Method and apparatus for tissue treatment with laser and electromagnetic radiation

• US 20030130575A1
• Filed: 11/19/2002
• Published: 07/10/2003
• Est. Priority Date: 10/18/1991
• Status: Active Grant

• Current Assignee: Pro SURG Incorporated
• Original Assignee: Pro SURG Incorporated
• Inventors: Desai, Ashvin
• Granted Patent: US 7,549,424 B2
• Time in Patent Office: Days
• US Class Current: 600/417
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 17/3498 Valves therefor, e.g. flapper valves, slide valves haemostasis valves A61M39/06; check valves A61M39/24
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1477 Needle-like probes
• 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 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00274 Prostate operation, e.g. prostatectomy, turp, bhp treatment
• CPC Class Codes: A61B 2017/00464 for use with different instruments with hole for different instruments A61B2017/22072
• CPC Class Codes: A61B 2017/22072 with an instrument channel, e.g. for replacing one instrument by the other in cannulas A61B17/3417
• CPC Class Codes: A61B 2017/3411 with a plurality of holes, e.g. holes in matrix arrangement
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2018/00547 Prostate
• CPC Class Codes: A61B 2018/0091 : Handpieces of the surgical instrument or device
• CPC Class Codes: A61B 2018/00916 : with means for switching or controlling the main function of the instrument or device
• 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 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/3925 : ultrasonic
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 6/12 : Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 8/0841 : for locating instruments
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61K 31/03 : aromatic
• CPC Class Codes: A61K 31/335 : having oxygen as the only ring hetero atom, e.g. fungichromin
• CPC Class Codes: A61K 31/337 : having four-membered rings, e.g. taxol
• CPC Class Codes: A61K 31/355 : Tocopherols, e.g. vitamin E
• CPC Class Codes: A61K 9/0031 : Rectum, anus
• CPC Class Codes: A61K 9/0034 : Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
• CPC Class Codes: A61M 1/772 : operating alternately
• CPC Class Codes: A61N 5/0601 : Apparatus for use inside the body
• CPC Class Codes: A61N 5/062 : Photodynamic therapy, i.e. excitation of an agent

Abstract

A method and apparatus wherein an application of energy is limited to a specific diseased portion of body tissue (target tissue) for the purpose of localizing the treatment to the target tissue and avoiding an adverse effect on surrounding tissue. In one embodiment, access to the target tissue is provided by inserting an energy transmission device through a needle for delivery of the energy into the target tissue. Guidance of the needle is alternatively enhanced through use of an image guidance device. Alternatively, in addition the localized treatment is further controlled by use of an energy-concentrating/enhancement agent and/or photosensitizing/photoselective agent, chromophore dye and viscous substance to cause selective interaction with a specific wavelength of an energy source. The treatment can be further controlled and localized by improving the accuracy and positioning of the delivery device into the target tissue using imaging guidance.

Claims

1. A method of treating a localized portion of body tissue comprising:

(a) inserting a delivery apparatus into a body to a target tissue, said delivery apparatus including at least one hollow core needle functioning to convey a transmission device for delivery of energy to said target tissue, and wherein said inserting includes guiding said delivery apparatus with a guidance apparatus; and

(b) transmitting said energy through said transmission device to said target tissue.

2. A method as recited in claim 1 wherein said hollow core needle is configured to serve as said transmission device.

3. A method as recited in claim 1 wherein said transmission device is a separate apparatus inserted into said hollow core needle.

4. A method as recited in claim 3 wherein said guiding is accomplished with a non-invasive guidance device including imaging guidance.

5. A method as recited in claim 3 wherein said guiding is accomplished with an invasive guidance device including imaging guidance.

6. A method as recited in claim 3 wherein said guiding is accomplished using an imaging device selected from the group consisting of ultrasound, CT, MRI, X-ray, Gamma ray and infrared devices.

7. A method as recited in claim 3 wherein said transmission device is for delivery of electromagnetic energy.

8. A method as recited in claim 3 wherein said energy is of a form selected from the group consisting of laser energy, radiowaves, RF (radio frequency), microwaves, ultrasound, cryoenergy, X-ray, infrared, UV, and gamma rays.

13. A method as recited in claim 7 wherein said electromagnetic energy is laser energy.

14. A method as recited in claim 1 wherein said guidance apparatus is selected from the group consisting of a biopsy needle guide, an ultrasound probe, an endoscope, a delivery catheter, laparoscope, cystoscope, resectoscope, hysteroscope, gastroscope, bronchoscope, uretroscope, falloscope, endoscopic probe, endoscopic instrument, ultrasound probe with needle guide, and CT, MRI, X-ray and gamma ray imaging apparatus.

17. A method as recited in claim 7 wherein said transmission device includes a fiber optic core with a tip profile configured according to at least one method selected from the group consisting of bare tip, sculptured tip, diffusing tip, machined tip, glass sleeve, polymer sleeve, gel tip, coated tip, cut tip, polished tip and other tip modifications as outlined in FIGS. 19A through 19F.

18. A method as recited in claim 1 wherein said method is for treatment of a disease condition selected from the group consisting of kidney tumor, lung tumor, liver tumor, cancers, uterine cavity disorders, fallopian tube disorders, reproductive and gastric organ, disorders, fibroids, breast tumors, cysts and fibroidenomas, breast cancer, hemorrhoids, gastric tumors, and growths, prostate cancer, enlarged prostate, BPH (benign prostate hyperplasia) bladder cancer, urethral obstructions and disorders of the urinary tract.

21. A method as recited in claim 1 further comprising

observing a tissue effect of said target tissue with an imaging method wherein said imaging method is selected from the group consisting of ultrasound imaging, infrared detection, light application and CCD (charge coupled device) imaging detection of reflected light, and light modification/application and video monitoring of reflected light.

22. A method as recited in claim 1 further comprising observing an area of target tissue for guiding energy delivery by

a) injecting a photosensitizing agent/chromophore dye having a florescence characteristic;

b) applying a selective light wavelength for activating said florescence; and

c) observing said florescence with a device selected from the group consisting of an infrared (IR) camera and imaging device.

29. A method for treating a prostate and lower urinary tract of a human body comprising:

(a) inserting an energy delivery apparatus including a hollow core needle into a prostatic target tissue via an approach selected from the group consisting of transurethral, transperineal, transrectal and transvesical;

(b) injecting at least one substance into said target tissue through said delivery apparatus, wherein said substance is selected from the group consisting of an energy concentrating/enhancement viscous substance, chromophore/fluorophore dye selected from the group consisting of chromophore dyes, fluorochromes dyes, fluorophores dyes and laser dyes including Indocyanine green, India ink, Indigo Carmen, Fluoroscein, Rhodamine, Cascade blue, Nile blue, Texas red, Oregon green, Coumarines, Bodipy dyes, Xanthene dyes, Cyanine dyes, Phycobiliprotins and other photosensitizing agents in liquid, solid, semi-solid, suspension, viscous and conjugate form;

(c) inserting a transmission device through said needle;

(d) guiding the energy delivery apparatus using an imaging device selected from the group consisting of transrectal ultrasound imaging device, endoscope, cystoscope, and resectoscope, said guiding including observing the prostatic target tissue by injecting a photosensitizing agent/chromophore/fluorophore dye having a fluorescence characteristic and applying a selective light wavelength for activating said fluorescence, and observing said fluorescence with a device selected from the group consisting of an Infrared (IR) camera and an imaging device; and

(e) applying energy to said target tissue through said delivery apparatus, wherein said energy includes laser energy of a specific wavelength to cause maximum absorption by photosensitizing dyes and energy enhancement agent for optimum tissue necrosis. 30. A method as recited in claim 5 wherein said guiding is accomplished using a device selected from the group consisting of an endoscope, laparoscope, cystoscope, hysteroscope, resectoscope, gastroscope, grid, neddleguide, positioning guide, endoscopic instrument and finger guide apparatus.

9. A method of treating a body part comprising:

(a) inserting a hollow core needle into a target tissue in a body;

(b) injecting a substance selected from the group consisting of energy concentrating/enhancement substances and chromophore/fluorophore dye into said target tissue through said needle,

(c) inserting a transmission device through said needle; and

(d) transmitting energy to said target tissue through said transmission device.

20. A method as recited in claim 9 wherein said target tissue includes diseased tissue of an organ selected from the group consisting of kidney, lung, liver, uterus, fallopian tube, breast, GI tract, rectum, stomach, intestines, prostate, bladder, urethra, urinary tract and other body organs.

23. A method as recited in claim 9 further comprising

observing a tissue effect said target tissue with an imaging method wherein said imaging method is selected from the group consisting of ultrasound imaging, infrared detection, light application and CCD (charge coupled device) imaging detection of reflected light, and light modification/application and video monitoring of reflected light.

24. A method as recited in claim 9 further comprising observing an area of target tissue for guiding energy delivery by

a) injecting a photosensitizing agent/chromophore/fluorophore dye having a florescence characteristic;

b) applying a selective light wavelength for activating said florescence; and

c) observing said florescence with a device selected from the group consisting of an infrared (IR) camera and imaging device.

25. A method as recited in claim 9 wherein said energy concentrating substance is an energy activating agent in a form selected from the group consisting of liquid, solid, semi-solid, suspension, conjugate, and viscous form.

26. A method as recited in claim 9 wherein said energy concentrating substance is a photosensitizing agent in a form selected from the group consisting of liquid, solid, semi-solid, suspension, conjugate, and viscous form.

27. A method as recited in claim 9 wherein said energy concentrating substance is an energy enhancement agent in a form selected from the group consisting of liquid, solid, semi-solid, suspension, conjugate, and viscous form.

28. A method as recited in claim 9 wherein said energy concentrating/enhancement substance is selected from the group consisting of chromophore dyes, fluorochromes dyes, fluorophores dyes and laser dyes including Indocyanine green, India ink, Indigo Carmen, Fluoroscein, Rhodamine, Cascade blue, Nile blue, Texas red, Oregon green, Coumarines, Bodipy dyes, Xanthene dyes, Cyanine dyes, Phycobiliprotins and other photosensitizing agents in liquid, solid, semi-solid, suspension, viscous and conjugate form.

10. An apparatus for delivering energy locally to a body tissue comprising:

(a) a delivery apparatus including a transmission device, said delivery apparatus for conveying of said transmission device to a target tissue in a body, wherein said delivery apparatus includes at least one hollow core needle functioning to convey said transmission device; and

(b) a guidance apparatus for guiding placement of said delivery apparatus.

11. An apparatus as recited in claim 10 wherein said hollow core needle is configured to serve as said transmission device.

12. An apparatus as recited in claim 10 wherein said transmission device is a separate apparatus inserted into said hollow core needle.

15. An apparatus as recited in claim 10 wherein said guidance apparatus is selected from the group consisting of endoscope, endoscopic probe, endoscopic instrument, laparoscope, cystoscope, hysteroscope, resectoscope, falloscope, biopsy needle guide, ultrasound probe, delivery catheter, bronchoscope, gastroscope, uretroscope, ultrasound probe with needle guide, and CT, MRI, X-ray and gamma ray imaging apparatus.

16. An apparatus as recited in claim 10 wherein said transmission device is for transmission of an energy form selected from the group consisting of radiowaves, RF, microwave, X-ray, UV, ultrasound, gamma rays, laser energy, cryoenergy, and infrared.

19. An apparatus as recited in claim 10 wherein said target tissue includes diseased tissue of an organ selected from the group consisting of kidney, lung, liver, uterus, fallopian tube, breast, rectum, stomach, intestines, prostate, bladder, urethra, urinary tract and other body organs.