Systems and methods for electrosurgical treatment of submucosal tissue

• US 20010025176A1
• Filed: 02/05/2001
• Published: 09/27/2001
• Est. Priority Date: 06/07/1995
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Woloszko, Jean, Eggers, Philip E., Hovda, David C., Ellsberry, Maria B., Thapliyal, Hira V.
• Granted Patent: US 6,544,261 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 18/1206 Generators therefor
• 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 2018/00607 : Coagulation and cutting with the same instrument
• 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 2018/1467 : 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 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems and methods for selectively applying electrical energy to a target location within the head and neck of a patient'"'"'s body, particularly including tissue in the ear, nose and throat. The present invention includes a channeling technique in which small holes or channels are formed within tissue structures in the mouth, such as the tonsils, tongue, palate and uvula, and thermal energy is applied to the tissue surface immediately surrounding these holes or channels to cause thermal damage to the tissue surface, thereby stiffening the surrounding tissue structure. Applicant has discovered that such stiffening of certain tissue structures in the mouth and throat helps to prevent the tissue structure from obstructing the patient'"'"'s upper airway during sleep.

Claims

1. A method for treating obstructive sleep disorders comprising:

positioning an active electrode adjacent to a tissue structure in a patient'"'"'s mouth or throat;

applying high frequency voltage between the active electrode and a return electrode, the high frequency voltage being sufficient to ablate tissue;

during the applying step, advancing the active electrode into the tissue to generate a space within the tissue; and

during the first applying step, applying a second high frequency voltage between the return electrode and a coagulation electrode, the second high frequency voltage being insufficient to ablate tissue.

2. The method of

claim 1

wherein the two applying steps are carried out at the same time.

3. The method of

claim 2

wherein the two applying steps are carried out by the same power supply.

4. The method of

claim 1

further comprising reducing the voltage applied to the coagulation electrode to a level insufficient to ablate tissue.

5. The method of

claim 4

wherein the reducing step is carried out with a voltage reduction element.

6. The method of

claim 1

wherein the tissue structure is selected from the group comprising the tonsils, palate, uvula, turbinates, pharynx and the tongue.

7. The method of

claim 1

further comprising providing an electrically conductive fluid around the active electrode and between the active and return electrodes prior to the applying step.

8. The method of

claim 7

wherein the providing step comprises positioning the active and return electrodes within a source of electrically conductive fluid and then positioning the active and return electrodes into the patient'"'"'s mouth adjacent to the tissue structure.

9. The method of

claim 7

wherein the providing step comprises delivering the electrically conductive fluid to the active and return electrodes at the target site in the patient'"'"'s mouth.

10. The method of

claim 7

wherein the electrically conductive fluid is selected from the group comprising a gel, a liquid and a gas.

11. The method of

claim 7

further comprising generating a current flow path between the active and return electrodes with the electrically conductive fluid.

12. The method of

claim 1

wherein the high frequency voltage applied between the coagulation and return electrodes is sufficient to thermally damage the surface of the tissue surrounding the space.

13. The method of

claim 1

further comprising axially translating the active electrode to form a hole through at least a portion of the tissue structure.

14. The method of

claim 1

wherein the space has a maximum lateral dimension less than about 2 mm.

15. The method of

claim 1

wherein the active, return and coagulation electrodes are all located on a shaft of an electrosurgical instrument.

16. The method of

claim 7

wherein the electrically conductive fluid is not present during the removal step.

17. A system for treating tissue comprising:

an electrosurgical instrument having a shaft with a proximal end portion and a distal end portion;

an electrode assembly comprising at least one active electrode terminal positioned on the distal portion of the shaft, at least one return electrode positioned on the shaft and axially spaced from the electrode terminal, and a coagulation electrode positioned on the shaft and axially spaced from the return electrode;

a power source coupled to the active, return and coagulation electrodes for applying a high frequency voltage between the active and return electrode, and between the coagulation and return electrodes at the same time; and

wherein the voltage applied between the coagulation and return electrodes is lower than the voltage applied between the active and return electrodes.

18. The system of

claim 17

wherein the distal end portion of the shaft is sized for delivery through a percutaneous opening in the patient to a spinal disc.

19. The system of

claim 17

further comprising a voltage reduction element coupled between the power source and the coagulation electrode to reduce the voltage applied to the coagulation electrode.

20. The system of

claim 19

wherein the voltage reduction element comprises a capacitor located within the electrosurgical instrument.

21. The system of

claim 17

wherein the voltage applied between the coagulation electrode and the return electrode is in the range of about 20 to 90 volts rms and the voltage applied between the active and return electrodes is in the range of about 150 to 350 volts rms.

22. The system of

claim 17

wherein the coagulation electrode comprises an annular band spaced proximally from the return electrode and having a substantially smooth, exposed surface to reduce current densities on said surface.

23. The system of

claim 17

wherein the expose surface of the coagulation electrode has a larger surface area than the exposed surface of the return electrode.

24. The system of

claim 17

wherein the coagulation electrode has an exposed length in the range of about 2.0 to 8.0 mm, and the return electrode has an exposed length in the range of about 2.0 to 8.0 mm.

25. The system of

claim 17

further including a first insulating member positioned between the active and return electrodes and a second insulating member between the return and coagulation electrodes

26. The system of

claim 17

further comprising a fluid delivery element for delivering electrically conductive fluid to the active electrode.

27. The system of

claim 26

wherein the fluid delivery element comprises a lumen extending adjacent to, or through, the shaft, and a distal opening on the shaft coupled to the lumen.

28. The system of

claim 27

further comprising a fluid aspiration element for aspirating fluid from the target site.

29. The system of

claim 17

wherein the distal end portion of the instrument shaft is sized for channeling within submucosal tissue.