Systems and methods for electrosurgical treatment of turbinates

• US 20030208194A1
• Filed: 09/26/2001
• Published: 11/06/2003
• Est. Priority Date: 06/07/1995
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Hovda, David C., Ellsberry, Maria B., Thapliyal, Hira V.
• Granted Patent: US 7,442,191 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 18/1206 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 2018/0016 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 2018/00505 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 2018/00666 : using a threshold value
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/0072 : Current
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00779 : Power or energy
• CPC Class Codes: A61B 2018/00791 : Temperature
• 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 2018/1467 : 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 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems and methods for selectively applying electrical energy to a target location within the head and neck of a patient'"'"'s body, particularly including tissue in the ear, nose and throat. In one aspect, a method is provided for reducing the volume of enlarge swollen tissue in the patient'"'"'s nose, such as swollen nasal tissue, mucus membranes, turbinates, polyps, neoplasms, cartilage (e.g., the nasal septum) or the like. In particular, the turbinates are treated by positioning one or more electrode terminal(s) adjacent to the turbinates, and delivering electrically conductive fluid, such as isotonic saline, to the nasal cavity to substantially surround the electrode terminal(s) with the fluid. High frequency voltage is applied between the electrode terminal(s) and one or more return electrode(s) to remove a small tissue segment, channel or hole from the region near or in the turbinates to shrink the turbinates and prevent swelling, due to the formation of scar tissue as the wound heals. The high frequency voltage may be selected to effect a small amount of thermal damage to the walls of the channel or hole to facilitate the formation of scar tissue without extending this thermal damage beyond the immediate region of the target site.

Claims

1. A method for reducing the size of an enlarged body structure comprising:

positioning an electrode terminal adjacent to an enlarged body structure; and

applying high frequency voltage between the electrode terminal and a return electrode, the high frequency voltage being sufficient to volumetrically remove at least a portion of the body structure.

2. The method of claim 1 wherein the enlarged body structure comprises a turbinate within the patient'"'"'s nose.

3. The method of claim 1 further comprising advancing at least a distal end of the electrode terminal into a space vacated by the removed portion of the turbinate.

4. The method of claim 3 further comprising applying thermal energy to the body structure to form a scar around the space.

5. The method of claim 1 further comprising axially translating the electrode terminal to form a hole through at least a portion of the body structure.

6. The method of claim 1 further comprising transversely translating the electrode terminal relative to the body structure to form a channel along the outer surface of the body structure.

7. The method of claim 1 further comprising:

introducing at least a distal end of an electrosurgical catheter into the patient'"'"'s nose; and

positioning the distal end of the catheter in close proximity to the turbinate.

8. The method of claim 1 further comprising:

introducing at least a distal end of an electrosurgical probe through a nostril into the patient'"'"'s nasal cavity; and

positioning the distal end of the probe in close proximity to the turbinate.

9. The method of claim 1 further comprising an electrode array including a plurality of electrically isolated electrode terminals.

10. The method of claim 1 wherein the electrode terminal comprises a single electrode at or near a distal end of an electrosurgical probe.

11. The method of claim 1 wherein the return electrode is located on an external surface of the patient'"'"'s body.

12. The method of claim 1 wherein the return electrode and the electrode terminal are both located on the electrosurgical probe.

13. The method of claim 2 further comprising delivering electrically conductive fluid into the nose to substantially surround the electrode terminal with the electrically conductive fluid.

14. The method of claim 2 further comprising delivering electrically conductive fluid into the nose to generate a current flow path between the return electrode and the electrode terminal.

15. The method of claim 1 further comprising aspirating fluid from the target site during the removal step.

16. The method of claim 9 further comprising independently controlling current flow from at least two of the electrode terminals based on impedance between the electrode terminal and a return electrode.

17. The method of claim 1 further comprising applying sufficient voltage to the electrode terminal in the presence of the electrically conducting fluid to vaporize at least a portion of the fluid between the electrode terminal and the tissue at the target site.

18. The method of claim 17 further comprising accelerating charged particles from the vaporized fluid to the tissue to cause dissociation of the molecular bonds within the tissue structures.

19. The method of claim 5 wherein the hole has a diameter less than about 2 mm.

20. The method of claim 5 wherein the hole has a diameter less than about 1 mm.

21. A method for treating turbinates comprising:

positioning an electrode terminal in contact with or in close proximity to the turbinate; and

applying a sufficient high frequency voltage difference between the electrode terminal and a return electrode to form a void within the turbinate.

22. The method of claim 21 wherein the void is a hole having a maximum lateral dimension of about 2.0 mm.

23. The method of claim 21 wherein the void is a channel extending along an outer surface of the turbinate.

24. The method of claim 21 further comprising applying a sufficient high frequency voltage difference between the electrode terminal and the return electrode to form a plurality of voids within the turbinate.

25. The method of claim 21 further comprising, during the applying step, translating at least a portion of the electrode terminal relative to the turbinate.

26. An apparatus for applying electrical energy to an enlarged body structure at a target site within or on a patient'"'"'s body, the apparatus comprising:

an instrument having a shaft with a proximal end portion and a distal end portion and an electrode terminal disposed near the distal end portion of the shaft;

a return electrode; and

a high frequency power supply coupled to the electrode terminal and the return electrode for applying a voltage difference therebetween, the voltage difference being sufficient to volumetrically remove at least a portion of an enlarged body structure to reduce a size of the enlarged body structure.

27. The apparatus of claim 26 further comprising a fluid delivery element defining a fluid path in electrical contact with the return electrode and the electrode terminal to generate a current flow path between the return electrode and the electrode terminal.

28. The apparatus of claim 26 wherein the distal end portion of the shaft is sized for delivery into a paranasal sinus of the patient.

29. The apparatus of claim 26 wherein the tissue is selected from the group comprising swollen tissue, turbinates, polyps, neoplasms, cartilage and swollen mucus membranes lining an inner surface of the nasal cavity.

30. The apparatus of claim 26 wherein the distal end portion of the shaft has a diameter less than 2 mm.

31. The apparatus of claim 26 wherein the distal end portion of the shaft has a diameter less than 1 mm.

32. The apparatus of claim 26 wherein the return electrode forms a portion of the shaft.

33. The apparatus of claim 26 further including an insulating member positioned between the return electrode and the electrode terminal, the return electrode being sufficiently spaced from the electrode terminal to minimize direct contact between the return electrode and a body structure at the target site when the electrode terminal is positioned in close proximity or in partial contact with the body structure.

34. The apparatus of claim 27, wherein the return electrode is a tubular member and the fluid delivery element comprises an axial lumen coupled to the return electrode, the axial lumen forming at least a portion of the fluid path and having an outlet in fluid communication with the electrode terminal.

35. The apparatus of claim 27 wherein the fluid delivery element comprises a fluid tube extending along an outer surface of the shaft, the tube having an inlet positioned proximal to the return electrode, wherein the return electrode is spaced proximally from the electrode terminal.

36. The apparatus of claim 27 wherein the fluid delivery element comprises a fluid supply instrument separate from the electrosurgical probe.

37. The apparatus of claim 27 wherein the electrode terminal comprises an electrode array disposed near the distal end of the shaft, the array including a plurality of electrically isolated electrode terminals disposed over a contact surface.

38. The apparatus of claim 27 wherein the electrode terminal comprises a single active electrode disposed near the distal end of the shaft.

39. The apparatus of claim 37 further comprising a plurality of current limiting elements each coupled to one of the electrode terminals for independently controlling current flow to each of the electrode terminals to inhibit power dissipation into the medium surrounding the target site.

40. The apparatus of claim 26 further comprising a fluid aspiration element for aspirating fluid from the target site.

41. The apparatus of claim 40 wherein the fluid aspiration element comprises a suction lumen extending through the shaft, the suction lumen having an inlet at a distal tip of the shaft adjacent the electrode terminal.