Systems and methods for electrosurgical tissue revascularization

• US 6,102,046 A
• Filed: 06/02/1998
• Issued: 08/15/2000
• Est. Priority Date: 11/22/1995
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Thapliyal, Hira V., Weinstein, Allan
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US09/089,012
• Time in Patent Office: 805 Days
• Field of Search: 606/41, 606/42, 606/45, 606/48, 607/101, 607/102, 607/104, 607/105, 604/22, 604/114, 128/898
• US Class Current: 128/898
• 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

Systems, apparatus and methods are provided for canalizing or boring channels, divots, trenches or holes through tissue to revascularize the region around this tissue. In one method, an electrode terminal is positioned in close proximity to a target site and a high frequency voltage difference is applied between the electrode terminal and a return electrode to volumetrically remove or ablate tissue at the target site. The electrode terminal(s) may be translated relative to the body structure during or after the application of electrical energy to sculpt a void within the body structure, such as a hole, channel, stripe, crater, divot or the like. The present invention may be useful for revascularization of a healthy meniscus, or a torn or damaged meniscus during a repair procedure. For example, channels may be formed from the inner aspect to the outer aspect of the meniscus to promote direct communication between blood within the outer aspect and that of existing meniscus vasculature to increase blood flow therein.

Claims

1. A method of revascularizing a region of tissue at a target site comprising:

positioning an electrode terminal in close proximity to tissue in a region of the target site;

applying high frequency voltage to the electrode terminal, the high frequency voltage being sufficient to promote revascularization of tissue in the region of the target site;

introducing at least a distal end of an electrosurgical probe into a patient'"'"'s knee;

positioning the distal end of the probe in close proximity to a meniscus within the knee; and

forming a hole within the meniscus from an inner aspect of the meniscus to an outer aspect of the tissue.

2. The method of claim 1 wherein revascularization of tissue is at least partly accomplished by volumetrically removing a portion of the tissue in said region.

3. The method of claim 2 further comprising advancing at least a distal surface of the electrode terminal into a space vacated by the removed tissue.

4. The method of claim 2 further comprising applying high frequency voltage between the electrode terminal and a return electrode, the high frequency voltage being sufficient to volumetrically remove tissue at the target site.

5. The method of claim 4 wherein the return electrode is located on an external surface of the patient'"'"'s body.

6. The method of claim 4 wherein the return electrode and the electrode terminal are both located on an electrosurgical probe.

7. The method of claim 4 further comprising locating electrically conductive fluid between the electrode terminal and the return electrode and generating a current flow path from the electrode terminal through the electrically conductive fluid to the return electrode.

8. The method of claim 1 wherein revascularization of tissue is at least partly accomplished by forming a channel within said region of the target site.

9. The method of claim 1 wherein revascularization of tissue is at least partly accomplished by forming a hole within said region of the target site.

10. The method of claim 1 further comprising an electrode array including a plurality of electrically isolated electrode terminals.

11. The method of claim 1 wherein the electrode terminal comprises a single electrode adjacent a distal end of an electrosurgical probe.

12. The method of claim 1 further comprising locating electrically conductive fluid between the electrode terminal and the tissue.

13. The method of claim 12 wherein the electrically conductive fluid comprises isotonic saline.

14. The method of claim 1 further comprising forming a hole with a lateral dimension of about 1.5 to 20 mm.

15. The method of claim 14 wherein the hole is about 5 mm to about 4.0 cm deep.

16. A method of revascularizing a region of a patient'"'"'s meniscus tissue comprising:

positioning a distal end of an electrosurgical instrument adjacent to a region of the meniscus tissue;

applying sufficient energy to the region of meniscus tissue to remove a portion of tissue within said region to promote blood flow to said region; and

forming a hole from an inner portion of the meniscus tissue to the outer portion of the meniscus tissue.

17. The method of claim 16 wherein said applying step comprises applying a high frequency voltage difference between an electrode terminal located on the electrosurgical instrument and a return electrode.

18. The method of claim 17 further comprising locating an electrically conductive fluid between the electrode terminal and return electrode to provide a current flow path therebetween.

19. The method of claim 16 further comprising forming a hole from an inner portion of the meniscus tissue to the outer portion of the meniscus tissue.