Electrosurgical treatment of tissue in electrically conductive fluid

• US 5,891,095 A
• Filed: 12/05/1996
• Issued: 04/06/1999
• Est. Priority Date: 05/10/1993
• 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): Buiz, Michael
• Assistant Examiner(s): MENDEZ, MANUEL A
• Application Number:
  US08/807,111
• Time in Patent Office: 852 Days
• Field of Search: 604/22, 604/49, 604/114, 606/27-29, 606/32-35, 606/37, 606/39, 606/40-41, 606/45, 606/48, 606/47, 606/49, 606/50
• 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: 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
• 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

A method is provided for applying electrical energy to a tissue structure within a patient'"'"'s body. The method includes positioning an electrosurgical probe adjacent to the tissue structure so that an electrode array including a plurality of isolated electrode terminals is brought into at least partial contact with the body structure. A high frequency voltage is then applied between each electrode terminal within the electrode array and a common, return electrode. Current flow from the electrode terminals is selectively limited to minimize low electrical impedance paths emanating from the electrode array. The present invention takes advantage of the differences in electrical properties between a target tissue and the surrounding conductive liquid (e.g. isotonic saline irrigant) in the region immediately adjacent to the electrode array to ablate the target tissue while minimizing overheating of the surrounding liquid.

Claims

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

positioning an electrode terminal into at least close proximity with the target site in the presence of an electrically conducting fluid;

positioning a return electrode within the electrically conducting fluid to generate a current flow path between the electrode terminal and the return electrode; and

applying high frequency voltage to the electrode terminal and the return electrode such that an electrical current flows from the electrode terminal, through the target site, and to the return electrode through the current flow path.

2. The method of claim 1 wherein the electric current flows substantially through the electrically conducting fluid while minimizing electric current flow passing through the body structure.

3. The method of claim 1 wherein at least a portion of the electric current passes through the body structure.

4. The method of claim 1 further comprising immersing the target site within a volume of the electrically conductive fluid and positioning the return electrode within the volume of electrically conductive fluid to generate the current flow path between the target site and the return electrode.

5. The method of claim 4 wherein the electrode terminal is introduced into a cavity in the patient'"'"'s body flooded with the electrically conducting fluid.

6. The method of claim 5 wherein the body cavity is selected from the group consisting essentially of the knee, shoulder, wrist, ankle, elbow, hip, foot, hand and spine.

7. The method of claim 1 wherein the electrode terminal comprises a single electrode disposed near the distal end of an instrument shaft.

8. The method of claim 1 wherein the electrode terminal includes an array of electrically isolated electrode terminals disposed near the distal end of an instrument shaft.

9. The method of claim 1 wherein the electrically conductive fluid is selected from the group consisting essentially of blood and electrolytic irrigants.

10. The method of claim 1 wherein the electrically conductive fluid comprises isotonic saline.

11. The method of claim 8 including independently controlling current flow from at least two of the electrode terminals based on electrical impedance between each electrode terminal and the return electrode.

12. The method of claim 1 wherein the return electrode is spaced from the electrode terminal such that when the electrode terminal is brought adjacent a tissue structure immersed in electrically conductive fluid, the return electrode is spaced from the tissue structure and the electrically conductive fluid completes a conduction path between the electrode terminal and the return electrode.

13. A method as in claim 1, further including maintaining a space between the electrode terminal and the body structure during the applying step.

14. The method of claim 13 wherein the maintaining step comprises moving the electrode terminal transversely across the body structure.

15. The method of claim 1 wherein the electrically conducting fluid is directed through a cannula into the body cavity, the electrode terminal and the return electrode being submerged in the fluid within the body cavity.

16. The method of claim 15 wherein the body cavity is selected from the group consisting essentially of the knee, shoulder, wrist, ankle, elbow, foot, hand and spine.

17. The method of claim 1 wherein the current flow between the electrode terminal and the return electrode has an inherent capacitance, the method further comprising delivering high frequency current across at least one current limiting element in series with the electrode terminal.

18. The method of claim 17 further comprising selecting the current limiting element such that the inherent capacitance associated with tissue and the electrically conducting fluid between the return electrode and the electrode terminal and the current limiting element together form a series resonant output circuit.

19. The method of claim 1 further comprising providing one or more electrode terminals surrounded by an insulating matrix at the distal tip of the probe to electrically isolate each terminal, the insulating matrix comprising an inorganic material.

20. The method of claim 19 wherein the inorganic material is selected from the group consisting essentially of ceramic, glass and glass/ceramic compositions.

21. The method of claim 8 further comprising actively limiting current to at least two of the electrode terminals based on electrical impedance between the electrode terminals and the return electrode.

22. The method of claim 21 further comprising measuring current flow for a given applied voltage.

23. The method of claim 21 further comprising changing the resonant frequency of a series resonant output circuit with changes in the inherent capacitance associated with the tissue and electrically conducting fluid between the electrode terminals.

24. The method of claim 21 further comprising interrupting or limiting current between the electrode terminals and the return electrode when the impedance sensor indicates an electrical impedance less than a threshold level.

25. The method of claim 8 further comprising passively limiting or interrupting current flow to the electrode terminals based on the electrical impedance between the electrode terminals and the return electrode.

26. The method of claim 1 wherein the frequency of the applied voltage is about 20 kHz to about 20 MHz.

27. The method of claim 1 wherein the high frequency voltage is greater than 10 volts and less than 1000 volts.

28. The method of claim 8 wherein the electrode array is disposed over a lateral surface of an electrode array support member near the distal end of the instrument shaft.

29. The method of claim 21 wherein the actively limiting current step is carried out by measuring current flow to the electrode terminals for a given applied voltage.

30. The method of claim 25 wherein the passive limiting current flow step is carried out with a passive current limiting element selected from the group consisting essentially of inductors, capacitors, resistors and combinations thereof.

32. The method of claim 7 further comprising a proximal handle coupled to the instrument shaft, and a current limiting element located in the handle.

33. The method of claim 1 further comprising an electrical connector for coupling the electrode terminal to a high frequency voltage supply and a current limiting element located within a high frequency power supply, the connector being adapted for coupling to the current limiting element.

34. The method of claim 1 further comprising an electrical connector for coupling the electrode terminal to a high frequency voltage supply and a current limiting element located within the connector.

35. The method of claim 1 wherein the electrode terminal and the return electrode are configured to effect the electrical breakdown of tissue in the immediate vicinity of the electrode terminal when high frequency voltage is applied between the electrode terminal and the return electrode in the presence of electrically conducting fluid.

36. The method of claim 8 further comprising generating a high electric field intensity at a distal portion of the electrode terminal.

37. The method of claim 1 wherein the distal surface of the electrode terminal has a shape selected from the group consisting essentially of flat, concave, convex, hemispherical, pyramidal, conical and cylindrical.

38. The method of claim 1 wherein the power to the electrode terminal is controlled based on the electrical impedance between the electrode terminal and the return electrode.

39. The method of claim 38 further comprising limiting power to the electrode terminal when the electrical impedance is less than a threshold value.

40. The method of claim 1 wherein temperature at the target site is measured by a temperature sensor adjacent to the electrode terminal which is electrically coupled to the high frequency voltage source such that power delivery to the electrode terminal is limited if the measured temperature exceeds a threshold value.

41. The method of claim 40 wherein the temperature sensor is integral with the electrode terminal.

42. The method of claims 8 wherein temperature at the target site is measured by a temperature sensor adjacent to the electrode terminal which is electrically coupled to the high frequency voltage source such that power delivery to the electrode terminal is limited if the measured temperature exceeds a threshold value.

43. The method of claim 8 wherein the electrode array and the return electrode are configured to effect the electrical breakdown of tissue in the immediate vicinity of the electrode array when high frequency voltage is applied between the electrode terminals of the electrode array and the return electrode in the presence of an electrically conductive fluid.

31. The method of 1 further comprising an electrical connector for coupling the electrode terminal to a high frequency voltage supply and a current limiting element located distal to the connector.

44. A method for removing a tissue structure within a patient'"'"'s body comprising:

introducing an electrically conductive fluid into the patient'"'"'s body to immerse the tissue structure within the electrically conductive fluid;

positioning an electrode terminal and return electrode into at least close proximity with the target site in the presence of the electrically conducting fluid; and

applying high frequency voltage to the electrode terminal and the return electrode such that an electrical current flows from the electrode terminal, through the target site, and to the return electrode through the electrically conductive fluid.

45. The method of claim 44 wherein the electric current flows substantially through the electrically conducting fluid without passing through the body structure.

46. The method of claim 44 wherein at least a portion of the electric current passes through the body structure.

47. The method of claim 44 wherein the tissue structure is selected from the group consisting essentially of fibrocartilage and articular cartilage.

48. The method of claim 44 wherein the electrode terminal comprises a single electrode disposed near the distal end of an instrument shaft.

49. The method of claim 44 wherein the electrically conductive fluid comprises isotonic saline.

50. The method of claim 44 wherein the electrode terminal comprises an array of electrode terminals, the method further comprising independently controlling current flow from at least two of the electrode terminals based on electrical impedance between each electrode terminal and the return electrode.

51. The method of claim 44 further comprising a plurality of current limiting circuit structures in parallel with each other and in series with a return voltage supply within a power supply.

52. The method of claim 44 further comprising limiting current flow to electrode terminals in contact with low impedance current path back to the return electrode.

53. The method of claim 44 wherein the return electrode is disposed proximally of the single electrode terminal on the instrument shaft.

54. A method as in claim 44, further including maintaining a space between the electrode array and the body structure during the applying step.

55. The method of claim 44 further comprising providing one or more electrode terminals surrounded by an insulating matrix at the distal tip of the probe to electrically isolate each electrode terminal, the insulating matrix comprising an inorganic material.

56. The method of claim 55 wherein the inorganic material is selected from the group consisting essentially of ceramic, glass and glass/ceramic compositions.

57. The method of claim 44 further comprising passively limiting or interrupting current flow to the electrode terminal based on the electrical impedance between the electrode terminal and the return electrode.

58. The method of claim 44 wherein the electrode terminal disposed over a lateral surface of an electrode support member near the distal end of an instrument shaft.

59. The method of claim 44 wherein the power to the electrode terminal is controlled based on the electrical impedance between the electrode terminal and the return electrode.

60. The method of claim 59 further comprising limiting power to the electrode terminal when the electrical impedance is less than a threshold value.

61. The method of claim 44 wherein temperature at the target site is measured by a temperature sensor adjacent to the electrode terminal which is electrically coupled to high frequency voltage source such that power delivery to the electrode terminal is limited if the measured temperature exceeds a threshold value.

62. The method of claim 61 wherein the temperature sensor is integral with the active electrode.

63. The method of claim 44 wherein the electrode terminal and return electrode are configured to effect the electrical breakdown of tissue in the immediate vicinity of the electrode terminal when high frequency voltage is applied between the active electrode and the return electrode in the presence of an electrically conductive fluid.

64. The method of claim 44 wherein the distal surface of the electrode terminal has a shape from the group consisting essentially of flat, concave, convex, hemispherical, pyramidal, and/or cylindrical.