Bipolar electrosurgical clamp for removing and modifying tissue

• US 7,717,912 B2
• Filed: 11/19/2007
• Issued: 05/18/2010
• Est. Priority Date: 01/07/1992
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Ormsby, Theodore, Woloszko, Jean, Tsuji, Craig
• Primary Examiner(s): Cohen; Lee S
• Application Number:
  US11/942,360
• Publication Number:
  US 20080119844A1
• Time in Patent Office: 911 Days
• Field of Search: 606/41, 606/48, 606/50, 600/377, 600/378, 607/116
• US Class Current: 606/41
• 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 2017/00101 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 2018/00327 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 2018/0066 : 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 2018/00791 : 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 2018/1412 : Blade
• CPC Class Codes: A61B 2018/1422 : Hook
• 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 2218/003 : using a spray or a foam
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems, apparatus and methods for selectively applying electrical energy to body tissue in order to ablate, contract, coagulate, or otherwise modify a target tissue or organ. The closed configuration is adapted for clamping and coagulating a target tissue while the apparatus is operating in the sub-ablation mode, while the open configuration is adapted for ablating the target tissue via molecular dissociation of tissue components. A method of the present invention comprises clamping a target tissue or organ with an electrosurgical probe. A first high frequency voltage is applied between the active electrode and the return electrode to effect coagulation of the clamped tissue. Thereafter, a second high frequency voltage is applied to effect localized molecular dissociation of the coagulated tissue.

Claims

1. A method of modifying a target tissue of a patient, the method comprising:

positioning an electrosurgical system including a probe adjacent to the target tissue, the probe electrically connected to a power supply and adapted for clamping the target tissue, and the probe including a shaft distal end bearing an electrode support and a return electrode, the electrode support having an active electrode affixed thereto, wherein the return electrode is moveable, and the return electrode is coupled to a mode switch for switching the power supply between a coagulation mode and an ablation mode;

wherein positioning the probe adjacent to the target tissue further comprises;

adjusting the probe to an open configuration;

positioning the probe such that the target tissue is positioned between the active electrode and the return electrode; and

adjusting the probe to a closed configuration, wherein the target tissue is clamped between the active electrode and the return electrode;

supplying the target tissue an electrically conductive fluid having a conductivity of at least isotonic saline;

coagulating the target tissue by application of a first high frequency voltage from the power supply to the active electrode; and

cutting the target tissue by generating a current flow path through the electrically conductive fluid and between the active electrode and the return electrode by application of a second high frequency voltage.

2. The method of claim 1, wherein said cutting step is prior to said coagulating step.

3. The method of claim 1, wherein said coagulating step is prior to said cutting step.

4. A method of modifying a target tissue of a patient, the method comprising:

positioning an electrosurgical system including a probe adjacent to the target tissue, the probe electrically connected to a power supply and adapted for clamping the target tissue, and the probe including a shaft distal end bearing an electrode support and a return electrode, the electrode support having an active electrode affixed thereto, the electrode support and the return electrode movable between an open configuration and a closed configuration;

coupling at least one of the active electrode and the return electrode to a mode switch for switching the power supply between a coagulation mode and an ablation mode upon moving the return electrode between the closed configuration and the open configuration;

positioning the target tissue between the electrode support and the return electrode in the open configuration;

adjusting the probe to a closed configuration, wherein the target tissue is clamped between the active electrode and the return electrode;

supplying the target tissue an electrically conductive fluid having a conductivity of at least isotonic saline; and

applying a high frequency voltage from the power supply to the active electrode to selectively modify the target tissue.

5. The method of claim 4, wherein the return electrode is coupled to the mode switch for switching the power supply between the coagulation mode and the ablation mode.

6. The method of claim 4, wherein the target tissue comprises a blood vessel.

7. The method of claim 4 wherein modifying the target tissue comprises coagulating the target tissue by application of a first high frequency voltage from the power supply.

8. The method of claim 7 wherein the first high frequency voltage comprises a voltage in the range of from about 200 volts RMS to 1800 volts RMS.

9. The method of claim 7 wherein the first high frequency voltage comprises a voltage in the range of from about 500 volts RMS to 1500 volts RMS.

10. The method of claim 7 wherein modifying the target tissue further comprises severing the tissue by application of a second high frequency voltage from the power supply.

11. The method of claim 10 wherein the second high frequency voltage comprises a voltage in the range of from about 10 volts RMS to 1000 volts RMS.

12. The method of claim 10 wherein the second high frequency voltage comprises a voltage in the range of from about 50 volts RMS to 250 volts RMS.

13. The method of claim 4 wherein modifying the target tissue comprises at least one selected from the group consisting of coagulating the target tissue, severing the target tissue and ablating the target tissue.

14. A method of modifying a target tissue of a patient, the method comprising:

positioning an electrosurgical system including a probe adjacent to the target tissue, the probe electrically connected to a power supply and adapted for clamping the target tissue, and the probe including a shaft distal end bearing an electrode support and a moveable return electrode, the electrode support having an active electrode affixed thereto and, wherein the movable return electrode is coupled to a mode switch for switching the power supply between a coagulation mode and an ablation mode;

supplying the target tissue an electrically conductive fluid having a conductivity of at least isotonic saline;

coagulating the target tissue by application of a first high frequency voltage from the power supply to the active electrode; and

cutting the target tissue by generating a current flow path through the electrically conductive fluid and between the active electrode and the return electrode by application of a second high frequency voltage.

15. A method of modifying a target tissue of a patient, the method comprising:

positioning an electrosurgical system including a probe adjacent to the target tissue, the probe electrically connected to a power supply and adapted for clamping the target tissue, and the probe including a shaft distal end bearing an electrode support and a return electrode the electrode support having an active electrode affixed thereto;

supplying the target tissue an electrically conductive fluid having a conductivity of at least isotonic saline;

coagulating the target tissue by application of a first high frequency voltage from the power supply to the active electrode; and

cutting the target tissue by generating a current flow path through the electrically conductive fluid and between the active electrode and the return electrode by application of a second high frequency voltage to generate high current densities upon an active edge of the active electrode, thereby effecting localized ablation via molecular dissociation of at least a portion of the target tissue in close proximity to the active edge;

wherein positioning the probe adjacent to the target issue further comprises;

adjusting the probe to an open configuration;

positioning the probe such that the target tissue is positioned between the active electrode and the return electrode; and

adjusting the probe to a closed configuration, wherein the target tissue is clamped between the active electrode and the return electrode; and

wherein the return electrode is moveable, and the return electrode is coupled to a mode switch for switching the power supply between a coagulation mode and an ablation mode.