System and method for electrosurgical tissue contraction

• US 6,159,194 A
• Filed: 10/02/1997
• Issued: 12/12/2000
• Est. Priority Date: 01/07/1992
• 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.
• Primary Examiner(s): Coggins, Wynn Wood
• Assistant Examiner(s): Sadula, Jennifer R.
• Application Number:
  US08/942,580
• Time in Patent Office: 1,167 Days
• Field of Search: 604/28, 604/500, 604/518, 604/522, 604/22, 604/113, 604/114, 604/23, 606/35-42
• US Class Current: 604/500
• 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 2017/00247 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 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• 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 2018/00726 : Duty cycle
• 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 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• 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 2090/378 : using ultrasound
• 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: 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 and methods are provided for performing electrosurgical interventions, such as selectively contracting soft collagen tissue and other body structures, while limiting thermal damage or molecular dissociation of such tissue and limiting the thermal damage to tissue adjacent to and underlying the treatment site. The systems and methods of the present invention are particularly useful for surgical procedures in electrically conducting environments, such as arthroscopic procedures in the joints, e.g., shoulder, knee, hip, hand, foot, elbow or the like. The present invention is also useful in relatively dry environments, such as treating and shaping the cornea, and dermatological procedures involving surface tissue contraction of tissue underlying the surface of the skin for tissue rejuvenation, wrinkle removal and the like.

Claims

1. A method for contracting collagen tissue at a target site on or within a patient'"'"'s body comprising:

heating an electrically conducting fluid in the region of the target site; and

directing the heated electrically conducting fluid onto tissue at the target site to induce contraction of collagen fibers in said tissue.

2. The method of claim 1 wherein the electrically conducting fluid is heated to a temperature sufficient to substantially irreversibly contract the collagen fibers.

3. The method of claim 1 wherein the collagen fibers are heated to a temperature in the range of about 45°

C. to 90°

C.

4. The method of claim 1 wherein the collagen fibers are heated to a temperature in the range of about 60°

C. to about 70°

C.

5. The method of claim 1 wherein the heating step comprises applying high frequency voltage to an electrode terminal in contact with the electrically conducting fluid.

6. The method of claim 5 wherein the heating step further comprises inhibiting electric current from contacting the tissue at the target site to minimize damage to, or removal of, said tissue.

7. The method of claim 5 further comprising immersing the target site within a supply of the electrically conductive fluid and heating the electrically conducting fluid in the region of the electrode terminal sufficiently to propel the heated electrically conducting fluid away from the electrode terminal to the target tissue.

8. The method of claim 7 further comprising positioning a return electrode within the supply of electrically conductive fluid to generate the current flow path between the target site and the return electrode.

9. The method of claim 1 further comprising contacting the electrically conducting fluid with a return electrode to provide a current flow path from the electrode terminal, through the electrically conducting fluid, and to the return electrode.

10. The method of claim 9 further comprising maintaining a space between the electrode terminal and the tissue to inhibit electric current from directly contacting said tissue.

11. The method of claim 10 wherein the space between the electrode terminal and the tissue is between about 5 to 30 mm.

12. The method of claim 9 wherein the return electrode is positioned proximal to the electrode terminal to induce current flow from the electrode terminal away from the target site.

14. The method of claim 9 further comprising supplying the electrically conductive fluid to a proximal end of an axial lumen defined by the return electrode and directing the fluid through a distal end of the axial lumen to the electrode terminal.

15. The method of claim 1 further comprising applying RF frequency voltage to a plurality of electrically isolated electrode terminals within the electrically conducting fluid.

16. The method of claim 15 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.

17. The method of claim 1 wherein the electrically conductive fluid comprises isotonic saline.

18. The method of claim 1 further comprising applying RF frequency voltage to at least one electrode terminal within the electrically conducting fluid, the voltage being in the range of about 20-90 volts rms.

19. The method of claim 1 wherein the electrode terminal comprises an electrode array including a plurality of electrically isolated electrode terminals.

20. The method of claim 1 further comprising directing the electrically conducting fluid along a fluid path past the electrode terminal and to the target site.

21. The method of claim 1 further comprising:

supporting the electrode terminal with an electrosurgical probe having a tissue treatment surface near a distal end of the probe, wherein the electrode terminal is substantially flush with the tissue treatment surface.

13. The method of 9 further comprising directing the electrically conducting fluid past the return electrode to generate the current flow path between the return electrode and the electrode terminal.

22. A method for contracting collagen tissue at a target site on or within a patient'"'"'s body comprising:

positioning a tissue treatment surface of an electrode terminal in close proximity to the target site in the presence of an electrically conducting fluid;

contacting the electrically conducting fluid with a contact surface of a return electrode to generate a current flow path between the electrode terminal and the return electrode; and

applying high frequency voltage to the electrode terminal and the return electrode, the voltage being sufficient to induce a contraction of collagen fibers at the target site without causing dissociation or molecular breakdown of the collagen fibers.

23. The method of claim 22 further comprising controlling a depth of tissue penetration of the electric current into the tissue to control a depth of thermal heating of said tissue.

24. The method of claim 23 wherein the depth of tissue heating is less than about 3.5 mm.

25. The method of claim 23 wherein the depth of tissue heating is less than about 0.5 mm.

26. The method of claim 23 wherein the controlling step further comprises positioning the return electrode such that electric current flows from the electrode terminal away from the target site to the return electrode.

27. The method of claim 23 wherein the controlling step is carried out by controlling a frequency of the voltage applied to the electrode terminal and the return electrode.

28. The method of claim 27 wherein the voltage has a frequency of about 100 to 200 kHz.

29. The method of claim 27 wherein the voltage has a frequency of less than 350 kHz.

30. The method of claim 27 wherein the thermal energy is sufficient to induce contraction of the collagen fibers at the target site and low enough to minimize molecular dissociation or breakdown of the tissue.

31. The method of claim 23 wherein the controlling step is carried out by controlling a diameter of the electrode terminal.

32. The method of claim 22 further comprising heating the electrically conductive fluid adjacent the electrode terminal with the high frequency voltage and propelling the heated fluid to the tissue at the target site to apply thermal energy to the tissue.

33. The method of claim 23 wherein the electrode terminal is supported at a distal end of an electrosurgical probe and the controlling step is carried out by controlling a distance between an outer perimeter of the probe and the electrode terminal.

34. The method of claim 22 wherein the voltage difference applied between the return electrode and the electrode terminal is about 30 to 70 volts rms.