Systems and methods for electrosurgical treatment of submucosal tissue

• US 6,544,261 B2
• Filed: 02/05/2001
• Issued: 04/08/2003
• Est. Priority Date: 06/07/1995
• Status: Expired due to Term

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Ellsberry, Maria B., Woloszko, Jean, Eggers, Philip E., Hovda, David C., Thapliyal, Hira V.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/776,799
• Publication Number:
  US 20010025176A1
• Time in Patent Office: 792 Days
• Field of Search: 606/41, 606/49, 606/50, 606/32, 606/45, 606/46, 606/48, 607/99, 607/105, 607/113, 607/122, 604/22, 604/114, 128/898
• 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 tissue comprising:

positioning an active electrode adjacent to tissue;

applying a first high frequency voltage between the active electrode and a return electrode;

during at least a portion of the applying step, advancing the active electrode into the tissue; and

during or after the first applying step, applying a second high frequency voltage between the return electrode and a coagulation electrode.

2. The method of claim 1 wherein the first and second high frequency voltages are the same.

3. The method of claim 1 wherein the second high frequency voltage is lower than the first high frequency voltage.

4. The method of claim 1 wherein the active electrode, return electrode and coagulation electrode are spaced from each other on an instrument shaft, the advancing step comprising advancing the active and return electrodes into the tissue.

5. The method of claim 4 wherein the advancing step further comprising advancing the coagulation electrode to at least the surface of the tissue such that at least a portion of the coagulation electrode is in contact with the tissue.

6. The method of claim 5 wherein the first and second high frequency voltages are the same voltage, the method further comprising applying the same voltage between the active electrode and the return and coagulation electrodes while maintaining the active, return and coagulation electrodes in contact with the tissue.

7. The method of claim 6 wherein the maintaining step is carried out for about 1 to 20 seconds, the method further comprising withdrawing the active, return and coagulation electrodes from the tissue after the maintaining step.

8. The method of claim 5 wherein the first and second high frequency voltages are the same voltage, the method further comprising applying the same voltage between the active electrode and the return and coagulation electrodes while withdrawing the active, return and coagulation electrodes from the tissue.

9. The method of claim 1 wherein the tissue is selected from the group consisting of the tonsils, palate, uvula, turbinates, pharynx and the tongue.

10. 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 first applying step.

11. The method of claim 10 wherein the providing step comprises positioning the active and return electrodes within a source of the electrically conductive fluid and then positioning the active and return electrodes adjacent to the tissue.

12. The method of claim 10 wherein the providing step comprises delivering the electrically conductive fluid to the active and return electrodes.

13. The method of claim 10 further comprising generating a current flow path between the active and return electrodes with the electrically conductive fluid.

14. The method of claim 1 wherein the first high frequency voltage is sufficient to ablate the tissue structure and the second high frequency voltage is sufficient to thermally damage a surface of the tissue structure in contact with the return and coagulation electrodes.

15. 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.

16. The method of claim 15 wherein the hole has a maximum lateral dimension less than about 2 mm.

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 first, second and third electrodes positioned on the distal end portion of the shaft and axially spaced from each other;

a power source coupled to the first, second and third electrodes for applying a high frequency voltage between the first and second electrodes, and between the second and third electrodes at the same time.

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

20. The system of claim 19 wherein the exposed surface of the third electrode has a larger surface area than an exposed surface of the first and second electrodes.

21. The system of claim 17 wherein the third electrode has an exposed length in the range of about 2.0 to 8.0 mm, and the second electrode has an exposed length in the range of about 2.0 to 8.0 mm.

22. The system of claim 17 further including a first insulating member positioned between the first and second electrodes and a second insulating member between the second and third electrodes.

23. The system of claim 17 further comprising a fluid delivery element for delivering electrically conductive fluid to the first and second electrodes.

24. The system of claim 17 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.

25. The system of claim 17 further comprising a fluid aspiration element for aspirating fluid from a region around the first electrode.