Method for electrosurgical tissue treatment near a patient's heart

• US 7,217,268 B2
• Filed: 06/24/2003
• Issued: 05/15/2007
• Est. Priority Date: 05/10/1994
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Thapliyal, Hira V.
• Primary Examiner(s): Cohen; Lee S.
• Application Number:
  US10/602,240
• Publication Number:
  US 20040087937A1
• Time in Patent Office: 1,421 Days
• Field of Search: 606/41, 606/48, 606/49, 606/50, 606/32, 606/46, 604/114, 607/99, 607/105, 607/113
• US Class Current: 606/32
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• 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 2017/00097 one of the thermometric elements being an electrode or the heating element
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• 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 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/22001 Angioplasty, e.g. PCTA
• CPC Class Codes: A61B 2017/22038 with a guide wire
• 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 2018/00196 : reciprocating lengthwise
• CPC Class Codes: A61B 2018/00327 : Ear, nose or throat
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/0047 : Upper parts of the skin, e.g. skin peeling or treatment of wrinkles
• CPC Class Codes: A61B 2018/00476 : Hair follicles
• 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 2018/00642 : with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/0066 : without feedback, i.e. open loop control
• 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 2018/00738 : Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00755 : Resistance or impedance
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00886 : Duration
• 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 2018/1246 : 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 2018/1407 : 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 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• 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
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• CPC Class Codes: A61M 25/0158 : with magnetic or electrical means, e.g. by using piezo materials, electroactive polymers, magnetic materials or by heating of shape memory materials

Abstract

An electrosurgical probe (10) comprises a shaft (13) having an electrode array (58) at its distal end and a connector (19) at its proximal end for coupling the electrode array to a high frequency power supply (28). The shaft includes a return electrode (56) recessed from its distal end and enclosed within an insulating jacket (18). The return electrode defines an inner passage (83) electrically connected to both the return electrode and the electrode array for passage of an electrically conducting liquid (50). By applying high frequency voltage to the electrode array and the return electrode, the electrically conducting liquid generates a current flow path between the return electrode and the electrode array so that target tissue may be cut or ablated. The probe is particularly useful in dry environments, such as the mouth or abdominal cavity, because the electrically conducting liquid provides the necessary return current path between the active and return electrodes.

Claims

1. A method for removing a structure in or around a patient'"'"'s heart comprising:

introducing a distal end of a tubular shall through an opening in the patient'"'"'s body to the patient'"'"'s heart, the tubular shaft having a distal opening and an inner lumen in communication with the distal opening;

positioning a distal end of the tubular shaft adjacent a structure in or around a patient'"'"'s heart;

positioning an electrode terminal and a return electrode through said tubular shaft such that the electrode terminal is located adjacent said structure;

spacing the return electrode away from the structure and the patient'"'"'s heart; and

applying a sufficient high frequency voltage difference between the electrode terminal and the return electrode to remove the structure from the patient'"'"'s heart.

2. The method of claim 1 wherein the applying step comprises applying a sufficient high frequency voltage difference between the electrode terminal and the return electrode to ablate a portion of the structure.

3. The method of claim 2 wherein the spacing step is carried out by locating the return electrode proximal to the electrode terminal.

4. The method of claim 2 wherein the high frequency voltage is applied in the presence of electrically conductive fluid.

5. The method of claim 4 further comprising generating a current flow path through the electrically conductive fluid between the return electrode and the electrode terminal through the electrically conductive fluid.

6. The method of claim 5 further comprising directing the electrically conductive fluid through a fluid lumen in the tubular shaft to generate a current flow path between the electrode terminal and the return electrode.

7. The method of claim 4 wherein the high frequency voltage is sufficient to vaporize the fluid in a thin layer between at least a portion of the electrode terminal and the structure.

8. The method of claim 4 wherein said electrically conductive fluid has an electrical conductivity of at least 2 mS/cm.

9. The method of claim 1 wherein the structure comprises heart tissue.

10. The method of claim 9 wherein the heart tissue is selected from the group consisting of epicardium, myocardium, and endocardium.

11. The method of claim 1 wherein the electrode terminal and the return electrode are positioned at a distal portion of the tubular shaft and radially outward from the distal opening, the method further comprising rotating at least the distal portion of the tubular shaft during the applying step.

12. The method of claim 1 wherein the electrode terminal comprises an electrode array of electrically isolated electrode terminals, the method further comprising applying high frequency voltage to the electrode array of electrically isolated electrode terminals and the return electrode in the presence of electrically conductive fluid such that an electrical current flows from each of the electrode terminals, through the electrically conductive fluid, and to the return electrode.

13. The method of claim 1 further comprising aspirating a region around the structure.

14. The method of claim 1 further comprising applying high frequency voltage between the electrode terminal and the return electrode to remove tissue at the heart wall.

15. The method of claim 14 further comprising forming a revascularizing channel through at least a portion of the heart wall, the revascularizing channel extending from a surface of the heart wall into the myocardium to restore blood flow to a portion of the myocardium.

16. The method of claim 1 wherein said tubular shaft comprises a flexible catheter member.

17. The method of claim 1 wherein said tubular shaft comprises a rigid trocar.

18. The method of claim 1 wherein said electrode terminal and return electrode are affixed to a probe distal portion and said probe is inserted through said shaft.