Multi fluid tissue resection methods and devices

• US 9,232,959 B2
• Filed: 02/04/2010
• Issued: 01/12/2016
• Est. Priority Date: 01/02/2007
• Status: Active Grant

• Current Assignee: AquaBeam, LLC
• Original Assignee: AquaBeam, LLC
• Inventors: Aljuri, Nikolai, Nair, Ajit, Shah, Paren, Nemeyer, Adam, Grupp, Daniel
• Primary Examiner(s): FARAH, AHMED M
• Application Number:
  US12/700,568
• Publication Number:
  US 20110184391A1
• Time in Patent Office: 2,168 Days
• Field of Search: 606/4, 606/7, 606 13- 15, 606/41, 606/45, 607 88- 93, 607/100, 607/101, 607104-107, 604/23, 604/48, 604/82, 604/83, 604/85, 128/898
• US Class Current: 1/1
• CPC Class Codes: A61B 17/3203 Fluid jet cutting instruments
• CPC Class Codes: A61B 17/32037 for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• 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 2017/00274 Prostate operation, e.g. prostatectomy, turp, bhp treatment
• CPC Class Codes: A61B 2017/22079 with suction of debris
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00285 Balloons
• CPC Class Codes: A61B 2018/00547 Prostate
• 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 2018/00946 slidable
• CPC Class Codes: A61B 2018/00952 rotatable
• CPC Class Codes: A61B 2018/046 in liquid form
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/1497 Electrodes covering only part of the probe circumference
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 9/007 : Methods or devices for eye surgery
• CPC Class Codes: A61F 9/00736 : Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments A61F9/008 takes precedence

Abstract

Prostate treatment using fluid stream to resect prostate tissue, thereby relieving symptoms of conditions such as BPH, prostatitis, and prostatic carcinoma. A device having a fluid delivery element is positioned within a lumen of the urethra within the prostate. A fluid stream is directed outwardly from the fluid delivery element toward a wall of the urethral lumen. The fluid delivery element is moved to scan the fluid stream over the wall to remove a volume of tissue surrounding the lumen. The fluid may be combined with therapeutically active substances or with substances that increase resection efficiency. Fluid force may be adjusted to provide selective tissue resection such that soft tissue is removed while harder tissue is left undamaged. In order to gain a working space within the urethra, another fluid may be introduced to insufflate the urethra in the region of treatment.

Claims

1. A method for tissue modification, comprising:

inserting a probe into an organ;

delivering a first fluid into the organ to create a working space;

delivering a second fluid through the probe as a fluid stream to the tissue, wherein the second fluid is different from the first fluid; and

resecting a volume of the tissue using the fluid stream wherein one or more fluid stream parameters has been selected such that the resecting is selective to a particular tissue type, the one or more parameters comprising fluid stream shape and fluid stream source pressure.

2. The method of claim 1, wherein the probe is inserted through an existing body lumen.

3. The method of claim 1, wherein the probe is inserted through solid body tissue.

4. The method of claim 1, wherein the first fluid is delivered until a pressure within the working space is in the range from 0.1 to 5 psi.

5. The method of claim 4, further comprising delivering the first fluid into the organ to maintain the working space.

6. The method of claim 1, further comprising delivering a sufficient amount of the first fluid to create a volume of the first fluid within the working space, such that the fluid stream travels through the volume of the first fluid.

7. The method of claim 6, wherein the first fluid is a gas and the second fluid is a liquid.

8. The method of claim 7, further comprising directing the first fluid towards the fluid stream, thereby allowing the first fluid to envelope the fluid stream to preserve a stream integrity of the fluid stream.

9. The method of claim 7, wherein the second fluid is delivered at a force sufficient to resect prostate tissue.

10. The method of claim 9, wherein the second fluid is delivered from a fluid source at a pressure in the 1 psi to 2,000 psi range.

11. The method of claim 9, wherein the second fluid is delivered from a fluid source at a pressure in the 100 psi to 1,500 psi range.

12. The method of claim 9, wherein the second fluid is delivered from a fluid source at a pressure in the 50 psi to 1,000 psi range.

13. The method of claim 1, further comprising using a visualization element in the working space.

14. The method of claim 1, further comprising transmitting energy through an interior of the fluid stream to cauterize the tissue.

15. The method of claim 14, wherein the energy is sufficient to resect the tissue.

16. The method of claim 14, further comprising adjusting the delivery of the second fluid such that the fluid stream transmits energy but does not resect tissue.

17. The method of claim 14, wherein the energy is electromagnetic energy.

18. The method of claim 17, wherein the electromagnetic energy is radiofrequency energy.

19. The method of claim 17, wherein the electromagnetic energy is light.

20. The method of claim 14, wherein the first fluid and the second fluid are selected such that a difference between their refractive indices causes the fluid stream to operate as an optical conduit.

21. The method of claim 1, further comprising removing a mixture of resected tissue and the second fluid from the working space.

23. The method of claim 1, wherein the second fluid is delivered from a fluid source at a pressure within range from 1 psi to 30,000 psi.

24. The method of claim 1, wherein the organ comprises one or more of a prostate, a brain, a heart, a lung, an intestine, an eye, skin, a kidney, a liver, a pancreas, a stomach, a uterus, an ovary, a testicle, a bladder, an ear, or a nose.

25. The method of claim 24, wherein the organ comprises the eye.

26. The method of claim 1, wherein the tissue comprises soft tissue.

27. The method of claim 26, wherein the soft tissue comprises one or more of soft tissue comprises one or more of bone marrow, adipose tissue, muscle, glandular tissue, spinal tissue, or cartilage.

28. The method of claim 1, wherein the tissue comprises hard tissue.

29. The method of claim 28, wherein the hard tissue comprises one or more of tooth or bone.

30. The method of claim 1, wherein the tissue comprises one or more of a body lumen or a body passage.

31. The method of claim 30, wherein the one or more of the body lumen or the body passage comprises one or more of a sinus, a ureter, a colon, an esophagus, a lung passage, or a blood vessel.

32. The method of claim 1, wherein a drug to is delivered to the tissue, the drug comprising one or more of anesthetics, antibiotics, anti-inflammatories, anti-neoplastics, tissue specific growth factors, anti-growth factors, hormones, anti-hormones, vasodilators, vasoconstrictors, vitamins or protein.

22. The method of 21, wherein the removing comprises generating a pressure differential between an outlet for the first fluid and an inlet for the mixture.