ES2300746T3 - Detector del movimiento para controlar la salida electroquirurgica. - Google Patents
Detector del movimiento para controlar la salida electroquirurgica. Download PDFInfo
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- A61B2018/00875—Resistance or impedance
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Abstract
Un lápiz electroquirúrgico (100), que comprende: un alojamiento alargado (102); y un elemento eléctricamente conductor (106) soportado dentro del alojamiento (102) y que se extiende distalmente desde el alojamiento (102), pudiendo ser conectado el elemento eléctricamente conductor (106) a una fuente de energía electroquirúrgica (G); y caracterizado por un sensor de movimiento (224) dispuesto dentro del alojamiento (102) y en conexión eléctrica con la fuente de energía electroquirúrgica (G), siendo el sensor (224) capaz de detectar movimiento del lápiz electroquirúrgico (100) y comunicar una señal a la fuente de energía electroquirúrgica (G) relativa al movimiento del lápiz electroquirúrgico (100), suministrando la fuente de energía electroquirúrgica (G) energía electroquirúrgica en respuesta a la señal comunicada desde el sensor (224).
Description
Detector del movimiento para controlar la salida
electroquirúrgica.
La presente invención se refiere en general a un
instrumento electroquirúrgico y, más particularmente, a un lápiz
electroquirúrgico que tiene un detector de movimiento para controlar
la salida electroquirúrgica del mismo.
Los cirujanos han utilizado ampliamente
instrumentos quirúrgicos en los últimos años. Por consiguiente, se
ha desarrollado la necesidad de equipo que sea fácil de manejar,
fácil de hacer funcionar, y fiable y seguro. En general, la mayoría
de los instrumentos quirúrgicos incluye típicamente una diversidad
de lápices de sujeción con la mano, por ejemplo, lápices
electroquirúrgicos, fórceps, tijeras y similares, y lápices
electroquirúrgicos que transfieren energía a un lugar de tejido. La
energía electroquirúrgica es transmitida inicialmente desde un
generador electroquirúrgico a un electrodo activo que, a su vez,
transmite la energía electroquirúrgica al tejido. En un sistema
monopolar, se coloca una placa de electrodo de retorno debajo del
paciente para completar el circuito eléctrico al generador
electroquirúrgico. Se coloca un electrodo de retorno más pequeño en
contacto con el cuerpo o inmediatamente adyacente al lugar
quirúrgico en una configuración de sistema bipolar.
Para los fines aquí perseguidos, el término
fulguración electroquirúrgica incluye la aplicación de una chispa
eléctrica a tejido biológico, por ejemplo, músculos humanos o al
tejido de órganos internos, sin corte significativo. La chispa es
producida por ráfagas de impulsos de energía eléctrica de
radiofrecuencia generada desde un generador electroquirúrgico
apropiado. En general, la fulguración electroquirúrgica se usa para
deshidratar, encoger, necrosar o carbonizar tejido. Como resultado,
los instrumentos de fulguración electroquirúrgica se usan
principalmente para cortar hemorragias y el rezumamiento de
diversos fluidos quirúrgicos. Estas operaciones están comprendidas
en general en el término "coagulación". Entretanto, el
"corte" electroquirúrgico incluye el uso de la chispa
eléctrica aplicada al tejido que produce un efecto de corte. En
contraposición, el "sellado" electroquirúrgico incluye
utilizar una combinación singular de energía electroquirúrgica,
presión y distancia de separación entre electrodos para fundir el
colágeno del tejido en forma de una masa fundida.
Se sabe que ciertas formas de ondas
electroquirúrgicas son preferidas para efectos quirúrgicos
diferentes. Por ejemplo, se prefieren una forma de onda sinusoidal
continua (es decir, constantes) para mejorar el efecto de corte de
la hoja electroquirúrgica en un lápiz electroquirúrgico o mejorar el
efecto cooperante de los dos miembros de mordaza enfrentados. Se
prefiere una serie de impulsos electroquirúrgicos discontinuos de
alta energía para mejorar la coagulación del tejido biológico. Se
prefieren otros tipos de formas de ondas electroquirúrgicas para
"mezcla" electroquirúrgica, cortocircuitación o fusión de
tejido. Como puede apreciarse, estas formas de ondas son reguladas
típicamente por el generador y dependen en general del modo deseado
del funcionamiento manualmente seleccionado por el cirujano al
comienzo (o durante) la operación.
Tal como se usa aquí, el término "lápiz
electroquirúrgico" se entiende que incluye instrumentos que
tienen una pieza manual que está fijada a un electrodo activo y se
usan par coagular, cortar y sellar tejido. El lápiz puede ser
accionado por un interruptor de mano (en la forma de un botón
oprimible previsto en la propia pieza manual) o un interruptor de
pie (en forma de un pedal oprimible conectado operativamente a la
pieza manual). El electrodo activo es un elemento eléctricamente
conductor que usualmente se prolonga y puede tener la forma de una
delgada hoja plana con un extremo distal puntiagudo o redondeado.
Típicamente, en la técnica los electrodos de esta clase son
conocidos como de tipo de "hoja". Alternativamente, el
electrodo activo puede incluir una aguja cilíndrica estrecha
alargada que es maciza o hueca con un extremo distal plano,
redondeado, puntiagudo o sesgado. Típicamente, en la técnica los
electrodos de esta clase son conocidos como de tipo de
"circuito" o "trampa", "aguja" o "bola".
Como se menciona en lo que se antecede, la pieza
manual del lápiz está conectada a una fuente electroquirúrgica
adecuada (por ejemplo, generador) que suministra la energía
electroquirúrgica necesaria al elemento conductor del lápiz
electroquirúrgico. En general, cuando se realiza una operación sobre
un paciente con un lápiz electroquirúrgico, la energía desde el
generador electroquirúrgico es conducida a través del electrodo
activo al tejido en el lugar de la operación y luego a través del
paciente a un electrodo de retorno. El electrodo de retorno es
colocado típicamente en un lugar conveniente del cuerpo del paciente
y es fijado al generador mediante un cable de retorno.
Durante la operación, el cirujano oprime el
interruptor de mano o el interruptor de pie para activar el lápiz
electroquirúrgico. Luego, dependiendo del nivel de la energía
electroquirúrgica de radiofrecuencia deseada para el efecto
quirúrgico particular, el cirujano ajusta manualmente el nivel de
potencia en el generador electroquirúrgico, por ejemplo, girando un
dial dispuesto en el instrumento electroquirúrgico. Recientemente,
se han desarrollado lápices electroquirúrgicos que varían el nivel
de energía electroquirúrgica suministrada dependiendo de la
cantidad de resistencia percibida por el electrodo activo o por el
grado en que el interruptor de mano ha sido oprimido por el
cirujano. Ejemplos de algunos de estos instrumentos son descritos en
las solicitudes provisionales norteamericanas, comúnmente cedidas,
números 60/398.620, presentada el 25 de julio de 2002, ahora
publicación de EE. UU. número US 2006/0058783, publicada el 16 de
marzo de 2006, y 60/424.352, presentada el 5 de noviembre de 2002,
ahora publicación de EE. UU. número US 2004/0092927, publicada el 13
de mayo de 2004.
Por consiguiente, existe necesidad de un lápiz
electroquirúrgico que sea activado sin el uso de interruptores de
mano o interruptores de pie y que pueda controlar automáticamente la
salida electroquirúrgica desde el generador electroquirúrgico sin
intervención manual por parte del cirujano.
La presente invención concierne a un lápiz
electroquirúrgico de acuerdo con la reivindicación 1. Las
reivindicaciones subordinadas definen realizaciones preferidas.
Está previsto que el sensor para detectar
movimiento del elemento eléctricamente conductor sea al menos uno de
los transductores perceptores de fuerza, acelerómetros, sistemas
ópticos de posicionamiento, sistemas de posicionamiento mediante
radiofrecuencia, sistemas de posicionamiento ultrasónicos y sistemas
de posicionamiento de campo magnético.
Preferiblemente, el elemento eléctricamente
conductor incluye un eje longitud definido a su través y el sensor
detecta al menos uno de un movimiento axial del elemento
eléctricamente conductor a lo largo del eje longitudinal, un
movimiento transversal a través del eje longitudinal del elemento
eléctricamente conductor, y un movimiento rotacional alrededor del
eje longitudinal del elemento eléctricamente conductor. En una
realización, está previsto que la fuente de energía
electroquirúrgica transmita una salida de energía de radiofrecuencia
de disección en respuesta a la detección de movimiento axial del
elemento eléctricamente conductor a lo largo del eje longitudinal.
En otra realización, está previsto que la fuente de energía
electroquirúrgica transmita una salida de energía de
radiofrecuencia hemostática en respuesta a la detección de
movimiento transversal del elemento eléctricamente conductor a
través del eje longitudinal.
Está previsto que el sensor sea al menos uno de
un acelerómetro de placa paralela diferencial, un acelerómetro de
dedo de peine interdigitalizado equilibrado, un acelerómetro de dedo
de peine interdigitalizado compensado y un acelerómetro de tipo de
película. Preferiblemente, el sensor incluye un primer acelerómetro
para detectar un movimiento del elemento eléctricamente conductor
en una dirección axial a lo largo del eje longitudinal y un segundo
acelerómetro para detectar movimiento del elemento eléctricamente
conductor en una dirección transversal a través del eje
longitudinal. Está previsto también que el sensor pueda incluir al
menos una película piezoeléctrica.
En una realización se contempla que el primer
acelerómetro esté configurado y adaptado para transmitir una señal
de salida a la fuente de energía electroquirúrgica correspondiente
al movimiento axial del elemento eléctricamente conductor, y que el
segundo acelerómetro esté configurado y adaptado para transmitir una
señal de salida a la fuente de energía electroquirúrgica
correspondiente al movimiento transversal del elemento
eléctricamente conductor. Preferiblemente, cada uno de los
acelerómetros primero y segundo es al menos uno de un acelerómetro
de placa paralela diferencial, un acelerómetro de dedo de peine
interdigitalizado equilibrado, un acelerómetro de dedo de peine
interdigitalizado compensado y un acelerómetro de tipo de
película.
En ciertas realizaciones, está previsto que la
fuente de energía electroquirúrgica deje de suministrar energía
electroquirúrgica cuando el sensor no detecte un movimiento del
lápiz electroquirúrgico durante un período predeterminado de tiempo
y/o no detecte un movimiento del lápiz electroquirúrgico por encima
de un nivel de umbral predeterminado de movimiento.
Está previsto además que en ciertas
realizaciones la fuente de energía electroquirúrgica vuelva a
suministrar energía electroquirúrgica cuando el sensor detecte un
movimiento del lápiz electroquirúrgico a continuación del período
predeterminado de tiempo y/o detecte un movimiento del lápiz
electroquirúrgico por encima del nivel de umbral predeterminado de
movimiento.
Estos y otros objetos se ilustrarán más
claramente en lo que sigue mediante la descripción de los dibujos y
la descripción detallada de las realizaciones preferidas.
Los dibujos que se acompañan, que se incorporan
y constituyen una parte de esta memoria descriptiva, ilustran
realizaciones de la invención y, junto con una descripción general
de la invención dada en lo que antecede, y la descripción detallada
de las realizaciones dada en lo que sigue, sirven para explicar los
principios de la invención.
La figura 1 es una vista en alzado lateral
parcialmente arrancada, de una realización del lápiz
electroquirúrgico de acuerdo con la presente invención;
Las figuras 2A-2C ilustran tres
realizaciones de acelerómetros adecuados para percibir o ejercer
fuerza en plano;
La figura 3 es una vista en perspectiva
parcialmente arrancada de un lápiz electroquirúrgico de acuerdo con
otra realización de la presente invención; y
La figura 4 es una vista en perspectiva, a mayor
escala, de la zona indicada de la figura 3.
Se describirán ahora con detalle realizaciones
del lápiz electroquirúrgico actualmente descrito haciendo referencia
a las figuras del dibujo en las que números de referencia similares
identifican elementos similares o idénticos. En los dibujos, y en la
descripción que sigue, como es tradicional, el término
"proximal" se referirá al extremo del lápiz electroquirúrgico
que está más cerca del operador, mientras que el término
"distal" se referirá al extremo del lápiz electroquirúrgico que
está más lejos del operador.
La aceleración es una cualidad física que con
frecuencia tiene que ser percibida o medida. La aceleración se
define como la tasa de cambio de la velocidad con respecto al
tiempo. Por ejemplo, la aceleración es percibida con frecuencia
para medir fuerza o masa, o para hacer funcionar algún tipo de
sistema de control. En el centro de cualquier medición de
aceleración hay un elemento perceptor de aceleración, o transductor
perceptor de fuerza. El transductor es a menudo un elemento
mecánico o electromecánico (por ejemplo, un transductor
piezoeléctrico, un transductor piezo-resistivo o un
calibre de esfuerzos) que está interconectado típicamente con una
señal eléctrica o circuitos eléctricos para proporcionar una señal
de salida útil a un generador, ordenador u otra consola quirúrgica.
Se describen transductores ilustrativos en las patentes de EE. UU
números 5.367.217, 5.339.698 y 5.331.242. Un acelerómetro se define
como un instrumento que mide la aceleración o a fuerza gravitatoria
capaz de comunicar aceleración. Otro tipo de transductor perceptor
de fuerza es un acelerómetro. Se describen acelerómetros
ilustrativos en las patentes de EE. UU. números 5.594.170,
5.501.103, 5.379.639, 5.377.545, 5.456.111, 5.456.110 y 5.005.413.
Se describen otros ejemplos de instrumentos electroquirúrgicos en
las patentes de EE. UU. números 4.625.723 y 6.649.882.
Se conocen diversos tipos de acelerómetros. Un
primer tipo de acelerómetro incorpora masa de silicio
micromecanizada a granel suspendida por barras de silicio, en que
piezorresistencias implantadas con iones en las barras de
suspensión perciben el movimiento de la masa. Un segundo tipo de
acelerómetro utiliza un cambio en la capacitancia para detectar el
movimiento de la masa. Un tercer tipo de acelerómetro detecta la
aceleración midiendo un cambio en una frecuencia resonante de la
estructura como resultado de una desviación en la carga física de
la estructura. Está previsto que los acelerómetros puedan incluir
una película piezoeléctrica intercalada en un circuito impreso
flexible ponderado. Está previsto también que podría usarse al menos
un circuito flexible resistivo para detectar la posición y/o la
orientación del instrumento quirúrgico en lugar de la
aceleración.
Volviendo ahora a la figura 1, se indica en ella
una vista en alzado lateral, parcialmente arrancada, de un lápiz
electroquirúrgico construido de acuerdo con una realización de la
presente invención y que en general lleva de referencia el número
100. Si bien la descripción que sigue se dirigirá a lápices
electroquirúrgicos, está previsto que las características y
conceptos de la presente invención puedan aplicarse a otros
instrumentos electroquirúrgicos, por ejemplo, disectores,
instrumentos de ablación, sondas, etc. El lápiz electroquirúrgico
100 incluye un alojamiento alargado (102) configurado y adaptado
para soportar un receptáculo de hoja 104 en un extremo distal 103
del mismo que, a su vez, recibe en él una hoja de
electrocauterización 106. Un extremo distal 108 de la hoja 106 se
extiende distalmente desde el receptáculo 104 mientras que un
extremo proximal 110 de la hoja 106 está retenido dentro del
extremo distal 103 del alojamiento 102. Preferiblemente, la hoja de
electrocauterización 106 está fabricada de un material conductor,
por ejemplo, acero inoxidable o aluminio o está revestida con un
material eléctricamente conductor.
Como se muestra, el lápiz electroquirúrgico 100
está acoplado a un generador electroquirúrgico convencional "G"
a través de un cable 112. El cable 112 incluye un alambre de
transmisión 114 que interconecta eléctricamente el generador
electroquirúrgico "G" con el extremo proximal 110 de la hoja de
electrocauterización 106. El cable 112 incluye un circuito de
control 116 que interconecta eléctricamente un dispositivo perceptor
de movimiento 124 (por ejemplo, un acelerómetro), soportado dentro
del alojamiento 102, con un generador electroquirúrgico
"G".
A título de ejemplo solamente, el generador
electroquirúrgico "G" puede ser uno cualquiera de los
siguientes generadores o equivalentes de los mismos: "FORCE
FX", "FORCE 2" o "FORCE 4" fabricados por Valleylab,
Inc, una división de Tyco Healthcare, LP, Boulder, Colorado.
Preferiblemente, la salida de energía del generador
electroquirúrgico "G" puede ser variable a fin de proporcionar
señales electroquirúrgicas apropiadas para corte de tejido (por
ejemplo, 1 a 300 vatios) y señales electroquirúrgicas apropiadas
para coagulación de tejido (por ejemplo, 1 a 120 vatios). En la
patente de EE. UU. comúnmente cedida número 6.068.627, de Orszulak
y otros, se describe un ejemplo de un generador electroquirúrgico
adecuado "G". El generador electroquirúrgico descrito en la
patente 6.068.627 incluye en él, entre otras cosas, un circuito de
identificación y un interruptor. En general, el circuito de
identificación responde a la información recibida desde un generador
y transmite una señal de verificación de nuevo al generador.
Mientras el interruptor esté conectado al circuito de identificación
y responde a las señales recibidas desde el circuito de
identificación.
El lápiz electroquirúrgico100 incluye además un
botón de activación 126 soportado en una superficie externa del
alojamiento 102. El botón de activación 126 puede ser accionado para
controlar un interruptor oprimible 128 que se usa para controlar el
suministro de energía eléctrica trasmitida a la hoja de
electrocauterización 106.
Volviendo de nuevo a la figura 1, como se ha
mencionado en lo que antecede, el lápiz electroquirúrgico 100
incluye un acelerómetro 124 que está soportado dentro del
alojamiento 102. El acelerómetro 124 está operativamente conectado
al generador "G" que, a su vez, controla y transmite una
cantidad apropiada de energía electroquirúrgica a la hoja de
electrocauterización 106 y/o controla la forma de onda producida
desde el generador electroquirúrgico "G".
\global\parskip0.870000\baselineskip
En el uso, el cirujano activa el lápiz
electroquirúrgico 100 oprimiendo el botón de activación 126
permitiendo con ello que sea transmitida energía eléctrica a la
hoja de electrocauterización 106. Con el botón de activación 126
oprimido, cuando el cirujano mueve el lápiz electroquirúrgico 100
repetidas veces a lo largo del eje X (es decir, en un movimiento a
manera de apuñalamiento) como se indica mediante una flecha "X"
con doble punta en la figura 1, el acelerómetro 124 transmite una
señal correspondiente, a través del circuito de control 116, al
generador "G". El generador "G" interpreta entonces la
señal recibida desde el acelerómetro 124 y, a su vez, transmite una
salida de energía electroquirúrgica de disección correspondiente
(por ejemplo, una potencia y forma de onda específicas asociadas con
la disección) a través del alambre 114, a la hoja de
electrocauterización 106.
Por otra parte, si el cirujano mueve el lápiz
electroquirúrgico 100 en una dirección ortogonal al eje X, por
ejemplo, como se indica mediante una flecha "Z" con doble punta
en la figura 1, el acelerador 124 transmite una señal
correspondiente, a través de un circuito de control 116, al
generador "G". El generador "G" interpreta la señal
ortogonal recibida desde el acelerómetro 124 y, a su vez, transmite
una salida de energía electroquirúrgica hemostática (es decir,
potencia y forma de onda específicas asociadas con hemostasis), a
través del alambre de transmisión 114, a la hoja de
electrocauterización 106.
Por consiguiente, el lápiz electroquirúrgico de
la presente invención hará posible que un cirujano controle el tipo
de salida y/o la cantidad de energía suministrada a la hoja de
electrocauterización 106 simplemente moviendo el lápiz
electroquirúrgico en un modelo o dirección particular. De esta
manera, el cirujano no tiene que oprimir ningún botón o
interruptores que están dispuestos en el lápiz electroquirúrgico 100
para producir una salida de energía de disección o hemostasis en la
hoja de electrocauterización 106. Como puede apreciarse, el
cirujano no tiene que ajustar diales o interruptores en el generador
"G" para producir la salida de energía de disección o
hemostasis en la hoja de electrocauterización 106.
Los acelerómetros adecuados para percepción de
posición o forzamiento electrostático pueden estar formados con
electrodos fijos o movibles en muchas configuraciones. En la figura
2 se muestran algunas realizaciones de acelerómetros que tienen
sensibilidad de movimiento en plano, junto con un sistema de
coordenadas ortogonales. En particular, como se ve en las figuras
2A-2C, se muestra un acelerómetro de placa paralela
diferencial generalmente como 150. El acelerómetro de placa
paralela diferencial 150 incluye un electrodo 152, fijado a una masa
de prueba 154, que puede moverse a lo largo del eje Y cambiando con
ello el espacio de separación entre el electrodo movible 152 y los
electrodos fijos 156 y 158. El movimiento del electrodo movible 152,
junto con el eje Y, produce cambios contrarios en capacitancia
formada por el par de electrodos 152, 156 y 152, 158. En la figura
2B, se muestra un acelerómetro de dedo de peine interdigitalizado
equilibrado generalmente como 160.
El acelerómetro de dedo de peine
interdigitalizado equilibrado 160 incluye un electrodo 162, fijado a
una masa de prueba 164, que puede moverse a lo largo del eje Y
cambiando con ello la zona de solapamiento entre el electrodo
movible 162 y un electrodo envuelto fijo 166. En la figura 2C, se
muestra un acelerómetro de dedo de peine interdigitalizado
compensado generalmente como 170. El acelerómetro de dedo de peine
interdigitalizado compensado 170 incluye un electrodo 172, fijado a
una masa de prueba 174, que puede moverse a lo largo del eje Y
cambiando los espacios de separación entre el electrodo movible 172
y un electrodo envuelto fijo 176.
Si bien se prefiere un solo acelerómetro 124 que
puede medir cambios en la aceleración del lápiz electroquirúrgico
100 en las direcciones axial (es decir, dirección X), lateral (es
decir, dirección Y) y vertical (es decir, dirección Z,) está
previsto que pueda usarse un par de acelerómetros idénticos o
acelerómetros diferentes (es decir, los acelerómetros 150, 160 y
170), como se muestra en las figuras 2A-2C. Por
ejemplo, un primer acelerómetro, tal como el acelerómetro de dedo
de peine interdigitalizado compensado 170, puede ser montado dentro
del lápiz electroquirúrgico 100 de tal manera que un desplazamiento
del electrodo movible 172 en la dirección Y da por resultado la
transmisión de energía electroquirúrgica de disección por el
generador "G" a la hoja de electrocauterización 106, mientras
que un segundo acelerador, tal como otro acelerómetro de dedo de
peine interdigitalizado compensado 170, puede ser montado dentro del
lápiz electroquirúrgico 100, ortogonal al primer acelerómetro, de
tal manera que un desplazamiento del electrodo movible 172 en la
dirección X da por resultado la transmisión de energía
electroquirúrgica hemostática por el generador "G" a la hoja de
electrocauterización 106.
Está previsto que pueda disponerse de cualquier
combinación de acelerómetros en el lápiz electroquirúrgico 100 en
cualquier número de orientaciones para medir cambios en la
aceleración en cualquier número de direcciones, incluida aceleración
rotacional (dirección Y y dirección Z). Asimismo, está previsto que
también pueda detectarse, medirse y calcularse cualquier combinación
de aceleraciones en la dirección X, dirección Y y dirección Z para
efectuar la salida electroquirúrgica desde el generador
"G".
Además de acelerómetros, está previsto que pueda
disponerse de muchos otros tipos de sensores para detectar el
movimiento de la hoja de electrocauterización 106. Pueden usarse
otros tipos de transductores de percepción de fuerza. Pueden usarse
otros tipos, incluidos y sin que se limite a ellos, sistemas de
posicionamiento óptico, sistemas de posicionamiento de
radiofrecuencia, sistemas de posicionamiento ultrasónicos y sistemas
de posicionamiento de campo magnético.
Aunque se ha mostrado y descrito un electrodo
activo en forma de una hoja, está previsto que pueda usarse
cualquier tipo de punta como electrodo activo de lápiz
electroquirúrgico 100. Por ejemplo, el electrodo activo puede ser
una aguja cilíndrica estrecha alargada que sea maciza o hueca con un
extremo distal plano, redondeado, puntiagudo o sesgado.
\global\parskip1.000000\baselineskip
Está previsto además que la cantidad de tiempo
requerida para la transmisión de energía electroquirúrgica desde el
generador "G" a la hoja de electrocauterización 106, en
respuesta a una señal de salida recibida desde el acelerómetro 124,
puede ser regulada basándose en el grado de respuesta deseado por el
cirujano. Por ejemplo, un tiempo de respues-
ta relativamente más corto se consideraría que responde mejor que un tiempo de respuesta relativamente más largo.
ta relativamente más corto se consideraría que responde mejor que un tiempo de respuesta relativamente más largo.
Además, está previsto que el acelerómetro 124
disponga de algoritmos de detección de movimiento que transmiten
señales de corte de energía al generador "G" si el lápiz
electroquirúrgico 100 se mantiene sin movimiento o abandonado
durante un período prolongado de tiempo. Está previsto que la
sensibilidad a la activación del lápiz electroquirúrgico 100, en
respuesta a un movimiento axial, vertical o transversal, puede ser
disminuida en forma de lapsos de tiempo desde la última vez que el
lápiz electroquirúrgico 100 se usó. Como tal, sería menos probable
que el lápiz electroquirúrgico 100 fuera activado inadvertidamente
cuando transcurriera más tiempo. Además, la posibilidad de hacer
inservible el lápiz electroquirúrgico 100 cuando no se usa mejora la
seguridad clínica del dispositivo. El algoritmo de detección de
movimiento produce efectivamente un "enfundamiento virtual"
que impide que el lápiz electroquirúrgico 100 sea activado
inadvertidamente.
Volviendo ahora a las figuras 3 y 4, se indica
en ellas una vista en perspectiva parcialmente arrancada de un lápiz
electroquirúrgico construido de acuerdo con otra realización de la
presente invención y que lleva en general de referencia el número
200. El lápiz electroquirúrgico 200 es similar al lápiz
electroquirúrgico 100 y solamente se describirá en detalle en la
medida necesaria para identificar diferencias en la construcción y
funcionamiento.
Como se ve en las figuras 3 y 4, el lápiz
electroquirúrgico 200 incluye un acelerómetro de tipo de película o
sensor 224 soportado en el alojamiento 102. El sensor 224 incluye
preferiblemente un substrato 226 fabricado de un material
elastomérico. El sensor 224 incluye además un grupo de electrodos
228 (para fines de claridad se han mostrado solamente cuatro
electrodos 228a-228d) situados alrededor de la
periferia del substrato 226. El sensor 224 incluye además una masa
de prueba 230 eléctricamente conectada a cada electrodo 228 a través
de conductores eléctricos 232. La masa de prueba 230 puede moverse
en cualquier dirección a lo largo de los ejes X, Y y Z cambiando con
ello la distancia de separación entre ella misma y los electrodos
228 y la resistencia a través de los conductores 232.
Por consiguiente, el movimiento de la masa de
prueba 230 a lo largo de los ejes X, Y y/o Z da por resultado la
transmisión de una señal particular, a través del circuito de
control 116, al generador "G" (véase la figura 1). El generador
"G" interpreta entonces la señal particular recibida desde el
sensor 224 y, a su vez, transmite una salida de energía
electroquirúrgica distinta correspondiente (es decir, potencia y/o
forma de onda específicas), a través del alambre de transmisión 114,
a la hoja de electrocauterización 106.
Por ejemplo, con el botón de activación 126
oprimido, el movimiento del lápiz electroquirúrgico 200 por el
cirujano en direcciones a lo largo del eje X (es decir, en un
movimiento a manera de apuñalamiento), hace que el sensor 224
transmita una primera señal característica al generador "G". El
generador "G" interpreta la primera señal característica y, a
su vez, transmite una salida de energía electroquirúrgica de
disección correspondiente (es decir, una potencia específica y una
forma de onda específicas asociadas con la disección) a la hoja de
electrocauterización 106.
En otro ejemplo, con el botón de activación 126
oprimido, el movimiento del lápiz electroquirúrgico 200 por el
cirujano en direcciones transversales al eje X, tal como, por
ejemplo, a lo largo de los ejes Y y/o Z, hace que el sensor 224
transmita una segunda señal característica al generador "G". El
generador "G" interpreta la segunda señal característica y, a
su vez, transmite una salida de energía electroquirúrgica
hemostática correspondiente (es decir, una potencia específica y una
forma de onda específicas asociadas con hemostasis) a la hoja de
electrocauterización 106.
Está previsto que el substrato 226 tenga una
configuración cóncava. De esta manera, cuando el cirujano todavía
sostiene el lápiz electroquirúrgico 200, la masa de prueba 230
tendrá tendencia a volver a la parte inferior del substrato 226 y se
reajustará eficazmente por sí misma de manera automática. En otras
palabras, un substrato cóncavo 226 puede ser autocentrable y
proporcionar de este modo al lápiz electroquirúrgico 200 una
capacidad de reajuste espontáneo. Está previsto también que puedan
usarse otras formas.
Por consiguiente, la salida de energía
electroquirúrgica de los lápices electroquirúrgicos 100, 200 será
controlada por los movimientos naturales de la mano del cirujano y
que no se requiere pensar específicamente en cambiar la salida de
energía correspondiente desde un ajuste de "disección" a un
ajuste "hemostático", y viceversa.
Está previsto que, cuando el electroquirúrgico
100, 200 esté mantenido sin movimiento durante una cantidad
predeterminada de tiempo y/o por debajo del nivel de umbral
predeterminado de movimiento (es decir, el acelerómetro 124 y/o el
sensor 224 no perciben movimiento del lápiz electroquirúrgico 100 ó
200 durante un período predeterminado de tiempo y/o perciben
movimiento que está por debajo de un nivel de umbral
predeterminado), el generador electroquirúrgico "G" no
transmita energía electroquirúrgica a la hoja de
electrocauterización. Está previsto además que puede aumentarse y/o
disminuirse la sensibilidad del lápiz electroquirúrgico 100 ó 200
ajustando correspondientemente los niveles de umbral de tiempo y
movimiento.
Está previsto además que el generador
electroquirúrgico "G" inicie y vuelva a iniciar el suministro
de energía electroquirúrgica a la hoja de electrocauterización
cuando el acelerómetro 124 y el sensor 224 detecten un movimiento
del lápiz electroquirúrgico 100 ó 200 después de que haya
transcurrido un período predeterminado de tiempo y/o después de que
haya sido sobrepasado el nivel de umbral predeterminado.
De lo que antecede y con referencia a los
diversos dibujos de las figuras, los versados en la técnica
apreciarán apreciarán que pueden hacerse ciertas modificaciones
respecto de la presente invención sin apartarse del alcance de la
misma. Por ejemplo, las realizaciones de la presente invención
incluyen un lápiz electroquirúrgico que tiene un botón para
controlar la salida de energía electroquirúrgica, además del sensor
o sensores descritos en lo que antecede. Aunque se han descrito en
esta memoria realizaciones de instrumentos electroquirúrgicos de
acuerdo con la presente invención, no se pretende que la invención
se limite a las mismas y que la anterior descripción deba
interpretarse como simplemente ilustraciones de realizaciones
preferidas.
Claims (14)
1. Un lápiz electroquirúrgico (100), que
comprende:
un alojamiento alargado (102);
y un elemento eléctricamente conductor (106)
soportado dentro del alojamiento (102) y que se extiende distalmente
desde el alojamiento (102), pudiendo ser conectado el elemento
eléctricamente conductor (106) a una fuente de energía
electroquirúrgica (G); y
caracterizado por un sensor de movimiento
(224) dispuesto dentro del alojamiento (102) y en conexión eléctrica
con la fuente de energía electroquirúrgica (G), siendo el sensor
(224) capaz de detectar movimiento del lápiz electroquirúrgico (100)
y comunicar una señal a la fuente de energía electroquirúrgica (G)
relativa al movimiento del lápiz electroquirúrgico (100),
suministrando la fuente de energía electroquirúrgica (G) energía
electroquirúrgica en respuesta a la señal comunicada desde el sensor
(224).
2. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 1, en el que el sensor (224) para detectar
movimiento del elemento eléctricamente conductor (106) es al menos
uno de acelerómetros, sistemas ópticos de posicionamiento, sistemas
de posicionamiento mediante radiofrecuencia y sistemas ultrasónicos
de posicionamiento.
3. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 1, en el que el elemento eléctricamente
conductor (106) incluye un eje longitudinal definido a su través y
el sensor (224) detecta al menos uno de un movimiento axial del
lápiz electroquirúrgico (100) a lo largo del eje longitudinal, un
movimiento transversal a través del eje longitudinal, y un
movimiento de rotación alrededor del eje longitudinal.
4. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 3, en el que la fuente de energía
electroquirúrgica (G) transmite una salida de energía de
radiofrecuencia de disección en respuesta a la detección del
movimiento axial del lápiz electroquirúrgico (100) a lo largo del
eje longitudinal.
5. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 3, en el que la fuente de energía
electroquirúrgica (G) transmite una salida de energía de
radiofrecuencia hemostática en respuesta a la detección de
movimiento transversal del lápiz electroquirúrgico (100) a través
del eje longitudinal.
6. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 1, en el que el sensor (224) es al menos uno
de un acelerómetro de placa paralela diferencial, un acelerómetro de
dedo de peine interdigitalizado equilibrado, un acelerómetro de dedo
de peine interdigitalizado compensado y un acelerómetro de tipo de
película.
7. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 6, en el que el sensor (224) incluye un primer
acelerómetro para detectar un movimiento del lápiz electroquirúrgico
(100) en una dirección axial a lo largo del eje longitudinal; y un
segundo acelerómetro para detectar movimiento del lápiz
electroquirúrgico (100) en una dirección transversal a través del
eje longitudinal.
8. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 7, en el que el primer acelerómetro está
configurado y adaptado para transmitir una señal de salida a la
fuente de energía electroquirúrgica (G) correspondiente al
movimiento axial del lápiz electroquirúrgico (100); y el segundo
acelerómetro está configurado y adaptado para transmitir una señal
de salida a la fuente de energía electroquirúrgica (G)
correspondiente al movimiento transversal del lápiz
electroquirúrgico (100).
9. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 7, en el que cada uno de los acelerómetros
primero y segundo es al menos uno de un acelerómetro de placa
paralela diferencial, un acelerómetro de dedo de peine
interdigitalizado equilibrado, un acelerómetro de dedo de peine
interdigitalizado compensado y un acelerómetro de tipo de
película.
10. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 7, en el que cada uno de los acelerómetros
primero y segundo incluye al menos un detector de movimiento de
película piezoeléctrica.
11. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 1, en el que la fuente de energía
electroquirúrgica (G) reduce sustancialmente el suministro de
energía electroquirúrgica cuando el sensor (224) no detecta al menos
uno de:
movimiento del lápiz electroquirúrgico (100)
durante un periodo predeterminado de tiempo; y
movimiento del lápiz electroquirúrgico (100) por
encima de un nivel de umbral predeterminado de movimiento.
12. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 11, en el que la fuente de energía
electroquirúrgica (G) aumenta sustancialmente el suministro de
energía electroquirúrgica cuando el sensor (224) detecta al menos
uno de:
movimiento del lápiz electroquirúrgico (100) a
continuación del período predeterminado de tiempo; y
movimiento del lápiz electroquirúrgico (100) por
encima del nivel de umbral predeterminado de movimiento.
13. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 3, en el que la fuente de energía
electroquirúrgica (G) reduce sustancialmente el suministro de
energía electroquirúrgica cuando el sensor (224) no detecta al menos
uno de:
movimiento del lápiz electroquirúrgico (100)
durante un periodo predeterminado de tiempo; y
movimiento del lápiz electroquirúrgico (100) por
encima de un nivel de umbral predeterminado de movimiento.
14. El lápiz electroquirúrgico (100) de acuerdo
con la reivindicación 13, en el que la fuente de energía
electroquirúrgica (G) aumenta sustancialmente el suministro de
energía electroquirúrgica cuando el sensor (224) detecta al menos
uno de:
movimiento del lápiz electroquirúrgico (100) a
continuación del período predeterminado de tiempo; y
movimiento del lápiz electroquirúrgico (100) por
encima del nivel de umbral predeterminado de movimiento.
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US7156842B2 (en) * | 2003-11-20 | 2007-01-02 | Sherwood Services Ag | Electrosurgical pencil with improved controls |
US7131860B2 (en) * | 2003-11-20 | 2006-11-07 | Sherwood Services Ag | Connector systems for electrosurgical generator |
US7169145B2 (en) | 2003-11-21 | 2007-01-30 | Megadyne Medical Products, Inc. | Tuned return electrode with matching inductor |
US7553309B2 (en) | 2004-10-08 | 2009-06-30 | Covidien Ag | Electrosurgical system employing multiple electrodes and method thereof |
US8216234B2 (en) | 2004-11-10 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Tissue resection device |
USD515412S1 (en) * | 2005-03-11 | 2006-02-21 | Sherwood Services Ag | Drape clip |
US7828794B2 (en) * | 2005-08-25 | 2010-11-09 | Covidien Ag | Handheld electrosurgical apparatus for controlling operating room equipment |
US20070260238A1 (en) | 2006-05-05 | 2007-11-08 | Sherwood Services Ag | Combined energy level button |
-
2004
- 2004-02-17 ES ES04711864T patent/ES2300746T3/es not_active Expired - Lifetime
- 2004-02-17 EP EP08002357.5A patent/EP1949867B1/en not_active Expired - Lifetime
- 2004-02-17 EP EP04711864A patent/EP1596743B1/en not_active Expired - Lifetime
- 2004-02-17 JP JP2006503650A patent/JP4469843B2/ja not_active Expired - Fee Related
- 2004-02-17 CA CA002516451A patent/CA2516451A1/en not_active Abandoned
- 2004-02-17 US US10/781,084 patent/US7235072B2/en active Active
- 2004-02-17 AU AU2004212990A patent/AU2004212990B2/en not_active Ceased
- 2004-02-17 DE DE602004012972T patent/DE602004012972T2/de not_active Expired - Lifetime
- 2004-02-17 WO PCT/US2004/004685 patent/WO2004073753A2/en active Application Filing
-
2007
- 2007-01-08 US US11/651,385 patent/US7955327B2/en not_active Expired - Fee Related
-
2010
- 2010-01-13 JP JP2010005344A patent/JP2010104813A/ja not_active Withdrawn
Also Published As
Publication number | Publication date |
---|---|
CA2516451A1 (en) | 2004-09-02 |
JP4469843B2 (ja) | 2010-06-02 |
EP1596743A2 (en) | 2005-11-23 |
JP2006518262A (ja) | 2006-08-10 |
US20070142832A1 (en) | 2007-06-21 |
US7955327B2 (en) | 2011-06-07 |
EP1596743B1 (en) | 2008-04-09 |
AU2004212990B2 (en) | 2009-12-10 |
WO2004073753A3 (en) | 2004-10-07 |
DE602004012972T2 (de) | 2009-06-10 |
JP2010104813A (ja) | 2010-05-13 |
EP1949867B1 (en) | 2013-07-31 |
US20040230262A1 (en) | 2004-11-18 |
EP1949867A1 (en) | 2008-07-30 |
US7235072B2 (en) | 2007-06-26 |
AU2004212990A1 (en) | 2004-09-02 |
WO2004073753A2 (en) | 2004-09-02 |
EP1596743A4 (en) | 2007-01-24 |
DE602004012972D1 (de) | 2008-05-21 |
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