System and method for electrosurgical cutting and ablation

• US 5,871,469 A
• Filed: 02/05/1997
• Issued: 02/16/1999
• 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): Yasko, John D.
• Assistant Examiner(s): MENDEZ, MANUEL A
• Application Number:
  US08/795,686
• Time in Patent Office: 741 Days
• Field of Search: 604/22, 604/113, 604/114, 604/41, 606/27-32, 606/35, 606/38, 606/41
• US Class Current: 604/114
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• 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 2018/0047 : Upper parts of the skin, e.g. skin peeling or treatment of wrinkles
• CPC Class Codes: A61B 2018/00476 : Hair follicles
• 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 2018/162 : 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

An electrosurgical probe (10) comprises a shaft (13) having an electrode array (58) at its distal end and a connector (19) at its proximal end for coupling the electrode array to a high frequency power supply (28). The shaft includes a return electrode (56) recessed from its distal end and enclosed within an insulating jacket (18). The return electrode defines an inner passage (83) electrically connected to both the return electrode and the electrode array for passage of an electrically conducting liquid (50). By applying high frequency voltage to the electrode array and the return electrode, the electrically conducting liquid generates a current flow path between the return electrode and the electrode array so that target tissue may be cut or ablated. The probe is particularly useful in dry environments, such as the mouth or abdominal cavity, because the electrically conducting liquid provides the necessary return current path between the active and return electrodes.

Claims

1. 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, an active electrode disposed near the distal end, and a connector near the proximal end of the shaft for electrically coupling the active electrode to the electrosurgical power supply; and

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

wherein the active and return electrodes are configured, upon the application of a sufficiently high frequency voltage therebetween, to vaporize the fluid in a thin layer over at least a portion of the active electrode and induce the discharge of energy from the vapor layer.

2. The system of claim 1 wherein the energy induced from the thin layer of vaporized liquid is in the form of energetic electrons.

3. The system of claim 1 wherein the energy induced from the thin layer of vaporized fluid is in the form of photons having a wavelength in the ultraviolet spectrum.

4. The system of claim 1 wherein the return electrode defines a fluid path in electrical contact with the return electrode and the active electrode, the fluid path having an inlet adapted to be fluidly coupled to the electrically conductive fluid supply for generating a current flow path between the return electrode and the active electrode.

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

6. The system of claim 5 wherein the isolated electrode terminals each have a contact area below 15 mm².

7. The system of claim 5 wherein the electrode surface includes at least two electrode terminals.

8. The system of claim 5 wherein the electrode surface comprises between 4 and 50 electrode terminals.

9. The system of claim 5 wherein the electrode terminals are spaced from each other a distance of 0.01 to 5 mm.

10. The system of claim 5 wherein the electrode array is disposed over a distal tip of an electrosurgical probe.

11. The system of claim 10 wherein the distal tip of the probe includes an insulating matrix between the electrode terminals, the insulating matrix comprising a material having a relatively low thermal conductivity.

12. The system of claim 5 wherein the electrode terminals comprises a material with a relatively low thermal conductivity.

13. The system of claim 12 wherein the electrode materials comprises a material selected from the group consisting of titanium, tungsten, platinum, aluminum and tantalum.

14. The system of claim 5 wherein the electrode terminals extend a distance of 0.0 to 5 mm from an electrically insulating matrix on the distal tip of the probe.

15. The system of claim 5 wherein the electrode terminals are substantially flush with an electrically insulating matrix on the distal tip of the probe.

16. The system of claim 5 wherein the electrode terminals are proximally recessed a distance of 0.0 to 5 mm from an electrically insulating matrix on the distal tip of the probe.

17. The system of claim 2 wherein the high frequency voltage is at least 300 volts peak to peak.

18. The system of claim 1 wherein the voltage is in the range from 600 to 1400 volts peak to peak.

19. The system of claim 1 wherein the electrically conducting fluid has a conductivity greater than 2 mS/cm.

20. The system of claim 1 wherein the electrically conductive fluid comprises isotonic saline.

21. An electrosurgical probe for applying high frequency electrical energy to a tissue structure at a target site in the presence of electrically conducting fluid, the probe comprising:

a shaft having a proximal end and a distal end;

an electrode terminal having a tissue treatment portion disposed at or near the distal end of the shaft;

a return electrode coupled to the shaft and having an exposed fluid contact surface; and

at least one connector disposed near the proximal end of the shaft for electrically coupling the electrode terminal to a high frequency voltage source; and

wherein the return electrode is spaced from the electrode terminal, and the return electrode and electrode terminal are configured such that, when the tissue treatment portion of the electrode terminal is brought adjacent a tissue structure in contact with electrically conductive fluid, and high frequency electrical energy is applied to the electrode terminal, the high frequency electrical energy is sufficient to effect the molecular breakdown of the tissue structure and to convert solid tissue cells at the target site directly into gaseous products of ablation.

22. The probe of claim 21 wherein the gaseous products of ablation comprise non-condensible gases.

23. The probe of claim 21 wherein the return electrode is spaced about 0.5 to 25 mm from the electrode terminal in a direction away from the tissue structure when the electrode terminal is brought adjacent a tissue structure.

24. The probe of claim 21 further comprising a power limiting element coupled to the electrode terminal for limiting power to the electrode terminal based on the electrical impedance between the electrode terminal and the return electrode.

25. The probe of claim 21 wherein the high frequency electrical energy is sufficient to vaporize at least a portion of the electrically conducting fluid at the target site.

26. The probe of claim 21 wherein the electrode terminal extends a distance of less than about 2.0 mm from the shaft.

27. An electrosurgical probe for applying high frequency electrical energy to a tissue structure at a target site in the presence of electrically conducting fluid, the probe comprising:

a shaft having a proximal end, a distal end with a distal tip;

at least one electrode having a tissue treatment portion disposed at or near the distal end of the shaft;

a return electrode on the shaft and having an exposed fluid contact surface spaced from the tissue treatment portion of the electrode terminal; and

at least one connector disposed near the proximal end of the shaft for electrically coupling the electrode terminal to a high frequency voltage source;

wherein the return electrode is spaced from the electrode terminal, and the return electrode and electrode terminal are configured such that, when the tissue treatment portion of the electrode terminal is brought adjacent a tissue structure in contact with electrically conductive fluid, and high frequency electrical energy is applied to the electrode terminal, electric fields are established between the electrode terminal and the tissue structure at the target site, the electric fields being sufficient to cause the breakdown of tissue through molecular dissociation or disintegration.

28. The probe of claim 27 wherein the electric fields are substantially confined to an area immediately surrounding the electrode terminal.

29. The probe of claim 27 wherein the return electrode is spaced about 0.5 to 25 mm from the electrode terminal in a direction away from the tissue structure when the electrode terminal is brought adjacent a tissue structure.

30. The probe of claim 27 wherein the electric fields are sufficient to convert solid tissue cells at the target site directly into non-condensible gases.

31. The probe of claim 27 wherein the electric fields are sufficient to vaporize at least a portion of the electrically conducting fluid at the target site.

32. The probe of claim 27 wherein the electrode terminal extends a distance of less than about 2.0 mm from the shaft.

33. The probe of claim 27 further comprising means, coupled to the shaft, for applying high frequency voltage in the range of about 300 to 1400 volts peak to peak to the target site in the presence of electrically conducting fluid.

34. The probe of claim 27 further comprising a power limiting element coupled to the electrode terminal for limiting power to the electrode terminal based on the electrical impedance between the electrode terminal and the return electrode.

35. An electrosurgical probe for applying high frequency electrical energy to a tissue structure at a target site, the probe comprising:

a shaft having a proximal end and a distal end;

means, coupled to the shaft, for applying high frequency voltage to the target site in the presence of electrically conducting fluid such that at least a portion of the electrically conducting fluid is vaporized.

36. The probe of claim 35 further comprising means, coupled to the shaft, for applying high frequency voltage in the range of about 300 to 1400 volts peak to peak to the target site in the presence of electrically conducting fluid.

37. The probe of claim 35 further comprising means, coupled to the shaft, for applying a sufficient high frequency voltage to the target site in the presence of electrically conducting fluid to cause the breakdown of tissue through molecular dissociation or disintegration.

38. An electrosurgical probe for applying high frequency electrical energy to a tissue structure at a target site, the probe comprising:

a shaft having a proximal end and a distal end;

means, coupled to the shaft, for applying a sufficient high frequency voltage to the target site in the presence of electrically conducting fluid to cause the breakdown of tissue through molecular dissociation or disintegration.