U.S. patent application number 10/777879 was filed with the patent office on 2004-08-26 for electrosurgery with improved control apparatus and method.
Invention is credited to Hilal, Said.
Application Number | 20040167513 10/777879 |
Document ID | / |
Family ID | 27609400 |
Filed Date | 2004-08-26 |
United States Patent
Application |
20040167513 |
Kind Code |
A1 |
Hilal, Said |
August 26, 2004 |
Electrosurgery with improved control apparatus and method
Abstract
In electrosurgical system includes an electrosurgical generator
providing power through an electrode, and a laser providing laser
energy through an optical fiber. The electrode optical fiber and a
source of environmental gas can all be included in a handpiece,
catheter or other delivery device. In operation, the environmental
gas can be released into the vicinity of an operative site and the
laser activated to energize atoms along a pathway. Electrosurgical
power can then be applied to ionize the items of the atoms of the
pathway and create a path of least resistance for an
electrosurgical arc. A reduction in the laser power required can be
achieved by matching the photon frequency of the laser with the
excitation frequency of the environmental gas. In a laparoscopic
procedure, the insufflation gas may be used as the environmental
gas.
Inventors: |
Hilal, Said; (Coto de Caza,
CA) |
Correspondence
Address: |
APPLIED MEDICAL RESOUCES CORPORATION
22872 Avenida Empresa
Rancho Santa Margarita
CA
92688
US
|
Family ID: |
27609400 |
Appl. No.: |
10/777879 |
Filed: |
February 11, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10777879 |
Feb 11, 2004 |
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10057227 |
Jan 25, 2002 |
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6740081 |
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Current U.S.
Class: |
606/45 ;
606/49 |
Current CPC
Class: |
A61B 18/042 20130101;
A61B 18/1442 20130101; A61B 18/20 20130101; A61B 2018/00065
20130101; A61B 18/1492 20130101; A61B 2018/00238 20130101; A61B
18/14 20130101; A61B 2018/0022 20130101 |
Class at
Publication: |
606/045 ;
606/049 |
International
Class: |
A61B 018/14 |
Claims
1. An electrosurgical apparatus adapted to perform electrosurgery
at an operative site on a patient, comprising: a source of
environmental gas providing gas molecules having properties for
being energized at a particular frequency to an excited state.
first delivery apparatus coupled to the source of gas and adapted
to deliver the gas molecules into proximity with the operative
site; a laser adapted to produce a laser beam providing laser
energy at a frequency equal to about an integer multiple of the
particular frequency of the environmental gas, and at a power
generally sufficient to excite the gas molecules: second delivery
apparatus coupled to the laser for delivering the laser beam along
a pathway leading toward the operative site; an electrosurgery
generator providing electrosurgical power; and third delivery
apparatus coupled to the electrosurgery generator and adapted to
deliver the electrosurgical power along the pathway toward the
operative site.
2. The electrosurgical apparatus recited in claim 1, wherein the
laser energy is provided in an amount generally insufficient to
ionize the gas molecules along the pathway.
3. The electrosurgical apparatus recited in claim 2, wherein the
electrosurgical power is provided in an amount generally sufficient
to ionize the gas molecules excited by the laser.
4. The electrosurgical apparatus recited in claim 1, wherein: the
source of gas provides molecules of a first gas; and the laser has
properties for generating the laser energy in an environment
containing molecules of a second gas.
5. The electrosurgical apparatus recited in claim 4, wherein the
first gas contains molecules of the second gas.
6. The electrosurgical apparatus recited in claim 4, wherein the
first gas and the second gas contain molecules of at least one of
carbon dioxide, argon, and helium.
7. The electrosurgical apparatus recited in claim 1, wherein the
laser is a first laser and the laser beam is a first laser beam,
and the apparatus further comprises: a second laser having a second
laser beam which converges with the first laser beam in proximity
to the operative site on the patient.
8. The electrosurgical apparatus recited in claim 7, wherein: the
first laser beam has properties including power, temperature,
frequency, and cross sectional configuration; and the second laser
beam has properties including power, temperature, frequency, and
cross sectional configuration, respectively; and at least one of
the properties of the first laser beam differs from the respective
property of the second laser beam.
9. The electrosurgical apparatus recited in claim 1, wherein: the
electrosurgical apparatus includes a handpiece with a housing; and
at least portions of the first delivery apparatus, second delivery
apparatus, and third delivery apparatus are disposed within the
housing of the handpiece.
10. The electrosurgical apparatus recited in claim 1, further
comprising: a first jaw and an opposing second jaw; the first
delivery apparatus being disposed in the first jaw; the second
delivery apparatus being disposed in one of the first jaw and the
second jaw; and the third delivery apparatus being disposed in one
of the first jaw and the second jaw.
11. An electrosurgical apparatus for performing laparoscopic
electrosurgery at an operative site in the abdominal cavity of a
patient, comprising the steps of: a source of environmental
shielding gas providing gas molecules having properties for being
energized at a particular frequency to an excited state. first
delivery apparatus coupled to the source of gas and adapted to
deliver the gas molecules into proximity with the operative site; a
laser adapted to produce a laser beam providing laser energy at a
frequency equal to about an integer multiple of the particular
frequency of the environmental gas, and at a power generally
sufficient to excite the gas molecules. second delivery apparatus
coupled to the laser for delivering the laser beam along a pathway
leading toward the operative site; an electrosurgery generator
providing electrosurgical power; third delivery apparatus coupled
to the electrosurgery generator and adapted to deliver the
electrosurgical power along the pathway to the operative site. a
handpiece including a housing and an elongate probe extending from
the housing; and at least the third delivery apparatus extending
through the probe of the handpiece.
12. The electrosurgery apparatus recited in claim 11, wherein: the
second delivery apparatus extends through the probe of the
handpiece.
13. The electrosurgery apparatus recited in claim 12, wherein: the
first delivery apparatus extends through the probe of the
handpiece.
14. The electrosurgery apparatus recited in claim 11, wherein the
source of gas is disposed in the housing of the handpiece.
15. The electrosurgery apparatus recited in claim 11, wherein the
laser is disposed in the housing of the handpiece.
16. The electrosurgery apparatus recited in claim 11, wherein the
laser includes a battery and a laser generator powered by the
battery.
17. The electrosurgery apparatus recited in claim 16, wherein the
battery is rechargeable
18. The electrosurgery apparatus recited in claim 15, wherein the
source of gas is included in the housing of the handpiece.
19. A catheter having a proximal end and a distal end, the catheter
being adapted to perform electrosurgery within a body conduit,
comprising: any elongate shaft extending to the distal end of the
catheter; a balloon carried by the shaft and being disposed
generally at the distal end of the catheter, the balloon having a
wall and being inflatable by an inflation gas having molecules
excitable by a laser; portions of the balloon defining at least one
hole providing for a controlled release of the inflation gas from
the balloon; inflation apparatus for inflating the balloon with the
inflation gas and for releasing a portion of the inflation gas
through the at least one hole in the balloon; laser apparatus
including a light fiber disposed along the wall of the balloon, the
fiber being adapted to release laser energy into the inflation gas
to excite the molecules of the gas along a pathway; and
electrosurgical apparatus including an electrode disposed along the
wall of the balloon, the electrode being adapted to release
electrosurgical energy along the pathway and to perform the
electrosurgery within the body conduit
20. The catheter recited in claim 19, wherein the wall of the
balloon has an inner surface, and the light fiber is disposed along
the inner surface of the balloon wall.
21. The catheter recited in claim 20, wherein the light fiber is a
side-light fiber.
22. The catheter recited in claim 19, wherein the wall of the
balloon has an outer surface and the electrosurgical electrode is
disposed along the outer surface of the balloon wall.
23. The catheter recited in claim 22, wherein the light fiber of
the laser apparatus is disposed along the outer surface of the
balloon wall.
24. The catheter recited in claim 19, wherein: the hole portions of
the balloon, the light fiber of the laser system, and the electrode
of the electrosurgery system are disposed generally longitudinally
of the shaft of the catheter.
25. The catheter recited in claim 19, wherein the inflation gas has
a excitation frequency and the laser energy of the laser apparatus
has a discharge frequency equal to about an integer multiple of the
excitation frequency.
26. An electrosurgical method for performing electrosurgery at an
operative site on a patient, comprising the steps of: providing a
source of environmental gas molecules having an excitation
frequency; moving the gas molecules from the source into proximity
with the operative site; providing a laser having a laser beam with
a frequency equal to about an integer multiple of the excitation
frequency of the enviromental gas; controlling the laser beam to
provide power sufficient to excite the gas molecules generally
along a pathway leading toward the operative site; providing an
electrosurgical generator having electrosurgical power; and
delivering the electrosurgical power along the pathway toward the
operative site to perform the electrosurgery on the patient.
27. The electrosurgical method recited in claim 26, wherein during
the delivering step, includes the step of: providing the
electrosurgical energy with power sufficient to ionize the excited
gas molecules along the pathway.
28. The electrosurgical method recited in claim 26, further
comprising the steps of: insufflating the patient with a particular
gas in a laparoscopic procedure; and the step of providing a laser
includes the step of generating the laser beam in a discharge laser
including the particular gas.
29. The electrosurgical method recited in claim 28, wherein the
generating step includes the step of generating the laser beam in a
carbon dioxide discharge laser.
30. The electrosurgical method recited in claim 26, wherein the
step of providing at least one laser comprises the steps of:
providing a first laser, having a first laser beam; providing a
second laser, having a second laser beam; and converging the first
laser beam and the second laser beam toward the operative site.
31. The electrosurgical method recited in claim 26, wherein the
step of delivering the electrosurgical power includes the step of
delivering the electrosurgical power in a monopolar
configuration.
32. The electrosurgical method recited in claim 26, wherein the
step of delivering the electrosurgical power includes the step of
delivering the electrosurgical power in a bipolar
configuration.
33. The electrosurgical method recited in claim 26, further
comprising the step of moving the laser beam relative to the
patient.
34. The method recited in claim 33, wherein the moving step
includes the step of scanning the laser beam relative to the
operative site.
35. The electrosurgical method recited in claim 26, wherein the
step of energizing the laser includes the step of pulsing the
laser.
36. A laparoscopic method for performing electrosurgery at an
operative site in the abdomen of a patient, comprising the steps
of: insufflating the abdomen with gas molecules having an
excitation frequency; exciting the gas molecules with a laser beam
to form a pathway of excited molecules leading toward the operative
site, the laser beam having a fundamental frequency or harmonic
thereof equal to about the excitation frequency of the insufflation
gas; and delivering electrosurgical energy along the pathway of
excited gas molecules to perform an electrosurgical operation at
the operative site.
37. The electrosurgical method recited in claim 36, further
comprising a step of moving the laser beam relative to the
patient.
38. The electrosurgical method recited in claim 36, further
comprising the step of focusing the laser beam at other than the
operative site.
39. The electrosurgical method recited in claim 37, wherein the
moving step includes the step of scanning the laser beam to provide
the pathway with a non-linear configuration.
40. The electrosurgical method recited in claim 39, wherein the
scanning step includes the step of scanning the laser beam to
provide the pathway with a planar configuration.
41. This electrosurgical method recited in claim 36, further
comprising the step of pulsing the laser beam.
42. The electrosurgical method recited in claim 41, further
comprising the step of pulsing the electrosurgical energy.
43. An electrosurgical method for performing laparoscopic
electrosurgery an operative site in the abdominal cavity of a
patient, comprising the steps of: insufflating the abdominal cavity
with an insufflation gas having an excitation frequency; lasing the
insufflation gas at a lasing frequency, during the lasing step,
exciting the gas molecules to form a pathway of excited gas
molecules leading toward the operative site; directing
electrosurgical energy along the pathway of excited gas molecules
toward the operative site; and operating electrosurgically on the
patient at the operative site.
44. The electrosurgical method recited in claim 43, wherein the
lazing frequency is dependent on the excitation frequency of the
insufflation gas.
45. The electrosurgical method recited in claim 44, wherein the
lazing frequency is an integer multiple of the excitation frequency
of the insufflation gas.
46. The electrosurgical method recited in claim 43, further
comprising the step of ionizing the excited gas molecules.
47. The electrosurgical method recited in claim 46, wherein the
lazing step includes the ionizing step.
48. The electrosurgical method recited in claim 46, wherein the
directing step includes the ionizing step occurs within the
directing step.
49. The electrosurgical method recited in claim 46, wherein the
directing step includes the steps of: providing the electrosurgery
energy with first characteristics during the ionizing step and with
second characteristics different than the first characteristics
during the operating step.
50. A method for performing electrosurgery within a body conduit,
comprising the steps of: providing a catheter having a shaft with a
proximal end and a distal end, and a balloon with a wall, the
balloon being carried by the shaft generally at the distal end of
the shaft; inflating the balloon with a gas having molecules;
releasing a portion of the gas molecules from the balloon; exciting
the molecules of the inflation gas with laser energy to produce a
pathway of excited gas molecules; and introducing electrosurgical
energy into the pathway to perform the electrosurgery within the
body conduit.
51. The method recited in claim 50, wherein the exciting step
includes the step of providing a light fiber within the shaft of
the catheter; delivering the laser energy through the light fiber
and into the gas to excite the molecules of the gas.
52. The method recited in claim 51, wherein the delivery step
includes the step of delivering the laser energy through the wall
of the balloon and into the molecules of the gas.
53. The method recited in claim 50, wherein the introducing step
includes the steps of: providing an electrosurgical electrode on
the wall of the balloon; and delivering the electrosurgical energy
along the pathway to perform the electrosurgery within the body
conduit.
54. The method recited in claim 50, wherein: the inflating step
includes the step of inflating the balloon with an inflation gas
having an excitation frequency; and the exciting step includes the
step of exciting the inflation gas with laser energy having a
discharge frequency equal to about an integer multiple of the
excitation frequency of the inflation gas.
55. An electrosurgical apparatus adapted to perform electrosurgery
at an operative site on a patient, comprising; an environmental gas
having gas molecules with properties for being energized at an
excitation frequency; a laser disposed to introduce a laser beam
into the shielding gas to excite but not ionize the environmental
gas along a pathway leading to the operative site on the patient,
the laser beam having a discharge frequency equal to about an
integer multiple of the excitation frequency of the shielding gas;
and an electrosurgical generator disposed to create an
electrosurgical arc along the pathway to perform the electrosurgery
at the operative site on the patient.
56. The electrosurgical apparatus recited in claim 55, wherein the
laser has an active medium with the discharge frequency.
57. The electrosurgical apparatus recited in claim 56, wherein the
laser is a gas laser and the active medium is a gas.
58. The electrosurgical apparatus recited in claim 56, wherein the
laser is a solid state laser and the active medium is a
crystal.
59. The electrosurgical apparatus recited in claim 56, wherein the
discharge frequency of the laser is tunable.
60. The electrosurgical apparatus recited in claim 58, wherein the
crystal is ruby.
61. The electrosurgical apparatus recited in claim 57, wherein the
gas is carbon dioxide.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of the Invention
[0002] This invention relates generally to electrosurgery and more
specifically to the efficient control of electrosurgical cutting
coagulation cautery and fulguration.
[0003] 2. Discussion of Related Art
[0004] The mechanism of electrosurgery is well known in its
capability to perform exacting surgical cuts and to provide
coagulation, cautery, fulgration and other unique effects. In
general, electrosurgery involves the discharge of high voltage at a
very high frequency, typically in the form of a spark or arc.
However, as with any electrical spark discharge, control is always
an issue. Without oversimplifying environment effects, it generally
is well known that electricity tends to follow the course of least
resistance. Unfortunately this tendency works against the need of a
surgeon to have absolute control of an electrosurgical discharge,
for example when he is attempting to make a precise surgical
incision in very tight quarters, as is the case in laparoscopic
procedures.
[0005] Failure to achieve this control can cause inadvertent
discharge of the electrosurgical spark to an undesirable location.
For example, if a metal grasper or clamp is holding a portion of
tissue, the electrical spark may discharge to the grasper or clamp
rather than overcome a smaller gap to the target tissue. This
inadvertent discharge is even more probable realizing that a small
gap between target tissue and the electrode is important to achieve
an optimal electrosurgical effect.
[0006] The designers of electrosurgical generators have designed
complex high frequency wave forms and blends of such wave forms, as
well as sophisticated feedback and patient monitoring systems to
achieve the present level of safety and efficacy. However, there is
always the potential for accidental discharge and ancillary damage,
particularly when electricity is provided in an open environment.
In comparison, to electrical current flows in a wire,
electrosurgical discharge by way of an arc has not been
particularly controllable. Certainly, a device and method adapted
to control and direct an arc of electrosurgical energy would be
particularly beneficial.
[0007] It is appreciated in U.S. Pat. No. 5,509,916, that a laser
can be used to establish an ionized conductive pathway for
electrosurgery. The laser ionizes the molecules of air along the
laser beam, thereby establishing a path of least resistance leading
to an operative site. An electrosurgical spark or arc will follow
this path of least resistance, ultimately producing an
electrosurgical effect at the operative site. Thus, the laser
effectively establishes a means for controlling the electrosurgical
arc, thereby avoiding an inadvertent or misdirected discharge.
[0008] While this system may work well in air, such a gas may
neither be available nor desired in an electrosurgical environment.
For example, lasing air would not be available in a laparoscopic
environment if carbon dioxide were used as an insufflation gas.
Furthermore, complete ionization of (rather than mere excitation)
environmental air by a laser may not maximize the efficiency of the
laser in establishing a pathway of least resistance.
SUMMARY OF THE INVENTION
[0009] In accordance with the present invention, a device and
method is disclosed for initiating, directing, and maintaining an
electrosurgical discharge in a highly controlled manner. A virtual
wire is created which substantially avoids inadvertent and
misplaced discharge of the electrosurgical energy. In one aspect,
the present invention provides for an environment of gas molecules
to be merely excited by a low-power laser beam to create a
well-defined path to a precise target. An electrosurgical generator
is then provided with sufficient power to fully ionize the excited
molecules, thereby creating a path of least resistance to the
operative site.
[0010] In a preferred embodiment, the device may use the ambient
gas of a laparoscopic environment, namely carbon dioxide, and a low
powered laser to direct and control an electrosurgical instrument
discharge. In an alternate embodiment, the electrosurgical
instrument may supply the environmental gas as well as the laser
beam. The gas stream and/or the laser beam may be scanned, pulsed,
defocused, or otherwise varied to provide a variety of
electrosurgical effects.
[0011] In order to maximize the efficiency of the system, the laser
can be provided with power only sufficient to energize the atoms of
the environmental gas. Once these energized atoms have established
the pathway to the operative site, energy from the electrosurgical
generator can be used to fully ionize the excited molecules to
define the path of least resistance.
[0012] The present invention can also be used in an environment
where air is neither available nor desired. For example in
laparoscopic surgery, the insufflation gas, such as carbon dioxide,
can provide the environmental gas and can be lased to define the
pathway.
[0013] Further efficiencies can be generated by providing a laser
beam at a frequency depended upon the excitation frequency of the
environmental gas. Thus, a carbon dioxide gas discharge laser can
most efficiently be used to excite carbon dioxide molecules, for
example, in a laparoscopic electrosurgical procedure.
[0014] In one aspect, the invention includes an electrosurgical
apparatus which is adapted to perform electrosurgery at an
operative site on a patient. The apparatus includes a source of
shielding gas that provides gas molecules having properties for
being energized at a particular frequency to an excited state. A
first delivery apparatus is coupled to this source of gas and
adapted to deliver the gas molecules in the proximity with the
operative site. A laser is adapted to produce a laser beam
providing laser energy at a frequency equal to about an integer
multiple of the particular frequency of the environmental gas, and
at a power generally sufficient to excite the gas molecules. A
second delivery apparatus is coupled to the lasers to deliver the
laser beam along a pathway leading toward the operative site. An
electrosurgery generator provides electrosurgical power and is
coupled by a third delivery apparatus which delivers the
electrosurgical power along the pathway toward the operative site.
A handpiece including a housing and an elongate probe can be used
for one or all of the first, second, and third delivery apparatus.
The laser energy is provided in an amount generally insufficient to
ionize the gas molecules along the pathway. However, the
electrosurgical power is provided in an amount generally sufficient
to ionize the gas molecules excited by the laser.
[0015] In another aspect of the invention, an electrosurgical
method is used to perform electrosurgery at an operative site of a
patient. The method includes the step of providing a source of
environmental gas molecules having an excitation frequency. These
molecules are moved into proximity with the operative site and
energized with a laser beam having a frequency equal to about an
integer multiple of the excitation frequency of the environmental
gas. The laser beam is controlled to provide power sufficient to
excite the gas molecules along a pathway leading toward the
operative site. Electrosurgical power is delivered along this
pathway to the operative site to perform the electrosurgery on the
patient. The pathway can be established by one or more and the
electrosurgical power can be provided in either a monopolar or
bipolar configuration.
[0016] In another aspect, the invention includes a laparoscopic
method for performing electrosurgery at an operative site in the
abdomen of a patient. This method includes the step of insufflating
the abdomen with gas molecules having an excitation frequency,
exciting the gas molecules with a laser beam having a fundamental
frequency or a harmonic thereof equal to about the excitation
frequency of the insufflation gas, and delivering electrosurgical
energy along the pathway of excited molecules to perform the
electrosurgical operation at the operative site. The laser beam can
be moved relative to the patient to vary the size and shape of the
pathway. Either or both the laser beam and the electrosurgery
energy can be pulsed.
[0017] In a further aspect of the invention, an electrosurgical
method is used to perform laparoscopic electrosurgery at an
operative site in the abdominal cavity of a patient. The cavity is
initially insufflated with a gas having an excitation frequency.
This insufflation gas is then lased at a lazing frequency to form a
pathway of excited gas molecules leading toward the operative site.
Electrosurgical energy is directed along this pathway to produce an
electrosurgical effect on the patient.
[0018] In another aspect of the invention, a catheter having a
proximal end and a distal end is adapted to perform electrosurgery
within a body conduit. The catheter includes an elongate shaft
which delivers an environmental gas into the conduit. A laser
apparatus includes a light fiber carried by the shaft and adapted
to release laser energy into the environmental gas to excite gas
molecules along the pathway. An electrosurgical apparatus includes
an electrode carried by the shaft and adapted to release
electrosurgical energy along the pathway to perform electrosurgery
along the body conduit. A balloon can be carried by the shaft and
inflated with a gas which is controllably released through a hole
in the wall of the balloon. This release provides the environmental
gas which is lased to produce the pathway. An associated process
includes the steps of inflating the balloon with an inflation gas,
releasing a portion of the inflation gas from the balloon, exciting
molecules of the inflation gas with laser energy to produce a
pathway, and introducing electrosurgical energy into the pathway to
perform electrosurgery within the body conduit.
[0019] In still a further aspect of the invention, the laser which
is used for exciting the gas molecules provides a laser beam which
is generated from an active medium having a discharge frequency.
The active medium may be a gas or a crystal and may be tunable to
vary the discharge frequency.
[0020] These and other features and advantages of the present
invention will become more apparent with a description of preferred
embodiments and reference to the associated drawings.
DESCRIPTION OF THE DRAWINGS
[0021] FIG. 1 is a top plan view illustrating a patient disposed on
an operating table and prepared for laparoscopic surgery;
[0022] FIG. 2 is a side elevation view of the patient showing
interior regions of the abdominal cavity during the laparoscopic
procedure;
[0023] FIG. 3 is a schematic view of a typical atom;
[0024] FIG. 4A is in a schematic view of the atom being
excited;
[0025] FIG. 4B is a schematic view of an excited atom giving up
energy in the form of a photon.
[0026] FIG. 4C is a schematic view of the excited atom being
ionized;
[0027] FIG. 5 is a schematic view of a process for creating a
pathway of excited molecules;
[0028] FIG. 6 is a schematic view of a process for ionizing the
excited molecules in the pathway;
[0029] FIG. 7 is an axial cross section view illustrating a
handpiece having a housing and probe and being adapted for use in a
monopolar electrosurgery procedure;
[0030] FIG. 8 is a side elevation view of a handpiece adapted for
use in a bipolar electrosurgery procedure;
[0031] FIG. 9 is a perspective view of a handpiece including
jaws;
[0032] FIG. 10 is a perspective view of a handpiece having a blade
configuration;
[0033] FIG. 11-FIG. 30 illustrates a catheter of the present
invention including a balloon providing for the controlled release
of an inflation gas to provide the environmental gas for the
present invention;
[0034] FIG. 11 is a side elevation view of one embodiment of a
balloon catheter;
[0035] FIG. 12 is a top plan view of the embodiment of FIG. 11;
[0036] FIG. 13 is an end elevation view of the embodiment of FIG.
11;
[0037] FIG. 14 is a side elevation view of a further embodiment of
a balloon catheter adapted for use in a bipolar configuration;
[0038] FIG. 15 is a top plan view of the embodiment of FIG. 14;
[0039] FIG. 16 is an end elevation view of the embodiment of FIG.
14;
[0040] FIG. 17 is a side elevation view similar to FIG. 2 and
showing a laser beam being defocused to facilitate electrosurgical
coagulation;
[0041] FIG. 18 is a perspective view of an embodiment including two
lasers with beams that converge toward the operative site of the
patient;
[0042] FIG. 19 is an end view taken along lines XIX-XIY of FIG. 18;
and
[0043] FIG. 20 is an axial cross section view taken along lines
XX-XX of FIG. 19.
DESCRIPTION OF PREFERRED EMBODIMENTS AND
Best Mode of the Invention
[0044] A patient is illustrated in FIG. 1 and designated generally
by the reference numeral 10. The patient 10 has an abdominal wall
12 which defines an interior abdominal cavity of 14. In this view,
the patient 10 is disposed on an operating table 16 and is prepared
for laparoscopic surgery which is performed through the abdominal
wall 12 within the abdominal cavity 14.
[0045] A laparoscopic procedure is facilitated by a plurality of
elongate trocars 18, 21, and 23, which are inserted through the
abdominal wall and into the abdominal cavity 14. Various
instruments can be inserted into and removed from the trocars 18,
21, and 23 to facilitate a particular operative procedure within
the abdominal cavity 14.
[0046] In FIG. 1, the patient 10 is prepared for electrosurgery in
a laparoscopic procedure. A laser 25 is provided and connected
through an optical fiber 27 to a laser probe 30 extending through
the trocar 21. In like manner, an electrosurgical generator 32 is
provided in a monopolar configuration with a grounding plate 34 and
an electrosurgery handpiece 36. The grounding plate 34 is connected
to the generator 32 through a lead 38, and provides a large area of
electrical contact with the patient 10. The handpiece 36 is
connected to the generator through a lead 41 and can be inserted
through the trocar 18 into the abdominal cavity 14. Other
instruments useful in this procedure might include a laparoscope 43
which might typically be inserted through the trocar 23 to provide
for illumination and visualization within the cavity 14.
[0047] This arrangement of trocars and instruments is best
illustrated in the side elevation view of FIG. 2. In this figure,
the abdominal cavity 14 is illustrated to include various organs
such as a stomach 45, kidneys 47, and bladder 50. In the
illustrated procedure, electrosurgery is being performed at an
operative site 52 on the stomach 45.
[0048] In accordance with a preferred method of the present
invention, the abdominal cavity 14 is initially inflated or
insufflated with a gas such as carbon dioxide. This insufflation
distends the abdominal wall 12 thereby increasing the volume of the
working area within the abdominal cavity 14. After the cavity 14
has been insufflated, the laser probe 30 can be inserted through
the trocar 21 and activated to direct a laser beam 54 toward the
operative site 52.
[0049] In a manner described in detail below, the laser beam 54
energies the molecules of the insulation gas to create a pathway 56
leading toward the operative site 52. Once this pathway 56 is
established, the electrosurgical generator 32 can be activated to
produce an electrosurgical potential between the handpiece 36 and
the grounding pad 34. This potential will produce a spark or arc 58
which is intended to produce an electrosurgical effect at the
operative site 52. Control of this spark or arc 58 is maintained by
introducing the arc 58 in proximity to the pathway 56 of excited
molecules.
[0050] In a preferred method, electrosurgical potential ionizes the
excited molecules along the pathway 56 to create a path of least
resistance leading toward the operative site 52. Following this
pathway 56, now defined by ionized molecules, the arc 58 can create
the desired electrosurgical effect at the operative site 52.
[0051] This procedure, including the steps of lasing the insulation
gas to excite molecules along a pathway, and then ionizing the
excited molecules can best be understood on the atomic level. In
FIG. 3, an atom 61 is illustrated schematically to include a
nucleus 63 and two electron orbits or shells 65 and 67. Two
electrons 720 and 72 are normally present in the inner most or
first shell 65 while four electrons 74 are typically present in the
second shell 67, the outer most shell in this particular atom. The
atoms associated with the various elements in the periodic table
differ primarily in the makeup of the nucleus 63, as well as the
number of shells, such as the shells 65, 70, and number of
electrons, such as the electrons 70, 72 and 74.
[0052] Of particular interest to the present invention is the
nature of the electrons 70, 72, 74, when they are exposed to an
energy source, such as an electrical probe 76. Initially it is
noted that in each of the shells 65 and 67, the associated
electrons have different energy levels. These energy levels are
lowest at the inner shell 65 and highest at the outer shell 67.
[0053] In response to the electrical field produced by the
electrode 76, the electrons, such as the electron 72, become
energized. As the energy level of the electron 72 increases, it
moves from the lower energy shell 65 to the higher energy shell 67
as shown by an arrow 78 in FIG. 4A. As the electron 72 moves
outwardly, it leaves an electron void or hole 81 in the first shell
65.
[0054] Even in the continued presence of the electrical field and
the electrode 76, the electron 72 in the outer shell 67 is unstable
particularly with the electron hole 81 present in the lower energy
shell 65. As a consequence, the electron 72 will tend to fall back
into the inner shell 65 as illustrated by the arrow 83 in FIG. 4b.
As the electron 72 moves from a higher energy level in the shell 67
to a lower energy level in the shell 65, the difference in energy
is released as a photon 85 For purposes of future discussion, note
that for a particular atom, the photon released in this process has
a known energy level equal to the product of its frequency (f) and
its wavelength (.lambda.).
[0055] In very basic terms, this describes the operation of a laser
wherein the photons are collected and collimated into a laser beam
such as the beam 54 (FIG. 2). In this process it will be noted in
particular that the energized electrons move between the shells 65,
67 of the atom 61. As a result, the number of electrons associated
with the atom does not change. The atom is merely excited, not
ionized. This excited atom is designated in FIG. 4A by the
reference numeral 86.
[0056] If additional energy is applied to an already excited atom,
as illustrated in FIG. 4C, the energy of the electron, such as the
electron 72 may exceed that necessary to maintain it in the outer
shell 67. Under these circumstances, the electron 72 may be
separated from the atom 61, as a free electron 87. This leaves an
ionized atom 88 in a charged state. Importantly, the free electrons
which result from this ionization, change the properties of the
pathway 56 (FIG. 2). What was heretofore merely a pathway of
excited atoms is now a pathway of ionized atoms which for the first
time offers a path of least resistance for the electrical arc (FIG.
2).
[0057] Given the distinctions between an energized atom and an
ionized atom, it can now be appreciated that the pathway 56
illustrated in FIG. 2 and FIG. 5 can initially be established
merely by the excited atoms 86. Although these excited atoms 86
will not produce a path of least resistance, they nevertheless
establishes a pathway of atoms which have already reached an
excited state. Under these circumstances, the electrosurgical
handpiece 36 can provide the remaining energy necessary to ionize
the excited molecules as illustrated in FIG. 4C. The resulting
release of free electrons (shown by the arrow 87 in FIG. 4C) makes
the pathway 56 a path of least resistance for subsequent delivery
of the arc 58 toward the operative site 52.
[0058] In the past, electrosurgery has been performed in open
procedures using a laser to fully ionize air along a pathway
leading to an operative site. Relying on a laser to produce a fully
ionized pathway of least resistance has necessarily required a very
high magnitude of laser power. Now, in accordance with this
invention, the laser is only required to produce a pathway of
excited atoms rather than a pathway of fully ionized atoms.
Although the pathway 56 resulting from this laser application does
not define a path of least resistance, nevertheless a path to the
operative site is defined by the excited atoms 86. These atoms are
most susceptible to the further application of energy to create
ionized atoms 88 and free electrons 87, thereby resulting in an
ionized pathway of least resistance.
[0059] It is of particular interest to the present invention to
contemplate the amount of energy, and particularly the frequency of
the energy, used to energize the atom 61. It has been noted that
the amount of energy required to displace an electron between atom
shells varies with the particular atom involved. Thus, an atom of
oxygen would require a different level of excitation energy then
would an atom of carbon, for example. In addition, the amount of
excitation power required is reduced when it is applied at a
frequency which is dependent upon the excitation frequency of a
particular atom. Importantly, when the excitation power is applied
at a frequency dependent upon the excitation frequency of the atom,
the amount of power required is reduced.
[0060] The excitation frequency in this case is the same as the
frequency previously discussed with reference to the energy of the
photon 85 (FIG. 4B). Energy applied at this excitation frequency,
or a harmonic thereof, requires less power to create the excited
atom, such as the atom 86. Thus, if the photon frequency of the
laser 86 is chosen to be the fundamental frequency (or the harmonic
thereof) of the excitation frequency associated with the
environmental gas, the power required for excitation can be greatly
reduced. The same power advantages can be achieved by choosing the
laser 76 with a photon frequency equal to the excitation frequency
or any integer multiple or divisor thereof.
[0061] Of course there are several types of lasers including gas
discharge lasers as well as crystal and diode lasers. Each laser
has its own photon frequency which can be chosen relative to the
excitation frequency of the environmental gas being used. Of course
the gas discharged lasers are easiest to contemplate with the
present invention, as it is only necessary to choose the particular
laser having a discharge gas which is the same as that of the
environmental gas used in the electrosurgical process. In some
cases, the environmental gas will dictate the choice of the laser,
while in other cases, the laser will dictate the choice of the
environmental gas.
[0062] In a laparoscopic surgery environment, carbon dioxide is
most commonly used as an insufflation gas. This gas necessarily
defines the environmental gas for an electrosurgical laparoscopic
procedure. The best choice for a laser under these circumstances
would be a carbon dioxide discharge laser. This laser would require
the least power to create the pathway of excited atoms in an
insufflated laparoscopic procedure using carbon dioxide as the
insufflation gas.
[0063] Given the low power requirements for the laser 25 in the
present invention, a preferred embodiment for the handpiece 36
might be that illustrated in FIG. 7. In this case, the handpiece 36
includes a housing 90 communicating with an elongate probe 92. A
gas cartridge 94 can be carried by the housing 90 and adapted to
release gas molecules 96 into the housing 90 and through the probe
92. These molecules 96 would provide the environmental gas in those
procedures not otherwise providing an insufflation gas. The laser
25 and associated batteries 98 could also be carried in the housing
90. Activation of the laser 25 through the optical fiber 27 would
energize the atoms associated with the gas molecules 96 to create
the energized pathway.
[0064] The handpiece 36 could be coupled through the lead 41 to the
electrosurgical generator 32. The generator 32, in a monopolar
configuration would also be coupled through the lead 38 to the
groundplate 34 disposed between the patient 10 and the operating
table 16. Activation of the electrosurgical generator 32 would
produce the electrosurgical power necessary to ionize the atoms of
excited gas in the pathway 56. As previously discussed, this would
create the path of less resistance for subsequent electrosurgical
arcing to the operative site 52 on the patient 10.
[0065] In a bipolar configuration, the handpiece 36 might be
constructed as illustrated in FIG. 8. In this embodiment, elements
of structure similar to those previously discussed are designated
with the same reference numeral followed by the lowercase letter
"a." Thus, the handpiece 36 is shown with the probe 92a including
the optical fiber 27a, and the gas molecules 96a are energized by
the laser beam 54a. In this bipolar embodiment, the probe 92a
includes two electrodes 99 and 101 which are connected respectively
to the leads 38a and 41a of the electrosurgical generator 32a. In
this embodiment, the spark or arc 58a will jump between the
electrodes 99 and 101 along the pathway 56 of energized free
electrons 87a.
[0066] Another embodiment for the handpiece 36 is illustrated in
FIG. 9 wherein elements of structure similar to those previously
disclosed on designated with the same reference followed by the
lowercase letter "b." In this embodiment, the probe 92b includes
the two electrodes 99b and 101b in a bipolar configuration, with
the electrode 101b provided with fiberoptic apertures 103.
Operation of this embodiment is similar to that of FIG. 8 in that
the environmental gases can be carried through the probe 92b to the
vicinity of the electrodes 98b and 101b. The laser 25b can be
coupled through the optical fiber 27b to the fiber apertures 103 in
order to excite the molecules of environmental gas. Electrosurgical
power can then be provided by the generator 32b and through the
leads 38b and 41b to the electrodes 101b and 98b, respectively.
This will produce the desired ionization of the excited atoms 86b
and facilitate arcing along a controlled pathway between the
electrodes 98b and 101b.
[0067] FIG. 10 illustrates an embodiment of the handpiece 36 which
is adapted to function as a laser knife or scalpel. In this
embodiment, elements of structure similar to those previously
discussed will be designated with the same reference numerals
followed by the lowercase letter "c." In FIG. 10, the handpiece 36
is illustrated to be completely self-contained and with powering
both the laser 25c and the electrosurgery generator 32c.
[0068] In a procedure wherein the environmental gas is provided,
for example by an insufflation gas, the laser 25c can initially be
operated to energize the environmental gas molecules. In this case,
the embodiment of FIG. 10 provides for the laser beam 54c to be
moveable through an aperture 105 to create the pathway 56c having
an elongate and generally planar configuration. By energizing the
electrosurgical generator 32c, the electrode 27c is activated to
ionize the atoms in the pathway 56c. This facilitates the control
led delivery of the electrosurgical spark or arc 58C along the
planar pathway 56c.
[0069] A further embodiment of the invention is illustrated in the
side elevation view of FIG. 11 where elements of structure similar
to those previously disclosed are designated with the same
reference numeral followed by the lowercase letter "d." In FIG. 11,
the concept of the invention is embodied as a catheter 108 having a
hub 110 and a catheter body 112 which extends to a distal end 114
along an axis 115. As best illustrated in the plan view of FIG. 12,
the electrosurgical lead 41b from the electrosurgical generator 32
(FIG. 1), and the optical fiber 27d from the laser 25 (FIG. 1), can
be introduced into the hub 110 and extended through the catheter
body 112. At the distal end 114, the electrosurgical lead 41d can
be terminated in an electrode which in a preferred embodiment
comprises a wire 116.
[0070] Also at the distal end 114, the optical fiber 27d can be
provided with a distal tip having facets 118, or a refractive index
coating selectively removed, to permit the escape of light in a
direction desired for the pathway 56d. In the illustrated
embodiment, this direction is laterally of the axis 115 as shown by
the pathway arrows 56d. In a particular embodiment wherein the
environmental gas is already present, the wire electrode 116 and
the optical fiber 27d may be all that is required to implement the
concept of the present invention. Applying laser energy through the
optical fiber 27d will excite the atoms of the environmental gas
creating the pathway 56d in the direction dictated for example by
the facets 118. Activating the wire electrode 116 will then cause
electrosurgical energy to ionize the pathway 56d and create the
desired electrosurgical effect.
[0071] A balloon 121 can also be provided at the distal end 114 of
the catheter 108 to perform typical catheter balloon functions. In
the illustrated embodiment, the balloon 121 has an inflatable wall
123 which includes portions that define a series of perforations
125. The balloon 121 may be centered on the catheter body 112 with
the faceted distal tip 117 of the optical fiber 27d disposed within
the balloon 121, for example near the axis 115. In this embodiment,
the wire electrode 116 is preferably disposed along the outer
surface of the balloon wall 123.
[0072] In operation, gas can be introduced through the hub 110 and
along the catheter body 112 to inflate the balloon 121. As the
balloon 121 is inflated, the inflation gas is permitted to leak
through the perforations 125 into the environment surrounding the
balloon 121. At this point, the laser 25 (FIG. 1) can be activated
to direct laser energy along the optical fiber 27d and to energize
the atoms of the environmental gas along the pathway 56d. In the
illustrated embodiment, this pathway 56D will extend from within
the balloon 121, through the inflation gas within the balloon 121,
outwardly through the perforations 125, and through the
environmental gas toward the operative site. Upon activation of the
wire electrode 116, electrosurgical power will follow the pathway
56a to create the electrosurgical effect.
[0073] The embodiment of a catheter, such as the catheter 108, can
be a particular advantage where the electrosurgical effect is
desired within a body conduit, such as the ureter. In such an
embodiment, the addition of the balloon 121 can produce many
synergistic effects. For example, the mere inflation of the balloon
can carry the electrode wire 116 into closer proximity to the wall
of the conduit. And as noted, the gas used to inflate the wall 123
of the balloon 121 can also provide the environmental gas for the
electrosurgical procedure. Appropriately perforated, the balloon
121 can be used to release the inflation gas into the environment
and in a predetermined direction.
[0074] Another catheter embodiment is illustrated in the side view
of FIG. 14, the top view of FIG. 15, and the end view of FIG. 16.
In these views, elements of structure similar to those previously
described are designated with the same reference numeral followed
by the lower case letter "e." Thus, the catheter 108e includes the
hub 110e and the catheter body 112e. The balloon 121e is also
included with its wall 123e and perforations 125e. As in the
embodiment of FIG. 11, the electrode wire 116e is disposed along
the outer surface of the balloon wall 123. However, in this
embodiment, the distal tip 117 of the optical fiber 127e is also
carried on the outer surface of the balloon wall 123.
[0075] As in the previous embodiment, inflation gas can be
introduce into the balloon 121e thereby expanding the wall 123 and
carrying the electrode wire 116e and optical fiber distal tip 117
radially outwardly. As before, this inflation gas can be permitted
to leak through the perforations 125e into the environment. When
the laser fiber 127e is activated, the distal tip 117e will direct
laser energy outwardly from the wall 123e of the balloon 121e in
order to create the energized pathway 156e. As in the previous
case, activation of the electrode wire 116e will follow this
pathway 156e toward the operative site.
[0076] A further embodiment of the laser probe is illustrated in
FIG. 17 which provides a view similar to that of FIG. 2. In FIG.
17, elements of structure similar to those previously disclosed
will be designated with the same reference numeral followed by the
lower case letter "f." In this embodiment, the probe 30f has a
distal end tip that is provided with a lens 130 at its distal end
114f. This lens 130 tends to diverge the laser beam 54f so that the
operative site 52f is defined by an area, rather than a point as
previously illustrated for the embodiment of FIG. 2. With the laser
beam 54f diverging, the pathway 56f of excited atoms also expands
as it approaches the area of the operative site 52f. When the
electrosurgical handpiece 36f is activated, the spark or arc 58f
will be randomly directed within the area of the operative site
52f. This can be of particular advantage when the desired
electrosurgical effect is to cauterize or coagulate over a wide
area of the operative site 52f.
[0077] A further embodiment of the handpiece 36 is illustrated in
FIGS. 18-20 wherein elements of structure similar to those
previously discussed are designated with the same reference numeral
followed by the lower case "g." Thus the handpiece 36g includes the
probe 92g containing at least the optical fiber 27g and the
electrosurgical electrode 101g. In the illustrated embodiment, the
probe 92g also contains a second optical fiber 132. In this case,
the two optical fibers 27g and 132 are distally terminated at
lenses 134 and 136, respectively. The lens 134 associated with the
fiber 27 causes the laser beam 54g to converge as illustrated.
Similarly, the lens 136 associated with the fiber 132 causes a
laser beam 138 to converge. Importantly, these two laser beams 54g
and 138 can also be converged toward the operative site 52. This
embodiment offers the advantage of providing increased laser power
for development of the pathway 56g. Even with this increased power,
the pathway 56g can be controlled to converge the electrosurgical
energy toward the operative site 52g.
[0078] It will be understood that many other modifications can be
made to the various disclosed embodiments without departing from
the spirit and scope of the concept. For example, various sizes of
the surgical device are contemplated as well as various types of
constructions and materials. It will also be apparent that many
modifications can be made to the configuration of parts as well as
their interaction. For these reasons, the above description should
not be construed as limiting the invention, but should be
interpreted as merely exemplary of preferred embodiments. Those
skilled in the art will envision other modifications within the
scope and spirit of the present invention as defined by the
following claims
* * * * *