Systems and methods for electrosurgical endoscopic sinus surgery

• US 6,109,268 A
• Filed: 12/15/1997
• Issued: 08/29/2000
• 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:
  US08/990,374
• Time in Patent Office: 988 Days
• Field of Search: 606/41, 606/42, 606/45-50, 607/100-105, 128/898, 604/21, 604/22, 604/114
• US Class Current: 128/898
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• 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 2018/00083 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 2018/00327 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. Depending on the specific procedure, the present invention may be used to: (1) volumetrically remove tissue (i.e., ablate or effect molecular dissociation of the tissue structure); (2) shrink or contract collagen connective tissue; and/or (3) coagulate severed blood vessels. For example, the present invention may be useful for ablation and hemostasis of tissue in sinus surgery (e.g., chronic sinusitis or the removal of turbinates, polypectomies), collagen shrinkage, ablation and/or hemostasis in procedures for treating snoring and obstructive sleep apnea (e.g., soft palate, such as the uvula, or tongue/pharynx stiffening, and midline glossectomies), for gross tissue removal, such as tonsillectomies, adenoidectomies, tracheal stenosis and vocal cord polyps and lesions, or for the resection or ablation of facial tumors or tumor with the mouth and pharynx, such as glossectomies, laryngectomies, acoustic neuroma procedures and nasal ablation procedures.

Claims

1. A method for treating tissue at a target site in a cavity within a patient'"'"'s nose comprising:

introducing an electrode terminal through an opening in the patient'"'"'s head such that the electrode terminal is positioned adjacent to the tissue within the cavity;

delivering electrically conductive fluid into the cavity and past the return electrode to substantially surround the electrode terminal with the electrically conductive fluid and to generate a current flow path between the return electrode and the electrode terminal; and

applying high frequency voltage between the electrode terminal and a return electrode, the high frequency voltage being sufficient to remove at least a portion of the tissue immediately while the voltage difference is being applied between the electrode terminal and the return electrode.

2. The method of claim 1 wherein the tissue comprises a blockage within the nasal cavity or a paranasal sinus of the patient.

3. The method of claim 2 wherein the blockage is selected from the group comprising swollen tissue, turbinates, polyps, neoplasms and swollen mucus membranes lining an inner surface of the nasal cavity.

4. The method of claim 1 wherein the tissue comprises cartilage within the nose.

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 wherein the electrode terminal comprises a single, active electrode at the distal end of a shaft.

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

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

9. The method of claim 1 wherein the opening in the patient'"'"'s head comprises one of the patient'"'"'s nasal passages.

10. The method of claim 1 further comprising viewing the target site with an endoscope delivering through one of the patient'"'"'s nasal passages.

11. The method of claim 10 wherein the electrode terminal and the endoscope are delivered through the same nasal passage.

12. The method of claim 7 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 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.

14. The method of claim 13 further comprising accelerating charged particles from the vaporized fluid to the tissue to cause dissociation of the molecular bonds within the tissue structures.

15. The method of claim 1 further comprising axially translating the electrode terminal towards the tissue to generate a hole within the tissue.

16. The method of claim 15 wherein the hole has a diameter less than about 2 mm.

17. The method of claim 15 wherein the hole has a diameter less than about 1 mm.

18. The method of claim 1 wherein the cavity is a sinus cavity, the method further comprising removing tissue around the natural ostium of the sinus cavity to enlarge the sinus cavity and increase aeration of the sinus.

19. A method for endoscopic sinus surgery comprising:

introducing an endoscope into a patient'"'"'s nasal cavity to view a tissue structure;

introducing an electrode terminal into the nasal cavity adjacent to the tissue structure;

applying an electrically conductive gel between the tissue structure and the electrode terminal; and

applying a high frequency voltage difference between the electrode terminal and a return electrode, the voltage difference being sufficient to modify a portion of the tissue structure.

20. A method for endoscopic sinus surgery comprising:

introducing an endoscope into a patient'"'"'s nasal cavity to view a tissue structure;

introducing an electrode terminal into the nasal cavity adjacent to the tissue structure;

applying electrically conductive fluid between the tissue structure and the electrode terminal; and

applying a high frequency voltage difference between the electrode terminal and a return electrode, the voltage difference being sufficient to remove a portion of the tissue structure immediately while the voltage difference is being applied between the electrode terminal and the return electrode.

21. The method of claim 20 wherein the voltage difference is sufficient to effect molecular dissociation of the tissue structure.

22. The method of claim 20 wherein the voltage difference is sufficient to cauterize and seal transected blood vessels as said portion of the tissue structure is removed.

23. The method of claim 20 wherein the electrically conductive fluid is a liquid that is delivered to the tissue structure by a fluid delivery element.

24. The method of claim 20 further comprising generating an electrically conductive path from the electrode terminal to the return electrode through the electrically conductive fluid.

25. The method of claim 20 wherein the electrode terminal is introduced through a nasal passage.

26. The method of claim 20 further comprising:

positioning the electrode terminal in contact with, or close proximity to, the tissue structure in the presence of the electrically conductive fluid; and

spacing the return electrode away from the tissue structure within the electrically conductive fluid such that the return electrode is not in contact with the tissue structure.