System and methods for electrosurgical treatment of obstructive sleep disorders

• US 6,159,208 A
• Filed: 03/15/1999
• Issued: 12/12/2000
• 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: Woloszko, Jean, Eggers, Philip E., Hovda, David C., Ellsberry, Maria B., Thapliyal, Hira V.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/268,616
• Time in Patent Office: 638 Days
• Field of Search: 606/41, 606/49, 606/50, 606/32, 606/45, 606/46, 606/48, 604/22, 604/117, 607/99, 607/105, 607/113, 607/122, 128/898
• US Class Current: 606/41
• 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 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2018/00119 with metal oxide nitride
• CPC Class Codes: A61B 2018/00327 Ear, nose or throat
• CPC Class Codes: A61B 2018/00583 Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00827 Current
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/124 switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1273 including multiple generators in one device
• CPC Class Codes: A61B 2018/1467 using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/162 located on the probe body
• CPC Class Codes: A61B 2018/165 Multiple indifferent electrodes

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 includes a channeling technique in which small holes or channels are formed within tissue structures in the mouth, such as the tonsils, tongue, palate and uvula, and thermal energy is applied to the tissue surface immediately surrounding these holes or channels to cause thermal damage to the tissue surface, thereby stiffening the surrounding tissue structure. Applicant has discovered that such stiffening of certain tissue structures in the mouth and throat helps to prevent the tissue structure from obstructing the patient'"'"'s upper airway during sleep.

Claims

1. A method for treating obstructive sleep disorders comprising:

positioning an active electrode adjacent to a tissue structure in a patient'"'"'s mouth or throat;

applying high frequency voltage between the active electrode and a return electrode, the high frequency voltage being sufficient to ablate tissue;

during the applying step, advancing the active electrode into the tissue to generate a space within the tissue; and

removing the active electrode from the space within the tissue.

2. The method of claim 1 further comprising, during the removing step, applying high frequency voltage between the active and return electrodes, the high frequency voltage being sufficient to coagulate blood at the tissue surface surrounding the space.

3. The method of claim 2 wherein the high frequency voltage during the removal step is sufficient to thermally damage the surface of the tissue surrounding the space.

4. The method of claim 1 further comprising providing an electrically conductive fluid around the active electrode and between the active and return electrodes prior to the applying step.

5. The method of claim 4 wherein the providing step comprises positioning the active and return electrodes within a source of electrically conductive fluid and then positioning the active and return electrodes into the patient'"'"'s mouth adjacent to the tissue structure.

6. The method of claim 4 wherein the providing step comprises delivering the electrically conductive fluid to the active and return electrodes at the target site in the patient'"'"'s mouth.

7. The method of claim 4 further comprising generating a current flow path between the active and return electrodes with the electrically conductive fluid.

8. The method of claim 4 further comprising aspirating fluid from a region around the active electrode.

9. The method of claim 4 wherein the electrically conductive fluid is not present during the removal step.

10. The method of claim 1 further comprising applying a sufficient high frequency voltage difference between the active and return electrodes to effect molecular dissociation of at least a portion of the tissue structure during the advancing step.

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

12. The method of claim 1 wherein the positioning step is carried out by positioning a single, active electrode adjacent to the tissue structure.

13. The method of claim 1 wherein the positioning step is carried out by positioning a plurality of electrically isolated electrode terminals adjacent to the tissue structure.

14. The method of claim 1 further comprising applying sufficient voltage to the active electrode in the presence of electrically conducting fluid to vaporize at least a portion of the fluid between the active electrode and the tissue structure.

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

16. The method of claim 1 further comprising axially translating the active electrode to form a hole through at least a portion of the tissue structure.

17. The method of claim 1 further comprising transversely translating the active electrode relative to the tissue structure to form a channel along the outer surface of the tissue structure.

18. The method of claim 1 wherein the space has a maximum lateral dimension less than about 2 mm.

19. The method of claim 1 wherein the space has a maximum lateral dimension less than about 1 mm.

20. The method of claim 1 wherein the positioning step is carried out by providing an electrode and a return electrode on a distal portion of a shaft of an electrosurgical instrument and positioning the distal portion of the shaft adjacent to the tissue structure.

21. The method of claim 20 wherein the return electrode is axially spaced at least about 1.0 mm from the active electrode.

22. The method of claim 20 further comprising, during the removal step, deactivating the active electrode and applying a high frequency voltage difference between a second active electrode and one or more return electrodes on the instrument shaft.

23. The method of claim 22 wherein the second active electrode is spaced proximally from the return electrode.

24. The method of claim 23 wherein the instrument shaft comprises a second return electrode spaced proximally from the second active electrode, the method comprising, during the removal step, applying a high frequency voltage difference between the second active electrode and the first and second return electrodes.

25. The method of claim 20 further comprising, during the removal step, deactivating the active electrode and applying a high frequency voltage difference between the return electrode on the instrument shaft and a dispersive return electrode coupled to an external surface of the patient.