Method and devices for coagulation of tissue

• US 8,241,273 B2
• Filed: 01/11/2010
• Issued: 08/14/2012
• Est. Priority Date: 01/09/2009
• Status: Active Grant

• Current Assignee: Atricure, Inc.
• Original Assignee: Ncontact Surgical, Inc.
• Inventors: Whayne, James G., Fleischman, Sidney D., Sicvol, Christopher W.
• Primary Examiner(s): Park, Kinam
• Application Number:
  US12/685,596
• Publication Number:
  US 20100217249A1
• Time in Patent Office: 946 Days
• Field of Search: 606/15, 606/14, 606/13, 606/33, 128/898
• US Class Current: 606/15
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/06 caused by chemical reaction , e.g. moxaburners
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• 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 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/201 with beam delivery through a hollow tube, e.g. forming an articulated arm through a flexible conduit A61B18/22; Hand-pieces therefor
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00809 measured thermochromatically
• CPC Class Codes: A61B 2018/00821 measured by a thermocouple
• CPC Class Codes: A61B 2018/126 bipolar

Abstract

Methods and devices described herein facilitate improved treatment of body organs.

Claims

1. A method of coagulating cardiac tissue, where the cardiac tissue comprises a first cardiac surface and a second cardiac surface, where the second cardiac surface is on an opposite side of the cardiac tissue from the first cardiac surface, the method comprising:

positioning a first coagulation device adjacent to the first cardiac surface;

forming a first coagulation lesion along the first cardiac surface using the coagulation device such that the first coagulation lesion forms an electrical barrier that prevents an electrical impulse from propagating in cardiac tissue across the first coagulation lesion;

positioning a second device having at least one electromagnetic energy source adjacent to the second cardiac surface;

applying electromagnetic energy adjacent to the second cardiac surface using the electromagnetic energy source;

identifying a location of the electromagnetic energy through the cardiac tissue from the first cardiac surface to locate the second device; and

repositioning the second device at a target location on the second cardiac surface in response to the location of the first coagulation lesion.

2. The method of claim 1, further comprising creating a second coagulation lesion along the second cardiac surface, where the second coagulation lesion extends the electrical barrier of the first coagulation lesion to form a contiguous lesion.

3. The method of claim 2, where the second device further includes at least one coagulation source, such that creating the second coagulation lesion comprises creating the second coagulation lesion with the second device.

4. The method of claim 2, further comprising advancing a second coagulation device to the target location to create the second coagulation lesion.

5. The method of claim 2, where the second coagulation lesion creates the electrical barrier across cardiac tissue without dissecting a pericardial reflection.

6. The method of claim 2, where the first coagulation device and the second device comprise opposite poles of an RF energy supply, and where energy flows between the first coagulation device and second device during application of the RF energy supply.

7. The method of claim 1, where the first coagulation device comprises a device selected from the group consisting of an RF energy device, a laser device, an infrared heating device, a chemical ablation device, a cryogenic device, a microwave energy device, and a resistive heating device.

8. The method of claim 1, where the electromagnetic energy comprises an energy selected from the group consisting of visible light, coherent light, ultraviolet light, magnetic energy, and electrical energy.

9. The method of claim 1, where identifying the electromagnetic energy through the cardiac tissue from the first cardiac surface comprises placing a sensor device adjacent to the first cardiac surface where the sensor device measures the electromagnetic energy to determine a proximity between the second device and the sensor device.

10. The method of claim 1, where the first cardiac surface comprises an epicardial surface and the second cardiac surface comprises an endocardial surface.

11. The method of claim 1, where the first cardiac surface comprises an endocardial surface and the second cardiac surface comprises an epicardial surface.

12. The method of claim 1, where the first coagulation device is advanced through a port or trocar positioned in a body and where the second device is advanced through a vascular path in the body.

13. The method of claim 12, where the port or trocar is located in an abdominal wall of the body and the first coagulation device is advanced through the diaphragm.

14. The method of claim 12, where no ports or trocars are positioned in a chest wall of the body.

15. The method of claim 12, where the first coagulation device is positioned adjacent to the first cardiac surface without requiring deflation of a lung.

16. The method of claim 12, where the port or trocar is located in a chest wall of the body and the first coagulation device is advanced through the diaphragm.

17. The method of claim 1, further comprising advancing a scope into a body where the scope comprises at least one visualization element and where identifying the location of the electromagnetic energy through the cardiac tissue from the first cardiac surface to locate the second device comprises using the visualization element to identify the location of the electromagnetic energy.

18. A method of forming a contiguous coagulation lesion in a tissue of a heart on multiple but opposite atrial surfaces, the method comprising:

positioning a first coagulation device adjacent to an endocardial surface of the tissue;

forming an endocardial coagulation lesion with the first coagulation device;

determining a location on the epicardial surface of the tissue that corresponds to an end of the endocardial coagulation lesion formed on the endocardial surface;

positioning a second coagulation device at or near the location on the epicardial surface such that creating an epicardial coagulation lesion on the epicardial surface causes the lesions to overlap, intersect, and/or join to form the contiguous coagulation lesion such that an electrical impulse is prevented from flowing in the across the contiguous coagulation lesion.

19. A method of creating a cardiac coagulation pattern in cardiac tissue using a minimally invasive surgical technique, the method comprising:

positioning a first coagulation device adjacent to a first cardiac surface;

partially forming the cardiac coagulation pattern by applying energy to the first coagulation device to create at least a first plurality of coagulation lesions along the first cardiac surface, where the first plurality of coagulation lesions includes at least two spaced lesions to define a gap section of tissue such that an electrical impulse is able to flow between the two spaced lesions through the gap section of tissue;

positioning a second coagulation device adjacent to a second cardiac surface, where the second cardiac surface is on an opposite side of the first cardiac surface; and

fully forming the cardiac coagulation pattern by applying energy to the second coagulation device to create at least one bridging coagulation lesion to span the gap section of tissue along the second cardiac surface, where the bridging coagulation lesion prevents an electrical impulse from flowing across the gap section of tissue.