Method and system for heating solid tissue

• US 5,954,717 A
• Filed: 09/25/1997
• Issued: 09/21/1999
• Est. Priority Date: 09/25/1997
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: RadioTherapeutics Corp (Boston Scientific Corporation)
• Inventors: Behl, Robert S., Kermit, Eben L., Lyons, Peter F., Nichols, Colin J.
• Primary Examiner(s): Peffley, Michael
• Assistant Examiner(s): YARNELL, BRYAN KEITH
• Application Number:
  US08/936,294
• Time in Patent Office: 726 Days
• Field of Search: 606/32, 606/34, 606/37-42, 606/45, 606/49, 606/27-29, 607/96, 607/98, 607/99, 607/113, 604/49, 604/114
• US Class Current: 606/34
• CPC Class Codes: A61B 18/1477 Needle-like probes

Abstract

Methods for heating tissue by delivering radio frequency energy through tissue electrodes comprise controlling energy delivery so that an abrupt increase in impedance between the electrodes and the tissue is observed, typically in the form of an abrupt decrease in power delivered to the electrodes. The power at which the impedance increases and/or the time required to induce such an increase in impedance, are relied on to determine acceptable ranges to achieve a maximum sustainable delivery of radio frequency energy to the tissue consistent with complete, rapid, and uniform heating of the tissue.

Claims

1. A method for heating a treatment region within solid tissue, said method comprising:

introducing at least one electrode to a target site within the treatment region;

energizing the electrode at a power level;

increasing the power level to an elevated power level at which an abrupt increase in electrode-tissue interface impedance is observed;

reducing power sufficiently below said elevated level to permit the electrode-tissue interface impedance to decrease; and

reenergizing the electrode at a level below said elevated level.

2. A method as in claim 1, wherein the electrode is energized with radio frequency current.

3. A method as in claim 2, wherein the radio frequency current is supplied with a controlled voltage power supply, wherein the increase in impedance is observed as a decrease in delivered power.

4. A method as in claim 1, wherein the reenergizing step is continued until at least a portion of the solid tissue in the treatment region is necrosed.

5. A method as in claim 1, wherein the solid tissue is liver tissue, kidney tissue, lung tissue, bowel tissue, stomach tissue, pancreas tissue, breast tissue, uterine tissue, prostate tissue, and muscle tissue.

6. A method as in claim 1, wherein the electrode power is increased to a level in the range from 50 W to 200 W.

7. A method as in claim 1, wherein the electrode is reenergized at a power level from 50% to 90% of the elevated power level.

8. A method as in claim 1, wherein the electrode energizing step comprises energizing with a power level selected to be less than the level which results in the abrupt increase in electrode/tissue interface impedance.

9. A method as in claim 8, wherein the elevated power level is predetermined and the power is increased abruptly, said method further comprising measuring the time elapsed from initiating the power increase to observing the electrode-tissue interface impedance increase, wherein the level of reenergization power varies inversely with the length of elapsed time.

10. A method as in claim 9, further comprising increasing the power level abruptly a second time to a elevated power level, measuring the elapsed time from initiating the second power increase to observing an electrode-tissue interface impedance increase, reducing power sufficiently below the elevated power level to permit the electrode-interface impedance to decrease, and reenergizing the electrode at a level which varies inversely with the second length of elapsed time.

11. A method as in claim 10, wherein the power is increased linearly at a rate in the range from 10 W/min. to 15 W/min.

12. A method as in claim 10, wherein the power is increased non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

13. A method as in claim 1, wherein the power is increased over time until the abrupt increase in electrode-tissue interface impedance is observed, further comprising:

determining the elevated power level at which the electrode-tissue interface impedance increase is observed;

wherein the reenergization power level is a predetermined fraction of the maximum power level.

14. A method as in claim 13, wherein the predetermined fraction is from 60% to 90%.

15. A system comprising:

an electrosurgical power supply; and

instructions setting forth the method of claim 1.

16. A computer program embodied in a tangible medium, wherein the program sets forth a method according to claim 1.

17. A method for energizing an electrode disposed within solid tissue, said method comprising:

delivering radio frequency power to the electrode under constant voltage;

monitoring a power level being delivered;

increasing the power until reaching an elevated power level at which the power level abruptly decreases due to an increase in impedance between the electrode and the tissue;

reducing the power level sufficiently to allow the impedance to decrease; and

restoring the power to the electrode at a power level below the elevated power level.

18. An improved method as in claim 17, wherein the electrode current is increased to a power level in the range from 50 W to 200 W.

19. An improved method as in claim 17, wherein the power is restored to a power level from 50% to 90% of the elevated power level.

20. A method as in claim 17, wherein the delivering step comprises energizing with a power level selected to be less than the level which results in the abrupt increase in electrode/tissue interface impedance.

21. A method as in claim 20, wherein the predetermined fraction is from 60% to 90%.

22. A method as in claim 17, wherein the elevated power level is predetermined and the power is increased abruptly, said method further comprising measuring the time elapsed from initiating the power increase to observing the abrupt power level decrease, wherein the level of restored current varies inversely with the length of elapsed time.

23. A method as in claim 22, further comprising increasing the power level abruptly a second time to a elevated power level, measuring the elapsed time from initiating the second power increase to observing an abrupt power level decrease, reducing power sufficiently below the elevated power level to permit the electrode-tissue impedance to decrease, and restoring current to the electrode at a level which varies inversely with the second length of elapsed time.

24. A method as in claim 23, wherein the power is increased non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

25. A method as in claim 17, wherein the current is increased over time until the abrupt decrease in power level is observed, further comprising:

determining the elevated power level at which the power level is observed;

wherein the restored current level is a predetermined fraction of the elevated power level.

26. A method as in claim 25, wherein the power is increased linearly at a rate in the range from 10 W/min. to 15 W/min.

27. A system comprising:

an electrosurgical power supply; and

instructions setting forth the method of claim 17.

28. A computer program embodied in a tangible medium, wherein the program sets forth a method according to claim 17.

29. An improved method for energizing an electrode disposed in tissue, said method being of the type wherein the electrode is powered by a radio frequency power supply, wherein the improvement comprises increasing voltage to increase power delivered to the electrode to a predetermined level, monitoring power delivered to the electrode until an abrupt drop in power delivered to the electrode is observed, and thereafter delivering current to the electrode at a level which results in a power level below that at which the abrupt drop in power delivered was observed.

30. A method as in claim 29, wherein the electrode current is increased to a power level in the range from 50 W to 200 W.

31. A method as in claim 29, wherein the electrode current is thereafter delivered at a power level from 50% to 90% of the maximum power level.

32. A method as in claim 29, wherein the current is increased at an initial time to a level preselected to result in the abrupt drop in power at a subsequent time, further comprising measuring the time elapsed from the initial time to the subsequent time, wherein the current delivered thereafter is delivered at a level which varies inversely with the length of elapsed time.

33. A method as in claim 29, wherein the current is increased linearly over time, further comprising determining the current at which the abrupt power decrease occurs, wherein the current is delivered thereafter at a fraction of the level at which the power decrease occurred.

34. A method as in claim 33, wherein the current is increased linearly at a rate in the range from 10 W/min. to 15 W/min.

35. A method as in claim 33, wherein the power is increased non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

36. A method as in claim 33, wherein the fraction is from 50% to 90%.

37. A system comprising:

an electrosurgical power supply; and

instructions setting forth the method of claim 29.

38. A computer program embodied in a tangible medium, wherein the program sets forth a method according to claim 29.

39. An electrosurgical power supply comprising:

a radio frequency power source having a controlled voltage output and a first connection for a tissue electrode and a second connection for a counter electrode; and

means for delivering and automatically adjusting power between an electrode in solid tissue connected to the first connection and a counter electrode electrically coupled to the solid tissue and connected to the second connection;

wherein the adjusting means increases power to a maximum level when an abrupt rise in impedance occurs, at which time the adjusting means reduces power below said maximum level sufficiently to permit the impedance to decrease, after which time the adjusting means increases power to a treatment level below the maximum power level.

40. An electrosurgical power supply as in claim 39, further comprising a counter electrode selected from the group consisting of dispersive or return electrodes and additional tissue electrodes.

41. An electrosurgical power supply as in claim 39, wherein the adjusting means initiates a cycle where it abruptly raises the power to a predetermined maximum level, determines the time elapsed from initiating the power increase to observing the abrupt rise in impedance, and determines the treatment power level based at least in part on the length of elapsed time.

42. An electrosurgical power supply as in claim 41, wherein the adjusting means repeats the cycle.

43. An electrosurgical power supply as in claim 39, wherein the adjusting means initiates a cycle where the power is increased over time until the abrupt increase in electrode-tissue interface impedance is observed, the maximum power level at which the abrupt impedance increase occurs is observed, and the treatment power level is determined as a fraction of the maximum power level.

44. An electrosurgical power supply as in claim 43, wherein the adjusting means increases power linearly over a rate in the range from 10 W/min. to 15 W/min.

45. An electrosurgical power supply as in claim 43, wherein the adjusting means increases power non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

46. An electrosurgical power supply as in claim 43, wherein the predetermined fraction is from 50% to 90%.

47. An electrosurgical power supply as in claim 46, wherein the power source operates at a frequency in the range from 300 kHz to 1.25 MHz and a power level in the range from 10 W to 200 W.

48. An electrosurgical power supply as in claim 46, wherein the adjusting means comprises a programmable digital controller.

49. An electrosurgical power supply as in claim 48, wherein the adjusting means comprises a control program embodied in a tangible medium.

50. An electrosurgical power supply as in claim 46, wherein the adjusting means is responsive solely to the delivered power.

51. A method for heating a treatment region within solid tissue, said method comprising:

introducing at least one electrode to a target site within the treatment region;

energizing the electrode at a power level;

increasing the power level to an elevated power level at which an abrupt increase in electrode-tissue interface impedance is observed;

reducing power sufficiently below said elevated level to permit the electrode-tissue interface impedance to decrease; and

reenergizing the electrode at a power level from 50% to 90% of the elevated power level.

52. A method as in claim 51, wherein the electrode is energized with radio frequency current.

53. A method as in claim 52, wherein the radio frequency current is supplied with a controlled voltage power supply, wherein the increase in impedance is observed as a decrease in delivered power.

54. A method as in claim 51, wherein the reenergizing step is continued until at least a portion of the solid tissue in the treatment region is necrosed.

55. A method as in claim 51, wherein the solid tissue is liver tissue, kidney tissue, lung tissue, bowel tissue, stomach tissue, pancreas tissue, breast tissue, uterine tissue, prostate tissue, and muscle tissue.

56. A method as in claim 51, wherein the electrode power is increased to a level in the range from 50 W to 200 W.

57. A method as in claim 51, wherein the electrode energizing step comprises energizing with a power level selected to be less than the level which results in the abrupt increase in electrode/tissue interface impedance.

58. A method as in claim 57, wherein the elevated power level is predetermined and the power is increased abruptly, said method further comprising measuring the time elapsed from initiating the power increase to observing the electrode-tissue interface impedance increase, wherein the level of reenergization power varies inversely with the length of elapsed time.

59. A method as in claim 58, further comprising increasing the power level abruptly a second time to a elevated power level, measuring the elapsed time from initiating the second power increase to observing an electrode-tissue interface impedance increase, reducing power sufficiently below the elevated power level to permit the electrode-interface impedance to decrease, and reenergizing the electrode at a level which varies inversely with the second length of elapsed time.

60. A method as in claim 59, wherein the power is increased non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

61. A method as in claim 51, wherein the power is increased over time until the abrupt increase in electrode-tissue interface impedance is observed, further comprising:

determining the elevated power level at which the electrode-tissue interface impedance increase is observed;

wherein the reenergization power level is a predetermined fraction of the maximum power level.

62. A method as in claim 61, wherein the predetermined fraction is from 60% to 90%.

63. A method as in claim 51, wherein the power is increased linearly at a rate in the range from 10 W/min. to 15 W/min.

64. A system comprising:

an electrosurgical power supply; and

instructions setting forth the method of claim 51.

65. A computer program embodied in a tangible medium, wherein the program sets forth a method according to claim 51.

66. A method for energizing an electrode disposed within solid tissue, said method comprising:

delivering radio frequency power to the electrode under constant voltage;

monitoring a power level being delivered;

increasing the power until reaching an elevated power level at which the power level abruptly decreases due to an increase in impedance between the electrode and the tissue;

reducing the power level sufficiently to allow the impedance to decrease; and

restoring the power to the electrode at a power level from 50% to 90% of the elevated power level.

67. An improved method as in claim 66, wherein the electrode current is increased to a power level in the range from 50 W to 200 W.

68. A method as in claim 66, wherein the delivering step comprises energizing with a power level selected to be less than the level which results in the abrupt increase in electrode/tissue interface impedance.

69. A method as in claim 68, wherein the predetermined fraction is from 60% to 90%.

70. A method as in claim 66, wherein the elevated power level is predetermined and the power is increased abruptly, said method further comprising measuring the time elapsed from initiating the power increase to observing the abrupt power level decrease, wherein the level of restored current varies inversely with the length of elapsed time.

71. A method as in claim 70, further comprising increasing the power level abruptly a second time to a elevated power level, measuring the elapsed time from initiating the second power increase to observing an abrupt power level decrease, reducing power sufficiently below the elevated power level to permit the electrode-tissue impedance to decrease, and restoring current to the electrode at a level which varies inversely with the second length of elapsed time.

72. A method as in claim 71, wherein the power is increased non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

73. A method as in claim 66, wherein the current is increased over time until the abrupt decrease in power level is observed, further comprising:

determining the elevated power level at which the power level is observed;

wherein the restored current level is a predetermined fraction of the elevated power level.

74. A method as in claim 73, wherein the power is increased linearly at a rate in the range from 10 W/min. to 15 W/min.

75. A system comprising:

an electrosurgical power supply; and

instructions setting forth the method of claim 66.

76. A computer program embodied in a tangible medium, wherein the program sets forth a method according to claim 66.

77. An improved method for energizing an electrode disposed in tissue, said method being of the type wherein the electrode is powered by a radio frequency power supply, wherein the improvement comprises increasing voltage to increase power delivered to the electrode to a predetermined level, monitoring power delivered to the electrode until an abrupt drop in power delivered to the electrode is observed, and thereafter delivering current to the electrode at a level which results in a power level from 50% to 90% of the maximum power level at which the abrupt drop in power delivered was observed.

78. A method as in claim 77, wherein the current is increased at an initial time to a level preselected to result in the abrupt drop in power at a subsequent time, further comprising measuring the time elapsed from the initial time to the subsequent time, wherein the current delivered thereafter is delivered at a level which varies inversely with the length of elapsed time.

79. A method as in claim 77, wherein the current is increased linearly over time, further comprising determining the current at which the abrupt power decrease occurs, wherein the current is delivered thereafter at a fraction of the level at which the power decrease occurred.

80. A method as in claim 79, wherein the current is increased linearly at a rate in the range from 10 W/min. to 15 W/min.

81. A method as in claim 79, wherein the power is increased non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

82. A method as in claim 79, wherein the fraction is from 50% to 90%.

83. A system comprising:

an electrosurgical power supply; and

instructions setting forth the method of claim 77.

84. A computer program embodied in a tangible medium, wherein the program sets forth a method according to claim 77.

85. An electrosurgical power supply comprising:

a radio frequency power source having a controlled voltage output and a first connection for a tissue electrode and a second connection for a counter electrode;

means for delivering and automatically adjusting power between an electrode in solid tissue connected to the first connection and a counter electrode electrically coupled to the solid tissue and connected to the second connection; and

a counter electrode selected from the group consisting of dispersive or return electrodes and additional tissue electrodes; and

wherein the adjusting means increases power to a maximum level when an abrupt rise in impedance occurs, at which time the adjusting means reduces power below said maximum level sufficiently to permit the impedance to decrease, after which time the adjusting means increases power to a treatment level below the maximum power level.

86. An electrosurgical power supply as in claim 85, wherein the adjusting means initiates a cycle where it abruptly raises the power to a predetermined maximum level, determines the time elapsed from initiating the power increase to observing the abrupt rise in impedance, and determines the treatment power level based at least in part on the length of elapsed time.

87. An electrosurgical power supply as in claim 86, wherein the adjusting means repeats the cycle.

88. An electrosurgical power supply as in claim 85, wherein the adjusting means initiates a cycle where the power is increased over time until the abrupt increase in electrode-tissue interface impedance is observed, the maximum power level at which the abrupt impedance increase occurs is observed, and the treatment power level is determined as a fraction of the maximum power level.

89. An electrosurgical power supply as in claim 88, wherein the adjusting means increases power linearly over a rate in the range from 10 W/min. to 15 W/min.

90. An electrosurgical power supply as in claim 88, wherein the adjusting means increases power non-linearly at a rate which increases within the range from 5 W/min. to 25 W/min.

91. An electrosurgical power supply as in claim 88, wherein the predetermined fraction is from 50% to 90%.

92. An electrosurgical power supply as in claim 91, wherein the power source operates at a frequency in the range from 300 kHz to 1.25 MHz and a power level in the range from 10 W to 200 W.

93. An electrosurgical power supply as in claim 91, wherein the adjusting means comprises a programmable digital controller.

94. An electrosurgical power supply as in claim 93, wherein the adjusting means comprises a control program embodied in a tangible medium.

95. An electrosurgical power supply as in claim 91, wherein the adjusting means is responsive solely to the delivered power.