JP4223289B2 - 電極の幾何学的形状を改良した内視鏡アブレーションシステム - Google Patents
電極の幾何学的形状を改良した内視鏡アブレーションシステム Download PDFInfo
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Description
本願は、次の共同出願に係る同時係属米国特許出願、即ち、米国特許出願第10/105,610号明細書(発明の名称:Endoscopic Ablation System with Flexible Coupling(撓み継手を有する内視鏡アブレーションシステム))(代理人事件番号END840)及び米国特許出願第10/105,609号明細書(発明の名称:Endoscopic Ablation System with Sealed Sheath(密封シースを有する内視鏡アブレーションシステム))(代理人事件番号END841)を相互に参照し、これら米国特許出願明細書の記載内容全体を本明細書の一部を形成するものとしてここに引用する。
本発明は一般的に内視鏡によるアブレーションシステムに関し、特に、軟性(フレキシブル型)内視鏡に装着されて食道の組織を焼灼するようになった複数の電極を含む内視鏡アブレーションシステムに関する。
胃食道逆流症(GERD)は、激しい胸やけを伴う病気であり、世界中の相当多くの人々がこの病気に罹っている。少なくとも1週間に1回胸やけを経験する人は、食道癌に罹る危険性が高いと言われている。治療しないまま放置すると、慢性GERDは、食道の内部の内膜が扁平上皮から円柱上皮(ときには腸上皮化生又はバレット食道(Barrett's esophagus)を含む)に変化する原因となる。治療しないまま放置すると、バレット食道は食道癌へと進行し、その一般的な外科療法は食道切除(食道を切除すること)である。
・外科的器械を治療されるべき組織領域に正確に位置決めし、可能な限り患者に外傷を生じないように行うこと。
・外科医がアブレーションの実施前及び実施中に目で見ることができる特定且つ所定の領域の組織だけを焼灼すること(治療電極の下に位置する組織は治療してはならない)。
・アブレーションの深さをコントロールするため、適当な時間でアブレーションを止めること。
・体内管腔の壁を支えること及び治療されるべき組織を治療電極にぴったりと接触させること。
本発明は、患者の身体組織を電気外科的に治療するアブレーションシステムに関する。アブレーションシステムは、少なくとも2つの電極を有し、各電極は、周長Pを有する。隣り合う電極は、距離dだけ間隔を置いた隣り合う互いに平行な縁部を有し、アブレーションインデックスI=P/dは、約1〜約200である。本発明のアブレーションシステムの一実施形態では、電極は、幅w、長さLの矩形の形をしており、P=2(w+L)である。アブレーションインデックスIは、達成可能なアブレーションの質に関連している。好ましいアブレーションの質は、アブレーションインデックスIが約15〜約35である場合、本発明を利用して達成できる。
図1は、軟性内視鏡12(以下、内視鏡12ともいう)、例えばオリンパス・コーポレイションから入手できるGIF−100モデルに取り付けられた本発明の内視鏡アブレーションシステム10を示している。軟性内視鏡12は内視鏡ハンドル34とフレキシブルシャフト32で構成されている。内視鏡アブレーションシステム10は、アブレーションキャップ20、複数の導体18、スイッチ62を備えたハンドピース16及びRF(高周波)発生器14から成る。アブレーションキャップ20はフレキシブルシャフト32の遠位端部に嵌められ、導体18は複数のクリップ30によってフレキシブルシャフト32に取り付けられている。アブレーションキャップ20は、剛性支持部材26、複数の電極28及び電極の間に位置決めされた観察窓29で構成されている。この実施形態では、剛性支持部材26は透明な材料、例えばポリカーボネートで作られ、観察窓29は、電極28の間にある剛性支持部材26の一部分である。ハンドピース16のスイッチ62を手動操作して、電極28をRF発生器14に電気的に接続し又は接続を切る。変形例として、スイッチ62は例えばフットスイッチ(図示せず)に取り付けてもよい。
上式において、Pは、電極28の周長、dは、電極28の隣り合う縁部8相互間の離隔距離である。
上式において、wは、電極28の幅、Lは、電極28の長さである。
Claims (11)
- 患者の身体組織を電気外科的に治療する内視鏡アブレーションシステムであって、少なくとも2つの電極を有し、前記電極は各々、周長Pを有し、隣り合う電極は、距離dだけ間隔を置いた隣り合う互いに平行な縁部を有し、アブレーションインデックスI=P/dは、約1〜約200であり、前記内視鏡アブレーションシステムは、隣り合う電極相互間に設けられた観察窓と、体内器官の管腔内に空間を作るアブレーションキャップとを更に有し、前記少なくとも2つの電極は、前記アブレーションキャップ上に位置決めされ、前記観察窓は、前記アブレーションキャップの一部をなしており、前記内視鏡アブレーションシステムは、前記少なくとも2つの電極に電気的に接続されたRF発生器を更に有し、オペレータは、前記RF発生器を作動させて前記観察窓を通して見ることができる組織を内視鏡で焼灼でき、
前記アブレーションエンドキャップは、中空であって、シースの遠位端部に取り付けられており、軟性内視鏡の遠位端部は、前記シースを通って挿入され、そして少なくとも部分的に前記アブレーションエンドキャップ内へ挿入でき、前記シース及び前記アブレーションエンドキャップは、前記軟性内視鏡に対し回転自在であり、
前記シースの近位端部の近くに設けられたシールを更に有し、前記シールは、軟性内視鏡の遠位端部を通過させることができるようになっており、前記シース及び前記アブレーションキャップは、患者の外部の空気から実質的に密封されたエンクロージャを形成していることを特徴とする内視鏡アブレーションシステム。 - 前記第1の電極及び第2の電極のアブレーションインデックスIは、15〜35であることを特徴とする請求項1記載の内視鏡アブレーションシステム。
- 前記アブレーションキャップは、テーパ付きエンドカバーに取り付けられた剛性支持部材から成ることを特徴とする請求項1記載の内視鏡アブレーションシステム。
- 前記テーパ付きエンドカバーは、常態では閉じられており、内視鏡の遠位端部が前記テーパ付きエンドカバーを通過することができるようにするために開くようになっていることを特徴とする請求項3記載の内視鏡アブレーションシステム。
- 前記テーパ付きエンドカバーは、常態では開いており、内視鏡の遠位端部が前記テーパ付きエンドカバーを通過できるようになっていることを特徴とする請求項3記載の内視鏡アブレーションシステム。
- 前記テーパ付きエンドカバーは、透明で可撓性材料から作られ、消息子管のような形をしており、ガイドワイヤ上でこれに沿って進められるようになっていることを特徴とする請求項3記載の内視鏡アブレーションシステム。
- 前記アブレーションキャップは、可撓性支持部材から成り、前記少なくとも2つの電極は、前記可撓性支持部材に取り付けられたハウジング内へ引っ込み可能な電極スレッドに取り付けられていることを特徴とする請求項1記載の内視鏡アブレーションシステム。
- 前記電極スレッドに操作的に係合する駆動ケーブルを更に有し、オペレータは、前記アブレーションキャップを体内器官の管腔内へ挿入するとき、前記駆動ケーブルを作動させて前記アブレーションキャップを引っ込み位置と伸長位置との間で動かすことができ、前記電極スレッドを伸長させることにより、構造的剛性が前記可撓性支持部材に与えられ、それにより、体内器官の管腔を支持するのを助けることを特徴とする請求項7記載の内視鏡アブレーションシステム。
- 前記シースの近位端部のところに取り付けられた回転ノブを更に有していることを特徴とする請求項1記載の内視鏡アブレーションシステム。
- 前記電極と前記RF発生器との間に直列に電気的に接続されたタイマを更に有し、前記タイマは、オペレータが前記RF発生器をオンに切り換えると、前記RF発生器の出力を所定期間にわたり前記電極に電気的に接続することを特徴とする請求項1記載の内視鏡アブレーションシステム。
- アクチュエータを更に有し、前記タイマは、オペレータが前記アクチュエータを作動させたときのみ動作できることを特徴とする請求項10記載の内視鏡アブレーションシステム。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US28000901P | 2001-03-30 | 2001-03-30 | |
US10/105,722 US6918906B2 (en) | 2001-03-30 | 2002-03-25 | Endoscopic ablation system with improved electrode geometry |
PCT/US2002/010184 WO2002078557A1 (en) | 2001-03-30 | 2002-03-29 | Endoscopic ablation system with improved electrode geometry |
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- 2002-03-25 US US10/105,722 patent/US6918906B2/en not_active Expired - Lifetime
- 2002-03-25 US US10/105,609 patent/US20020183739A1/en not_active Abandoned
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- 2002-03-29 JP JP2002576802A patent/JP2005508658A/ja not_active Ceased
- 2002-03-29 JP JP2002576828A patent/JP4223289B2/ja not_active Expired - Fee Related
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EP1389067A4 (en) | 2006-01-18 |
JP2005508658A (ja) | 2005-04-07 |
EP1389067A1 (en) | 2004-02-18 |
US20020183739A1 (en) | 2002-12-05 |
WO2002078557A1 (en) | 2002-10-10 |
AU2002254494B2 (en) | 2007-06-07 |
EP1414360A2 (en) | 2004-05-06 |
US6918906B2 (en) | 2005-07-19 |
CA2442402A1 (en) | 2002-10-10 |
EP1414360A4 (en) | 2006-01-18 |
CA2442401A1 (en) | 2002-10-10 |
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