DE10224154A1 - Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue - Google Patents
Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissueInfo
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B18/1477—Needle-like probes
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
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- A61B2018/00875—Resistance or impedance
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/143—Needle multiple needles
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Abstract
Description
Die vorliegende Erfindung betrifft eine Vorrichtung zum elektrochirurgischen Veröden von Körpergewebe. The present invention relates to a device for electrosurgical desolation of body tissue.
Das elektrochirurgische, insbesondere das elektrothermische Veröden von pathologisch verändertem Gewebe, im folgenden kurz Gewebe genannt, ist eine in der Medizin bekannte Methode. Von besonderem Interesse ist diese Methode für die Therapie von Organtumoren, zum Beispiel Lebertumoren. Zur Verödung werden eine oder mehrere Elektroden im zu verödenden Gewebe, d. h. dem Tumorgewebe, oder in dessen unmittelbarer Nähe platziert und ein Wechselstrom zwischen den Elektroden oder einer Elektrode und einer außen am Körper fixierten Neutralelektrode fließen lassen. Fließt der Strom zwischen der Elektrode und der Neutralelektrode (ggf. auch zwischen mehreren Elektroden und einer oder mehreren Neutralelektroden), so spricht man von einer monopolaren Elektrodenanordnung. Fließt der Strom dagegen zwischen den im Gewebe befindlichen Elektroden selbst (in diesem Fall müssen im Gewebe mindestens zwei Elektroden vorhanden sein), so spricht man von einer bipolaren Anordnung. Von einer multipolaren Anordnung spricht man, wenn im Gewebe mehr als zwei Elektroden vorhanden sind, zwischen denen Wechselstrom fließt. The electrosurgical, in particular the electrothermal desolation of pathologically altered tissue, hereinafter referred to as tissue a method known in medicine. This is of particular interest Method for the therapy of organ tumors, for example liver tumors. For sclerotherapy, one or more electrodes are to be sclerosed Tissue, d. H. the tumor tissue, or in its immediate vicinity placed and an alternating current between the electrodes or an electrode and a neutral electrode fixed on the outside of the body. flows the current between the electrode and the neutral electrode (if necessary also between several electrodes and one or more neutral electrodes), one speaks of a monopolar electrode arrangement. Flows the Current, however, between the electrodes in the tissue itself (in In this case, at least two electrodes must be present in the tissue ), one speaks of a bipolar arrangement. From one Multipolar arrangement is called when there are more than two electrodes in the tissue are present, between which alternating current flows.
Die zum platzieren im Gewebe vorgesehenen Elektroden sind in der Regel als Elektrodennadeln ausgebildet. Sie besitzen einen elektrisch leitenden zylinderförmigen Schaft, der mit Ausnahme eines oder mehrerer distalen Bereiche, den sog. aktiven Bereichen der Elektrode oder kurz aktiven Elektroden, gegen das umliegende Gewebe elektrisch isoliert ist. Die aktiven Elektroden stehen dagegen mit dem Körpergewebe in elektrisch leitfähiger Verbindung. Optional sind die aktiven Elektroden auch mit integrierten Thermosensoren ausgestattet. In speziellen Ausführungsformen können am distalen Ende des Schaftes weitere aktive Elektroden, mechanisch ausgefahren werden, um das therapierbare Gewebevolumen zu vergrößern. The electrodes intended for placement in the tissue are usually designed as electrode needles. They have an electrically conductive cylindrical shaft, with the exception of one or more distal Areas, the so-called active areas of the electrode or briefly active Electrodes that are electrically isolated from the surrounding tissue. The active ones Electrodes, on the other hand, are electrically conductive with the body tissue Connection. The active electrodes are also optionally available with integrated ones Thermosensors equipped. In special embodiments further active electrodes at the distal end of the shaft, mechanical can be extended to increase the volume of tissue that can be treated enlarge.
Mittels Hochfrequenzgenerator wird in der monopolaren Anordnung ein Stromfluss zwischen den aktiven Elektroden und der bzw. den Neutralelektroden induziert. In der alternativen bipolaren Anordnung kann auf die Neutralelektroden verzichtet werden. Der Stromkreis wird in diesem Fall über eine weitere aktive Elektrode geschlossen, wobei die erforderlichen aktiven Elektroden in einer koaxialen Anordnung gegeneinander isoliert auf der Elektrodennadel oder auf zwei getrennten Elektrodennadeln angeordnet sein können. A high-frequency generator is used in the monopolar arrangement Current flow between the active electrodes and the or Neutral electrodes induced. In the alternative bipolar arrangement, the Neutral electrodes can be dispensed with. In this case the circuit is over closed another active electrode, the required active Electrodes in a coaxial arrangement isolated from each other on the Electrode needle or arranged on two separate electrode needles could be.
Durch den Gewebewiderstand, auch Gewebeimpedanz genannt, erfolgt eine Umsetzung des über die Elektroden applizierten Wechselstroms in joulsche Wärme. Bei Temperaturen zwischen 50 und 100°C kommt es zu einer massiven Denaturierung der körpereigenen Proteine (Koagulation) und in der Folge zum Absterben der betroffenen Gewebeareale. Aufgrund der hohen Stromdichte an den aktiven Elektroden erfolgt die Erwärmung vorwiegend im Bereich dieser Elektroden, so dass eine lokale thermische Tumordestruktion möglich ist. Due to the tissue resistance, also called tissue impedance a conversion of the alternating current applied via the electrodes into joul heat. At temperatures between 50 and 100 ° C it happens massive denaturation of the body's own proteins (coagulation) and subsequently to the death of the affected tissue areas. by virtue of The high current density at the active electrodes causes heating predominantly in the area of these electrodes, so that a local thermal Tumor destruction is possible.
Eine Vorrichtung und ein Verfahren zum elektrothermischen Veröden pathologischen Gewebes sind beispielsweise in US 5,630,426 offenbart. An apparatus and method for electrothermal depletion pathological tissue is disclosed, for example, in US 5,630,426.
Entscheidend für eine effektive und vor allem sichere Therapie ist die Ausbildung einer thermischen Destruktionszone, die der Ausdehnung des pathologischen Gewebes, d. h. des Tumorgewebes, optimal angepasst ist. Decisive for an effective and above all safe therapy is that Formation of a thermal destruction zone corresponding to the expansion of the pathological tissue, d. H. of the tumor tissue is optimally adapted.
Aufgabe der vorliegenden Erfindung ist es, eine Vorrichtung zum elektrothermischen Veröden von Geweben zur Verfügung zu stellen, die eine zuverlässige Destruktion pathologischen Gewebes ermöglicht. The object of the present invention is to provide a device for to provide electrothermal desiccation of tissues, the one enables reliable destruction of pathological tissue.
Diese Aufgabe wird durch eine Vorrichtung zum Applizieren eines Hochfrequenzstroms zur thermischen Verödung von Körpergewebe nach Anspruch 1 gelöst. Die Unteransprüche enthalten weitere vorteilhafte Ausgestaltungen der Erfindung. This object is achieved by a device for applying a High-frequency current for thermal obliteration of body tissue after Claim 1 solved. The sub-claims contain further advantageous Embodiments of the invention.
Der Erfindung liegt die Erkenntnis zugrunde, dass für die Ausbildung einer optimal an das Tumorgewebe angepassten Destruktionszone die Elektrodenanordnung im Tumor eine entscheidende Rolle spielt. In der klinischen Praxis ist es mittlerweile üblich, bei größeren zu zerstörenden Gewebearealen mehrere Elektrodennadeln im Gewebe zu positionieren, um mittels Superposition der von den einzelnen Elektroden erzeugten thermischen Destruktionszonen eine Effizienzsteigerung zu erzielen. Darüber hinaus soll bei einigen Anwendungen durch eine mehrkanalige Temperaturmessung eine gleichmäßige thermische Destruktionszone erzielt werden. Dies hat sich in der Praxis jedoch als unzulänglich erwiesen, weil es sich nur um Punktmessungen handelt und die Gewebeeigenschaften in einiger Entfernung der Messstellen nicht berücksichtigt werden können. Damit kommt es immer wieder zu Untertherapie, d. h. in zu behandelnden Gewebearealen wird die für eine vollständige Destruktion des Tumorgewebes erforderliche Temperatur nicht erreicht. Infolgedessen erleiden die Patienten einen Rückfall und müssen sich erneut einer Therapie unterziehen. The invention is based on the finding that for the formation of a Destruction zone optimally adapted to the tumor tissue Electrode placement in the tumor plays a crucial role. In clinical In practice, it is now common to destroy larger ones Tissue areas to position multiple electrode needles in the tissue by means of Superposition of the thermal generated by the individual electrodes Destruction zones to achieve an increase in efficiency. Beyond that in some applications through a multi-channel temperature measurement a uniform thermal destruction zone can be achieved. this has proved in practice to be inadequate, however, because it is only Spot measurements are concerned and the tissue properties in some Distance of the measuring points cannot be taken into account. So it comes again and again to under therapy, d. H. in areas of tissue to be treated becomes the one required for complete destruction of the tumor tissue Temperature not reached. As a result, the patient suffers one Relapse and have to undergo therapy again.
Die Gewebeimpedanz hängt stark vom Fortschreiten der thermischen Gewebezerstörung ab. Mit zunehmender Verödung des Gewebes steigt dessen Impedanz an. Der grundlegende Gedanke der Erfindung ist die Tatsache, dass im Gegensatz zur Temperatur die Gewebeimpedanz eine Volumeninformation darstellt, welche die Gewebeeigenschaften zwischen den beiden für die Impedanzmessung nötigen Messstellen integral beschreibt. Erfindungsgemäß soll daher die Änderung des Impedanzverhaltens in Kombination mit einer multipolaren Applikationsanordnung zur optimalen Steuerung der Therapie genutzt werden. Überraschenderweise zeigt sich, dass bei einer Mehrfachapplikation, d. h. dem Fließenlassen von Hochfrequenzströmen zwischen mehreren aktiven Elektrodenpaaren, die Gewebeimpedanz zwischen den einzelnen aktiven Elektroden keinen einheitlichen Verlauf aufweist. Vielmehr kann das Gewebe zwischen einzelnen aktiven Elektrodenpaaren bereits in den Austrocknungszustand übergegangen sein, wobei es eine sehr hohe Impedanz aufweist, während das Gewebe zwischen anderen aktiven Elektrodenpaaren diesen Zustand noch nicht erreicht hat und demgemäss eine sehr niedrige Impedanz aufweist. Dies korreliert mit der klinischen Erkenntnis, dass auch bei punktueller Temperaturmessung eine sichere Volumendestruktion nicht garantiert werden kann. Ursache dieser nichthomogenen Austrocknung des Körpergewebes sind beispielsweise nicht gleichmäßig verteilte Blutgefässe, die eine lokal begrenzte Kühlwirkung ausüben und damit dem Therapieeffekt entgegenwirken. The tissue impedance depends heavily on the progress of the thermal Tissue destruction. With increasing desolation of the tissue increases its impedance. The basic idea of the invention is that The fact that, unlike temperature, tissue impedance is a Volume information representing the tissue properties between the integrally describes both measuring points required for the impedance measurement. According to the invention, the change in impedance behavior in Combination with a multipolar application arrangement for optimal Therapy control can be used. Surprisingly, it turns out that with a multiple application, d. H. the flowing of High frequency currents between several active electrode pairs, the Tissue impedance between the individual active electrodes is not uniform Has history. Rather, the tissue can be active between individual Electrode pairs have already passed into the drying state be, it has a very high impedance while the tissue this state does not yet exist between other active electrode pairs has reached and accordingly has a very low impedance. This correlates with the clinical knowledge that even with selective Temperature measurement a safe volume destruction can not be guaranteed. The cause of this non-homogeneous drying out of the body tissues are for example, blood vessels that are not evenly distributed, one locally exercise limited cooling effect and thus the therapeutic effect counteract.
Außerdem kann bei einer Mehrelektrodenkonfiguration, ähnlich wie bei einer rein bipolaren Anordnung, auf die Neutralelektrode oder die Neutralelektroden ganz verzichtet werden. Der Stromfluss bleibt dadurch auf die Zielregion beschränkt, Nebenwirkungen, wie sie von der monopolaren Anwendung bekannt sind, können daher nicht mehr auftreten. In addition, in a multi-electrode configuration, similar to a purely bipolar arrangement, on the neutral electrode or the Neutral electrodes can be dispensed with entirely. The current flow remains on the Target region limited, side effects, such as those of the monopolar Application are known, can therefore no longer occur.
Die erfindungsgemäße Applikationsvorrichtung zum Applizieren eines Hochfrequenzstroms zum thermischen Veröden von Körpergewebe umfasst eine Elektrodenmenge mit mindestens drei in Körpergewebe einführbare aktive Elektroden, einen Hochfrequenzgenerator zum Erzeugen einer Hochfrequenzspannung, der umschaltbar mit einer oder mehreren der aktiven Elektroden zu verbinden ist, und eine Messeinrichtung zum Messen der Impedanz des Gewebes zwischen allen oder ausgewählten aktiven Elektroden. Außerdem umfasst die Applikationsvorrichtung eine Auswahleinrichtung, die mit der Messeinrichtung verbunden ist und ausgestaltet ist eine mindestens zwei aktive Elektroden umfassende Untermenge aus der Elektrodenmenge anhand der gemessenen Impedanz auszuwählen. Des weiteren ist eine Steuereinrichtung vorhanden, die mit der Auswahleinrichtung verbunden und zum Anlegen der Hochfrequenzspannung an die aktiven Elektroden der ausgewählten Untermenge derart, dass zwischen ihnen ein Hochfrequenzstrom durch das Körpergewebe fließt, ausgestaltet ist. The application device according to the invention for applying a High-frequency current for the thermal desolation of body tissue comprises an electrode set with at least three in body tissue insertable active electrodes, a high frequency generator for generating a High frequency voltage that can be switched with one or more of the to connect active electrodes, and a measuring device for measuring the impedance of the tissue between all or selected active Electrodes. In addition, the application device comprises a Selection device which is connected to the measuring device and designed is a subset comprising at least two active electrodes the electrode quantity based on the measured impedance. Furthermore, there is a control device which is connected to the Selection device connected and for applying the high-frequency voltage to the active electrodes of the selected subset such that between a high-frequency current flows through the body tissue is.
Als Untermenge ist hierbei jede mindestens zwei aktive Elektroden umfassende Teilmenge der Elektrodenmenge zu verstehen, einschließlich des Falles, dass als Untermenge die gesamte Elektrodenmenge ausgewählt wird. Da die Impedanz als Volumeninformation über die Gewebeeigenschaften ein Maß für den Fortschritt der Verödung darstellt, ist die Impedanzmessung geeignet, unterschiedliche Verödungsgrade in Bereichen des zu verödenden Gewebes festzustellen. Die verschiedenen Gewebebereiche können dann durch das Anlegen der Hochfrequenzspannung an ausgewählte aktive Elektroden der Elektrodenmenge gezielt behandelt werden. Die Auswahl der Elektroden, d. h. das Bilden der Untermenge, bestimmt dabei die Strompfade durch das zu verödenden Gewebe. Each subset is at least two active electrodes comprehend comprehensive subset of the electrode set, including the In that case, the entire electrode quantity is selected as the subset becomes. Since the impedance as volume information about the Tissue properties is a measure of progress in desolation Suitable for impedance measurement, different degrees of sclerotherapy in areas of the tissue to be obliterated. The different Tissue areas can then be applied by applying the high frequency voltage selected active electrodes of the set of electrodes treated specifically become. The choice of electrodes, i. H. forming the subset, determines the current paths through the tissue to be obliterated.
In einer Ausgestaltung der Erfindung ist die Auswahleinrichtung derart ausgestaltet, dass eine neue Impedanzmessung und eine neue Auswahl einer mindestens zwei aktive Elektroden umfassenden Untermenge vorgenommen wird, wenn seit der vorangegangenen Auswahl eine vorbestimmte Zeit verstrichen ist. In one embodiment of the invention, the selection device is such designed that a new impedance measurement and a new selection of a subset comprising at least two active electrodes is made if a predetermined time since the previous selection has passed.
Durch das Applizieren des Hochfrequenzstromes nur über eine vorbestimmte Zeit und das Neuauswählen der Untermenge anhand einer neuen Impedanzmessung lässt sich der Fortschritt des Verödungsprozesses in vorbestimmten Abständen überprüfen und die weitere Applikation an den festgestellten Fortschritt anpassen. Die Neuauswahl bietet dabei die Möglichkeit, eine andere Untermenge von Elektroden als die bisher verwendete Untermenge auszuwählen und so auf die fortschreitende Verödung mit veränderten Strompfaden im zu verödenden Gewebe zu reagieren. Dies ist insbesondere von Vorteil, wenn die Verödung nicht im gesamten zu verödenden Gewebe gleichmäßig erfolgt, sondern lokal mit unterschiedlicher Geschwindigkeit voranschreitet. Außerdem lassen sich durch die zeitliche Begrenzung der Applikation Verbrennungen der behandelten Gewebebereiche durch zu lange Applikation des Hochfrequenzstromes vermeiden. By applying the high frequency current only over one predetermined time and reselecting the subset based on a new one Impedance measurement shows the progress of the desolation process Check the predetermined intervals and send the further application to the adjust detected progress. The new selection offers the Possibility of a different subset of electrodes than the one used previously Select subset and so on the progressive desolation with to react to changed current paths in the tissue to be obliterated. This is particularly beneficial if the sclerotherapy is not over desolating tissue occurs evenly, but locally with different Speed progresses. In addition, the temporal Limitation of application Burns of the treated Avoid tissue areas by applying the high-frequency current for too long.
In einer weiteren Ausgestaltung der Erfindung ist die Messeinrichtung dazu ausgelegt, die Impedanz des Körpergewebes während der Applikation des Hochfrequenzstroms zu messen. Die gemessenen Impedanzen können z. B. mit Referenzwerten, die vor Beginn der elektrothermischen Behandlung gemessen worden sind, in Beziehung gesetzt werden. Diese Ausgestaltung bietet den Vorteil, dass anhand der Impedanzmessung am Gewebe zwischen den Elektroden, insbesondere anhand der Änderung der Impedanzwerte gegenüber den Referenzwerten, der Fortschritt der Verödung laufend erfasst wird. Die Dauer der Applikation des Hochfrequenzstroms über die Elektrodenuntermenge kann so abhängig vom Fortschreiten der Verödung bestimmt werden. Durch den Vergleich der gemessenen Impedanzwerte mit den vorab bestimmten Referenzwerten lassen sich unerwünschte Einflüsse auf die gemessenen Impedanzwerte, die bspw. aus unterschiedlichen Abständen zwischen den verschiedenen Elektroden oder aus bereits vor Beginn der Behandlung unterschiedlichen Impedanzen verschiedener zu behandelnder Gewebebereiche resultieren, beim Bestimmen der Applikationsdauer berücksichtigen In a further embodiment of the invention, the measuring device is for this designed the impedance of the body tissue during the application of the To measure high frequency current. The measured impedances can z. B. with reference values before the start of the electrothermal Treatment have been measured to be related. This Design offers the advantage that the impedance measurement on the tissue between the electrodes, especially based on the change in Impedance values compared to the reference values, the progress of desolation is recorded continuously. The duration of the application of the high frequency current over the electrode subset can depend on the progression of the Desolation can be determined. By comparing the measured Impedance values with the predetermined reference values can be undesirable influences on the measured impedance values, for example different distances between the different electrodes or from different impedances before the start of treatment different areas of tissue to be treated result when determining take into account the duration of the application
Vorteilhafterweise ist die Auswahleinrichtung derart ausgestaltet, dass eine neue Auswahl einer mindestens zwei aktive Elektroden umfassenden Untermenge vorgenommen wird, wenn die Impedanz des Körpergewebes zwischen einer vorgegebenen Anzahl aktiver Elektroden der Untermenge einen vorbestimmten Wert erreicht oder überschreitet. The selection device is advantageously designed such that a new selection of at least two active electrodes Subset is made when the impedance of body tissue between a predetermined number of active electrodes of the subset reaches or exceeds a predetermined value.
Das Erreichen oder Überschreiten eines vorbestimmten Impedanzwertes zeigt an, dass die Verödung bis zu einem bestimmten Grad fortgeschritten ist. Die Verödung kann dann an einem anderen, noch nicht so weit verödeten Teil des zu verödenden Gewebes fortgesetzt werden. Damit lassen sich unnötig lange Applikationsdauern und daraus resultierende Belastungen des Patienten vermeiden. Daneben lassen sich auch Verbrennungen des Gewebes durch zu lange Applikation des Hochfrequenzstromes an einem Gewebebereich besonders effektiv vermeiden. Reaching or exceeding a predetermined impedance value indicates that the desolation has progressed to a certain extent is. The desolation can then be on another, not so far desolated portion of the tissue to be desolated. So that can be unnecessarily long application times and the resulting stress avoid the patient. In addition, burns of the Tissue due to too long application of the high-frequency current on one Avoid tissue area particularly effectively.
Die zeitabhängige und die impedanzabhängige Auswahl können auch kombiniert werden, so dass eine Neuauswahl immer dann stattfindet, wenn eine vorbestimmte Zeit verstrichen oder eine vorbestimmte Impedanz erreicht ist. The time-dependent and the impedance-dependent selection can also can be combined so that a new selection always takes place when a predetermined time has passed or a predetermined impedance is reached.
In noch einer weiteren Ausgestaltung der Erfindung ist die Auswahleinrichtung derart ausgestaltet, dass sie vor der Auswahl bzw. der Neuauswahl der mindestens zwei aktive Elektroden umfassenden Untermenge die Messeinrichtung veranlasst, eine Messung der Impedanz des Körpergewebes zwischen allen möglichen Paaren aus aktiven Elektroden durchzuführen, und als Untermenge diejenigen aktiven Elektroden auswählt, zwischen denen die Impedanz am geringsten ist oder einen vorbestimmten Wert nicht überschreitet. In yet another embodiment of the invention Selection device designed such that it before the selection or the new selection of the subset comprising at least two active electrodes Measuring device causes a measurement of the impedance of the Body tissue between all possible pairs of active electrodes and selects those active electrodes as a subset between which have the lowest impedance or a predetermined value does not exceed.
Dadurch, dass bei der Neuauswahl diejenigen aktiven Elektroden ausgewählt werden, zwischen denen das Körpergewebe die geringste Impedanz aufweist, lässt sich die Hochfrequenzspannung gezielt auf diejenigen Gewebebereiche anwenden, in denen die Verödung am wenigsten weit fortgeschritten ist. Due to the fact that the active electrodes in the new selection be selected between which the body tissue has the lowest impedance , the high-frequency voltage can be targeted to those Apply tissue areas where the desolation is the least distant is advanced.
Eine vorteilhafte Weiterbildung der erfindungsgemäßen Applikationsvorrichtung zeichnet sich dadurch aus, dass die Steuervorrichtung derart ausgestaltet ist, dass zu Beginn der Applikation die Hochfrequenzspannung in einem vorgegebenen zyklischen Wechsel an die aktiven Elektroden angelegt wird und die Auswahl der mindestens zwei aktive Elektroden umfassenden Untermenge anhand der Impedanz zu einem spätem Zeitpunkt der Applikation einsetzt. Zu beginn der Applikation besitzt die Impedanz im gesamten zu verödenden Gewebe häufig noch einen gleichen oder annähernd gleichen Wert. Die lokalen Unterschiede in der Impedanz stellen sich erst im Verlauf der Applikation ein, so dass eine impedanzangepasste Auswahl der Elektroden erst im Verlauf der Applikation sinnvoll wird. An advantageous development of the invention Application device is characterized in that the control device is such is designed so that the high-frequency voltage in a predetermined cyclical change to the active electrodes is applied and the selection of at least two active electrodes comprehensive subset based on the impedance at a late point in time Application. At the beginning of the application, the impedance in the entire tissue to be sclerosed often the same or approximately the same value. The local differences in impedance arise only in the course of the application, so that an impedance-adjusted Selection of the electrodes only makes sense in the course of the application.
In einer weiteren vorteilhaften Weiterbildung zeichnet sich die Applikationsvorrichtung dadurch aus, dass die Auswahleinrichtung derart ausgestaltet ist, dass als Untermenge mindestens drei aktive Elektroden ausgewählt werden und die Steuereinrichtung derart ausgestaltet ist, dass die aktiven Elektroden mit Hochfrequenzspannungen beaufschlagt werden, die jeweils um einen festen Phasenwinkel zueinander phasenverschoben sind. Der phasenverschobene Hochfrequenzstrom führt zu einer verbesserten Homogenität des applizierten Hochfrequenzstroms im zu verödenden Gewebe. In a further advantageous development, the Application device characterized in that the selection device is configured in such a way is that at least three active electrodes are selected as the subset are and the control device is designed such that the active Electrodes are subjected to high-frequency voltages, each are phase-shifted from one another by a fixed phase angle. The phase-shifted high-frequency current leads to an improved Homogeneity of the applied high-frequency current in the area to be obliterated Tissue.
Vorteilhafterweise werden als Untermenge drei aktive Elektroden ausgewählt, wobei die Phasenwinkel 120 Grad betragen. Dies ermöglicht es, die aktiven Elektroden mit Dreiphasenstrom, d. h. Drehstrom, zu betreiben. Three active electrodes are advantageously selected as the subset, the phase angles being 120 degrees. This makes it possible to operate the active electrodes with three-phase current, ie three-phase current.
Die aktiven Elektroden der Applikationsvorrichtung sind in einer vorteilhaften Ausgestaltung der Erfindung an Elektrodennadeln angeordnet, die das genaue interstitielle Anordnen der aktiven Elektroden im zu verödenden Gewebebereich oder um den zu verödenden Gewebebereich herum ermöglichen. The active electrodes of the application device are in one advantageous embodiment of the invention arranged on electrode needles that exact interstitial arrangement of the active electrodes in the area to be obliterated Tissue area or around the tissue area to be obliterated enable.
Die Elektrodennadeln können als bipolare Elektrodennadeln ausgestaltet sein, also jeweils zwei voneinander isolierte aktive Elektroden umfassen, die unabhängig voneinander mit Hochfrequenzspannung beaufschlagt werden können. Dadurch ist es möglich den Hochfrequenzstrom nicht nur zwischen verschiedenen Elektrodennadeln fliesen zu lassen, sondern auch entlang einer einzelnen Elektrodennadeln, was die Variationsmöglichkeit der Strompfade und damit die Anzahl der individuell verödbaren Teilbereiche des zu verödenden Gewebebereiches erhöht. The electrode needles can be designed as bipolar electrode needles be, ie each comprise two active electrodes insulated from one another, which act independently of each other with high frequency voltage can be. This makes it possible not only for the high-frequency current to let it flow between different electrode needles, but also along a single electrode needles what the variation possibility the current paths and thus the number of individually obliterable ones Partial areas of the tissue area to be obliterated increased.
Die Variationsmöglichkeiten können durch die Verwendung multipolarer Elektrodennadeln, d. h. Elektrodennadeln mit mehr als zwei aktiven Elektroden, weiter vermehrt werden. The possible variations can be achieved by using multipolar Electrode needles, d. H. Electrode needles with more than two active ones Electrodes, can be propagated further.
Eine vorteilhafte Weiterbildung der Elektrodennadeln zeichnet sich dadurch aus, dass sie mit einer isolierenden Umhüllung umgeben sind, aus der sie um vorbestimmte Längen ausfahrbar sind, so dass die Anzahl der Elektroden der multipolaren Elektrodennadeln durch Aus- und Einfahren der Elektrodennadeln aus der Umhüllung einstellbar ist. This is an advantageous development of the electrode needles from the fact that they are surrounded with an insulating covering from which they are extendable by predetermined lengths, so that the number of Electrodes of the multipolar electrode needles by extending and retracting the Electrode needles can be adjusted from the covering.
Eine Elektrodennadel kann einen oder mehrere Kanäle für ein Fluid zur Kühlung oder Heizung der aktiven Elektroden oder der gesamten Nadel aufweisen. Als Fluid kommen insbesondere Gase oder Flüssigkeiten in betracht. Die Heizung bzw. Kühlung kann dazu Verwendung finden, die durch den Hochfrequenzstrom erfolgende Erwärmung des Gewebes, d. h. den Temperaturverlauf im Gewebe, zu homogenisieren. Die Kanäle für das Fluid lassen sich auch in den bisher üblichen Elektrodennadeln zum Erzielen eines homogeneren Temperaturverlaufs einsetzen. An electrode needle can have one or more channels for a fluid Cooling or heating the active electrodes or the entire needle exhibit. In particular, gases or liquids come in as the fluid considered. The heating or cooling can be used for that heating of the tissue by the high frequency current, d. H. homogenize the temperature curve in the tissue. The channels for that Fluid can also be used in conventional electrode needles Achieve a more homogeneous temperature curve.
In einer Ausgestaltung zeichnen sich die Kanäle dadurch aus, dass sie zu den aktiven Elektroden führen und zum Zuführen von Kühlfluid geeignet sind. Die Erwärmung des Gewebes ist dort am stärksten, wo die Stromdichte des Hochfrequenzstroms am höchsten ist. Typischerweise ist die Stromdichte an den aktiven Elektroden höchsten. Die Kühlung der Elektroden kann die Temperatur des unmittelbar an die Elektroden angrenzenden Gewebes herabsetzen und so zu einem homogeneren Verlauf der Temperatur im Gewebe führen. In one embodiment, the channels are characterized in that they are closed lead the active electrodes and suitable for supplying cooling fluid are. The warming of the tissue is strongest where the Current density of the high-frequency current is highest. Typically that is Current density at the active electrodes is highest. Cooling the Electrodes can be the temperature of the one immediately adjacent to the electrodes Reduce tissue and thus to a more homogeneous course of the Temperature in the tissue.
Vorteilhafterweise ist das Fluid eine entionisierte Flüssigkeit. Flüssigkeiten haben typischerweise einen höheren Wärmekoeffizienten als Gase, sind jedoch in der Regel elektrisch leitfähig, so dass für eine gute elektrische Isolation der Kanäle gesorgt werden muss. Durch das Verwenden von entionisierten und daher nicht leitenden Flüssigkeiten kann auf die elektrische Isolation der Kanäle weitgehend verzichtet werden. Je besser die Entionisierung der Flüssigkeit ist, desto weniger aufwändig braucht die Isolation zu sein. The fluid is advantageously a deionized liquid. liquids typically have a higher heat coefficient than gases however, usually electrically conductive, so for good electrical Isolation of the channels must be taken care of. By using Deionized and therefore non-conductive liquids can affect the electrical Isolation of the channels can be largely dispensed with. The better that Deionization of the liquid is, the less complex the isolation takes his.
Weitere Merkmale und Vorteile der vorliegenden Erfindung werden nachfolgend anhand eines detaillierten Ausführungsbeispiels unter Bezugnahme auf die beiliegenden Zeichnungen beschrieben. Other features and advantages of the present invention will be below with reference to a detailed embodiment described on the accompanying drawings.
Fig. 1 zeigt in einem Blockschaltbild die Komponenten der vorliegenden Erfindung. Fig. 1 shows a block diagram of the components of the present invention.
Fig. 2 zeigt das Blockschaltbild einer alternativen Ausgestaltung der Erfindung. Fig. 2 is a block diagram showing an alternative embodiment of the invention.
Fig. 3a und 3b zeigen eine Elektrodennadel zur Verwendung in der erfindungsgemäßen Vorrichtung. Fig. 3a and 3b show an electrode needle for use in the inventive device.
Fig. 4a und 4b zeigen eine beispielhafte Anordnung der Elektrodennadeln im Gewebe in Draufsicht und Seitenansicht sowie die zugehörigen Stromflüsse. FIGS. 4a and 4b show an exemplary arrangement of the electrode needles in the tissue in plan view and side view as well as the associated current flows.
Fig. 5a und 5b zeigen eine weitere beispielhafte Anordnung der Elektrodennadeln im Gewebe in Draufsicht und Seitenansicht sowie die zugehörigen Stromflüsse. FIGS. 5a and 5b show a further exemplary arrangement of the electrode needles in the tissue in plan view and side view as well as the associated current flows.
Fig. 1 ist ein Blockschaltbild eines Ausführungsbeispieles für die erfindungsgemäße Vorrichtung zum Veröden von Körpergeweben. Die Vorrichtung umfasst eine Anzahl von aktiven Elektroden 1 bis 6, die zusammen eine Elektrodenmenge 7 bilden. Die Elektroden 1 bis 6 sind jeweils über individuelle Leitungen 9 mit einer Steuereinheit 11 verbunden. Mit der Steuereinheit 11 sind wiederum eine Messeinrichtung 13 zum Messen der Impedanz des Gewebes zwischen Elektroden 1 bis 6, eine Auswahleinrichtung 15 zum Auswählen von Elektroden und ein Hochfrequenzgenerator 17 zum Erzeugen hochfrequenter Wechselspannungen verbunden. Fig. 1 is a block diagram of an embodiment for the inventive device for sclerosing of body tissues. The device comprises a number of active electrodes 1 to 6 , which together form an electrode set 7 . The electrodes 1 to 6 are each connected to a control unit 11 via individual lines 9 . A control device 13 for measuring the impedance of the tissue between electrodes 1 to 6 , a selection device 15 for selecting electrodes and a high-frequency generator 17 for generating high-frequency alternating voltages are connected to the control unit 11 .
Der Hochfrequenzgenerator 17 hat bei multipolarer Anwendung beispielsweise eine Ausgangsleistung von 250 W an 20-50 Ω, bei einer Arbeitsfrequenz von 470 kHz. Im Falle bipolarer Anwendungen beträgt die Ausgangsleistung beispielsweise 125 W an 100 Ω, ebenfalls bei einer Arbeitsfrequenz von 470 kHz. Der Arbeitsbereicht des Hochfrequenzgenerators liegt zwischen 10 und 1.000 Ω. Die Impedanzmessung durch die Messeinrichtung 13 kann entweder bei der Arbeitsfrequenz von 470 kHz erfolgen, oder aber bei einer anderen Frequenz, insbesondere einer niedrigeren Frequenz, zum Beispiel 20 kHz. Der Hochfrequenzgenerator ist derart ausgelegt, dass er für typische Applikationszeiten von 20 Minuten und länger bei Volllast geeignet ist. The high-frequency generator 17 has, for example, an output power of 250 W at 20-50 Ω in a multipolar application, at an operating frequency of 470 kHz. In the case of bipolar applications, the output power is, for example, 125 W at 100 Ω, also at an operating frequency of 470 kHz. The working range of the high frequency generator is between 10 and 1,000 Ω. The impedance measurement by the measuring device 13 can either take place at the working frequency of 470 kHz, or else at another frequency, in particular a lower frequency, for example 20 kHz. The high-frequency generator is designed in such a way that it is suitable for typical application times of 20 minutes and longer at full load.
Die Messeinrichtung 13 ist derart ausgestaltet, dass sie in der Lage ist, die Impedanz des Gewebes zwischen jeweils zwei Elektroden der Elektrodenmenge 7 zu messen. Der Messvorgang kann beispielsweise erfolgen, indem zwischen zwei Elektroden der Elektrodenmenge 7 eine Wechselspannung angelegt wird und die Messeinrichtung 13 dann den durch die beiden Elektroden fließenden Wechselstrom misst. Dabei ist es ausreichend, den Betrag der Impedanz, also den Widerstand des Gewebes, zu messen. Alternativ kann die Messeinrichtung 13 jedoch auch den Phasenwinkel zwischen dem durch die beiden Elektroden fließenden Wechselstrom und der an den Elektroden anliegenden Wechselspannung ermitteln, so dass sich die Impedanz vollständig bestimmen lässt. Aus dem Ergebnis der Impedanzmessung kann die Auswahleinrichtung 15 den Verödungsgrad des Gewebes zwischen den beiden Elektroden ermitteln. Je höher der Verödungsgrad ist, desto höher ist die Impedanz des Gewebes. The measuring device 13 is designed in such a way that it is able to measure the impedance of the tissue between each two electrodes of the electrode set 7 . The measuring process can take place, for example, by applying an alternating voltage between two electrodes of the electrode set 7 and then measuring device 13 to measure the alternating current flowing through the two electrodes. It is sufficient to measure the amount of impedance, i.e. the resistance of the tissue. Alternatively, however, the measuring device 13 can also determine the phase angle between the alternating current flowing through the two electrodes and the alternating voltage applied to the electrodes, so that the impedance can be determined completely. From the result of the impedance measurement, the selection device 15 can determine the degree of sclerotherapy of the tissue between the two electrodes. The higher the degree of obliteration, the higher the impedance of the tissue.
Um die Frequenzabhängigkeit der Impedanz beim Bestimmen des Gewebezustandes berücksichtigen zu können, kann die Impedanzmessung bei mehreren Frequenzen vorgenommen werden. Die in der Frequenzabhängigkeit der Impedanz enthaltene Information kann beispielsweise beim Bestimmen von Applikationsparametern für die Applikation des Hochfrequenzstromes Berücksichtigung finden. To determine the frequency dependence of the impedance when determining the The impedance measurement can be used to take tissue condition into account several frequencies can be made. The in the Information contained in the frequency dependence of the impedance can be found, for example, in Determination of application parameters for the application of the Find high-frequency current.
Die beschriebene Impedanzmessung erfolgt im vorliegenden Ausführungsbeispiel für alle möglichen Elektrodenpaare der Elektrodenmenge 7, so dass der Auswahleinrichtung 15 Impedanzwerte für alle Gewebebereiche zwischen jeweils zwei Elektrodenpaaren zur Verfügung stehen. Anhand dieser Impedanzwerte wählt die Auswahleinrichtung 15 dann mindestens zwei Elektroden der Elektrodenmenge 7 aus, die eine Untermenge der Elektrodenmenge 7 bilden. In the present exemplary embodiment, the described impedance measurement is carried out for all possible electrode pairs of the electrode set 7 , so that the selection device 15 has impedance values available for all tissue areas between two respective electrode pairs. Based on these impedance values, the selection device 15 then selects at least two electrodes of the electrode set 7 , which form a subset of the electrode set 7.
Die ausgewählte Untermenge teilt die Auswahleinrichtung 15 der Steuereinheit 11 mit, die dann über die Leitungen 9 den Elektroden der Untermenge 19, hier die Elektroden 5 und 6, die vom Hochfrequenzgenerator 17 erzeugte Hochfrequenzspannung zuführt. Dazu umfasst die Steuereinheit 11 eine Schalteinheit, mit deren Hilfe die Leitungen 9 individuell mit dem Hochfrequenzgenerator 17 verbindbar sind. Der Hochfrequenzgenerator 17 kann beispielsweise eine Konstantstrom- oder Konstantspannungsquelle sein. The selected subset communicates the selection device 15 to the control unit 11 , which then supplies the electrodes of the subset 19 , here the electrodes 5 and 6 , via lines 9 to the high frequency voltage generated by the high frequency generator 17 . For this purpose, the control unit 11 comprises a switching unit, by means of which the lines 9 can be individually connected to the high-frequency generator 17 . The high-frequency generator 17 can be, for example, a constant current or constant voltage source .
Wenn die Hochfrequenzspannung an die Elektroden 5 und 6 der Untermenge 19 angelegt wird, fließt zwischen ihnen ein hochfrequenter Wechselstrom, der zu einer Erwärmung des Gewebes und als Folge dessen zu einer Denaturierung des Gewebes führt. Nach einer vorgegebenen Zeitdauer beendet die Steuereinheit 11 das Zuführen der Hochfrequenzspannung an die Elektroden der Untermengen 19 und veranlasst die Messeinrichtung 13, erneut die Impedanz zwischen allen möglichen Elektrodenpaaren der Elektrodenmenge 7 zu messen. Die Auswahleinrichtung 15 wählt dann beispielsweise aus der Elektrodenmenge das Elektrodenpaar als Untermenge 19 aus, zwischen dem das Gewebe den geringsten Impedanzanstieg aufweist. Die Impedanzwerte können ggf. auch mit Gewichtungsfaktoren unterschiedlich gewichtet werden. Das ausgewählte Elektrodenpaar kann dasselbe Elektrodenpaar 5, 6 wie im vorangegangenen Auswahlprozess oder ein anderes Elektrodenpaar sein. Letzteres wird der Fall sein, wenn aufgrund der elektrothermischen Behandlung die Impedanz des Gewebes zwischen den Elektroden 5 und 6 derart angestiegen ist, dass sie höher ist als die Impedanz des Gewebes zwischen mindestens einem anderen Elektrodenpaar. When the high-frequency voltage is applied to the electrodes 5 and 6 of the subset 19 , a high-frequency alternating current flows between them, which leads to heating of the tissue and, as a result, to denaturation of the tissue. After a predetermined period of time, the control unit 11 stops supplying the high-frequency voltage to the electrodes of the subsets 19 and causes the measuring device 13 to measure the impedance again between all possible pairs of electrodes of the electrode set 7 . The selection device 15 then selects, for example, the pair of electrodes as a subset 19 from the quantity of electrodes, between which the tissue exhibits the smallest increase in impedance. If necessary, the impedance values can also be weighted differently with weighting factors. The selected pair of electrodes can be the same pair of electrodes 5 , 6 as in the previous selection process or a different pair of electrodes. The latter will be the case if, due to the electrothermal treatment, the impedance of the tissue between the electrodes 5 and 6 has risen in such a way that it is higher than the impedance of the tissue between at least one other pair of electrodes.
Eine Untermenge 19 der Elektrodenmenge 7 kann auch mehr als zwei Elektroden umfassen. In diesem Fall kann es sinnvoll sein, eine Impedanzschwelle vorzugeben, die vorgibt, ob dem Gewebe zwischen den entsprechenden Elektrodenpaaren ein Hochfrequenzstrom zugeführt werden soll oder nicht. Erreicht oder überschreitet die Impedanz des Gewebes zwischen einem Elektrodenpaar die Impedanzschwelle nicht, so wird das betreffende Elektrodenpaar in die Untermenge 19 aufgenommen. A subset 19 of the electrode set 7 can also comprise more than two electrodes. In this case, it can be useful to specify an impedance threshold that specifies whether a high-frequency current should be supplied to the tissue between the corresponding pairs of electrodes or not. If the impedance of the tissue between a pair of electrodes does not reach or exceed the impedance threshold, the pair of electrodes in question is included in the subset 19 .
In einer alternativen Ausgestaltung der Erfindung misst die Messeinrichtung 13 während der Applikation des Hochfrequenzstroms kontinuierlich die Impedanz zwischen den Elektroden und gibt ein Signal an die Steuereinrichtung 11 aus, sobald die Impedanz oder der Impedanzanstieg des Gewebes zwischen den Elektroden 5 und 6 einen vorbestimmten Schwellenwert überschreitet. Die Steuereinrichtung beendet dann die Applikation des Hochfrequenzstroms. Nach dem Beenden der Applikation des Hochfrequenzstromes veranlasst die Steuereinrichtung 11 die Messeinrichtung 13, erneut die Impedanz des Gewebes zwischen allen Elektrodenpaaren zu messen, und veranlasst danach die Auswahleinrichtung 15 anhand des Ergebnisses der Impedanzmessung eine neue Untermenge 19 der Elektrodenmenge 7 auszuwählen, über die dann dem Gewebe der Hochfrequenzstrom zugeführt wird. In an alternative embodiment of the invention, the measuring device 13 continuously measures the impedance between the electrodes during the application of the high-frequency current and outputs a signal to the control device 11 as soon as the impedance or the increase in impedance of the tissue between the electrodes 5 and 6 exceeds a predetermined threshold value. The control device then ends the application of the high-frequency current. After the application of the high-frequency current has ended, the control device 11 causes the measuring device 13 to measure the impedance of the tissue between all the electrode pairs again, and then causes the selection device 15 to select a new subset 19 of the electrode set 7 based on the result of the impedance measurement, via which the Tissue of the high frequency current is supplied.
Umfasst die Untermenge 19 mehr als zwei Elektroden, so kann es vorgesehen sein, dass die Steuereinrichtung 11 die Applikation des Hochfrequenzstroms beendet, sobald die Impedanz des Gewebes zwischen einem der Elektrodenpaare einen vorbestimmten Wert überschreitet oder alternativ dann, wenn bei einer vorbestimmten Anzahl von Elektrodenpaaren das dazwischen liegende Gewebe die vorgegebene Impedanzschwelle überschreitet. If the subset 19 comprises more than two electrodes, it can be provided that the control device 11 ends the application of the high-frequency current as soon as the impedance of the tissue between one of the electrode pairs exceeds a predetermined value or alternatively if this occurs for a predetermined number of electrode pairs Intermediate tissue exceeds the specified impedance threshold.
Eine alternative Ausgestaltung der Erfindung ist als Blockschaltbild in Fig. 2 dargestellt. Gleiche Elemente wie in der in Fig. 1 dargestellten Ausführungsform sind mit den gleichen Bezugszeichen bezeichnet und werden im Folgenden nicht weiter erläutert. An alternative embodiment of the invention is shown as a block diagram in FIG. 2. The same elements as in the embodiment shown in FIG. 1 are denoted by the same reference numerals and are not explained further below.
Die alternative Ausgestaltung unterscheidet sich von der in Fig. 1 dargestellten dadurch, dass eine Schalteinheit 12 vorhanden ist, die als von der Steuereinheit 11 getrennte Einheit ausgebildet ist. Mit der Schalteinheit 12 direkt verbunden ist der Hochfrequenzgenerator 17 sowie ein A/D-Wandler 14 zum Umwandeln der aus der Impedanzmessung resultierenden analogen Signale in digitale Signale, die an einen Prozessor 16 abgegeben werden. Die Schalteinheit 12 ist dazu ausgelegt, jede Elektrode 1-6 individuell mit dem Hochfrequenzgenerator 17 und/oder dem A/D-Wandler 14 zu verbinden. The alternative embodiment differs from that shown in FIG. 1 in that a switching unit 12 is provided, which is designed as a unit separate from the control unit 11 . The high-frequency generator 17 and an A / D converter 14 for converting the analog signals resulting from the impedance measurement into digital signals, which are output to a processor 16 , are connected directly to the switching unit 12 . The switching unit 12 is designed to connect each electrode 1-6 individually to the high-frequency generator 17 and / or the A / D converter 14 .
Der Prozessor 16 umfasst die Mess- oder Auswerteeinheit 13', die mit dem A/D-Wandler 14 zum Empfang der aus der Impedanzmessung resultierenden digitalen Signale verbunden ist und aus den empfangenen Signalen die Impedanz des Körpergewebes ermittelt. Die Auswerteeinheit 13' ist außerdem zum Ausgeben der Impedanzwerte mit der Auswahleinheit 15 verbunden, die wiederum mit der Steuereinheit 11 verbunden ist. Die Auswahleinheit 15 wählt die zu verwendenden aktiven Elektroden (im dargestellten Ausführungsbeispiel die Elektroden 5 und 6) anhand der Impedanzwerte aus und teilt die Auswahl dann der Steuereinheit 11 mit. Gemäß dieser Auswahl wirkt die Steuereinheit 11 über eine Steuerleitung auf die Schalteinheit 12 ein, so dass sie die ausgewählten aktiven Elektroden mit dem Hochfrequenzgenerator 17 verbindet. The processor 16 comprises the measuring or evaluation unit 13 ', which is connected to the A / D converter 14 for receiving the digital signals resulting from the impedance measurement and determines the impedance of the body tissue from the received signals. The evaluation unit 13 ′ is also connected to the selection unit 15 for outputting the impedance values, which in turn is connected to the control unit 11 . The selection unit 15 selects the active electrodes to be used (in the exemplary embodiment shown, the electrodes 5 and 6 ) on the basis of the impedance values and then communicates the selection to the control unit 11 . According to this selection, the control unit 11 acts on the switching unit 12 via a control line, so that it connects the selected active electrodes to the high-frequency generator 17 .
Alternativ kann die Steuereinheit 11 zusätzlich über eine Steuerleitung mit dem Hochfrequenzgenerator 17 verbunden sein, um die Frequenz der vom Hochfrequenzgenerator 17 abgegebenen Hochfrequenzspannung einstellen zu können. Alternatively, the control unit 11 can additionally be connected to the high-frequency generator 17 via a control line in order to be able to set the frequency of the high-frequency voltage output by the high-frequency generator 17 .
In den dargestellten Ausführungsformen sind die aktiven Elektroden als Elektrodennadeln ausgeführt. Eine solche Elektrodennadel ist in der Fig. 3a gezeigt. Die Elektrodennadel 100 weist an ihrem proximalen Ende, d. h. dem aus dem Gewebe herausragenden Ende, einen Griffbereich 102 und an ihrem distalen Ende, d. h. dem zum Einbringen in das Gewebe vorgesehenen Ende 104 zwei aktive Elektroden 120 und 122 auf (siehe Fig. 3b). Zwischen den beiden Elektroden 120 und 122 befindet sich ein isolierender Bereich 124, der die beiden Elektroden voneinander elektrisch isoliert. Obwohl die in Fig. 3a und 3b dargestellte Elektrodennadel zwei Elektroden aufweist, kann die Elektrodennadel auch mehr als zwei aktive Elektroden oder nur eine Elektrode aufweisen. Sind mehr als zwei Elektroden vorhanden, so befindet sich zwischen allen Elektroden jeweils ein isolierender Bereich. Alle Elektroden einer Elektrodennadel 100 sind jeweils über individuelle Leitungen mit einem Steuergerät (nicht gezeigt) derart verbunden, dass jeder Elektrode individuell eine Hochfrequenzspannung zugeführt werden kann. In the illustrated embodiments, the active electrodes are designed as electrode needles. Such an electrode needle is shown in FIG. 3a. The electrode needle 100 has a handle area 102 at its proximal end, ie the end protruding from the tissue, and two active electrodes 120 and 122 at its distal end, ie the end 104 intended for insertion into the tissue (see FIG. 3b). There is an insulating region 124 between the two electrodes 120 and 122 , which electrically insulates the two electrodes from one another. Although the electrode needle shown in FIGS . 3a and 3b has two electrodes, the electrode needle can also have more than two active electrodes or only one electrode. If there are more than two electrodes, there is an insulating area between each electrode. All electrodes of an electrode needle 100 are each connected via individual lines to a control device (not shown) in such a way that a high-frequency voltage can be supplied to each electrode individually.
Die Elektrodennadel 100 kann in ihrem Inneren auch einen oder mehrere Kanäle zum Zuführen eines Fluids umfassen, um die aktiven Elektroden oder die gesamte Nadel zu kühlen oder zu heizen. Electrode needle 100 may also include one or more fluid supply channels therein to cool or heat the active electrodes or the entire needle.
In den Fig. 4a und 4b ist ein erstes Beispiel für die Anwendung der Applikationsvorrichtung schematisch dargestellt. Die Figuren zeigen ein pathologisches Gewebe 200, das Zielgewebe, in das drei Elektrodennadeln 100 derart punktiert sind, dass ihre aktiven Elektroden 120 und 122 in direktem elektrischen Kontakt mit dem Zielgewebe stehen. A first example of the application of the application device is shown schematically in FIGS. 4a and 4b. The figures show a pathological tissue 200 , the target tissue, into which three electrode needles 100 are punctured such that their active electrodes 120 and 122 are in direct electrical contact with the target tissue.
Die Elektroden 120 und 122 werden von der Steuereinheit 11 zuerst derart mit einer Hochfrequenzspannung beaufschlagt, dass ein Hochfrequenzstrom entlang den Elektrodennadeln 100 in axialer Richtung zwischen den Elektroden 120 und 122 fließt. Diese Stromflüsse sind in Fig. 4b, die entsprechenden Potentiale in Fig. 4a durch punktierte Linien angedeutet. The control unit 11 first applies a high-frequency voltage to the electrodes 120 and 122 in such a way that a high-frequency current flows along the electrode needles 100 in the axial direction between the electrodes 120 and 122 . These current flows are indicated in FIG. 4b, the corresponding potentials in FIG. 4a by dotted lines.
Fig. 4a zeigt eine Draufsicht auf die drei Elektrodennadeln 100, während Fig. 4b eine Seitenansicht von zwei der drei Elektrodennadeln 100 zeigt. Durch die Überlagerung der Stromflüsse aller drei Elektrodennadeln 100 entsteht zwischen den Nadeln ein Gewebebereich mit homogenem Stromfluss, so dass sich eine homogene Erwärmung des Gewebebereiches erzielen lässt. FIG. 4a shows a top view of the three electrode needles 100 , while FIG. 4b shows a side view of two of the three electrode needles 100 . The superimposition of the current flows of all three electrode needles 100 creates a tissue area with a homogeneous current flow between the needles, so that a homogeneous heating of the tissue area can be achieved.
Gleichzeitig mit der Applikation des Hochfrequenzstromes wird bei der Arbeitsfrequenz oder aber einer anderen Frequenz von der Messeinrichtung 13 die Gewebeimpedanz zwischen den Elektroden 120 und 122 gemessen. Insbesondere, wenn dafür eine Frequenz gewählt wird, die nicht der Arbeitsfrequenz entspricht, so kann bei laufender Applikation die Impedanz des Gewebes zwischen einzelnen Elektrodenpaaren gemessen werden, ohne dass der Applikationsstrom diese Messung wesentlich behindert. Dazu umfasst die Messeinrichtung einen Frequenzdiskriminator oder -filter, der in der Lage ist, die Frequenz der Impedanzmessung, beispielsweise 20 kHz, von der Arbeitsfrequenz, beispielsweise 470 kHz, zu trennen. Simultaneously with the application of the high-frequency current, the tissue impedance between the electrodes 120 and 122 is measured by the measuring device 13 at the working frequency or another frequency. In particular, if a frequency is selected for this that does not correspond to the working frequency, the impedance of the tissue between individual electrode pairs can be measured while the application is running, without the application current significantly impeding this measurement. For this purpose, the measuring device comprises a frequency discriminator or filter, which is able to separate the frequency of the impedance measurement, for example 20 kHz, from the working frequency, for example 470 kHz.
Die Fig. 5a und 5b zeigen ein weiteres Beispiel für die Anwendung der erfindungsgemäßen Applikationsvorrichtung. Statt in das Zielgewebe werden in diesem Beispiel drei Elektrodennadeln 100 knapp außerhalb des Zielgewebes punktiert, so dass das Zielgewebe sich zwischen den drei Elektrodennadeln 100 befindet. Im Gegensatz zu dem in den Fig. 4a und 4b dargestellten Beispiel erfolgt der Stromfluss hier nicht parallel zu den Nadelachsen, sondern von einer Elektrodennadel 100 zur anderen. Dadurch lässt sich im Zielgewebe 200 ein homogener Stromfluss erzielen. Außerdem kann ein Verschleppen malignen Gewebes beim Entfernen der Elektrodennadeln vermieden werden. FIGS. 5a and 5b show a further example of the application of the application device according to the invention. In this example, instead of into the target tissue, three electrode needles 100 are punctured just outside the target tissue, so that the target tissue is located between the three electrode needles 100 . In contrast to the example shown in FIGS. 4a and 4b, the current flow here does not take place parallel to the needle axes, but from one electrode needle 100 to the other. As a result, a homogeneous current flow can be achieved in the target tissue 200 . Carryover of malignant tissue when removing the electrode needles can also be avoided.
Die Applikationsvorrichtung kann entweder ausschließlich mit axialem Stromfluss entlang der Nadeln, ausschließlich mit Stromfluss zwischen zwei verschiedenen Nadeln oder einer Kombination von beidem betrieben werden. Die Richtung des Stromflusses kann nach einer Neuauswahl der Untermenge aktiver Elektroden von dem einen Modus in den anderen Modus umgeschaltet werden. The application device can either exclusively with axial Current flow along the needles, only with current flow between operated two different needles or a combination of both become. The direction of the current flow can be selected after a new selection Subset of active electrodes from one mode to the other Mode can be switched.
Obwohl in den Ausführungsbeispielen jeweils Elektrodenmengen mit sechs Elektroden dargestellt sind, kann die Elektrodenmenge auch mehr oder weniger als sechs Elektroden enthalten. Although in the exemplary embodiments each electrode sets with six Electrodes are shown, the amount of electrodes can also be more or contain less than six electrodes.
Claims (15)
Priority Applications (8)
Application Number | Priority Date | Filing Date | Title |
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DE2002124154 DE10224154A1 (en) | 2002-05-27 | 2002-05-27 | Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue |
CNB038120747A CN100409822C (en) | 2002-05-27 | 2003-05-23 | Device for electrosurgically destroying body tissue |
AT03735453T ATE515285T1 (en) | 2002-05-27 | 2003-05-23 | DEVICE FOR ELECTROSURGICAL DESCROPTION OF BODY TISSUE |
EP03735453A EP1511534B1 (en) | 2002-05-27 | 2003-05-23 | Device for electrosurgically destroying body tissue |
PCT/EP2003/005439 WO2003099372A2 (en) | 2002-05-27 | 2003-05-23 | Device for electrosurgically destroying body tissue |
US10/515,945 US8216219B2 (en) | 2002-05-27 | 2003-05-23 | Device for electrosurgically destroying body tissue |
AU2003237671A AU2003237671A1 (en) | 2002-05-27 | 2003-05-23 | Device for electrosurgically destroying body tissue |
JP2004506895A JP4338631B2 (en) | 2002-05-27 | 2003-05-23 | Device for hardening body tissue by electrosurgery (thermal scrosis) |
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DE2002124154 DE10224154A1 (en) | 2002-05-27 | 2002-05-27 | Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue |
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