 ELECTROSURGICAL SYSTEM
专利摘要:
electrosurgical system. a method for controlling electrosurgical energy delivery based on a comparison of felt tissue impedance for various impedance threshold values. energy is delivered to the tissue in a sealing cycle as a series of pulses. energy is delivered to the tissue in a sealing cycle as a series of pulses. a start pulse has a profile with a preset energy start value that increases at a ramp rate to a preset end value. Sensed impedance data is monitored across each pulse and compared for each of an rf setpoint impedance threshold value, a cumulative time impedance threshold value, and a cumulative time impedance threshold value, and a impedance threshold value for power reduction. based on the impedance felt during one pulse, the profile of a subsequent pulse can be modified. in the case of a high impedance event that reflects the presence of low tissue, energy may be reduced. a seal cycle is interrupted when a cumulative amount of time with an impedance value over the impedance cumulative timeout value reaches a seal cycle duration threshold. 公开号:BR112012021212B1 申请号:R112012021212-5 申请日:2011-03-25 公开日:2021-07-13 发明作者:Tim Koss；Miriam H. Taimisto；Roseanne Varner 申请人:Aesculap Ag； IPC主号:
专利说明:
FIELD OF THE INVENTION The present disclosure relates to systems and methods for electrosurgical technology. More particularly, the technology relates to impedance-mediated control of energy delivery for electrosurgical systems and methods for tissue sealing. FUNDAMENTALS Bipolar electrosurgical instruments apply high radio frequency (RF) electrical current to a surgical site to cut, ablate, or coagulate tissue. A particular application of these electrosurgical effects is to seal luminal structures, such as blood vessels or gastrointestinal sites or tissue edges. A typical electrosurgical instrument takes the form of a pair of forceps with electrodes placed in both jaws of the forceps. In an electrosurgical procedure, electrodes are placed in close proximity to each other as the jaws are closed at a target location so that the current path between the two electrodes passes through tissue within the target location. The mechanical force exerted by the jaws and electrical current combine to create the desired surgical effect. By controlling the level of mechanical pressure applied by the jaws, the empty distance between the electrodes, and the intensity, frequency, and duration of electrosurgical energy applied to tissue, a surgeon can coagulate, cauterize, or seal tissue toward a therapeutic purpose. A typical goal of controlling electrosurgical energy delivery, more particularly, is to apply no more and not less than the precise amount of energy required to create the desired effect within the targeted seal site, while minimizing deleterious effects to peripheral tissue to the target location. As tissue absorbs energy, such as radio frequency energy, its impedance relative to radio frequency energy increases. This increase in impedance is generally taken as a measure of the degree to which tissue has been "processed" toward a therapeutic endpoinf state. US2003/158551 A1 discloses a system and method for sealing biological tissue by applying RF voltage during a first stage to electrodes of a tissue sealing instrument; tissue impedance monitoring, and determination of a minimum tissue impedance value during the first stage; determination of relative tissue impedance; detecting when the relative tissue impedance reaches a predetermined relative tissue impedance value and starts a second step; calculating second stage duration as a function of first stage duration; and applying the RF voltage during the second step to the tissue sealing instrument electrodes. US2006/293649 A1 discloses a method and apparatus which includes determining a parameter value associated with the operation of an electrosurgical probe having a particular probe model, and determining whether the parameter value is within a predetermined range of values. . Power is delivered to the probe according to an algorithm based on the determination that the parameter value is out of range. The algorithm delivers force in a pulsed profile including low-strength and high-strength portions. In one embodiment, the method limits force release when the probe is not narrowing tissue. US6398779 B1 discloses a method of electrosurgically sealing a tissue which includes steps of applying an initial pulse of RF energy to the tissue, the pulse having characteristics selected so as not to appreciably heat the tissue; measuring a value of a tissue impedance in response to the applied pulse; determining, in accordance with the measured impedance value, an initial adjustment of pulse parameters for use during a first pulse of RF energy that is applied to tissue; and varying the pulse parameters of individual pulses of subsequent RF energy pulses in accordance with at least one characteristic of an electrical transient that occurs during subsequent energy pulses. The method ends the generation of subsequent RF energy pulses with the determination that the electrical transient is absent or that a minimum output voltage has been reached. Currently disclosed system modalities and methods are directed towards using target tissue impedance as a feedback signal to properly control the energy level applied to a target seal site. DISCLOSURE SUMMARY Modalities of the electrosurgical system and related methods provided include delivering energy from an electrosurgical device to a target tissue in a seal cycle in the form of a series of pulses, each pulse being of a preset duration. The pulse series starts with a start pulse having a profile comprising a preset RF level start value that increases at a preset ramp rate to a preset RF end value. Embodiments may further include sending sensed tissue impedance values to a processor, or more specifically, to an impedance comparator element within a processor, over each pulse. Each pulse is either a pulse before a subsequent pulse or a final pulse in a seal cycle. Modalities may additionally include comparing sensed impedance values to each of the three preset impedance threshold values, including an RF setpoint impedance threshold value, a cumulative time impedance threshold value, and a value of impedance limit for power reduction. Embodiments may further include controlling power delivery during the seal cycle by responsive to comparing sensed impedance values to impedance threshold values. In particular embodiments, controlling energy delivery includes ceasing the seal cycle when the tissue cumulative time showing an impedance value above the impedance cumulative time threshold value reaches a preset seal cycle duration threshold. Electrosurgical system modalities may additionally include recording the cumulative time within an ongoing seal cycle during which the sensed tissue impedance value exceeds the cumulative time impedance threshold value. Based on these comparisons of sensed impedance data to impedance threshold values, various consequences of electrosurgical operation can occur. When the sensed impedance value at the end of a previous pulse is less than the impedance threshold value for the RF setpoint, the modalities may additionally include controlling the energy delivery for the subsequent pulse so that it has substantially the same pulse profile as that of the initial pulse. When the sensed impedance value at the end of a previous pulse exceeds the impedance threshold for the RF setpoint, modalities can further include controlling the energy delivery for the subsequent pulse so that it has a high profile. Such an elevated pulse profile may include ramping up at the start of the pulse directly to the final RF value. A high pulse profile may also include mobilizing from the initial RF value to the final RF value at a rate greater than that of the previous pulse. When the impedance felt at any time during a pulse exceeds the impedance threshold for power reduction, the system can include power reduction down. Such power reduction may occur immediately, or may include waiting for a pre-set elapsed amount of time to accumulate during which the sensed impedance exceeds the power reduction impedance threshold before reducing power delivery (up to about 2 seconds , for example). Power delivery reduction can also include reducing either an RF delivery level or a ramp rate. Reducing the amount of power being delivered can include decreasing power delivery by an amount between about 1 and about 100 volts. Alternatively, reducing the amount of energy being delivered may include decreasing energy delivery by a fractional percentage of what is being delivered. More particularly, reducing the amount of power being delivered may comprise decreasing the power delivery by a fractional percentage of the power amount proportional to the extent to which the sensed impedance exceeds the impedance threshold for the power reduction value. With respect to pulse duration and RF pulse values, in various modalities the RF pulses are typically each of a constant duration which can range from about 0.5 sec to about 10 sec. The number of pulses in the pulse series can range from 1 pulse to about 30 pulses. In various embodiments, the cumulative seal endpoint duration is between about 0.1 sec and about 5 sec. In various embodiments, the starting RF value is in the range of about 25 watts to about 150 watts and the final RF value is in the range of about 50 watts to about 150 watts. With respect to the aforementioned impedance limits, in various method modalities, the impedance limit for RF setpoint is in the range of about 5 ohms to about 250 ohms, the impedance limit for the power reduction value is in the range of about 100 ohms to about 900 ohms, and the impedance limit for cumulative time value is in the range of about 100 ohms to about 750 ohms. Regarding the transition from an initial RF value to the final RF value of a pulse, in various modalities of the electrosurgical system, delivering energy includes increasing the level of energy being delivered from an initial RF value to a final RF value preset during a pulse. In some modalities, raising the energy level during a pulse includes mobilizing at a rate ranging from about 1 watt/sec to about 100 watts/sec. In some modalities, increasing the RF energy level during a pulse includes mobilizing in one or more steps. In some modalities, increasing the energy level during a pulse may include mobilizing at a constant rate or at an alternating rate. Still in additional modalities, increasing the energy level during a pulse comprises immediately raising to a pre-set RF final value after the onset of a pulse. In another aspect, an embodiment of an electrosurgical system includes delivering energy from an electrosurgical device to a target tissue site in a seal cycle that includes a series of pulses, each pulse having a preset pulse duration. Pulse series begins with a start pulse having a start pulse profile comprising a preset RF level start value that increases to a preset RF end value. This modality further includes sending a sensed tissue impedance value to a processor during each pulse, each pulse being either a preceding pulse to a subsequent pulse or being a final pulse. This last modality additionally includes controlling energy delivery during a seal cycle so that: (A) a profile of a successor pulse relative to its previous pulse profile has either an identical profile or a higher energy profile , depending on a comparison of the impedance value shown by the tissue during the initial or previous pulse against a preset impedance threshold value for the RF setpoint, (B) energy is reduced during a pulse when the impedance value sense exceeds a preset threshold value to reduce energy; and (C) power delivery ceases when a cumulative amount of the time that the impedance sensed has exceeded a preset impedance threshold value for cumulative time accumulated a preset seal cycle duration threshold. Additionally, in relation to the latter mode, when the sensed impedance exceeds the preset threshold value for the RF setpoint, the energy profile of the successor pulse exceeds the energy profile of the previous pulse, and when the sensed impedance is less than the preset threshold value for the RF setpoint, the energy profile of the successor pulse is identical to the energy profile of the previous pulse. With respect to modalities, the energy profile of a pulse includes an initial RF value, an final RF value, and a transition phase between the initial RF value and the final RF value. In these modalities, a reduced pulse energy profile of a successor pulse, relative to the previous pulse, can include any of a reduced RF start value, a reduced RF end value, and/or a lower transition rate from the value. from RF to the final RF value. A boosted energy pulse profile of a successor pulse, relative to the previous pulse, can include any of a higher RF start value, a higher RF end value, and/or a higher rate of transition from an initial RF value to the final RF value. And finally, the transition from the initial RF value to the final RF value comprises either a steep transition and/or a stepped transition. BRIEF DESCRIPTION OF THE FIGURES Fig. 1 is a schematic block diagram of an impedance-mediated RF energy delivery system for electrosurgery according to one embodiment of the disclosed technology. Fig. 2 is a schematic representation of impedance thresholds against which sensed impedance values can be compared and consequent responses with respect to RF energy delivery during an electrosurgical sealing cycle. Fig. 3 is a flow diagram showing aspects of the disclosed method for using sensed impedance as feedback to control RF energy delivery during an electrosurgical sealing procedure. Fig. 4 is a flow diagram showing aspects of a system and method for using sensed impedance as feedback data to control RF energy delivery during an electrosurgical sealing procedure. Fig. 5 is a timing diagram showing an example of impedance-mediated control of a power delivery ramp for electrosurgery according to an embodiment of the method. Fig. 6 is a timing diagram showing an alternative example of impedance-mediated control of the energy delivery interval for electrosurgery according to an embodiment of the method. Fig. 7 is a timing diagram showing an RF energy delivery profile as controlled by tissue impedance feedback according to an embodiment of the method. Fig. 7B is a timing diagram showing a tissue impedance profile during energy delivery according to an embodiment of the method. Fig. 8 is a timing diagram showing a tissue impedance profile during energy delivery as modified by the occurrence of a rapid increase in impedance which is indicative of low tissue presence in the RF circuit path. DETAILED DESCRIPTION The electrosurgical tissue sealing technology provided here refers to the application of tissue response dynamics to RF energy as feedback information to control energy delivery during an electrosurgical procedure. Tissue sealing that is surgically optimal occurs when an adequate level of energy is delivered to a target site at an optimal rate; too much energy or energy delivered too fast can damage the target site and surround tissue, and too little energy does not create a seal of high integrity. Another consideration is that the effects of absorption of a given amount of energy by a tissue sealing site is a function of tissue type specifics and total tissue volume reception energy, both of which are variable at play in each procedure. of sealing. As tissue is being impacted or "processed" by RF energy, such as by coagulation, dissection or fulguration, or any combination thereof, the tissue's impedance for electrical current increases. The change in impedance is generally attributed to a change in the "phase" or "state" of the tissue. The relationship between energy input and the rate of change in tissue state is affected by factors such as tissue composition, tissue density, water content and electrolyte content. In these terms, an optimal rate of RF energy delivery is one that triggers the tissue phase change, as reflected in the rate of impedance increase, at an optimal rate. The optimal rate of change in impedance can be learned empirically from experimental and clinical experience. Consequently, and as provided by the method modalities, the felt change in tissue impedance during an electrosurgical procedure is an advantageous parameter to use as feedback in guiding the rate of RF energy delivery to a given seal site. A theoretical rationale for the method is offered to support an understanding of its operation, but without any characterization that would limit claims to the method. It is considered beneficial to recognize when tissue is processing slowly and, in response, deliver energy to tissue slowly. And, when tissue is processing quickly in response, it is advantageous to deliver energy to tissue quickly. The system is therefore balanced so that it directs energy to a target site no faster than it can absorb energy through tissue processing. Thus tissue is efficiently processed to a proper endpoint and excess energy spillage beyond the targeted tissue seal site is minimized. As further described below, impedance threshold values can be used to control the delivery of RF energy in a seal cycle comprising a series of energy pulses delivered to a targeted tissue location. Sensed impedance can be used to control power delivery in a variety of ways in real time, such as during a pulse or in a prospective manner, controlling power delivery in a successor pulse, as well as ending a power delivery cycle at any point during a pulse. Fig. 1 is a schematic block diagram of a system for impedance-mediated energy delivery for electrosurgery in accordance with the disclosed technology. Although the description, examples, and figures of the present disclosure primarily refer to aspects of a method for sealing electrosurgical tissue, modalities of the technology also include a system and any sub-adjustments of its components that are adapted or configured to function by modalities of the method. In fig. 1, a procedure in which electrosurgery is being performed on target tissue 10 of a patient by an electrosurgical device 12. A power source such as radio frequency (RF) generator 18 is coupled to the electrosurgical apparatus by a control circuit 16. In some embodiments the control circuit is operable to adjust any of the current and voltage outputs and therefore adjust the power output of the RF generator. The control circuit can also adjust the RF generator output up and down in scales or can move up or down on a selected slope during a pulse. Method modalities and systems for operating method modalities provided herein are suitable for both single-channel and multi-channel electrosurgical system operation. Multi-channel systems typically include an RF generator with multiple outputs coupled to multiple electrodes or electrode pairs. In multi-channel systems that make use of the method modalities described here, a generator may be able to address electrodes individually and independently so that electrode burnout can occur without constraint with respect to repeating the individual electrode burn or with respect to sequential order of adjacent electrode burning. In other words, the burn parameters for each electrode can be based on settings and/or feedback associated with that electrode alone. The effect of the electrosurgical device on tissue is monitored at the tissue treatment site by one or more sensors associated with the electrosurgical device. A signal produced by one or more sensors is coupled to a sensor circuit 14. The sensors can monitor environmental factors and operating parameters such as temperature, impedance, RF voltage, RF current, elapsed time and others. In particular embodiments, at least some of the sensors monitor tissue impedance and RF energy parameters. A sensor circuit 14 generates an output signal which is transmitted to a processor 15. The processor, operating under program control by aspects of the currently described method, is configured to adjust the output of the RF generator by assigning control signals to the circuit. of control. By doing this, the processor can adjust the RF energy delivered to tissue in real time, in response to signal generation by the sensors. The program can be held in memory 17 and includes both instructions for operating the processor and parameters that determine how to respond to signals from the sensor, timing and other information as it can be used to control power delivery by aspects of the method. . As tissue is processed by the application of energy, a phase or state change occurs in the tissue which, in turn, causes a change in tissue impedance. A particular feature of the technology provided is the manner in which the processor operates the control circuit and thus the manner in which energy is supplied to the tissue in response to signals provided to the processor from one or more types of sensors. , such as impedance sensors, through sensor circuitry. More particularly, method modalities apply sensed impedance to alter aspects of the profile of an electrosurgical pulse, components of a profile include an initial RF initial value, an RF final value, and either a stepped or ramped increase in RF delivery over stroke pulse from the initial RF value. As used herein, an energy output "ramp" refers to the difference between the output level at the beginning of an energy delivery pulse and the output level reached at the end of the pulse, while "slope" refers to more specifically the rate at which energy output changes over time during the pulse. Energy is normally delivered in a series of pulses that can be of a pre-selected duration or a pre-set constant, although in some of the modalities, the pulses can vary in length. Electrosurgical system modalities and method monitor the sensed impedance that the target tissue manifests when being exposed to a pulse of RF energy and compares impedance data to various preset impedance threshold values during a seal cycle that includes a series of wrists. System and method modalities respond to these comparisons by varying the ongoing pulse profile adjustment, by adjusting the immediately successor or subsequent pulse profile, and by tracking time toward an endpoint duration of the cumulative seal cycle, in at which point the sealing cycle is completed. These various system responses collectively represent a method for controlling aspects of an electrosurgical system's performance during a seal cycle, including the amount of energy delivered during individual RF pulses and during the seal cycle as a whole. These impedance threshold values include an impedance threshold value for an RF setpoint, an impedance threshold value for timing the cumulative seal cycle duration, and an impedance threshold value for power reduction. Although the impedance values for each of these three threshold values include regions of overlap, the thresholds within typical method modalities are ordered so that the impedance threshold value for an RF setpoint is the smallest threshold value. , the impedance threshold for cumulative seal cycle duration is the middle threshold value, and the impedance threshold value for power reduction is the highest threshold value. These impedance threshold values and their roles in power delivery control are detailed and further described below. Tables 1 and 2, as well as figs. 2, 3, and 4 provide overviews of aspects of the method, with particular attention to the ways in which impedance data is returned to the processor and used to control the delivery of power to a targeted seal location. In one aspect, modalities of the impedance-based energy control method refer to controlling the profile of individual pulses within a pulse series. Radio frequency pulses, as delivered by the method modalities, have a profile that includes an initial preset RF value and a final preset RF value, usually higher than the initial preset value of RF. During the course of a pulse, RF energy typically rises from a start value to an end value at a preset rate. On some pulses, in response to threshold impedance values as further described below, a pulse can go directly from the initial value to the final value. Each of these parameters of a pulse profile is normally preset for a particular tissue sealing cycle, but each parameter can be adjustable within a range of values. The initial RF value can range from about 25 to about 150 watts; a typical value, by way of example, is about 50 watts. The final RF value can range from about 50 to about 150 watts; a typical value, by way of example, is about 150 watts. The rate of ramp or slope at which energy can increase from the initial RF value to the final RF value can change between about 1 watt/sec and about 100 watts/sec; a typical value, by way of example, is about 50 watts/sec. The impedance threshold value for RF setpoint is typically the smallest of the three impedance thresholds. This threshold mediating performance control has a preset value ranging from about 5 to about 250 ohms; a typical value, by way of example, is about 50 ohms. Some system modalities are configured to compare tissue impedance at the completion of a pulse (or at its maximum) to this threshold value and to drive the profile of the next pulse in one or two paths depending on whether the final pulse impedance drops below or exceeds the RF setpoint threshold value. In case the final pulse impedance (from a previous pulse) is less than this threshold, the successor pulse is operated with the same profile as the previous pulse. In case the final pulse impedance (from a previous pulse) exceeds the impedance threshold value for the RF setpoint, the successor pulse can be operated with a higher energy level profile. A high energy profile can occur by any approach that raises the integrated force-multiplied pulse duration value; for example, in one modality, the pulse may start with the initial RF value and then pass directly (without an attenuated ramp) to the final RF value. In other modalities, the slope of energy delivery during the pulse may be elevated. In still other modalities, the initial RF value or the final RF value can be high. The impedance threshold value for cumulative seal time duration is typically higher than the RF setpoint threshold value. In some embodiments, this performance control mediation threshold has a preset value ranging from about 100 ohms to about 750 ohms; a typical value, by way of example, is about 250 ohms. During the course of an electrosurgical procedure, as delivered by a series of pulses by aspects of the method, the impedance of the target tissue increases. This elevation is understood to be generally reflective of a tissue "processing" by RF energy at a level adequate to serve a particular therapeutic purpose. Thus, the impedance displayed by the tissue can be considered a marker of tissue processing and an optimal level of processing can be considered to be yielded by absorbing an optimal level of RF energy for an optimal duration of time. Thus, the system and method can be directed to record accumulated time into an impedance threshold value for cumulative time duration, which, after being reached, ceases to deliver RF energy. Termination of energy delivery can occur immediately during an RF pulse after a preset seal time duration has accumulated. The cumulative sealing endpoint duration, by method modalities, can vary between about 0.1 sec. and about 5 sec. The power reduction impedance threshold value is typically the highest of the three impedance thresholds. This performance control mediation threshold has a preset value ranging between about 100 ohms and 900 ohms in some modalities; a typical value, by way of example, is about 700 ohms. A high impedance level (see fig. 8) reading during an RF pulse can be considered to be a consequence of the low presence of tissue in the electrosurgical space between the forceps of a device. It is, after all, tissue that is enabling the conduction of RF energy between the forceps. In the complete absence of tissue, the impedance within the circuit is either absolute or infinite in practical terms. In the presence of an inferior tissue, impedance is not infinite, but it can quickly become very high. The presence of inferior tissue can occur if, for example, tissue or a portion of it is particularly thin compared to a normal amount of target tissue between the forceps. Or, there may be spaces between the forceps tips where tissue is simply missing. The electrosurgical system can respond to the high impedance event by reducing the energy delivery level. System modalities thus include a timer that is configured to record the amount of time the tissue is manifesting its high level of impedance and after accumulating a pre-set amount of accumulated time, the system responds by reducing the amount of energy being delivered. The energy reduction, by the method modalities, occurs by decreasing the energy pulse profile being delivered. Such energy reduction can occur immediately, at any point during a pulse, when the impedance threshold for energy reduction is exceeded. In alternative embodiments of the method, energy reduction may occur after a preset delay has elapsed. In still other modalities, energy reduction can be initiated on a successor pulse. The amount of energy reduction can occur through reducing the energy delivery level, or through decreasing the rate of energy increase during a pulse. Any one or more of a number of approaches can adjust the energy delivery level downward. For example, power delivery can be decayed by an absolute amount of power or voltage. Alternatively, the energy delivery level can be decayed by a fractional percentage of the energy level being delivered at the time when the impedance threshold for energy reduction is exceeded. In another variation, the energy delivery level can be decayed by the fractional portion that corresponds to the difference between the sensed impedance and the impedance threshold for RF energy reduction. It may be noted, just for the purpose of understanding the reason for the method aspects, that an exceptionally rapid increase in impedance that includes exceeding the impedance limit for energy reduction is indicative of a small amount of tissue, rather than a normal amount. of tissue, absorbing all of the delivered energy and thus being processed more quickly than is desired. Fig. 2 provides a schematic sketch of the three impedance thresholds used in aspects of the method to control energy delivery during an electrosurgical procedure, and consequences that follow from sensed impedance data being delivered back to the system components that control the power delivery. Impedance thresholds can be arranged on the left side of the figure, aligned against an axis of rising ohm values. Impedance limit 1 belongs to RF setpoint, impedance limit 2 refers to cumulative time, and impedance limit 3 refers to power reduction. The right side of the figure shows the consequences of delivering energy to the impedance values felt during a pulse, as they fall into ranges limited by these limits. These energy delivery consequences pertain either to a pulse following the previous pulse (during which sensed impedance time occurred) or to immediate real-time consequences for energy delivery during the pulse. Continuing with fig. 2, starting with the lowest limit, the impedance limit for the RF setpoint, the limited segment 201 on the right side of the figure shows that a sensed impedance value (usually the impedance at the completion of a time pulse) that falls at or below this level causes the energy delivery profile on the subsequent pulse to remain the same or be decreased. Such a decrease may be a one-time event, after which the profile remains constant, or such a decrease may continue with each successive pulse. As noted above, a profile can decrease either through downward adjustment of RF setpoints or by decreasing the rate at which RF energy increases during the pulse. Continuing with fig. 2, ascending from the lowest limited segment 201, the next limited segment 202 extends upward from the impedance for RF setpoint to the impedance limit for power reduction. The right side of the figure notices that the energy pulse profile that follows a previous pulse where the sensed impedance (usually the impedance at the completion of a time pulse) has dropped in this segment is delivered with a high profile. Such an increase may be in one event at a time, after which the profile remains constant, or such an increase may continue with each successive pulse. As noted above, a profile can increase either through upward adjustment of RF setpoints or by increasing the rate at which RF energy increases during the pulse. Continuing further with fig. 2, a limited segment 203 extends above the threshold for power reduction towards a maximum impedance. The consequence of a sensed impedance value occurring at any point during a pulse falling within this limited range is that delivered power is reduced even though the pulse is in progress. In some modalities, energy is immediately reduced; in other modalities, energy is reduced after a delay of up to seconds. This delay, if implemented, is for the purpose of validating that high impedance event is real and sustaining, not due to a transient or erroneous signal from an impedance sensor. Finally, with reference to fig. 2, a large limited segment 204 encompasses sensed impedance values that vary upward from the cumulative time impedance threshold. As sensed impedance values grow above their threshold, a timer is started that runs as long as the impedance is above this threshold value. If impedance drops below this threshold value, as it would when power is reduced, the timer stops accumulating time. As the impedance can then grow again to exceed the threshold, the timer again accumulates time. After the accumulation of a preset cumulative time duration for the seal cycle, energy delivery during the cycle ceases. Fig. 3 is a flow diagram showing elements of a method for using sensed impedance as feedback data to control RF energy delivery during an electrosurgical sealing procedure. In an initial step 198, energy is delivered to a target tissue site in a series of pulses, each pulse having a profile that may or may not be adjusted in response to impedance data sensed in the subsequent pulse. In a second step 199, sensed impedance data is sent to an impedance threshold comparator within the system. In a third step 200, sensed impedance data is compared to an impedance threshold (1) for the RF setpoint, an impedance threshold (2) for cumulative timing of the preset seal cycle duration, and (3 ) an impedance threshold (3) for power reduction at any time during a pulse. As a result of these ongoing comparisons within the comparator (Fig. 3), any one of several consequences can occur. In the case 201 that sensed impedance is less than impedance threshold 1, the profile of the subsequent pulse is either maintained or decreased. In the case 202 that sensed impedance is greater than impedance threshold 1, the profile of the subsequent pulse is either maintained or raised. In the case 203 that sensed impedance is greater than impedance threshold 2, a cumulative timing function is initiated, which accumulates time towards a preset seal cycle duration. When such time reaches a preset seal cycle duration, energy delivery ceases immediately. In the case 204 that sensed impedance is greater than impedance threshold 3, power delivery is either decreased immediately during the present pulse, or decreased after a short delay to serve the purpose of validating the high incident impedance. Fig. 4 is a flow diagram showing aspects of a method and system for using sensed impedance as feedback to control RF energy delivery during an electrosurgical sealing procedure. Aspects of the method based on a library and trimmer 100 of RF pulse profiles that include an initial profile 101, a high profile 102 and a low profile 103. The initial profile is preset; RF Initial Value, RF Final Value, and the transition between them (slope or scaling) parameter values can all vary within their respective ranges, as shown in Table 1. Low and high profile parameters also vary across ranges of Table 1, with the qualification that the profiles as a whole are either lower or higher, respectively, than the initial pulse profile parameters 101. Prior to delivering an RF pulse, an RF pulse selector 110 selects which pulse profile in the profile library (101, 102 or 103) to deliver to tissue 150. Pulse selector 110 makes the selection based on input of a limit comparator 170 (see additionally below). The RF pulse selector 110 has an output that triggers the setpoint for the RF energy generator 120, which delivers a pulse of RF energy 140 that is ultimately directed to a target tissue location 150. is being delivered this passes through an intervention mechanism in the form of an RF energy attenuator or reduction block 130 that can attenuate the energy delivery, in real time, based on data from threshold comparator 170. The target tissue location 150 is both the RF energy container 140 being delivered by the system via electrosurgical forceps 145, as well as the source for impedance data 160 that is transmitted back to the system, stored in a memory and processed by a processor, as represented by a threshold comparator 170. The threshold comparator performs constant surveillance of sensed impedance data from the target tissue and compares that data against three particular impedance thresholds as outlined in FIG. 2, and as further described below in an highlighted summary of an embodiment of the method. Briefly, these impedance limits include an impedance limit for RF setpoint 171, an impedance limit for pulse duration cumulative timing 172, and an impedance limit for power reduction 173. It can be seen that the result of a comparison 171 of impedance data with respect to an RF setpoint threshold value is routed to the profile selector and adjuster 110, which then normally assigns either a high profile 102 or a low profile 103 to the subsequent pulse in response to arrival data. The result of comparing impedance data 172 against an impedance threshold for cumulative time is directed to the RF power generator/delivery block 120; if the cumulative time is less than the preset duration, block 120 is allowed to generate RF energy. When the cumulative time reaches the preset seal cycle duration, further power delivery from block 120 is stopped. The result of comparing impedance data against a power reduction impedance threshold 173 is directed to the RF energy attenuator reduction block 130. If impedance comparison data 173 indicates that the impedance is less than the impedance threshold for energy reduction, power delivery proceeds without attenuation. If data from impedance comparison 173 indicates that the impedance exceeds the impedance threshold for power reduction, power delivery proceeds with real-time attenuation. In some embodiments, in response to tissue impedance exceeding the energy reduction impedance threshold, energy is reduced by an amount proportional to the total amount of energy being delivered during the high impedance case. The fractional amount by which energy is reduced, in some modalities, can be related to the proportional amount by which the sensed impedance is in excess of the impedance limit for energy reduction. For example, if the impedance limit for power reduction is 300 ohms and sensed impedance is 450 ohms (50% greater than the 300 ohm impedance limit), power delivery can be reduced by 50%. In some embodiments of this proportional energy reduction procedure, the reduction is performed in a continuous real-time manner, with the response to the energy reduction immediately tracking the extent to which sensed impedance exceeds the threshold for energy reduction. Table 1 summarizes the values of various parameters associated with radiofrequency energy delivery and the sensed target tissue impedance during an electrosurgical tissue sealing procedure, according to aspects of the disclosed methods. The specific value plotted from within a range (for RF values and impedance limits) is normally preset and fixed by any given electrosurgical procedure, however these preset values are adjustable within the range. Table 2 summarizes the profile of the RF pulse that follows a previous pulse, as controlled by the tissue impedance felt during the previous pulse, as well as how another system responds to the impedance values felt during an exemplary seal cycle. Table 2. Subsequent Power Delivery and Seal Cycle Endpoint Consequences for Felt Tissue Impedance Response During Power Delivery One embodiment of the method by which sensed impedance controls the delivery of RF energy during an electrosurgical tissue sealing cycle is summarized below. 1. Initiates a seal cycle with a pulse at a preset initial RF start value; mobilizes energy at a preset initial RF ramp rate during the pulse until the energy reaches a final RF value; continues at that energy level for the duration of a preset pulse duration, and then stops delivering energy to complete the pulse. 2. Obtain sensed tissue impedance data continuously through the initial RF pulse and each subsequent pulse. All sensed impedance data is stored in a memory to which a processor has access. In various aspects of the method, impedance data sensed from any point during the pulse can be used as a value to compare to any one or more of three impedance threshold values. In some aspects of the method, the impedance felt at the end of a pulse is a particular value used in comparison to impedance threshold values. 3. Continuously compare the impedance values felt from all points during a pulse against (a) an impedance RF setpoint threshold value, (b) an impedance threshold for cumulative timing threshold, and (c) an impedance power reduction threshold value. Continue the sealing cycle according to the following options (4A, 4B, 4C or 4D), depending on the result of these comparisons. 4A. If, at the end of a previous pulse, the sensed pulse end impedance value is less than the impedance threshold for RF setpoint value, deliver power during the subsequent pulse with a pulse profile substantially identical to that of the pulse previous. The sealing cycle proceeds in this way until a preset sealing time duration is reached, as in 4C. 48. If, at the end of a pulse, the sensed pulse end impedance value is greater than the impedance threshold for the RF setpoint value, deliver energy during the subsequent pulse with a pulse profile greater than that of the previous pulse. In some modalities of the method, this increase in pulse profile occurs only once, during the pulse that follows the initial pulse. In some embodiments of the method, the pulse profile is elevated by supporting an immediate increase from the initial RF value to the final RF value (instead of through a ramped increase, as typical of the initial pulse). The sealing cycle proceeds in this way until a preset sealing time duration is reached, as in 4C. 4C. If, at any time during any pulse, the sensed impedance exceeds an impedance threshold for cumulative seal time, a timer is started that runs for a pre-set seal time duration. If the sensed impedance falls below this threshold, the cumulative timer stops recording time. Upon completion of the preset sealing time duration, energy delivery ceases, thus completing the sealing cycle. 4D. If, at any time during any pulse, the tissue impedance value exceeds the impedance threshold for the energy reduction threshold value, the energy level being delivered is reduced. In some modalities, energy is immediately reduced; in other modes the energy is reduced following the passage of a pre-set energy reduction time. After energy reduction, the seal cycle continues until either the impedance limit for energy reduction is exceeded again (in which case, energy is reduced again), or until the preset seal duration time is reached, such as in 4C, about what stops the delivery of energy. Figs. 5-8 provides examples and demonstrations of aspects of the electrosurgical tissue sealing method provided here. Fig. 5 is a timing diagram showing an example of an impedance-mediated power delivery ramp as it occurs in a series of four pulses (40, 42, 44 and 46), each of which is preset. to be 3 seconds in duration. As seen in Table 1, the length of the pulse intervals can be preset to range from this 3 second duration within a range of about 0.5 sec to about 10 sec. In this current example of the method, the pulses (or pulse intervals) are all equivalent in duration. In alternative embodiments of the method, the pulse duration or intervals may also vary in length from one to another, either by the present schedule or in response to a comparison of sensed impedance values against impedance threshold values during a seal cycle. When the pulses are of variable duration during a seal cycle, they can be preset to either increase or decrease in length through the cycle, or they can increase or decrease in any pre-set pattern. When pulse length varies in response to sensed impedance values, the length can rise or fall in any pattern. In the example provided by fig. 5, the total amount of energy being delivered is decreasing with each successive pulse. The slope of the first ramp range 40 includes a steep first portion, a shallow middle portion and a substantially flat third portion. Upon completion of the pulse, power is reduced and the next ramp begins. In this modality of the method, the slope of each ramp is adjusted in real time, in response to the rate of change in tissue impedance during the previous pulse. The slope of the second ramp 42 includes an initial portion that is shallower than that of the first ramp 40; and the slope of the third ramp 44 is more shallow than the initial portion of the ramp 42 before that; and the initial slope of the fourth ramp 46 is even more shallow. The area under each ramp indicates the total energy supplied to the tissue during the ramp. So, in this example, a decreasing amount of energy is applied during each successive pulse. In other embodiments of the system and method, the ramped RF values and the slope between them can be independently varied in response to sensed impedance values. This pattern of a gradual decrease in energy being delivered in each pulse, followed by a stabilization of energy delivery is typical of an electrosurgical seal cycle in which the sensed impedance is falling below the impedance threshold for the RF setpoint. Fig. 6 is another timing diagram showing an example of an impedance-mediated power delivery ramp as it occurs in a series of three pulses (50, 52 and 54) being operated in accordance with an aspect of the method. In fig. 5, an initial energy ramp 50 is supplied to the tissue. In this case, in response to tissue impedance readings and comparison to impedance threshold values, an increase in the pulse profile subsequent to the initial pulse is provided. Once the desired impedance is reached, the energy supplied to the tissue at pulses 52 and 54 is maintained at a desired level for a predetermined amount of time. This pattern of a gradual rise in energy being delivered in each pulse, followed by a stabilization of energy delivery is typical of an electrosurgical seal cycle in which the sensed impedance is in excess of the impedance threshold for the RF setpoint. Figs. 7A and 7B are accompanying figures showing aspects of the events underlining an electrosurgical sealing procedure that occurs in a series of four 3-second pulses, as provided by an aspect of the method. Fig. 7A shows the profile of the RF energy pulses delivered during the procedure, while fig. 7B focuses on the tissue matching impedance profile. The length of each pulse is labeled as the RF pulse duration and the maximum number of pulses allowed for each stamp is labeled as the maximum RF pulse count. The following cases occur during this example fabric sealing procedure: 1. The first RF pulse for a tissue sealing procedure starts at an energy level labeled the RF Setpoint Start Value (Fig. 7A). 2. The RF energy level is increased from the Initial RF Setpoint Value at a preset RF Ramping Rate until the energy level reaches the upper level labeled as the Final RF Setpoint Value . The RF energy level remains at this value until the end of the 3-second pulse time is reached (Fig. 7A). 3. At the end of each pulse, the sensed tissue impedance value is determined and recorded as the RF Pulse End Impedance (Fig. 7B) and the energy level is then set to zero (Fig. 7A). 4. For all pulses subsequent to the first, the following evaluations were made (Figs. 7A and 7B): a. If the RF Pulse End Impedance is less than the RF Setpoint Threshold, the RF energy delivered is ramped at a rate identical to that of the first pulse.b. If the RF Pulse End Impedance is greater than the threshold for the RF Setpoint, the delivered RF energy is passed directly to the RF Setpoint End Value. Fig. 7B shows the course of tissue impedance events that relate to control energy delivery and termination of the electrosurgical procedure. The seal cycle is terminated when the tissue impedance reaches a predetermined Impedance Threshold for Cumulative Time. (A detected fault or error condition may also terminate a seal cycle). Interrupting the sealing procedure according to the cumulative sealing endpoint duration value occurs as follows: 1. Tissue impedance is determined using signals from RF monitoring hardware circuitry. 2. When the calculated tissue impedance exceeds the Cumulative Time Impedance Threshold (in this example 250 ohms), an accumulation endpoint timer is started. When the calculated tissue impedance falls below the Cumulative Time Impedance Threshold (for example, when a pulse completes), the endpoint timer is stopped. Thus, the timer records only the total time that the tissue impedance is greater than the Cumulative Time Impedance Threshold. 3. When the timer accumulates a preset amount of time, labeled as the Seal endpoint, the RF delivery is stopped, the system user is notified of the seal completed, and the system is placed in a ready state . Fig. 8 provides an example of an electrosurgical tissue sealing procedure that is modified to accommodate a low amount of tissue within the target site, between the jaws of the electrosurgical forceps. A relatively low amount of tissue can occur when the tissue is particularly thin (eg 0.5 mm thick or less) or when portions of the electrode are not in contact with any tissue. As described below, a low tissue circumstance typically creates a high level of impedance. The events shown in fig. 8 occur during a single 3-second pulse. The following steps illustrate how aspects of the method intervene to correct for low tissue presence. 1. Tissue impedance is calculated using signals from RF monitoring hardware circuitry. 2. When the sensed tissue impedance exceeds the Power Reduction Impedance Threshold, for a duration time labeled as the Impedance Reduction Time (in this example, 0.1 sec), the RF delivery is reduced by decreasing the RF voltage being delivered (see Table 1). The reduction in energy delivery is reflected in the immediate drop in felt tissue impedance. If the tissue impedances were to exceed the Power Reduction Impedance Threshold a second time, the RF voltage would be reduced again. 3. When sensed tissue impedance exceeds a Cumulative Time Impedance Threshold (in this example 250 ohms), an Endpoint timer is activated. Upon completion of a predetermined amount of time, the Seal Endpoint Time (in this example 1.5 seconds), as recorded by the Endpoint Timer, the electrosurgical procedure or seal cycle is terminated. Unless defined otherwise, all technical terms used herein have the same meanings as commonly understood by one of ordinary skill in the technique of electrosurgery. Specific methods, devices and materials are described in this application, but any methods and materials similar or equivalent to those described herein may be used in the practice of the present invention. Although embodiments of the invention have been described in some detail and by way of illustrations, such illustration is for clarity of understanding purposes only, and is not intended to be limiting. Various terms were used in the description to convey an understanding of the invention; it will be understood that the meaning of these various terms extends to common grammatical or linguistic variations or forms thereof. It will also be understood that when terminology refers to devices or equipment, that these terms or names are provided as contemporary examples, and the invention is not limited by such literal scope. Terminology that is introduced at a later date can reasonably be understood as a derivative of a contemporary term or designator of a hierarchical subset addressed by a contemporary time will be understood to have been described by current contemporary terminology. Additionally, although some theoretical considerations have been put forward in support of the understanding of the dynamics of tissue response to absorb radiofrequency energy, consequences regarding tissue impedance, and exploration of these dynamics towards the optimization control of an electrosurgical system and method , claims for the invention are not bound by such theory. Furthermore, any one or more features of any embodiment of the invention may be combined with any one of the claims or more other features of any other embodiment of the invention, without departing from the scope of the invention. Furthermore, it should be understood that the invention is not limited to the modality that has been established for the purposes of illustration, but to be defined only by a fair reading of the claims attached to the patent application, including the full range of equivalence to which each element of the it is titled.
权利要求:
Claims (8) [0001] 1. Electrosurgical system characterized in that it comprises: an RF generator (18) configured to deliver energy through an electrosurgical device (12) to a target tissue in a sealing cycle comprising a series of pulses, the series starting with a start pulse having a profile comprising a preset RF level start value which rises at a preset ramp rate to a preset RF level end value; and a comparator (170) configured to compare sensed target tissue impedance values for each of the three preset impedance threshold values, which threshold values comprising a first impedance threshold value (171) for RF setpoint , a second impedance threshold value (172) for cumulative time that is greater than the first impedance threshold level, and a third impedance threshold value (173) for power reduction, which is greater than the second impedance threshold level. impedance threshold; wherein the RF generator (18) is additionally configured to control power delivery during the seal cycle by responding to the comparison of sensed impedance values to impedance threshold values, wherein the system is configured to record time accumulated in an impedance threshold value per cumulative time duration, and to cease the seal cycle when a cumulative tissue time showing an impedance value over the second value impedance limit r (172) reaches a preset seal cycle duration limit. [0002] 2. Electrosurgical system according to claim 1, characterized in that when the impedance value felt at the end of a previous pulse is less than the first impedance threshold value (171) for the RF setpoint , the system is configured to control the energy delivery for the subsequent pulse so that it has the same pulse profile as that of the initial pulse. [0003] 3. Electrosurgical system according to claim 1, characterized in that when the impedance value felt at the end of a previous pulse exceeds the first impedance threshold (171) for the RF setpoint, the system is additionally configured to control the energy delivery for the subsequent pulse so that it has a high energy profile where the integrated force multiplied pulse duration value is increased. [0004] 4. Electrosurgical system according to claim 3, characterized by the fact that the high profile of the subsequent pulse comprises an increase in a pulse start from the initial RF value directly to the final RF value. [0005] 5. Electrosurgical system according to claim 3, characterized by the fact that the elevated profile of the subsequent pulse comprises any one or more of an initial increased RF value, an increased RF final value and an increased ramp rate from from the RF start value to the RF end value when compared to the RF start value, RF end value and ramp rate, respectively, of the previous pulse. [0006] 6. Electrosurgical system according to claim 1, characterized in that when the impedance felt at any time during a pulse exceeds the third impedance threshold value (173) for energy reduction, the system is configured to reduce delivery power. [0007] 7. Electrosurgical system according to claim 6, characterized in that the energy reduction comprises any one of a reduction in the initial RF value, a reduction in the final RF value or a reduction in the ramp rate from the starting value to RF end value when compared to RF start value, RF end value or the ramp rate of the previous pulse, respectively. [0008] 8. Electrosurgical system according to claim 6, characterized in that the energy reduction comprises a reduction in the amount of energy being delivered by a fractional amount of that being delivered in time when the sensed impedance exceeds the impedance threshold (173) for energy reduction.
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同族专利:
公开号 | 公开日 CA2793961A1|2011-09-29| RU2012145668A|2014-05-10| AU2011230632A1|2012-08-16| CN102834069A|2012-12-19| US20150025529A1|2015-01-22| WO2011119933A2|2011-09-29| CN102834069B|2015-11-25| ES2562269T3|2016-03-03| MX2012008814A|2012-09-28| KR101818784B1|2018-01-16| BR112012021212A2|2016-05-17| US8827992B2|2014-09-09| WO2011119933A3|2012-03-01| JP5883844B2|2016-03-15| EP2552335B1|2016-01-13| EP2552335A2|2013-02-06| KR20130052534A|2013-05-22| JP2013523219A|2013-06-17| US20110238056A1|2011-09-29| US10130411B2|2018-11-20| EP2552335A4|2013-11-27|
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法律状态:
2018-03-27| B15K| Others concerning applications: alteration of classification|Ipc: A61B 18/12 (2006.01), A61B 18/14 (2006.01), A61B 1 | 2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]| 2020-07-07| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]| 2021-05-25| B09A| Decision: intention to grant [chapter 9.1 patent gazette]| 2021-07-13| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 25/03/2011, OBSERVADAS AS CONDICOES LEGAIS. PATENTE CONCEDIDA CONFORME ADI 5.529/DF, QUE DETERMINA A ALTERACAO DO PRAZO DE CONCESSAO. |
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申请号 | 申请日 | 专利标题 US12/748,229|US8419727B2|2010-03-26|2010-03-26|Impedance mediated power delivery for electrosurgery| US12/748,229|2010-03-26| US12/907,646|US8827992B2|2010-03-26|2010-10-19|Impedance mediated control of power delivery for electrosurgery| US12/907,646|2010-10-19| PCT/US2011/029958|WO2011119933A2|2010-03-26|2011-03-25|Impedance mediated control of power delivery for electrosurgery| 相关专利
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