Abstract:
A surgical system for sealing a hollow organ, the surgical system including: a pair of electrodes; a memory storing data which include patterns corresponding to predetermined burst pressure value; an electrosurgical generator configured to generate a high frequency current for sealing the hollow organ; and one or more processors configured to: perform the sealing by application of the high frequency current through the hollow organ; measure impedance of the hollow organ between the pair of electrodes with time during the performing the sealing; subsequent to performing the sealing, classify parameters related to the impedance as one of patterns corresponding to predetermined burst pressure value according to the data; and estimate the burst pressure value of the hollow organ based on the one of patterns.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation application of U.S. patent application Ser. No. 12/980,875 filed on Dec. 29, 2010, which is a continuation application of PCT International Application No. PCT/JP2010/067439 filed on Oct. 5, 2010 and claims benefit of U.S. Provisional Patent Application No. 61/255,536 filed in the U.S.A. on Oct. 28, 2009, the entire contents of each of which are incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
       [0002]    The present invention relates to a high frequency surgery apparatus and a medical instrument operating method for performing surgery by passing a high frequency current through a living tissue. 
       2. Description of the Related Art 
       [0003]    In recent years, various types of surgery apparatus are used in surgery and the like. For example, a technique of injecting high frequency energy into a blood vessel to perform treatment is conventionally known. In this case, a high frequency surgery apparatus is used which passes a high frequency current through the blood vessel which is being grasped with an appropriate grasping force and seals the blood vessel using thermal energy thereby generated. 
         [0004]    For example, a high frequency surgery apparatus described in Japanese Patent Application Laid-Open Publication No. 2002-325772 measures an electric impedance of a living tissue while supplying a high frequency current to the living tissue, performs control so as to sequentially reduce the output value of high frequency power in three stages, stops the output when a predetermined electric impedance is reached and ends the processing. 
       SUMMARY OF THE INVENTION 
       [0005]    A method for estimating a burst pressure value of a hollow organ, the method comprising:
       measuring impedance of the hollow organ between a pair of electrodes with time based on a high frequency current through the hollow organ;   classifying parameters related to the impedance as one of patterns corresponding to predetermined burst pressure value according to stored data in a memory which comprises the patterns subsequent to sealing the hollow organ by application of the high frequency current; and   estimating the burst pressure value of the hollow organ based on the one of patterns.       
 
         [0009]    A surgical controller for sealing a hollow organ, the surgical controller comprising one or more processors configured to:
       measure impedance of the hollow organ between a pair of electrodes with time based on a high frequency current through the hollow organ;   classify parameters related to the impedance as one of patterns corresponding to predetermined burst pressure value according to stored data in a memory which comprises the patterns subsequent to sealing the hollow organ by application of the high frequency current; and   estimate the burst pressure value of the hollow organ based on the one of patterns.       
 
         [0013]    A surgical system for sealing a hollow organ, the surgical system comprising:
       a pair of electrodes;   a memory storing data which comprise patterns corresponding to predetermined burst pressure value;   an electrosurgical generator configured to generate a high frequency current for sealing the hollow organ; and   one or more processors configured to:
           perform the sealing by application of the high frequency current through the hollow organ;   measure impedance of the hollow organ between the pair of electrodes with time during the performing the sealing;   subsequent to performing the sealing, classify parameters related to the impedance as one of patterns corresponding to predetermined burst pressure value according to the data; and   estimate the burst pressure value of the hollow organ based on the one of patterns.   
               
 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0022]      FIG. 1  is a diagram illustrating an overall configuration of a high frequency surgery apparatus according to a first embodiment of the present invention; 
           [0023]      FIG. 2  is a block diagram illustrating an internal configuration of a high frequency power supply apparatus of the high frequency surgery apparatus; 
           [0024]      FIG. 3  is a flowchart illustrating a typical example of high frequency surgery control method for a blood vessel to be treated according to the first embodiment; 
           [0025]      FIG. 4A  is an explanatory operation diagram illustrating an impedance variation when sealing treatment is applied to a large diameter blood vessel according to the high frequency surgery control method in  FIG. 3  through intermittent output; 
           [0026]      FIG. 4B  is an explanatory operation diagram illustrating an impedance variation when sealing treatment is applied to a small diameter blood vessel according to the high frequency surgery control method in  FIG. 3  through intermittent output; 
           [0027]      FIG. 5A  is an explanatory operation diagram illustrating an impedance variation when sealing treatment is applied to a large diameter blood vessel according to the high frequency surgery control method in  FIG. 3  through continuous outputs; 
           [0028]      FIG. 5B  is an explanatory operation diagram illustrating an impedance variation when sealing treatment is applied to a small diameter blood vessel according to the high frequency surgery control method in  FIG. 3  through continuous outputs; 
           [0029]      FIG. 6A  is a diagram illustrating an impedance variation when a high frequency current is supplied under the same condition to apply sealing treatment to a small diameter blood vessel and a large diameter blood vessel; 
           [0030]      FIG. 6B  is a diagram illustrating the way to realize high sealing performance by setting two control parameters according to the first embodiment; 
           [0031]      FIG. 6C  is a diagram illustrating measured data of average blood vessel withstand pressure values when sealing treatment is applied to a large diameter blood vessel and a small diameter blood vessel using an output time threshold and an impedance threshold as control parameters respectively; 
           [0032]      FIG. 7A  is a diagram illustrating measured data to determine an impedance threshold as a control parameter in the case of a large diameter blood vessel; 
           [0033]      FIG. 7B  is a diagram illustrating measured data to determine an output time threshold as a control parameter in the case of a small diameter blood vessel; 
           [0034]      FIG. 7C  is a diagram illustrating measured data to determine an output time threshold as a control parameter in the case of a medium diameter blood vessel; 
           [0035]      FIG. 8A  is a diagram illustrating constant power control and constant voltage control when performing output control according to a second embodiment of the present invention; 
           [0036]      FIG. 8B  is a flowchart illustrating a typical example of a high frequency surgery control method for a blood vessel to be treated according to the second embodiment; 
           [0037]      FIG. 9A  is an explanatory operation diagram illustrating an impedance variation or the like when sealing treatment is applied to a large diameter blood vessel according to the high frequency surgery control method of the second embodiment; 
           [0038]      FIG. 9B  is an explanatory operation diagram illustrating an impedance variation or the like when sealing treatment is applied to a small diameter blood vessel according to the high frequency surgery control method of the second embodiment; 
           [0039]      FIG. 10  is a block diagram illustrating an internal configuration of a high frequency power supply apparatus according to a third embodiment of the present invention; 
           [0040]      FIG. 11  is a flowchart illustrating a processing procedure for exercising output control when performing sealing treatment according to the third embodiment; 
           [0041]      FIG. 12  is a diagram illustrating an example of measured data of an impedance variation in the case of a sample when a near-best blood vessel withstand pressure value is obtained and a sample of a near-minimum blood vessel withstand pressure value; and 
           [0042]      FIG. 13  is a flowchart illustrating a processing procedure when performing sealing treatment in a modification example of the third embodiment. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0043]    Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. 
       First Embodiment 
       [0044]    As shown in  FIG. 1 , a high frequency surgery apparatus  1  according to a first embodiment of the present invention includes a high frequency power supply apparatus  2  provided with a high frequency current generation section  31  that generates a high frequency current for treatment (see  FIG. 2 ). 
         [0045]    The high frequency power supply apparatus  2  is provided with a connector receiver  3  that outputs a high frequency current generated and a connector  5  provided at a proximal end of a connection cable  4   a  of a high frequency probe  4  is detachably connected to the connector receiver  3  as a high frequency treatment instrument. 
         [0046]    The high frequency probe  4  includes an operation section  6  for an operator to grasp to operate, a sheath  7  that extends from a top end of the operation section  6  and a treatment section  9  provided via a link mechanism  8  at a distal end of the sheath  7  to pass a high frequency current through a living tissue to be treated and perform treatment of high frequency surgery. 
         [0047]    A slide pipe  10  is inserted into the sheath  7  and a rear end of the slide pipe  10  is connected to a connection bearing  13  at one top end of handles  12   a  and  12   b  forming the operation section  6  via a connection shaft  11 . The connection bearing  13  is provided with a slit  13   a  that allows a rear end side of the connection shaft  11  to pass and does not allow its spherical portion at the rear end to pass. 
         [0048]    The handles  12   a  and  12   b  are pivotably coupled at a pivoted section  14  and are provided with finger hooking members  15   a  and  15   b  on the bottom end side. 
         [0049]    When the operator performs operation of opening or closing the finger hooking members  15   a  and  15   b , the top ends of the handles  12   a  and  12   b  move in opposite directions. The operator can then push forward or move backward the slide pipe  10 . 
         [0050]    A distal end of the slide pipe  10  is connected to a pair of treatment members  16   a  and  16   b  making up the treatment section  9  via a link mechanism  8  for opening/closing. 
         [0051]    Therefore, the operator performs operation of opening/closing the handles  12   a  and  12   b , and can thereby drive the link mechanism  8  connected to the slide pipe  10  that moves forward/backward and open/close the pair of treatment members  16   a  and  16   b . The blood vessel  17  as the living tissue to be treated can be grasped using the two mutually facing inner surface parts of the pair of treatment members  16   a  and  16   b  that open/close (see  FIG. 2 ). 
         [0052]    The state in  FIG. 1  is a state in which the handles  12   a  and  12   b  are closed and if the handles  12   a  and  12   b  are opened from this condition, the slide pipe  10  moves forward and the pair of treatment members  16   a  and  16   b  can be opened via the link mechanism  8 . 
         [0053]    The pair of treatment members  16   a  and  16   b  are provided with bipolar electrodes  18   a  and  18   b  on the inner surfaces facing each other. The rear end sides of the treatment members  16   a  and  16   b  are connected to the link mechanism  8 . 
         [0054]    A pair of signal lines  21  are passed through the slide pipe  10  and connected to the electrodes  18   a  and  18   b  respectively. Furthermore, the rear end of the signal line  21  is connected to a connector receiver  23  provided, for example, at a top of the handle  12   b . A connector at the other end of the connection cable  4   a  is detachably connected to the connector receiver  23 . 
         [0055]    A foot switch  27  as an output switch that performs operation of instructing output ON (energization) or output OFF (disconnection) of a high frequency current is connected to the high frequency power supply apparatus  2 , in addition to a power supply switch  26 . The operator can step on the foot switch  27  with the foot to thereby supply or stop supplying the high frequency current to the treatment section  9 . 
         [0056]    Furthermore, a setting section  28  for setting a high frequency power value or the like is provided on the front of the high frequency power supply apparatus  2 . The setting section  28  is provided with a power setting button  28   a  that sets a high frequency power value and a selection switch  28   b  that selects one of an intermittent output mode in which a high frequency current is outputted intermittently and a continuous output mode in which a high frequency current is outputted continuously. The operator is allowed to set a high frequency power value suitable for treatment and set an output mode used to perform high frequency surgery. 
         [0057]    A display section  29  that displays the set high frequency power value or the like is provided above the setting section  28 . 
         [0058]    As shown in  FIG. 2 , the high frequency power supply apparatus  2  is configured by a high frequency current generation section  31  that generates a high frequency current to be transmitted to a living tissue to be operated on using an insulation transformer  32 . A parallel resonance circuit  33   a  to which a capacitor is connected in parallel is provided on a primary wiring side of the insulation transformer  32 . A DC voltage is applied to one end of the parallel resonance circuit  33   a  from a variable power supply  34  and a switching circuit  35  is connected to the other end thereof. 
         [0059]    The variable power supply  34  can change and output the DC voltage. Furthermore, the switching circuit  35  performs switching through application of a switching control signal from a waveform generation section  36 . 
         [0060]    The switching circuit  35  switches a current that flows from the variable power supply  34  to the primary wiring of the insulation transformer  32  and generates a voltage-boosted high frequency current at an output section  33   b  on a secondary wiring side of the insulation transformer  32  insulated from the primary wiring side. A capacitor is also connected to the secondary wiring. 
         [0061]    The output section  33   b  on the secondary wiring side of the insulation transformer  32  is connected to contacts  3   a  and  3   b  of the connector receiver  3  which is an output end of the high frequency current. Treatment such as sealing can be performed by transmitting a high frequency current via the high frequency probe  4  connected to the connector receiver  3  and supplying (applying) the high frequency current to a blood vessel  17  as a living tissue to be operated on. 
         [0062]    Furthermore, both ends of the output section  33   b  are connected to an impedance detection section  37 . The impedance detection section  37  detects a voltage between output ends (two contacts  3   a  and  3   b ) when the high frequency current is passed through the blood vessel  17  as the living tissue as shown in  FIG. 2  and a current that flows through the blood vessel  17  which becomes a load and detects an electric impedance (simply abbreviated as “impedance”) obtained by dividing the voltage in that case by the current. The impedance detection section  37  outputs the detected impedance to a control section  38 . As will be described later, the impedance detection section  37  may also be configured so as to further calculate an impedance Za of the blood vessel  17  portion and output the impedance Za to the control section  38 . 
         [0063]    Furthermore, the control section  38  is connected to a timer  39  as a time measuring section that measures time, a memory  40  that stores various kinds of information, the foot switch  27  that turns ON or OFF the output of a high frequency current, the setting section  28  and the display section  29 . 
         [0064]    The control section  38  that controls the sections of the high frequency power supply apparatus  2  sends setting conditions and control signals corresponding to the impedance detected by the impedance detection section  37  and the measured time by the timer  39  to the variable power supply  34  and the waveform generation section  36 . 
         [0065]    The variable power supply  34  outputs DC power corresponding to the control signal sent from the control section  38 . Furthermore, the waveform generation section  36  outputs a waveform (here, square wave) corresponding to the control signal sent from the control section  38 . 
         [0066]    The high frequency current generation section  31  generates a high frequency current through the operation of the switching circuit  35 , which is turned ON or OFF by the DC power sent from the variable power supply  34  and the square wave sent from the waveform generation section  36  and outputs the high frequency current from the connector receiver  3 . The parallel resonance circuit  33   a  reduces spurious caused by the square wave obtained through the switching operation. The output section  33   b  also forms a resonance circuit and reduces spurious. 
         [0067]    The control section  38  is constructed, for example, of a CPU  38   a  and the CPU  38   a  controls the respective sections when performing treatment such as sealing on the blood vessel  17  according to the program stored in the memory  40 . 
         [0068]    In the present embodiment, in order to be able to appropriately perform sealing treatment on any blood vessel  17  of small to large diameter, the memory  40  stores a first threshold Tm of output time and a second threshold Zs of impedance as control parameters for appropriately performing sealing treatment. 
         [0069]    In order to detect impedance at the connector receiver  3  to which the connector  5  at the proximal end of the high frequency probe  4  is connected, the impedance detection section  37  actually detects a net impedance Za of the blood vessel  17  at the electrodes  18   a  and  18   b  as an impedance Za′ including an impedance component of the high frequency probe  4 . 
         [0070]    The present embodiment will describe that the impedance detection section  37  further calculates the net impedance Za from the impedance Za′ and outputs the impedance Za to the CPU  38   a . This processing may also be performed by the CPU  38   a . Hereinafter, suppose the impedance detection section  37  calculates (detects) the net impedance Za of the blood vessel  17  at the electrodes  18   a  and  18   b  and outputs the net impedance Za to the CPU  38   a.    
         [0071]    The impedance threshold Zs stored in the memory  40  is a threshold set for the net impedance of the blood vessel  17  at the electrodes  18   a  and  18   b.    
         [0072]    When the threshold Zs′ itself that corresponds to the impedance Za′ detected through the measurement by the impedance detection section  37  is used instead of the threshold Zs, the impedance Za′ may be compared with the threshold Zs′. 
         [0073]    As will be described below, upon starting treatment with high frequency energy, the CPU  38   a  of the control section  38  has the function of the judging section  38   b  that measures an output time Ta via the timer  39 , judges whether or not the output time Ta has reached the threshold Tm and judges whether or not the impedance Za detected by the impedance detection section  37  has reached the second threshold Zs. 
         [0074]    Upon judging that the condition of having reached the first threshold Tm and the condition of having reached the second threshold Zs are satisfied, the CPU  38   a  has the function of the output control section  38   c  that performs output control of stopping the output of the high frequency current from the high frequency current generation section  31 . 
         [0075]    Next, the operation when performing treatment of sealing the blood vessel  17  using the high frequency probe  4  according to the present embodiment will be described with reference to a flowchart in  FIG. 3 . 
         [0076]    The operator turns ON the power supply switch  26  and makes an initial setting of a high frequency power value and an output mode or the like when performing treatment as shown in step S 1 . 
         [0077]    Furthermore, the operator grasps the blood vessel  17  as a living tissue to be treated using the electrodes  18   a  and  18   b  of the treatment section  9  at the distal end portion of the high frequency probe  4  shown in  FIG. 1 .  FIG. 2  schematically shows the blood vessel  17  as the living tissue grasped by the electrodes  18   a  and  18   b.    
         [0078]    As shown in step S 2 , the operator turns ON the foot switch  27  as an output switch to perform sealing treatment on the blood vessel  17 . The output switch may also be provided in the high frequency probe  4 . 
         [0079]    When the output switch is turned ON, the CPU  38  of the control section  38  controls the high frequency current generation section  31  so as to generate a high frequency current. The high frequency current generation section  31  outputs the high frequency current from the output end and the high frequency probe  4  transmits the high frequency current and supplies the high frequency current to the blood vessel  17  contacting the electrodes  18   a  and  18   b . The high frequency current flows through the blood vessel  17  and sealing treatment starts. That is, the output of the high frequency current in step S 3  in  FIG. 3  starts. 
         [0080]    At this moment, as shown in step S 4 , the CPU  38   a  causes the timer  39  as the time measuring section to start measurement (counting) of the output time Ta of the high frequency current. 
         [0081]    Furthermore, as shown in step S 5 , the CPU  38   a  takes in the impedance Za detected (measured) by the impedance detection section  37  in a predetermined cycle. 
         [0082]    As shown in next step S 6 , the CPU  38   a  judges whether or not the impedance Za taken in has reached a preset second threshold Zs, that is, Za≧Zs. 
         [0083]    When the condition of Za≧Zs is not satisfied (that is, Za&lt;Zs), the CPU  38   a  returns to the processing in step S 5 . 
         [0084]    On the other hand, when the judgment result shows that the condition of Za≧Zs is satisfied, the CPU  38   a  moves to processing in step S 7 . In step S 7 , the CPU  38   a  judges whether or not the output time Ta measured by the timer  39  has reached the first threshold Tm, that is, judges whether or not Ta≧Tm. When the CPU  38   a  performs judgment in step S 7 , since the judgment in step S 6  has already proved that the condition of Za≧Zs is satisfied, step S 7  is processing of substantially judging whether or not Za≧Zs and Ta≧Tm. 
         [0085]    When the judgment result in step S 7  does not satisfy Ta≧Tm (that is, Ta&lt;Tm), the CPU  38   a  returns to the processing in step S 7 . On the other hand, when the judgment result shows that the condition of Ta≧Tm is satisfied, the CPU  38   a  moves to the processing in step S 8 . In step S 8 , the CPU  38   a  performs control of stopping the output. The CPU  38   a  then ends the control processing on the sealing treatment in  FIG. 3 . 
         [0086]      FIG. 4A  illustrates a typical variation of the impedance Za when the high frequency current is set to an intermittent output mode and sealing treatment is applied to a large diameter blood vessel. Here, the horizontal axis shows time t and the vertical axis shows an impedance.  FIG. 4A  (the same applies to  FIG. 4B  or the like) also illustrates a situation in which a high frequency current is intermittently outputted in the intermittent output mode. 
         [0087]    In the case of the intermittent output mode, the present embodiment has such a setting that a first period T 1  for outputting a high frequency current intermittently and a second period T 2  for stopping the output, the first period T 1  and the second period T 2  forming a cycle, are set to 2:1. The periods T 1  and T 2  are set to 60 ms and 30 ms respectively. Furthermore, during the period in this intermittent output mode, the high frequency current is set to a constant power value. 
         [0088]    A typical variation of the impedance Za when sealing treatment is applied to a small diameter blood vessel under output conditions similar to those in the case with  FIG. 4A  is as shown in  FIG. 4B . 
         [0089]    As is clear from  FIG. 4A  and  FIG. 4B , when treatment is applied to the large diameter blood vessel, the value of impedance Za increases relatively slowly. The impedance Za is smaller than the second threshold Zs even when the output time Ta reaches the first threshold Tm. 
         [0090]    Thus, the intermittent output mode continues even when the time exceeds the first threshold Tm. The output is stopped when the impedance Za reaches (exceeds) the second threshold Zs. 
         [0091]    On the other hand, in the case of the treatment on the small diameter blood vessel, compared to the case with the large diameter blood vessel, the value of impedance Za increases earlier. The impedance Za exceeds the second threshold Zs before the output time Ta reaches the first threshold Tm. 
         [0092]    When the intermittent output mode continues with the value of impedance Za exceeding the second threshold Zs and the output time Ta reaches (exceeds) the first threshold Tm, the output is stopped. In  FIG. 4B , if the intermittent output is stopped at timing at which the output time Ta exceeds the first threshold Tm, the output may also be stopped at timing slightly delayed as shown by a dotted line. 
         [0093]    Although  FIG. 4A  and  FIG. 4B  illustrate a case where sealing treatment is applied to in the intermittent output mode, treatment may also be performed in a continuous output mode. 
         [0094]      FIG. 5A  and  FIG. 5B  illustrate a typical variation of impedance Za when sealing treatment is applied to a large diameter blood vessel and a small diameter blood vessel in the continuous output mode. 
         [0095]    The tendency (situation) of variation of impedance Za when treatment is performed in the continuous output mode is similar to that in the case described in  FIG. 4A  and  FIG. 4B . 
         [0096]    As described above, the present embodiment sets the first threshold Tm corresponding to the output time Ta and the second threshold Zs corresponding to the value of impedance Za, performs sealing treatment with a high frequency current, and can thereby appropriately perform sealing treatment on the blood vessel  17  of small (to be more specific, on the order of 1 mm) to large diameter (to be more specific, on the order of 7 mm). 
         [0097]    Thus, the operator can smoothly perform sealing treatment on the blood vessel  17  and the burden on the operator when performing sealing treatment can be alleviated. Furthermore, since sealing treatment can be performed smoothly, the surgery time can be reduced. 
         [0098]    The effectiveness in performing such control according to the present invention will be described below. As is clear from characteristics of variation of impedance Za in  FIG. 4A  to  FIG. 5B , in the case of a small diameter blood vessel, the value of impedance Za increases together with the output time Ta in a shorter time than in the case of a large diameter blood vessel. 
         [0099]    A common sealing mechanism includes concrescence and coagulation. In the case of a small diameter blood vessel, sealing can be realized through coagulation by dehydration of removing water content, but in the case of a large diameter blood vessel, sealing is realized using concrescence whereby mainly collagen in the blood vessel is heated and liquefied. 
         [0100]    Thus, in the case of the small diameter blood vessel, sealing characteristics do not deteriorate even when the treatment time extends, whereas sealing characteristics are affected in the case of the large diameter blood vessel. 
         [0101]    A solid line and a dotted line in  FIG. 6A  schematically indicate variations of impedances Z 1  and Z 2  of the small diameter blood vessel and the large diameter blood vessel when a high frequency current is supplied under the same condition to seal the small diameter blood vessel and the large diameter blood vessel. The horizontal axis shows time t during which sealing treatment is being performed. 
         [0102]    As shown in  FIG. 6A , the impedances Z 1  and Z 2  greatly differ from each other in variation, and therefore the method in the prior art of detecting an impedance value, stopping the output when the value reaches a preset threshold and ending the sealing treatment is limited to cases in a narrow range of blood vessel diameter. 
         [0103]    A characteristic Qa shown by a two-dot dashed line in  FIG. 6B  schematically illustrates sealing performance when the diameter of blood vessel is changed when a threshold (Δ) of impedance is set as a control parameter in the case with a medium diameter blood vessel (M) so as to obtain sealing performance that exceeds target performance. 
         [0104]    The characteristic Qa results in sealing performance lower than required target performance in the cases of small diameter blood vessel (S) and large diameter blood vessel (L). 
         [0105]    Thus, the present embodiment uses the threshold Tm of the output time in addition to the threshold Zs of impedance as a control parameter. As shown in  FIG. 6A , the threshold Zs of impedance is set for a large diameter blood vessel so as to obtain appropriate sealing performance. This threshold Zs of impedance may be approximated to be substantially made up of a resistance component only. 
         [0106]    In the case of the small diameter blood vessel as shown in  FIG. 6A , the threshold Tm of the output time is set so as to be able to secure required sealing performance. The present embodiment performs output control so as to end the sealing treatment when conditions for both thresholds Tm and Zs are satisfied. 
         [0107]    An overview of sealing performance in this case is as shown by a solid line and a thick dotted line in  FIG. 6B . A characteristic Qb shown by the solid line in  FIG. 6B  is a characteristic that the threshold Tm of the output time is adjusted (tuned) so as to obtain appropriate sealing performance for a small diameter blood vessel (S). 
         [0108]    Furthermore, a characteristic Qc shown by a thick dotted line is a characteristic that the threshold Zs of impedance is tuned for a large diameter blood vessel (L). By performing output control so as to satisfy both thresholds Tm and Zs, sealing performance that exceeds target performance can be achieved as shown in  FIG. 6B . To be more specific, output control is performed mainly with the characteristic Qb in the case of a small diameter blood vessel, while output control is performed with the characteristic Qc on the large diameter blood vessel side. 
         [0109]    A case has been described in  FIG. 6B  where tuning of output time is performed for a small diameter blood vessel and tuning of impedance is performed for a large diameter blood vessel.  FIG. 6C  illustrates measured data showing grounds when such tuning is performed. 
         [0110]    Two bars on the left and two bars on the right in  FIG. 6C  illustrate average blood vessel sealing pressure values (VBP) [mmHg] when sealing treatment is applied using a threshold of output time (4 seconds in a specific example) and a threshold of impedance (where Zs′ is 670Ω, 890Ω) as control parameters in the cases of a large diameter blood vessel and a small diameter blood vessel respectively. 
         [0111]    The blood vessel withstand pressure value is a measured value of a pressure when a blood vessel sealed part which is the blood vessel  17  subjected to sealing (treatment) is burst by applying a water pressure thereto in order to objectively evaluate the sealing strength. Since a standard blood pressure of human being is 120 mmHg, sealing performance is considered sufficient when it is possible to obtain a blood vessel withstand pressure value three times that blood pressure, that is 360 mmHg or more. 
         [0112]    Furthermore, in  FIG. 6C , output time control is described as “T control” in abbreviated form and impedance control is described as “Z control” in abbreviated form. Furthermore, the measured data in  FIG. 6C  is an example where the threshold Zs′ of impedance is used as a control parameter when an impedance component of a cable such as the high frequency probe  4  for a blood vessel as a living tissue is included, but using the threshold Zs of impedance for only the blood vessel produces a similar result. The measured data is actually obtained according to a high frequency surgery control method of a second embodiment. 
         [0113]    In the case of the large diameter blood vessel, it is obvious from the measured data that impedance control is more effective than output time control. 
         [0114]    On the other hand, in the case of the small diameter blood vessel, it is obvious that output time control is more effective than impedance control. 
         [0115]    Thus, as described in  FIG. 6B , the present embodiment performs tuning using the output time in the case of the small diameter blood vessel and performs tuning using impedance in the case of the large diameter blood vessel. 
         [0116]    Furthermore,  FIG. 7A  illustrates measured data of an average blood vessel withstand pressure value V for determining the threshold Zs′ of impedance and a probability P exceeding 360 mmHg when tuning is performed for the large diameter blood vessel. That is,  FIG. 7A  illustrates measured data obtained when the impedance control described in  FIG. 6C  is performed by changing the threshold Zs′ of impedance. 
         [0117]    It is obvious from the measured data in  FIG. 7A  that the threshold Zs′ of impedance may be set in the vicinity of, for example, 650Ω, with consideration given to the fact that the probability P exceeding 360 mmHg shown by a polygonal line of is high. 
         [0118]    That is, the threshold Zs′ of impedance as a tuning value of impedance is 650Ω and the threshold Zs of net impedance of the blood vessel  17  portion in this case is 925Ω. Therefore, the vicinity of 700Ω to 1100Ω including this value 925Ω may be set to the threshold Zs of impedance of the blood vessel  17  as the living tissue to be treated (to be operated on). 
         [0119]    The probability P that exceeds 360 mmHg in  FIG. 7A  shows a relative value which is a probability of exceeding 360 mmHg statistically calculated from the blood vessel withstand pressure value obtained. 
         [0120]    Furthermore,  FIG. 7B  illustrates measured data of an average blood vessel withstand pressure value V for determining the threshold Tm of the output time Ta and the probability P exceeding 360 mmHg when tuning is performed for the small diameter blood vessel. That is,  FIG. 7B  illustrates measured data obtained when the output time control described in  FIG. 6C  is performed by changing the threshold Tm of the output time Ta. The upper part in  FIG. 7B  shows measured data of the probability P exceeding 360 mmHg and the lower part shows the average blood vessel withstand pressure value V. 
         [0121]    From the measured data in  FIG. 7B , for example, the vicinity of 3 seconds to 6 seconds may be set as the threshold Tm of the output time Ta. 
         [0122]    Furthermore,  FIG. 7C  illustrates measured data of the average blood vessel withstand pressure value V for determining the threshold Tm of output time Ta and the probability P exceeding 360 mmHg when tuning is performed for a medium diameter blood vessel. That is,  FIG. 7C  illustrates measured data obtained when the output time control described in  FIG. 6C  is performed by changing the threshold Tm of the output time Ta. 
         [0123]    In the measured data in  FIG. 7C , although the average blood vessel withstand pressure value V in the case of 4 seconds is somewhat low, since a value nearly twice 360 mmHg is maintained in this case too, any value in the vicinity of, for example, 3 seconds to 6 seconds may be adopted as the threshold Tm of the output time Ta. 
         [0124]    Using two control parameters set in this way, it is possible to smoothly perform sealing treatment in the case of any blood vessel  17  of small to large diameter according to the present embodiment as described above. Furthermore, according to the present embodiment, it is possible to perform sealing treatment simply and in a short time in the case of any blood vessel  17  of small to large diameter and alleviate the burden on the operator and patient. 
       Second Embodiment 
       [0125]    Next, a second embodiment of the present invention will be described. The configuration of the present embodiment is a configuration similar to that of the first embodiment shown in  FIG. 1  and  FIG. 2 . 
         [0126]    The CPU  38   a  of the control section  38  according to the present embodiment performs output control different from that of the first embodiment. In the first embodiment, sealing treatment is performed in one output mode. 
         [0127]    By contrast, in the present embodiment, the CPU  38   a  performs control so as to use the intermittent output mode when starting the output and switch the mode from the intermittent output mode to the continuous output mode when the detected impedance Za reaches a third threshold Zf of impedance as a control parameter used to switch a preset output mode. That is, in the present embodiment, the CPU  38   a  has a function of a switching control section (indicated by  38   d  in  FIG. 10  which will be described later) that performs switching control of the output mode. The threshold Zf is a value by far smaller than the threshold Zs, to be more specific, on the order of 101Ω. The threshold Zf is stored in the memory  40  (see  FIG. 2 ). 
         [0128]    As shown in  FIG. 8A , the present embodiment performs constant power control for the period in the intermittent output mode and performs constant voltage control after reaching the threshold Zf of impedance and shifting to the continuous output mode. When the constant power control is shifted to the constant voltage control, the amount of high frequency energy injected into the blood vessel  17  is gradually reduced. 
         [0129]    By switching between the output modes in this way, the present embodiment allows sealing treatment to be smoothly performed for any blood vessel of small to large diameter. In  FIG. 8A , the horizontal axis shows an impedance and the vertical axis shows a power value. 
         [0130]    Next, a high frequency surgery control method according to the present embodiment will be described with reference to  FIG. 8B . After turning ON the power, the operator makes an initial setting in first step S 11 . 
         [0131]    In the present embodiment, the threshold Tm of the output time and the threshold Zs of impedance as control parameters are set to 4 seconds and 925Ω respectively by default. Furthermore, the threshold Zf of impedance used for switching between output modes is set to 101Ω by default. 
         [0132]    Furthermore, the intermittent output mode period is set by default such that a high frequency current is outputted in a cycle including 60 ms of ON and 30 ms of OFF with constant power of 40 W. Furthermore, the continuous output mode period is set by default such that a high frequency current is outputted at a constant voltage of 70 Vrms. 
         [0133]    Therefore, when performing sealing treatment with the default setting as is, the operator can perform the treatment without changing these values. The operator may also operate the setting section  28  to make a selective setting from, for example, 3 seconds of level 1, 4 seconds of level 2 and 5 seconds of level 3, which are prepared in advance, as the threshold Tm of the output time. 
         [0134]    The operator grasps the blood vessel to be treated using the electrodes  18   a  and  18   b  at the distal end of the high frequency probe  4  and turns ON the foot switch  27  as the output switch as shown in step S 12 . The CPU  38   a  of the control section  38  then performs control so as to cause the high frequency current generation section  31  to generate a high frequency current. 
         [0135]    As shown in step S 13 , the high frequency power supply apparatus  2  outputs a high frequency current from the output end in the intermittent output mode. The high frequency current is transmitted to the blood vessel  17  via the high frequency probe  4 , the high frequency current passes through the blood vessel  17  and sealing treatment is started. That is, the output starts in the intermittent output mode. 
         [0136]    In this case, as shown in step S 14 , the CPU  38   a  causes the timer  39  to start measuring (counting) the output time Ta of the high frequency current. 
         [0137]    Furthermore, as shown in step S 15 , the CPU  38   a  takes in a detected impedance Za in a predetermined cycle using the impedance detection section  37 . 
         [0138]    As shown in next step S 16 , the CPU  38   a  judges whether or not the impedance Za taken in has reached a preset threshold Zf (to be more specific, Zf=101Ω), that is, Za≧Zf. 
         [0139]    When the condition of Za≧Zf is not satisfied (that is, Za&lt;Zf), the CPU  38   a  returns to the processing in step S 15 . 
         [0140]    On the other hand, when the judgment result shows that the condition of Za≧Zf is satisfied, the CPU  38   a  moves to processing in step S 17 . In step S 17 , the CPU  38   a  switches (shifts) the high frequency current of the high frequency current generation section  31  from the intermittent output mode to the continuous output mode. Therefore, the high frequency current in the continuous output mode flows through the blood vessel  17 . 
         [0141]    Furthermore, in next step S 18 , the CPU  38   a  takes in the detected (measured) impedance Za from the impedance detection section  37  in a predetermined cycle. 
         [0142]    As shown in next step S 19 , the CPU  38   a  judges whether or not the impedance Za taken in has reached the preset threshold Zs (to be more specific, Zs=925Ω), that is, Za≧Zs. 
         [0143]    When the condition of Za≧Zs is not satisfied (that is, Za&lt;Zs), the CPU  38   a  returns to the processing in step S 18 . 
         [0144]    On the other hand, when the judgment result shows that the condition of Za≧Zs is satisfied, the CPU  38   a  moves to processing in step S 20 . In step S 20 , the CPU  38   a  judges whether or not the measured (counted) output time Ta has reached the threshold Tm, that is, Ta≧Tm from the timer  39 . Since the judgment result in step S 19  before the judgment in step S 20  shows that the condition of Za≧Zs is satisfied, it is substantially judged in step S 20  whether or not Za≧Zs and Ta≧Tm. 
         [0145]    When the judgment result in step S 20  shows that Ta≧Tm is not satisfied (that is, Ta&lt;Tm), the CPU  38   a  returns to the processing in step S 20 . On the other hand, when the judgment result shows that the condition of Ta≧Tm is satisfied, the CPU  38   a  moves to processing in step S 21 . In step S 21 , the CPU  38   a  performs control so as to stop the output. The CPU  38   a  then ends the control processing on the sealing treatment in  FIG. 8B . 
         [0146]      FIG. 9A  and  FIG. 9B  illustrate a variation of the impedance Za when the high frequency control method in  FIG. 8B  is applied to a large diameter blood vessel and a small diameter blood vessel. 
         [0147]    As is clear from a comparison of  FIG. 9A  and  FIG. 9B , since the impedance Za increases more slowly in the case of the large diameter blood vessel than in the case of the small diameter blood vessel, the time until the impedance Za reaches the threshold Zf is longer than in the case of the small diameter blood vessel. Therefore, in the case of the large diameter blood vessel, the treatment time in the intermittent output mode is longer than in the case of the small diameter blood vessel. 
         [0148]    When the impedance Za reaches the threshold Zf, the output mode shifts to the continuous output mode. After the shift, even when the output time Ta reaches the threshold Tm of the output time, the impedance Za in the case of the large diameter blood vessel is less than the threshold Zs. Furthermore, when the continuous output mode continues and the impedance Za thereof reaches or exceeds the threshold Zs, the output is stopped. 
         [0149]    On the other hand, in the case of the small diameter blood vessel, the impedance Za increases sooner than in the case of the large diameter blood vessel, and therefore the impedance Za reaches the threshold Zf in a shorter time than in the case of the large diameter blood vessel. 
         [0150]    When the impedance Za reaches the threshold Zf, the output mode shifts to the continuous output mode. After the shift, before the output time Ta reaches the threshold Tm of the output time, the impedance Za thereof exceeds the threshold Zs. Furthermore, the continuous output mode continues and when the output time Ta reaches or exceeds the threshold Tm, the output is stopped. 
         [0151]    The present embodiment allows sealing treatment to be smoothly performed such that a sufficient blood vessel withstand pressure value is obtained for any blood vessel  17  of small to large diameter. 
         [0152]    In the case of the small diameter blood vessel, the aforementioned threshold Tm of output time is a value on the lower limit side of the time set so as to satisfy a target value of the blood vessel withstand pressure value required by sealing treatment and sealing treatment may be performed for a longer time than the threshold Tm in the case of the small diameter blood vessel. 
         [0153]    Furthermore, in the case of the large diameter blood vessel, the impedance Za is smaller than the threshold Zs of impedance during the output time until the threshold Tm, and therefore the value of the threshold Tm may also be set to a value slightly greater than 3 to 6 seconds (on the order of 1 second). 
       Third Embodiment 
       [0154]    Next, a third embodiment of the present invention will be described. The configuration of the present embodiment is a configuration similar to that of the first embodiment shown in  FIG. 1  and  FIG. 2 .  FIG. 10  illustrates a configuration of a high frequency power supply apparatus  2 B in a high frequency surgery apparatus  1 B of the present embodiment. 
         [0155]    In the high frequency power supply apparatus  2 B, the CPU  38   a  making up the control section  38  in the high frequency power supply apparatus  2  in  FIG. 2  includes an impedance variation calculation section  38   e  that calculates an impedance variation ΔZa per predetermined time from an impedance Za detected by the impedance detection section  37 . Furthermore, the CPU  38   a  includes a judging section that judges whether or not the calculated impedance variation ΔZa is equal to or above a preset threshold ΔZt. 
         [0156]    Furthermore, upon judging that the calculated impedance variation ΔZa is equal to or above the preset threshold ΔZt, the CPU  38   a  has a function of a second output control section  38   f  that performs output control so as to reduce a high frequency current (or high frequency energy) that performs sealing treatment. The output control section  38   c  may include this function as well. 
         [0157]    In other words, the CPU  38   a  performs output control so that the calculated impedance variation ΔZa falls within a predetermined range. 
         [0158]    When calculating the impedance variation ΔZa, the value of the predetermined time is set to, for example, on the order of several tens of ms to 100 ms. Furthermore, the threshold ΔZt is set to a value on the order of 200Ω/200 ms (=1 kΩ/s) or slightly smaller than this value. The threshold ΔZt is set based on measured data shown in  FIG. 12  which will be described later. 
         [0159]    The CPU  38   a  also has the function of the switching control section  38   d  described in the second embodiment. 
         [0160]    Therefore, the present embodiment corresponds to the second embodiment further provided with the impedance variation calculation section  38   e  and the second output control section  38   f.    
         [0161]    The second output control section  38   f  reduces a set value of high frequency power during a period in an intermittent output mode and reduces a set value of voltage during a period in a continuous output mode. 
         [0162]    The high frequency power supply apparatus  2 B of the present embodiment includes a notifying section  51  that notifies the operator et al., when sealing treatment is performed using control parameters, that the output is not stopped even after a lapse of an allowable output time. 
         [0163]    To be more specific, when a threshold Tm of an output time Ta has elapsed, the CPU  38   a  judges whether or not a threshold Te set to a value greater than the threshold Tm (e.g., 10 seconds) is exceeded. When the threshold Te is exceeded, the operator is vocally notified through, for example, a speaker that makes up the notifying section  51  that a standard treatment time has been exceeded. 
         [0164]    Notification is not limited to notification by voice but may also be realized by means of display on a display section  29 . After the notification, stoppage of the output may be realized interlocked therewith. Furthermore, the operator may be asked to judge whether or not to stop the output and the stoppage or continuation of the output may be decided according to the judgment result. 
         [0165]    The rest of the configuration is similar to the configuration of the second embodiment. The processing procedure for output control of the present embodiment corresponding to a case where sealing treatment according to the second embodiment is performed is as shown in  FIG. 11 . 
         [0166]    When the power is turned ON, the high frequency surgery apparatus  1 B is set in an operating state. When the operator turns ON the output switch as in step S 31 , a high frequency current is supplied to a blood vessel to be treated through the high frequency probe  4  as shown in step S 32  and the output is started. As shown in step S 33 , the CPU  38   a  causes the timer  39  to start to measure an output time Ta and causes the impedance detection section  37  to take in the detected impedance Za. 
         [0167]    Furthermore, in next step S 34 , the CPU  38   a  calculates an impedance variation ΔZa per predetermined time. The predetermined time may also be set to an appropriate time. 
         [0168]    In next step S 35 , the CPU  38   a  judges whether or not the impedance variation ΔZa reaches or exceeds a preset threshold ΔZt. That is, the CPU  38   a  judges whether or not ΔZa≧ΔZt. 
         [0169]    When this judgment condition is satisfied, in next step S 36 , the CPU  38   a  reduces the output by lowering the set power value by a value of X1 or lowering the set voltage value by X2, and then returns to the processing in step S 33 . 
         [0170]    When the output is started as described in the second embodiment, treatment is performed in an intermittent output mode with constant power. Therefore, when the judgment condition in step S 35  is met during the period in the intermittent output mode, the set power value is reduced by X1. When, for example, the set power value is 40 W, the set power value is reduced by on the order of several W. When the judgment condition in step S 35  is met during the period in the continuous output mode, the set voltage value is reduced by X2. When, for example, the set voltage value is 70 Vrms, the set voltage value is reduced by on the order of 5 Vrms. 
         [0171]    On the other hand, when the judgment condition in step S 35  is not satisfied, the CPU  38   a  moves to step S 37  and in step S 37 , the CPU  38   a  judges whether or not the output ending condition is satisfied. To be more specific, the output ending condition is the judgment processing in step S 20  in  FIG. 8B . When the output ending condition is satisfied, in step S 38 , the CPU  38   a  performs processing of stopping the output and ends the output control in  FIG. 11 . 
         [0172]    In the case of a judgment result that the output ending condition in step S 37  is not satisfied, the CPU  38   a  moves to processing in step S 39  and in this step S 39 , the CPU  38   a  judges whether or not the output time Ta exceeds a threshold Te close to a maximum value allowable as a preset standard output time. That is, the CPU  38   a  judges whether or not Ta&gt;Te. 
         [0173]    When the judgment condition is not satisfied, the CPU  38   a  returns to step S 33  and repeats the aforementioned processing. On the other hand, when the judgment condition in step S 39  is satisfied, in next step S 40 , the CPU  38   a  notifies through the notifying section  51  that the standard output time (treatment time) is exceeded and then moves to processing in step S 38 . 
         [0174]    By performing output control as shown in  FIG. 11 , it is possible to reduce the possibility that treatment may be performed departing from the characteristics of the standard impedance Za according to the second embodiment shown in  FIG. 9A  and  FIG. 9B . 
         [0175]      FIG. 12  illustrates impedance variations in cases with near-best blood vessel withstand pressure values in a plurality of samples sealed according to the second embodiment (samples # 10  and # 13  on the left) and near-minimum blood vessel withstand pressure values (samples # 9  and # 14  on the right). 
         [0176]    In the sample with the near-minimum blood vessel withstand pressure values compared with the near-best sample, a steep impedance variation has occurred until about the middle of the output time (for a lapse of time). A steep impedance variation (ΔZ/Δt), to be more specific, ΔZ/Δt≈200Ω/200 ms has occurred, for example, in the vicinity of 1.5 to 2 seconds in sample # 9  and in the vicinity before 3 seconds in sample # 14 . Thus, the samples showing the occurrence of steep impedance variations (ΔZ/Δt) until about the middle of the output time have shown a tendency that their blood vessel withstand pressure values decrease. 
         [0177]    Furthermore, when such samples were examined, a tendency was found that degeneration of the tissue occurred on the surface of the tissue due to an excessive temperature rise, transmission of high frequency energy was blocked by the degeneration of the surface and concrescence effects on the interior of the tissue or dehydrations were often not obtained. 
         [0178]    For this reason, the present embodiment performs control to reduce the amount of high frequency energy injected so as to prevent such a steep impedance variation from occurring, resulting in an excessive temperature rise on the surface of the tissue. 
         [0179]    To be more specific, when the impedance variation ΔZa exceeds the threshold ΔZt during an intermittent output mode period when a high frequency current is outputted with a constant power value as described above, the constant power value thereof is reduced by a predetermined power value (X1) at a time through a control loop. 
         [0180]    On the other hand, when the impedance variation ΔZa exceeds the threshold ΔZt during the period in continuous output mode in which a high frequency current is outputted with a constant voltage value, the constant voltage value thereof is reduced by a predetermined voltage value (X2) at a time through a control loop. 
         [0181]    With such output control, the present embodiment not only has effects similar to those of the second embodiment, but also can reduce the probability that an insufficient blood vessel withstand pressure value may be generated when sealing treatment is applied and perform more preferable sealing treatment. The present embodiment may also be applied to the first embodiment. 
         [0182]    The present embodiment may reference accumulated past data when sealing treatment is performed, use data such as impedance Za, impedance variation ΔZa or the like at each output time Ta obtained when sealing treatment is actually performed, and estimate sealing strength, to be more specific, an evaluation result of blood vessel withstand pressure values as an objective measure of sealing treatment thereof. 
         [0183]    In this case, when known data is not enough to give an evaluation result with predetermined reliability, data may be accumulated until it is possible to give an evaluation result with the predetermined reliability. 
         [0184]      FIG. 13  illustrates a procedure for a high frequency surgery control method designed to notify a blood vessel withstand pressure value as estimated sealing strength after treatment using accumulated data. Since  FIG. 13  is only partially different from  FIG. 11 , only differences will be described. 
         [0185]    In step S 51  provided between steps S 34  and S 35  in  FIG. 11  in the processing procedure shown in  FIG. 13 , the CPU  38   a  records the output time Ta, the impedance Za and the impedance variation ΔZa in recording means such as the memory  40 . 
         [0186]    Furthermore, in step S 52  after step S 36 , the CPU  38   a  records the output time Ta, set power value −X1 or set voltage value −X2 in recording means such as the memory  40 . 
         [0187]    Furthermore, in step S 53  after step S 38 , the CPU  38   a  calculates an estimate value of blood vessel withstand pressure value estimated in the case of the blood vessel  17  immediately after treatment is ended based on data such as the output time Ta, the impedance Za, the impedance variation ΔZa or the like when sealing treatment is performed in  FIG. 13  and the accumulated past data, and displays the estimate value on the display section  29 . 
         [0188]    For example, the CPU  38   a  records the accumulated data (however, data whose blood vessel withstand pressure value is known) in the memory  40  or the like with its characteristics such as the value of impedance Za corresponding to the passage of the output time Ta and the impedance variation ΔZa or the like classified into a plurality of patterns. 
         [0189]    Furthermore, the CPU  38   a  records, for example, an average blood vessel withstand pressure value and reliability thereof in the case of the blood vessel  17  subjected to sealing treatment while being included in each pattern in the memory  40  or the like. 
         [0190]    The CPU  38   a  then judges to which pattern of characteristics the data of the blood vessel  17  subjected to sealing treatment corresponds and calculates an estimate value of the blood vessel withstand pressure value in that case. Furthermore, reliability or the like corresponding to the estimate value is also displayed. 
         [0191]    By so doing, for the blood vessel  17  treated, the operator can confirm a blood vessel withstand pressure value immediately after the treatment through estimation which can be an objective measure (or guideline) when the blood vessel  17  is sealed. 
         [0192]    Furthermore, the blood vessel withstand pressure value through this estimation is assumed to improve reliability as data accumulation advances. 
         [0193]    Not only the estimate value of the blood vessel withstand pressure value, but also a judgment result as to whether or not a preset target value (e.g., 360 mmHg) of, for example, the blood vessel withstand pressure value is exceeded and a standard blood vessel withstand pressure value obtained by standard sealing or the like may be displayed or notified together with a value indicating the reliability of the judgment result. In this case, the operator can also confirm an objective judgment result corresponding to the treatment result. 
         [0194]    A case has been described in the aforementioned embodiments where the ratio of the ON time to OFF time in the case of, for example, intermittent output is set to 2:1. In this case, the ON time and OFF time may be changed while keeping this ratio according to the type or the like of the high frequency probe  4 . 
         [0195]    An embodiment configured by partially combining the aforementioned embodiments or the like also belongs to the present invention.