Robotic surgical system and method for automated creation of ablation lesions

• US 10,258,285 B2
• Filed: 12/29/2006
• Issued: 04/16/2019
• Est. Priority Date: 05/28/2004
• Status: Active Grant

• Current Assignee: St. Jude Medical, Atrial Fibrillation Division, Inc. (Abbott Laboratories)
• Original Assignee: St. Jude Medical, Atrial Fibrillation Division, Inc. (Abbott Laboratories)
• Inventors: Hauck, John A., Schweitzer, Jeffrey A., Belhe, Kedar Ravindra, Burrell, Jeffrey L.
• Primary Examiner(s): Nganga, Boniface
• Application Number:
  US11/647,296
• Publication Number:
  US 20070185485A1
• Time in Patent Office: 4,491 Days
• Field of Search: 700245, 606 1, 128898
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/301 for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61B 34/71 Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 5/6885 Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61M 25/0105 Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B

Abstract

A system for ablating tissue includes an ablation catheter for insertion into the body of a patient and a robotic controller for moving the catheter within the body. The robotic controller advances the catheter until the catheter contacts the tissue surface, maintains contact between the catheter and the tissue surface, and moves the catheter along a predetermined path to create a substantially continuous lesion of ablated tissue. A display device may be used to present a graphical representation of an area of tissue to be ablated. A user interface permits selection of a plurality of treatment points on the graphical representation. The interface is preferably coupled to the controller and catheter such that the controller may cause the catheter to automatically ablate tissue at and between the plurality of treatment points in response to the received user input.

Claims

1. A method of ablating tissue, comprising the steps of:

analyzing areas of ablated tissue to identify at least a first ablated area and a second ablated area separated by a gap of unablated tissue;

robotically moving a catheter to a treatment area near a tissue surface, said catheter having an ablation electrode located near a distal end of the catheter;

monitoring proximity or degree of contact between the catheter and the tissue surface;

robotically advancing the catheter to contact a point in the first ablated area;

automatically robotically moving the catheter to a point in the second ablated area in a way that maintains contact between the catheter and the tissue surface, thereby defining a path along the gap between the first ablated area and the second ablated area;

activating the ablation electrode to ablate the tissue after the catheter reaches the point in the second ablated area; and

automatically robotically withdrawing the catheter along the path along the gap between the first ablated area and the second ablated area from the point in the second ablated area to the point in the first ablated area while the ablation electrode is active,

thereby ablating the tissue along the path along the gap between the first ablated area and the second ablated area.

2. The method of claim 1, wherein the step of monitoring comprises monitoring a contact sensor that is located near a distal end of the catheter.

3. The method of claim 1, wherein the step of monitoring comprises monitoring a force sensor that is located at a distal end of the catheter for a degree of force that is indicative of contact between the catheter and the tissue surface.

4. The method of claim 3, further comprising utilizing information from the force sensor to orient the catheter in a preset orientation relative to the tissue surface.

5. The method of claim 4, further comprising utilizing information from the force sensor to orient the catheter substantially orthogonally to the tissue surface.

6. A method of ablating tissue, comprising the steps of:

analyzing areas of ablated tissue to identify at least a first ablated area and a second ablated area separated by a gap of unablated tissue;

robotically moving a catheter to a treatment area near a tissue surface within the first ablated area, said catheter having an ablation electrode and a contact sensor located near a distal end of the catheter;

while monitoring the contact sensor for contact between the catheter and the tissue surface, advancing the catheter until the catheter contacts the tissue surface at a point in the first ablated area;

automatically robotically moving the catheter from the point in the first ablated area, through the gap of unablated tissue, and to a point in the second ablated area while maintaining contact between the catheter and the tissue surface, thereby defining a path between the point in the first ablated area and the point in the second ablated area;

activating the ablation electrode to ablate the tissue after reaching the point in the second ablated area;

robotically moving the catheter from the point in the second ablated area, along the path between the point in the first ablated area and the point in the second ablated area, to the point in the first ablated area with the ablation electrode active,

thereby ablating the tissue along the path between the point in the first ablated area and the point in the second ablated area.

7. The method of claim 6, wherein the contact sensor is a force sensor, and wherein the step of monitoring comprises monitoring the force sensor for a degree of force that is indicative of contact between the catheter and the tissue surface.

8. The method of claim 6, further comprising:

generating a three-dimensional model of at least a portion of the tissue surface;

presenting a graphical representation of the three-dimensional model; and

receiving input from a user that identifies at least two target locations that define the point in the first ablated area and the point in the second ablated area.

9. A method of ablating tissue, comprising the steps of:

analyzing, using an electrophysiology processor, areas of ablated tissue to identify at least a first ablated area and a second ablated area separated by a gap, the gap being characterized by tissue that has not been ablated;

robotically moving a catheter to a point on a surface of the first ablated area, such that the catheter is in contact with the first ablated area;

robotically moving the catheter to a point in the second ablated area along a path between the first ablated area and the second ablated area;

activating an ablation electrode on the catheter to ablate the tissue after reaching the point in the second ablated area; and

robotically moving the catheter from the point in the second ablated area, along the path between the first ablated area and the second ablated area, to the point on the surface of the first ablated area with the ablation electrode active.

10. The method of claim 9, further comprising:

monitoring a degree of contact between the catheter and tissue being ablated;

wherein the ablation is carried out while maintaining contact between the catheter and the tissue being ablated.

11. The method of claim 9, further comprising:

generating a three-dimensional model of a tissue surface to be ablated;

presenting a graphical representation of the three-dimensional model of the tissue surface; and

receiving input from a user that identifies at least two target locations that define the path between the first ablated area and the second ablated area that includes at least a portion of the gap, whereby the tissue along the path will be ablated,

wherein the ablation is carried out along the path input by the user.

12. A method of ablating tissue, comprising the steps of:

receiving, from a probe and at an electrophysiology processor, measured electrophysiology information for a plurality of measurement points on a surface of a heart, the probe including a measurement device for measuring electrophysiology information;

analyzing, using the electrophysiology processor, the measured electrophysiology information to identify areas with previously ablated tissue;

generating a three-dimensional surface model of a portion of the heart;

presenting a graphical representation of the three-dimensional surface model of the heart;

superimposing on the graphical representation information to identify the areas with previously ablated tissue;

receiving input from a user that identifies at least two target locations that define a predetermined path on the graphical representation of the three-dimensional model of the heart, whereby tissue along the path will be ablated, said predetermined path including tissue that has not been previously ablated;

robotically moving an ablation electrode to one of the at least two target locations along the predetermined path;

robotically moving the ablation electrode along the predetermined path defined by the at least two target locations; and

robotically moving the ablation electrode along the predetermined path defined by the at least two target locations in reverse with the ablation electrode activated to ablate tissue along the predetermined path.

13. The method of claim 12, further comprising:

monitoring a degree of contact between the catheter and tissue being ablated; and

wherein the ablation is carried out while maintaining contact between the catheter and the tissue being ablated.

14. The method of claim 12, wherein the probe is a catheter, and wherein the ablation electrode is located on the catheter, said method further comprising:

monitoring electrophysiology information of the tissue being ablated during the ablation process;

adjusting the position and/or speed of the catheter during the ablation process based on changes in the electrophysiology information being monitored.

15. The method of claim 14, wherein the electrophysiology information being monitored is filtered using an RF filter to remove biasing effects caused by RF energy during the ablation process.

16. The method of claim 14, wherein the monitoring of electrophysiology information comprises monitoring electrophysiology information for changes in amplitude of the electrophysiology information.

17. The method of claim 14, wherein the monitoring of electrophysiology information comprises monitoring electrophysiology information for changes in fractionation of the electrophysiology information.

18. The method of claim 14, wherein the monitoring of electrophysiology information comprises monitoring electrophysiology information for changes in a parameter that is indicative of a degree of tissue ablation.

19. A robotic system for tissue ablation, comprising:

an electrophysiology processor configured to analyze measured electrophysiology information from a cardiac surface and to identify, from the measured electrophysiology information, a first ablated area on the cardiac surface and a second ablated area on the cardiac surface, wherein the first ablated area and the second ablated area are separated by an unablated gap; and

a robotic controller for moving a catheter within a patient'"'"'s body, wherein the robotic controller automatically;

advances the catheter to an initial waypoint within the first ablated area;

maintains contact between the catheter and the cardiac surface while moving the catheter to a final waypoint within the second ablated area along a lesion pathway that crosses the unablated gap; and

withdraws the catheter from the final waypoint, along the lesion pathway;

to the initial waypoint.

20. The robotic system of claim 19, further comprising a contact sensor to detect when a distal end of the catheter is in contact with the cardiac surface.

21. The robotic system of claim 20, wherein the contact sensor is a force sensor that determines when contact has been made between the catheter and the cardiac surface using information relating to a force exerted on said catheter by the cardiac surface.

22. The robotic system of claim 20, wherein the robotic controller utilizes feedback from the contact sensor to orient the catheter in a preset orientation relative to the cardiac surface.

23. The robotic system of claim 22, wherein the controller utilizes feedback from the contact sensor to orient the catheter substantially orthogonally to the cardiac surface.

24. The robotic system of claim 20, wherein the contact sensor is a sensor that determines when contact has been made between the catheter and the cardiac surface using a rate of change in a parameter measured at a location on the catheter.

25. The robotic system of claim 24, wherein the parameter is an electrophysiological characteristic.

26. The robotic system of claim 20, wherein the contact sensor comprises an RF filter to filter out any biasing effects caused by RF energy when the system is ablating tissue.

27. The robotic system of claim 19, further comprising:

a display device for presenting a graphical representation of the cardiac surface; and

an interface to permit a user to define the initial waypoint and the final waypoint on the graphical representation of the cardiac surface.

28. The robotic system of claim 27, wherein the interface further permits the user to define a plurality of waypoints including the initial waypoint and the final waypoint on the graphical representation of the cardiac surface, wherein the plurality of waypoints defines the lesion pathway.

29. The robotic system of claim 19, wherein the electrophysiology processor is configured to determine the initial waypoint, the final waypoint, and the lesion pathway.