U.S. patent application number 09/840666 was filed with the patent office on 2001-08-16 for electrosurgical handpiece for treating tissue.
Invention is credited to Ellman, Alan G., Garito, Jon C..
Application Number | 20010014806 09/840666 |
Document ID | / |
Family ID | 23173932 |
Filed Date | 2001-08-16 |
United States Patent
Application |
20010014806 |
Kind Code |
A1 |
Ellman, Alan G. ; et
al. |
August 16, 2001 |
Electrosurgical handpiece for treating tissue
Abstract
An electrosurgical handpiece that is bipolar or unipolar in
operation and that is configured for use in MIS. The bipolar
operation confines the electrosurgical currents to a small active
region between the active ends of the bipolar electrode and thus
reduces the possibility that excessive heat will be developed that
can damage patient tissue. The position of the active region can be
controlled to avoid patient tissue that may be moire sensitive to
excessive heat. In one embodiment, the handpiece is constructed
with a flexible end controllable by the surgeon so as to allow the
surgeon to manipulate the end as desired during the surgical
procedure. This feature allows the surgeon to position the active
electrode end at the optimum location within, say, a herniated disk
to remove undesired regions and to provide controlled heat to
shrink the tissue during surgery. In another embodiment, the
handpiece is constructed to contain both a bipolar as well as a
unipolar electrode, with provision made for selectively operating
either of the electrodes. In still another embodiment, a
replaceable element for the handpiece comprises scissors.
Inventors: |
Ellman, Alan G.; (Hewlett,
NY) ; Garito, Jon C.; (Hewlett, NY) |
Correspondence
Address: |
Jack Oisher
200 High Point Dr.-PH2
Hartsdale
NY
10530
US
|
Family ID: |
23173932 |
Appl. No.: |
09/840666 |
Filed: |
April 23, 2001 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
09840666 |
Apr 23, 2001 |
|
|
|
09303839 |
May 3, 1999 |
|
|
|
6231571 |
|
|
|
|
Current U.S.
Class: |
606/45 ; 606/46;
606/48; 606/49; 606/50 |
Current CPC
Class: |
A61B 18/1485 20130101;
A61B 18/148 20130101; A61B 18/1482 20130101; A61B 18/14
20130101 |
Class at
Publication: |
606/45 ; 606/46;
606/48; 606/49; 606/50 |
International
Class: |
A61B 018/14 |
Claims
What is claimed is:
1. An electrosurgical bipolar handpiece comprising: (a) an
elongated tubular first member having a first end and a remote
flexible second end, (b) an elongated tubular second member located
within the first member, said second member comprising an
electrically-insulating tube having a first end and a remote
flexible second end adjacent the first member's second end and
comprising electrically-insulating means dividing the second tube
into first and second compartments, (c) first and second
electrically-conductive wires each positioned, respectively, in the
first and second compartments and electrically-insulated from each
other, (d) first means connected to the first member at its first
end for applying electrosurgical bipolar currents to the first and
second wires, (e) second means connected to the first member at its
first end for selectively flexing the remote flexible end of the
first member relative to the first end of the first member together
with the remote flexible end of the second member, (f) active
electrically-insulated electrosurgical electrodes connected to the
first and second wires and extendable at the remote flexible end,
said electrosurgical electrodes flexing together with the remote
flexible ends when the second means is operated while maintaining
them electrically-insulated.
2. An electrosurgical bipolar handpiece as claimed in claim 1,
wherein the first member comprises a weakened section at its
flexible end.
3. An electrosurgical bipolar handpiece as claimed in claim 2,
wherein the weakened section comprises at least one slot in a side
of the first member close to but spaced from the remote end of the
first member.
4. An electrosurgical bipolar handpiece as claimed in claim 3,
wherein the weakened section comprises a plurality of spaced
slots.
5. An electrosurgical bipolar handpiece as claimed in claim 1,
wherein the divider comprises an electrically-insulating wall
portion which projects outwardly from the remote end of the second
member, the electrodes being positioned on opposite sides of the
projecting wall portion.
6. An electrosurgical bipolar handpiece as claimed in claim 1,
wherein the second means comprises a pull wire or string positioned
inside of the first member and connected at one end to the remote
end of the first member, further comprising means for pulling the
other end of the pull wire or string.
7. An electrosurgical bipolar handpiece as claimed in claim 1,
wherein the first member has a length of about 10-20 inches and a
diameter between about 0.07-0.1 inches for insertion into an MIS
cannula.
8. An electrosurgical handpiece comprising: (a) a handle having a
grip and a part pivotable with respect to the grip, said handle
having means for mounting a tubular member, (b) an elongated
tubular first member having a first end and a remote flexible
second end, (c) an elongated tubular electrically-insulating second
member located within the first member, said second member
comprising an electrically-insulating tube having a first end and a
remote flexible second end adjacent the first member's second end,
(d) an electrically-conductive wire positioned within the second
member, (e) first means connected to the first member at its first
end for applying electrosurgical currents to the
electrically-conductive wire, (f) second means connected to the
pivotable part for selectively flexing the remote flexible end of
the first member relative to the first end of the first member
together with the remote flexible end of the second member, (g) an
active electrosurgical electrode connected to the
electrically-conductive wire and extending out of the remote
flexible end, said electrosurgical electrode flexing together with
the remote flexible end when the pivotable part is operated.
9. An electrosurgical handpiece as claimed in claim 8, wherein the
second means comprises a pull wire or string connected at its
remote end to the flexible end of the first member and connected at
its proximal end to the trigger.
10. An electrosurgical handpiece as claimed in claim 9, wherein the
pull wire or string is positioned between the first and second
members.
11. An electrosurgical handpiece as claimed in claim 8, wherein the
second member comprises a bipolar electrode.
12. An electrosurgical handpiece as claimed in claim 8, wherein the
second member comprises a unipolar electrode.
13. An electrosurgical handpiece as claimed in claim 8 wherein the
second member is removably mounted within the first member.
14. An electrosurgical handpiece comprising: (a) a handle having a
grip and a trigger pivotable with respect to the grip, said handle
having means for mounting a tubular member, (b) an elongated
tubular first member having a first end and a remote flexible
second end, (c) an elongated tubular electrically-insulating second
member located within the first member, said second member
comprising an electrically-insulating tube having a first end and a
remote flexible second end adjacent the first member's second end
and providing clearance for gas flow between the first and second
members, (d) an electrically-conductive wire positioned within the
second member, (e) first means connected to the first member at its
first end for applying electrosurgical currents to the
electrically-conductive wire, (f) second means connected to the
trigger for selectively flexing the remote flexible end of the
first member relative to the first end of the first member together
with the remote flexible end of the second member, (g) an active
electrosurgical electrode connected to the electrically-conductive
wire and extending out of the remote flexible end, said
electrosurgical electrodes flexing together with the remote
flexible end when the trigger is operated, (h) suction means
connected to the handle and between the first and second members
and providing suction at the remote second end via the clearance
between the first and second members.
15. An electrosurgical handpiece as claimed in claim 14, wherein
the second member is removably mounted within the first member.
16. An electrosurgical handpiece comprising: (a) a handle having a
grip and a first part movable with respect to the grip, said handle
having means for mounting a support member, (b) a generally tubular
first member having a first end and a remote second end and
comprising one of bipolar and unipolar electrodes having a first
end and a second end adjacent the first member's second end, said
electrically-insulated bipolar electrodes being connected to the
first part and being movable within the tubular first member, (c) a
generally tubular second member mounted on the handle alongside of
the tubular first member, said tubular second member comprising the
other of the bipolar and unipolar electrodes and movable within the
tubular second member, (d) first and second means connected
respectively to the bipolar and unipolar electrodes for applying
thereto respective bipolar and unipolar electrosurgical currents,
(e) third means for selectively making the bipolar and unipolar
electrodes accessible at the remote second end and for selectively
energizing the selected electrodes by applying thereto
electrosurgical currents.
17. An electrosurgical handpiece as claimed in claim 16, further
comprising fourth and fifth means for selectively advancing and
retracting the respective bipolar and unipolar electrodes causing
the respective ends thereof to project outwardly from their
respective tubular first and second members.
18. An electrosurgical handpiece for MIS use comprising: (a) a
handle having a grip and a first part movable with respect to the
grip, said handle having means for mounting a tubular member, (b)
an elongated tubular first member having a first end and a remote
second end, (c) an elongated tubular second member located within
the first member, said second member comprising
electrically-insulated bipolar electrodes and having a first end
and a second end adjacent the first member's second end, said
tubular second member being slidable within the tubular first
member, (d) a tubular third member mounted on the handle alongside
of the tubular first member, said tubular third member comprising
an unipolar electrode slidable within the tubular third member, (e)
first and second means connected respectively to the bipolar and
unipolar electrodes for applying thereto respective bipolar and
unipolar electrosurgical currents, (f) third means for selectively
advancing and retracting respectively the tubular second member and
its bipolar electrodes and the unipolar electrode causing the
respective ends thereof to project outwardly from their respective
tubular second and third members thereby to apply selectively
respective bipolar and unipolar electrosurgical currents at the
respective electrode ends.
19. An electrosurgical handpiece for MIS use as claimed in claim
18, wherein at least one of the bipolar and unipolar electrodes
comprises a remote end configured so as to assume a predetermined
orientation when advanced from their respective tubular member.
20. An electrosurgical handpiece for MIS use as claimed in claim
18, wherein at least one of the bipolar and unipolar electrodes
comprises a bent remote end, said one of the bipolar and unipolar
electrodes being selectively removable from its respective tubular
member thereby allowing replacement of said one of the bipolar and
unipolar electrodes with another similar electrode with a remote
end bent in a different direction.
21. An electrosurgical handpiece for MIS use comprising: (a) an
elongated tubular first member having a first end and a remote
second end, (b) an elongated tubular second member located within
the first member, said second member comprising an elongated member
terminating in a pair of scissor elements, said second member being
slidably removably mounted within the first member, (c) first means
connected to the pair of scissor elements for selectively extending
and retracting same, said scissor elements being configured such
that extending them causes the scissor elements to open and
retracting them causes the scissor elements to close.
22. An electrosurgical handpiece for MIS use as claimed in claim
21, further comprising terminal means connected to the scissor
elements for applying electrosurgical currents thereto.
23. An electrosurgical handpiece for MIS use as claimed in claim
21, wherein the scissor elements are insulated from each other
allowing the application of bipolar currents thereto.
24. An electrosurgical handpiece for MIS use as claimed in claim
21, wherein the tubular second member is removably and slidably
mounted within the first member.
25. A procedure for surgically treating tissue comprising: (I)
providing an electrosurgical handpiece comprising: (I) providing an
electrosurgical bipolar handpiece comprising: (a) an elongated
tubular first member having a first end and a remote flexible
second end, (b) an elongated tubular second member located within
the first member, said second member comprising an
electrically-insulating tube having a first end and a remote
flexible second end adjacent the first member's second end and
containing an electrically-insulating divider dividing the second
tube into first and second compartments, (c) first and second
electrically-conductive wires each positioned, respectively, in the
first and second compartments and electrically-insulated from each
other, (d) first means connected to the first member at its first
end for applying electrosurgical bipolar currents to the first and
second wires, (e) second means connected to the first member at its
first end for selectively flexing the remote flexible end of the
first member relative to the first end of the first member together
with the remote flexible end of the second member, (f) active
electrically-insulated electrosurgical electrodes connected to the
first and second wires and selectively extendable out of their
respective compartments at the remote flexible end, said
electrosurgical electrodes flexing together with the remote
flexible ends when the second means is operated while maintaining
them electrically-insulated, (II) inserting the first tubular
member into a patient in the vicinity of tissue to be treated,
(III) flexing the remote flexible end to position the
electrosurgical electrodes at the tissue to be treated, (IV)
applying electrosurgical currents to the first end to provide a
bipolar discharge to generate heat at and treat the tissue.
26. A procedure for surgically shrinking tissue as set forth in
claim 25, wherein a cannula is first inserted into the patient and
the first tubular member is then inserted into the cannula until
its flexible end is adjacent the tissue, after step (IV), the
second tubular member is removed from the first tubular member and
replaced by another second tubular member with a different
electrode configuration without removing the first tubular member
from the cannula, and then the electrode in the other second
tubular member is energized.
27. A procedure for surgically shrinking tissue as set forth in
claim 25, wherein clearance for gas flow is provided between the
first and second members, and suction is applied to the
clearance.
28. A procedure for surgically shrinking tissue as set forth in
claim 26, wherein the electrosurgical handpiece is provided with a
unipolar electrode and means for selectively making accessible at
the remote end one of the bipolar and unipolar electrodes and for
selectively energizing same, further comprising the step of first
treating the tissue with one of the bipolar and unipolar electrodes
and then treating the tissue with the other of the bipolar and
unipolar electrodes while the first tubular member remains within
the cannula.
Description
[0001] This invention relates to an electrosurgical handpiece and
an activator for an electrosurgical handpiece.
BACKGROUND OF THE INVENTION
[0002] Electrosurgery is a common procedure for dentists, doctors,
and veterinarians. Electrosurgical handpieces are commercially
available that will accommodate a wide variety of electrode shapes
and sizes, such as needles, blades, scalpels, balls and wire loops.
Also, multi-function electrodes are available. Electrosurgery has
been used for many different kinds of surgical procedures. One
surgical procedure involves minimally invasive surgery (MIS), also
referred to as laparoscopy, in which a small diameter cannula is
inserted via an incision in the patient's body, and a fiber optics
viewer (TV camera and monitor) as well as an elongated nozzle from
an electrosurgical handpiece are extended through the cannula to
the region of the patient where surgery is necessary, and the
surgery carried out by the surgeon using the electrosurgical
electrode while viewing the procedure through the viewer. Our
issued U.S. Pat. No. 5,304,763 describes one form of MIS, the
contents of which patent are herein incorporated by reference.
[0003] MIS with electrosurgery has also been used for the reduction
of herniated disks, by introducing a unipolar electrode via the
cannula into the herniated disk region and activating the electrode
for the purpose of shrinking the disk. One such system also
provides for bending the end of the unipolar electrode in order to
position the active end in the desired disk region. In such a
procedure, care must he exercised to avoid nerve damage. In the
known system, a heat sensor is built into the active unipolar
electrode end for the purpose of sensing the heat generated by the
electrosurgical currents and shutting off the electrosurgical
currents when the heat reaches too high a level.
SUMMARY OF THE INVENTION
[0004] An object of the invention is an electrosurgical handpiece
that is capable of treating tissue when energized.
[0005] Another object of the invention is an electrosurgical
handpiece that can be used in MIS and reduces the danger of
excessive heat causing possible patient harm.
[0006] According to one aspect of the invention, an electrosurgical
handpiece is provided that is bipolar in operation and that is
configured for use in MIS. The bipolar operation confines the
electrosurgical currents to a small active region between the
active ends of the bipolar electrode and thus reduces the
possibility that excessive heat will be developed that can damage
patient tissue. Moreover, the position of the active region can be
controlled to avoid patient tissue that may be more sensitive to
excessive heat.
[0007] In accordance with a preferred embodiment of this aspect of
the invention, the handpiece is provided with a dual compartment
insulated elongated tube, each of the compartments serving to house
one of the two wires of bipolar electrodes.
[0008] According to another aspect of the invention, the electrode
for MIS use is constructed with a flexible end controllable by the
surgeon so as to allow the surgeon to manipulate the end as desired
during the surgical procedure. In a preferred embodiment, the
flexible end is achieved by weakening at the end the housing for
the electrode, and providing a pull string or wire connected to the
weakened housing end and with a mechanism at the opposite end for
the surgeon to pull the string or wire to flex the housing end to
the desired position. This feature allows the surgeon to position
the active electrode end at the optimum location within the
herniated disk to remove undesired regions and to provide
controlled heat to shrink the tissue during surgery.
[0009] Still another aspect of the invention is a multi-purpose
electrode system adapted for MIS use, which combines both a
unipolar and a bipolar electrode. Preferably, the electrodes can be
easily interchanged. In a preferred embodiment, the handpiece is
provided with a three compartment insulated elongated tube, two of
the compartments serving to house one of the two wires of bipolar
electrodes, and the third compartment serving to house the wire of
an unipolar electrode. Means are provided to selectively extend and
operate either the bipolar or unipolar electrode enabling the
surgeon, without having to remove the handpiece from the cannula,
to successively use the bipolar or unipolar electrode as
needed.
[0010] In still another aspect of the invention, one of the
replaceable elements of the muti-purpose electrode system adapted
for MIS use can be a scissors operated either electrically or
mechanically.
[0011] The construction of the invention will provide important
benefits not only for MIS of herniated disks but also for other MIS
procedures where controlled electrode position and controlled heat
generation is of importance. Such procedures include drying,
shrinking, or denaturazing tissue generally and collagen tissue in
particular for such purposes as tightening or reducing the
tissue.
[0012] The various features of novelty which characterize the
invention are pointed out with particularity in the claims annexed
to and forming a part of this disclosure. For a better
understanding of the invention, its operating advantages and
specific objects attained by its use, reference should be had to
the accompanying drawings and descriptive matter in which there are
illustrated and described the preferred embodiments of the
invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] In the drawings:
[0014] FIG. 1 is a perspective view of one form of an
electrosurgical handpiece according to the invention fitted with a
bipolar activator according to the invention and with the handle in
its open position;
[0015] FIG. 2 is a side view of a variant of the handpiece of FIG.
1 with the handle in its closed position;
[0016] FIG. 3 is a cross sectional view of the handpiece of FIG. 2
along the line 3-3;
[0017] FIG. 4 partial perspective view of the working end of the
electrosurgical handpiece of FIG. 2 illustrating an early step in
its manufacture;
[0018] FIGS. 5 and 6 views similar to that of FIG. 4 illustrating
later steps in its manufacture;
[0019] FIG. 7 shows the assembled end of the handpiece of FIG.
2;
[0020] FIGS. 8 and 9 are views similar to that of FIG. 7 fitted
with two kinds of unipolar activators according to the
invention;
[0021] FIGS. 10 is a view similar to that of FIG. 7 fitted with a
different kind of bipolar activator;
[0022] FIG. 11 is a perspective view of the device of FIG. 7 shown
connected to a bipolar adaptor and to an electrosurgical unit;
[0023] FIG. 12 illustrates use of the device of FIG. 11 in a
laparoscopy procedure, namely, to reduce a herniated disk;
[0024] FIG. 13 is a perspective view of still another variant of a
handpiece according to the invention comprising both a bipolar and
a unipolar electrode;
[0025] FIG. 14 is an enlarged view of the working end of the
handpiece of FIG. 13 with both electrodes in the retracted
position;
[0026] FIG. 15 is a cross-sectional view along the line 15-15 of
FIG. 13;
[0027] FIG. 16 is a perspective view of the handpiece of FIG. 13
with the bipolar electrode in its extended position and the
unipolar electrode in its retracted position;
[0028] FIG. 17 is an enlarged view of the working end of the
handpiece of FIG. 16;
[0029] FIG. 18 is a perspective view of the handpiece of FIG. 13
with the unipolar electrode in its extended position and the
bipolar electrode in its retracted position;
[0030] FIG. 19 is an enlarged view of the working end of the
handpiece of FIG. 18;
[0031] FIG. 20 is an enlarged view of the working end of a
handpiece of the type shown in FIG. 13 illustrating the use of a
scissors embodiment.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0032] The MIS procedures are well known in the art and need no
further elaboration here except to state that the invention has to
do with the construction of the electrosurgical electrode that is
inserted into the cannula during the procedure for the purpose of
shrinking or excising tissue. The use of electrosurgical procedures
to chrink herniated sidks and other tissue is also well known in
the art and also needs little elaboration here. It will suffice to
state that the procedure with the novel handpiece of the present
invention is similar to that using the unipolar electrode with the
incorporated heat sensor, except that, with the bipolar handpiece
of the invention, no complex temperature sensor and associated
control circuit are needed, as, in the case of the bipolar
electrode, electrosurgical currents are confined to the small
active region between the electrode tips and will cause little if
any heat generation at remote tissue locations.
[0033] In a preferred embodiment of the invention, an electrode
designed for MIS is provided with an outer tubular housing that is
stiff enough to be inserted into the cannula and has a straight end
port ion that is capable of flexure when a bending force is applied
but which end portion has inherent memory that will restore the
tubular housing to its pre-flexed configuration when the bending
force is removed. The tube may be made out of a plastic or a metal
such as stainless steel. Examples of suitable plastics with some
flexibility and inherent memory that will keep the tubing straight
when the bending flex is removed are Delron, vinyls, and nylon. The
location in the tubing where flexure occurs can be established in
several ways, the preferred way being to weaken one side of the
outer tubing, as for example by spaced slots, at an end region
spaced from the tip where flexure is desired. In a preferred
embodiment, a handle is provided for supporting the outer tubular
housing and the handle is provided with a hand grip and a trigger
that is connected to a mechanism to flex the tube end when
squeezed. In a preferred embodiment, this result can be obtained by
attaching a pull string or wire to the side of the tube that has
been weakened by the cutting of slots but beyond the slots. The
pull string or wire is attached to the trigger at the opposite end
of the tube. When the trigger is squeezed against the grip, the
tube end will flex in the direction of the weakened side of the
tube. When the trigger is released, the tube due to its inherent
memory returns back to its original straight position.
[0034] Referring now to FIG. 1, one form of bipolar handpiece
according to the invention is shown at 10. It comprises a handle 12
having a grip 13, a trigger 14, and through a bore 15 at its top is
mounted the outer first tubular member 16. The latter has a small
outside diameter that will allow it to be inserted into the
standard cannula used for MIS. A typical range is about 0.07-0.1
inches. A typical length is about 10-20 inches. The outer tubular
member 16 is preferably supplied with an enlarged diameter end 18
(see FIG. 11) acting as a stop for the tubular member 16 when it is
inserted into the handle bore 15 and secured therein by, for
example, a set screw (not shown). This simple mounting allows the
use of disposable assemblies of tubular member and electrodes if
desired.
[0035] Inside the outer tubular member 16 is an inner
electrically-insulating, for example, plastic, lumen (second
tubular member) 20 that has an electrically-insulating wall 21 down
its middle forming two electrically-insulated compartments 22, 24
(FIG. 3). The inner tubular member 20 may be secured within the
outer tubular member 16 by any convenient means, such as a set
screw (not shown), which, as will be explained in greater detail
below, allows replacement of the second tubular member 20 with its
bipolar electrode by a another bipolar electrode or a
similarly-configured unipolar electrode. FIG. 1 illustrates this
feature by showing an electrode 20 being plugged into the housing
12 via the opening 15 and extending into the outer tubular member
16. Two electrically-conductive wires 26, 28, for example of
stainless steel, are each extended through one of the insulated
compartments 22, 24, with the result that the wall 21 electrically
separates the two conductive wires (FIG. 4). Additionally, the
circular wall 30 surrounding the separating wall 21 for a short
distance at the tube end is stripped back (FIG. 5) leaving only the
separating wall 21 projecting forward. This projecting wall 21 now
becomes the insulation between two half-ball electrodes 30, 32
connected as by welding to the projecting ends of the wires 26, 28
(FIG. 6).
[0036] FIG. 4 shows the remote end of the assembly before the
half-ball electrodes have been added, and FIG. 6 shows the
electrode wires 26, 28 which were first pulled forward to provide
extra room to attach the half-ball electrodes 30, 32 to the wire
ends, after which the wires are retracted pulling the half-ball
electrodes back to their operative position, as shown in FIG. 7, in
which the ball electrodes 30, 32 are fully spaced over their entire
length (the direction of the longitudinal dimension of the
assembly) by the center wall insulation 21.
[0037] The outer tubular member 16 is weakened at a location spaced
a short distance from the remote end of the tubular member 16, as
by cutting a series of spaced slots 34 that extend through the
outer wall 30. A pull wire 36 is extended through the outer tubular
member 16 along the bottom side of and outside of the inner tubular
member 20, i.e., at the same side as the slots 34, and anchored 38
(FIG. 4) to the outer wall 30 as by use of adhesive or by fusion if
the outer tubular member is of plastic, or by welding if the outer
tubular member is of metal. An opening 35 is made in front of the
slots 34 on the top part to provide access to the pull wire end to
allow this connection to be made during assembly. The opposite end
of the pull wire 36 is attached 39 to the trigger 14 (FIG. 1). The
outer tubular member 16 is held in a stationery position within the
handle 12, and the grip 13 is likewise stationery with respect to
the handle 12. Hence, when the trigger 14, which is pivotably
mounted 41 on the handle 12, is squeezed, illustrated in FIG. 2,
the pull wire 36 to which it is attached applies a pulling force on
the remote end of the outer tubular member 16 which as shown at 44
causes it to flex downward about the weakened section 34. When the
trigger is released, the natural tendency of the outer tubular
member 16 to return to its normal straight position restores it to
the position shown in FIG. 1. If desired, a return spring 46 can be
added to the trigger 14 to aid this motion.
[0038] The inner tubular member 20 together with its insulated
half-ball electrodes 30, 32 positioned at the end of this flexible
tip is the actual bipolar electrode. Connected to the proximate
ends of each of the wires 26, 28 is a standard bipolar connector 42
(FIG. 1). When the latter is plugged into a like connector on the
front panel of a conventional electrosurgical unit, shown
schematically at 48 (FIG. 11), and the unit activated, bipolar
electrosurgical currents flow along the wires 26, 28 to the ball
tips 30, 32 and an electrosurgical discharge is generated that
extends between the ball electrodes 30, 32 around the end of the
insulating wall separator 21. While it is preferred for reduction
of herniated disks to use the ball electrodes, in a bipolar
arrangement to confine the discharge to the immediate vicinity of
the electrode ends, it will be understood that other known
electrode shapes can be substituted for the ball electrodes, such
as straight wires, needles, hooks, or loops. In addition, a feature
of the invention is that the dual tubular member assembly makes it
particularly easy to accommodate other electrode ends, by sliding
out the inner tubular member 20 (see FIG. 1) from the outer tubular
member 16 and sliding in its place another inner tubular member 20
with a different electrode configuration. This can be done before
the outer tubular member 16 is extended through the cannula in the
patient or even while the cannula is in place within the patient.
In addition, a bipolar assembly in its dual lumen arrangement can
be replaced by a unipolar electrode in a lumen with only a single
compartment, in which case, the unipolar electrode end, with one of
the aforementioned electrode shapes, would project forward from the
end of the inner tubular member 20', which in this case would not
require the center insulation present. This is illustrated in FIG.
9. When an electrode substitution is to be made, the surgeon can
pull out the inner tubular member and replace it with another inner
tubular member with a different electrode thereby enabling the
surgeon to change electrodes during the procedure without removing
the handle with its outer tubular member that has already been
strategically placed in the surgical site. While a range of
electrosurgical current frequencies can be employed, it is
preferred that the frequency range employed be preferably in the
range between 1.5 and 4 MHz.
[0039] FIGS. 8 and 10 illustrate other active electrode
configurations. FIG. 10 shows a bipolar hook assembly 50, which can
also easily be made unipolar. FIG. 8 shows a unipolar loop assembly
52. FIG. 9 shows a unipolar needle 54 or pointed electrode
assembly.
[0040] Among the benefits of this invention is that it offers the
surgeon control and flexibility during surgeries that require
difficult placement of electrodes and also movement of the active
end at the active surgical area while the electrode is within the
cannula to perform precision surgery. The degree to which the
surgeon actually needs to bend the flexible tip depends upon its
location relative to the disk area to be cut or shrunk. The
flexible tip provides the surgeon with an additional degree of
freedom in finding the optimum electrode position before energizing
the electrosurgical unit. The long nozzle 16 is needed because,
typically, the cannula 50 is inserted from the patient's side (FIG.
12), and the cannula 56 is positioned while the surgeon is
observing the position of the cannula though the viewer. After the
cannula is positioned properly, then the electrode 16 can itself be
pushed through the cannula 56 until its flexible end 44 is outside
the end of the cannula and further positioned within the disk
surgical site by moving it forward or backwards and by flexing the
electrode tip 44.
[0041] The connector 42 can be plugged directly into the
electrosurgical mainframe 48, and thus the electrosurgical energy
furnished at the electrode working end will be determined by the
mainframe controls and a conventional footswitch. However, most
surgeons prefer hand control of the electrosurgical energy, as was
explained in the earlier referenced patent, which is easily
accomplished by using the finger switch activator described in that
earlier referenced patent and which can be mounted on the cannula
or handle.
[0042] FIG. 1 shows a variant 10 in which the inner tubular member
20 is replaceable, and also is provided with a suction tube 56
connected to the handle and to the clearance space 58 (FIG. 3)
between the inner and outer tubular members. When suction is
provided at the end 56, it is delivered to the remote end of the
outer tubular member 16 at the surgical site and thus will exhaust
any fumes or smoke that may interfere with the surgeon's vision as
well as cool the surgical site. The variant 10' of FIGS. 2 and 11
include a fixed inner tubular member 20 and lacks the suction
feature.
[0043] While the parts of the electrosurgical handpiece, made up of
metal and if of plastic, of Delrin for example, are autoclavable,
the device is sufficiently simple that it can be manufactured at
very low cost with a less expensive plastic and thus can be made
disposable.
[0044] The handpiece of the invention is generally useful for
treating tissue and is useful in particular in the following
situations. Thermally induced radiofrequency for shrinkage of
collagen, shrinkage and tissue denaturazation, and collagen
contraction. For treating and producing profound shrinkage of
capsular tissue, for example, due to denaturazation of collagen
fibers. Also to shrink and remodel collagen fibrils after exposure
to high frequency radiowave energy. As a further example, shrinkage
of collagen to promote capsular stability has been shown to be
effective for shoulder dislocations and herniated discs, as
examples.
[0045] FIGS. 13-19 show a modification according to the invention
comprising both a bipolar and a unipolar electrode, with the
additional feature of allowing the surgeon to selectively choose
and activate a bipolar or a unipolar electrode. This embodiment
also includes as an additional feature electrodes with
pre-configured ends such as pre-bent ends which are normally inside
of a relatively stiff outer tube but which when extended outside of
the outer tube will assume its pre-bent position. One form of this
this embodiment comprises a handle 60 to which is attached a hand
grip having a forward portion 62 affixed to the handle 60 and a
rearward portion 64 which is secured to a slidable stiff member 66
comprising an upper part 68 and a lower part 70. The upper part 68
is connected to a relatively stiff inner tube 72 which is slidable
within the handle 60 and which is connected to and functions to
push forward, when the grip is squeezed, a dual lumen 74 of the
type illustrated in FIG. 7 together with its wires 78, 80 of a
bipolar electrode 80 that may be of the half-ball type shown in
FIG. 7 which extend through the dual compartments 82, 84 of the
relatively stiff electrically-insulated inner first plastic tube
74. The latter is slidably mounted within a stiff outer tube 75.
Below the latter is mounted a stiff second tube 77 which slidably
houses a slidable electrically-insulated tube 79 housing a wire 81
connected at its end to an unipolar electrode 88. FIG. 15 shows
just the two side-by-side electrically-insulated tubes 74 and 79
without the outer housings 75, 77.
[0046] Normally, both the bipolar and the unipolar electrodes are
in their retracted position shown in FIGS. 13 and 14. When the grip
is squeezed, the member 72 is pushed forward toward the working end
causing the dual lumen 74 to which it is connected, together with
its bipolar wires to which the bipolar electrode 80 is connected,
to project forwardly out of their housing 74 as shown in FIGS. 16
and 17. The surgeon can then activate the electrosurgical unit to
supply via terminals 91 bipolar electrosurgical currents to the
bipolar electrode end 80. When the grip is released, the spring
tension of the grip, or an additional spring (not shown) if needed,
will cause the tube 74 to retract to the position shown in FIGS. 13
and 14. When it is desired to operate the unipolar electrode, the
surgeon presses a slide 90 on the side of the tube 70, which slide
is connected to the single tube 79, which causes it to move
forwardly from its retracted position (FIG. 14) to its extended
position shown in FIGS. 18 and 19. This action causes the unipolar
electrode 88 to project forwardly. The surgeon can then activate
the electrosurgical unit via wire 92 to supply unipolar
electrosurgical currents to the unipolar electrode end 88. The two
electrode movements are separate from one another so that the
surgeon can selectively choose which electrode to use inthe
procedure. When the surgeon releases the slide 90, a spring (not
shown) causes the single tube 79 to retract within its outer hole
77.
[0047] Preferably, at least the projecting end of one , preferably
both, of the respective bipolar/unipolar tube is made of a material
that can be pre-bent and has sufficient memory to retain its
pre-bent shape when extended outwardly from its restraining outer
tube. Either a plastic can be used or a metal, such as stainless
steel, which has been treated, as by tempering, to retain a
pre-bent shape. This is well known in the art and suitable
materials will be apparent to those in this art. If a metal is used
for the inner tube, the electrode wires will have to be suitably
insulated from one another or alternatively, the tube can be lined
with an insulating layer. In this embodiment, with electrodes
having a pre-bent and thus fixed shape, it is not possible to
change their orientation, i.e., whether straight or the angle of
the bending. The only control that the surgeon has is over the
length of the extension. A feature of the invention is a family of
unipolar and bipolar electrodes with differently-oriented ends,
some bent in one direction, others bent is still other directions,
and some straight. FIG. 17 shows one member of the family with an
end that bends to the left. FIG. 19 shows a member of the family
with an end that is straight. Typically, the family would contain
either bipolar or unipolar electrodes or both with ends that are
pre-bent in all four directions as well as straight. As in the FIG.
1 embodiment, new electrodes 74, 79 are easily plugged into the end
of their respective tubular housing handle as needed, which can be
done during the procedure. With the bipolar electrode, the
replacement electrode telescopes through tube 68, so that when the
latter is moved relative to grip 62, the entire tube 72 moves with
it. With the unipolar electrode, as one example, the side can be
provided with a rack (visible through the side slot in FIG. 13),
with the slide 90 fitted with a suitable gear or other means to
move the replacement tube 77 with the slide. The electrodes can be
made at a relatively low cost and thus can be made disposable. The
more expensive handle can be reused. Other handle constructions
that allow extension and retraction of replaceable electrodes will
be apparent to those skilled in this art.
[0048] Another example according to the invention of a replacement
element for the bipolar or unipolar housing is shown in FIG. 20. In
this case, the new structure is the same as that of FIG. 13 except
that if desired the unipolar structure can be omitted. Only the
working end is shown in FIG. 20, which in this embodiment is a
scissors 94 comprising bent stainless steel scissor elements 96
connected at the gun end to the tube 72 and at the remote end
connected by a pivot 95. As will be noted, the scissor elements 96
when extended out of their tube 75 are pre-configured to assume an
open position. The grip 62, 64 (FIG. 13) is spring loaded so that
the surgeon can extend the scissor elements 96 as shown by
squeezing the grip. When the grip is released, the spring action
causes the scissor elements to be retracted, the confining action
of the walls of the tube 75 forcing the scissor ends together
cutting in a normal scissor action any tissue around which the
scissor ends have been placed. The dual lumen 74 allows bipolar
currents to be applied to the scissor ends if desired, in which
case the pivot 95 would have to electrically-insulate the two
scissor elements, as with washers for example. The scissors 94 can
also be configured for mounting in the unipolar tube 77 in which
case unipolar currents can be applied to the scissor elements 96.
It is also possible to have no terminals connected to the scissors
94 so that no electrosurgical currents can be applied thereto, in
which case the scissors 94 can be operated just with a mechanical
action. As before, the scissors 94 can have its own tubular housing
74 and thus be plugged into the gun of FIG. 13 to replace a bipolar
or unipolar electrode, all while the tubular structure remains
within the cannula during the procedure. It is preferred that the
scissor end is pre-configured as in the FIG. 13 embodiment so that
it can be caused to assume a particular orientation when extended,
with the possibility of repalcing it with a scissors of a different
orientation if needed. Or if desired, it can be mounted as in the
FIG. 1 embodiment with means for flexing the remote end of the
structure. Other usable mechanical or electrical structures will be
appreciated by those skilled in this art.
[0049] While the invention has been described in connection with
preferred embodiments, it will be understood that modifications
thereof within the principles outlined above will be evident to
those skilled in the art and thus the invention is not limited to
the preferred embodiments but is intended to encompass such
modifications.
* * * * *