Method for treating tissue in arthroscopic environment using precooling and apparatus for same

• US 6,544,260 B1
• Filed: 12/31/1999
• Issued: 04/08/2003
• Est. Priority Date: 08/20/1996
• Status: Expired due to Term

• Current Assignee: Oratec Interventions Incorporated
• Original Assignee: Oratec Interventions Incorporated
• Inventors: Markel, Mark, Sharkey, Hugh R., Fanton, Gary S.
• Primary Examiner(s): GIBSON, ROY DEAN
• Application Number:
  US09/476,018
• Time in Patent Office: 1,194 Days
• Field of Search: 606/41, 606/42, 606/45, 606/46, 606/48, 606/49-50, 606/34, 606/37-40, 606/31-33, 607/100-103, 607/105, 607/109, 607/113, 607/116
• US Class Current: 606/41
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3203 Fluid jet cutting instruments
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• 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 2017/320078 Tissue manipulating surface
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61N 1/403 for thermotherapy, e.g. hyperthermia
• CPC Class Codes: A61N 7/02 Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

A thermal energy delivery apparatus has a probe including a distal end and a proximal end. A first electrode is positioned at the distal end of the probe. The first electrode is configured to deliver sufficient thermal energy to a fibrillated cartilage surface to reduce a level of fibrillation of the fibrillated cartilage surface. A cabling is coupled to the proximal end of the probe. A method for thermal protection of non-targeted tissues that may be exposed to thermal probes used during arthroscopic procedures includes a pre-procedural cooling Lavage. The pre-cooled tissues provide a convective buffer for tissues not intended for thermal intervention, thereby reducing collateral damage.

Claims

1. A method for treating tissue in an arthroscopic environment, comprising the steps of precooling the arthroscopic environment and adjacent structures, providing a thermal energy delivery device including a probe with a distal end, a proximal end and a thermal energy delivery surface, providing a thermal energy source coupled to the thermal energy delivery surface, positioning the thermal energy delivery surface adjacent to a targeted tissue surface and delivering sufficient thermal energy from the thermal energy delivery surface to modify at least a portion of the targeted tissue surface, the precooling step being discontinued before the commencement of the delivering step.

2. The method of claim 1, wherein the precooling is accomplished by an irrigating solution selected from liquids consisting of normal saline, ringers lactated solution, Glycine, and bacteriostatic water.

3. The method of claim 2, wherein the irrigating solution is cooled to a temperature between approximately 20°

C. and approximately −

5°

C.

4. The method of claim 1, wherein the probe is heated to a temperature of greater than approximately 50°

C.

5. The method of claim 4, wherein the temperature is between approximately 60°

and approximately 90°

C.

6. The method of claim 4, wherein the probe delivers monopolar RF energy mediated by an electrothermal generator.

7. The method of claim 4, wherein the probe delivers bipolar RF energy mediated by a radiofrequency generator.

8. The method of claim 4, wherein the probe delivers optical energy.

9. The method of claim 4, wherein the probe delivers ultrasonic energy.

10. The method of claim 4, wherein the probe delivers resistive or conductive thermal energy.

11. The method claim 4, wherein the probe delivers thermal energy by means of a heated liquid.

12. The method of claim 4, wherein the probe delivers microwave energy.

13. A method of protecting non-targeted tissues in an arthroscopic environmrent, comprising the steps of precooling the arthroscopic environment and adjacent structures by means of an irrigating solution selected from liquids consisting of normal saline, ringers lactated solution, Glycine, and bacteriostatic water, the composition of the irrigating solution being modified to lower a freezing point by the addition of at least one substance that effects a decrease in the freezing point and is selected from the group consisting of glycine, glucose and electrolyte, providing a thermal energy delivery device including a probe with a distal end, a proximal end and a thermal energy delivery surface, providing a thermal energy source coupled to the thermal energy delivery surface, positioning the thermal energy delivery surface adjacent to a targeted tissue surface and delivering sufficient thermal energy from the thermal energy delivery surface to modify at least a portion of the targeted tissue surface.

14. A method for treating tissue within an arthroscopic environment, comprising the steps of precooling the arthroscopic environment and adjacent structures, providing a thermal energy delivery device including a probe with a distal end, a proximal end and a thermal energy delivery surface, providing a thermal energy source coupled to the thermal energy delivery surface, positioning the thermal energy delivery surface adjacent to an articular joint lining and delivering sufficient thermal energy from the thermal energy delivery surface to reduce a level of fibrillation at a fibrillated cartilage surface.

15. The method of claim 14, wherein the probe is used to coagulate the fibrillated cartilage surface to cause shrinking and removal of fibrillated cartilage.

16. The method of claim 15, wherein the probe delivers monopolar RF energy mediated by an electrothermal generator.

17. The method of claim 15, wherein the probe delivers bipolar RF energy mediated by a radiofrequency generator.

18. The method of claim 15, wherein the probe delivers optical energy.

19. The method of claim 15, wherein the probe delivers ultrasonic energy.

20. The method of claim 15, wherein the probe delivers resistive or conductive thermal energy.

21. The method of claim 15 wherein the probe delivers a heated liquid.

22. The method of claim 15, wherein the probe delivers microwave energy.

23. The method of claim 14, wherein the probe is used to coagulate the fibrillated cartilage to cause sealing of the fibrillated cartilage surface.

24. The method of claim 14, wherein precooling is accomplished with a liquid irrigant used in arthroscopic surgery selected from the group consisting of normal saline, ringers lactated solution, Glycine, and bacteriostatic water.

25. The method of claim 14, wherein the precooling step includes the step of Aid as supplying the arthroscopic environment and adjacent structures with an irrigating solution cooled to temperatures less than approximately 20°

C.

26. The method of claim 18, wherein the irrigating solution is modified to lower a freezing point by the addition of at least one substance that effects a decrease in the freezing point and is selected from the group consisting of glycine, glucose, and electrolyte.

27. The method of claim 14, wherein the probe is heated to a temperature of greater than approximately 50°

C.

28. The method of claim 27 wherein the temperature is between approximately 60°

and approximately 90 C.

30. The apparatus of claim 24, wherein the liquid is selected from the group consisting of normal saline ringers lactated solution, Glycine and bacteriostatic water.

29. An apparatus to protect non-targeted tissues in an arthros environment, comprising a thermal energy delivery device including a probe with a distal end, a proximal end and a thermal energy delivery surface, a thermal energy source coupled to the thermal energy delivery surface, a conduit for providing a cooling irrigating solution to the arthroscopic environment and a source of a cooling liquid coupled to the conduit, the liquid being modified to lower a freezing point by the addition of at least one substance that effects a decrease in the freezing point and is selected from the group consisting of glycine, glucose and electrolyte.

31. The apparatus of claim 29, wherein said source includes a reservoir and a heat exchanger coupled to the reservoir.

32. The apparatus of claim 29, wherein said source operates according to an algorithm that transforms data concerning the liquid into signals that control the temperature of the liquid.

33. A method for treating tissue in an arthroscopic environment having adjacent structures with a thermal energy delivery device having proximal and distal extremities with an electrode carried by the distal extremity and a thermal energy source coupled to the proximal extremity and the electrode, comprising the steps of precooling the arthroscopic environment and the adjacent structures, positioning the electrode adjacent to the targeted tissue and delivering thermal energy from the thermal energy source to the electrode to modify at least a portion of the targeted tissue, the precooling step being discontinued before the commencement of the delivering step whereby the precooling of the arthroscopic environment minimizes damage to the adjacent structures.

34. The method of claim 33, wherein the electrode is a radio frequency electrode and the thermal energy source is a radio frequency generator.

36. The method of claim 33, wherein positioning step includes the step of positioning the electrode adjacent to an articular joint lining.

37. The method of claim 36, wherein the delivering step includes the step of delivering sufficient thermal energy from the thermal energy source to the electrode to reduce a level of fibrillation at a fibrillated cartilage tissue.

35. The method claim 35, wherein the delivering step includes the step of delivering radio frequency energy between the radio frequency electrode and a return electrode coupled to the radio frequency generator.

38. A method for treating tissue in an arthroscopic environment having adjacent structures with a thermal energy delivery device having proximal and distal extremities with an electrode carried by the distal extremity and a thermal energy source coupled to the proximal extremity and the electrode, comprising the steps of precooling the arthroscopic environment and the adjacent structures, positioning the electrode adjacent to the targeted tissue and delivering thermal energy from the thermal energy source to the electrode to modify at least a portion of the targeted tissue, the delivering step including the step of delivering radio frequency energy between the radio frequency electrode and a return electrode coupled to the radio frequency generator and carried by the distal extremity of the thermal energy delivery device, whereby the precooling of the arthroscopic environment minimizes damage to the adjacent structures.