Shaped electrodes and methods for electrosurgical cutting and ablation

• US 5,843,019 A
• Filed: 07/18/1996
• Issued: 12/01/1998
• 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:
  US08/687,792
• Time in Patent Office: 866 Days
• Field of Search: 604/65, 604/49, 604/22, 604/113, 604/114, 604/41, 606/42, 606/39, 606/27
• US Class Current: 604/22
• 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 2018/00083 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 2018/00642 : 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 2018/00761 : 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 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1273 : including multiple generators in one device
• CPC Class Codes: A61B 2018/1467 : 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 2090/378 : using ultrasound
• CPC Class Codes: A61B 2218/002 : Irrigation
• 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: 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

An electrosurgical system and method allow the surgical team to perform electrosurgical interventions, such as ablation and cutting of body structures, while limiting the depth of necrosis and limiting damage to tissue adjacent the treatment site. The system includes an electrosurgical probe having a shaft with a proximal end, a distal end, and at least one active electrode at or near the distal end. The active electrode includes at least one active portion having a surface geometry configured to promote substantially high electric field intensities and associated current densities between the active portion and the target site when a high frequency voltage is applied to the electrodes. These high electric field intensities and current densities are sufficient to break down the tissue by processes including molecular dissociation or disintegration. The high frequency voltage imparts energy to the target site to ablate a thin layer of tissue without causing substantial tissue necrosis beyond the boundary of the thin layer of tissue ablated. This ablative process can be precisely controlled to effect the volumetric removal of tissue as thin as a few layers of cells with minimal heating of or damage to surrounding or underlying tissue structures.

Claims

1. An electrosurgical instrument for applying electrical energy to a target site on a structure within or on a patient'"'"'s body, the instrument comprising:

a shaft having a proximal end and a distal end;

one or more active electrodes disposed near the distal end of the shaft, the active electrodes each having an active portion with a surface geometry configured to promote substantially high electric field intensities between the active portion and the target site when a high frequency voltage is applied to the electrodes, wherein the electric field intensities are sufficient to vaporize an electrically conducting liquid in contact with at least the active portion of the active electrodes; and

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

2. The instrument of claim 1 wherein active portion of each electrode comprises one or more sharp edges at the distal end portion for promoting localized electric fields around the edges.

3. The instrument of claim 1 wherein the active portion of each electrode comprises surface asperities for promoting localized electric fields near the surface asperities.

4. The instrument of claim 1 further comprising a return electrode positioned near the active electrodes and electrically coupled to the connector.

5. The instrument of claim 4 further comprising a liquid path in communication with the return electrode and the target site for directing electrically conducting liquid between the active electrodes and the return electrode to generate a current flow path between the target site and the return electrode.

6. The instrument of claim 1 wherein the active portion of each electrode comprises an elongate body defining a non-circular cross-sectional shape.

7. The instrument of claim 1 wherein the active portion of each electrode comprises an elongate body defining a cross-sectional shape selected from a group consisting essentially of annular, square, rectangular, L-shaped, V-shaped, D-shaped, C-shaped, star-shaped and crossed-shaped.

8. The instrument of claim 1 wherein the electrodes are fabricated by drawing round wire through a shaping die.

9. The instrument of claim 1 wherein the electrodes are fabricated by removing material from round, solid electrodes.

10. The instrument of claim 1 wherein the electrodes each comprise an elongate body having transverse grooves formed therein for promoting localized electric fields around the grooves.

11. The instrument of claim 1 wherein the electrodes each comprise an elongate, threaded rod having circumferential grooves formed therein for promoting localized electric fields around the grooves.

12. The instrument of claim 1 wherein the distal end of the shaft comprises a cylindrical support member, wherein the electrodes annular electrodes each having an inner hole for receiving the support member.

13. The instrument of claim 12 wherein the annular electrodes have tapered side walls whose thickness is larger at support member to define grooves between adjacent annular electrodes for promoting localized electric fields around the perimeter of the electrodes, the annular electrodes being in electrical contact with each other.

14. The instrument of claim 12 wherein the annular electrodes are longitudinally spaced from each other along the support member.

15. The instrument of claim 12 further comprising electrically insulating spacers each having a hole for receiving the support member and being positioned between the annular electrodes to electrically insulate the annular electrodes from each other.

16. The instrument of claim 4 wherein the surface asperities are formed by a chemical etchant.

17. The instrument of claim 4 wherein the surface asperities are formed by an abradable material.

18. The instrument of claim 1 wherein the electrodes each define a non-active portion, the instrument further comprising an electrically insulating material covering the non-active portion of each electrode to preferentially direct electrical current through the active portion.

19. An electrosurgical instrument for applying electrical energy to a target site on a structure within or on a patient'"'"'s body, the instrument comprising:

a shaft having a proximal end and a distal end;

at least one electrode disposed near the distal end of the shaft, the electrode having an exposed section with one or more active portions and one or more non-active portions;

an electrically insulating material covering the non-active portions of the electrode to insulate the non-active portions from the target site and preferentially direct electrical current through the active portions; and

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

20. The instrument of claim 19 wherein the electrically insulating material comprises a plasma deposited coating on a surface of the non-active portions of the electrodes.

21. The instrument of claim 19 wherein the electrically insulating material comprises a thin-film deposition of insulating material on a surface of the non-active portions of the electrodes.

22. The instrument of claim 19 wherein the electrically insulating material comprises a dip coating of insulating material on a surface of the non-active portions of the electrodes.

23. The instrument of claim 19 wherein the nonactive portions of the electrode are mounted to an electrically insulating support member.

24. The instrument of claim 23 wherein the support member comprises an elongate support member having one or more longitudinal grooves formed in a surface of the support member, the instrument includes a plurality of electrodes mounted to the support member such that the non-active portions contact the surface within the grooves to insulate the non-active portions from the target site.

25. The instrument of claim 19 further comprising a plurality of discrete, electrically insulating members mounted to the non-active portions of the electrode such that the non-active portions are insulated from the target site.

26. The instrument of claim 19 wherein the active portions of the electrode have surface geometries configured to promote substantially high electric field intensities between the active portions and the target site when a high frequency voltage is applied to the electrodes.

27. An electrosurgical system for use with a high frequency power supply and an electrically conducting fluid supply, the system comprising:

an electrosurgical probe comprising a shaft having a proximal end and a distal end, one or more active electrodes disposed near the distal end, and a connector near the proximal end of the shaft for electrically coupling the active electrodes to the electrosurgical power supply, the active electrodes each having an active portion with a surface geometry configured to promote substantially high electric field intensities between the active portion and the target site when a high frequency voltage is applied to the electrodes, wherein the electric field intensities are sufficient to vaporize an electrically conducting liquid in contact with at least the active portion of the active electrodes; and

a return electrode adapted to be electrically coupled to the electrosurgical power supply.

28. The system of claim 27 wherein the electrosurgical probe defines a liquid path from the electrically conducting liquid supply, the liquid path being in electrical contact with and between the return electrode and the active electrodes for generating a current flow path between the return and active electrodes.

29. The system of claim 27 wherein the active portion of each electrode comprising one or more sharp edges for promoting localized electric fields around the edges.

30. The system of claim 27 wherein the active portion of each electrode has surface asperities for promoting localized electric fields near the surface asperities.

31. The system of claim 27 wherein the active electrodes further comprise a non-active portion insulated from the target site to preferentially direct electrical current through the active portion.

32. A method for applying electrical energy to a target site on a structure within or on a patient'"'"'s body, the method comprising:

positioning an active portion of one or more active electrodes into at least close proximity with the target site in the presence of an electrically conductive fluid;

applying high frequency voltage to the active electrodes and a return electrode such that an electrical current flows from the active electrode, through the body structure in the region of the target site, and to the return electrode; and

generating substantially high, localized electric field intensities between the active portion of each active electrode and the target site.

33. The method of claim 32 further comprising locating the active electrodes within an electrically conducting liquid, wherein the electric field intensities are sufficient to vaporize the electrically conducting liquid in a thin layer over at least the active portion of the active electrodes and to induce the discharge of energy from the vapor layer.

34. The instrument of claim 32 further comprising generating localized electric fields and associated current densities around one or more edges of the active portion of each electrode.

35. The method of claim 32 further comprising positioning the return electrode within an electrically conducting liquid to generate a current flow path between the target site and the return electrode.

36. The method of claim 32 wherein the generating step is carried out by creating surface asperities on the active portion of the active electrodes to promote localized electric fields near the surface asperities.

37. The method of claim 36 further comprising forming the active portion of each electrode from an elongate body having a non-circular, transverse cross-sectional shape.

38. The method of claim 37 wherein the cross-sectional shape of each elongate electrode body is selected from a group consisting essentially of annular, square, rectangular, L-shaped, V-shaped, D-shaped, C-shaped, star-shaped and crossed-shaped.

39. The method of claim 32 further comprising forming the electrodes by drawing round wire through a shaping die.

40. The instrument of claim 32 further comprising forming the electrodes by removing material from round, solid wires.

41. The method of claim 32 further comprising forming transverse grooves into the active electrodes to promote localized high electric field intensities around the grooves.

42. The method of claim 32 further comprising forming circumferential grooves around elongate, threaded rods to promote localized high electric field intensities around the grooves.

43. The method of claim 36 wherein the surface asperities are formed by a chemical etchant.

44. The method of claim 36 wherein the surface asperities are formed by an abradable material.

45. The method of claim 32 further comprising insulating a non-active portion of the active electrodes to preferentially direct electrical current through the active portion.

46. The method of claim 45 further comprising depositing a plasma deposited coating on a surface of the non-active portion of each active electrodes.

47. The method of claim 45 further comprising depositing a thin film of insulating material on a surface of the non-active portion of each active electrodes.

48. The method of claim 45 further comprising dip coating insulating material on a surface of the non-active portion of each active electrodes.

49. The method of claim 45 further comprising mounting the non-active portion of each active electrode to an electrically insulating support member.

50. A method for applying electrical energy to a target site on a structure within or on a patient'"'"'s body, the method comprising:

positioning an active portion of one or more active electrodes into at least close proximity with the target site in the presence of an electrically conducting fluid;

applying high frequency voltage to the active electrode and a return electrode such that an electrical current flows from the active electrode to the return electrode; and

generating electric field intensities between the active portion of each active electrode and the target site, the electric field intensities being sufficient to vaporize the fluid in contact with a portion of the active electrode.