Systems and methods for electrosurgical sinus surgery

• US 6,053,172 A
• Filed: 05/22/1998
• Issued: 04/25/2000
• Est. Priority Date: 06/07/1995
• Status: Expired due to Term

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Hovda, David C., Ellsberry, Maria B., Thapliyal, Hira V.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US09/083,526
• Time in Patent Office: 704 Days
• Field of Search: 128/898, 606/41, 606/42, 606/45-52, 607/100-105
• US Class Current: 128/898
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• 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 2017/00101 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 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 2018/00327 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 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• 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 2018/1253 : 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 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems and methods for selectively applying electrical energy to a target location within the head and neck of a patient'"'"'s body, particularly including tissue in the ear, nose and throat. The present invention applies high frequency (RF) electrical energy to one or more electrode terminals in the presence of electrically conductive fluid to remove and/or modify the structure of tissue structures. The present invention is particularly useful for removing occlusive media within the small body passages connected to sinus cavities within the patient'"'"'s nose to treat chronic sinusitis.

Claims

1. A method for treating tissue in a body lumen within a patient'"'"'s nose comprising:

introducing an electrode terminal through an opening in the patient'"'"'s head into the nasal cavity;

advancing the electrode terminal into a body lumen coupled to a sinus cavity;

applying sufficient high frequency voltage to the electrode terminal to remove at least a portion of the occlusive media within the body lumen and to convert solid occlusive media molecules into non-condensable gases; and

aspirating the non-condensable gases from the body lumen.

2. The method of claim 1 further comprising applying sufficient high frequency voltage to the electrode terminal to effect molecular dissociation of at least a portion of the occlusive media.

3. The method of claim 1 wherein the applying step includes generating a voltage gradient between the electrode terminal and the tissue, the voltage gradient being sufficient to create an electric field that breaks down the tissue through molecular dissociation.

4. The method of claim 1 wherein the positioning step comprises advancing catheter shaft through the body lumen, the electrode terminal being located on the distal end portion of the catheter shaft.

5. The method of claim 1 wherein the high frequency voltage is sufficient to effect hemostasis of severed blood vessels within the tissue during the removal step.

6. The method of claim 1 further comprising locating conductive fluid within the body lumen such that the electrode terminal is substantially surrounded by the electrically conductive fluid and electrically conductive fluid is located between the electrode terminal and the occlusive media.

7. The method of claim 6 further comprising applying high frequency voltage between the electrode terminal and a return electrode and generating a current flow path between the return electrode and the electrode terminal with the electrically conductive fluid.

8. The method of claim 6 further comprising applying sufficient voltage to the electrode terminal in the presence of the electrically conducting fluid to vaporize at least a portion of the fluid between the electrode terminal and the tissue at the target site.

9. The method of claim 8 further comprising accelerating charged particles from the vaporized fluid to the tissue to cause dissociation of the molecular bonds within the tissue structures.

10. The method of claim 1 wherein the electrode terminal comprises a single, active electrode at the distal end of a shaft.

11. The method of claim 1 wherein the electrode terminal comprises a plurality of electrically isolated electrode terminals at the distal end of a shaft.

12. The method of claim 11 further comprising independently controlling current flow from at least two of the electrode terminals based on impedance between the electrode terminal and a return electrode.

13. The method of claim 1 further comprising aspirating fluid from the target site during the removal step.

14. The method of claim 1 further comprising axially translating the electrode terminal through the vacated occlusive media to clear an opening within the body lumen.

15. A method for treating tissue in a body lumen within a patient'"'"'s nose comprising:

introducing an electrode terminal through an opening in the patient'"'"'s head into the nasal cavity;

advancing the electrode terminal into a body lumen coupled to a sinus cavity;

applying sufficient high frequency voltage to the electrode terminal to remove at least a portion of the occlusive media within the body lumen; and

aspirating fluid from the target site.

16. The method of claim 15 further comprising applying sufficient high frequency voltage to the electrode terminal to effect molecular dissociation of at least a portion of the occlusive media.

17. The method of claim 15 further comprising applying sufficient high frequency voltage to the electrode terminal to convert solid occlusive media molecules into non-condensable gases.

18. The method of claim 17 further comprising aspirating the non-condensable gases from the body lumen.

19. The method of claim 15 wherein the applying step includes generating a voltage gradient between the electrode terminal and the tissue, the voltage gradient being sufficient to create an electric field that breaks down the tissue through molecular dissociation.

20. The method of claim 15 wherein the positioning step comprises advancing catheter shaft through the body lumen, the electrode terminal being located on the distal end portion of the catheter shaft.

21. The method of claim 15 wherein the high frequency voltage is sufficient to effect hemostasis of severed blood vessels within the tissue during the removal step.

22. The method of claim 15 further comprising locating conductive fluid within the body lumen such that the electrode terminal is substantially surrounded by the electrically conductive fluid and electrically conductive fluid is located between the electrode terminal and the occlusive media.

23. The method of claim 22 further comprising applying high frequency voltage between the electrode terminal and a return electrode and generating a current flow path between the return electrode and the electrode terminal with the electrically conductive fluid.

24. The method of claim 22 further comprising applying sufficient voltage to the electrode terminal in the presence of the electrically conducting fluid to vaporize at least a portion of the fluid between the electrode terminal and the tissue at the target site.

25. The method of claim 15 wherein the electrode terminal comprises a single, active electrode at the distal end of a shaft.

26. The method of claim 15 wherein the electrode terminal comprises a plurality of electrically isolated electrode terminals at the distal end of a shaft.

27. The method of claim 26 further comprising independently controlling current flow from at least two of the electrode terminals based on impedance between the electrode terminal and a return electrode.

28. The method of claim 15 further comprising aspirating fluid from the target site during the removal step.

29. The method of claim 15 further comprising accelerating charged particles from the vaporized fluid to the tissue to cause dissociation of the molecular bonds within the tissue structures.

30. The method of claim 15 further comprising axially translating the electrode terminal through the vacated occlusive media to clear an opening within the body lumen.