Methods for electrosurgical tendon vascularization

• US 6,805,130 B2
• Filed: 04/27/2001
• Issued: 10/19/2004
• Est. Priority Date: 11/22/1995
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Woloszko, Jean, Eggers, Philip E., Thapliyal, Hira V., Tasto, James P.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US09/845,034
• Publication Number:
  US 20020068930A1
• Time in Patent Office: 1,271 Days
• Field of Search: 606/41, 606/42, 606/45, 606/48-50, 607/101, 607/102, 607/104, 607/105, 604/22, 604/114, 128/898
• US Class Current: 128/898
• 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 18/1492 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 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00178 Electrical connectors
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00583 Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00702 Power or energy
• 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 2018/00875 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 2018/1246 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 2018/1467 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 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• 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

Abstract

Systems, apparatus, and methods are provided for promoting blood flow to a target tissue. In one aspect, the invention involves canalizing or boring channels, divots, trenches or holes through an avascular connective tissue, or through a tissue having sparse vascularity, such as a tendon or a meniscus, in order to increase blood flow within the tissue. In one method, an active electrode is positioned in close proximity to a target site on a tendon, and a high frequency voltage difference is applied between the active electrode and a return electrode to selectively ablate tendon tissue at the target site, thereby forming a channel or void in the tendon. The active electrode(s) may be moved relative to the tendon during, or after, the application of electrical energy to damage or sculpt a void within the tendon, such as a hole, channel, crater, or the like. In another aspect of the invention, an electrosurgical probe is used to elicit a wound healing response in a target tissue, such as an injured tendon, in order to stimulate vascularization of the target tissue. The present invention may also be used for vascularization of a torn or damaged tissue in conjunction with a surgical repair procedure.

Claims

1. A method of promoting blood flow to a target tissue, the method comprising:

positioning an active electrode in at least close proximity to the target tissue; and

applying a high frequency voltage to the active electrode, the high frequency voltage being sufficient to promote vascularization of the target tissue, wherein the target tissue is selected from the group consisting of a tendon, a ligament, and a meniscus.

2. The method of claim 1, wherein the vascularization of the target tissue is at least partly accomplished by volumetric removal of a portion of the target tissue.

3. The method of claim 2, further comprising:

advancing at least a distal surface of the active electrode into a space vacated by the volumetrically removed target tissue.

4. The method of claim 1, wherein said applying step comprises applying the high frequency voltage between the active electrode and a return electrode, the high frequency voltage being sufficient to volumetrically remove at least a portion of the target tissue.

5. The method of claim 4, wherein the return electrode is located on an external surface of a patient'"'"'s body.

6. The method of claim 4, wherein the return electrode and the active electrode are both located on an electrosurgical probe.

7. The method of claim 4, further comprising:

placing an electrically conductive fluid between the active electrode and the return electrode, the electrically conductive fluid providing a current flow path between the active electrode and the return electrode.

8. The method of claim 7, wherein the electrically conductive fluid comprises isotonic saline.

9. The method of claim 1, wherein the vascularization of the target tissue is at least partly accomplished by forming a void within the target tissue.

10. The method of claim 9, wherein the comprises a channel, a hole, or a furrow within the target tissue.

11. The method of claim 9, wherein the void has a lateral dimension in the range of from about 0.5 mm to about 2.0 mm.

12. The method of claim 9, wherein the void has a depth in the range of from about 0.5 mm to about 4.0 cm.

13. The method of claim 1, wherein the active electrode comprises a single electrode adjacent to a distal end of an electrosurgical probe.

14. The method of claim 6, wherein the electrosurgical probe includes an electrode array comprising a plurality of electrically isolated active electrodes, and wherein said applying step comprises applying the high frequency voltage to the electrode array.

15. The method of claim 1, further comprising:

providing an electrically conductive fluid between the active electrode and the target tissue.

16. The method of claim 1, further comprising:

introducing at least a distal end of an electrosurgical probe into a patient'"'"'s knee, shoulder, or elbow;

wherein said positioning step comprises positioning the distal end of the probe in at least close proximity to the tendon within the knee, the shoulder, or the elbow.

17. A method of vascularizing a region of a tendon, comprising:

positioning a distal end of an electrosurgical instrument adjacent to the tendon; and

applying energy to the tendon to heat the tendon to promote blood flow to the tendon.

18. The method of claim 17, wherein the energy applied is sufficient to damage the tendon.

19. The method of claim 17, wherein said applying step is sufficient to remove a portion of the tendon.

20. The method of claim 17, wherein said applying step comprises applying a high frequency voltage difference between an active electrode located on the electrosurgical instrument and a return electrode.

21. The method of claim 20, further comprising providing an electrically conductive fluid between the active electrode and the return electrode to provide a current flow path therebetween.

22. The method of claim 17, further comprising forming a hole in the tendon.

23. The method of claim 17, further comprising forming a channel in the tendon.

24. A method of vascularizing a tendon, the method comprising:

positioning an active electrode in at least close proximity to the tendon; and

heating the tendon via a voltage applied to the active electrode so as to damage the tendon, wherein the damage is sufficient to cause a neovascular response and increased blood flow to the tendon.

25. A method of vascularizing a target tissue, the method comprising:

a) positioning an electrosurgical probe in at least close proximity to the target tissue; and

b) applying sufficient radio frequency energy to the target tissue to promote blood flow to the target tissue, wherein the target tissue is selected from the group consisting of a tendon, a ligament, and a meniscus.

26. The method of claim 25, wherein said step b) comprises volumetrically removing a portion of the target tissue.

27. The method of claim 25, wherein said step b) comprises forming at least one void within the target tissue.

28. The method of claim 25, wherein said step b) comprises forming at least one channel in the target tissue.

29. The method of claim 25, wherein said step b) comprises inducing a wound healing response in the target tissue.

30. The method of claim 25, wherein said step b) comprises heating the target tissue, and the heating promotes vascularization of the target tissue.

31. The method of claim 25, wherein said step b) induces angiogenesis in the target tissue.

32. A method of vascularizing a target tissue where the target tissue is a non-cardiac tissue, the method comprising:

a) positioning an active electrode in at least close proximity to the target tissue at a first location;

b) applying a high frequency voltage to the active electrode, the high frequency voltage being sufficient to form a first channel within the target tissue at the first location;

c) re-positioning the active electrode in at least close proximity to the target tissue at a subsequent location;

d) applying the high frequency voltage to the active electrode, the high frequency voltage being sufficient to form a subsequent channel within the target tissue at the subsequent location; and

e) sequentially repeating said steps c) and d) until a suitable number of channels have been formed within the target tissue.

33. The method of claim 32, wherein the non-cardiac tissue is selected from the group consisting of a tendon, a ligament, and a meniscus.

34. The method of claim 32, further comprising:

f) inserting an implant in at least one of the number of channels.

35. The method of claim 34, wherein the implant comprises a device selected from the group consisting of:

a stent, a splint, or a hemostasis plug.

36. The method of claim 34, wherein the implant comprises an elongate device adapted for affixing a portion of severed tissue to a second portion of tissue.

37. The method of claim 36, wherein the target tissue is the meniscus of the knee.

38. The method of claim 32, wherein the first channel and the subsequent channel are formed via molecular dissociation of target tissue components.

39. The method of claim 38, wherein the molecular dissociation of target tissue components is plasma-induced.

40. The method of claim 39, wherein the plasma is generated by high electric field intensities in the presence of an electrically conductive fluid, the high electric field intensities located at a surface of the active electrode.