System and method for electrosurgical tissue canalization

• US 5,683,366 A
• Filed: 11/22/1995
• Issued: 11/04/1997
• 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
• Application Number:
  US08/562,331
• Time in Patent Office: 713 Days
• Field of Search: 604/22, 604/114, 604/280, 604/264, 604/96, 606/27, 606/28, 606/29-31, 606/32, 606/39, 606/41, 606/45
• 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 2017/00106 ultrasonic
• 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 2018/00083 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 2018/00196 : reciprocating lengthwise
• 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 2018/00642 : 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 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00738 : Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00755 : Resistance or impedance
• 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 2018/00982 : 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 2018/1246 : characterised by the output polarity
• 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 2018/1497 : Electrodes covering only part of the probe circumference
• CPC Class Codes: A61B 2018/162 : located on the probe body
• CPC Class Codes: A61B 2018/165 : Multiple indifferent electrodes
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• 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: A61F 2/95 : Instruments specially adapted for placement or removal of stents or stent-grafts
• 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: A61M 25/0158 : with magnetic or electrical means, e.g. by using piezo materials, electroactive polymers, magnetic materials or by heating of shape memory materials

Abstract

A method for transmyocardial revascularization of the heart of a patient comprises introducing a probe (10) into the thoracic cavity through a percutaneous penetration, a thoracotomy or a sternotomy. An active electrode surface (58) is then positioned adjacent a wall of the patient'"'"'s heart, e.g., the ventricular wall. Electrically conducting liquid (50) is directed to the heart wall to provide a current flow path and high frequency voltage is applied to ablate or disintegrate tissue at the heart wall. The probe is then axially translated towards the ventricular wall to form a revascularizing channel or artificial vessel from the ventricle to the myocardium to increase blood flow therethrough.

Claims

1. A method for canalizing through tissue on a target site within a patient'"'"'s body comprising:

providing a return electrode and an active electrode electrically coupled to a high frequency voltage source;

positioning the active electrode in close proximity to the a target site on the patient'"'"'s body;

providing a current flow path between the target site and the return electrode;

applying high frequency voltage between the active electrode and the return electrode to ablate the tissue; and

axially translating the active electrode towards the tissue to form a channel through the tissue.

2. The method of claim 1 further comprising supplying an electrically conductive liquid to a proximal end of an axial lumen defined by the return electrode within the probe and directing the liquid through a distal end of the axial lumen to the active electrode.

3. The method of claim 1 wherein the active electrode comprises an electrode array including a plurality of isolated electrode terminals.

4. The method of claim 1 wherein the active electrode comprises a single electrode protruding from a distal end of an electrosurgical probe.

5. The method of claim 1 further comprising generating a high electric field intensity at a distal portion of the active electrode.

6. The method of claim 5 wherein the electric field intensity is sufficient to cause molecular disintegration of tissue structure on the target site.

7. The method of claim 3 including independently controlling current flow from at least two of the electrode terminals based on impedance between the electrode terminal and the return electrode.

8. The method of claim 1 wherein the return electrode is an outer tubular member, the shaft including an insulating member defining an axial passage between the insulating member and the outer tubular member, the method further comprising directing an electrically conductive liquid through the axial passage to the distal end of the shaft over the active electrode.

9. The method of claim 8 wherein the positioning step includes positioning a guide cannula against a surface of the target tissue and axially guiding the active electrode through the guide cannula to the tissue surface.

10. The method of claim 1 further comprising maintaining a space between the active electrode and the tissue structure to allow for the formation of a vapor layer therebetween.

11. The method of claim 10 further comprising axially reciprocating the active electrode relative to the tissue structure to allow the electrically conductive liquid to flow into the space and onto the tissue structure.

12. The method of claim 10 further comprising rotating the active electrode relative to the tissue structure to allow the electrically conductive liquid to flow into the space and onto the tissue structure.

13. The method of claim 11 wherein the active electrode is reciprocated a distance of about 0.05 to 0.20 inches.

14. The method of claim 1 further comprising aspirating liquid and gaseous products of ablation from the target site.

15. The method of claim 14 wherein the aspirating step comprises applying suction pressure to a proximal end of an inner lumen extending to the distal end of the probe.

16. The method of claim 1 wherein the voltage is in the range from 800 to 1400 volts peak-to-peak.

17. The method of claim 1 wherein the voltage is in the range from 700 to 900 volts peak-to-peak.

18. The method of claim 1 further comprising:

vaporizing the electrically conducting liquid in a thin layer over at least a portion of the active electrode surface; and

inducing the discharge of ultraviolet energy from the vapor layer.

19. The method of claim 1 further comprising:

vaporizing the electrically conducting liquid in a thin layer over at least a portion of the active electrode surface; and

inducing the discharge of energetic electrons from the vapor layer.

20. The method of claim 1 wherein the channel has a diameter of 0.5 to 3 mm.

21. The method of claim 1 wherein the voltage is applied substantially continuously.

22. The method of claim 1 wherein the target tissue is a wall of the patient'"'"'s heart.

23. The method of claim 22 wherein the channel is a revascularizing channel extending transversely from the ventricle to the myocardium of the patient'"'"'s heart.

24. The method of claim 1 wherein the electrically conducting liquid has a conductivity greater than 2 mS/cm.

25. The method of claim 1 wherein the electrically conductive liquid comprises isotonic saline.

26. A method of transmyocardial revascularization of the heart of a patient comprising:

providing a return electrode and an active electrode electrically coupled to a high frequency voltage source;

positioning the active electrode in close proximity to the a target site on a wall of the patient'"'"'s heart;

providing a current flow path between the target site and the return electrode;

applying high frequency voltage between the active electrode surface and return electrode to ablate tissue at the heart wall; and

axially translating the active electrode towards the heart wall to form a revascularizing channel through at least a portion of the heart.

27. The method of claim 26 further comprising:

introducing at least a distal end of an electrosurgical probe into the ventricle of the heart; and

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

28. The method of claim 27 wherein the introducing step comprises delivering the electrosurgical probe through a percutaneous penetration in the patient.

29. The method of claim 27 further comprising applying a high frequency voltage between an active electrode at the distal end of the probe and a return electrode and axially translating the distal end of the probe until a revascularizing channel is formed from the ventricle to the myocardium to increase blood flow therethrough.

30. The method of claim 26 wherein the voltage is continuously applied between the active and return electrodes.

31. The method of claim 26 wherein the voltage is applied in pulses to correspond to beating of the patient'"'"'s heart.

32. The method of claim 26 further comprising axially reciprocating the active electrode relative to the heart wall to allow the electrically conductive liquid to flow onto the tissue structure.