Visual electrode ablation systems

• US 10,624,695 B2
• Filed: 03/26/2014
• Issued: 04/21/2020
• Est. Priority Date: 05/11/2007
• Status: Active Grant

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Inventors: Willis, N. Parker, Malchano, Zachary J., Rothe, Chris A., Saadat, Vahid, Peh, Ruey-Feng, Miller, David, Tam, Edmund A.
• Primary Examiner(s): Fowler, Daniel W
• Application Number:
  US14/226,151
• Publication Number:
  US 20140316406A1
• Time in Patent Office: 2,218 Days
• CPC Class Codes: A61B 1/00089 Hoods
• CPC Class Codes: A61B 1/012 characterised by internal passages or accessories therefor
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00809 measured thermochromatically
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2218/002 Irrigation

Abstract

A method of ablating a tissue region within a blood-filled environment comprises restraining a fluid within a visualization field in a portion of the blood-filled environment and visualizing the tissue region through the fluid within the visualization field. The method also includes transmitting ablating electrical energy from the fluid into the visualized tissue region.

Claims

1. A method of ablating a tissue region within a blood-filled environment, comprising:

restraining, with a hood, a fluid within a visualization field in a portion of the blood-filled environment, the hood having a plurality of support members extending from a base of the hood to bias the hood to a conical shape;

injecting the fluid into the hood while extracting the fluid from the hood such that a rate at which the fluid is being injected is different than a rate at which the fluid is extracted;

visualizing the tissue region through the fluid within the visualization field;

forming a seal between the tissue region and an aperture of a distal membrane at a distal end of the hood such that the tissue region is pulled through the aperture proximally past the distal membrane; and

while the aperture is sealed to the tissue region, with an electrode assembly positioned upon the support members, transmitting ablating electrical energy through the aperture, the aperture having a diameter that is less than an outer diameter of the distal membrane, the electrical energy being transmitted from the fluid into the visualized tissue region.

2. The method of claim 1 wherein the tissue region comprises a target tissue surface region within a chamber of a heart, wherein the target tissue surface region is visualized during ablation and while the heart is beating, and further comprising:

expanding the hood from an insertion configuration to a deployed configuration within the chamber of the heart; and

positioning the aperture in alignment with the target tissue surface region so that fluid is exposed to the tissue region and so that the ablating mitigates an arrhythmia of the heart.

3. The method of claim 2 wherein positioning comprises intravascularly advancing the hood into a chamber of a heart.

4. The method of claim 1 further comprising monitoring a change in color of the tissue region whereby a blanched color is indicative of lesion formation.

5. The method of claim 1 further comprising monitoring the tissue region for formation of bubbles.

6. The method of claim 5 further comprising monitoring a quantity and/or rate of bubble formation.

7. The method of claim 6 further comprising automatically adjusting a power level of the electrical energy based upon the quantity and/or rate of bubble formation.

8. The method of claim 1 wherein visualizing comprises inspecting the tissue region for discontiguous lesion formations.

9. The method of claim 8 wherein transmitting comprises transmitting electrical energy through an aperture along one or more gaps between discontiguous lesions.

10. The method of claim 1 further comprising monitoring a thermochromic indicator positioned upon the hood for changes in temperature.

11. The method of claim 10 further comprising adjusting a power level of the electrical energy based upon the changes in temperature.

12. The method of claim 1 wherein restraining comprises creating a negative pressure within the visualization field such that the tissue region is adhered to the aperture.

13. The method of claim 12 further comprising recirculating the fluid within the visualization field.

14. The method of claim 1, wherein the rate at which the fluid is injected is greater than the rate at which the fluid is extracted.

15. The method of claim 1, wherein the rate at which the fluid is injected is less than the rate at which the fluid is extracted.

16. A method of ablating a target tissue region, the target tissue region being disposed along a tissue surface, the method comprising:

restraining a conductive fluid within a hood, the hood comprising a distal membrane, the distal membrane comprising an aperture having a diameter that is less than an outer diameter of the distal membrane, the hood having a plurality of support members extending from a base of the hood to bias the hood to a conical shape;

using negative pressure of a purging fluid, forming a seal between the tissue region and the aperture such that the tissue region is pulled through the aperture proximally past the distal membrane; and

while the aperture is sealed to the tissue region, with an electrode assembly positioned upon the support members, selectively directing ablating energy through the purging fluid into the target tissue region through the aperture and through the tissue surface while imaging the tissue surface along the target tissue region.