Method and system for performing plate type radiofrequency ablation

• US 6,312,426 B1
• Filed: 05/30/1997
• Issued: 11/06/2001
• Est. Priority Date: 05/30/1997
• Status: Expired due to Term

• Current Assignee: Massachusetts General Hospital (Mass General Brigham, Inc.), Covidien AG (Medtronic Plc)
• Original Assignee: Sherwood Services AG
• Inventors: Tanabe, Kenneth K., Cosman, Eric R., Rittman, William J. III, Goldberg, S. Nahum
• Primary Examiner(s): Reip, David O.
• Assistant Examiner(s): WOO, JULIAN W
• Application Number:
  US08/866,765
• Time in Patent Office: 1,621 Days
• Field of Search: 606/35, 606/37, 606/38, 606/48, 606/49, 606/50, 606/51, 606/52, 606/45, 606/205, 606/33, 606/47
• US Class Current: 606/33
• CPC Class Codes: A61B 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00648 using more than one sensed parameter
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00744 Fluid flow
• 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 2018/00892 Voltage
• CPC Class Codes: A61B 2018/142 at least partly surrounding the target, e.g. concave, curved or in the form of a cave
• CPC Class Codes: A61B 2090/3782 transmitter or receiver in catheter or minimal invasive instrument

Abstract

A method and apparatus for inducing large volume heat ablations of tissue in a patient involving electrodes that are in contact with the patient'"'"'s external surface or the surface of an internal organ. A high frequency signal or output from a generator is applied to the tissue near the area electrodes by connection of the generator to the electrodes. Various applications and configurations of electrodes and temperature monitoring are appropriate for different clinical needs and thermal distributions. The use for interoperative ablation of a tumor site within an internal organ or for ablation of a tumor from electrodes placed on the surface of the patient provides a clinical advantage.

Claims

1. A system for inducing heat ablations in an operative field in patient'"'"'s anatomy, which includes a volume of tissue to be ablated, comprising:

at least one active plate electrode having an area greater than one square centimeter adapted to contact a first portion of tissue within the operative field;

at least one reference electrode adapted to contact a second portion of tissue within the operative field, wherein the at least one plate electrode and the at least one reference electrode are cooperatively adapted and positioned to define a volume of tissue to be ablated within the patient'"'"'s anatomy;

a high frequency generator that generates an electrical output which when connected to the electrodes induces heating in the volume of tissue to induce an ablation of at least a portion of the volume of tissue; and

at least one electrical coupling connecting the high frequency generator to the at least one plate electrode and the at least one reference electrode.

2. The system of claim 1 wherein the at least one plate electrode comprises one or more plates of conductive material.

3. The system of claim 1 wherein the at least one plate electrode comprises a surface of conductive metal.

4. The system of claim 1 wherein the at least one plate electrode comprises a conductive mesh of metal wires.

5. The system of claim 1 wherein the at least one plate electrode comprises an area of a plurality of conductive elements.

6. The system of claim 1 wherein the at least one plate electrode has a predetermined configuration suitable to conform the plate electrode to at least a portion of the first portion of tissue.

7. The system of claim 1 wherein the at least one plate electrode comprises at least one temperature sensor.

8. The system of claim 1 further comprising:

an imaging scanner to provide image representations of tissue within the operative field so as to monitor a position of the at least one plate electrode relative to the operative field.

9. The system of claim 1 further comprising:

a structure for grasping the at least one plate electrode and the at least one reference electrode to guide the at least one plate electrode and the at least one reference electrode in positions relative to a portion of tissue within the operative field such that the at least one plate electrode and the at least one reference electrode grasp the portion of tissue between them.

10. The system of claim 9 wherein the structure further comprises at least one hinge joint proximate the at least one plate electrode for adapting the at least one plate electrode to conform to a shape of a portion of the tissue.

11. The system of claim 1 wherein the at least one plate electrode comprises a fluid cooling system that cools at least a portion of the at least one plate electrode to prevent excessive heating of at least a portion of tissue within the operative field.

12. The system of claim 1 wherein the at least one plate electrode comprises a plurality of electrodes, which are configured to enable insertion into a portion of tissue within the operative field.

13. The system of claim 1 wherein the at least one plate electrode has an area between one square centimeter and fifty square centimeters.

14. The system of claim 1 wherein the at least one plate electrode has an area between one hundred square centimeter and one thousand square centimeters.

15. The system of claim 1 wherein the at least one plate electrode comprises a flexible material.

16. The system of claim 1 wherein the at least one plate electrode comprises a substrate with conductive elements.

17. The system of claim 1 wherein the at least one plate electrode comprises a mesh of conductors.

18. The system of claim 1 wherein the volume of tissue defines a tumor and the heating in the volume of tissue induces an ablation of at least a portion of the tumor.

19. A system for heat ablation of tissue within an operative field in a patient'"'"'s anatomy, which includes a volume of tissue to be ablated, comprising:

at least two plate electrodes adapted to contact surface tissue of a portion of the patient'"'"'s anatomy and each of the plate electrodes having an area of at least one square centimeter, wherein the at least two plate electrodes are cooperatively adapted and positioned to define a volume of tissue to be ablated within the patient'"'"'s anatomy, at least one of the plate electrodes being an active electrode;

a high frequency generator that generates an electrical output which, when the at least two plate electrodes are in contact with the surface tissue within the operative field and when the electrical output is connected to the at least two plate electrodes, causes heating in the volume of tissue to induce an ablation of at least a portion of the volume of tissue; and

an electrical coupling of the generator to the at least two plate electrodes.

20. The system of claim 19 wherein the plate electrodes comprise one or more plates of conductive material.

21. The system of claim 19 wherein the plate electrodes comprise a surface of conductive metal.

22. The system of claim 19 wherein the plate electrodes comprise a conductive mesh of metal wires.

23. The system of claim 19 wherein the plate electrodes comprise an area of a plurality of conductive elements.

24. The system of claim 19 wherein the plate electrodes have predefined configurations suitable to conform to at least a portion of the surface tissue.

25. The system of claim 19 wherein the plate electrodes comprise at least one temperature sensor.

26. The system of claim 19 further comprising:

a structure for grasping the plate electrodes to enable at least a portion of the surface tissue to be grasped by the plate electrodes.

27. The system of claim 19 wherein the plate electrodes comprise a fluid cooling system that cools at least a portion of the plate electrodes.

28. The system of claim 19 wherein the volume of tissue defines a tumor and the heating in the volume of tissue induces an ablation of at least a portion of the tumor.

29. The system of claim 19 wherein at least one of the plate electrodes comprises a flexible material.

30. The system of claim 19 wherein at least one of the plate electrodes comprises a substrate with conductive elements.

31. The system of claim 19 wherein at least one of the plate electrodes comprises a mesh of conductors.

32. A process of heat ablation of a volume of tissue of a patient in an operative field, comprising the steps of:

disposing at least two plate electrodes each having an area greater than one square centimeter in contact with tissue within the operative field, wherein the at least two plate electrodes are cooperatively adapted and positioned to define a volume of tissue to be ablated within the operative field, at least one of the plate electrodes being an active electrode;

coupling the at least two plate electrodes to a high frequency generator; and

applying electrical output from the generator to the volume of tissue through the electrodes whereby to heat and ablate at least a portion of the volume of tissue.

33. The process of claim 32 further including the step of:

urging the plate electrodes against tissue within the operative field with a grasping structure which is adapted to force the electrodes toward one another and against the tissue within the operative field.

34. The process of claim 33 wherein the grasping structure comprises forceps with the electrodes coupled to the tongs of the forceps, and wherein the urging step comprises the step of applying a force on the forceps to close the electrodes together to press the electrodes against the tissue within the operative field.

35. The process of claim 32 wherein the plate electrodes comprise at least one temperature sensor, the process further comprising the step of:

monitoring at least one temperature of the tissue within the operative field by the at least one temperature sensor to control the heat ablation.

36. A system for inducing heat ablations in an operative field in a patient'"'"'s anatomy, which includes tissue to be ablated, comprising:

at least one active plate electrode having an area greater than one square centimeter adapted to contact a portion of tissue proximate to a tissue volume within the operative field to be ablated, the at least one plate electrode comprising a mesh of conductors;

at least one reference electrode adapted to contact a portion of tissue proximate to a tissue volume within the operative field to be ablated;

a high frequency generator that generates an electrical output which when connected to the at least one plate electrode and the at least one reference electrode induces heating in the tissue volume and induces an ablation proximate the at least one plate electrode; and

at least one electrical coupling connecting the high frequency generator to the at least one plate electrode and the at least one reference electrode.

37. The system of claim 36 wherein the at least one plate electrode comprises at least one temperature sensor.

38. The system of claim 37 wherein the at least one plate electrode further comprises a fluid cooling system that cools at least a portion of the at least one plate electrode to prevent excessive heating of at least a portion of tissue within the operative field.

39. The system of claim 36 wherein the at least one plate electrode comprises a fluid cooling system that cools at least a portion of the at least one plate electrode to prevent excessive heating of at least a portion of tissue within the operative field.

40. The system of claim 36 wherein the at least one plate electrode has a configuration suitable to conform the at least one plate electrode to a portion of tissue.

41. The system of claim 40 wherein the at least one plate electrode comprises at least one temperature sensor.

42. The system of claim 41 wherein the at least one plate electrode further comprises a fluid cooling system that cools at least a portion of the at least one plate electrode to prevent excessive heating of at least a portion of tissue within the operative field.

43. The system of claim 42 further comprising:

an imaging scanner to provide image representations of at least a portion of tissue and at least a portion of the at least one plate electrode within the operative field.

44. The system of claim 40 wherein the configuration is predetermined.

45. The system of claim 36 wherein the at least one reference electrode comprises at least one additional plate electrode having an area greater than one square centimeter.

46. The system of claim 36 further comprising:

a structure for grasping the at least one plate electrode and the at least one reference electrode to guide the at least one plate electrode and the at least one reference electrode in positions relative to a portion of tissue within the operative field such that the at least one plate electrode and the at least one reference electrode grasp a portion of tissue between them.

47. The system of claim 36 wherein the at least one plate electrode comprises a flexible material.

48. A system for inducing heat ablations in an operative field in a patient'"'"'s anatomy, which includes tissue to be ablated, comprising:

at least one active plate electrode having an area greater than one square centimeter adapted to contact a portion of tissue proximate to a tissue volume within the operative field to be ablated, the at least one plate electrode comprising a fluid cooling system that cools at least a portion of the plate electrode to prevent excessive heating of a portion of tissue within the operative field;

at least one reference electrode adapted to contact a portion of tissue proximate to a tissue volume within the operative field to be ablated;

a high frequency generator that generates an electrical output which when connected to at least one plate electrode and the least one reference electrode induces heating in the tissue volume and induces an ablation proximate the at least one plate electrode; and

at least one electrical coupling connecting the high frequency generator to the at least one plate electrode and the least one reference electrode.

49. The system of claim 48 wherein the at least one plate electrode comprises at least one temperature sensor.

50. The system of claim 49 wherein the at least one plate electrode further comprises a substrate with conductive elements.

51. The system of claim 49 wherein the at least one plate electrode has a configuration suitable to conform the at least one plate electrode to a portion of tissue.

52. The system of claim 51 further comprising:

an imaging scanner to provide image representations of at least a portion of tissue and at least a portion of the at least one plate electrode within the operative field.

53. The system of claim 48 wherein the at least one plate electrode has a configuration suitable to conform the at least one plate electrode to a portion of tissue.

54. The system of claim 53 wherein the at least one plate electrode further comprises a substrate with conductive elements.

55. The system of claim 53 wherein the configuration is predetermined.

56. The system of claim 48 wherein the at least one plate electrode comprises a mesh of conductors.

57. The system of claim 48 wherein the at least one plate electrode comprises a substrate with conductive elements.

58. The system of claim 48 further comprising:

an imaging scanner to provide image representations of at least a portion of tissue and at least a portion of the at least one plate electrode within the operative field.

59. The system of claim 48 wherein the at least one plate electrode comprises a flexible material.

60. The system of claim 48 wherein the at least one reference electrode comprises at least one additional plate electrode having an area greater than one square centimeter.

61. A method of heat ablation of tissue of a patient in an operative field, comprising the steps of:

disposing at least two plate electrodes each having an area greater than one square centimeter in contact with the tissue within the operative field near to the tissue to be ablated within the operative field, wherein at least one of the plate electrodes comprises a mesh of conductors, and is an active electrode;

coupling the at least two plate electrodes to a high frequency generator; and

applying electrical output from the generator to the tissue to be ablated within the operative field through the electrodes whereby to heat and ablate the tissue to be ablated within the operative field.

62. A method of heat ablation of tissue of a patient in an operative field, comprising the steps of:

disposing at least two plate electrodes each having an area greater than one square centimeter in contact with the tissue within the operative field near to the tissue to be ablated within the operative field, wherein at least one of the plate electrodes is an active electrode and comprises a fluid cooling system that cools at least a portion of the at least one plate electrode to prevent excessive heating of a portion of tissue within the operative field;

coupling the at least two plate electrodes to a high frequency generator; and

applying electrical output from the generator to the tissue to be ablated within the operative field through the electrodes whereby to heat and ablate the tissue to be ablated within the operative field.