Methods for tissue resection, ablation and aspiration

• US 6,190,381 B1
• Filed: 01/21/1998
• Issued: 02/20/2001
• Est. Priority Date: 06/07/1995
• Status: Expired due to Fees

• 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., Olsen, Phillip M.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/010,382
• Time in Patent Office: 1,126 Days
• Field of Search: 606/41, 606/45, 606/46, 606/48-50, 606/32, 604/114, 604/35, 607/99, 607/105, 607/113
• US Class Current: 606/32
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• 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 2018/00666 : using a threshold value
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/0072 : Current
• 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 2018/00779 : Power or energy
• 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

The present invention provides systems and methods for selectively applying electrical energy to a target location within or on a patient'"'"'s body. In particular, methods and apparatus are provided for resecting, cutting, partially ablating, aspirating or otherwise removing tissue from a target site, and ablating the tissue in situ. The systems and methods of the present invention are particularly useful for ablation and hemostasis of tissue in sinus surgery (e.g., chronic sinusitis and/or removal of polypectomies) and for resecting and ablating soft tissue structures, such as the meniscus and synovial tissue within a joint.

Claims

1. A method for treating tissue at a target site comprising:

introducing a distal end of an instrument to a target site on or within a patient'"'"'s body, wherein the instrument comprises an active electrode and a return electrode;

positioning the return electrode at the target site such that the return electrode does not contact tissue;

aspirating tissue from the target site through an aspiration lumen within the instrument; and

applying high frequency voltage between the return electrode and the active electrode, the high frequency voltage being sufficient to remove at least a portion of the tissue.

2. The method of claim 1 further comprising applying high frequency voltage to an aspiration electrode coupled to the aspiration lumen, wherein the lumen has a distal opening and the aspiration electrode is positioned adjacent the distal opening.

3. The method of claim 2 wherein the aspiration electrode is positioned across the distal opening of the aspiration lumen.

4. The method of claim 2 wherein the aspiration electrode is positioned within the lumen proximal to the distal opening of the aspiration lumen.

5. The method of claim 2 wherein the aspiration and active electrodes are different electrodes, the method further comprising applying high frequency voltage between the active and return electrodes to remove at least a portion of the tissue and applying high frequency voltage between the aspiration and return electrodes to inhibit clogging of the aspiration lumen.

6. The method of claim 2 wherein the aspiration and active electrodes are the same electrode, the method further comprising applying high frequency voltage between the active and return electrodes to remove at least a portion of the tissue and applying high frequency voltage between the aspiration and return electrodes to inhibit clogging of the aspiration lumen.

7. The method of claim 2 further comprising delivering an electrically conductive fluid past the return electrode to generate a current flow path between the return electrode and the aspiration electrode.

8. The method of claim 2 further comprising:

drawing the tissue towards the aspiration electrode such that the aspiration electrode is in contact with, or close proximity to, the tissue in the presence of an electrically conductive fluid.

9. The method of claim 1 further comprising:

delivering electrically conductive fluid to the target site to substantially surround the active electrode with the electrically conductive fluid; and

applying high frequency voltage between the active electrode and the return electrode, the high frequency voltage being sufficient to remove at least a portion of the tissue.

10. The method of claim 9 further comprising:

generating tissue fragments during the tissue removal step;

aspirating the tissue fragments through the lumen, wherein the aspiration lumen has a distal end and the instrument comprises an aspiration electrode adjacent the distal end of the aspiration lumen; and

reducing the size of the tissue fragments by applying high frequency voltage between the aspiration electrode and the return electrode when the tissue fragments are adjacent the aspiration electrode.

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

12. The method of claim 11 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.

13. The method of claim 1 wherein the aspiration lumen has a distal end and the applying high frequency voltage step comprises applying high frequency voltage to a single, active electrode at the distal end of the aspiration lumen.

14. The method of claim 1 wherein the aspiration lumen has a distal end and the applying high frequency voltage step comprises applying high frequency voltage to a plurality of electrically isolated electrodes at the distal end of the aspiration lumen.

15. 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.

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