Systems and methods for electrosurgical tendon vascularization

• US 20030055418A1
• Filed: 06/18/2002
• Published: 03/20/2003
• Est. Priority Date: 06/02/1998
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Woloszko, Jean, Eggers, Philip E., Thapliyal, Hira V., Baker, Michael A., Pacek, James L., Tasto, James P.
• Granted Patent: US 6,763,836 B2
• Time in Patent Office: Days
• US Class Current: 606/32
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• 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 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00583 Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00738 Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00755 Resistance or impedance
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/1273 including multiple generators in one device
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2090/3782 transmitter or receiver in catheter or minimal invasive instrument

Abstract

Systems, apparatus, and methods are provided for promoting blood flow to a target tissue. In one variation, the invention involves creating a pattern of voids in connective tissue, or through a tissue having sparse vascularity, such as a tendon or a meniscus, in order to increase blood flow within the tissue. This also includes using a template device to assist in the creation of the pattern of voids. Also included is an electrosurgical device with a self-contained fluid supply for providing conductive fluid to the target tissue or to active electrodes of the device.

Claims

1. A method of inducing a controlled inflammatory response in tissue, the method comprising:

selecting a target tissue from an area of soft tissue;

applying energy to the target the target tissue; and

forming at least one pattern of voids by repeating the applying act.

2. The method of claim 1 comprising:

selecting a target tissue from an area of soft tissue;

positioning an active electrode in at least close proximity to the target tissue;

removing a void in the tissue by applying a high frequency voltage to the active electrode, the high frequency voltage being sufficient volumetrically remove a portion of the target tissue; and

forming at least one pattern of voids by repeating the positioning and applying acts.

3. The method of claim 2, wherein selecting the target tissue comprises selecting target tissue from a group consisting of a tendon, a ligament, and a meniscus.

4. The method of claim 2, wherein the pattern comprises a pattern selected from a group consisting of a grid, a circle, at least two circles, at least two concentric circles, a helical pattern, a linear pattern, a non-linear pattern, a random pattern, and a combination thereof.

5. The method of claim 4, wherein a spacing between voids ranges between 0.5 mm and 10 mm.

6. The method of claim 4, wherein a spacing between voids is constant.

7. The method of claim 4, wherein a spacing between voids varies.

8. The method of claim 4, further comprising placing a template adjacent to the target tissue prior to the positioning step, wherein the template comprises a plurality of holes arranged in a layout similar to the pattern.

9. The method of claim 8, wherein the forming step comprises using the template as a guide for positioning the active electrode.

10. The method of claim 8 wherein the template further serves to separate tissue adjacent to the target tissue.

11. The method of claim 2, wherein the void has a lateral dimension in the range of from about 0.5 mm to about 2.0 mm.

12. The method of claim 2, wherein the void has a depth in the range of from about 0.5 mm to about 4.0 cm.

13. The method of claim 2, wherein the void comprises an opening in tissue selected from the group consisting of a channel, a hole, a furrow, a crater, a divot, and a combination thereof.

14. The method of claim 13, wherein the act of removing the void comprises applying the high frequency voltage between the active electrode and a return electrode.

15. The method of claim 13, wherein the return electrode is located on an external surface of a patient'"'"'s body.

16. The method of claim 13, wherein the return electrode and the active electrode are both located on an electrosurgical probe.

17. The method of claim 13, further comprising placing an electrically conductive fluid between the active electrode and the return electrode, the electrically conductive fluid providing a current flow path between the active electrode and the return electrode.

18. The method of claim 16, wherein the electrically conductive fluid comprises isotonic saline.

19. The method of claim 2, wherein the active electrode comprises a single electrode adjacent to a distal end of an electrosurgical probe.

20. The method of claim 19, wherein the active electrode comprises an electrode array comprising a plurality of electrically isolated active electrodes, and

wherein said applying step comprises applying the high frequency voltage to the electrode array.

21. The method of claim 2, further comprising providing an electrically conductive fluid between the active electrode and the target tissue.

22. The method of claim 2, further comprising introducing at least a distal end of an electrosurgical probe into a patient'"'"'s knee, shoulder, or elbow;

wherein said positioning step comprises positioning the distal end of the probe in at least close proximity to the tendon within the knee, the shoulder, or the elbow.

47. The device of claim 31, further comprising a return electrode coupled to the high frequency power supply, the high frequency power supply adapted for applying a voltage difference between the return electrode and the active electrode, the voltage difference being sufficient to promote vascularization of the tendon tissue.

23. A template device for use in applying therapy to tissue, the template comprising:

a proximal surface and a distal surface, the distal surface being placed adjacent to tissue;

a plurality of openings forming a pattern, the holes extending from the proximal surface to the distal surface;

wherein at least the proximal surface and distal surface are bio-compatible and electrically non-conductive; and

wherein the pattern comprises a pattern selected from a group consisting of a grid, a circle, at least two circles, at least two concentric circles, a helical pattern, a linear pattern, a non-linear pattern, a random pattern, and a combination thereof.

24. The template device of claim 23, wherein an entire surface of the template is coated with a bio-compatible and non-conductive coating.

25. The template device of claim 23, wherein a spacing between openings ranges between 0.5 mm and 10 mm.

26. The template device of claim 23, wherein a spacing between openings is constant.

27. The template device of claim 23, wherein a spacing between openings varies.

28. The template device of claim 23, wherein the openings comprise at least two channels.

29. The template device of claim 23, further comprising a plurality of incremental markings on at least the proximal surface, the markings denoting the spacing of openings.

30. The template device of claim 23, further comprising a tissue retractor portion adapted to separate tissue.

31. An electrosurgical device for applying energy to tissue, the device comprising:

an instrument shaft having proximal and distal end portions and an active electrode disposed on the distal end portion; and

a connector disposed on or within the shaft, the connector adapted for coupling the active electrode to a high frequency power supply, the high frequency power supply adapted for applying a high frequency voltage to the active electrode, the high frequency voltage being sufficient to effect the volumetric removal of tissue adjacent to the active electrode;

a fluid delivery lumen extending at least through a portion of said instrument shaft and having an opening adjacent to the active electrode; and

a self-contained fluid supply unit coupled to the fluid delivery element, the selfcontained fluid supply comprising a reservoir, a fluid driving member, and a connector lumen, wherein the fluid driving member is moveably located in the fluid reservoir and the connector lumen fluidly couples the reservoir to the fluid delivery lumen.

32. The electrosurgical device of claim 31, further comprising an electrically conductive fluid located in the reservoir, the fluid supply unit being configured such that it cannot be re-filled.

33. The electrosurgical device of claim 31, wherein at least a portion of the fluid supply unit is located externally to the instrument shaft.

34. The electrosurgical device of claim 31, wherein at least a portion of the fluid supply unit is located in the instrument shaft.

35. The electrosurgical device of claim 34, wherein the entire fluid supply unit is located in the instrument shaft, and wherein a portion of the fluid driving member extends out of the instrument shaft.

36. The electrosurgical device of claim 31, further comprising a gate in fluid communication with said fluid delivery lumen, the gate adapted to prevent leaking or discharge of fluid from the device.

37. The device of claim 31, further comprising a return electrode adapted for coupling to the high frequency power supply, the high frequency power supply adapted for applying a high frequency voltage difference between the return electrode and the active electrode.

38. The device of claim 37, wherein the return electrode is disposed on the instrument shaft at a location proximal to the active electrode.

39. The device of claim 37, wherein the return electrode is a dispersive pad in contact with an external body surface of a patient.

40. The device of claim 37, further comprising an electrically conductive fluid in the reservoir of the fluid supply unit, wherein fluid delivery element is adapted to provide fluid the active electrode and the return electrode to provide a current flow path therebetween.

41. The device of claim 31, wherein the maximum lateral dimension of the distal end portion of the instrument shaft is less than about 1.0 mm.

42. The device of claim 31, wherein the active electrode is substantially surrounded by an electrically insulating support.

43. The device of claim 31, wherein the instrument shaft is configured for arthroscopic delivery into ajoint cavity, the joint selected from the group consisting of a knee, a shoulder, and an elbow.

44. The device of claim 31, wherein the distal end portion of the instrument shaft is sized for advancing into a space vacated by the volumetrically removed tissue.

45. The device of claim 44, wherein the distal end portion of the instrument shaft space has a maximum lateral dimension of about 2.0 mm.

46. The device of claim 31, further comprising an electrode array disposed at or near the distal end of the instrument shaft, the electrode array including a plurality of electrically isolated active electrodes, wherein current flow from at least two of the plurality of electrically isolated active electrodes is independently controlled based on impedance between each of the at least two active electrodes and a return electrode.

48. A kit for applying energy to tissue comprising:

a template device for use in treating tissue, the template comprising a proximal surface and a distal surface, the distal surface being placed adjacent to tissue, a plurality of openings forming a pattern, the holes extending from the proximal surface to the distal surface, wherein the proximal surface and distal surface are bio-compatible and nonconductive, and

an electrosurgical device for applying energy to tissue, the device comprising an instrument shaft having proximal and distal end portions and an active electrode disposed on the distal end portion, and a connector disposed on or within the shaft, the connector adapted for coupling the active electrode to a high frequency power supply, the high frequency power supply adapted for applying a high frequency voltage to the active electrode, the high frequency voltage being sufficient to effect the volumetric removal of tissue adjacent to the active electrode.

49. The kit of claim 48 further comprising a self-contained fluid supply unit, the self-contained fluid supply comprising a reservoir containing an electrically conductive fluid, a fluid driving member moveably located in the fluid reservoir and a connector lumen for fluidly coupling to the electrosurgical device.