Systems and methods for selective electrosurgical treatment of body structures

• US 6,355,032 B1
• Filed: 02/27/1998
• Issued: 03/12/2002
• 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: Eggers, Philip E., Hovda, David C., Thapliyal, Hira V.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/032,375
• Time in Patent Office: 1,474 Days
• Field of Search: 606/32, 606/41, 606/49, 606/34, 607/99, 607/105, 607/113, 607/122, 604/114
• US Class Current: 606/32
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• 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 2017/00101 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 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 2018/00327 Ear, nose or throat
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• 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 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• 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 2018/00982 : 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 2018/1253 : 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 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems and methods for selectively applying electrical energy to a target location within a patient'"'"'s. The present invention positions an electrosurgical instrument, such as a probe or catheter, in close proximity to a first body structure adjacent to a second body structure so that one or more electrode terminal(s) are brought into at least partial contact or close proximity with the first and second body structures. High frequency voltage is then applied between the electrode terminal(s) and one or more return electrode(s) to cut, remove, ablate, contract, coagulate, vaporize, desiccate or otherwise modify the first body structure without clinically damaging the second body structure. The first body structure is typically soft tissue, such as sinus, mucosal, spinal, or brain tissue, and the second body structure typically comprises a structure either having different electrical or molecular properties than soft tissue, such as bone, cartilage, adipose tissue, nerves and the like. The present invention provides a method for automatically discriminating between the two body structures such that the soft tissue is removed or otherwise modified, while the second structure (e.g., a nerve) is left relatively unaffected by the procedure.

Claims

1. A method for selectively treating body structures at a target comprising:

positioning an electrode terminal in close proximity with a tissue structure adjacent to nerves fibers enclosed within an outer sheath so that the electrode terminal is brought into at least partial contact or close proximity with the tissue structure and the outer sheath; and

applying high frequency voltage between the electrode terminal and a return electrode;

during the applying step, removing at least a portion of the tissue structure in situ with the high frequency voltage without causing damage to the nerve fibers within the outer sheath.

2. The method of claim 1 further comprising removing the tissue structure in situ while inhibiting impairment of nerve function of the nerve fibers closely adjacent to said tissue structure.

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

4. The method of claim 3 wherein the nerve fibers comprises stronger molecular bonds than the tissue structure, the method further comprising accelerating charged particles from the vaporized fluid to the tissue to cause dissociation of the molecular bonds within the tissue structure, wherein the energy of the charged particles is insufficient to cause dissociation of the molecular bonds within the nerve fibers.

5. The method of claim 4 wherein the tissue structure has a molecular bond strength of less than 4.5 eV and the nerve fibers have a molecular bond strength of greater than 5 eV.

6. The method of claim 1 further comprising positioning the electrode terminal within electrically conductive fluid and positioning the return electrode within the electrically conductive fluid to generate a current flow path between the return electrode and the electrode terminal.

7. The method of claim 1 wherein the electrode terminal comprises a single, active electrode at the distal end of a shaft.

8. The method of claim 1 further comprising aspirating fluid adjacent to the tissue structure during the removal step.

9. An apparatus for selectively applying electrical energy to a body structure at a target site, the apparatus comprising:

an electrosurgical probe having a shaft with a proximal end portion, a distal end portion and an electrode terminal disposed near the distal end portion;

a connector near the proximal end portion of the shaft for electrically coupling the electrode terminal to a high frequency power supply;

a return electrode adapted to be electrically coupled to the high frequency power supply; and

means for applying sufficient high frequency voltage between the electrode terminal and the return electrode to remove at least a portion of a tissue structure in situ without causing damage to nerve fibers adjacent to the tissue structure.

10. The apparatus of claim 9 further comprising a fluid delivery element for delivering electrically conductive fluid to the electrode terminal and, wherein said means for applying sufficient high frequency voltage comprises means for vaporizing at least a portion of the electrically conductive fluid between the electrode terminal and the tissue structure.

11. The apparatus of claim 10 wherein the nerve fibers are enclosed within an outer sheath comprising stronger molecular bonds than the tissue structure, the apparatus further comprising means for accelerating charged particles from the vaporized fluid to the tissue structure to cause dissociation of the molecular bonds within the tissue structure, wherein the energy of the charged particles is insufficient to cause dissociation of the molecular bonds within the outer sheath.

12. The apparatus of claim 9 further comprising a fluid delivery element defining a fluid path in electrical contact with the return electrode and the electrode terminal to generate a current flow path between the return electrode and the electrode terminal.

13. The apparatus of claim 9 wherein the distal end portion of the shaft is sized for delivery into a paranasal sinus.

14. The apparatus of claim 9 wherein the return electrode forms a portion of the shaft.

15. The apparatus of claim 9 wherein the electrode terminal comprises an electrode array disposed near the distal end portion of the shaft, the array including a plurality of electrically isolated electrode terminals disposed over a contact surface.

16. The apparatus of claim 9 wherein the electrode terminal comprises a single active electrode disposed near the distal end portion of the shaft.