PATENT DOCUMENT

Abstract:
A medical treatment apparatus includes an energy source which applies energy to living tissues, a first treating portion which joins the living tissues together, a second treating portion which is interposed between the living tissues and which removes surface portions of tissues in the joint surfaces of the living tissues, a detecting portion, and a controller. The first treating portion includes at least a pair of holding members having holding surfaces to hold the living tissues, and an energy output unit which is provided on the holding surfaces of the holding members and which join the living tissues together when energy is applied thereto from an energy source. The detecting portion detects biological information regarding the living tissues held by the pair of holding members. The controller controls outputs from the energy output unit in accordance with the biological information regarding the living tissues obtained by the detecting portion.

Full Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    This invention relates to a medical treatment apparatus, a medical treatment instrument and a treatment method for living tissue using energy that are capable of joining a plurality of living tissues together using energy. 
         [0003]    2. Description of the Related Art 
         [0004]    In surgical operations including an abdominal operation and a laparoscopic operation, a tubular tissue or organ of, for example, a blood vessel may be sealed, or other tissues may be joined together. For example, a suture or clip is used to seal the blood vessel to be disjoined. A suture or staple is used to seal or anastomose cut ends of a digestive tract. In addition, techniques using energy have been in use recently. A high-frequency device or ultrasonic device is constantly used to seal a blood vessel, and moreover, other devices used for thicker living tissues are also making progress. In such a procedure, living tissues are held with a forceps-shaped device and treated. Energy is input to the held living tissues from an electrode disposed on the surface of a holding member and from an ultrasonic probe having a holding function together, such that the living tissues are joined together. In such a procedure, macromolecules of the living tissues are denatured, so that the living tissues themselves can be used as adhesive components to join the living tissues together. 
         [0005]    Among the macromolecules of the living tissues, collagen is one of the components that are most easily bonded. The living tissues can be firmly joined together if collagens in the joint surfaces of the living tissues can be bonded together. This enables a stable treatment. 
         [0006]    However, since the surface of an organ is covered with components other than collagen such as epithelial cells, collagens in the joint surfaces of the living tissues can not be joined together merely by holding the tissues and outputting energy thereto. In order to enable the joint surfaces of the living tissues to be joined together by collagens, it is necessary to remove the components other than collagen on the surface of an organ, in particular, the epithelial cells. 
         [0007]    Techniques for removing surface tissues include, for example, cavitation using ultrasonic energy, transpiration of living tissues caused by high-frequency energy, and physical friction. For example, the techniques for removing living tissues by ultrasonic energy are disclosed in EP 1 526 825 A1 and U.S. Pat. No. 6,736,814 B2. EP 1 526 825 A1 describes a technique which uses ultrasonic vibrations to perform a procedure called debridment for eliminating damaged living tissues. U.S. Pat. No. 6,736,814 B2 describes a technique which uses ultrasonic suction when treating the central nerve system. There is also a technique described in U.S. Pat. No. 6,461,350 B1 which uses high-frequency energy to remove living tissues. The technique described in U.S. Pat. No. 6,736,814 B2 uses high-frequency energy to remove adipose cells under epidermal tissues. On the other hand, techniques which have both ultrasonic and high-frequency devices between forceps structures for holding and joining living tissues include U.S. Pat. No. 6,500,176 B1, Jpn. Pat. Appln. KOKAI Publication No. 2007-229270, and U.S. Pat. No. 6,736,814B2. 
       BRIEF SUMMARY OF THE INVENTION 
       [0008]    According to a first aspect of the present invention, there is provided a medical treatment apparatus to join target living tissues in a body, the medical treatment apparatus including: an energy source which applies energy to the target living tissues; a first treating portion which joins the target living tissues together when energy is applied thereto from the energy source; a second treating portion which is interposed between the target living tissues and which removes surface portions of tissues in the joint surfaces of the target living tissues; an operation portion; and a controller. The first treating portion includes at least a pair of holding members having holding surfaces to hold the target living tissues, and energy emitters which are provided on the holding surfaces of the holding members and which join the target living tissues together when energy is applied thereto from the energy source. The operation portion has a function of operating the holding members so that at least one of the holding members moves relative to the other. The controller controls outputs from the energy emitters. 
         [0009]    According to a second aspect of the present invention, there is provided a medical treatment instrument to join target living tissues in a body, the treatment instrument including: a first treating portion which joins the target living tissues together when energy is applied thereto from an energy source; a second treating portion which is interposed between the target living tissues and which removes surface portions of tissues in the joint surfaces of the target living tissues; and an operation portion. The first treating portion includes at least a pair of holding members having holding surfaces to hold the target living tissues, and energy emitters which are provided on the holding surfaces of the holding members and which join the target living tissues together when energy is applied thereto from the energy source. The operation portion has a function of operating the holding members so that at least one of the holding members moves relative to the other. 
         [0010]    According to a third aspect of the present invention, there is provided a treatment method for living tissue using energy, including: holding at least two living tissues with predetermined pressure; removing surface portions of tissues in the joint surfaces of the at least two target living tissues; and applying energy to the joint surfaces to join the joint surfaces together. 
         [0011]    Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING 
         [0012]    The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention, and together with the general description given above and the detailed description of the embodiments given below, serve to explain the principles of the invention. 
           [0013]      FIG. 1A  is a schematic perspective view showing a medical treatment apparatus according to a first embodiment; 
           [0014]      FIG. 1B  is a partial sectional view of a handle and a shaft of an energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0015]      FIG. 2  is a schematic diagram showing the medical treatment apparatus according to the first embodiment; 
           [0016]      FIG. 3A  is a schematic longitudinal sectional view showing the shaft and a treatment portion in which first and second holding members are closed and in which an ultrasonic probe is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0017]      FIG. 3B  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the ultrasonic probe is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0018]      FIG. 3C  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the ultrasonic probe is drawn into the shaft from between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0019]      FIG. 3D  is a schematic cross sectional view along the line  3 D- 3 D in  FIG. 3A , wherein the first and second holding members of the treatment portion are closed, and the ultrasonic probe is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0020]      FIG. 4A  is a schematic view showing a holding surface of the main body of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0021]      FIG. 4B  is a schematic cross sectional view along the line  4 B- 4 B in  FIG. 4A , showing the main body of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to the first embodiment; 
           [0022]      FIG. 5  is a flowchart for joining living tissues by use of the medical treatment apparatus according to the first embodiment; 
           [0023]      FIG. 6  is a schematic graph showing the relation of the impedance of living tissues with time when the medical treatment apparatus is used to continuously apply high-frequency energy to the living tissues and thereby treat the living tissues; 
           [0024]      FIG. 7A  is a schematic view showing the holding surface of the main body of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to a modification of the first embodiment; 
           [0025]      FIG. 7B  is a schematic cross sectional view along the line  7 B- 7 B in  FIG. 7A , showing the main body of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to the modification of the first embodiment; 
           [0026]      FIG. 8  is a schematic perspective view showing the medical treatment apparatus according to a modification of the first embodiment; 
           [0027]      FIG. 9  is a schematic perspective view showing the medical treatment apparatus according to a modification of the first embodiment; 
           [0028]      FIG. 10A  is a schematic diagram showing how to treat by a bipolar medical treatment apparatus according to the first embodiment; 
           [0029]      FIG. 10B  is a schematic diagram showing how to treat by a monopolar medical treatment apparatus according to the first embodiment; 
           [0030]      FIG. 11  is a schematic perspective view showing a medical treatment apparatus according to a second embodiment; 
           [0031]      FIG. 12  is a schematic diagram showing the medical treatment apparatus according to the second embodiment; 
           [0032]      FIG. 13A  is a schematic longitudinal sectional view showing a shaft and a treatment portion in which first and second holding members are closed and in which an ultrasonic suction probe is disposed between the first and second holding members of an energy treatment instrument of the medical treatment apparatus according to the second embodiment; 
           [0033]      FIG. 13B  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the ultrasonic suction probe is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the second embodiment; 
           [0034]      FIG. 13C  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the ultrasonic suction probe is drawn into the shaft from between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the second embodiment; 
           [0035]      FIG. 13D  is a schematic cross sectional view along the line  13 D- 13 D in  FIG. 13A , wherein the first and second holding members of the treatment portion are closed, and the ultrasonic suction probe is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the second embodiment; 
           [0036]      FIG. 14  a flowchart for joining living tissues by use of the medical treatment apparatus according to the second embodiment; 
           [0037]      FIG. 15A  is a schematic view showing a holding surface of a main body of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to a modification of the second embodiment; 
           [0038]      FIG. 15B  is a schematic longitudinal sectional view along the line  15 B- 15 B in  FIG. 15A , showing the main body and a base of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to the modification of the second embodiment; 
           [0039]      FIG. 15C  is a schematic longitudinal sectional view along the line  15 C- 15 C in  FIG. 15A , showing the main body and a base of the first holding member of the treatment portion of the energy treatment instrument of the medical treatment apparatus according to the modification of the second embodiment; 
           [0040]      FIG. 16  is a schematic diagram showing a medical treatment apparatus according to a third embodiment; 
           [0041]      FIG. 17A  is a schematic longitudinal sectional view showing a shaft and a treatment portion in which first and second holding members are closed and in which a rod electrode is disposed between the first and second holding members of an energy treatment instrument of the medical treatment apparatus according to the third embodiment; 
           [0042]      FIG. 17B  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the rod electrode is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the third embodiment; 
           [0043]      FIG. 17C  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the rod electrode is drawn into the shaft from between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the third embodiment; 
           [0044]      FIG. 17D  is a schematic cross sectional view along the line  17 D- 17 D in  FIG. 17A , wherein the first and second holding members of the treatment portion are closed, and the rod electrode is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the third embodiment; 
           [0045]      FIG. 18  a flowchart for joining living tissues by use of the medical treatment apparatus according to the third embodiment; 
           [0046]      FIG. 19A  is a schematic diagram showing how to treat by a bipolar medical treatment apparatus according to the third embodiment; 
           [0047]      FIG. 19B  is a schematic diagram showing how to treat by a monopolar medical treatment apparatus according to the third embodiment; 
           [0048]      FIG. 20  is a schematic partial sectional view of a medical treatment apparatus according to a fourth embodiment; 
           [0049]      FIG. 21  is a schematic diagram showing the medical treatment apparatus according to the fourth embodiment; 
           [0050]      FIG. 22A  is a schematic longitudinal sectional view showing a shaft and a treatment portion in which first and second holding members are closed and in which a detachment member is disposed between the first and second holding members of an energy treatment instrument of the medical treatment apparatus according to the fourth embodiment; 
           [0051]      FIG. 22B  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the detachment member is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the fourth embodiment; 
           [0052]      FIG. 22C  is a schematic longitudinal sectional view showing the shaft and the treatment portion in which the first and second holding members are opened and in which the detachment member is drawn into the shaft from between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the fourth embodiment; 
           [0053]      FIG. 22D  is a schematic cross sectional view along the line  22 D- 22 D in  FIG. 22A , wherein the first and second holding members of the treatment portion are closed, and the detachment member is disposed between the first and second holding members of the energy treatment instrument of the medical treatment apparatus according to the fourth embodiment; and 
           [0054]      FIG. 23  a flowchart for joining living tissues by use of the medical treatment apparatus according to the fourth embodiment. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0055]    The best mode for carrying out this invention will be described below with reference to the drawings. 
       First Embodiment 
       [0056]    A first embodiment is described with  FIG. 1A  to  FIG. 10B . 
         [0057]    Here, a linear bipolar high-frequency energy treatment instrument  12  for a treatment, for example, through an abdominal wall is described as an example of an energy treatment instrument. 
         [0058]    As shown in  FIG. 1A  and  FIG. 2 , a medical treatment apparatus  10  includes the energy treatment instrument (medical treatment instrument)  12 , a high-frequency energy source  14  for providing high-frequency energy to the energy treatment instrument  12 , and an ultrasonic energy source  16  for providing ultrasonic energy to the energy treatment instrument  12 . The medical treatment apparatus  10  is connected to the high-frequency energy source  14  by a connector  17   a  of a cable  17  extending from the energy treatment instrument  12 . The medical treatment apparatus  10  is connected to the ultrasonic energy source  16  by a connector  19   a  of a cable  19  extending from the energy treatment instrument  12 . 
         [0059]    As shown in  FIG. 2 , the high-frequency energy source  14  includes a detecting portion  22 , a high-frequency energy controller (hereinafter referred to as a high-frequency output controller)  24 , and a high-frequency energy output unit (hereinafter referred to as a high-frequency output unit)  26 . The detecting portion  22  is connected to a later-described high-frequency electrode  82   b  of the energy treatment instrument  12 . The high-frequency output controller  24  and the high-frequency output unit  26  of the high-frequency energy source  14  are connected to the detecting portion  22 . The high-frequency output controller  24  is further connected to the high-frequency output unit  26 . Moreover, the high-frequency output unit  26  is connected to the high-frequency electrode  82   b  of a later-described first holding member  72  of the energy treatment instrument  12  through the detecting portion  22 , and is also connected to a high-frequency electrode  84   b  of a later-described second holding member  74  of the energy treatment instrument  12 . 
         [0060]    The detecting portion  22  detects electric biological information regarding living tissues held by the later-described first and second holding members (a pair of holding members)  72 ,  74  of the energy treatment instrument  12 . That is, the detecting portion  22  detects the values of a current and a voltage flowing through the living tissues held between the first and second holding members  72 ,  74 , calculates the value of the impedance Z from the detected current and voltage values, and provides the calculated impedance Z as biological information. The high-frequency output unit  26  outputs high-frequency energy under the control of the high-frequency output controller  24 . Thus, the high-frequency output controller  24  can control the output of the high-frequency energy from the high-frequency output unit  26  to the energy treatment instrument  12  on the basis of the biological information detected by the detecting portion  22 . 
         [0061]    In addition, an unshown foot switch or hand switch is connected to the high-frequency energy source  14 . 
         [0062]    The ultrasonic energy source  16  includes an ultrasonic energy controller (hereinafter referred to as an ultrasonic output controller)  32 , and an ultrasonic energy output unit (hereinafter referred to as an ultrasonic energy output unit)  34 . The ultrasonic output controller  32  is connected to the ultrasonic energy output unit  34 . The ultrasonic energy output unit  34  is connected to a later-described ultrasonic transducer  43  of the energy treatment instrument  12 . 
         [0063]    In addition, an unshown foot switch or hand switch is connected to the ultrasonic energy source  16 . Thus, the foot switches or hand switches are connected to the high-frequency energy source  14  and the ultrasonic energy source  16 , respectively. Alternatively, it is also preferable that a common foot switch or hand switch be connected to the high-frequency energy source  14  and the ultrasonic energy source  16 . 
         [0064]    As shown in  FIG. 1A , the energy treatment instrument  12  includes a handle  42 , a shaft  44  and a treatment portion  46 . 
         [0065]    The handle  42  is substantially L-shaped. The proximal end of the shaft  44  is disposed at one end of the handle  42 . On the other hand, the other end of the handle  42  serves as a grip portion gripped by an operator (user of the energy treatment instrument  12 ). The handle  42  is provided with a first knob (lengthwise feed lever)  42   a  side by side with the other end (grip portion) of the handle  42 , and the first knob  42   a  serves to operate the later-described first treating portion  62  of the treatment portion  46 . If the first knob  42   a  is brought closer to or away from the other end of the handle  42 , a later-described sheath  54  axially moves. The handle  42  is provided, at its one end, with a second knob (lengthwise feed lever)  42   b  for moving a later-described second treating portion  64  along the axial direction of the shaft  44 . The second knob  42   b  can be brought closer to or away from the operator. 
         [0066]    As shown in  FIG. 1B , the ultrasonic transducer  43  is provided within the handle  42 . A housing  43   a  of the ultrasonic transducer  43  is formed integrally with the second knob  42   b  of the handle  42 . Further, the proximal end of a later-described ultrasonic probe  76  of the second treating portion  64  of the treatment portion  46  is connected to the ultrasonic transducer  43 . Then, when energy is supplied from the ultrasonic energy source  16  to the ultrasonic transducer  43  through a later-described ultrasonic energy conducting line  20   a , the ultrasonic transducer  43  ultrasonically vibrates. That is, electric energy is converted to mechanical energy. Then, the vibrations of the ultrasonic transducer  43  are transmitted from the proximal end to distal end of the ultrasonic probe  76 . 
         [0067]    As shown in  FIG. 3A  to  FIG. 3D , the shaft  44  includes a cylindrical member  52 , and the sheath  54  slidably provided outside the cylindrical member  52 . The cylindrical member  52  is fixed at its proximal end to one end of the handle  42 . The sheath  54  is slidable along the axial direction of the cylindrical member  52  by the operation of the first knob  42   a  at the other end of the handle  42 . 
         [0068]    As shown in  FIG. 1A , the treatment portion  46  includes the first treating portion  62  and the second treating portion  64 . The first treating portion  62  has the first and second holding members (a pair of holding members)  72 ,  74  which can open and close with respect to each other. The second treating portion  64  has the ultrasonic probe  76  which can be provided between the first and second holding members  72 ,  74 . 
         [0069]    In addition, the second holding member  74  has the same structure as the first holding member  72  shown in  FIG. 4A  and  FIG. 4B , and therefore, the structure of the first holding member  72  is mainly described for representation. Moreover, the detailed structure of the second holding member  74  is not shown, but is properly provided with numerals for the purpose of explanation. 
         [0070]    As shown in  FIG. 1A , the first and second holding members  72 ,  74  are provided at the distal end of the shaft  44 . The first holding member  72  integrally has a main body  72   a  and a base  72   b . The second holding member  74  integrally has a main body  74   a  and a base  74   b . In addition, the distal ends of the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74  are most distal to the handle  42 , and the proximal ends of the main bodies  72   a ,  74   a  are most proximal to the handle  42 . The first and second holding members  72 ,  74  have longitudinal axes determined by the distal ends and the proximal ends. Later-described grooves  92 ,  94  are formed along the longitudinal axes. 
         [0071]    As shown in  FIG. 3D  and  FIG. 4B , the outer surfaces of the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74  are smoothly curved. Although not shown, the outer surfaces of the bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are also smoothly curved. When the second holding member  74  is closed with respect to the first holding member  72 , the cross sections of the main bodies  72   a ,  74   a  of the holding members  72 ,  74  are substantially circular or substantially elliptic as a whole. When the second holding member  74  is closed with respect to the first holding member  72 , the cross sections of the bases  72   b ,  74   b  are substantially cylindrical as a whole. In this state, the outside diameters of the proximal ends of the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74  are greater than the outside diameters of the first and second bases  72   b ,  74   b . Thus, steps  73  are formed between the first and second main bodies  72   a ,  74   a  and the bases  72   b ,  74   b . The distal end of the sheath  54  of the shaft  44  comes into or out of contact with the steps  73  by the operation of the first knob  42   a.    
         [0072]    Here, when the second holding member  74  is closed with respect to the first holding member  72 , the outer peripheral surfaces, which are substantially circular or substantially elliptic as a whole, of the bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are substantially flush with or slightly greater in diameter than the outer peripheral surface of the distal end of the cylindrical member  52 . Therefore, the sheath  54  of the shaft  44  can be slid over the cylindrical member  52  so that the bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are covered with the distal end of the sheath  54 . 
         [0073]    The proximal ends of the bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are both supported rotatably around the distal end of the cylindrical member  52  of the shaft  44  in a direction perpendicular to the axial direction of the shaft  44  by support pins  56   a ,  56   b  which are disposed at the distal end of the cylindrical member  52 . These support pins  56   a ,  56   b  are provided at the distal end of the cylindrical member  52  in parallel with each other. The bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are rotated around the axes of the support pins  56   a ,  56   b  so that the main bodies  72   a ,  74   a  of the holding members  72 ,  74  can be opened or closed with respect to each other. The bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are respectively urged by elastic members  58   a ,  58   b  such as leaf springs so that later-described holding surfaces  82 ,  84  of the main bodies  72   a ,  74   a  to be in contact with the living tissue are opened with respect to the position where the holding surfaces are in contact with each other. Actually, as shown in  FIG. 3A  to  FIG. 3C , the elastic members  58   a ,  58   b  are provided on the outer peripheries of the support pins  56   a ,  56   b  provided at the distal end of the cylindrical member  52 . Therefore, the bases  72   b ,  74   b  of the first and second holding members  72 ,  74  are urged in a direction to open. 
         [0074]    Thus, when the first knob  42   a  is operated to move the distal end of the sheath  54  (forward) distally with respect to the operator, force is applied so that the bases  72   b ,  74   b  may be closed by the distal end of the sheath  54 . Then, the first and second holding members  72 ,  74  close against the urging force by the elastic members  58   a ,  58   b . In this case, if the living tissue is not in contact with the holding surfaces  82 ,  84  of the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74 , the holding surfaces  82 ,  84  are in contact with each other. On the other hand, when the first knob  42   a  is operated to move the distal end of the sheath  54  (backward) proximally with respect to the operator, there is no force of the distal end of the sheath  54  to close the bases  72   b ,  74   b , that is, the first holding member  72  and the second holding member  74  are opened due to the urging force by the elastic members  58   a ,  58   b.    
         [0075]    As shown in  FIG. 3B , the first holding surface  82  for holding a treatment target living tissue is formed on the side of the main body  72   a  of the first holding member  72  proximate to the main body  74   a  of the second holding member  74 . The second holding surface  84  for holding the treatment target living tissue is formed on the side of the main body  74   a  of the second holding member  74  proximate to the main body  72   a  of the first holding member  72 . The first holding surface  82  has a first contact surface  82   a  which comes into contact with the living tissue when holding the living tissue, and a first electrode  82   b  as an energy emitter for emitting energy to the living tissue. The second holding surface  84  has a second contact surface  84   a  which comes into contact with the living tissue when holding the living tissue, and a second electrode  84   b  as an energy emitter for emitting energy to the living tissue. 
         [0076]    As shown in  FIG. 4A , the first and second contact surfaces  82   a ,  84   a  are flat. The first contact surface  82   a  is provided with the flat-plate-shaped first electrode  82   b , as shown in  FIG. 4B . The second contact surface  84   a  is provided with the flat-plate-shaped second electrode  84   b . The first and second electrodes  82   b ,  84   b  are provided over the substantially entire surfaces of the first and second contact surfaces  82   a ,  84   a  except for their distal ends, as shown in  FIG. 4A . In addition, the end face (side surface) of the first electrode  82   b  is aligned with the side surface of the main body  72   a  of the first holding member  72 . The end face (side surface) of the second electrode  84   b  is aligned with the side surface of the main body  74   a  of the second holding member  74 . 
         [0077]    The first groove (recess)  92  where the ultrasonic probe  76  is disposed is formed in the center of the contact surface  82   a  (first electrode  82   b ) of the holding surface  82  of the main body  72   a  of the first holding member  72 . Similarly to the main body  72   a , the second groove  94  is formed in the center of the contact surface  84   a  (second electrode  84   b ) of the holding surface  84  of the main body  74   a  of the second holding member  74  at a position opposite to the first groove  92  of the first holding member  72 . The width of the grooves  92 ,  94  of the first and second main bodies  72   a ,  74   a  is greater than the width of the ultrasonic probe  76 . Moreover, the depth of the grooves  92 ,  94  of the first and second main bodies  72   a ,  74   a  is greater than half of the height of the ultrasonic probe  76 . Thus, when the first treating portion  62  is closed, that is, when the first and second holding members  72 ,  74  are closed, the ultrasonic probe  76  is stored movably in and out without contacting the grooves  92 ,  94 . 
         [0078]    In addition, as shown in  FIG. 4B , in order to apply sufficient high-frequency energy to the surface where the living tissue is removed, the groove  92  of the first holding member  72  is also provided with the first electrode (high-frequency electrode)  82   b , and the groove  94  of the second main body  74   a  is also provided with the second electrode (high-frequency electrode)  84   b . The first electrode  82   b  of the groove  92  of the first holding member  72  is formed to be discontinuous with but to have the same potential as the electrode  82   b  of the first contact surface  82   a  of the first holding member  72 . Similarly, the second electrode  84   b  of the groove  94  of the second holding member  74  is formed to be discontinuous with but to have the same potential as the electrode  84   b  of the second contact surface  84   a  of the second holding member  74 . 
         [0079]    Elastic members  92   a ,  94   a  such as leaf springs (see  FIG. 3A  to  FIG. 3C ) are provided on the rear surfaces of the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94 . The elastic members  92   a ,  94   a  can act together with the operation of the second knob  42   b . When the ultrasonic probe  76  is between the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74  as shown in  FIG. 3A  and  FIG. 3B , the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  are drawn in the main bodies  72   a ,  74   a . When the ultrasonic probe  76  is removed from between the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74  and thus drawn in the shaft  44  as shown in  FIG. 3C , the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  are pressed by the elastic members  92   a ,  94   a  and are flush with the holding surfaces  82 ,  84 . 
         [0080]    Thus, when the second knob  42   b  is disposed distally with respect to the operator, the elastic members  92   a ,  94   a  act together with the second knob  42   b  in such a manner as to draw the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  into the main bodies  72   a ,  74   a . On the other hand, when the second knob  42   b  is disposed proximally with respect to the operator, the elastic members  92   a ,  94   a  act together with the second knob  42   b  so that the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  may be flush with the holding surfaces  82 ,  84  of the main bodies  72   a ,  74   a . That is, the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  are on the same surface as the electrodes  82   b ,  84   b  disposed on the holding surfaces  82 ,  84 . Therefore, the elastic members  92   a ,  94   a  bring the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  out of an urged state together with the forward movement of the ultrasonic probe  76 , and bring the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  into an urged state together with the backward movement of the ultrasonic probe  76 . At the same time, the living tissue is also pressed by the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94 . 
         [0081]    As shown in  FIG. 3D , the cross section of the ultrasonic probe  76  is, for example, circular, but is permitted to have various shapes such as a polygonal shape. The sectional shape of the grooves  92 ,  94  of the holding surfaces  82 ,  84  formed by the first and second holding members  72 ,  74  is preferred to be similar to that of the ultrasonic probe  76 , but is permitted to be various shapes such as circular, elliptic and polygonal shapes. 
         [0082]    First and second conducting lines  18   a ,  18   b  are provided inside the cylindrical member  52  of the shaft  44 , inside the handle  42 , and within the cable  17 . The first and second conducting lines  18   a ,  18   b  are connected on one end to the first and second electrodes  82   b ,  84   b  and connected on the other end to the connector  17   a  of the cable  17 . Thus, energy can be supplied to the first electrode  82   b  and the second electrode  84   b  from the high-frequency energy source  14  through the connector  17   a  and the first and second conducting lines  18   a ,  18   b.    
         [0083]    At the same time, the first and second high-frequency electrodes  82   b ,  84   b  serve as sensors, and thus measure a current, voltage, etc. flowing the first and second high-frequency electrodes  82   b ,  84   b  through the living tissue, and then input relevant signals to the detecting portion  22  of the high-frequency energy source  14  through the first and second conducting lines  18   a ,  18   b.    
         [0084]    The ultrasonic energy conducting line  20   a  is provided inside the handle  42  and within the cable  19 . The ultrasonic energy conducting line  20   a  is connected on one end to the ultrasonic transducer  43  and connected on the other end to the connector  19   a  of the cable  19 . Thus, energy can be supplied to the ultrasonic transducer  43  from the ultrasonic energy source  16  through the connector  19   a  and the ultrasonic energy conducting line  20   a.    
         [0085]    The ultrasonic probe  76  described above is provided inside the cylindrical member  52  of the shaft  44 . Insulating supports  76   a  such as O-rings formed of, for example, rubber are provided on the outer peripheral surface of the ultrasonic probe  76  at the positions of vibration nodes in the transmission of ultrasonic vibrations from the ultrasonic transducer  43 . This makes it possible to prevent a direct contact between the outer peripheral surface of the ultrasonic probe  76  and the inner peripheral surface of the cylindrical member  52 . 
         [0086]    Furthermore, the housing  43   a  of the ultrasonic transducer  43  at the proximal end of the ultrasonic probe  76  is fixed to the second knob  42   b  of the handle  42 . Thus, when the second knob  42   b  is moved distally with respect to the operator, the ultrasonic probe  76  for removing surface tissues of the target living tissues by cavitation effects projects from the distal end of the cylindrical member  52  and is then located between the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74 , as shown in  FIG. 3A  and  FIG. 3B . When the second knob  42   b  is moved toward the operator, the ultrasonic probe  76  located between the first and second holding members  72 ,  74  axially moves toward the operator, as shown in  FIG. 3C . As a result, the distal end of the ultrasonic probe  76  is stored in the distal end (treatment side end) of the cylindrical member  52 . 
         [0087]    In addition, the length of the ultrasonic probe  76  located between the first and second holding members  72 ,  74  is formed so that the ultrasonic probe  76  may not extend beyond the distal ends of the first and second high-frequency electrodes  82   b ,  84   b  provided in the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74 . That is, the distal end of the ultrasonic probe  76  is prevented from contacting the distal ends of the grooves  92 ,  94 . Moreover, the width of the ultrasonic probe  76  disposed between the first and second holding members  72 ,  74  is smaller than the width of the first and second high-frequency electrodes  82   b ,  84   b . Thus, the tissue can be removed in a more limited manner in the treatment with the ultrasonic probe  76  than in the treatment with the first and second high-frequency electrodes  82   b ,  84   b.    
         [0088]    Now, the effects of the medical treatment apparatus  10  according to this embodiment are described. 
         [0089]    When unshown power switches provided in the high-frequency energy source  14  and the ultrasonic energy source  16  are, for example, pressed and turned on, the high-frequency energy source  14  and the ultrasonic energy source  16  become operable (on standby). 
         [0090]    As shown in  FIG. 3A , the second holding member  74  is closed with respect to the first holding member  72 , in which state the treatment portion  46  and the shaft  44  of the energy treatment instrument  12  are inserted into, for example, an abdominal cavity through an abdominal wall. The treatment portion  46  of the energy treatment instrument  12  is put face-to-face with the target living tissues (treatment target). At this point, the distal end of the ultrasonic probe  76  may be inside or outside the cylindrical member  52  of the shaft  44 . 
         [0091]    The first knob  42   a  of the handle  42  is operated so that the target living tissues may be held (grasped) by the first holding member  72  and the second holding member  74 . At the same time, the sheath  54  is moved with respect to the cylindrical member  52  toward the operator side of the shaft  44 . Owing to the urging force by the elastic members  58   a ,  58   b , a cylindrical space between the first and second bases  72   b ,  74   b  can not be maintained, and the first holding member  72  and the second holding member  74  open with respect to each other. Here, the first holding member  72  and the second holding member  74  simultaneously open at the same angle to the axial direction (central axis) of the shaft  44 . 
         [0092]    Then, the second knob  42   b  is operated to extend the ultrasonic probe  76  with respect to the distal end of the cylindrical member  52  of the shaft  44 . At the same time, one of the two treatment target living tissues (one living tissue) is disposed between the first high-frequency electrode  82   b  of the first holding member  72  and the ultrasonic probe  76 , and the other living tissue to be joined to the former living tissue is disposed between the second high-frequency electrode  84   b  of the second holding member  74  and the ultrasonic probe  76 . That is, the ultrasonic probe  76  is disposed between the target living tissues so that the ultrasonic probe  76  is held by the two living tissues, and the living tissues are disposed between the first and second holding members  72 ,  74 . 
         [0093]    In this state, the first knob  42   a  of the handle  42  is operated. At the same time, the sheath  54  is moved with respect to the cylindrical member  52  toward the distal side of the shaft  44 . The space between the first and second bases  72   b ,  74   b  is closed and formed into a cylindrical shape by the sheath  54  against the urging force by the elastic members  58   a ,  58   b . As a result, the main body  72   a  formed integrally with the base  72   b  of the first holding member  72  is closed with respect to the main body  74   a  formed integrally with the base  74   b  of the second holding member  74 . Thus, the target two living tissues are held (grasped) between the first holding member  72  and the second holding member  74 . 
         [0094]    When tubular-shaped organs such as blood vessels or intestinal tracts are joined together, it is necessary to insert the ultrasonic probe  76  into the tube such as blood vessels or intestinal tracts. It is also possible to insert the ultrasonic probe  76  into the tube while ultrasonically vibrating the ultrasonic probe  76 . The ultrasonic probe  76  also has a function of physical puncture with no application of energy. Therefore, the ultrasonic probe  76  can be disposed on the joint surfaces of the tube after the first and second holding members  72 ,  74  are closed. 
         [0095]    In this case, the target living tissues are in contact with both the first electrode  82   b  of the first holding member  72  and the second electrode  84   b  of the second holding member  74 . Tissues around the target living tissues are in close contact with both the holding surface (contact surface, grasping surface)  82  of the first holding member  72  and the holding surface (contact surface, grasping surface)  84  of the second holding member  74  as well. 
         [0096]    In this state, a foot switch or hand switch connected to the high-frequency energy source  14  and a foot switch or hand switch connected to the ultrasonic energy source  16  are properly operated. The effects of the medical treatment apparatus  10  are described below in detail along with a flowchart shown in  FIG. 5 . 
         [0097]    Energy is supplied to the ultrasonic transducer  43  from the ultrasonic energy source  16  via the ultrasonic energy conducting line  20   a  in the cable  19 . The electric energy output from the ultrasonic energy source  16  is converted into ultrasonic vibrations by the ultrasonic transducer  43 . Thus, the ultrasonic vibrations are transmitted to the proximal end of the ultrasonic probe  76  (S 1 ). Then, the living tissues are cavitated by the distal end of the ultrasonic probe  76  using the ultrasonic vibrations transmitted from the proximal end to distal end of the ultrasonic probe  76 . 
         [0098]    Cells in the surfaces of the living tissues are broken by the cavitation so that epithelial cells in the surface portion are desquamated (removed). The desquamated living tissues are forced out of the first and second holding members  72 ,  74  due to the holding pressure of the first and second holding members  72 ,  74 . Collagen (although not described in particular, it will hereinafter be assumed that collagen contains collagen fibers) is a living body component that is difficult to break due to cavitation caused by an ultrasonic energy treatment, and therefore remains even after the ultrasonic treatment. As a result, collagen is exposed in the joint surfaces of the living tissues. 
         [0099]    In this case, if the side surface of the distal end of the ultrasonic probe  76  includes uneven or curved shapes, cavitation is also caused on the side surface of the ultrasonic probe  76 , so that the living tissue in contact with the side surface of the ultrasonic probe  76  can be treated. When the side surface of the ultrasonic probe  76  has no unevenness and curved shapes, cavitation is caused in front of the distal end of the ultrasonic probe  76 . In this case, the second knob  42   b  of the handle  42  is operated to bring the ultrasonic probe  76  closer to or away from the operator during the output of ultrasonic waves. Consequently, more collagen can be exposed in the joint surfaces of the living tissues over as entire length of the living tissues held by the holding members  72 ,  74  as possible. In addition, the ultrasonic probe  76  may be automatically moved forward and backward (brought closer to and away from the operator) together with the output from the ultrasonic energy output unit  34 . 
         [0100]    The treatment by the ultrasonic vibrations is limited by time, for example, three seconds (S 2 ). Therefore, the ultrasonic output controller  32  automatically stops the output from the ultrasonic energy output unit  34  of the ultrasonic energy source  16  after a given period of time from the start of the output (S 3 ). 
         [0101]    After the output from the ultrasonic energy output unit  34  has been stopped, the second knob  42   b  of the handle  42  is moved to the side proximate to the operator. That is, the ultrasonic probe  76  located between the holding members  72 ,  74  is moved backward to the side proximate to the operator. Then, the distal end of the ultrasonic probe  76  is stored in the distal end of the cylindrical member  52  (S 4 ). 
         [0102]    At the same time, as shown in  FIG. 3C , the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  are brought into an urged state by the elastic members  92   a ,  94   a  together with the backward movement of the ultrasonic probe  76 . Thus, the living tissues are pressed by the electrodes  82   b ,  84   b  disposed in the grooves  92 ,  94  of the first and second holding members  72 ,  74 . As a result, there is no longer the space where the ultrasonic probe  76  is disposed between the joint surfaces of the living tissues, so that exposed collagens can be brought into contact with each other by the ultrasonic probe  76 . 
         [0103]    Then, the foot switch or hand switch connected to the high-frequency energy source  14  is operated. Energy is supplied to the first high-frequency electrode  82   b  and the second high-frequency electrode  84   b  from the high-frequency energy source  14  through the first and second conducting lines  18   a ,  18   b  within the cable  17 . 
         [0104]    A high-frequency current is applied across the first high-frequency electrode  82   b  provided in the first holding member  72  and the second high-frequency electrode  84   b  provided in the second holding member  74  via the target living tissues. That is, high-frequency energy is supplied to the living tissues in contact with the electrodes  82   b ,  84   b  out of the living tissues held between the first and second holding members  72 ,  74  (S 5 ). Thus, the high-frequency energy is supplied to the target living tissues grasped between the electrodes  82   b ,  84   b . As a result, the target living tissues in contact with the electrodes  82   b ,  84   b  generate heat. That is, Joule heat is generated within the living tissues grasped between the electrodes  82   b ,  84   b  so that the living tissues themselves are heated. The high-frequency energy denatures proteins contained in the living tissues including collagens in the tissue surfaces exposed by the ultrasonic energy. At the same time, the living tissues themselves generate heat and are dehydrated. Consequently, proteins bond with each other, such that components constituting the living tissues bond with each other at the junction of the living tissues. That is, the target living tissues are gradually denatured and dehydrated and thus united. 
         [0105]    Simultaneously with the start of the treatment of the living tissues by the high-frequency energy, the detecting portion  22  of the high-frequency energy source  14  detects the impedance Z of the living tissues in contact with the high-frequency electrodes  82   b ,  84   b  of the first and second holding members  72 ,  74 . The impedance Z at the beginning of the treatment shown in  FIG. 6  (initial value) is, for example, about 50 [Ω], which however varies depending on the size and shape of the electrodes  82   b ,  84   b . Then, as high-frequency energy is applied to the living tissues and the living tissues are denatured and dehydrated, the value of the impedance Z once drops from about 50 [Ω], and then rises, as shown in  FIG. 6 . Such a rise in the value of the impedance Z represents that the living tissues are losing water and drying. 
         [0106]    Then, it is judged whether the calculated impedance Z has exceeded, for example, 1000 [Ω] (not limited to this value and any value can be set) set as the threshold value in the high-frequency output controller  24  (S 6 ). When the impedance Z is judged to have exceeded a threshold value of 1000 [Ω], the high-frequency output controller  24  stops the output of the high-frequency electric power from the high-frequency output unit  26  (S 7 ). 
         [0107]    That is, joining of the living tissues using the ultrasonic energy and the high-frequency energy is ended. 
         [0108]    The series of steps of such a control method shown in the flowchart of  FIG. 5  is performed when the foot switches or hand switches connected to the ultrasonic energy source  16  and the high-frequency energy source  14  are kept pressed. On the other hand, when the foot switches or hand switches are released, the treatment of the living tissues is forcibly ended. It goes without saying that the treatment is automatically ended when the impedance Z has exceeded a threshold value of 1000 [Ω]. In this case, it is preferable that the user be informed of the end of the treatment such as the stopped generation of the ultrasonic vibrations or the stopped supply of the high-frequency energy by a buzzer, light or some other indication. It is also preferable to change, for example, the tone of the buzzer between the ultrasonic treatment and the high-frequency treatment. 
         [0109]    Although the generation of the ultrasonic vibrations by the ultrasonic probe  76 , the backward movement of the ultrasonic probe  76  and the output to the living tissues between the first and second holding members  72 ,  74  are manually performed here, the series of operations may be automatically performed. In this case, although not shown, the high-frequency output controller  24  of the high-frequency energy source  14  is preferably connected to the ultrasonic output controller  32  of the ultrasonic energy source  16  by a cable. Such connection enables improved transfer of electric signals between the high-frequency energy source  14  and the ultrasonic energy source  16 . Thus, the series of operations including the generation of the ultrasonic vibrations by the ultrasonic probe  76 , the backward movement of the ultrasonic probe  76  and the output to the living tissues between the first and second holding members  72 ,  74  can be performed in a shorter time than when manually performed. Moreover, the series of operations can be preferably ended by pressing a common foot switch or hand switch of the high-frequency energy source  14  and the ultrasonic energy source  16 . It goes without saying that the treatment is forcibly ended when the common foot switch or hand switch is released in the middle of the treatment. 
         [0110]    It is also advantageous to provide an idle period in the high-frequency output or to repeat lower outputs and high outputs. That is, the treatment may be performed with the threshold value of the impedance Z set at, for example, 500 [Ω]. Then, after an idle period of several seconds to wait for the drop of the impedance Z, the treatment (the application of electricity to the living tissues) may be repeatedly performed in such a manner as to sequentially increase the threshold value by 100 [Ω] up to 1000 [Ω]. 
         [0111]    Furthermore, as to a termination condition for a treatment, the treatment may be automatically ended not only after judging whether the threshold value of the impedance Z has exceeded the threshold value set as the termination condition but also after output of the high-frequency energy for a certain period of time. 
         [0112]    As described above, the following can be said according to this embodiment. 
         [0113]    In the present embodiment, first, cells in the surfaces of the target living tissues can be fractured by the treatment with ultrasonic output. In this case, if the surface of the ultrasonic probe  76  includes uneven or curved shapes, cavitation can also be caused on the side surface of the ultrasonic probe  76 , so that the living tissue on the side surface of the ultrasonic probe  76  can be treated. When the side surface of the ultrasonic probe  76  includes no unevenness or curved shapes, cavitation is only caused in front of the ultrasonic probe  76 . In this case, the second knob  42   b  of the handle  42  is operated to move the ultrasonic probe  76  forward or backward during the output of ultrasonic waves, such that the living tissues can be broken over the entire length of the target living tissues. The ultrasonic probe  76  can be moved forward or backward manually or automatically. 
         [0114]    Collagen is a component that is more difficult to fracture due to cavitation than other living tissue components such as cells, and therefore remains even after the ultrasonic treatment. The fractured living tissues are then excluded by pressure to the side of the holding members  72 ,  74  in the step of holding the living tissues. As a result, collagens can be exposed in the surfaces (joint surfaces) of the target living tissues. 
         [0115]    Then, the ultrasonic probe  76  is brought out of contact with the joint surfaces (treatment surfaces) of the living tissues and stored in the sheath  54 , such that the exposed collagens can be brought into close contact with each other. Such close contact between collagens enables denatured collagen molecules to be bonded together during the subsequent treatment by the high-frequency output. 
         [0116]    In the subsequent treatment by the high-frequency output, the collagens exposed and in close contact with each other are denatured by Joule heat and bonded together, as described above. At the same time, heat generation is caused to the living tissues to evaporate the water contained in the living tissues. 
         [0117]    Collagen is a protein that has the strongest bonding force among the proteins present in a living body. Exposing the collagen in the joint surfaces enables firmer bonding of the living tissues than the bonding of living tissues including cells present in the joint surfaces. Moreover, the difference in the kind of proteins present in the surface of the tissue is one reason for the variation in the bonding force of different tissues in a living body. If collagens can always be exposed in every living tissue, the composition of the living tissues in the joint surfaces can be uniform, and stable tissue bonding is therefore enabled. That is, it is possible to reduce the variation of tissue bonding strength due to the difference of species of cells present in the surface or the difference of structure of tissues depending on the kind of organs. 
         [0118]    Collagens are brought close to each other and joined together, so that fibroblasts easily migrate from neighboring tissues. This enables early healing of tissues and creation of an environment that improves the strength of living tissues early after surgery. 
         [0119]    The present embodiment makes it possible to provide the energy treatment instrument  12  having such effects and assuring high safety. 
         [0120]    In addition, although the living tissues are joined together by the energy treatment instrument  12  in the example described here, the living tissues can also be simply coagulated. 
         [0121]    Furthermore, when moving the ultrasonic probe  76  forward and backward, it is also preferable to rotate the ultrasonic probe  76  around its axis. For example, a motor (included in the numeral  43  in  FIG. 1B ) is provided in the housing  43   a  of the ultrasonic transducer  43 , such that the ultrasonic probe  76  can be rotated for each ultrasonic transducer  43 . When the ultrasonic probe  76  is thus rotatable, it is possible to more easily remove epithelial cells and expose, for example, collagen. 
         [0122]    Moreover, in this embodiment, the foot switch or hand switch is provided in each of the high-frequency energy source  14  and the ultrasonic energy source  16 , and the ultrasonic treatment and the high-frequency treatment are performed in this order. However, when the foot switch or hand switch of the high-frequency energy source  14  is to be operated before the foot switch or hand switch of the ultrasonic energy source  16 , it is also preferable to set so that no energy may be output from the high-frequency output unit  26 . In this case, it is naturally possible to output energy from the high-frequency output unit  26  after the output of energy from the ultrasonic output unit  34 . 
         [0123]    The medical treatment apparatus  10  has been described above with  FIG. 1A  to  FIG. 6  in the present embodiment, but the present invention is not limited to this. Each component can be replaced with any component having a similar function. Although not shown, similar effects can be obtained if the high-frequency electrodes  82   b ,  84   b  of the holding members  72 ,  74  are replaced with, for example, heater elements (heaters). In this case, the heater elements can serve as sensors as described above. Moreover, the heater element may be combined with the high-frequency electrode. 
         [0124]    Although the impedance Z of the target living tissues is detected to recognize the state of the target living tissues in the present embodiment, the biological information is not limited to the impedance Z. For example, other electric information such as an electric power value or a phase is also permitted. That is, the biological information includes, for example, a current, a voltage and electric power for calculating the impedance Z, the impedance Z calculated therefrom, and phase information. 
         [0125]    It is also preferable that the electrodes  82   b ,  84   b  of the holding members  72 ,  74  be formed and arranged as shown in  FIG. 7A  and  FIG. 7B . In this case, the electrodes  82   b ,  84   b  are circular. Moreover, some of the electrodes  82   b  disposed in the groove  92  may be arranged proximately to each other in the axial direction instead of being arranged at equal intervals. When the electrodes  82   b  of the first holding member  72  are thus arranged, it is possible to perform a treatment wherein current density is increased for the opposite electrode  84   b  of the second holding member  74 . 
         [0126]    Moreover, in the case described in this embodiment, the second knob  42   b  separate from the first knob  42   a  is used to move the ultrasonic probe  76  with respect to the shaft  44 , as shown in  FIG. 1A  and  FIG. 1B . Otherwise, it is also preferable that the first knob  42   a  and the second knob  42   b  be provided side by side. When the second knob  42   b  shown in  FIG. 8  is brought closer to the other end of the handle  42 , the distal end of the ultrasonic probe  76  is drawn into the distal end of the shaft  44 . When the second knob  42   b  is brought away from the other end of the handle  42 , the distal end of the ultrasonic probe  76  projects from the distal end of the shaft  44  and is located between the first and second holding members  72 ,  74 . 
         [0127]    Furthermore, the linear energy treatment instrument  12  (see  FIG. 1A ) for treating living tissues in an abdominal cavity (in the body) through an abdominal wall has been described as an example in this embodiment. However, it is also possible to use, for example, an open linear energy treatment instrument (medical treatment instrument)  12   a  shown in  FIG. 9  for taking treatment target living tissues out of the body through an abdominal wall and then treating the same. This energy treatment instrument  12   a  includes a handle  42  and a treatment portion  46 . That is, the energy treatment instrument  12   a  has no shaft  44  (see  FIG. 1A ) in contrast with the energy treatment instrument  12  for treating through an abdominal wall. On the other hand, a member having the same function as the shaft  44  is provided in the handle  42 . Thus, the energy treatment instrument  12   a  can be used similarly to the above-described energy treatment instrument  12  shown in  FIG. 1A . 
         [0128]    In addition, a bipolar treatment has been described as schematically shown in  FIG. 10A  in connection with the high-frequency treatment in the first embodiment. That is, electricity is applied to the living tissues between the first and second electrodes  82   b ,  84   b  in the case described. Here, it is also preferable to perform a monopolar treatment as shown in  FIG. 10B . In this case, a return electrode plate R is attached to a patient P to be treated. The return electrode plate R is connected to the high-frequency energy source  14  via a conducting line  18   c.    
         [0129]    Then, as shown in  FIG. 10B , when the first and second electrodes  82   b ,  84   b  are homopolar, electricity is applied to the return electrode plate R and the living tissue between the first and second electrodes  82   b ,  84   b . In this case, the area of the living tissue in contact with the first and second electrodes  82   b ,  84   b  is sufficiently smaller than the area of the living tissue in contact with the return electrode plate R. Therefore, energy density is higher for the living tissue in contact with the first and second electrodes  82   b ,  84   b . Thus, the living tissue held between the first and second electrodes  82   b ,  84   b  is treated. 
       Second Embodiment 
       [0130]    Next, a second embodiment is described with  FIG. 11  to  FIG. 15 . This embodiment is a modification of the first embodiment, and the same parts as the parts described in the first embodiment are provided with the same numerals and are not described in detail. 
         [0131]    As shown in  FIG. 11  and  FIG. 12 , the ultrasonic probe  76  (see  FIG. 1A  to  FIG. 3D ) which can be provided between first and second holding members  72 ,  74  is removed, and a cylindrical probe (hereinafter referred to as an ultrasonic suction probe)  176  is provided instead which can transmit ultrasonic vibrations and which can suck, for example, removed living tissues through its internal portion (suction passage  176   a ). 
         [0132]    A medical treatment apparatus  10  includes an energy treatment instrument (treatment instrument)  12  called a handpiece, and a high-frequency energy source  14 , an ultrasonic energy source  16 , and a fluid feeding/suction unit  102 . 
         [0133]    The fluid feeding/suction unit  102  includes a bag  112  containing a physiological saline, a conveying tube (fluid feeding tube)  114 , a suction tube  116 , a suction tank  118  and a conveying volume/suction pressure adjuster  120 . The conveying volume/suction pressure adjuster  120  has a conveying volume adjustment section  122  and a suction pressure adjustment section  124 . The conveying volume/suction pressure adjuster  120  is detachably connected to the ultrasonic energy source  16  by a cable  121  and a connector  121   a  provided at its end. 
         [0134]    In addition, the conveying tube  114  and the suction tube  116  are preferably formed of a chemical-resistant and flexible resin material such as PTFE. 
         [0135]    The rear end of the conveying tube  114  is connected to the bag  112  containing the physiological saline, and provided side by side with the ultrasonic suction probe  176 . The suction tube  116  is connected to the proximal end of the ultrasonic suction probe  176  and to the suction tank  118  for collecting, for example, sucked living tissues. That is, the energy treatment instrument  12  is provided with the conveying tube  114  and the suction tube  116 . The conveying tube  114  is connected to the physiological saline bag  112  through the conveying volume adjustment section  122 . The suction tube  116  is connected to the suction tank  118  via the suction pressure adjustment section  124 . The conveying volume adjustment section  122  changes the inside diameter of the conveying tube  114  to control the volume of the physiological saline fed from the bag  112 . The suction pressure adjustment section  124  adjusts the pressure for sucking, for example, living tissues into the suction tank  118 . 
         [0136]    An ultrasonic output controller  32  of the ultrasonic energy source  16  is connected to the fluid feeding/suction unit  102  located outside the ultrasonic energy source  16 , that is, connected to the conveying volume adjustment section  122  and the suction pressure adjustment section  124 . 
         [0137]    The physiological saline bag  112  retains the physiological saline. The physiological saline in the bag  112  is fed to a living tissue (treatment portion) through the conveying tube  114  provided in the conveying volume adjustment section  122  by the activation of, for example, an unshown rotary pump. On the other hand, the living tissue is retained in the suction tank  118  by an unshown suction device through the suction passage  176   a  of the ultrasonic suction probe  176  and the suction tube  116  provided for the suction pressure adjustment section  124 . 
         [0138]    An ultrasonic transducer  43  is stored in a handle  42 , and the ultrasonic suction probe  176  for transmitting the vibrations of the ultrasonic transducer  43  to the living tissue is stored in a shaft  44 . The suction passage  176   a  is formed in the ultrasonic suction probe  176  over the entire length of the ultrasonic suction probe  176  to ultrasonically treat the living tissue and to suck the ultrasonically treated living tissue. It is preferable that the side surface of the ultrasonic suction probe  176  be curved or uneven. It is also preferable that the ultrasonic suction probe  176  have a structure for lateral vibrations or torsional vibrations. 
         [0139]    Furthermore, the conveying tube  114  is provided side by side with the ultrasonic suction probe  176  of a sheath  54 . Thus, the conveying tube  114  can pass the physiological saline sent from the physiological saline bag  112 . 
         [0140]    Now, the effects of the medical treatment apparatus  10  according to this embodiment are described along with a flowchart shown in  FIG. 14 . 
         [0141]    This embodiment is similar in effects to the first embodiment expect that the fluid feeding/suction unit  102  is added. 
         [0142]    Target living tissues are brought into contact with both of the first and second holding members  72 ,  74 , and the ultrasonic suction probe  176  is disposed between the joint surfaces, in which state a foot switch or hand switch connected to the ultrasonic energy source  16  is operated. The vibrations of the ultrasonic suction probe  176  disposed between the first and second holding members  72 ,  74  are caused by the ultrasonic energy source  16  through a cable  19  and the ultrasonic transducer  43 . At the same time, the physiological saline is fed to the living tissues (treatment portions), and the suction of the living tissue is started (S 11 ). Cells in the surfaces of the living tissues are removed by cavitation caused to the living tissues due to the transmission of the ultrasonic vibrations, and collagens that contribute most to the joining of the living tissues are exposed on the joint surfaces. In this case, the physiological saline is fed to the living tissues being ultrasonically treated, so that the cells in the surfaces of the living tissues are sucked into the suction passage  176   a  of the ultrasonic suction probe  176  together with the physiological saline. Thus, collagens are exposed out of the target living tissues. 
         [0143]    The ultrasonic treatment and suction of the living tissues are performed for a given period of time (e.g., three seconds) (S 12 ), and are automatically stopped thereafter (S 13 ). In addition, the feeding of the physiological saline to the treatment portions and the suction of the tissues are also stopped simultaneously with the stopping of the ultrasonic output. 
         [0144]    Then, the ultrasonic suction probe  176  provided between the holding members  72 ,  74  is moved backward (S 14 ). At the same time, the collagens exposed on the joint surfaces of the living tissues by the ultrasonic treatment are brought into close contact with each other by the pressing of electrodes  82   b ,  84   b  due to elastic members  92   a ,  94   a , as described in the first embodiment. 
         [0145]    Subsequently, a foot switch or hand switch connected to the high-frequency energy source  14  is operated. Then, energy is supplied to the first and second high-frequency electrodes  82   b ,  84   b  and the living tissues held between the first and second high-frequency electrodes  82   b ,  84   b  are denatured and dehydrated (S 5  to S 7 ). 
         [0146]    As described above, the following can be said according to this embodiment. 
         [0147]    In this embodiment, not only the living tissues are crushed by cavitation as in the first embodiment but also the crushed living tissues are sucked, such that the cells in the surfaces of the living tissues to be joined together can be effectively removed from the joint surfaces of the living tissues. Thus, collagens in the joint surfaces can be exposed. 
         [0148]    As the fluid retained in the bag  112 , it is preferable to use a fluid capable of inducing electric energy, such as an ionized conductive fluid permeable to living tissues. Such a fluid used includes, for example, a physiological saline, a hypertonic saline, a hypotonic saline or an electrolyte fluid replacement drug. The use of a highly viscous gel (fluid) such as hyaluronic acid is also permitted. 
         [0149]    Moreover, as shown in  FIG. 15A  to  FIG. 15C , apertures (conveyance apertures)  136   a  can be arranged in a holding surface  82  of the first holding member  72 . 
         [0150]    As shown in  FIG. 15A  to  FIG. 15C , the first and second holding members  72 ,  74  have structures (conveyance mechanisms) capable of discharging the fluid to the target living tissues. A main body  72   a  of the first holding member  72  is provided with an electrode  132  having a planar surface to be in contact with living tissues. The electrode  132  is substantially rectangular, and an annular groove  134  serving as the passage of vapor generated from the living tissues is formed on the outer periphery of the electrode  132 . On the other hand, a groove  92  where the ultrasonic probe  76  or the ultrasonic suction probe  176  is disposed is formed on the central axis of the main body  72   a  of the first holding member  72 , as described in the first embodiment. 
         [0151]    A conduit  136  is provided within the main body  72   a  of the first holding member  72 . The conduit  136  bends substantially in the shape of L within the main body  72   a  of the first holding member  72 , and a plurality of apertures (through-holes)  136   a  are formed in the conduit  136 . The plurality of apertures  136   a  are open in the surface of the electrode  132 . That is, the conduit  136  is in communication with the outside of the electrode  132 . In particular, the plurality of apertures  136   a  open in the electrode  132  are formed with the same diameter at predetermined intervals at positions predetermined distance away from the central axis of the main body  72   a  of the first holding member  72 . Thus, when a fluid such as a physiological saline runs through the conduit  136 , the fluid is discharged from the apertures  136   a  of the conduit  136 . 
         [0152]    In addition, the apertures  136   a  are provided at equal intervals at positions substantially parallel with the groove  92  formed on the central axis of the main body  72   a  of the first holding member  72 . The outer peripheries of the apertures  136   a  are covered with insulating materials. It is also preferable that the conduit  136  itself be formed of an insulating material. The conduit  136  is preferred to be, for example, a circularly cylindrical or squarely cylindrical, but is permitted to have various cross sectional shapes such as elliptically cylindrical or polygonally cylindrical shapes. 
         [0153]    The conduit  136  is formed continuously to the handle  42  through a cylindrical member  52  of the shaft  44  or between the cylindrical member  52  and a sheath  54 . The conduit  136  is in communication with the conveying tube  114 , and enables the physiological saline fed from the bag  112  through the conveying tube  114  to be discharged from the apertures  136   a  provided inside the electrodes  132 ,  142  of the first and second holding members  72 ,  74 . 
         [0154]    The proximal end of the electrode  132  opposite to the side facing the second holding member  74  is connected to a cable  17  extending from the handle  42  via a first conducting line  18   a.    
         [0155]    Although not shown, the second holding member  74  is formed symmetrically to the first holding member  72 . Here, for convenience of explanation, the numeral  142  is assigned to the electrode provided in the second holding member  74 , the numeral  144  is assigned to an annular groove, the numeral  146  is assigned to a conduit, and the numeral  146   a  is assigned to apertures. 
         [0156]    In the case where the electrodes  132 ,  142  of the first and second holding members  72 ,  74  have the same potential (homopolar), living tissues in contact with the electrode  132  of the first holding member  72  and the electrode  142  of the second holding member  74  are heated when supplied with energy (high-frequency electric power) from the high-frequency energy source  14 . In this case, the electrodes  132 ,  142  serve as sensors to measure a current, a voltage, etc. flowing the electrodes  132 ,  142  through the living tissues. Then, the electrodes  132 ,  142  input relevant signals to a detecting portion  22  of the high-frequency energy source  14  through the first and second conducting lines  18   a ,  18   b.    
         [0157]    In addition, the conduits  136 ,  146  of the first and second holding members  72 ,  74  extend to the handle  42  through the cylindrical member  52  of the shaft  44 . These conduits  136 ,  146  extend from the handle  42  as tubes (not shown) provided side by side with the first and second conducting lines  18   a ,  18   b , and are connected to, for example, the conveying tube  114  (see  FIG. 11 ). Thus, a liquid such as a conductive fluid can be injected into the apertures  136   a ,  146   a  through the conduits  136 ,  146 . 
         [0158]    The apertures  136   a ,  146   a  are circular in  FIG. 15A  to  FIG. 15C , but are not limited to the circular shape and are permitted to have various shapes such as elliptic and polygonal shapes. Further, the apertures  136   a  in the first holding member  72  and the apertures  146   a  in the second holding member  74  are not exclusively aligned at predetermined intervals along the longitudinal direction of the first and second high-frequency electrodes  132 ,  142 , and are permitted to be arranged in a plurality of lines or at random. 
         [0159]    In the holding surface  82  of the first holding member  72  shown in  FIG. 15A  to  FIG. 15C , both conveyance apertures for conveying the fluid and suction apertures for sucking can be arranged by, for example, dividing the conduit  136  into two parts. That is, a conveyance mechanism and a suction mechanism can be provided side by side in the first holding member  72 . Moreover, although not described in detail, the conveyance apertures  136   a  in the holding surface  82  can be replaced with suction apertures and thus changed to the suction mechanism. 
       Third Embodiment 
       [0160]    Next, a third embodiment is described with  FIG. 16  to  FIG. 19B . This embodiment is a modification of the first embodiment, and the same parts as the parts described in the first embodiment are provided with the same numerals and are not described in detail. 
         [0161]    As shown in  FIG. 16  to  FIG. 17D , the ultrasonic probe  76  which can be provided between first and second holding members  72 ,  74  is removed, and a rod high-frequency electrode (energy emitter)  276  is provided instead. 
         [0162]    As shown in  FIG. 16 , a high-frequency energy source  14  of a medical treatment apparatus  10  includes a detecting portion  22 , a high-frequency output controller  24 , a high-frequency output unit  26 , a switching unit  202  and a user interface  204 . 
         [0163]    The switching unit  202  is connected to the detecting portion  22  and to an energy treatment instrument  12 . The switching unit  202  closes/opens a circuit between the first electrode  82   b , the second electrode  84   b  and the rod electrode  276 , and the energy treatment instrument  12 , in order to change the flow of a current. In the present embodiment, the circuit is switched between a first stage output and a second stage output that will be described later. 
         [0164]    In addition, the user interface  204  is used, for example, to indicate the current state of the high-frequency energy source  14  or to set a threshold value for living tissues between the frequency electrodes  82   b ,  84   b ,  276 . 
         [0165]    A second knob  42   b  of a handle  42  is connected to the proximal end of a lengthwise feed rod  276   a  shown in  FIG. 17A  to  FIG. 17C . The distal end of the lengthwise feed rod  276   a  is connected to the proximal end of the rod electrode  276  through a shaft  44 . That is, instead of the ultrasonic probe  76 , the rod electrode  276  is disposed between the first and second holding members  72 ,  74 . If the second knob  42   b  provided in the handle  42  is moved toward the operator, the rod electrode  276  disposed between the holding members  72 ,  74  of the energy treatment instrument  12  shown in  FIG. 17A  to  FIG. 17C  axially moves to the side proximate to the operator. Then, as shown in  FIG. 17C , the distal end of the rod electrode  276  is stored in the distal end of a cylindrical member  52  of the shaft  44 . If the second knob  42   b  is moved to the side of the holding members  72 ,  74 , that is, distally with respect to the operator, the distal end of the rod electrode  276  comes out of the distal end of the cylindrical member  52  of the shaft  44  and is again located between the holding members  72 ,  74  as shown in  FIG. 17B . 
         [0166]    Inside the handle  42 , there are provided a first conducting line  18   a  which supplies a high-frequency current to the electrode  82   b  provided in the first holding member  72 , a second conducting line  18   b  which supplies a high-frequency current to the electrode  84   b  of the second holding member  74 , and a third conducting line  18   d  which supplies a high-frequency current to the rod electrode  276 . The first to third conducting lines  18   a ,  18   b ,  18   d  are provided in a cable  17 . That is, the third conducting line  18   d  is electrically connected to the rod electrode  276 . Thus, the first to third conducting lines  18   a ,  18   b ,  18   d  are connected to a connector  17   a  of the cable  17 . 
         [0167]    While the sectional shape of the rod electrode  276  is, for example, rectangular as shown in  FIG. 17D , its cross section is permitted to have various shapes such as circular and polygonal shapes. The sectional shape of grooves  92 ,  94  of holding surfaces  82 ,  84  is preferred to be similar to the sectional shape of the rod electrode  276 , but is permitted to be various shapes such as elliptic and polygonal shapes. 
         [0168]    The rod electrode  276  is smaller in surface area than the first and second electrodes  82   b ,  84   b  of the first and second holding members  72 ,  74 . Thus, when the first and second electrodes  82   b ,  84   b  are homopolar and high-frequency energy is output to the living tissues between the electrodes  82   b ,  84   b  and the rod electrode  276 , the current density increases on the surface of the rod electrode  276 , so that the living tissues can transpire. 
         [0169]    Furthermore, in order to sufficiently treat the living tissues held between main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74 , it is preferable that the electrodes  82   b ,  84   b  be continuously formed in a direction perpendicular to the longitudinal direction of main bodies  72   a ,  74   a , as shown in  FIG. 17A  to  FIG. 17D  ( FIG. 17D  in particular). The use of such electrodes  82   b ,  84   b  makes it possible to have a greater contact area between the electrodes  82   b ,  84   b  and the living tissues. Thus, pressure sufficient to treat the living tissues can be applied without disposing elastic members  92   a ,  94   a  (see  FIG. 3A  to  FIG. 3C ). 
         [0170]    Now, the effects of the medical treatment apparatus  10  according to this embodiment are described. 
         [0171]    Here, during the above-mentioned first stage output, the first electrode  82   b  and the second electrode  84   b  have the same polarity, and the rod electrode  276  has a polarity different from the polarity of the first electrode  82   b  and the second electrode  84   b . Thus, in the first stage output, the current flows from the first and second electrodes  82   b ,  84   b  to the rod electrode  276  under the control of the switching unit  202 . 
         [0172]    Before the second stage output, the rod electrode  276  is stored in the shaft  44 . Moreover, before the second stage output, the circuit is switched by the switching unit  202  so that the first electrode  82   b  and the second electrode  84   b  differ in polarity. As a result, a current flows through the living tissue between the first electrode  82   b  and the second electrode  84   b  during the second stage output. 
         [0173]    The operation of the medical treatment apparatus  10  is described in detail below along with a flowchart shown in  FIG. 18 . 
         [0174]    As described in the first embodiment, living tissues are held between the holding surfaces  82 ,  84  of the main bodies  72   a ,  74   a  of the first and second holding members  72 ,  74 . At this point, the target living tissues are in contact with a contact surface  82   a  and the first high-frequency electrode  82   b  of the holding surface  82  of the first holding member  72  and with a contact surface  84   a  and the second high-frequency electrode  84   b  of the holding surface  84  of the second holding member  74 . In this state, a foot switch or hand switch connected to the frequency energy source  14  is operated. 
         [0175]    In this case, the switching unit  202  is set to the first stage output. Therefore, energy is supplied from the frequency energy source  14  to the first electrode  82   b  and the second electrode  84   b  which are homopolar and to the rod electrode  276  different in polarity from the electrodes  82   b ,  84   b  through the conducting lines  18   a ,  18   b ,  18   d . As a result, a current flows from the first electrode  82   b  and the second electrode  84   b  to the rod electrode  276  through the living tissues (S 21 ). 
         [0176]    Here, the area of the living tissue in contact with the rod electrode  276  is smaller than the area of the living tissue in contact with the first electrode  82   b  and the second electrode  84   b . Thus, current density in the tissue surface in contact with the rod electrode  276  is higher than current density in the first and second electrodes  82   b ,  84   b . As a result, the living tissues around the rod electrode  276  can efficiently transpire. Thus, epithelial tissues are detached and removed, and layers containing collagen are exposed in the joint surfaces of the living tissues. It is judged whether a given period of time (e.g., three seconds) has passed since the start of the outputs from the first electrode  82   b  and the second electrode  84   b  which are homopolar and the output from the rod electrode  276  different in polarity from the electrodes  82   b ,  84   b  (S 22 ). Thus, the high-frequency output is automatically stopped after three seconds have passed (S 23 ). 
         [0177]    In addition, simultaneously with the start of the first stage output, the impedance Z of the living tissues in contact with the rod electrode  276  can be detected by the detecting portion  22  in the frequency energy source  14 . The impedance Z at the beginning of the first stage output (initial value) is, for example, about 50 [Ω], which however varies depending on the size and shape of the electrodes  82   b ,  84   b ,  276 . Then, as high-frequency electric power is applied to the living tissues and the living tissues are cauterized, the value of the impedance Z once drops from about 50 [Ω], and then rises. The first stage output may be stopped when the impedance Z of the living tissues has increased to, for example, about 1000 [Ω] rather than when a given period of time (e.g., three seconds) has passed since the start till the end of the high-frequency output. 
         [0178]    After the end of the application of electricity to the living tissues between the first and second electrodes  82   b ,  84   b  and the rod electrode  276  different in polarity from the electrodes  82   b ,  84   b , an indication saying, for example, “rod electrode can be moved backward” is displayed on the user interface  204  of the frequency energy source  14 . This indication represents that the first stage output has been finished. After confirming this indication, the operator (user) releases the foot switch or hand switch. It is also preferable that “first stage output finished” be displayed on the user interface  204 . 
         [0179]    After the frequency energy source  14  has stopped the output of the high-frequency energy from the high-frequency output unit  26 , the switching unit  202  automatically switches the circuit to the second stage output (S 24   b ). On the other hand, simultaneously with the switch of the circuit by the switching unit  202  or at a proper period (before or after the switch of the circuit), the rod electrode  276  is moved backward with the first and second holding members  72 ,  74  closed, and is stored in the shaft  44  (S 24   a ). At the same time, the second knob  42   b  provided in the handle  42  is moved toward the operator. Then, the rod electrode  276  located between the holding members  72 ,  74  of the energy treatment instrument  12  axially moves toward the operator through the shaft  44 . 
         [0180]    In the second stage output, the circuit is switched so that the first electrode  82   b  and the second electrode  84   b  differ in polarity. The foot switch or hand switch connected to the frequency energy source  14  is again operated. As a result, a current flows through the living tissue between the first and second electrodes  82   b ,  84   b  during the second stage output. That is, a high-frequency current is applied to the first high-frequency electrode  82   b  and the second high-frequency electrode  84   b  via the target living tissues (S 5 ). Thus, the target living tissues between the first high-frequency electrode  82   b  and the second high-frequency electrode  84   b  is heated. 
         [0181]    Simultaneously with the start of the second stage output, the impedance Z of the living tissues in contact with the first and second electrodes  82   b ,  84   b  is detected by the detecting portion  22  in the frequency energy source  14 . The impedance Z at the beginning of the treatment (initial value) is, for example, about 50 [Ω], which however varies depending on the size and shape of the electrodes  82   b ,  84   b . Then, as high-frequency electric power is applied to the living tissues and the living tissues are cauterized, the value of the impedance Z once drops from about 50 [Ω], and then rises. Such a rise in the value of the impedance Z represents that the living tissues are losing water and drying. Consequently, as the target living tissues are heated and cauterized, the living tissues are gradually denatured and dehydrated and thus united. 
         [0182]    Then, it is judged whether the calculated impedance Z has exceeded, for example, 1000 [Ω] (not limited to this value and any value can be set) set as the threshold value in the high-frequency output controller  24  (S 6 ). When the impedance Z is judged to have exceeded a threshold value of 1000 [Ω], the high-frequency output controller  24  stops the output of the high-frequency electric power from the high-frequency output unit  26  (S 7 ). 
         [0183]    After the end of the application of electricity to the living tissues between the first high-frequency electrode  82   b  and the second high-frequency electrode  84   b , an indication saying, for example, “treatment finished” is displayed on the user interface  204  of the frequency energy source  14 . This indication represents that the second stage output has been finished. After confirming this indication, the operator (user) releases the foot switch or hand switch. It is also preferable that “second stage output finished” be displayed on the user interface  204 . 
         [0184]    As described above, the following can be said according to this embodiment. 
         [0185]    In this embodiment, the high-frequency electrode (rod electrode)  276  is used instead of the ultrasonic probe  76  in the first embodiment to desquamate the living tissues on the joint surfaces. The high-frequency energy does not have such specific properties of only preserving collagen as in the treatment with the ultrasonic energy. However, in the case of, for example, epithelial tissues, collagen present deeper than the epithelial tissues can be exposed when the high-frequency energy is used to cause the transpiration of the cell components present on the surface. 
         [0186]    Although the emission of the high-frequency energy is continued for a given period of time in the first stage output and the second stage output in the case described in the present embodiment, it is also advantageous to provide an idle period in the high-frequency output or to repeat lower outputs and high outputs. As to a termination condition for a treatment (termination condition for the second stage output), the treatment may be automatically ended not only judging whether the impedance Z has exceeded the threshold value set as the termination condition but also after the high-frequency energy is output for a certain period of time. 
         [0187]    As in the first and second embodiments, it is also preferable that the elastic members  92   a ,  94   a  be disposed within the holding members  72 ,  74  so that the electrodes  82   b ,  84   b  in the grooves  92 ,  94  of the holding members  72 ,  74  may be pressed from the rear. As a result, holding pressure can be applied to the living tissues when the rod electrode  276  is not located between the holding members  72 ,  74 . 
         [0188]    Moreover, although the transpiration by the first stage output is achieved here by the application of a current across the rod electrode  276  and the first and second electrodes  82   b ,  84   b , it is also preferable to perform a treatment using another electrode provided side by side with the rod electrode  276 . 
         [0189]    In addition, the bipolar treatment as schematically shown in  FIG. 19A  has been described above in the third embodiment. That is, in the case described, electricity is applied to the living tissues between the first and second electrodes  82   b ,  84   b  and the rod electrode  276  and to the living tissues between the first electrode  82   b  and the second electrode  84   b.    
         [0190]    Here, as shown in  FIG. 19B , it is also preferable to perform a monopolar treatment. In this case, a return electrode plate R is attached to a patient P to be treated. The return electrode plate R is connected to the high-frequency energy source  14  via a conducting line  18   e.    
         [0191]    Then, when the first and second electrodes  82   b ,  84   b  are homopolar, electricity is applied to the return electrode plate R and the living tissue between the first and second electrodes  82   b ,  84   b . In this case, the area of the living tissue in contact with the first and second electrodes  82   b ,  84   b  is sufficiently smaller than the area of the living tissue in contact with the return electrode plate R. Therefore, energy density is higher for the living tissue in contact with the first and second electrodes  82   b ,  84   b . Thus, the living tissue held between the first and second electrodes  82   b ,  84   b  is treated. 
         [0192]    It is also possible to apply electricity to the living tissue between the rod electrode  276  and the return electrode plate R. In this case, the area of the living tissue in contact with the rod electrode  276  is sufficiently smaller than the area of the living tissue in contact with the return electrode plate R. Therefore, energy density is higher for the living tissue in contact with the rod electrode  276 . Thus, the joint surface of the living tissue in contact with the rod electrode  276  (here, the living tissue held between the first and second holding members  72 ,  74 ) is treated. 
       Fourth Embodiment 
       [0193]    Next, a fourth embodiment is described with  FIG. 20  to  FIG. 23 . This embodiment is a modification of the first embodiment, and the same parts as the parts described in the first embodiment are provided with the same numerals and are not described in detail. 
         [0194]    As shown in  FIG. 20  and  FIG. 21 , a medical treatment apparatus  10  includes an energy treatment instrument (medical treatment instrument)  12 , and a high-frequency energy source  14  for providing high-frequency energy to the energy treatment instrument  12 . 
         [0195]    As shown in  FIG. 21 , the high-frequency energy source  14  includes a detecting portion  22 , a high-frequency output controller  24 , a high-frequency output unit  26 , a desquamation member controller  302  and a desquamation member output unit  304 . The desquamation member output unit  304  for driving a desquamation member moving mechanism  306  of a mechanical desquamation member  376  is connected to the desquamation member controller  302 . 
         [0196]    As shown in  FIG. 20 , in a handle  42 , the mechanical desquamation member moving mechanism  306  such as a linear motor is provided to rotate or vibrate the desquamation member  376  disposed between holding members  72 ,  74 . In order to acquire electric power, the desquamation member moving mechanism  306  is connected to the high-frequency energy source  14  by a connector  319   a  of a cable  319  extending from the energy treatment instrument  12 . The mechanical desquamation member moving mechanism  306  is connected to the proximal end of a lengthwise feed rod  376   a  inserted through a cylindrical member  52  of a shaft  44 . The distal end of the lengthwise feed rod  376   a  is formed integrally with the proximal end of the desquamation member  376  disposed between the holding members  72 ,  74 . 
         [0197]    As shown in  FIG. 22D , the cross section of the desquamation member  376  is, for example, circular, but is permitted to have various shapes such as an elliptic and polygonal shape. The sectional shape of grooves  92 ,  94  of main bodies  72   a ,  74   a  of the holding members  72 ,  74  is preferred to be similar to the outer shape (circular shape) of the desquamation member  376 , but is permitted to be various shapes such as elliptic and polygonal shapes. The use of a plurality of desquamation members  376  is also permitted. 
         [0198]    As shown in  FIG. 22B , the surface of the desquamation member  376  has uneven portions such as axial or annular grooves so that the surface layer of the living tissue may be easily desquamated. The edges of the uneven portions are preferred to be sharp. 
         [0199]    Now, the effects of the medical treatment apparatus  10  according to this embodiment are described along with a flowchart shown in  FIG. 23 . 
         [0200]    Living tissues are held between the first and second holding members  72 ,  74 , and the desquamation member  376  is disposed between the living tissues to be joined together. Then, a hand switch or foot switch connected to the frequency energy source  14  is pressed. 
         [0201]    The detachment member moving mechanism  306  inside the handle  42  is rotated or vibrated by the frequency energy source  14  via the cable  319 . Thus, the desquamation member moving mechanism  306  transmits the rotational or vibrational movement to the lengthwise feed rod  376   a . In addition, the vibrations referred to here mean vibrations lower in frequency than ultrasonic vibrations. The lengthwise feed rod  376   a  transmits its rotational or vibrational movement to the detachment member  376 . This rotates or vibrates the desquamation member  376  disposed between the holding members  72 ,  74 . Components of the surfaces of the living tissues are desquamated or cut by the rotation or vibrations of the desquamation member  376 , and layers containing collagen having relatively high strength are exposed on the joint surfaces (S 31 ). 
         [0202]    In addition, the detaching operation by the desquamation member  376  is performed for a given period of time (S 32 ). After a given period of time from the start of the output, for example, three seconds, the detachment member controller  302  stops the output of electric power from the physical desquamation member output unit  304 . Thus, the rotation or vibration by the desquamation member moving mechanism  306  is also stopped. Accordingly, the rotation or vibration by the desquamation member  376  is also stopped (S 33 ). 
         [0203]    Then, the desquamation member  376  between the first and second holding members  72 ,  74  is moved backward. When a second knob  42   b  of the handle  42  is moved toward the operator, the desquamation member  376  located between the holding members  72 ,  74  of the energy treatment instrument  12  axially moves toward the operator through the shaft  44 , and the distal end of the desquamation member  376  is stored in the distal end of the shaft  44  (S 34 ). 
         [0204]    While details have been described in the first embodiment and are therefore omitted, the frequency energy source  14  then drives the high-frequency output unit  26  therein under the control of the high-frequency output controller  24 , and outputs high-frequency electric power from the high-frequency output unit  26  (S 5 ). As a result, the living tissues are joined together (S 6 , S 7 ). 
         [0205]    As in the first embodiment, when the impedance Z detected by the detecting portion  22  is judged to have exceeded a threshold value of 1000 [Ω], the high-frequency output controller  24  stops the output of the high-frequency electric power from the high-frequency output unit  26 . 
         [0206]    As described above, the following can be said according to this embodiment. 
         [0207]    In this embodiment, in order to desquamate the living tissues in the joint surfaces, the desquamation member  376  for providing a mechanical stimulus such as friction is used instead of the ultrasonic probe  76  in the first embodiment. The mechanical stimulus does not have such specific properties of only preserving collagen as in the treatment with the ultrasonic energy. However, if, for example, cell components such as epitheliums present on the surface are removed by the friction, collagen present in deeper parts can be exposed. 
         [0208]    Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.