Methods and apparatus for ablation of luminal tissues

• US 5,681,282 A
• Filed: 04/11/1995
• Issued: 10/28/1997
• Est. Priority Date: 01/07/1992
• Status: Expired due to Term

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Thapliyal, Hira V.
• Primary Examiner(s): MENDEZ, MANUEL A
• Application Number:
  US08/419,886
• Time in Patent Office: 931 Days
• Field of Search: 606/13, 606/14, 606/27, 606/28, 606/32, 606/33, 606/35, 606/37, 606/39, 606/41, 606/48, 606/50, 604/32, 604/114
• US Class Current: 604/114
• 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 2017/00097 one of the thermometric elements being an electrode or the heating element
• 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 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/22001 Angioplasty, e.g. PCTA
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2018/00029 open
• 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 2018/00196 : reciprocating lengthwise
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• 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 2018/00642 : with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/0066 : without feedback, i.e. open loop control
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• 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 2018/00886 : Duration
• 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 2018/126 : 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 2090/378 : using ultrasound
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• CPC Class Codes: A61N 1/05 : for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/403 : for thermotherapy, e.g. hyperthermia

Abstract

An electrosurgical probe comprises a shaft having an electrode array disposed over a recessed surface at its distal end. The electrode array includes a plurality of isolated electrode terminals, and an electrosurgical power supply may be connected to the array via a connector at the distal end of the probe. The electrosurgical power supply will be provided with a plurality of independently limited or controlled current sources. By applying very high frequency electrical energy to the electric array with the power supply, target issue may be ablated while heat dissipation through low impedance past is minimized. The probe is particularly suitable for treatment of surfaces of body lumens, such as the mucosal surface within an enlarged prostate.

Claims

1. A method for enlarging a body lumen within a patient body, said method comprising:

engaging an electrode array including a plurality of electrically isolated electrode terminals against a wall of the body lumen;

applying high frequency voltage between each electrode terminal in the electrode array and on or in the patient body; and

applying laterally outward force on the electrode array while applying the high frequency voltage to ablate peripheral tissue in the lumen.

2. A method as in claim 1, wherein the body lumen is the urethra and the electrode array is engaged against the mucosal surface of the prostate.

3. A method as in claim 2, further comprising introducing the electrode array transurethrally prior to engaging the electrode array against the mucosal surface of the prostate.

4. A method as in claim 3, further comprising introducing the electrode array suprapubically prior to engaging the electrode array against the mucosal surface of the prostate.

5. A method as in claim 1, further comprising introducing a viewing scope having a working lumen to the body lumen and viewing a target location in the body lumen and viewing a target location in the body lumen,

wherein the electrode array is introduced through the working lumen prior to engaging against the body lumen wall.

6. A method as in claim 1, wherein current flow from at least two of said electrode terminals is independently controlled based on impedance between the electrode terminal and the common electrode.

7. A method as in claim 6, wherein current flow is limited when a low impedance path exists between the electrode terminal and the common electrode.

8. A method as in claim 6, wherein current flow is limited when a high impedance path exists between the electrode terminal and the common electrode.

9. A method as in claim 1, wherein the high frequency voltage is in the range from 20 kHz to 20 MHz and in the range from 5 volts to 300 volts (RMS).

10. A method as in claim 1, further comprising measuring temperature at an interface between the electrode array and the lumen wall and controlling the voltage, current, or duty cycle to maintain a preset interface temperature.

11. A method as in claim 1, wherein the electrode array is present in an electrically conductive environment.

12. A method as in claim 11, wherein the electrically conductive environment comprises saline.

13. A method as in claim 1, wherein the electrode array is disposed at the distal end of a cylindrical shaft and is recessed relative to a proximal portion of the shaft.

14. A method as in claim 13, wherein the electrode array has an area in the range from 1 mm² to 75 mm².

15. A method as in claim 14, wherein the electrode array consists of from 2 to 50 individual electrode terminals.

16. A method as in claim 15, wherein the individual electrode terminals each have contact surfaces with a cross-sectional area in the range from 0.0001 m² to 1 mm².

17. A method as in claim 16, wherein the individual electrode terminals protrude over the recessed surface by a distance in the range from 0 mm to 2 mm.

18. The method of claim 1 wherein high frequency voltage is applied between at least three electrode terminals in the electrode array to one or more common electrodes.

19. The method of claim 1 wherein high frequency voltage is applied between at least five electrode terminals in the electrode array to one or more common electrodes.

20. The method of claim 1 wherein high frequency voltage is applied between each of at least two electrode terminals and a single common electrode disposed proximally from the electrode terminals.

21. A method as in claim 1 wherein the electrode terminals have an inherent capacitance, the method further comprising delivering high frequency current across at least one current limiting element in series with one of the electrode terminals.

22. A method as in claim 21 further comprising selecting the current limiting element such that the capacitance of each electrode terminal and the associated current limiting element together form a series resonant output circuit.

23. A method as in claim 21 wherein the current limiting element comprises an inductor.

24. A method as in claim 23 further comprising positioning at least on capacitor in series with each inductor to form a lumped capacitance.

25. An improved method for treating prostate disease of the type wherein energy is applied to the mucosal surface of the prostate, wherein the improvement comprises engaging an electrode array against the mucosal surface and applying high frequency voltage to the electrode array under conditions where current flow from individual terminals from the electrode array is limited to inhibit power loss through low impedance paths from the electrode array.

26. An electrosurgical probe comprising:

a shaft having a proximal end, a distal end, and a recessed surface near the distal end;

an electrode array disposed over the recessed surface near the distal end of the shaft, said array including a plurality of electrically isolated electrode terminals having substantially the same potential; and

a connector disposed near the proximal end of the shaft for electrically coupling the electrode terminals to a high frequency voltage source.

27. An electrosurgical probe as in claim 26, wherein the shaft has a length in the range from 5 cm to 50 cm and an outer diameter in the range from 0.5 mm to 5 mm.

28. An electrosurgical probe as in claim 27, wherein the shaft is flexible along at least a portion of its length.

29. An electrosurgical probe as in claim 28, wherein at least a distal portion of the shaft is rigid.

30. An electrosurgical probe as in claim 27, wherein the electrode array consists of from 2 to 50 individual electrode terminals.

31. An electrosurgical probe as in claim 30, wherein the individual electrode terminals each have a cross-sectional area in the range from 0.0001 mm² to 1 mm².

32. An electrosurgical probe as in claim 26, further comprising a common electrode on the shaft, wherein the common electrode is disposed proximally of the electrode array and wherein the connector also provides for electrical coupling of the common electrode to the power supply.

33. An electrosurgical probe as in claim 26, further comprising a plurality of electrically isolated conductors disposed in the shaft and connecting the electrode terminals to the connector.

34. An electrosurgical probe as in claim 33 wherein the electrode terminals have an inherent capacitance, the probe further comprising a current limiting element connected across the power supply conductors to supplement the inherent capacitance of the electrodes.

35. An electrosurgical probe as in claim 34 wherein the capacitance of the electrodes and the current limiting element together form a series resonant output circuit.

36. An electrosurgical probe as in claim 34 wherein the current limiting element comprises a capacitor.

37. An electrosurgical probe as in claim 34 wherein the current limiting element comprises one or more inductors coupled in series between the conductors and the connector.

38. An electrosurgical probe as in claim 26, wherein the recessed surface is planar or convex.

39. An electrosurgical probe as in claim 26, wherein the shaft is cylindrical and the recessed surface is defined over a coaxial plane spaced radially inward from the cylindrical surface.

40. An electrosurgical probe as in claim 39, wherein the individual electrode terminals protrude over the released surface by a distance in the range from 0 mm to 2 mm.

41. An electrosurgical probe as in claim 26, wherein the electrode array has an area in the range from 1 mm² to 75 mm².

42. The probe of claim 26 wherein the electrode array includes at least three electrically isolated terminals having substantially the same potential.

43. The probe of claim 26 wherein the electrode array includes at least five electrically isolated terminals having substantially the same potential.

44. The probe of claim 26 further comprising a single common electrode disposed proximally from the electrode terminals, wherein voltage is applied between each of the electrode terminals and the single common electrode.

45. A method for treating prostate disease comprising:

engaging an electrode array including a plurality of electrically isolated terminals against prostatic tissue at a target site adjacent the urethra;

applying high frequency voltage between each electrode terminal in the electrode array and one or more common electrodes on or in the patient body; and

independently controlling current flow through individual electrode terminals to inhibit power dissipation into the medium surrounding the target site.