DEVICE FOR DETERMINING A CURRENT STOP POINT OF A MEDICAL INSTRUMENT

Description

Technical area

[0001] The invention relates to a device and a method for measuring tissue temperature, in particular of human tissue, in a medical high-frequency surgical instrument during a thermal process (HF, ultrasound, laser instrument, etc.). Background of the invention

[0002] In high-frequency surgery (hereinafter referred to as HF surgery), high-frequency alternating current is passed through the human body or a body part to specifically cauterize (coagulate) or cut (electrotomy) tissue through the resulting heat. The damaged tissue is later reabsorbed by the surrounding healthy tissue. A significant advantage over conventional cutting techniques using a scalpel is that bleeding can be stopped simultaneously with the incision by closing the affected vessels, in the sense of coagulation. To securely close vessels, so-called Seal & Cut instruments should be used. The devices used are also referred to as electroscalpels.

[0003] At the frequencies used for HF (high-frequency) surgery, body tissue behaves like an ohmic resistor (impedance). The specific resistance depends strongly on the tissue type. The specific resistance of muscle tissue and highly perfused tissue is relatively low. That of fat is approximately 15 times higher, and that of bone by a factor of 1000. The frequency, shape, and magnitude of the current must / should therefore be tailored to the type of tissue being operated on.

[0004] Currently, monopolar HF technology is most commonly used in HF surgery. One pole of the HF voltage source is connected to the patient via a counter electrode with the largest possible surface area, e.g. through contacts on the operating table on which the patient lies, through contact armbands or contact footbands, or through adhesive electrodes. This counter electrode is often called the neutral electrode. The other pole is connected to the surgical instrument and this forms the so-called active electrode. The current flows via the path of least resistance from the active electrode to the neutral electrode. The current density is highest in the immediate vicinity of the active electrode; this is where the thermal effect is most pronounced. The current density decreases with the square of the distance.The neutral electrode should cover as large a surface area as possible and be firmly connected to the body to keep the current density in the body low and avoid burns. The skin at the neutral electrode is not noticeably heated due to its large surface area. Strict safety precautions apply when applying the neutral electrode. To avoid burns, correct positioning and good contact of the neutral electrode (depending on the surgical area) are crucial.

[0005] In bipolar HF technology, unlike monopolar technology, the current flows through a small part of the body—the part where the surgical effect (incision or coagulation) is desired. Two mutually insulated electrodes (e.g., located in instrument branches), between which the HF voltage is applied, are applied directly to the surgical site. The circuit is closed via the tissue in between. The thermal effect occurs in the tissue between the electrodes.

[0006] Coagulation clamps are well-known. The high-frequency connectors are usually located on the handles. A screw with an insulating coating often serves as the pivot point for the joint, which also pivots the two clamping arms and their handles together.

[0007] With a bipolar RF vessel sealing and / or cutting system, vessels or tissue bundles can be effectively and permanently sealed, either generally or during cutting. This limits lateral thermal damage to the surrounding tissue and minimizes tissue adhesions.

[0008] In medicine, tissue is an organic material consisting of a group of similar or differently differentiated cells that share a common function or structure. In addition to cells, tissue also includes the extracellular matrix (ECM). Examples of human tissue include blood vessels.

[0009] The chemical composition of the human body is approximately 56% oxygen (O), 28% carbon (C), 9% hydrogen (H), 2% nitrogen (N), 1.5% calcium, 1% chlorine (Cl), 1% phosphorus (P), 0.25% potassium (K), 0.2% sulfur (S) and other chemical substances in smaller proportions (all values ​​in weight percent).

[0010] The substance composition of the human body consists of approximately 67% water, 16% proteins (e.g. collagen), 10% lipids (e.g. fat), 1% carbohydrates, 1% nucleic acids and 5% various minerals (all values ​​in weight percent).

[0011] Collagens are a group of structural proteins (proteins forming a bundle of fibers) found in humans and animals, primarily in connective tissue (more precisely, the extracellular matrix). Collagens are found, among other things, in the white, inelastic fibers of tendons, ligaments, bones, and cartilage. Layers of the skin (subcutaneous tissue) also consist of collagen. In the human body, collagen is the most abundant protein, accounting for over 30% of the total mass of all proteins.

[0012] In living organisms, lipids are used primarily as structural components in cell membranes, as energy stores, or as signaling molecules. The term "fat" is often used as a synonym for lipids, but fats (triglycerides) represent only a subgroup of lipids.

[0013] The main optical absorbers in tissues such as blood vessels in the NIR range are water and collagen. Blood vessels are usually surrounded by fat.

[0014] When electromagnetic radiation interacts with solids, liquids, or gases, various effects occur, such as absorption, reflection, scattering, or transmission. In other words, when electromagnetic radiation encounters an obstacle, it is either absorbed (swallowed), scattered (deflected from its original direction), transmitted (passed through), or reflected (bounced back) – this is also referred to as remission during reflection.

[0015] In physics, remission refers to diffuse (undirected) electromagnetic radiation, especially light, that penetrates a scattering medium through its surface, interacts with it, and exits through that surface again. This contrasts with regular, directed reflection, which obeys the law of reflection. However, both cases are more commonly referred to as reflection. A distinction is then made between specular and diffuse reflection. In remission (diffuse reflection), a portion of the light is absorbed and transmitted. The surface-related measure of remission is the remission coefficient.

[0016] Reflectance spectroscopy is a branch of spectroscopy that measures the radiation reflected by a sample. Reflectance spectroscopy is primarily used for the spectral investigation of opaque and insoluble samples. The measured reflectance spectrum of a sample consists of two components: 1) regular reflection, in which the radiation is specularly reflected from the surface. This is described by Fresnel's equations; 2) diffuse reflection, in which the radiation emerges from the sample isotropically in all directions. This occurs when the radiation penetrates the sample and returns to the surface after partial absorption and multiple scattering.

[0017] The respective absorption spectra of water, collagen, and fat have already been measured by numerous groups. Absorption coefficient values ​​are available in both the visible (VIS) and near-infrared (NIR) spectral ranges.

[0018] The control processes in bipolar RF technology are currently controlled via tissue impedance, which changes during the energy delivery process, primarily due to water loss. Tissue impedance is calculated using Ohm's law based on the measured voltage and current values. Due to the configuration of an instrument, the determined impedance is always an average value of the entire system (tissue, instrument, cable, generator).

[0019] The quality of blood vessel sealing depends essentially on the regulation process and the associated energy input into the tissue. This can lead to overheating of the instruments and thermal damage to the surrounding tissue. Insufficient energy input can also lead to failure or rupture of the fused areas, which in turn manifests as bleeding. Often, this bleeding does not occur until hours after the actual surgery, so depending on the vessel diameter, emergency surgery may be necessary to stop the bleeding or securely close the vessel. State of the art

[0020] It is therefore known from the prior art to measure tissue temperature and incorporate the measured temperature values ​​into the regulation / control of the thermal process. To prevent the temperature measurement results from being distorted by the electrode temperature, a sufficiently large distance, or thermal separation / insulation, between the tissue temperature sensor and the electrode(s) is required. However, this is disadvantageous in that the measured tissue temperature does not exactly correspond to the tissue temperature directly at the electrode(s).

[0021] EP 3 011 924 A1 discloses a treatment system comprising: a treatment instrument that applies treatment energy to living tissue; a power source that outputs power; a temperature measuring section for measuring a temperature of the living tissue; a calculating section that calculates a heating amount Q, which is a time integral value of the temperature of the living tissue, from the temperature of the living tissue and a time duration of application of the treatment energy; a comparing section that compares the heating amount Q and a predetermined heating amount set value Qset; and an instructing section that outputs an instruction based on a result of the comparison by the comparing section.

[0022] US 2012 / 245576 A1 discloses a system for remotely controlling a surgical device including an imaging device. The surgical device sends information to a computer with software, which displays the information and / or controls the operation of the surgical device. A display is coupled to the computer to display a graphical user interface and a unified image.

[0023] US 2016 / 166309 A1 discloses a method and a system for determining ablation parameters for ablating tissue. In one embodiment, a method comprises determining the thickness of a tissue to be ablated. The method further comprises selecting the ablation temperature from a range of ablation temperature values ​​predefined for the tissue to be ablated. The method comprises determining the optimal tissue temperature for effective lesion formation across the entire thickness of the tissue, wherein the optimal tissue temperature corresponds to the selected ablation temperature. Furthermore, the method comprises determining the optimal time period required for effective lesion formation across the entire thickness of the tissue at the optimal tissue temperature.

[0024] US 2018 / 345029 A1 discloses a method and system for generating and distributing heat in a target area of ​​a patient's body for treating lesions, tumors, cancer, body aches, and neuralgia. The generated heat and tissue temperature are monitored in real time. The system includes a radio frequency (RF) antenna for receiving the RF waves generated by an RF generator. An RF absorber comprising multiple closed-loop circuits and a miniaturized thermometer are implanted in the body near the target tissue. A controller / optimizer regulates a frequency and transmission timing of the RF waves based on the measured target tissue temperature. The thermometer, RF absorber, and wireless transmitter are placed in a screw. The RF absorber is made of metal with a higher RF absorption rate than that of biological tissue.Ultrasound energy is also used to treat the target area.

[0025] US 2017 / 020597 A1 discloses devices, systems, and methods for evaluating the success of a treatment applied to a patient's tissue, such as a radiofrequency ablation treatment for neuromodulation of nerves connected to the renal artery. A system monitors parameters or values ​​generated during a treatment. Summary of the invention

[0026] The object of the invention is therefore to enable, in addition to or as an alternative to measuring impedance, the most precise possible measurement of the temperature of the tissue to be fused, preferably online, in order to perform controlled tissue damage directly at the electrode(s) and, if necessary, also prevent overheating of the instruments. In other words, the object of the invention is to enable good coagulation by providing a shutdown criterion for deactivating a medical instrument.

[0027] The object of the invention is solved by the features of claims 1 and 11.

[0028] The invention relates to a medical instrument and a computer-readable storage medium on which instructions are stored that cause a processor of the medical instrument to execute a method for determining a shutdown time, comprising the steps (preferably in this order): Measuring the duration for which the temperature of the tissue is above 85°Celsius, preferably above 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius (Dur95), calculating the average temperature from the first reaching of 85°Celsius, preferably 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius (MeanTempabTmax), measuring and / or calculating the energy input until 85°Celsius is reached, preferably 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius (E2Tmax), calculating a parameter SP which links the above results and switches off the medical instrument at a predetermined value, preferably between 2 and 3, particularly preferably at SP = 2.5, or allows a switch-off from this value.

[0029] A thermal process is preferably any process that generates thermal effects in tissue through the release of energy. This includes processes that use high-frequency, ultrasound, laser, and / or temperature. This also includes processes that use high-frequency, ultrasound, laser, and / or temperature instruments (e.g., thermocautery), or any medical instrument that generates thermal effects in tissue through the release of energy.

[0030] Preferably, the method further comprises at least one of the following steps: Emitting light with an excitation spectrum, preferably in the VIS / NIR range, into a tissue by means of at least one illumination, receiving the remission of the light with a remission spectrum from the tissue by at least one detector, preferably a sensor, converting the remission spectrum by means of the detector into a detector signal, preferably an electrical signal / data signal, sending the detector signal to a computing unit, preferably a CPU, calculating the remission spectrum from the detector signal by means of the computing unit, calculating an absorption spectrum of the tissue by comparing the excitation spectrum with the remission spectrum by means of the computing unit, calculating at least one absorption maximum from the absorption spectrum by means of the computing unit, calculating a temperature in the tissue by comparing the absorption maximum with at least one value, preferably stored in the computing unit,Reference using the computing unit to calculate a switch-off time for a medical instrument based on the temperature. ,

[0031] Preferably, the step of calculating a switch-off time for a medical instrument based on the temperature consists of the individual steps: measuring the duration during which the temperature of the tissue is above 85°C, preferably above 95°C and preferably below 110°C, preferably below 100°C (Dur95), calculating the average temperature from the first reaching of 85°C, preferably 95°C and preferably below 110°C, preferably below 100°C (MeanTempabTmax), measuring and / or calculating the energy input until reaching 85°C, preferably 95°C and preferably below 110°C, preferably below 100°C (E2Tmax), calculating a parameter SP that links the above results and switches off the medical instrument at a predetermined value, preferably between 2 and 3, particularly preferably at SP = 2.5, or a switch-off from this value allows.In other words, the switch-off criterion can cause a direct switch-off, which means that the device switches off actively, and enable an indirect switch-off, which means that from this value onwards a passive switch-off (by a further step or by a person) is possible / permitted (by a program on the computing unit).

[0032] Preferably, the duration during which the temperature of the tissue is above 85°Celsius, preferably above 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius (Dur95) is measured in that the computing unit calculates the temperature in the tissue and measures the time from the time at which the temperature has reached 85°Celsius, preferably 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius.

[0033] Preferably, the average temperature from the first reaching of 85°Celsius, preferably 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius, (MeanTempabTmax), is calculated by the computing unit by calculating online, preferably in real time, the average of the temperature from the first reaching of 85°Celsius, preferably 95°Celsius and preferably below 110°Celsius, preferably below 100°Celsius.

[0034] Preferably, the energy input until 85°C, preferably 95°C (E2Tmax) is reached is measured by incorporating a power meter into the medical instrument. The power meter measures the power / i.e. the energy consumed until the tissue reaches 95°C. Alternatively, or additionally, the power can also be determined or calculated based on the tissue impedance or the temperature increase of the tissue over time until 85°C, preferably 95°C, is reached. The power meter can also be implicitly present in the device through sensors suitable for current and voltage measurement. In other words, the computing unit can calculate the power using data from a dedicated current and voltage measurement.

[0035] The parameter SP is calculated, which links the above results and switches off the medical instrument at a predetermined value, preferably between 2 and 3, particularly preferably at SP = 2.5, by dividing the product of the duration for which the temperature of a tissue is above 85°Celsius, preferably above 95°Celsius, and the average temperature from the first reaching of 95°Celsius by the energy input until reaching 85°Celsius, preferably 95°Celsius.

[0036] The parameter SP determines a favorable time for switching off a medical instrument, preferably during a sealing process, more preferably during a Seal&Cut process. The product of the time duration / duration during which the tissue is kept above 85°Celsius, preferably above 95°Celsius, and the average temperature during this period is divided by the energy required to reach 85°Celsius, preferably 95°Celsius, which results in the parameter SP. In other words: Parameter SP = (Dur95*MeanTempabTmax) / E2Tmax. From a value of SP>2.5 the sealing process is terminated. A parameter value of >2.5 ensures that the temperature in the sealing tissue remains below 85°Celsius once it has been reached, preferably 95°Celsius, orthe time of the impedance change is kept above 85°Celsius, preferably above 95°Celsius, for a certain time and that the control temperature is around 85°Celsius, preferably 95°Celsius. This means that some of the water is evaporated during sealing, which is a prerequisite for successful sealing. The variable E2Tmax in the denominator of the quotient depends on the process sequence selected for the various sealing programs and on the mass and composition of the tissue grasped between the electrodes. By recording this value, one can infer the heat capacity and thus the mass of the tissue in the sealing forceps. The numerator of the equation can be interpreted as an empirical variant of the Arrhenius formalism, according to which the degree of denaturation of tissue when exposed to heat is described, in simplified terms, by the integral of the tissue temperature over time. Ω t = A ⋅ ∫ 0 t e E a R ⋅ T t ⋅ dt

[0037] The parameters Ea and A are tissue-specific constants, and R is the general gas constant. Since a portion, but not too much, of the tissue water must be expelled for a good sealing result, the parameter E2Tmax in the denominator is a corrective factor that results in a longer exposure time for large tissue volumes.

[0038] The SP parameter can be integrated into the sealing process in different ways. One possibility is to integrate the parameter as a trigger for the shutdown process based on the existing impedance shutdown criterion. In other words, the termination of the sealing process is enabled as soon as a certain value, preferably 2, and particularly preferably 2.5, is exceeded.

[0039] Another option is to define the parameter as a shutdown criterion rather than a trigger. As soon as the parameter exceeds the threshold of 2.5, the process can be terminated. The shutdown criterion would then be independent of the impedance as the parameter used for the shutdown criterion.

[0040] Preferably, the (tissue) temperature is not measured directly, but determined by measuring another parameter (other than the temperature) which, on the one hand, allows a direct or indirect conclusion to be drawn about the current temperature (causal relationship between the temperature and the parameter) and, on the other hand, is (exclusively) tissue-specific, i.e. is not influenced by the electrode(s). The tissue temperature is determined using at least one absorption maximum. More precisely, at least one absorption spectrum of the tissue, preferably for at least one tissue component, is determined by subtracting the remission spectrum from the excitation spectrum. Preferred tissue components are water, fat and / or collagen. From the absorption spectrum thus obtained, it can be determined at which point at least one absorption maximum of the absorption spectrum of the tissue, preferably of at least one tissue component, is located.The absorption maximum, preferably the frequency, wavelength, or position of the absorption maximum, is compared with at least one reference stored on the computing unit, preferably on the storage medium. The at least one stored reference can then be determined from a table or by means of a reference measurement, so that it can be determined that a certain temperature prevails in the tissue at a specific position / wavelength / frequency of the absorption maximum. If this position / wavelength / frequency of the absorption maximum is not stored in a table, the temperature in the tissue can be calculated by shifting the calculated position / wavelength / frequency of the absorption maximum from a stored position / wavelength / frequency of the absorption maximum on the computing unit.Instead of the absorption maximum, any other position / wavelength / frequency from the absorption spectrum can be used that has a significant recognition value (e.g. maxima or minima).

[0041] The tissue components exhibit a typical absorption characteristic. For example, water has an absorption maximum at approximately 1470 nm at room temperature, collagen has an absorption maximum at approximately 1500 nm at room temperature, and fat has an absorption maximum at 1210 nm and approximately 1400 nm at room temperature. Preferably, the absorption maximum of water is at 1470 nm + / - 20 nm, more preferably at 1470 nm + / - 10 nm, more preferably at 1470 nm + / - 5 nm. Preferably, the absorption maximum of collagen is at 1500 nm + / - 20 nm, more preferably at 1500 nm + / - 10 nm, more preferably at 1500 nm + / - 5 nm. Preferably, the absorption maximum of fat is at 1210 and 1400 nm + / - 20 nm, more preferably at 1210 and 1400 nm + / - 10 nm, more preferably at 1210 and 1400 nm + / - 5 nm.

[0042] Preferably, the method further comprises the step: Storing at least one reference in the form of an absorption maximum at a specific temperature in the computing unit, preferably a storage medium in the computing unit, preferably for water and / or fat and / or collagen.

[0043] Preferably, the temperature prevailing in the tissue can be determined by means of the computing unit using the characteristic absorption spectrum of water as a reference. The computing unit or the storage medium stores information that water has a specific absorption maximum at a specific temperature (e.g. 1470 nm at room temperature). By comparing the shift of the absorption maxima from a pre-stored value and / or by comparing it with a large number of predetermined corresponding values ​​in a stored table, it can be determined at which wavelength of the absorption maximum which temperature prevails in the water in the tissue. The characteristic absorption spectrum of water can be determined most easily because the tissue components in the body are known and water is most strongly present in the tissue at approximately 67%.Based on the measured absorption spectrum, the shift of the spectral absorption maximum of water can be calculated / determined. Based on this shift of the absorption maximum, which is approximately 0.5 nm / K, the temperature can be determined. The above applies analogously to fat and / or collagen and / or other tissue components.

[0044] The above steps for measuring the absorption spectrum can be applied analogously to fat, collagen, or other tissue components in addition to water. Thus, the individual absorption spectra of water, fat, and collagen in tissue can be determined from an absorption spectrum recorded by a detector and calculated by a computing unit.

[0045] Preferably, the method further comprises the step: Applying the illumination and detector to the tissue. This advantageously ensures that the detector and illumination are in direct contact with the tissue.

[0046] Preferably, the method further comprises the step: Controlling and / or regulating and / or switching off a device, preferably a medical instrument, by means of the computing unit on the basis of the calculated temperature and / or tissue impedance.

[0047] Preferably, the control and / or regulation and / or shutdown takes place upon reaching a predetermined temperature, preferably at a temperature greater than 85°C, preferably greater than 95°C, and less than 110°C, preferably less than 100°C. Tissue coagulation achieves the best results at a temperature, preferably a constant temperature, above 85°C, preferably above 95°C, and more preferably at a temperature below 110°C, preferably 100°C.

[0048] Preferably, all steps take place online / in real time. This means that the control and / or regulation and / or shutdown of the medical instrument takes place online, preferably in real time. In other words, the absorption spectrum of the tissue is measured online, preferably in real time, allowing the temperature in the tissue to be calculated online, i.e., in real time. The temperature is then incorporated, preferably online, preferably in real time, into the control / regulation of at least one electrode / sonotrode / laser source of the medical instrument, preferably the cut-and-seal device.

[0049] Preferably, the temperature measurement method is carried out during a sealing process, particularly preferably in the tissue in the medical instrument.

[0050] Preferably, the detectors are provided and adapted to detect remission, preferably the remission spectra, in the NIR range from 1000nm to 1700nm, particularly preferably in the range from 1400nm to 1600nm.

[0051] Preferably, the at least one illumination and the at least one detector are spaced apart, preferably in a medical instrument.

[0052] Preferably, the method for measuring a tissue temperature is used in a medical instrument.

[0053] Preferably, a temperature measuring device comprises a storage medium on which at least one of the following steps is stored (in the case of a plurality of steps, preferably in this order): Storing at least one reference in the form of an absorption maximum at a specific temperature in the computing unit, preferably a storage medium in the computing unit, preferably for water and / or fat and / or collagen. Applying the illumination and detector to the tissue. Advantageously, the detector and illumination are thus in direct contact with the tissue. Emitting light with an illumination spectrum, preferably in the VIS / NIR range, into a tissue by means of at least one illumination, receiving the remission of the light with a remission spectrum from the tissue by at least one detector, preferably a sensor, converting the remission spectrum by means of the detector into a detector signal, preferably an electrical signal / data signal, sending the detector signal to a computing unit, preferably a CPU, calculating the remission spectrum from the detector signal by means of the computing unit, calculating an absorption spectrum of the tissue by comparing the illumination spectrum with the remission spectrum by means of the computing unit, calculating at least one absorption maximum from the absorption spectrum by means of the computing unit, calculating a temperature in the tissue by comparing the absorption maximum with at least one value, preferably stored in the computing unit,Reference by means of the computing unit, controlling and / or regulating and / or switching off a device, preferably a medical instrument, by means of the computing unit on the basis of the calculated temperature and / or tissue impedance. ,

[0054] In other words, during the temperature measurement process, a detector records online reflectance spectra in the NIR range from 1000 nm to 1700 nm. The shift in the position of the absorption maxima derived from the recorded spectra can be used to determine the temperature of the tissue held in the instrument with sufficient accuracy for the application. As the temperature increases, the position of the absorption peak shifts toward shorter wavelengths. The shift is approximately 0.5 nm / K. If the tissue cools further, the absorption peak shifts again toward longer wavelengths. Since the main absorber in the tissue to be sealed in the wavelength range around 1470 nm is water, the temperature determined in this way reflects the temperature in the water portion of the tissue.The particular advantage of this temperature measurement method is that it allows the actual temperature in the tissue to be measured, as the NIR radiation can pass through the entire thickness of the tissue layer due to scattering. In contrast, when measuring the temperature during sealing with a thermocouple, only the temperature of the contact surface is measured. The temperature and heat capacity of the electrodes represent an interference factor for determining the tissue temperature with this method. This leads to latency times and falsifications of the true tissue temperature. This method therefore does not reflect the tissue temperature, but rather represents the temperature of the environment with which the thermocouple is in contact. With optical temperature determination, it is possible to obtain important parameters for controlling the sealing process. Furthermore, the determined temperature can be used as a shutdown / regulation / control criterion / process parameter.for process control.

[0055] It has been shown that light of a specific wavelength (e.g., white light in the VIS-NIR range) is preferentially remitted by body tissue, with the spectrum of the light remitted by the body tissue varying depending on the temperature. It is therefore possible to place an illumination / illumination output for irradiating body tissue and a detector / detector input for detecting light remitted by the body tissue directly at the electrode(s), thus determining the tissue temperature in the immediate vicinity of (between) the electrode(s) via the detected remitted light and its spectral distribution.

[0056] In the preferred embodiment, a medical instrument (of the RF type) has at least one instrument branch which forms at least one energizable electrode for sealing and / or cutting tissue or which is arranged in or on the at least one energizable electrode for sealing and / or cutting tissue, wherein the energization of the electrode is controllable and / or regulatable by a computing unit, and at least one temperature measuring device with at least one illumination and at least one light detector, which are each formed or arranged in or on the at least one instrument branch or opposite one another in / on two instrument branches (alternately) and which are in electrical connection with the computing unit.

[0057] Preferably, the medical instrument is a surgical instrument, a monopolar instrument, a bipolar instrument, an electrosurgical instrument, a surgical clamp, a surgical forceps, surgical scissors, a scalpel, and / or the like. Particularly preferably, the medical instrument is a seal-and-cut instrument designed and adapted to cut and simultaneously seal tissue using RF technology. Monopolar instruments have the advantage that, due to their single-shell design (only a single instrument branch), a compact design is possible and thus lower manufacturing costs. Bipolar instruments (two opposing instrument branches) have the advantage that high-resolution analysis is easier to implement and that they are more flexible in the implementation of duplication.

[0058] Preferably, the at least one instrument branch is to be understood as the part / end of a medical instrument that can be brought into contact with the tissue. More preferably, the at least one instrument branch is a jaw part branch. The at least one instrument branch can be designed as an electrode for sealing tissue; the instrument branch is preferably integral / made from a single part made of a conductive metal or graphite. Alternatively, the electrode can be formed / arranged / embedded in and / or on and / or on the instrument branch; in this case, the instrument branch is preferably made of an insulator or electrically insulating material.

[0059] The medical instrument preferably has two opposing instrument branches, which are preferably movable / pivotable relative to one another, at the ends of which mutually facing sides / jaws / areas / instrument branch ends are arranged / formed, which can be brought into contact with the tissue. The instrument branches themselves can be designed as electrodes for sealing tissue; preferably, the instrument branches are made of a conductive metal or graphite and are insulated from one another. However, the electrodes can also be formed / arranged / embedded in and / or on and / or on the instrument branches; preferably, the instrument branches are made of an insulator or electrically insulating material, or are made of metal and insulated from the electrodes.

[0060] Preferably, at least one electrode is controllable and / or adjustable by the computing unit. More specifically, the current intensity, voltage, phase, and / or frequency of the electrical current applied to the electrode is controllable or adjustable.

[0061] Preferably, the temperature measuring device is an optical temperature measuring device / thermometer with an optical transmitter in the form of an illumination and an optical receiver in the form of a light detector.

[0062] Preferably, illumination is understood to mean at least one light source / excitation light source and, alternatively, additionally other optical components, such as a light tunnel comprising optical fibers / mirrors / lenses / reflective interior walls / scattering media, and the like. Further preferably, light source is understood to mean a white light source / an LED (in the VIS and / or IR and / or UV range), a deuterium lamp (UV range), and / or a halogen lamp (VIS range).In other words, the light can be generated at / in / on the instrument branch at the irradiation location / at the at least one inlet opening directly by means of a light source, or by guiding the light from a light source by means of optical fibers / mirrors / lenses / light tunnels / scattering media, and the like, to an irradiation location / a light inlet opening / a light entry opening of the contact surface of the instrument branch, which is provided and adapted to come into contact with the tissue. Further preferably, the irradiation of the light from the illumination occurs at a specific angle relative to the tissue contact surface of the corresponding instrument branch or electrode, i.e., the illumination has an angled / oblique exit opening and / or light radiation in / on / at the instrument branch.In other words, the light source itself is arranged obliquely / angled on / at / in the instrument branch or has an oblique / angled surface relative to the tissue contact surface or light exit surface. Alternatively, an optical element such as a mirror and / or an optical fiber can be arranged obliquely on / at / in the contact surface (the surface intended and adapted to come into contact with tissue) of the instrument branch and guide the light from the light source to the irradiation point or contact surface.

[0063] A white light source, i.e., a light source that emits electromagnetic radiation across the entire visible spectrum, has the advantage of allowing more information to be obtained from the tissue being illuminated, enabling tissue detection and / or multivariate data analysis. Furthermore, it is possible to perform a wide variety of measurements. For example, the instrumentation can accommodate at least one illumination unit with a white light source and at least one detector designed and adapted to measure spectral ranges, preferably with different sensors (Si, InGaAs sensors, etc.).

[0064] A light source with a narrow spectral bandwidth has the advantage that it is easy to implement, that such a light source is cost-effective, that a high temporal sampling can be achieved with such a light source and that distances of more than 2 mm from each other and / or from a detector are possible, since a higher intensity on a specific spectral range is possible.

[0065] A detector or light detector is preferably understood to mean at least one sensor / photodiode and / or a photomultiplier (PMT) and optionally other optical components, such as a light tunnel, which may comprise optical fibers / mirrors / lenses / reflective inner walls / scattering media, and the like. In other words, the light from the detector / detector part installed in / on / at the instrument branch can be measured directly at the remission location by means of a sensor of the detector or the like arranged there on / in / on the instrument branch, or it can be guided via a light tunnel, which may comprise optical fibers / mirrors / lenses / reflective inner walls / scattering media, and the like, and light from the contact surface / a light entry opening of the instrument branch to a sensor or the like arranged remotely from the contact surface of the instrument branch or even remotely from the instrument branch.Further preferably, the light emanating from the illumination device is irradiated at a specific angle (0° < angle ≤ 90°) relative to the tissue contact surface of the corresponding instrument branch or electrode. Further preferably, the detector has an entrance opening in / on / at the instrument branch that is also angled / slanted to the contact surface. In other words, the detector itself is arranged at an angle / slant on / at / in the instrument branch or has an inclined / angled surface with respect to the tissue contact surface. Alternatively, an optical element such as a mirror and / or an optical fiber can be arranged at an angle / lane on / at / in the contact surface (the surface intended and adapted to come into contact with tissue) of the instrument branch and guide reflected light to a remote sensor or the like.The light remitted from the body tissue after irradiation is preferably spectrally resolved into at least two channels (by means of spectrometers, prisms or different filters) and then detected by the at least two sensors or the like, which, depending thereon, send at least two signals to the computing unit / CPU, which transforms the at least two signals into a temperature value.

[0066] The electrode for sealing tissue is preferably made of metal, conductive ceramic, metallized ceramic, graphite, or metallized graphite. The electrode is further preferably formed with a surface designed and adapted to reflect electromagnetic radiation.

[0067] The computing unit preferably comprises a processor and a storage medium. The storage medium is provided and adapted to store steps for executing the temperature measurement and / or the control and / or regulation of the electrode current.

[0068] The computing unit controls the illumination / light source (duration, intensity, wavelength, etc.) using a first electrical signal, and the detector detects the light scattered / reflected (exclusively) by the body tissue, or the remission directly at the tissue to be measured / treated (between the instrument branches), and sends the determined data as a second electrical signal to the computing unit. The computing unit then uses an algorithm on the storage medium to calculate the tissue temperature derived from the respective second electrical signal. Based on the tissue temperature calculated in this way, the current strength, voltage, and / or frequency of the electrical current applied to the at least one electrode is calculated online / in real time.

[0069] Additionally, in one embodiment, the tissue resistance (tissue impedance) can also be determined by the computing unit and incorporated into the calculation. In other words, the tissue impedance of the tissue at / between the electrodes / sonotrodes can be determined, so that the current, voltage, and / or frequency of the electrical current applied to the electrode(s) or the US transducer can be controlled or regulated by the computing unit in response to the determined tissue impedance and (in combination with) the second signal from the (optical) temperature measuring device.

[0070] Preferably, the computing unit is connected to the (optical) temperature measuring device according to the invention in such a way that the current intensity, the voltage and / or the frequency of the electrical current applied to the at least one electrode can be changed in response to the temperature calculated by the computing unit / CPU, preferably automatically and / or by a predetermined algorithm.

[0071] Preferably, the second electrical signal from the detector corresponds to a light spectrum representing the wavelength and intensity of the light detected by the detector. Based on this spectrum, the shift of the spectral absorption maximum of water is calculated / determined. Based on this shift of the absorption maximum, which is approximately 0.5 nm / K, the temperature can be determined. Since the absorption spectrum of water is characteristic, the shift can be determined with and / or without a reference measurement.

[0072] Preferably, the computing unit is configured to have at least one of the following steps or at least one of the following steps is stored on a storage medium in the computing unit (preferably in the following order): Controlling the illumination by the computing unit with a first electrical signal, preferably with an electrical current with a specific current intensity and / or a specific voltage and / or a specific frequency, Emitting electromagnetic radiation from the illumination (preferably white light) into the tissue, in a specific area in the immediate vicinity of an electrode or between two opposing electrodes, Measuring (using the detector) the remission / diffuse reflection of the electromagnetic radiation emanating from the body tissue, Sending the measurement results from the detector to the computing unit by means of a second electrical signal, Transforming the second electrical signal into a tissue temperature value, Preferably determining the tissue impedance, preferably between two electrodes, Processing the tissue temperature value and preferably the determined tissue impedance by means of the computing unit,preferably by means of a pre-programmed algorithm on the storage medium, for determining a new current, voltage and / or frequency for the electrical current applied to the electrode(s) to achieve or approach a tissue temperature of above 85°C, preferably above 95°C, and preferably simultaneously below 110°C, preferably below 100°C.; Continuous calculation of the parameter SP from the continuously determined values ​​Dur95, MeanTempabTmax and E2Tmax; Provision of the shutdown trigger.

[0073] In one embodiment, the light tunnel connected to the light source can be powered at at least one end by at least one light source, and at least one other end can terminate in the instrument branch. In other words, light from at least one light source can be guided via an optical fiber or the like to at least one output located on / at / in the instrument branch. Alternatively, at least one light source, e.g., the LED, can be located directly on / at / in the instrument branch.

[0074] In one embodiment, the light tunnel connected to the detector may have at least one sensor at at least one end and terminate at at least one other end in the instrument branch. In other words, light / remission from at least one input located on / in the instrument branch may be guided via a reflective light channel / optical fiber or the like to at least one sensor / photodiode / photomultiplier or the like. Alternatively, at least one sensor / photodiode / photomultiplier may be located / arranged on / at / in the instrument branch.

[0075] Preferably, the illuminator and detector can share one end of a light tunnel. In other words, the light source's optical path and the sensor / photodiode / photomultiplier's optical path can share a light tunnel, so that both are in optical contact with the body tissue via a single optical aperture that simultaneously forms the input and output of the light on / at / in the instrument branch.

[0076] Preferably, a plurality of detectors and a plurality of illumination devices are arranged on at least one instrument branch. The detectors or illumination devices can each be arranged on an instrument branch in a predetermined pattern. The pattern is preferably linear. Alternatively, at least one detector and / or illumination device can be arranged on a first instrument branch and at least one detector and / or illumination device can be arranged on a second instrument branch, preferably on mutually facing sides of opposite instrument branches. In other words, in this embodiment for bipolar instruments, the light from an illumination device can be introduced into the tissue, and on an opposite side, a detector can measure the light remitted by the tissue.

[0077] Preferably, the distance between the at least one illumination and the at least one detector is between 0 and 5 mm, particularly preferably between 0 and 1 mm, since the intensity of the remission is very high there.

[0078] Preferably, the at least one instrument branch has multiple detectors per illumination source; particularly preferably, the detectors are arranged at the same and / or different distances from the illumination source. In other words, the distance from one illumination source to a second detector can be greater than the distance to a first detector.

[0079] Preferably, the illumination comprises a discrete light source, preferably with a defined bandwidth, particularly preferably with a bandwidth of less than 100 nm.

[0080] Preferably, the (optical) temperature measuring device is arranged on a plane of the instrument branch that is lower than the contact surface of the electrode. In other words, a contact surface of the electrodes and / or the instrument branches that comes into contact with tissue forms a plane. This plane is higher in the contact direction (closer to the tissue) than the plane on which the at least one illumination and / or the at least one detector is arranged.

[0081] Preferably, the (optical) temperature measurement device enables real-time / online determination of the temperature during a sealing process. Online determination is particularly important for the quality of the seal. The measurement represents the temperature in the tissue and does not exhibit any latency or distortion of the measured temperature due to the heat capacity of the measurement device, for example, due to the heat capacity of metal electrodes. The advantage of an optical temperature measurement, which is sensitive to the water in the tissue being captured or in the tissue that comes into contact with it, is that this temperature measurement device has no significant heat capacity.

[0082] Preferably, the remission measurement can be performed in the instrument branch or in the jaw part of a Seal&Cut instrument, regardless of the position at which the tissue comes into contact with the instrument branch. In other words, the temperature measuring device is distributed, preferably evenly distributed, on the surface of the instrument branch in the area intended and adapted to come into contact with the tissue. As explained above, the at least one instrument branch can have a plurality of excitation and detection paths / illumination or detection paths, preferably along and / or in an electrode.

[0083] As explained above, in addition to or alternatively to the impedance measurement, a temperature measurement should be carried out. The temperature is measured directly in the tissue to be fused, preferably between two opposing instrument branches, preferably during the (temporal) course of the current application / heating of the tissue. This allows the change in the tissue condition to be detected directly / online and thus also to be responded to. By expanding the algorithm with an additional control / regulation parameter, it is possible to better evaluate the energy input into the tissue and thus better control / regulate the tissue fusion. Furthermore, other properties of the tissue can also be measured with the temperature measuring device according to the invention, for example the water proportion / water content in the tissue.

[0084] The electrode preferably has at least one first electrode surface on the area intended and adapted to come into contact with the tissue. The electrode is preferably located on an instrument branch body (in the jaw part) of an instrument branch or is formed by the instrument branch. At least one light source / at least one light guide / at least one optical component (dichroic mirror / radiation splitter / mirror) and / or at least one light detector (or a part thereof) with at least one sensor and optionally a light guide are preferably incorporated into the electrode and / or the instrument branch. A photodiode or a photomultiplier can also be understood as a sensor. The electrode preferably has at least one light exit opening from / through which the light from the light source radiates from the electrode surface and / or into the tissue.The electrode preferably has at least one light entry opening through which the light (exclusively) radiates / remits / is reflected from the tissue (remission) into / through the electrode surface into the sensor. The electrode preferably has at least one channel that is provided and adapted to transmit data to at least one computing unit via at least one cable / electrical line, or to transmit light to a remote sensor via at least one scattering medium / at least one optical fiber / at least one reflective surface, which in turn transmits data to at least one computing unit via at least one cable / electrical line. If the invention has more than one electrode surface or more than one instrument branch, the electrode surfaces / instrument branches are spaced apart from one another, preferably parallel.The space between the electrode surfaces / instrument branches is preferably provided and adapted to insertably accommodate a cutting device, such as a knife, scalpel, RF scalpel, or the like, which is provided and adapted to separate / cut tissue. The electrode / branch surfaces are thus shaped on at least two sides of the tissue cut to coagulate the tissue using RF technology.

[0085] A narrowband filter is preferably arranged in front of the sensor. A light tunnel can be formed in the electrode and / or the instrument branch. In other words, the light tunnel can guide light through the instrument branch and / or the at least one electrode. All embodiments can be combined with one another.

[0086] The object of the invention is achieved with regard to a medical instrument in that the medical instrument is provided and adapted to carry out the method according to the invention. In particular, the medical instrument can have a shutdown device / a device for determining a shutdown time, which is provided and adapted to carry out the method according to the invention. Short description of the characters

[0087] The invention is explained in more detail below using preferred embodiments with the aid of figures. They show: Fig.1 a section of an instrument industry according to a first embodiment, Fig.2 a first illumination and detection arrangement of an instrument industry, Fig.3 a second illumination and detection arrangement of an instrument branch, Fig.4 a third illumination and detection arrangement of an instrument industry, Fig.5 a section of an instrument industry according to a second embodiment, Fig.6 the lighting in the instrument industry according to the second embodiment, Fig.7 a section of an instrument industry according to a third embodiment, Fig.8 the lighting in the instrument industry according to the third embodiment, Fig.9 a section of an instrument industry according to a fourth embodiment, Fig.10 the lighting in the instrument industry according to the fourth embodiment, Fig. 11 a section of an instrument industry according to a fifth embodiment, Fig.12 the lighting in the instrument industry according to the fifth embodiment, Fig.13 a section of an instrument industry according to a sixth embodiment, Fig.14 the lighting in the instrument industry according to the sixth embodiment, Fig.15a sector of an instrument industry according to a seventh embodiment, Fig. 16 the lighting in the instrument industry according to the sixth embodiment, Fig. 17 a sector of an instrument industry according to an eighth embodiment, Fig. 18 the lighting in the instrument industry according to the eighth embodiment, Fig. 19 a sector of an instrument industry according to a ninth embodiment, Fig. 20 the lighting in the instrument industry according to the ninth embodiment, Fig. 21 a sector of an instrument industry according to a tenth embodiment, Fig. 22 the lighting in the instrument industry according to the tenth embodiment, Fig. 23 a bipolar instrument branch according to the above embodiments, Fig. 24 opposing detectors and illuminations on a bipolar RF instrument, Fig. 25a schematic representation of a medical device according to the invention, and Fig. 26 a schematic representation of the temperature curve during the process.

[0088] The figures are schematic in nature and are intended only to aid understanding of the invention. Like elements are designated by the same reference numerals. The features of the various embodiments may be interchanged. Detailed description of preferred embodiments

[0089] Fig.1shows a region of an instrument branch 1 according to a first embodiment. The instrument branch 1 has at least one electrode 2, which is embedded in the instrument branch 1 in an insulated manner. The electrode 2 has a first electrode surface 4 and a second electrode surface 6 on the branch side that is intended and adapted to come into contact with body tissue. The electrode(s) 2 are located in particular in / on an instrument branch body 8 of the instrument branch 1, which represents one half of an actuatable instrument jaw part. Light sources (LEDs) 10 and light detectors or sensors 12 are alternately introduced into the electrode 2 or into the instrument branch 1 / the instrument branch body 8. The electrode 2 or the instrument branch 1 / the instrument branch body 8 has light exit openings 14 through which the light from the light source 10 emerges from the electrode surface 4 and / or 6 orthe branch contact surface into the tissue. The electrode 2 or the instrument branch 1 / the instrument branch body 8 further has light inlet openings 16 through which the light is remitted from the tissue into / through the electrode surface 4 and / or 6 or through the branch contact surface into the sensor 12. The electrode 2 or the instrument branch 1 / the instrument branch body 8 has at least one (longitudinal) channel 18, which is provided and adapted to conduct data / signals from the sensors 12 by means of a cable (not shown in detail) to a computing unit (not shown in detail).

[0090] Fig.2 shows a first variant of an illumination and detection arrangement of the instrument branch 1. Each of the embodiments of this application can comprise the first illumination and detection arrangement. The upper row of the illumination and detection arrangement of the Figure 2is on / in the second electrode / branch surface 6 of the Fig. 1 arranged / embedded. The lower row of the illumination and detection arrangement of the Figure 2 is on / in the first electrode / branch surface 4 of the Fig. 1 arranged / embedded. A detector / sensor 12 and an illumination / light source 10 are arranged alternately in the rows. The dark spots represent a detector / sensor 12, and the bright spots represent an illumination / light source 10. A narrow-band (light) filter (not shown) is preferably arranged in front of the detector / sensor 12. Furthermore, the optoelectronic components (sensor 12 and illumination 10) are preferably mounted on a circuit board below the electrode / below the tissue contact surface of the branch.

[0091] Fig.3shows a second variant of an illumination and detection arrangement for an instrument industry. Each of the embodiments of this application can comprise the second variant of an illumination and detection arrangement. The dark spots represent a sensor 12, and the bright spots represent a light source 10. The second variant of an illumination and detection arrangement is configured such that four sensors 12 are arranged around a light source 10 at an equal distance from the light source 10, with each light source 10 sharing two sensors 12 with another, immediately adjacent light source. In other words, the / each light source 10 is located at the center of an imaginary rectangle, at the corners of which the sensors 12 are positioned.

[0092] Fig.4shows a third variant of an illumination and detection arrangement for an instrument branch. Each of the embodiments of this application can include the third variant of an illumination and detection arrangement. The dark spots represent a sensor 12, and the bright spots represent a light source 10. The third variant of an illumination and detection arrangement is identical to the first variant of an illumination and detection arrangement, with the difference that the series of illumination and detection arrangements for the second electrode / branch surface begins where the series of illumination and detection arrangements for the first electrode / branch surface ends.

[0093] Fig.5shows a region of an instrument branch 101 according to a second embodiment. The instrument branch 101 has an electrode 102. The electrode 102 has a first electrode surface 104 and a second electrode surface 106 on the (branch) surface intended and adapted to come into contact with the tissue. In this respect, the branch of the second embodiment corresponds to the branch of the first embodiment. The electrode 102 is located in particular on a distal instrument branch body 108 of the instrument branch 101, which represents part of an instrument jaw. Light sources and sensors (not shown in detail) are incorporated into the instrument branch 101 at a distance from the tissue contact surface of the instrument branch body 108.The electrode 102 / instrument branch body 108 has light exit openings 114 through which the light from the light source (not shown) is directed and from which light from the electrode surface 104 and / or 106 or tissue contact surface of the instrument branch body 108 radiates / enters the tissue. The electrode 102 / instrument branch body 108 has light entry openings 116 through which the light from the tissue radiates / enters the electrode surface 104 and / or 106 or tissue contact surface of the instrument branch body 108 into a light tunnel 120 that ends in the sensor. The light from the light source to the light exit opening 114 is also directed through a, preferably different, light tunnel 120. The light tunnels 120 are filled with air or another gas or have a vacuum. The light tunnels 120 pass through the instrument branch body 108 and / or through the electrode 102.The preferably cylindrical light tunnels 120 have an inner tunnel surface (in the hollow cylindrical shape), which in turn has reflective properties for electromagnetic waves (light waves). The tunnel surface on the inner side of the tunnel is thus designed and adapted to enable total internal reflection.

[0094] Fig.6shows the light guidance in the area of ​​the instrument branch / instrument branch body according to the second embodiment in the light tunnel 120. The incoming light from the light source is totally reflected on the inner surface of the light tunnel 120 and can thus be guided through the light tunnel 120. Due to the total reflection on the inside of the light tunnel 1202, the light can also be guided through bent areas / at least one bend or the like. In this case, the light tunnel 120 is guided along the branch body 108 and then reaches the tissue contact surface of the branch body 108 in a substantially 90° bend (or at another angle with respect to the tissue contact surface), where the light tunnel 120 opens.

[0095] Fig.7shows a portion of an instrument branch 201 according to a third embodiment. The instrument branch 201 has an instrument branch body 208, which forms part of an instrument jaw, which is an electrode or in which, as in the Fig. 7shown, an electrode 202 is embedded in an insulating manner. The electrode 202 has a first electrode surface 204 and a second electrode surface 206 on the branch surface that is intended and adapted to come into contact with the tissue. The electrode 202 is accordingly located on / in the instrument branch body 208 of the instrument branch 201. Light sources and sensors are introduced into the instrument branch 201 at a distance from the tissue contact surface (not shown). The electrode 202 or the instrument branch body 208 has light exit openings 214 through which the light from the light source (not shown) is directed and from which light from the electrode surface 204 and / or 206 or the tissue contact surface radiates / enters the tissue. The electrode 202 or the instrument branch body 208 has light entry openings 216 through which the light from the tissue into / through the electrode surface 204 and / or 206 respectively.the tissue contact surface of the instrument branch body 208 radiates / enters a light tunnel 220, which terminates in a sensor. The light from the light source to the light entry opening 214 is also guided through a, preferably different, light tunnel 220. The light tunnels 220 are filled with air or another gas or form a vacuum. The light tunnels 220 lead through the instrument branch body 208 and / or through the electrode 202. The light from the light source is introduced / irradiated perpendicular to the opening of the, preferably cylindrical, light tunnel 220 / to the longitudinal direction of the cylindrical light tunnel 220. The light is thus guided straight / rectilinearly in the light tunnel 220. To direct the light, at least one mirror and / or one prism is used in the light tunnel 220 to deflect / guide the light at a desired angle. The tunnel 220 can take any geometric shape, e.g. cylindrical, cuboid, etc.

[0096] Fig.8 shows the light guidance in the instrument industry according to the third embodiment in the light tunnel 220. The incoming light from the light source is fed into the light tunnel 220 in a straight line / directed line / parallel line. By guiding the light by means of at least one mirror in the light tunnel 220, the light can also be guided over angled paths / angles or the like.

[0097] Fig.9shows a region of an instrument branch 301 according to a fourth embodiment. The instrument branch 301 has an electrode 302 which is received in an instrument branch body 308 which forms a tissue contact surface. The electrode 302 has a first electrode surface 304 and a second electrode surface 306 on the surface which is intended and adapted to come into contact with the tissue. The electrode 302 is thus located in / on the instrument branch body 308 of the instrument branch 301. Light sources and sensors (not shown) are incorporated in the instrument branch 301 at a distance from the tissue contact surface of the instrument branch body 308. The electrode 302 or the instrument branch body 308 has light exit openings 314 through which the light from the light source (not shown) is directed and from which light from the electrode surface 304 and / or 306 orthe instrument branch body 308 into the tissue. The electrode 302 or the instrument branch body 308 has light entry openings (not shown) through which the light from the tissue radiates into / enters the electrode surface 304 and / or 306 or through the contact surface of the instrument branch body 308 into a light tunnel 320 that terminates in a sensor. The light from the light source to the light exit opening 314 is also guided through a, preferably different, light tunnel (not shown). The light tunnels 320 are filled with a scattering bulk material 322. The light tunnels 320 lead through the instrument branch body 308 and / or through the electrode 302.In this embodiment, at least two light tunnels 320 are arranged in parallel in a row / line in the electrode 302 and / or the instrument branch body 308, so that a row of light entry openings 314 and light exit openings (not shown) is introduced into each electrode surface 304 and 306. In an embodiment not shown, the bulk material of the fourth embodiment can itself represent a light source, ie, the bulk material can luminesce.

[0098] Fig.10shows the light guidance in the field of instrumentation according to the fourth embodiment in a light tunnel 320. The incoming light from the light source is fed into the light tunnel 320, more precisely into the scattering and / or luminous bulk material 322 in the light tunnel 320. Due to the scattering of the light in the bulk material 322, the light is radiated into the tissue and the remitted light is guided / scattered to the sensor by another light tunnel (not shown) with the same structure.

[0099] Fig. 11shows a region of an instrument branch 401 according to a fifth embodiment. The instrument branch 401 has an electrode 402, which in this case is insulatingly embedded in an instrument branch body 408. The electrode 402 has a first electrode surface 404 and a second electrode surface 406 on the surface of the instrument branch body 408 that is intended and adapted to come into contact with the tissue. The electrode 402 is thus located in / on the instrument branch body 408 of the instrument branch 401. Light sources and sensors (not shown) are incorporated into the instrument branch 401 at a distance from the tissue contact surface of the instrument branch body 408. The electrode 402 or the instrument branch body 408 has light exit openings 414 through which the light from a light source (not shown) is directed and from which light from the electrode surface 404 and / or 406 orfrom the tissue contact surface into the tissue. The electrode 402 or the instrument branch body 408 has light entry openings (not shown) through which the light from the tissue radiates into / exits through the electrode surface 404 and / or 406 or through the tissue contact surface into a light tunnel 420, which ends in a sensor. The light from the light source to the light exit opening 414 is also guided through a, preferably different, light tunnel (not shown). The light tunnels 420 are filled with a structured bulk material 422. The light tunnels 420 lead through the instrument branch body 408 and / or through the electrode 402.In this embodiment, at least two light tunnels 420 are arranged in parallel in a row / line in the electrode 402 and / or the instrument branch body 408, so that a row of light entry openings 414 and light exit openings (not shown) is introduced into each electrode surface 404 and 406. In an embodiment not shown, the bulk material of the fifth embodiment can itself represent a light source, ie, the bulk material can luminesce.

[0100] Fig.12shows the light guidance in the field of the instrument industry according to the fifth embodiment in a light tunnel 420. The incoming light coming from the light source is fed into the light tunnel 420, more precisely into the structured bulk material 422 in the light tunnel 420. Due to the structure of the insert in the bulk material 422, the light is radiated into the tissue and the remitted light is guided / scattered to a sensor by another light tunnel (not shown) with the same structure.

[0101] Fig.13shows a region of an instrument branch 501 according to a sixth embodiment. The instrument branch 501 has an electrode 502; in this embodiment, the instrument branch body 501 and the electrode 502 correspond to the previous embodiments in terms of their structure and arrangement. Light sources and sensors (not shown) are incorporated in the instrument branch body. The electrode 502 / the instrument branch body has light exit openings 514 through which the light from a light source (not shown) is guided and from which light radiates / enters the tissue. The electrode 502 / the instrument branch body has light entry openings (not shown) through which the light radiates / enters the tissue into a light tunnel 520, which ends in a sensor. The light from the light source to the light entry opening 514 is guided through at least one light tunnel 520.In this embodiment, a single light tunnel 520 is formed in the electrode 502 and thus in the instrument branch body 501. A row of light exit openings 514 and light entry openings (not shown) are formed in the electrode 502 and in the instrument branch body, respectively. InAt least one mirrored / reflective inclined / angled plane 524 is formed in the light tunnel 520. The plane 524 can be created by polishing the electrode or the instrument branch body, or by inserting a mirror into the light tunnel 520. The light tunnel 520 extends through the instrument branch body. At least one row of light exit openings 514 and light entry openings (not shown) is formed in a surface of the electrode 502 / the instrument branch body. Alternatively or additionally, a single light tunnel 520 of this type can serve both for the excitation and for the reception of reflected light—with the appropriate filters.This means that a filter corresponding to the remission wavelength range is placed after the light source, but the remaining light is directed into the tissue and is received by the same and / or a neighboring opening and guided back to the sensor via the same reflective plane 524.

[0102] Fig.14 shows the light guidance in the area of ​​the instrument branch 501 according to the sixth embodiment in the light tunnel 520. The incoming light from the light source is fed into the light tunnel 520 and deflected at the angled, reflective plane 524 at a predetermined angle (preferably between 0° and 90°). The light is radiated into the tissue by the mirror / reflective surface / reflective plane 524, and the remitted light is guided to a sensor by another light tunnel (not shown) with the same structure.

[0103] Fig. 15shows a region of an instrument branch 601 according to a seventh embodiment. The instrument branch 601 has an electrode 602 accommodated by an instrument branch body 608. The electrode 602 has a first electrode surface 604 and a second electrode surface 606 on the surface of the instrument branch body 608 that is provided and adapted to come into contact with the tissue. Light sources and sensors (not shown) are incorporated into the instrument branch body 608. The instrument branch body 608 has light exit openings 614 through which the light from a light source (not shown) is guided and radiates / enters the tissue from the tissue contact surface.The instrument branch body 608 further has light inlet openings (not shown) through which the light from the tissue radiates / enters into / through the tissue contact surface of the instrument branch body 608 into a light tunnel 620, which ends in a sensor. The light from the light source to the light outlet opening 614 is also guided through a second light tunnel (not shown). At least one partially transparent plane 626 is introduced into the light tunnel 620, which plane transmits a portion of electromagnetic radiation, i.e., is transparent to a portion of the light and reflects a portion of the light. Preferably, the partially transparent plane is a partially transparent mirror, and more preferably, several partially transparent planes 626 are arranged one behind the other in the light tunnel.

[0104] Fig.16shows the light guidance in the instrument branch area 601 according to the seventh embodiment in a light tunnel 620. The incoming light from the light source is fed into the light tunnel 620. The incoming light from the light source is fed into the light tunnel 620 in a straight line / directed line / parallel line. By guiding the light by means of at least one partially transparent mirror 626 in the light tunnel 620, the light is guided / reflected / mirrored over angled areas / angles or the like. The light that passes through a partially transparent mirror 626 strikes another partially transparent mirror 626, which is arranged at the same angle as the previous mirror, and so on.The light is radiated into the tissue through the partially translucent mirror / reflective surface / reflective plane 626 and the remitted light is guided / guided to a sensor by another light tunnel (not shown) with the same structure.

[0105] Fig.17shows a region of an instrument branch 701 according to an eighth embodiment. The instrument branch 701 has an electrode 702. The electrode 702 is located on an instrument branch body 708 of the instrument branch 701. Light sources and sensors are introduced into the instrument branch 701 at a distance from the instrument branch body 708, preferably externally (not shown). The instrument branch body 708 has at least one light tunnel 720 through which the light from the light source (not shown) is guided and from which light radiates / enters the tissue. The instrument branch body 708 has at least one further light tunnel 720 through which the light is guided from the tissue to a sensor. In this embodiment, the light tunnels 720 are formed by optical waveguides such as glass fibers.

[0106] Fig.18shows the light guidance in the instrument industry according to the eighth embodiment in a light tunnel 720. The incoming light from the light source is totally reflected on the inner surface of the light tunnel 720 and can thus be guided through the light tunnel 720. Due to the total reflection on the inside of the light tunnel 720, the light can also be guided through bent areas / at least one bend or the like.

[0107] Fig. 19shows a portion of an instrument branch 801 according to a ninth embodiment. The instrument branch 801 has an electrode 802. The electrode 802 has a first electrode surface 804 and a second electrode surface 806 on the tissue contact surface of its instrument branch body, which is provided and adapted to come into contact with the tissue. Light sources and sensors (not shown) are incorporated into the instrument branch body. The instrument branch body also has light exit openings 814 through which the light from a light source (not shown) is directed and radiates / enters the tissue. The instrument branch body also has light entry openings 816 through which the light from the tissue radiates / enters the instrument branch body into a light tunnel 820, which ends in a sensor. The light from the light source to the light exit opening 814 is directed through the same light tunnel.In other words, light exit openings 814 can function as light entry openings 816 and vice versa. At least two partially transparent planes 626 are introduced into the light tunnel 820, which transmit a portion of electromagnetic radiation, i.e., are transparent to a portion of the light, and reflect a portion of the light. Preferably, the partially transparent plane is a partially transparent mirror, and more preferably, several partially transparent planes 626 are arranged one behind the other in the light tunnel. Due to this arrangement in this embodiment, a partially transparent mirror is assigned to a respective light exit opening 814 or a respective light entry opening 816.

[0108] Fig.20shows the light guidance in the instrument industry area 801 according to the ninth embodiment in a light tunnel 820. The incoming light from the light source is fed into the light tunnel 820. The incoming light from the light source is fed into the light tunnel 820 in a straight line / directed line / parallel line. By being guided by at least two partially transparent mirrors 826 in the light tunnel 820, the light is guided / reflected / mirrored over angled areas / angles or the like. The light that passes through a partially transparent mirror 826 strikes at least one further partially transparent mirror 826, which is arranged at the same angle as the previous mirror, and so on.The light is radiated into the tissue through the partially translucent mirror / reflective surface / reflective plane 826, and the remitted light is guided by the same light tunnel 820 but through an adjacent opening to a sensor. In other words, one opening is both a light exit opening and a light entry opening for an adjacent opening.

[0109] Fig.21shows a region of an instrument branch 901 according to a tenth embodiment. The instrument branch 901 has an electrode 902; in this embodiment, the instrument branch body and the electrode correspond in terms of their structure and arrangement to the previous exemplary embodiments. Accordingly, light sources and sensors are introduced into the instrument branch at a distance from the tissue contact surface of the instrument branch body (not shown). The instrument branch body has light exit openings 914 through which the light from a light source (not shown) is guided and from which light radiates / enters the tissue. The instrument branch body further has light entry openings 916 through which the light radiates / exits from the tissue into a light tunnel 920, which ends in a sensor. The light from the light source to the light exit opening 914 is guided through at least one 920 light tunnel.The light from the light inlet opening 91 to the sensor is guided through at least one further light tunnel 920 (of the same design). In this embodiment, at least two light tunnels 920 are formed in the instrument branch body. The light outlet opening(s) 914 and light inlet opening(s) 916 are alternately formed in the instrument branch body. At least one mirrored / reflective inclined / angled plane 924 is formed in the light tunnel 920.

[0110] Fig.22shows the light guidance in the area of ​​the instrument branch 901 according to the tenth embodiment in the light tunnel 920. The incoming light from the light source is fed into the light tunnel 920 and deflected at the angled reflecting plane 924 at a predetermined angle (preferably between 0 and 90°). The light is radiated into the tissue by the mirror / reflecting surface / reflecting plane 924, and the remitted light is guided to a sensor by another light tunnel 924 with the same structure.

[0111] Fig. 23 shows a bipolar instrument branch according to the above embodiments. Embodiments one to ten are intended and adapted for use in a bipolar medical HF instrument in which two instrument branch bodies are preferably pivotally mounted relative to one another and define a tissue receiving gap between them.

[0112] Fig. 24 shows opposing detectors and illuminators on a bipolar RF instrument. The light exit apertures 1014 of the illuminators and the light entrance apertures 1016 of the detectors are each arranged on opposite instrument branches / instrument branch bodies.

[0113] Fig. 25shows a schematic representation of a medical device 1100 according to the invention. A light source 1110 is provided and adapted to emit light. A sensor 1112 is provided and adapted to detect light. The light source emits the light through a light exit opening 1114. The sensor 1112 receives light via a light entry opening 1116. The light sources 1110 and the sensors 1112 are connected to data lines 1130 and 1132 located in a channel 1118. The channel 1118 is formed in an instrument branch body, which also insulatively accommodates the electrodes. One instrument branch body, in which the electrode 1134 is accommodated, clamps the tissue 1138 with an instrument branch body, in which the opposite electrode 1136 is accommodated. Electrode 1134 and electrode 1136 are connected to leads 1140 and 1142.The data lines 1130 and 1132, as well as the lines 1140 and 1142 are connected to a computing unit 1144, which has a storage medium 1146.

[0114] Fig. 26shows a schematic representation of a temperature curve during the process. The temperature v of the tissue is plotted against time t in a graph. t1 marks the point in time at which the tissue reaches a temperature of 85°C, preferably 95°C. T2 marks the point at which the value SP reaches a value of 2.5. The value SP was calculated online from the point in time at which the tissue temperature reached 85°C, preferably 95°. From this point in time, the duration for which the temperature of a tissue is above 85°C, preferably above 95°C, was measured and the average temperature from the first time 85°C, preferably 95°C, was reached was calculated online (shown here with the dashed line). These two values ​​are multiplied in real time and divided by the energy input until 85°C, preferably 95°C, is reached, whereby the value SP is calculated, preferably in real time. List of reference symbols

[0115] 1, 101, 201, 301, 401, 501, 601, 701, 801, 901 Instrument branch 2, 102, 202, 302, 402, 502, 602, 702, 802, 902 Electrode 4, 104, 204, 304, 404, 604, 804, 904 First electrode surface 6, 106, 206, 306, 406, 606, 806, 906 Second electrode surface 8, 108, 208, 308, 408, 708 Instrument branch body 10, 1110 Light source 12, 1112 Sensor 14, 114, 214, 314, 414, 514, 614, 714, 814, 914, 1014, 1114 Light entrance opening 16, 116, 216, 616, 716, 816, 916, 1016, 1116 Light exit opening 18, 1118 Channel 120, 220, 320, 420, 520, 620, 720, 820, 920 Light tunnel 322, 422 Bulk material 524, 924 Mirrored inclined plane 626, 826 Semi-transparent plane 1028 Bipolar instrument branch 1130, 1132, 1140, 1142 Lines 1134 First Electrode 1136 Second electrode 1138 Tissue 1144 Computing unit 1146 Storage medium

Claims

1. A computer-readable storage medium of a medical instrument with a temperature measurement device for measuring the temperature of a tissue, preferably of a medical instrument according to claim 11, having a method for determination of a switch-off time of a medical instrument stored thereon, comprising the steps of: • measuring a duration for which the temperature of a tissue is above 85° Celsius, preferably above 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, • calculating, preferably online, a mean temperature as from the first time when the temperature reaches 85° Celsius, preferably 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, • measuring and / or calculating an energy input until the temperature of 85° Celsius is reached, preferably until the temperature of 95° Celsius is reached, and preferably below 110° Celsius, preferably below 100° Celsius, • calculating a parameter SP, which links the above-mentioned results, and at a predetermined value of the parameter SP, preferably at a predetermined value SP between 2 and 3, in particular at a predetermined value SP of 2.5, switch-off of the medical instrument and, when executed by a computer, cause the computer to carry out the method, wherein the parameter SP is the result from the duration for which the temperature of the tissue is above 85° Celsius, preferably above 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, multiplied by the mean temperature as from the first time when the temperature of 85° Celsius is reached, preferably 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, divided by the energy input until the temperature of 85° Celsius, preferably 95° Celsius, is reached.

2. The storage medium according to claim 1, characterized in that the method moreover comprises the steps of • emitting light with an excitation spectrum into a tissue by means of at least one illumination (10, 1110), • receiving the remission of light with a remission spectrum from the tissue by at least one detector (12, 1112), • converting the remission spectrum by means of the detector (12, 1112) into a detector signal, • sending the detector signal to a calculating unit (1144), • calculating the remission spectrum from the detector signal by means of the calculating unit (1144), • calculating an absorption spectrum of the tissue by comparing the excitation spectrum with the remission spectrum using the calculating unit (1144), • calculating at least one absorption maximum from the absorption spectrum by means of the calculating unit (1144), and • calculating a temperature in the tissue by comparing the absorption maximum with at least one reference by means of the calculating unit (1144)3. The storage medium according to one of the preceding claims, characterized in that the method moreover comprises the step of • storing at least one reference in the form of an absorption maximum at a certain temperature in the calculating unit, preferably a storage medium in the calculating unit, preferably for water and / or fat and / or collagen.

4. The storage medium according to one of the preceding claims, characterized in that the method moreover comprises the step of • applying the illumination and the detector (12, 1120) to the tissue.

5. The storage medium according to one of the preceding claims, characterized in that the method moreover comprises the step of • controlling and / or adjusting and / or switching off a device, preferably a medical instrument, by means of the calculating unit based on the calculated temperature and / or tissue impedance.

6. The method according to claim 5, characterized in that the controlling and / or adjusting and / or switching off takes place when a predetermined temperature is reached, preferably at a temperature that is greater than 85° Celsius, preferably greater than 95° Celsius, and preferably less than 100° Celsius.

7. The storage medium according to claim 5 or 6, characterized in that the controlling and / or adjusting and / or switching off of a medical instrument takes place online, preferably in real time.

8. The storage medium according to one of the preceding claims, characterized in that the method for temperature measurement is performed during a sealing process.

9. The storage medium according to any one of claim 2 to 8, characterized in that the detectors are provided and adapted to measure remission, preferably the remission spectra, in the NIR range of 1000 nm to 1700 nm, more preferable in the range of 1400 nm to 1600 nm.

10. The storage medium according to one of the preceding claims, characterized in that the illumination and the detector are spaced apart.

11. A medical instrument (1110) for sealing and / or cutting of tissue, comprising a temperature measurement device which is provided and adapted to measure a temperature of a tissue, and comprising a calculating unit (1144), wherein the medical instrument (1110), in particular the temperature measurement device is provided and adapted to measure a duration for which the temperature of the tissue is above 85° Celsius, preferably above 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, wherein the calculating unit (1144) is provided and adapted to calculate, preferably online, a mean temperature as from which the temperature of 85° Celsius is reached for the first time, preferably as from which the temperature of 95° Celsius is reached for the first time, and preferably below 110° Celsius, preferably below 100° Celsius, wherein the medical instrument (1110) is moreover adapted to measure and / or to calculate an energy input until the temperature of 85° Celsius is reached, preferably 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, wherein the calculating unit (1144) is provided and adapted to calculate a parameter SP which links the above-mentioned results of the duration, the mean temperature and the energy input, and wherein the medical instrument (1110), in particular the calculating unit (1144,) is adapted to switch off the medical instrument (1110), at and / or as from a predetermined value SP, preferably at a predetermined value SP between 2 and 3, in particular at and / or as from a value SP of 2.5, wherein the parameter SP is the result from the duration for which the temperature of the tissue is above 85° Celsius, preferably above 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, multiplied by the mean temperature as from the first time when the temperature of 85° Celsius is reached, preferably 95° Celsius, and preferably below 110° Celsius, preferably below 100° Celsius, divided by the energy input until the temperature of 85° Celsius, preferably 95° Celsius, is reached.

12. The medical instrument (1110) according to claim 11, characterized in that the medical instrument (1110) comprises at least one instrument branch (1, 101, 201, 301, 401, 501, 601, 701, 801, 901), which forms at least one energizable electrode (502, 602, 702, 802, 902, 1134, 1136) for sealing and / or cutting of tissue, or is arranged in or on the at least one energizable electrode (2, 102, 202, 302, 402, 702) for sealing and / or cutting of tissue, wherein the energization of the electrode (2, 102, 202, 302, 402, 502, 602, 702, 802, 902, 1134, 1136) is controllable and / or adjustable by the calculating unit (1144).