Bipolar electrosurgical clamp for removing and modifying tissue

• US 20030097126A1
• Filed: 04/20/2001
• Published: 05/22/2003
• Est. Priority Date: 05/10/1993
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Woloszko, Jean, Ormsby, Theodore C., Tsuji, Craig
• Granted Patent: US 6,974,453 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• 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 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• CPC Class Codes: A61B 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• 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 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/00119 with metal oxide nitride
• CPC Class Codes: A61B 2018/00148 with metal
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00178 Electrical connectors
• CPC Class Codes: A61B 2018/00327 Ear, nose or throat
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00404 : Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/0047 : Upper parts of the skin, e.g. skin peeling or treatment of wrinkles
• CPC Class Codes: A61B 2018/00476 : Hair follicles
• CPC Class Codes: A61B 2018/00505 : Urinary tract
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00583 : Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00601 : Cutting
• CPC Class Codes: A61B 2018/00625 : Vaporization
• CPC Class Codes: A61B 2018/0066 : without feedback, i.e. open loop control
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00815 : measured by a thermistor
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1273 : including multiple generators in one device
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1412 : Blade
• CPC Class Codes: A61B 2018/1422 : Hook
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/162 : located on the probe body
• CPC Class Codes: A61B 2018/165 : Multiple indifferent electrodes
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/003 : using a spray or a foam
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems, apparatus and methods for selectively applying electrical energy to body tissue in order to ablate, contract, coagulate, or otherwise modify a target tissue or organ of a patients. An electrosurgical apparatus of the invention includes a shaft having a shaft distal end bearing an active electrode and a return electrode. At least one of the active electrode and the return electrode is moveable such that the shaft distal end can adopt a closed configuration or an open configuration. The apparatus can operate in an ablation mode or a sub-ablation mode. The closed configuration is adapted for clamping and coagulating a target tissue while the apparatus is operating in the sub-ablation mode, while the open configuration is adapted for ablating the target tissue via molecular dissociation of tissue components. A method of the present invention comprises clamping a target tissue or organ with an electrosurgical probe. A first high frequency voltage is applied between the active electrode and the return electrode to effect coagulation of the clamped tissue. Thereafter, a second high frequency voltage is applied to effect localized molecular dissociation of the coagulated tissue. The present invention allows the ablation or modification of the target tissue with minimal or no damage to surrounding, non-target tissue.

Claims

1. An electrosurgical probe, comprising:

a shaft having a shaft distal end portion and a shaft proximal end portion;

an electrode support disposed on the shaft distal end portion;

an active electrode disposed on the electrode support; and

a return electrode disposed on the shaft distal end portion, wherein the shaft distal end portion is adapted for being shifted between a first configuration or a second configuration, wherein the first configuration is adapted for clamping and coagulating a tissue, and the second configuration is adapted for releasing and severing the tissue.

2. The probe of claim 1, wherein at least one of the active electrode and the return electrode is moveable.

3. The probe of claim 1, wherein the active electrode is fixed and the return electrode is pivotable.

4. The probe of claim 3, wherein the return electrode is pivotable about the return electrode proximal end.

5. The probe of claim 1, wherein the return electrode and the active electrode are in opposition.

6. The probe of claim 1, wherein the first configuration is a closed configuration wherein the return electrode and the active electrode are juxtaposed, and the second configuration is an open configuration wherein the return electrode and the active electrode are parted from each other.

7. The probe of claim 6, wherein in the closed configuration a gap exists between the active electrode and the return electrode.

8. The probe of claim 7, wherein in the closed configuration the gap between the active electrode and the return electrode in the range of from about 0.2 mm to about 10 mm.

9. The probe of claim 6, wherein in the closed configuration the return electrode is arranged substantially parallel to the active electrode.

10. The probe of claim 6, wherein in the closed configuration the return electrode is disposed superjacent to the active electrode.

11. The probe of claim 6, wherein in the closed configuration a first portion of the active electrode is concealed by the return electrode.

12. The probe of claim 11, wherein in the open configuration the first portion of the active electrode is at least partially exposed.

13. The probe of claim 1, wherein in the open configuration the return electrode is arranged at an angle in the range of from about 30°

to 120°

to the active electrode.

14. The probe of claim 1, wherein the return electrode comprises a cowl.

15. The probe of claim 14, wherein the cowl is curved in a lateral direction.

16. The probe of claim 14, wherein the cowl distal end is quasi dome-shaped.

17. The probe of claim 14, wherein the cowl includes a notch in the cowl distal end, the notch adapted for accommodating a portion of the active electrode when the shaft distal end portion is in the closed configuration.

18. The probe of claim 1, wherein the return electrode comprises a removeable cowl.

19. The probe of claim 1, wherein the return electrode has an undulating perimeter.

20. The probe of claim 1, wherein the active electrode is disposed on the distal terminus of the electrode support.

21. The probe of claim 1, wherein the active electrode protrudes distally and laterally from the electrode support.

22. The probe of claim 1, wherein the active electrode protrudes from the electrode support by a distance in the range of from about 0.2 mm to about 10 mm.

23. The probe of claim 1, wherein the active electrode consists essentially of a single blade having at least one active edge and first and second blade sides.

24. The probe of claim 1, wherein at least a portion of the active electrode is serrated.

25. The probe of claim 1, wherein the active electrode is adapted for severing a target tissue via localized molecular dissociation of target tissue components.

26. The probe of claim 1, wherein the active electrode comprises a material selected from the group consisting of platinum, tungsten, palladium, iridium, and titanium.

27. The probe of claim 1, wherein the shaft comprises an insulating material, and the electrode support comprises a ceramic or a silicone rubber.

28. The probe of claim 6, further comprising an actuator unit for shifting the probe between the open configuration and the closed configuration.

29. The probe of claim 28, wherein the actuator unit comprises a clamp unit for urging the shaft distal end portion towards the closed configuration.

30. The probe of claim 29, wherein the clamp unit is adapted for exerting a force on at least one of the return electrode and the active electrode.

31. The probe of claim 28, wherein the actuator unit comprises a release unit for urging the shaft distal end portion towards the open configuration.

32. The probe of claim 28, further comprising a handle affixed to the shaft proximal end portion, wherein the actuator unit is disposed on the handle.

33. The probe of claim 32, wherein the handle accommodates a connection block, the connection block adapted for coupling the active electrode and the return electrode to a high frequency power supply.

34. The probe of claim 1, further comprising a mode switch for switching the probe between a sub-ablation mode and an ablation mode.

35. The probe of claim 34, wherein the mode switch is responsive to a configuration of the shaft distal end portion.

36. The probe of claim 35, wherein the mode switch switches the system to the sub-ablation mode when the shaft distal end portion is in the closed configuration.

37. The probe of claim 35, wherein the mode switch switches the system to the ablation mode when the shaft distal end portion is in the open configuration.

38. The probe of claim 34, wherein the mode switch is responsive to actuation of an actuator unit, the actuator unit adapted for shifting the probe between an open configuration and a closed configuration.

39. The probe of claim 38, wherein the mode switch switches the probe to the sub-ablation mode when the probe is shifted to the closed configuration.

40. The probe of claim 38, wherein the mode switch switches the system to the ablation mode when the probe is shifted to the open configuration.

41. An electrosurgical system, comprising:

a shaft having a shaft distal end portion and a shaft proximal end portion, the shaft distal end portion capable of adopting an open configuration or a closed configuration;

an electrode support disposed on the shaft distal end portion;

an active electrode disposed on the electrode support;

a return electrode disposed on the shaft distal end portion;

a power supply having first and second opposite poles, the active and the return electrode coupled to the first and second opposite poles, the power supply adapted for applying a high frequency voltage between the active electrode and the return electrode; and

an actuator unit in communication with at least one of the active electrode and the return electrode, the actuator unit adapted for shifting the shaft distal end portion between the open configuration and the closed configuration.

42. The system of claim 41, wherein the return electrode is moveable with respect to the active electrode, and actuation of the actuator unit moves the return electrode such that the shaft distal end portion adopts the open configuration or the closed configuration.

43. The system of claim 41, further comprising a mode switch for switching the system between a sub-ablation mode and an ablation mode.

44. The system of claim 43, wherein the mode switch is responsive to a shift in configuration of the shaft distal end portion.

45. The system of claim 43, wherein the mode switch is responsive to actuation of the actuator unit.

46. The system of claim 45, wherein the actuator unit comprises a release unit, and the mode switch switches the system to the ablation mode when the release unit is actuated.

47. The system of claim 41, wherein the closed configuration is adapted for clamping and coagulating a target tissue, and the open configuration is adapted for releasing and ablating the target tissue.

48. The system of claim 41, wherein in the sub-ablation mode the active electrode is adapted for coagulating a target tissue.

49. The system of claim 43, wherein in the ablation mode the active electrode is adapted for ablating a target tissue via localized molecular dissociation of target tissue components.

50. An electrosurgical probe, comprising:

a shaft having a shaft distal end portion and a shaft proximal end portion;

an electrode support affixed to the shaft distal end portion;

an active electrode arranged on the electrode support; and

a moveable return electrode opposing the active electrode, the return electrode adapted for movement between a closed configuration and an open configuration, wherein in the closed configuration the return electrode is juxtaposed with the active electrode, and in the open configuration the return electrode is withdrawn from the active electrode.

51. The probe of claim 50, wherein the return electrode comprises a removeable cowl.

52. The probe of claim 50, further comprising an actuator unit for moving the return electrode between the closed configuration and the open configuration.

53. The probe of claim 52, further comprising a mode switch in communication with the actuator unit, the mode switch for switching the probe between a sub-ablation mode and an ablation mode.

54. The probe of claim 53, wherein the mode switch is responsive to a configuration of the return electrode or to actuation of the actuator unit.

55. The probe of claim 50, wherein in the closed configuration the active electrode is arranged substantially parallel to the return electrode, and a first portion of the active electrode is at least partially concealed by the return electrode

56. The probe of claim 55, wherein in the open configuration the active electrode is exposed.

57. An electrosurgical probe, comprising:

a shaft having a shaft distal end portion and a shaft proximal end portion;

a return electrode affixed to shaft distal end portion;

an electrode support affixed to the shaft distal end portion; and

a moveable active electrode mounted on the electrode support, the active electrode capable of movement between a closed configuration and an open configuration, wherein in the closed configuration the active electrode is juxtaposed with the return electrode, and in the open configuration the active electrode is withdrawn from the return electrode.

58. The probe of claim 57, wherein the active electrode comprises a substantially flat elongate blade which protrudes axially and laterally from the shaft, and the return electrode comprises a cowl.

59. A method of modifying a target tissue of a patient, comprising:

a) providing an electrosurgical probe having a shaft distal end, the shaft distal end bearing an electrode support and a return electrode, the electrode support having an active electrode affixed thereto, at least one of the active electrode and the return electrode moveable responsive to actuation of an actuator unit such that the shaft distal end can adopt an open configuration or a closed configuration, the open configuration for accommodating at least a portion of the target tissue between the active electrode and the return electrode, and the closed configuration for clamping the target tissue between the active electrode and the return electrode;

b) positioning the shaft distal end in at least close proximity to the target tissue; and

c) applying a first high frequency voltage between the active electrode and the return electrode, wherein at least a portion of the target tissue is ablated or modified.

60. The method of claim 59, wherein the ablated or modified tissue is dissected, transected, incised, contracted, or coagulated.

61. The method of claim 59, wherein the first high frequency voltage is in the range of from about 10 volts RMS to about 150 volts RMS.

62. The method of claim 59, further comprising:

d) after said step b) and before said step c), clamping the target tissue between the active electrode and the return electrode.

63. The method of claim 59, wherein the first high frequency voltage is sufficient to coagulate the target tissue and insufficient to ablate the target tissue, and the method further comprises:

e) after said step c), applying a second high frequency voltage between the active electrode and the return electrode, wherein at least a portion of the target tissue is ablated.

64. The method of claim 63, wherein the second high frequency voltage is in the range of from about 200 volts RMS to about 1000 volts RMS.

65. The method of claim 63, wherein neither said step c) nor said step e) results in significant damage to non-target tissue.

66. The method of claim 59, wherein the return electrode comprises a removeable cowl.

67. The method of claim 64, wherein during said step e) the target tissue is ablated via electrosurgical molecular dissociation of tissue components in the vicinity of the active electrode.

68. The method of claim 63, further comprising:

f) during said step e), manipulating the probe such that the active electrode moves with respect to the target tissue.

69. A method of modifying a target tissue of a patient, the method comprising:

a) providing an electrosurgical system including a probe and a power supply, the probe adapted for clamping the target tissue, and the probe including a shaft distal end bearing an electrode support and a return electrode, the electrode support having an active electrode affixed thereto, the active electrode adapted for coagulating the target tissue and for severing the target tissue via molecular dissociation of target tissue components;

b) clamping the target tissue at the shaft distal end;

c) coagulating the target tissue by application of a first high frequency voltage from the power supply to the active electrode; and

d) severing the target tissue by application of a second high frequency voltage from the power supply to the active electrode.

70. The method of claim 69, further comprising:

e) prior to said step d) unclamping the target tissue.

71. The method of claim 69, wherein at least one of the active electrode and the return electrode is adapted for moving such that the probe can adopt an open configuration or a closed configuration.

72. The method of claim 69, wherein the electrosurgical system further includes an actuator unit for shifting the probe between an open configuration and a closed configuration.

73. The method of claim 72, wherein the probe includes a handle and the actuator unit is arranged on the handle.

74. The method of claim 72, wherein said step b) comprises:

f) configuring the probe to the open configuration;

g) positioning the probe such that the target tissue is positioned between the active electrode and the return electrode; and

h) configuring the probe to the closed configuration, wherein the target tissue is clamped between the active electrode and the return electrode.

75. The method of claim 74, wherein at least one of said steps f) and h) comprises actuating the actuator unit.

76. The method of claim 72, wherein the return electrode is moveable via actuation of the actuator unit, and the return electrode is coupled to a mode switch for switching the power supply between a sub-ablation mode and an ablation mode.

77. The method of claim 72, wherein the actuator unit is directly coupled to a mode switch for switching the power supply between a sub-ablation mode and an ablation mode.

78. The method of claim 69, wherein the active electrode comprises a single blade electrode, the single blade electrode including at least one active edge and first and second blade sides.

79. A method of incising a target tissue with an electrosurgical system including a probe and a power supply, the target tissue having at least one blood vessel running therethrough, and the method comprising:

a) ablating the target tissue with the probe, the probe including an active electrode and a return electrode coupled to the power supply, and the system operating in an ablation mode;

b) upon encountering a blood vessel, clamping the blood vessel between the active electrode and the return electrode;

c) switching the system to a sub-ablation mode adapted for coagulating the blood vessel;

d) coagulating the clamped blood vessel; and

e) switching the system to the ablation mode, wherein the coagulated blood vessel is severed.

80. The method of claim 79, further comprising:

f) prior to said step e), configuring the probe to an open configuration wherein the coagulated blood vessel is unclamped.

81. The method of claim 79, wherein said step c) comprises applying a first high frequency voltage between the active electrode and the return electrode, the first high frequency voltage sufficient to coagulate the blood vessel.

82. The method of claim 79, wherein said step e) comprises applying a second high frequency voltage between the active electrode and the return electrode, the second high frequency voltage sufficient to ablate the coagulated blood vessel.

83. The method of claim 82, wherein the second high frequency voltage applied between the active electrode and the return electrode results in localized molecular dissociation of tissue components of the coagulated blood vessel.

84. The method of claim 79, wherein said step b) comprises:

g) configuring the probe to an open configuration;

h) positioning the probe distal end against the blood vessel; and

i) configuring the probe to a closed configuration, wherein the blood vessel is clamped between the active electrode and the return electrode.

85. The method of claim 79, further comprising:

j) after said step e), manipulating the probe with respect to the coagulated blood vessel.

86. A method of severing a blood vessel with an electrosurgical system including a probe and a power supply, the method comprising:

a) positioning the blood vessel between an active electrode and a return electrode;

b) clamping the blood vessel between the active electrode and the return electrode;

c) applying a first high frequency voltage between the active electrode and the return electrode, wherein the blood vessel is coagulated;

d) unclamping the coagulated blood vessel; and

e) applying a second high frequency voltage between the active electrode and the return electrode, wherein the coagulated blood vessel is severed.

87. The method of claim 86, wherein at least one of the active electrode and the return electrode is moveable.

88. The method of claim 86, wherein the return electrode comprises a removeable cowl.

89. The method of claim 86, wherein the electrosurgical system further includes an actuator unit for shifting the probe between an open configuration and a closed configuration, and a mode switch responsive to actuation of the actuator unit, the mode switch coupled to the power supply, and the mode switch adapted for switching the electrosurgical system between a sub-ablation mode and an ablation mode upon actuation of the actuator unit.

90. The method of claim 86, wherein the return electrode is moveable, the electrosurgical system further including a mode switch in communication with the return electrode, the mode switch coupled to the power supply, the mode switch adapted for switching the electrosurgical system between a sub-ablation mode and an ablation mode, and the mode switch responsive to a position of the return electrode.