35;
606/38 |
Current CPC
Class: |
A61B
18/16 (20130101); G05F 1/12 (20130101) |
Current International
Class: |
A61B
18/16 (20060101); A61B 18/14 (20060101); G05F
1/12 (20060101); G05F 1/10 (20060101); A61B
017/36 () |
Field of
Search: |
;128/303.1-303.14,303.17,417 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
1,178,528 |
|
Sep 1964 |
|
DT |
|
1,139,927 |
|
Nov 1962 |
|
DT |
|
Primary Examiner: Trapp; L. W.
Claims
I claim:
1. High frequency electrosurgical apparatus for operating on
electrically conductive tissue comprising first and second
electrodes, each of said electrodes being adapted for electrically
contacting tissue whereby an electric current path is established
between said electrodes via said tissue, means for generating a
high frequency electric current having a controllably varying
amplitude, means for connecting said generating means to said
electrodes, reference means for establishing a desired amplitude
for the current passing through the tissue, sensing means for
sensing the amplitude of the actual current passing through the
tissue, and control means responsive to said reference means and
said sensing means for controlling said generating means to
generate a high frequency electric current having an amplitude
substantially equal to said desired amplitude.
2. Apparatus as in claim 1 wherein said generating means includes
means for selectively operating said generating means to operate in
a first mode to generate a continuous alternating current, or in a
second mode to generate time-spaced packets of alternating
current.
3. Apparatus as in claim 2 wherein said reference means comprises
means for establishing a first desired amplitude for electric
current related to said continuous alternating current generated by
said generating means and a second desired amplitude for electric
current related to said time-spaced packets of alternating current
generated by said generating means, and further comprising
selection means for simultaneously controlling the mode of
operation of said generating means and controlling which desired
amplitude of electric current is received by said control means for
controlling said generating means.
4. The apparatus of claim 1 wherein said first electrode is an
active electrode and said second electrode is an indifferent
electrode, and means for rendering said generating means
inoperative when an open circuit exists in the electrical circuit
including the tissue, said indifferent electrode and said
generating means.
5. High frequency electrosurgical apparatus for operating on
electrically conductive tissue comprising: a controllably operable
generating means for generating a high frequency electric current;
an active electrode adapted to be applied to tissue at the situs of
the operation; an indifferent electrode for contact with tissue at
the situs of the operation, said indifferent electrode comprising a
sheet of porous material, adhesive means connected to said sheet of
material for removably affixing said indifferent electrode to
tissue, and a pair of spaced electrical terminals in contact with
said porous material; circuit means for connecting said active
electrode and said terminals of said indifferent electrode to said
generating means; and control means for rendering said generating
means inoperative when the conductivity in a circuit including the
tissue, said indifferent electrode and said circuit means
connecting said indifferent electrode to said generating means is
less than a given value.
Description
BACKGROUND OF THE INVENTION
This invention pertains to electrosurgical apparatus and more
particularly, to such apparatus which is powered by high frequency
current for cutting tissue, coagulating blood vessels and
fulguration of growths.
Known electrosurgical apparatus generates a high frequency electric
current which is fed to an active electrode. An indifferent
electrode is placed in contact with the patient to supply a return
path for the current. When the active electrode is applied to
tissue of the patient at the operating site, a circuit is closed
and the high frequency power emitted by the active electrode
generates heat at the site. The resultant heat implements the
desired operative procedure.
The amplitude of the current flowing between the electrodes is a
function of the electrical resistance of the tissue current path
between the electrodes. If the current generator is set to transmit
a current of a given amplitude, such amplitude will be effectively
related to a given load resistance. If the resistance decreases,
the current amplitude increases; and vice versa.
During an operation, the impedance of the tissue changes as the
active electrode moves through different types of tissue.
Accordingly, a selected initial setting of the current generator at
the start of an operation may not produce the desired current
conditions as the operation proceeds.
It is a general object of this invention to provide electrosurgical
apparatus wherein the power delivered to the active electrode as
the same engages the tissue, is maintained at a constant desired
level during the entire operational procedure.
Another object of this invention is to provide in apparatus of the
character described, means for monitoring the amplitude of the
power flow to the electrodes of the apparatus and controlling the
output of the high frequency generator to maintain a desired or
selected power amplitude.
Essentially, the electrosurgical apparatus of the instant invention
comprises a pair of electrodes applicable to biological tissue; the
electrodes being powered from a high frequency generator operative
to controllably vary the power amplitude. The apparatus further
includes reference means to establish a desired power amplitude in
respect to the operating current passing through the biological
tissue; together with means for sensing the amplitude of the power
passing through the tissue and control means for comparing the
amplitudes of the desired and actual power; the control means being
responsive to such amplitude comparison to regulate the operation
of the generator so that the generator will transmit power having
an amplitude substantially equal to the desired power
amplitude.
It is known in the art that different operative procedures require
differing high frequency current waveforms. Thus, a cutting
operation calls for a continuous wave or sinusoidal radio frequency
oscillation of the current; whereas a coagulating procedure
requires an oscillating current of the type provided by a spark gap
oscillator. Such a spark gap oscillator generates a spectrum of
frequencies between 0.5 mHz. and 1.5 mHz. This noise spectrum is
distinguished by high voltage "spikes" with low average power
values. Such a signal when impressed by way of the electrode on
tissue, has a drying effect which leads to a coagulating action in
respect to such tissue, with very little tissue separation or
cutting.
It is believed that any waveform which spreads the signal over a
reasonable frequency spectrum, will produce the same effect.
Accordingly, the instant invention comprises a high frequency
current generator which can be selectively controlled to operate in
a continuous wave mode or a pulsed wave mode with the amplitudes of
the signals being held at predetermined values.
In electrosurgical procedures the input current is applied to the
tissue by way of an active electrode of very small cross section so
as to obtain high current densities at the operation site. These
high current densities provide the desired heating effects. However
the return or indifferent electrode must be in contact over a
substantial area of the tissue so that the return current has a low
density, which prevents burning or scarring of the tissue in
contact with the indifferent electrode.
If for any reason, the indifferent electrode or its connection to
the current source is broken or faulty, the low current density is
not achieved and the tissue at the situs where the high frequency
currents leave, will be burned or scarred.
With the apparatus of the instant invention, the conductive state
of the indifferent electrode and its connection to the current
generator is monitored and the generator made inoperative when the
conductive state falls below a given value.
In known electrosurgical apparatus, the indifferent electrode takes
the form of a stainless steel plate which is placed under the
patient and a conductive fluid is spread thereover to increase the
contact area. Such an electrode must be sterilized before each use
thereof and must be prewet with conductive fluid. This procedure
may lead to omissions and inexact applications of fluid.
In the apparatus of the instant invention there is provided an
inexpensive, prepackaged disposable indifferent electrode which is
presterilized and prewet with conductive fluid. Such an electrode
facilitates monitoring its conductive state and thus avoids tissue
burns or scars.
Other objects of this invention will in part be obvious and in part
hereinafter pointed out.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a circuit diagram for electrosurgical apparatus embodying
the invention;
FIG. 2 is a top plan view of the indifferent electrode, forming
part of the apparatus;
FIG. 3 is a sectional view taken on the line 3-3 of FIG. 2;
FIG. 4 is an enlarged, partial sectional view of a portion of said
electrode;
FIG. 5 is a top plan view showing a connector for the electrode of
FIG. 2;
FIG. 6 is a sectional view taken on the line 6-6 of FIG. 5.
DESCRIPTION OF THE PREFERRED EMBODIMENT
As shown in the drawings, and particularly FIG. 1, electrosurgical
apparatus embodying the invention is indicated at 10, for operative
application to selected tissue portions of a patient indicated at
12. The apparatus 10 comprises a high frequency current generating
system including an R.F. oscillator 14 which drives a gain
controlled power amplifier 16. The power amplifier 16 is coupled
via step-up transformer 18 and coupling capacitors 20, 22 to active
electrode 24 and an indifferent electrode 100, respectively.
During normal operation, when on/off switch 28 is in its closed
position, the output of oscillator 14 is amplified by power
amplifier 16 and transformer 18 to provide a alternating current
which flows via capacitor 20 and active electrode 24 to the
selected tissue area in contact therewith. The current passes
through the body of patient 12 to the indifferent electrode 100
where it is returned via lead 30 and capacitor 22 to transformer
18.
The power output in the form of the square of the amplitude of the
alternating current must be set at a selected, desired level and
maintained at such level for the desired operating procedure. Such
desired levels are attained by adjusting one of the two calibrated
power level setting potentiometers 32, 34. The operation of the
respective potentiometers 32, 34 will be hereinafter described.
It is assumed that a voltage indicating the desired square law
power amplitude level is present on lead 36 which feeds one input
of difference amplifier 38. The other input of difference amplifier
38 is a voltage on lead 40 from square-law detector 42. The inputs
of detector 42 are connected to a winding 44 of a magnetic core
toroid 46 through which passes lead 30 connecting indifferent
electrode 100 to capacitor 22. The combination of lead 30, toroid
46 and winding 44 provides in effect a transformer acting as a
current sensor.
As the alternating current flows through lead 30, it will induce an
alternating current in winding 44 which is detected in detector 42
to thereby generate a DC voltage having an amplitude proportional
to the square of the AC current in lead 30. Difference amplifier 38
compares the DC voltage on line 40 with the DC voltage on line 36
and transmits a signal on line 48 to gain control amplifier 50
which amplifies the signal and transmits the same by lead 52 to a
gain control terminal of power amplifier 16.
The relationship of the signals is such that if the amplitude of
the current in lead 30 is greater than the desired amplitude as
represented by the DC voltage on line 36, the signal on line 52 has
a value to decrease the gain of amplifier 16. A similar effect
occurs in the opposite direction when the actual current amplitude
is less than the desired amplitude. Thus, amplifier 16 and the
elements connected to its output comprise a servo system with the
current sensor, square law detector, difference amplifier and gain
control amplifier being the feedback loop; the signal on line 52
being the error signal and the signal on line 36 being the
reference signal.
When the indicated surgical procedure involves a cutting operation,
cutting switch 54 is closed to energize relay 56 which causes
transfer contact 56A to connect potentiometer 32 to lead 36, and
transfer contact 56B to connect with fixed contact 56C. In this
case, oscillator 14 transmits a continuous wave of AC signal, as
will be hereinafter described, and lead 36 transmits a DC voltage
related to the desired amplitude of the alternating current for the
cutting operation.
When a coagulating action is desired, switch 58 is closed, switch
54 being open, to energize relay 60 causing its transfer contact
60A to connect with fixed contact 60B; transfer contact 56A of
relay 56 now connects lead 36 to potentiometer 34. In this case,
oscillator 14 emits packets of alternating current, as later
described, and lead 36 transmits a DC voltage related to the
desired amplitude of the alternating current for a coagulating
operation.
The indifferent electrode 100 requires an electrolyte to provide
good conductive contact with patient 12. When the quantity of
electrolyte falls below a certain level, poor contact results and
the patient may suffer from burns. Accordingly, the electrolyte is
monitored as to quantity and the oscillator 14 is rendered
inoperative when the quantity falls below a given value.
To this end, a series circuit is established between voltage source
V, lead 62, a terminal 102 of electrode 100, the electrolyte in the
electrode, another terminal 104 of the electrode lead 64, switch
28, the coil of relay 66 and ground. If sufficient electrolyte is
present when switch 28 is closed, relay 66 is energized, closing
contact set 66A which supplies operating power to oscillator 14,
and opening contact set 66B which breaks the series circuit from
voltage source V via contact set 66B and neon bulb 68 and ground to
deenergize bulb 68.
If the electrolyte is insufficient, relay 66 is not energized and
oscillator 14 is made inoperative, while bulb 68 is energized to
direct attention to the insufficiency of electrolyte in electrode
100.
The R.F. oscillator 14 comprises transistor T1 and transformer 70
whose primary winding is connected between the collector of the
transistor and ground. The output winding of the transformer is
connected to a voltage source V and the input of power amplifier
16. The feedback winding of the transformer has one end connected
to the base of the transistor, the other end being connected to
transfer contact 56B, and a center tap being connected to relay
contact 60A. The emitter of the transistor T1 is connected via
contact set 66A to operating voltage source V. A timing capacitor
72 connects the emitter to junction 74 which is connected to fixed
contact 56C. Resistor 76 connects junction 74 to ground while
resistor 78 connects junction 74 to contact 60B.
When relay 66 is energized, an operating voltage is applied to the
transistor T1 by virtue of the closing of contact set 66A. Now, if
relay 56 is energized, the feedback winding of transformer 70 is
connected to the emitter of the transistor via capacitor 72 and the
oscillator 14 operates in the continuous wave mode with a frequency
determined by the constants of the transformer, the capacitor 72
and the load on the transformer. The frequency may thus be set at 1
mHz. However, when relay 60 is energized the center tap of
transformer 70 is connected to junction 74. Now, as capacitor 72
charges via resistor 76, the oscillator is turned off until the
base-emitter junction of the transistor is forward biased. At that
time the oscillator oscillates at 1 mHz. for a period of time
determined by the time required for capacitor 72 to discharge via
resistor 78 to a value which again back biases the base-emitter
junction. By a suitable choice of values for resistor 78 it is
possible to cause the oscillator to block at a 100 kHz. rate.
The power amplifier 16 is conventional in form and whose gain is
controlled by shifting its operating voltage which is supplied by
line 52. Gain control amplifier 50, difference amplifier 38 and
square-law detector 42 are known devices. Active electrode 24 takes
the form of known electrosurgical probes regularly used in the
art.
The indifferent electrode 100 is shown in detail in FIGS. 2--4; the
same comprising a conductive base member 110 which may take the
form of a sheet of plastic such as polyvinyl chloride (PVC) whose
top surface is metallized as by depositing aluminum or the like
thereon by known techniques. Tabs 112, 114 are affixed to the
bottom surface of member 110 at the opposite ends thereof, in the
form of adhesive tapes, for affixing the electrode to patient
12.
A porous sheet 116 of flexible spongy material such as sponge
rubber, latex or polyurethane foam, or the like, is fixed to the
top metallized surface of member 110 by an appropriate adhesive.
The porous sheet 116 is impregnated with nontoxic electrolyte such
as a saturated saline solution. The solution is preferably rendered
somewhat viscous by adding gelatine thereto, to thereby reduce the
evaporation of the same.
A protective plastic film bag 118 encloses the electrode 100
including the saturated sheet 116 and the exposed adhesive surfaces
of tabs 112, 114. Bag 118 provides a leakproof container for the
electrolyte contained in sheet 116, while the same is in storage.
When electrode 100 is to be used, no additional electrolyte need be
added to sheet 116. Also, bag 118 serves as a germproof shield for
its contents and need be sterilized but once when the same is
filled. The bag protects the adhesive areas of the tabs 112, 114
until ready for use in applying the electrode in place.
At the time of use of electrode 100, the bag 118 is opened to
expose sheet 116 and tabs 112, 114. The top of sheet 116 is placed
against the patient and held in place by adhesive tabs 112, 114. A
terminal connector is clipped to the electrode.
A terminal connector 120 for attachment to electrode 100, is shown
in FIGS. 5, 6. Connector 120 comprises a pair of plates 122, 124
which are hingedly interconnected by ear portions extending toward
each other at the side edges thereof, as at 126, 128. Plates 122,
124 are formed of Nylon or the like to be resistant to sterilizing
temperatures. A spring 130 biases the forward jawlike portions of
plates 122, 124 toward each other.
A pair of stainless steel terminal blocks 102, 104 are suitably
affixed to the underside of top plate 122 and signal leads 62, 64
are respectively connected to said blocks. To clip the connector
120 to electrode 100, the rear portions of plates 122, 124 are
pinched together to open the jaw portions to receive the edge
portion of electrode 100 therebetween. The terminal blocks 102, 104
will then embed themselves in the porous sheet 116 to make good
contact therewith. Terminal blocks 102, 104 are electrically
interconnected only when sheet 116 is saturated with electrolyte
and a measurement of the conductivity between the terminal blocks
will determine the presence or absence of electrolyte.
The on/off switch 28 may be of the conventional foot pedal operated
type. Alternatively such switch may be finger operated and mounted
on the active electrode 24. Also the switch may be of the reed type
which has a magnet to operate the same. Obviously, the foot
operated and finger operated switches may be connected in parallel
to afford a maximum of convenience in operation.
* * * * *