Methods for ablating tissue

• US 6,746,447 B2
• Filed: 04/17/2001
• Issued: 06/08/2004
• Est. Priority Date: 05/10/1993
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Ormsby, Theodore C., Davison, Terry S., Willink, Christopher L.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/836,940
• Publication Number:
  US 20020052600A1
• Time in Patent Office: 1,148 Days
• Field of Search: 606/32, 606/34, 606/41, 607/99, 607/105, 607/113, 604/35, 604/114, 128/898
• US Class Current: 606/41
• 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 2018/00291 using suction
• 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 2018/00666 : 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 2018/00779 : Power or energy
• 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

Abstract

Electrosurgical methods, systems, and apparatus for the controlled ablation of tissue from a target site of a patient. An electrosurgical instrument includes a working portion having a plurality of working zones differentiated according to their relative rates of aspiration and ablation. The instrument further includes an aspiration channel in communication with a plurality of aspiration ports, and a plurality of active electrodes disposed on the working portion. Each of the plurality of working zones may have at least one of the plurality of active electrodes and at least one of the plurality of aspiration ports. The aspiration rate of each working zone is dependent, inter alia, on the number, size, and distribution of the aspiration ports on that zone. In one embodiment, the ablation rate of a working zone is inversely related to the aspiration rate of that zone. Each of the plurality of active electrodes is adapted for ablating tissue to form low molecular weight ablation by-products. The ablation by-products may be aspirated from the target site via aspiration port(s) on one or more of the plurality of working zones.

Claims

1. A method of ablating a target tissue using an electrosurgical probe, comprising:

a) advancing a working portion of the probe towards the target tissue, the working portion including a plurality of working zones, each of said plurality of working zones comprising at least one aspiration port;

b) positioning a first working zone in at least close proximity to the target tissue;

c) ablating at least a portion of the target tissue using the first working zone, wherein said step c) generates gaseous ablation by-products; and

d) aspirating at least a first portion of the gaseous ablation by-products from a second working zone.

2. The method of claim 1, further comprising aspirating from the first working zone, wherein the first working zone is characterized by a first aspiration rate, the second working zone is characterized by a second aspiration rate, and the first aspiration rate is less than the second aspiration rate.

3. The method of claim 1, wherein each of the plurality of working zones is aspirating and is characterized by a different aspiration rate.

4. The method of claim 3, wherein a suction pressure gradient exists between each of the plurality of working zones.

5. The method of claim 1, wherein the first working zone is characterized by a first ablation rate, the second working zone is ablating and is characterized by a second ablation rate, and the first ablation rate is greater than the second ablation rate.

6. The method of claim 1, further comprising:

after said step c), aspirating a second portion of the gaseous ablation by-products from the first working zone.

7. The method of claim 1, wherein said step c) further generates resected tissue fragments, and the method further comprises:

after said step c), ablating the resected tissue fragments using the second working zone.

8. The method of claim 1, further comprising:

prior to said step c), delivering an electrically conductive fluid to at least one of the plurality of working zones.

9. The method of claim 1, wherein the first working zone includes at least one active electrode, and the method further comprises:

during said step c), applying a high frequency voltage between the at least one active electrode and a return electrode, the high frequency voltage sufficient to generate a plasma in the vicinity of at least the first working zone.

10. The method of claim 1,wherein at least two working zones are in different planes.

11. The method of claim 1, wherein the second working zone has a plurality of aspiration ports therein, and the plurality of aspiration ports are adapted for rapidly aspirating a fluid from a site of ablation of the target tissue.

12. The method of claim 11, wherein the fluid comprises bubbles of gaseous ablation by-products entrapped within a liquid.

13. The method of claim 12, wherein the liquid comprises blood or saline.

14. The method of claim 1, wherein each of the plurality of working zones has at least one active electrode.

15. The method of claim 1, wherein the probe includes a plurality of active electrodes disposed on the working portion, and at least one of the plurality of active electrodes comprises a metal selected from the group consisting of platinum, tungsten, palladium, iridium, and titanium.

16. The method of claim 15, wherein at least one of the plurality of active electrodes comprises a platinum/iridium alloy.

17. The method of claim 15, wherein at least one of the plurality of active electrodes comprises from about 80% to 95% platinum and from about 5% to 20% iridium.

18. A method of removing tissue from a target site of a patient, comprising:

a) advancing a shaft distal end of an electrosurgical apparatus in the vicinity of the target site, the shaft distal end having a working portion disposed thereon, the working portion including a plurality of working zones, the working portion having a plurality of active electrodes disposed thereon, each of the plurality of working zones having at least one of the plurality of active electrodes;

b) positioning at least one of the plurality of working zones in at least close proximity to the tissue at the target site;

c) applying a high frequency voltage between the plurality of active electrodes and a return electrode, wherein at least one of the plurality of active electrodes forms a plasma between at least one of the plurality of working zones and the tissue at the target site, such that at least a portion of the tissue at the target site is ablated; and

d) aspirating ablation by-products from the target site.

19. The method of claim 18, wherein the plasma is formed between a first working zone and the target site, and at least a portion of the ablation by-products are aspirated by a second working zone.

20. The method of claim 18, wherein the working portion includes a first working zone and a second working zone, and the at least one active electrode of the first working zone is capable of ablating tissue from the target site via molecular dissociation of tissue components to generate low molecular weight ablation by-products and resected tissue fragments.

21. The method of claim 20, wherein the at least one active electrode of the second working zone is capable of ablating resected tissue fragments via molecular dissociation of tissue components.

22. The method of claim 18, further comprising:

e) prior to said step c), delivering an electrically conductive fluid to at least one of the plurality of working zones or to the target site, wherein the electrically conductive fluid provides a current flow path between at least one of the plurality of active electrodes and the return electrode.

23. The method of claim 18, wherein the tissue at the target site is ablated to a controlled depth by plasma-induced volumetric removal of the tissue.

24. The method of claim 18, further comprising:

manipulating the apparatus such that the plurality of active electrodes are moved with respect to a surface of the tissue at the target site.

25. The method of claim 18, wherein the high frequency voltage applied between the plurality of active electrodes and the return electrode is in the range of from about 10 to 500 volts RMS.

26. The method of claim 18, wherein the tissue at the target site is exposed to a temperature in the range of from about 40°

C. to 90°

C.

27. The method of claim 18, wherein each of the plurality of active electrodes is in the form of a wire loop, the wire loop comprising a material selected from the group consisting of platinum, tungsten, palladium, iridium, and titanium.

28. The method of claim 18 wherein each of the plurality of working zones comprises at least one aspiration port.

29. The method of claim 18 wherein at least two of the plurality of working zones are in different planes.