TISSUE CUTTING SYSTEMS AND METHODS

• US 20130172870A1
• Filed: 07/02/2012
• Published: 07/04/2013
• Est. Priority Date: 07/06/2011
• Status: Active Grant

• Current Assignee: Minerva Surgical, Inc.
• Original Assignee: Arqos Surgical, Inc.
• Inventors: Germain, Aaron, Shadduck, John H., Walker, Michael D., Klein, Kyle, Truckai, Csaba
• Granted Patent: US 9,737,362 B2
• Time in Patent Office: Days
• US Class Current: 606/33
• CPC Class Codes: A61B 1/012 characterised by internal passages or accessories therefor
• CPC Class Codes: A61B 1/303 for the vagina, i.e. vaginoscopes
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 18/08 by means of electrically-heated 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 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2017/320028 with reciprocating movements
• CPC Class Codes: A61B 2017/4216 Operations on uterus, e.g. endometrium
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/1475 Electrodes retractable in or deployable from a housing
• CPC Class Codes: A61B 2218/002 Irrigation
• CPC Class Codes: A61B 2218/007 Aspiration

Abstract

A probe for resecting and coagulating tissue comprises an outer sleeve having a tissue cutting window and an inner sleeve having a tissue cutting distal end. And RF cutting region is formed at the distal end of the inner member and an RF coagulation region is formed on an exterior surface of the inner member immediately proximal to the cutting surface. A single power supply providing a single RF energy mode can be connected to both RF applicator regions to simultaneously cut and coagulate tissue.

Claims

1. A method resecting tissue, comprising:

interfacing an electrosurgical probe with tissue targeted for resection, the probe comprising a cutting member configured to apply simultaneous first and second RF-induced energy application levels to tissue utilizing a single RF power mode, and

moving the probe relative to tissue wherein (i) a leading portion of the cutting member applies a first energy level for vaporization and cutting of tissue and (ii) a trailing portion of the cutting member applies a second energy level for coagulating tissue.

2. The method of claim 1 wherein the probe comprises a windowed outer sleeve and the cutting member is reciprocatable therein across the window to cut and coagulate tissue.

3. The method of claim 1 wherein the first RF-induced energy application level provides a plasma capable of vaporization and cutting of tissue.

4. The method of claim 1 wherein the second RF-induced energy application level is configured for ohmic heating of tissue.

5. The method of claim 1 wherein the second RF-induced energy application level is configured for passive conductive heating of tissue.

6. The method of claim 1 wherein the second RF-induced energy application provides a low-intensity plasma for heating tissue.

7. The method of claim 1 wherein the first RF-induced energy application is provided at sharp distal edge of the cutting member.

8. The method of claim 1 wherein the second RF-induced energy application is provided about a surface of the cutting member.

9. The method of claim 1 wherein the second RF-induced energy application results from capacitive coupling through a thin-wall dielectric.

10. The method of claim 1 wherein the second RF-induced energy application results from passive heating of a resistive material or a positive temperature coefficient of resistance (PTCR) material.

11. The method of claim 1 wherein the second RF-induced energy application results from active or ohmic heating between opposing polarity electrodes.

12. A method resecting tissue, comprising:

interfacing an electrosurgical probe with tissue targeted for resection, the probe comprising a windowed outer sleeve and an reciprocating inner cutting sleeve with first and second RF applicator regions coupled to a single RF source; and

reciprocating the inner sleeve while the single RF power supply delivers a single RF mode simultaneously to both the first applicator region to form an ablative plasma for cutting tissue and the second RF applicator region to form non-ablative non-plasma energy for coagulating a just-cut tissue surface.

13. The method of claim 12 wherein the inner cutting sleeve is configured to reciprocate in an extending stroke and a retracting stroke across the window, and wherein the application of the ablative plasma occurs in the extending stroke.

14. The method of claim 13 wherein the application of the ablative plasma occurs in the retracting stroke.

15. The method of claim 13 wherein the application of non-ablative non-plasma energy occurs in the extending stroke.

16. The method of claim 13 wherein the application of non-ablative non-plasma energy occurs in the retracting stroke.

17. The method of claim 12 wherein the application of ablative plasma occurs about a distal edge of the inner sleeve.

18. The method of claim 17 wherein said distal edge extends from 90°

to 360°

about a longitudinal axis of said sleeve.

19. The method of claim 12 wherein the application of non-ablative non-plasma energy occurs over a surface area of the inner sleeve ranging between 1 mm² and 200 mm².

20. The method of claim 12 wherein the application of non-ablative non-plasma energy is provided by capacitive coupling of said energy through a thin-wall dielectric.

21. The method of claim 12 wherein the application of non-ablative non-plasma energy is provided by ohmic heating of tissue disposed between the second RF applicator region comprising a first polarity electrode and a spaced-apart second polarity electrode.

22. The method of claim 12 wherein the second RF applicator region comprises a positive temperature coefficient of resistance (PTCR) material.

23. The method of claim 12 wherein the second RF applicator region comprises a resistive material.

24. A tissue cutting system comprising:

a probe including an outer sleeve having a cutting window near a distal end thereof and an inner cutting sleeve mounted to reciprocate in the outer sleeve between window-open and window-closed configurations;

wherein the inner cutting sleeve is configured with first and second discrete RF applicator regions, with both regions are adapted to be coupled to a single RF source; and

an RF source coupled to said sleeve which (i) generates an ablative plasma at a tissue interface with the first RF applicator region for cutting tissue and (ii) causes tissue heating at a tissue interface with the second RF applicator region for coagulating a tissue surface.

25. The tissue cutting probe of claim 24 wherein the first RF applicator region comprises a first polarity active electrode cooperating with a second polarity electrode having a larger surface area that said first polarity active electrode.

26. The tissue cutting probe of claim 24 wherein the second RF applicator region comprises a thin wall dielectric material.

27. The tissue cutting probe of claim 24 wherein the second RF applicator region comprises a resistive material.

28. The tissue cutting probe of claim 24 wherein the second RF applicator region comprises a PTCR material.

29. The tissue cutting probe of claim 24 wherein the second RF applicator region comprises paired opposing polarity electrodes.

30. A tissue cutting probe comprising:

a windowed outer sleeve and a reciprocating inner cutting sleeve wherein such reciprocation moves the probe between window-open and window-closed configurations;

an electrode at a distal edge of the cutting sleeve coupled to an energy source; and

an energy applicator surface on the cutting sleeve coupled to an energy source.

31. The tissue cutting probe of claim 30 wherein the electrode and the energy applicator surface are coupled to a single energy source.

32. The tissue cutting probe of claim 30 wherein the electrode and the energy applicator surface are coupled to different energy sources.

33. The tissue cutting probe of claim 30 wherein the energy applicator surface includes at least one of an electrode, a resistively heated material, a PTCR material or a dielectric material configured for capacitive coupling therethrough.

34. A tissue cutting probe comprising:

an outer sleeve with a tissue-receiving window and a reciprocating inner cutting sleeve wherein such reciprocation moves the probe between window-open and window-closed configurations; and

an RF electrode at a distal edge of the cutting sleeve coupled to an energy source;

wherein an outer sleeve body at least partly defining the window is a dielectric material.

35. The tissue cutting probe of claim 34 wherein the outer sleeve body comprises at least one of a ceramic, a glass or a polymer.

36. A tissue cutting probe comprising:

an outer sleeve with a tissue-receiving window and a reciprocating inner cutting sleeve wherein such reciprocation moves the probe between window-open and window-closed configurations; and

an RF electrode at a distal edge of the cutting sleeve coupled to an energy source;

wherein at least one surface of the outer sleeve proximate the cutting window comprises a material having a comparative tracking index value ranging from 200 volts to 800 volts.

37. A tissue cutting probe comprising:

an outer sleeve with a tissue-receiving window and a reciprocating inner cutting sleeve wherein such reciprocation moves the probe between window-open and window-closed configurations; and

an RF electrode at a distal edge of the cutting sleeve coupled to an energy source;

at distal tip of the outer sleeve configured with a cutting tip for penetrating tissue.

38. The tissue cutting probe of claim 37 wherein the cutting tip has a sharp tip or an RF tip.

39. The tissue cutting probe of claim 38 wherein the cutting tip is retractable.

40. A tissue cutting probe comprising:

a handle coupled to a windowed outer sleeve and a reciprocating inner cutting sleeve wherein such reciprocation moves the probe between window-open and window-closed configurations;

a motor drive in the handle for reciprocating the cutting sleeve;

a negative pressure source in communication with a tissue extraction channel in the inner sleeve, wherein the extraction channel extends through the handle and includes a heat exchanger configures to allow extracted fluids to cool the motor and/or handle.

41. A tissue cutting probe comprising:

a handle coupled to a windowed outer sleeve and a reciprocating RF inner cutting sleeve wherein such reciprocation moves the probe between window-open and window-closed configurations;

a motor drive in the handle for reciprocating the cutting sleeve, wherein the cutter speed in variable over an extending stroke.

42. The tissue cutting probe of claim 41 wherein is cutting sleeve has a faster speed on a retracting stroke and a slower speed during an extending stroke to increase RF cutting time when engaging tissue.

43. The tissue cutting probe of claim 41 wherein is cutting sleeve has a dwell time in the fully extended stroke position to thereby allow negative and/or positive pressures to move tissue in the extraction lumen.

44. The tissue cutting probe of claim 43 wherein is cutting sleeve wherein the dwell time is at least 0.1 second.

45. The tissue cutting probe of claim 43 wherein is cutting sleeve within a peak speed range from 50 mm/s to 200 mm/s.

46. The tissue cutting probe of claim 41 wherein a controller moves the cutting sleeve to the window-closed position when the motor is off.

47. The tissue cutting probe of claim 41 wherein the controller is configured to allow selectable reciprocation rates.

48. The tissue cutting probe of claim 47 wherein the controller allows the selection of a single extending stroke.

49. The tissue cutting probe of claim 47 wherein the controller allows the selection of a single retraction stroke and locking the cutting sleeve in the window open position.

50. The tissue cutting probe of claim 46 wherein the controller allows the selection of at least two reciprocation rates between 1 Hz and 4 Hz.

51. The tissue cutting probe of claim 46 wherein the controller allows the selection of locking the cutting sleeve in a partially extended position.

52. The tissue cutting probe of claim 51 wherein the controller allows the selection of a low RF power delivery at least in said partially extended position for use in tissue coagulation.