Electrosurgery with infiltration anesthesia

• US 7,004,174 B2
• Filed: 09/13/2002
• Issued: 02/28/2006
• Est. Priority Date: 05/31/2002
• Status: Expired due to Term

• Current Assignee: Covidien AG (Medtronic Plc)
• Original Assignee: Neothermia Corporation (Medtronic Plc)
• Inventors: Eggers, Philip E., Jopling, Michael W.
• Primary Examiner(s): Rollins, Rosiland
• Application Number:
  US10/243,028
• Publication Number:
  US 20030225401A1
• Time in Patent Office: 1,264 Days
• Field of Search: 606/41, 606 45- 47, 606 49- 52, 600564-568
• 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 2018/00333 Breast
• CPC Class Codes: A61B 2018/1213 creating an arc
• CPC Class Codes: A61B 2218/002 Irrigation
• CPC Class Codes: A61M 19/00 Local anaesthesia syringes therefor A61M5/00; Hypothermia A61M5/42 takes precedence; cooling blood in a bypass of the arterial system A61M1/36

Abstract

Method for carrying out the recovery of an intact volume of tissue wherein a delivery cannula tip is positioned in confronting adjacency with the volume of tissue to be recovered. The electrosurgical generator employed to form an arc at a capture component extending from the tip is configured having a resistance-power profile which permits recovery of the specimen without excessive thermal artifact while providing sufficient power to sustain a cutting arc. For the recovery procedure, a local anesthetic employing a diluent which exhibits a higher resistivity is utilized and the method for deploying the capture component involves an intermittent formation of a cutting arc with capture component actuation interspersed with pauses of duration effective to evacuate any accumulation or pockets of local anesthetic solution encountered by the cutting electrodes.

Claims

1. The method for accessing subcutaneous target tissue of an animal comprising the steps of:

providing an electrosurgical system including an electrosurgical generator and an operatively associated cutting electrode assembly energizable to provide a tissue cutting arc;

anesthetizing said animal by parenterally administering at the site of said tissue a solution of a local anesthetic agent and biocompatible diluent exhibiting an electrical conductivity of value effective for providing an electrical resistance at tissue confronting said electrode sustaining said tissue cutting arc when said solution is infiltrated within the tissue of said animal;

positioning said electrode subcutaneously at said site;

energizing said cutting electrode to provide said tissue cutting arc; and

maneuvering said electrode with respect to said target tissue.

2. The method of claim 1 in which said step of anesthetizing said animal is carried out with a said solution exhibiting an electrical conductivity of less than about 10 milliSiemens/cm.

3. The method of claim 2 in which said step of anesthetizing said animal is carried out with a said solution exhibiting an osmolarity between about 240 and about 340 milliOsmols/liter.

4. The method of claim 1 in which said step of anesthetizing said animal is carried out with a said solution exhibiting an electrical conductivity of less than about 5 milliSiemens/cm.

5. The method of claim 1 in which said step of anesthetizing said animal is carried out with a said solution comprising D-glucose monohydrate in water as a said diluent.

6. The method of claim 1 further comprising the steps of:

providing an evacuation system having an intake port located in adjacency with said electrode; and

applying a vacuum at said intake port effective to evacuate accumulations of said solution encountered by said electrode assembly during said maneuvering step.

7. The method of claim 6 in which:

said step of maneuvering said electrode is carried out by moving said electrode assembly about said target tissue in an intermittent manner wherein said electrode assembly is energized while being advanced for a cutting interval, then de-energized and maintained stationary for a pause interval while said vacuum is applied.

8. The method of claim 7 in which:

said electrode assembly is advanced for a said cutting interval of from about one second to about two seconds.

9. The method of claim 7 in which:

said electrode assembly is de-energized during said pause interval.

10. The method of claim 7 in which:

said electrode is maintained stationary for a pause interval of from about four seconds to about six seconds.

11. The method of claim 10 in which:

said electrode assembly is de-energized during said pause interval.

12. The method of claim 7 in which:

said step for providing an evacuation system provides said system as comprising a vacuum pump having a vacuum port and a transparent tube coupled in vacuum communication between said vacuum port and said intake port; and

said pause interval is maintained while said solution is visibly perceptible in said transparent tube.

13. The method for surgically accessing a target tissue volume of a patient comprising the steps of:

(a) providing an accessing instrument having an electrosurgical cutting assembly at its distal end which is energizable to form an electrosurgical cutting arc;

(b) providing a fluid evacuation assembly having a fluid intake port adjacent said electrosurgical cutting assembly and actuable to effect a fluid suction condition at said fluid intake port;

(c) anesthetizing said patient by parenterally administering a solution of a local anesthetic agent and biocompatible diluent about the site of said target tissue volume;

(d) forming an opening of limited depth in the skin of said patient using a cutting instrument;

(e) positioning said distal end of said instrument within said opening;

(f) energizing said electrosurgical cutting assembly to effect creation of said cutting arc;

(g) actuating said fluid evacuation assembly; and

(h) maneuvering said accessing instrument with respect to said target tissue volume with a motion effective to cause the aspiration through said intake port of accumulations of said solution within the tissue of said patient to an extent wherein said cutting arc is maintained effective to cut tissue.

14. The method of claim 13 in which:

said step (h) of maneuvering said electrode is carried out by moving said electrosurgical cutting assembly about said target tissue volume in an intermittent manner wherein said electrosurgical cutting assembly is energized while being advanced for a cutting interval, then is maintained stationary for a pause interval of duration to effect said aspiration of said solution.

15. The method of claim 14 in which:

said electrosurgical cutting assembly is de-energized during said pause interval.

16. The method of claim 14 in which:

said electrosurgical cutting assembly is maintained stationary for a pause interval of from about four seconds to about six seconds.

17. The method of claim 14 in which:

said step (b) for providing said fluid evacuation assembly provides said assembly as comprising a vacuum pump having a vacuum port and a transparent tube coupled in vacuum communication between said vacuum port and said intake port; and

said pause interval is maintained while said solution is visibly perceptible in said transparent tube.

18. The method for surgically accessing a target tissue volume of a patient comprising the steps of:

(a) providing an accessing instrument having an electrosurgical assembly at a distal end thereof which is energizable from an electrosurgical cutting output to form an electrosurgical cutting arc;

(b) providing an electrosurgical generator assembly controllable to provide a said electrosurgical output at a boost cutting voltage level effective to create said cutting arc, and to provide a said electrosurgical output at an arc supporting cutting voltage level less than said boost cutting voltage level;

(c) forming an opening of limited depth in the skin of said patient;

(d) positioning said distal end of said instrument within said opening;

(e) controlling said electrosurgical generator assembly to provide a said electrosurgical output at said boost cutting voltage level for a boost interval effective to create said cutting arc;

(f) then controlling said electrosurgical generator assembly to provide a said electrosurgical output at said arc supporting cutting voltage level; and

(g) maneuvering said accessing instrument to access said target tissue volume.

19. The method of claim 18 in which:

said step (e) controls said electrosurgical generator to provide a said boost cutting voltage level which is greater than said arc supporting voltage level by a factor within a range of about 1.2 to 1.5.

20. The method of claim 18 in which:

said step (e) controls said electrosurgical generator assembly to provide said electrosurgical output at said boost cutting voltage level for a boost interval of about 55 milliseconds.

21. The method of claim 18 in which:

said step (g) of maneuvering said accessing instrument is carried out in an intermittent manner wherein said electrosurgical assembly is energized while being maneuvered for a cutting interval, then is maintained substantially stationary for a pause interval during which said electrosurgical assembly is de-energized.

22. The method of claim 21 in which:

said step (a) further comprises the step;

(a1) providing a fluid evacuation assembly having a fluid intake port adjacent said electrosurgical assembly and providing a fluid removal condition at said fluid intake port; and

said step (g) maintains said pause interval for a duration effective to remove cutting arc defeatable fluid from the vicinity of said electrosurgical assembly.

28. The method of claim 18 in which:

said step (a) further comprises the step;

(a1) providing a fluid evacuation assembly having a fluid intake port adjacent said electrosurgical assembly and providing a fluid removal condition at said fluid intake port; and

said fluid removal condition is rovided simultaneously with said steps (e), (f), and (g).

23. The method for accessing and isolating a target tissue volume of given peripheral extent within adjacent tissue of a patient, comprising the steps of:

(a) providing an electrosurgical generator controllable to derive an electrosurgical output;

(b) providing a tissue accessing and isolating assembly having a forwardly disposed portion with an accessing electrosurgical electrode and a deployable tissue isolating electrosurgical electrode assembly;

(c) providing a local anesthetic as a solution of local anesthetic agent and a biocompatible diluent;

(d) anesthetizing said patient by parenterally administering said local anesthetic to effect infiltration of said solution within said adjacent tissue;

(e) applying said electrosurgical output from said electrosurgical generator to said accessing electrosurgical electrode to an extent effective to derive an electrosurgical cutting arc while maneuvering said tissue accessing and isolating assembly forwardly disposed portion within said adjacent tissue into a location adjacent to said target tissue volume;

(f) terminating said step (e) application of said electrosurgical output to said accessing electrosurgical electrode when said tissue accessing and isolating forwardly disposed portion is within said adjacent tissue at said location adjacent to said target tissue volume;

(g) applying said electrosurgical output from said electrosurgical generator to said tissue isolating electrode at a voltage level effective to derive an electrosurgical cutting arc while substantially avoiding formation of caloric artifact at said target tissue volume; and

(h) maneuvering said tissue isolating electrode circumscriptively within said adjacent tissue about said target tissue volume during said step (g) to effect the isolation thereof from said adjacent tissue.

24. The method of claim 23 in which said step (e) further comprises the step:

(e1) effecting removal of fluid within said patient located adjacent said accessing electrosurgical electrode in conjunction with said step (e) maneuvering of said forwardly disposed portion to an extent effective to maintain said derivation of said electrosurgical cutting arc.

25. The method of claim 23 in which:

said step (e), wherein said tissue accessing and isolating assembly forwardly disposed portion is maneuvered within said adjacent tissue, is carried out in an intermittent manner wherein said electrosurgical output is applied for a cutting interval, then said forwardly disposed portion is maintained substantially stationary for a pause interval during which said application of said electrosurgical output is terminated.

26. The method of claim 24 in which:

said step (e), wherein said tissue accessing and isolating assembly forwardly disposed portion is maneuvered within said adjacent tissue, is carried out in an intermittent manner wherein said electrosurgical output is applied for a cutting interval, then said forwardly disposed portion is maintained substantially stationary for a pause interval during which said application of said electrosurgical output is terminated.

27. The method of claim 26 in which:

said step (e) maintains said pause interval for a duration effective to remove cutting arc defeatable fluids from the vicinity of said accessing electrosurgical electrode.

29. The method for carrying out a surgical procedure upon a patient comprising the steps of:

(a) providing an accessing instrument having an electrosurgical cutting assembly which is energizable to form an electrosurgical cutting arc;

(b) anesthetizing said patient by parenterally administering a solution of a local anesthetic agent and biocompatible diluent into tissue of said patient;

(c) energizing said electrosurgical cutting assembly to effect creation of said cutting arc;

(d) maneuvering said accessing instrument borne electrosurgical cutting assembly to carry out a surgical procedure within the tissue of said patient; and

(e) simultaneously with said step (d) evacuating fluid within the path of said maneuvering.

30. The method for surgically accessing a target tissue volume of a patient comprising the steps of:

(a) providing an accessing instrument having an electrosurgical cutting assembly at its distal end which is energizable to form an electrosurgical cutting arc;

(b) providing a fluid evacuation assembly having a fluid intake port adjacent said electrosurgical cutting assembly and actuable to effect a fluid suction condition at said fluid intake port;

(c) anesthetizing said patient by parenterally administering a solution of a local anesthetic agent and biocompatible diluent about the site of said target tissue volume;

(d) forming an opening of limited depth in the skin of said patient using a cutting instrument;

(e) positioning said distal end of said instrument within said opening;

(f) energizing said electrosurgical cutting assembly to effect creation of said cutting arc;

(g) actuating said fluid evacuation assembly; and

(h) maneuvering said accessing instrument with respect to said target tissue volume while activating said fluid evacuation assembly to effect said fluid suction condition at said fluid intake port.

31. The method for accessing and isolating a target tissue volume of given peripheral extent within adjacent tissue of a patient, comprising the steps of:

(a) providing an electrosurgical generator controllable to derive an electrosurgical output;

(b) providing a tissue accessing and isolating assembly having a forwardly disposed portion with an accessing electrosurgical electrode and a deployable tissue isolating electrosurgical electrode assembly;

(c) providing a fluid evacuation assembly having a fluid intake port at said tissue accessing and isolating assembly forwardly disposed portion and actuable to effect a fluid suction condition at said fluid intake port;

(d) providing a local anesthetic as a solution of local anesthetic agent and a biocompatible diluent;

(e) anesthetizing said patient by parenterally administering said local anesthetic to effect infiltration of said solution within said adjacent tissue;

(f) applying said electrosurgical output from said electrosurgical generator to said accessing electrosurgical electrode to an extent effective to derive an electrosurgical cutting arc while maneuvering said tissue accessing and isolating assembly forwardly disposed portion within said adjacent tissue into a location adjacent to said target tissue volume

(g) terminating said step (f) application of said electrosurgical output to said accessing electrosurgical electrode when said tissue accessing and isolating forwardly disposed portion is within said adjacent tissue at said location adjacent to said target tissue volume

(h) applying said electrosurgical output from said electrosurgical generator to said tissue isolating electrode at a voltage level effective to derive an electrosurgical cutting arc while substantially avoiding formation of caloric artifact at said target tissue volume;

(i) maneuvering said tissue isolating electrode circumscriptively within said adjacent tissue about said target tissue volume during said step (g) to effect the isolation thereof from said adjacent tissue; and

(k) actuating said fluid evacuation assembly to effect said fluid suction condition during said steps (f), (h) and (i).