Methods and systems for organ resection

• US 6,123,701 A
• Filed: 10/08/1998
• Issued: 09/26/2000
• Est. Priority Date: 10/09/1997
• Status: Expired due to Term

• Current Assignee: Aesculap AG (B. Braun Holding GmbH & Co. KG)
• Original Assignee: Perfect Surgical Techniques Incorporated
• Inventors: Nezhat, Camran
• Primary Examiner(s): O'Connor, Cary
• Assistant Examiner(s): ASTORINO, MICHAEL C
• Application Number:
  US09/169,019
• Time in Patent Office: 719 Days
• Field of Search: 606/33-34, 606/41-42, 606/45-52, 606/76
• US Class Current: 606/33
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1477 Needle-like probes
• 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 18/16 Indifferent or passive electrodes for grounding
• CPC Class Codes: A61B 2017/4216 Operations on uterus, e.g. endometrium
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/1253 monopolar
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61B 2018/1425 Needle

Abstract

Methods and systems are provided for necrosing and resecting tissue. A pair of electrodes are placed on opposed tissue surfaces, and radio frequency power is applied through the electrodes to necrose a tissue mass therebetween. After necrosis has been effected, the tissue may be resected along a plane within the necrosed region with minimum or no bleeding. The tissue mass may then be removed.

Claims

1. A method for resecting tissue in a patient, said method comprising:

engaging a first electrode structure and a second electrode structure against opposed surfaces of a tissue mass prior to resecting the tissue mass from the patient, wherein each electrode has a surface area of at least 1 cm² ;

applying high frequency power through said electrodes to said tissue mass, wherein said power is applied for a time and in amount sufficient to necrose said tissue mass between said electrode structures;

stopping the high frequency power application; and

resecting the tissue within the necrosed tissue mass after the tissue has been necrosed and the application of high frequency power stopped.

2. A method as in claim 1, wherein the engaging step comprises engaging a first electrode structure which spans an area of at least 2 cm² against a first tissue surface and engaging a second electrode structure which spans an area of at least 2 cm² against a second tissue surface.

3. A method as in claim 2, wherein the engaging step comprises contacting at least one of the tissue surfaces with a flat or conformable electrode surface in a surface-to-surface manner.

4. A method as in claim 2, wherein the engaging step comprises penetrating a plurality of tissue penetrating elements into at least one of the tissue surfaces.

5. A method as in claim 2, wherein the engaging step further comprises expanding at least one of the first and second electrode structures from a retracted configuration to an expanded configuration prior to said electrode structure against the tissue surface.

6. A method as in claim 5, wherein the at least one electrode structure comprises an elastic or expansible braid or woven support.

7. A method as in claim 5, wherein the electrode structure comprises non-distensible surface.

8. A method as in claim 1, further comprising introducing the first and second electrode structures through a percutaneous access port prior to engaging said electrode structures against the tissue mass surfaces.

9. A method as in claim 8, wherein said electrode surfaces are introduced in a retracted configuration through the access port and are thereafter expanded prior to the engaging step.

10. A method as in claim 1, wherein the tissue mass is a body organ.

11. A method as in claim 10, wherein the opposed surfaces are on the exterior of the body organ.

12. A method as in claim 10, wherein one of the tissue surfaces is defined by a natural lumen within the organ and the other surface is on the exterior of the body organ.

13. A method as in claim 12, further comprising introducing an electrically conductive fluid into the lumen to enhance electrical coupling of an electrode structure in the lumen to the tissue surface.

14. A method as in claim 10, further comprising dissecting an exterior surface of the body organ away from adjacent tissue prior to the engaging step structure.

15. A method as in claim 10, further comprising creating an incision in the tissue mass, wherein the incision exposes at least one tissue surface for engagement with an electrode structure.

16. A method as in claim 1, wherein the applying step comprises applying radio frequency current at a frequency in the range from 100 kHz to 10 MHz and a power in the range from 1 W/cm² to 10 W/cm².

17. A method as in claim 16, wherein the applying step comprises heating the tissue between said opposed electrodes to a temperature above 60°

C.

18. A method as in claim 1, wherein the applying step defines a volume of necrosed tissue between said necrosed electrodes having a boundary between the necrosed tissue and adjacent viable tissue.

19. A method as in claim 18, wherein the resecting step comprises morcellating at least a portion of the tissue volume but not the adjacent viable tissue.

20. A method as in claim 1, wherein the engaging step comprises engaging a pair of semi-circular electrode structures against opposed sides of a tubular tissue mass.

21. A method as in claim 20, wherein the semi-circular electrodes are engaged to circumscribe the tubular tissue mass.

22. A method as in claim 20, where in the applying step creates a planar, disk-like region of necrosed tissue within the tubular body mass.

23. A method as in claim 22, wherein the resecting step comprises cutting along a plane within said disk-like region of necrosed tissue.

24. A method as in claim 1, further comprising removing the resected tissue from the patient.

25. A method as in claim 24, wherein the removing step comprises morcellating the tissue.

26. A method as in claim 1, wherein the engaging step comprises engaging a first electrode surface which spans an area of at least 5 cm² against a first tissue surface and engaging a second electrode surface which spans an area of at least 5 cm² against a second tissue surface.

27. A method as in claim 1, wherein the engaging step comprises engaging a first electrode surface which spans an area of at least 10 cm² against a first tissue surface and engaging a second electrode surface which spans an area of at least 10 cm² against a second tissue surface.

28. A method as in claim 1, wherein the engaging step comprises engaging a first electrode surface which spans an area of at least 50 cm² against a first tissue surface and engaging a second electrode surface which spans an area of at least 50 cm² against a second tissue surface.