U.S. patent application number 13/680972 was filed with the patent office on 2013-11-28 for voltage threshold ablation apparatus.
This patent application is currently assigned to ARQOS Surgical, Inc.. The applicant listed for this patent is Bruno Strul, Csaba Truckai. Invention is credited to Bruno Strul, Csaba Truckai.
Application Number | 20130317493 13/680972 |
Document ID | / |
Family ID | 35061545 |
Filed Date | 2013-11-28 |
United States Patent
Application |
20130317493 |
Kind Code |
A1 |
Truckai; Csaba ; et
al. |
November 28, 2013 |
VOLTAGE THRESHOLD ABLATION APPARATUS
Abstract
The present invention relates to the field of electrosurgery,
and more particularly to systems and methods for ablating,
cauterizing and/or coagulating body tissue using radio frequency
energy. More in particular, the systems utilize voltage threshold
means for controlling the voltage applied to tissue in a
cycle-to-cycle manner.
Inventors: |
Truckai; Csaba; (Saratoga,
CA) ; Strul; Bruno; (Portola Valley, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Truckai; Csaba
Strul; Bruno |
Saratoga
Portola Valley |
CA
CA |
US
US |
|
|
Assignee: |
ARQOS Surgical, Inc.
Cupertino
CA
|
Family ID: |
35061545 |
Appl. No.: |
13/680972 |
Filed: |
November 19, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12790561 |
May 28, 2010 |
8333763 |
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13680972 |
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11090706 |
Mar 24, 2005 |
7744595 |
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12790561 |
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10995660 |
Nov 22, 2004 |
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11090706 |
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10135135 |
Apr 30, 2002 |
6821275 |
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10995660 |
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09631040 |
Aug 1, 2000 |
6413256 |
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10135135 |
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Current U.S.
Class: |
606/33 |
Current CPC
Class: |
A61B 2018/1213 20130101;
A61B 2218/002 20130101; A61B 18/14 20130101; A61B 2018/143
20130101; A61B 2018/00065 20130101; A61B 2018/00666 20130101; A61B
18/18 20130101; A61B 2018/00892 20130101 |
Class at
Publication: |
606/33 |
International
Class: |
A61B 18/18 20060101
A61B018/18 |
Claims
1. A surgical probe for applying electrical energy to tissue, the
probe working end having an electrically non-conductive
tissue-contacting surface with a thickness of less than about 1000
microns and an interior electrode within an interior of the working
end coupled to an electrical source, and a voltage threshold switch
mechanism operatively coupled with the electrical source and the
interior electrode, said switch located proximal the inferior of
the working end or within an interior of a handle portion of the
probe.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 12/790,561 (Attorney Docket No.
33291-703.303), filed May 28, 2010, which is a continuation of U.S.
patent application Ser. No. 11/090,706 (Attorney Docket No.
33291-703.501), filed on Mar. 24, 2005, now U.S. Pat. No.
7,744,595, which is a continuation-in-part of U.S. patent
application Ser. No. 10/995,660 (Attorney Docket No.
33291-703.302), filed on Nov. 22, 2004, which was a continuation of
U.S. patent application Ser. No. 10/135,135 (Attorney Docket No.
33291-703.301), filed on Apr. 30, 2002, now U.S. Pat. No.
6,821,275, which was a continuation of U.S. patent application Ser.
No. 09/631,040 (Attorney Docket No. 33291-703.201), filed on Aug.
1, 2000, now U.S. Pat. No. 6,413,256, and also claims the benefit
of U.S. Provisional Patent Application No. 60/555,777 (Attorney
Docket No. 33291-703.101) filed Mar. 24, 2004, the full disclosures
of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION
Field of the Invention
[0002] The present invention relates to the field of
electrosurgery, and more particularly to systems and methods for
ablating, cauterizing and/or coagulating body tissue using radio
frequency energy. More in particular, the systems utilize voltage
threshold means for controlling the voltage applied to tissue in a
cycle-to-cycle manner.
[0003] Radio frequency ablation is a method by which body tissue is
destroyed by passing radio frequency current into the tissue. Some
RF ablation procedures rely on application of high currents and low
voltages to the body tissue, resulting in resistive heating of the
tissue which ultimately destroys the tissue. These techniques
suffer from the drawback that the heat generated at the tissue can
penetrate deeply, making the depth of ablation difficult to predict
and control. This procedure is thus disadvantageous in applications
in which only a fine layer of tissue is to be ablated, or in areas
of the body such as the heart or near the spinal cord where
resistive heating can result in undesirable collateral damage to
critical tissues and/or organs.
[0004] It is thus desirable to ablate such sensitive areas using
high voltages and low currents, thus minimizing the amount of
current applied to body tissue.
BRIEF SUMMARY OF THE INVENTION
[0005] The present invention is a method and apparatus for treating
tissue using an electrosurgical system. The system includes an
electrosurgical system having an RF generator, a treatment
electrode electrically coupled to the RF generator and positioned
in contact with target tissue to be treated, and a spark gap switch
positioned between the RF generator and the target tissue. The
spark gap includes a threshold voltage and is configured to prevent
conduction of current from the RF generator to the tissue until the
voltage across the spark gap reaches the threshold voltage.
[0006] A method according to the present invention includes the
steps of using the RF generator to apply a voltage across the spark
gap switch, the spark gap switch causing conduction of current from
the RF generator to the target tissue once the voltage across the
spark gap reaches the threshold voltage.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] FIG. 1 is a cross-sectional side elevation view of a first
embodiment of an ablation device utilizing principles of the
present invention.
[0008] FIG. 2 is an end view showing the distal end of the device
of FIG. 1.
[0009] FIG. 3 is a graphical representation of voltage output from
an RF generator over time.
[0010] FIG. 4A is a graphical representation of voltage potential
across a body tissue load, from an ablation device utilizing
voltage threshold ablation techniques as described herein.
[0011] FIG. 4B is a graphical representation of voltage potential
across a body tissue load, from an ablation device utilizing
voltage threshold ablation techniques as described herein and
further utilizing techniques described herein for decreasing the
slope of the trailing edge of the waveform.
[0012] FIGS. 5A through 5D are a series of cross-sectional side
elevation views of the ablation device of FIG. 1, schematically
illustrating use of the device to ablate tissue.
[0013] FIG. 6A is a cross-sectional side view of a second
embodiment of an ablation device utilizing principles of the
present invention.
[0014] FIG. 6B is an end view showing the distal end of the device
of FIG. 6A.
[0015] FIGS. 7A and 7B are cross-sectional side elevation view of a
third embodiment of an ablation device utilizing principles of the
present invention. In FIG. 7A, the device is shown in a contracted
position and in FIG. 7B the device is shown in an expanded
position.
[0016] FIG. 8A is a perspective view of a fourth embodiment of an
ablation device utilizing principles of the present invention.
[0017] FIG. 8B is a cross-sectional side elevation view of the
ablation device of FIG. 8A.
[0018] FIG. 9A is a perspective view of a fifth embodiment of an
ablation device utilizing principles of the present invention.
[0019] FIG. 9B is a cross-sectional side elevation view of the
ablation device of FIG. 9A.
[0020] FIG. 10 is a cross-sectional side elevation view of a sixth
ablation device utilizing principles of the present invention.
[0021] FIG. 11A is a perspective view of a seventh embodiment of an
ablation device utilizing principles of the present invention.
[0022] FIG. 11B is a cross-sectional side elevation view of the
ablation device of FIG. 11A.
[0023] FIG. 11C is a cross-sectional end view of the ablation
device of FIG. 11A.
[0024] FIG. 12A is a perspective view of an eighth embodiment of an
ablation device utilizing principles of the present invention.
[0025] FIG. 12B is a cross-sectional side elevation view of the
ablation device of FIG. 12A.
[0026] FIG. 13A is a cross-sectional side elevation view of a ninth
embodiment of an ablation device utilizing principles of the
present invention.
[0027] FIG. 13B is a cross-sectional end view of the ablation
device of FIG. 13A, taken along the plane designated 13B-13B in
FIG. 13A.
[0028] FIG. 14A is a cross-sectional side elevation view of a tenth
embodiment of an ablation device utilizing principles of the
present invention.
[0029] FIG. 14B is a front end view of the grid utilized in the
embodiment of FIG. 14A.
[0030] FIG. 15A is a cross-sectional side elevation view of an
eleventh embodiment.
[0031] FIG. 15B is a cross-sectional end view of the eleventh
embodiment taken along the plane designated 15B-15B in FIG.
15A.
[0032] FIG. 15C is a schematic illustration of a variation of the
eleventh embodiment, in which the mixture of gases used in the
reservoir may be adjusted so as to change the threshold
voltage.
[0033] FIGS. 16A-16D are a series of drawings illustrating use of
the eleventh embodiment.
[0034] FIG. 17 is a series of plots graphically illustrating the
impact of argon flow on the ablation device output at the body
tissue/fluid load.
[0035] FIG. 18 is a series of plots graphically illustrating the
impact of electrode spacing on the ablation device output at the
body tissue/fluid load.
[0036] FIG. 19 is a schematic illustration of a twelfth embodiment
of a system utilizing principles of the present invention, in which
a spark gap spacing may be selected so as to pre-select a threshold
voltage.
[0037] FIG. 20 is a perspective view of a hand-held probe
corresponding to the invention with a voltage threshold mechanism
at the interior of a microporous ceramic working surface.
[0038] FIG. 21 is a sectional view of the working end of the probe
of FIG. 20.
[0039] FIG. 22 is a greatly enlarged cut-away schematic view of the
voltage threshold mechanism and microporous ceramic working surface
of FIG. 21.
[0040] FIG. 23 is a cut-away schematic view of an alternative
voltage threshold mechanism with multiple spark gaps
dimensions.
[0041] FIG. 24 is a cut-away schematic view of an alternative
voltage threshold mechanism with a microporous electrode.
[0042] FIG. 25 is a sectional view of an alternative needle-like
probe with a voltage threshold mechanism at it interior.
[0043] FIG. 26 is a sectional view of an alternative probe with a
voltage threshold mechanism at it interior together with an
exterior electrode to allow functioning in a bi-polar manner.
DETAILED DESCRIPTION OF THE INVENTION
[0044] Several embodiments of ablation systems useful for
practicing a voltage threshold ablation method utilizing principles
of the present invention are shown in the drawings. Generally
speaking, each of these systems utilizes a switching means that
prevents current flow into the body until the voltage across the
switching means reaches a predetermined threshold potential. By
preventing current flow to tissue until a high threshold voltage is
reached, the invention minimizes collateral tissue damage that can
occur when a large amount of current is applied to the tissue. The
switching means may take a variety of forms, including but not
limited to an encapsulated or circulated volume of argon or other
fluid/gas that will only conduct ablation energy from an
intermediate electrode to an ablation electrode once it has been
transformed to a plasma by being raised to a threshold voltage.
[0045] The embodiments described herein utilize a spark gap switch
for preventing conduction of energy to the tissue until the voltage
potential applied by the RF generator reaches a threshold voltage.
In a preferred form of the apparatus, the spark gap switch includes
a volume of fluid/gas to conduct ablation energy across the spark
gap, typically from an intermediate electrode to an ablation
electrode. The fluid/gas used for this purpose is one that will not
conduct until it has been transformed to conductive plasma by
having been raised to a threshold voltage. The threshold voltage of
the fluid/gas will vary with variations in a number of conditions,
including fluid/gas pressure, distance across the spark gap (e.g.
between an electrode on one side of the spark gap and an electrode
on the other side of the spark gap), and with the rate at which the
fluid/gas flows within the spark gap--if flowing fluid/gas is used.
As will be seen in some of the embodiments, the threshold voltage
may be adjusted in some embodiments by changing any or all of these
conditions.
[0046] A first embodiment of an ablation device 10 utilizing
principles of the present invention is shown in FIGS. 1-2. Device
10 includes a housing 12 formed of an insulating material such as
glass, ceramic, siliciumoxid, PTFE or other material having a high
melting temperature. At the distal end 13 of the housing 12 is a
sealed reservoir 20. An internal electrode 22 is disposed within
the sealed reservoir 20. Electrode 22 is electrically coupled to a
conductor 24 that extends through the housing body. Conductor 24 is
coupled to an RF generator 28 which may be a conventional RF
generator used for medical ablation, such as the Model Force 2 RF
Generator manufactured by Valley Lab. A return electrode 30 is
disposed on the exterior surface of the housing 12 and is also
electrically coupled to RF generator 28.
[0047] A plurality of ablation electrodes 32a-32c are located on
the distal end of the housing 12. Ablation electrodes 32a-32c may
be formed of tungsten or any conductive material which performs
well when exposed to high temperatures. In an alternative
embodiment, there may be only one ablation electrode 32, or a
different electrode configuration. A portion of each ablation
electrode 32a-32c is exposed to the interior of reservoir 20.
Electrodes 22 and 32a-32c, and corresponding electrodes in
alternate embodiments, may also be referred to herein as spark gap
electrodes.
[0048] FIGS. 5A through 5D illustrate the method of using the
embodiment of FIG. 1. Referring to FIG. 5A, prior to use the
reservoir 20 is filled with a fluid or gas. Preferably, an inert
gas such as argon gas or a similar gas such as Neon, Xenon, or
Helium is utilized to prevent corrosion of the electrodes, although
other fluids/gases could be utilized so long as the electrodes and
other components were appropriately protected from corrosion. For
convenience only, the embodiments utilizing such a fluid/gas will
be described as being used with the preferred gas, which is
argon.
[0049] It should be noted that while the method of FIGS. 5A-5D is
most preferably practiced with a sealed volume of gas within the
reservoir 20, a circulating flow of gas using a system of lumens in
the housing body may alternatively be used. A system utilizing a
circulating gas flow is described in connection with FIGS.
15A-15B.
[0050] The distal end of the device 10 is placed against body
tissue to be ablated, such that some of the electrodes 32a, 32b
contact the tissue T. In most instances, others of the electrodes
32c are disposed within body fluids F. The RF generator 28 (FIG. 1)
is powered on and gradually builds-up the voltage potential between
electrode 22 and electrodes 32a-32c.
[0051] Despite the voltage potential between the internal electrode
22 and ablation electrodes 32a-32c, there initially is no
conduction of current between them. This is because the argon gas
will not conduct current when it is in a gas phase. In order to
conduct, high voltages must be applied through the argon gas to
create a spark to ionize the argon and bring it into the conductive
plasma phase. Later in this description these voltages may also be
referred to as "initiating voltages" since they are the voltages at
which conduction is initiated.
[0052] The threshold voltage at which the argon will begin to
immediately conduct is dependent on the pressure of the argon gas
and the distance between electrode 22 and surface electrodes
32a-32c.
[0053] Assume P1 is the initial pressure of the argon gas within
reservoir 20. If, at pressure P1, a voltage of V1 is required to
ignite plasma within the argon gas, then a voltage of V>V1 must
be applied to electrode 22 to ignite the plasma and to thus begin
conduction of current from electrode 22 to ablation electrodes
32a-32c.
[0054] Thus, no conduction to electrodes 32a-32c (and thus into the
tissue) will occur until the voltage potential between electrode 22
and ablation electrodes 32a-32c reaches voltage V. Since no current
flows into the tissue during the time when the RF generator is
increasing its output voltage towards the voltage threshold, there
is minimal resistive heating of the electrodes 32a-32c and body
tissue. Thus, this method relies on the threshold voltage of the
argon (i.e. the voltage at which a plasma is ignited) to prevent
overheating of the ablation electrodes 32a, 32b and to thus prevent
tissue from sticking to the electrodes.
[0055] The voltage applied by the RF generator to electrode 22
cycles between +V and -V throughout the ablation procedure.
However, as the process continues, the temperature of the tip of
the device begins to increase, causing the temperature within the
reservoir and thus the pressure of the argon to increase. As the
gas pressure increases, the voltage needed to ignite the plasma
also increases. Eventually, increases in temperature and thus
pressure will cause the voltage threshold needed to ignite the
plasma to increase above V. When this occurs, flow of current to
the ablation electrodes will stop (FIG. 5D) until the argon
temperature and pressure decrease to a point where the voltage
required for plasma ignition is at or below V. Initial gas pressure
P1 and the voltage V are thus selected such that current flow will
terminate in this manner when the electrode temperature is reaching
a point at which tissue will stick to the electrodes and/or char
the tissue. This allows the tip temperature of the device to be
controlled by selecting the initial gas pressure and the maximum
treatment voltage.
[0056] The effect of utilizing a minimum voltage limit on the
potential applied to the tissue is illustrated graphically in FIGS.
3 and 4A. FIG. 3 shows RF generator voltage output V.sub.RF over
time, and FIG. 4A shows the ablation potential V.sub.A between
internal electrode 22 and body tissue. As can be seen, V.sub.A
remains at 0 V until the RF generator output V.sub.RF reaches the
device's voltage threshold V.sub.T, at which time V.sub.A rises
immediately to the threshold voltage level. Ablation voltage
V.sub.A remains approximately equivalent to the RF generator output
until the RF generator output reaches 0 V. V.sub.A remains at 0 V
until the negative half-cycle of the RF generator output falls
below (-V.sub.T), at which time the potential between electrode 22
and the tissue drops immediately to (-V.sub.T), and so on. Because
there is no conduction to the tissue during the time that the RF
generator output is approaching the voltage threshold, there is
little conduction to the tissue during low voltage (and high
current) phases of the RF generator output. This minimizes
collateral tissue damages that would otherwise be caused by
resistive heating.
[0057] It is further desirable to eliminate the sinusoidal trailing
end of the waveform as an additional means of preventing
application of low voltage/high current to the tissue and thus
eliminating collateral tissue damage. Additional features are
described below with respect FIGS. 14A-18. These additional
features allow this trailing edge to be clipped and thus produce a
waveform measured at the electrode/tissue interface approximating
that shown in FIG. 4B.
[0058] Another phenomenon occurs between the electrodes 32a-32c and
the tissue, which further helps to keep the electrodes sufficiently
cool as to avoid sticking This phenomenon is best described with
reference to FIGS. 5A through 5D. As mentioned, in most cases some
of the electrodes such as electrode 32c will be in contact with
body fluid while others (e.g. 32a-32b) are in contact with tissue.
Since the impedance of body fluid F is low relative to the
impedance of tissue T, current will initially flow through the
plasma to electrode 32c and into the body fluid to return electrode
30, rather than flowing to the electrodes 32, 32b that contact
tissue T. This plasma conduction is represented by an arrow in FIG.
5A.
[0059] Resistive heating of electrode 32c causes the temperature of
body fluid F to increase. Eventually, the body fluid F reaches a
boiling phase and a resistive gas/steam bubble G will form at
electrode 32c. Steam bubble G increases the distance between
electrode 22 and body fluid F from distance D1 to distance D2 as
shown in FIG. 5B. The voltage at which the argon will sustain
conductive plasma is dependent in part on the distance between
electrode 22 and the body fluid F. If the potential between
electrode 22 and body fluid F is sufficient to maintain a plasma in
the argon even after the bubble G has expanded, energy will
continue to conduct through the argon to electrode 32c, and
sparking will occur through bubble G between electrode 32c and the
body fluid F.
[0060] Continued heating of body fluid F causes gas/steam bubble G
to further expand. Eventually the size of bubble G is large enough
to increase the distance between electrode 22 and fluid F to be
great enough that the potential between them is insufficient to
sustain the plasma and to continue the sparking across the bubble
G. Thus, the plasma between electrodes 22 and 32c dies, causing
sparking to discontinue and causing the current to divert to
electrodes 32a, 32b into body tissue T, causing ablation to occur.
See FIG. 5C. A gas/steam insulating layer L will eventually form in
the region surrounding the electrodes 32a, 32b. By this time,
gas/steam bubble G around electrode 32c may have dissipated, and
the high resistance of the layer L will cause the current to divert
once again into body fluid F via electrode 32c rather than through
electrodes 32a, 32b. This process may repeat many times during the
ablation procedure.
[0061] A second embodiment of an ablation device 110 is shown in
FIGS. 6A and 6B. The second embodiment operates in a manner similar
to the first embodiment, but it includes structural features that
allow the threshold voltage of the argon to be pre-selected.
Certain body tissues require higher voltages in order for ablation
to be achieved. This embodiment allows the user to select the
desired ablation voltage and to have the system prevent current
conduction until the pre-selected voltages are reached. Thus, there
is no passage of current to the tissue until the desired ablation
voltage is reached, and so there is no unnecessary resistive tissue
heating during the rise-time of the voltage.
[0062] As discussed previously, the voltage threshold of the argon
varies with the argon pressure in reservoir 120 and with the
distance d across the spark gap, which in this embodiment is the
distance extending between electrode 122 and ablation electrodes
132a-132c. The second embodiment allows the argon pressure and/or
the distance d to be varied so as to allow the voltage threshold of
the argon to be pre-selected to be equivalent to the desired
ablation voltage for the target tissue. In other words, if a
treatment voltage of 200V is desired, the user can configure the
second embodiment such that that voltage will be the threshold
voltage for the argon. Treatment voltages in the range of 50V to
10,000V, and most preferably 200V-500V, may be utilized.
[0063] Referring to FIG. 6A, device 110 includes a housing 112
formed of an insulating material such as glass, ceramic,
siliciumoxid, PTFE or other high melting temperature material. A
reservoir 120 housing a volume of argon gas is located in the
housing's distal tip. A plunger 121 is disposed within the housing
112 and includes a wall 123. The plunger is moveable to move the
wall proximally and distally between positions 121A and 121B to
change the volume of reservoir 120. Plunger wall 123 is sealable
against the interior wall of housing 112 so as to prevent leakage
of the argon gas.
[0064] An elongate rod 126 extends through an opening (not shown)
in plunger wall 123 and is fixed to the wall 123 such that the rod
and wall can move as a single component. Rod 126 extends to the
proximal end of the device 110 and thus may serve as the handle
used to move the plunger 121 during use.
[0065] Internal electrode 122 is positioned within the reservoir
120 and is mounted to the distal end of rod 126 such that movement
of the plunger 121 results in corresponding movement of the
electrode 122. Electrode 122 is electrically coupled to a conductor
124 that extends through rod 126 and that is electrically coupled
to RF generator 128. Rod 126 preferably serves as the insulator for
conductor 124 and as such should be formed of an insulating
material.
[0066] A return electrode 130 is disposed on the exterior surface
of the housing 112 and is also electrically coupled to RF generator
128. A plurality of ablation electrodes 132a, 132b etc. are
positioned on the distal end of the housing 112.
[0067] Operation of the embodiment of FIGS. 6A-6B is similar to
that described with respect to FIGS. 5A-5B, and so most of that
description will not be repeated. Operation differs in that use of
the second embodiment includes the preliminary step of moving rod
126 proximally or distally to place plunger wall 123 and electrode
122 into positions that will yield a desired voltage threshold for
the argon gas. Moving the plunger in a distal direction (towards
the electrodes 132a-132c) will decrease the volume of the reservoir
and accordingly will increase the pressure of the argon within the
reservoir and vice versa. Increases in argon pressure result in
increased voltage threshold, while decreases in argon pressure
result in decreased voltage threshold.
[0068] Moving the plunger 126 will also increase or decrease the
distance d between electrode 122 and electrodes 132a-132c.
Increases in the distance d increase the voltage threshold and vice
versa.
[0069] The rod 126 preferably is marked with calibrations showing
the voltage threshold that would be established using each position
of the plunger. This will allow the user to move the rod 126
inwardly (to increase argon pressure but decrease distance d) or
outwardly (to decrease argon pressure but increase distance d) to a
position that will give a threshold voltage corresponding to the
voltage desired to be applied to the tissue to be ablated. Because
the argon will not ignite into a plasma until the threshold voltage
is reached, current will not flow to the electrodes 132a, 132b etc.
until the pre-selected threshold voltage is reached. Thus, there is
no unnecessary resistive tissue heating during the rise-time of the
voltage.
[0070] Alternatively, the FIG. 6A embodiment may be configured such
that plunger 121 and rod 126 may be moved independently of one
another, so that argon pressure and the distance d may be adjusted
independently of one another. Thus, if an increase in voltage
threshold is desired, plunger wall 123 may be moved distally to
increase argon pressure, or rod 126 may be moved proximally to
increase the separation distance between electrode 122 and
132a-132c. Likewise, a decrease in voltage threshold may be
achieved by moving plunger wall 123 proximally to decrease argon
pressure, or by moving rod 126 distally to decrease the separation
distance d. If such a modification to the FIG. 6A was employed, a
separate actuator would be attached to plunger 121 to allow the
user to move the wall 123, and the plunger 126 would be slidable
relative to the opening in the wall 123 through which it
extends.
[0071] During use of the embodiment of FIGS. 6A and 6B, it may be
desirable to maintain a constant argon pressure despite increases
in temperature. As discussed in connection with the method of FIGS.
5A-5D, eventual increases in temperature and pressure cause the
voltage needed to ignite the argon to increase above the voltage
being applied by the RF generator, resulting in termination of
conduction of the electrodes. In the FIG. 6A embodiment, the
pressure of the argon can be maintained despite increases in
temperature by withdrawing plunger 121 gradually as the argon
temperature increases. By maintaining the argon pressure, the
threshold voltage of the argon is also maintained, and so argon
plasma will continue to conduct current to the electrodes 132a,
132b etc. This may be performed with or without moving the
electrode 122. Alternatively, the position of electrode 122 may be
changed during use so as to maintain a constant voltage threshold
despite argon temperature increases.
[0072] FIGS. 7A and 7B show an alternative embodiment of an
ablation device 210 that is similar to the device of FIGS. 6A and
6B. In this embodiment, argon is sealed within reservoir 220 by a
wall 217. Rather than utilizing a plunger (such as plunger 121 in
FIG. 6A) to change the volume of reservoir 220, the FIGS. 7A-7B
embodiment utilizes bellows 221 formed into the sidewalls of
housing 212. A pullwire 226 (which may double as the insulation for
conductor 224) extends through internal electrode 222 and is
anchored to the distal end of the housing 212. The bellows may be
moved to the contracted position shown in FIG. 7A, the expanded
position shown in FIG. 7B, or any intermediate position between
them.
[0073] Pulling the pullwire 226 collapses the bellows into a
contracted position as shown in FIG. 7A and increases the pressure
of the argon within the reservoir 220. Advancing the pullwire 226
expands the bellows as shown in FIG. 7B, thereby decreasing the
pressure of the argon. The pullwire and bellows may be used to
pre-select the threshold voltage, since (for a given temperature)
increasing the argon pressure increases the threshold voltage of
the argon and vice versa. Once the threshold voltage has been
pre-set, operation is similar to that of the previous embodiments.
It should be noted that in the third embodiment, the distance
between electrode 222 and ablation electrodes 232a-c remains fixed,
although the device may be modified to allow the user to adjust
this distance and to provide an additional mechanism for adjusting
the voltage threshold of the device.
[0074] An added advantage of the embodiment of FIG. 7A is that the
device may be configured to permit the bellows 221 to expand in
response to increased argon pressure within the reservoir. This
will maintain the argon pressure, and thus the threshold voltage of
the argon, at a fairly constant level despite temperature increases
within reservoir 220. Thus, argon plasma will continue to conduct
current to the electrodes 132a 132b etc and ablation may be
continued, as it will be a longer period of time until the
threshold voltage of the argon exceeds the voltage applied by the
RF generator.
[0075] FIGS. 8A through 13B are a series of embodiments that also
utilize argon, but that maintain a fixed reservoir volume for the
argon. In each of these embodiments, current is conducted from an
internal electrode within the argon reservoir to external ablation
electrodes once the voltage of the internal electrode reaches the
threshold voltage of the argon gas.
[0076] Referring to FIGS. 8A and 8B, the fourth embodiment of an
ablation device utilizes a housing 312 formed of insulating
material, overlaying a conductive member 314. Housing 312 includes
exposed regions 332 in which the insulating material is removed to
expose the underlying conductive member 314. An enclosed reservoir
320 within the housing 212 contains argon gas, and an RF electrode
member 322 is positioned within the reservoir. A return electrode
(not shown) is attached to the patient. The fourth embodiment
operates in the manner described with respect to FIGS. 5A-5D,
except that the current returns to the RF generator via the return
electrode on the patient's body rather than via one on the device
itself.
[0077] The fifth embodiment shown in FIGS. 9A and 9B is similar in
structure and operation to the fourth embodiment. A conductive
member 414 is positioned beneath insulated housing 412, and
openings in the housing expose electrode regions 432 of the
conductive member 414. The fifth embodiment differs from the fourth
embodiment in that it is a bipolar device having a return electrode
430 formed over the insulated housing 412. Return electrode 430 is
coupled to the RF generator and is cutaway in the same regions in
which housing 412 is cutaway; so as to expose the underlying
conductor.
[0078] Internal electrode 422 is disposed within argon gas
reservoir 420. During use, electrode regions 432 are placed into
contact with body tissue to be ablated. The RF generator is
switched on and begins to build the voltage of electrode 422
relative to ablation electrode regions 432. As with the previous
embodiments, conduction of ablation energy from electrode 422 to
electrode regions 432 will only begin once electrode 422 reaches
the voltage threshold at which the argon in reservoir 420 ignites
to form a plasma. Current passes through the tissue undergoing
ablation and to the return electrode 430 on the device
exterior.
[0079] The sixth embodiment shown in FIG. 10 is similar in
structure and operation to the fifth embodiment, and thus includes
a conductive member 514, an insulated housing 512 over the
conductive member 512 and having openings to expose regions 532 of
the conductive member. A return electrode 530 is formed over the
housing 512, and an internal electrode 522 is positioned within a
reservoir 520 containing a fixed volume of argon. The sixth
embodiment differs from the fifth embodiment in that the exposed
regions 532 of the conductive member 514 protrude through the
housing 512 as shown. This is beneficial in that it improves
contact between the exposed regions 532 and the target body
tissue.
[0080] A seventh embodiment is shown in FIGS. 11A through 11C. As
with the sixth embodiment, this embodiment includes an insulated
housing 612 (such as a heat resistant glass or ceramic) formed over
a conductive member 614, and openings in the insulated housing 612
to expose elevated electrode regions 632 of the conductive member
614. A return electrode 630 is formed over the housing 612. An
internal electrode 622 is positioned within a reservoir 620
containing a fixed volume of argon.
[0081] The seventh embodiment differs from the sixth embodiment in
that there is an annular gap 633 between the insulated housing 612
and the elevated regions 632 of the conductive member 614 Annular
gap 633 is fluidly coupled to a source of suction and/or to an
irrigation supply. During use, suction may be applied via gap 633
to remove ablation byproducts (e.g. tissue and other debris) and/or
to improve electrode contact by drawing tissue into the annular
regions between electrode regions 632 and ground electrode 630. An
irrigation gas or fluid may also be introduced via gap 633 during
use so as to flush ablation byproducts from the device and to cool
the ablation tip and the body tissue. Conductive or non-conductive
fluid may be utilized periodically during the ablation procedure to
flush the system.
[0082] Annular gap 633 may also be used to deliver argon gas into
contact with the electrodes 632. When the voltage of the electrode
regions 632 reaches the threshold of argon delivered through the
gap 633, the resulting argon plasma will conduct from electrode
regions 632 to the ground electrode 630, causing lateral sparking
between the electrodes 632, 630. The resulting sparks create an
"electrical file" which cuts the surrounding body tissue.
[0083] An eighth embodiment of an ablation device is shown in FIGS.
12A and 12B. This device 710 is similar to the device of the fifth
embodiment, FIGS. 9A and 9B, in a number of ways. In particular,
device 710 includes a conductive member 714 positioned beneath
insulated housing 712, and openings in the housing which expose
electrode regions 732 of the conductive member 714. A return
electrode 730 is formed over the insulated housing 712. Internal
electrode 722 is disposed within an argon gas reservoir 720 having
a fixed volume.
[0084] The eighth embodiment additionally includes a pair of
telescoping tubular jackets 740, 742. Inner jacket 740 has a lower
insulating surface 744 and an upper conductive surface 746 that
serves as a second return electrode. Inner jacket 740 is
longitudinally slidable between proximal position 740A and distal
position 740B.
[0085] Outer jacket 742 is formed of insulating material and is
slidable longitudinally between position 742A and distal position
742B.
[0086] A first annular gap 748 is formed beneath inner jacket 740
and a second annular gap 750 is formed between the inner and outer
jackets 740, 742. These gaps may be used to deliver suction or
irrigation to the ablation site to remove ablation byproducts.
[0087] The eighth embodiment may be used in a variety of ways. As a
first example, jackets 740, 742 may be moved distally to expose
less than all of tip electrode assembly (i.e. the region at which
the conductive regions 732 are located). This allows the user to
expose only enough of the conductive regions 732 as is needed to
cover the area to be ablated within the body.
[0088] Secondly, in the event bleeding occurs at the ablation site,
return electrode surface 730 may be used as a large surface area
coagulation electrode, with return electrode surface 746 serving as
the return electrode, so as to coagulate the tissue and to thus
stop the bleeding. Outer jacket 742 may be moved proximally or
distally to increase or decrease the surface area of electrode 746.
Moving it proximally has the effect of reducing the energy density
at the return electrode 746, allowing power to be increased to
carry out the coagulation without increasing thermal treatment
effects at return electrode 746.
[0089] Alternatively, in the event coagulation and/or is needed,
electrode 730 may be used for surface coagulation in combination
with a return patch placed into contact with the patient.
[0090] FIGS. 13A-13B show a ninth embodiment of an ablation device
utilizing principles of the present invention. The ninth embodiment
includes an insulated housing 812 having an argon gas reservoir 820
of fixed volume. A plurality of ablation electrodes 832 are
embedded in the walls of the housing 812 such that they are exposed
to the argon in reservoir 832 and exposed on the exterior of the
device for contact with body tissue. A return electrode 830 is
formed over the housing 812, but includes openings through which
the electrodes 832 extend. An annular gap 833 lies between return
electrode 830 and housing 812. As with previous embodiments,
suction and/or irrigation may be provided through the gap 833.
Additionally, argon gas may be introduced through the annular gap
833 and into contact with the electrodes 832 and body tissue so as
to allow argon gas ablation to be performed.
[0091] An internal electrode 822 is positioned within reservoir
820. Electrode 822 is asymmetrical in shape, having a curved
surface 822a forming an arc of a circle and a pair of straight
surfaces 822b forming radii of the circle. As a result of its
shape, the curved surface of the electrode 820 is always closer to
the electrodes 832 than the straight surfaces. Naturally, other
shapes that achieve this effect may alternatively be utilized.
[0092] Electrode 822 is rotatable about a longitudinal axis and can
also be moved longitudinally as indicated by arrows in FIGS. 13A
and 13B. Rotation and longitudinal movement can be carried out
simultaneously or separately. This allows the user to selectively
position the surface 822a in proximity to a select group of the
electrodes 832. For example, referring to FIGS. 13A and 13B, when
electrode 822 is positioned as shown, curved surface 822a is near
electrodes 832a, whereas no part of the electrode 822 is close to
the other groups of electrodes 832b-832d.
[0093] As discussed earlier, the voltage threshold required to
cause conduction between internal electrode 822 and ablation
electrodes 832 will decrease with a decrease in distance between
the electrodes. Thus, there will be a lower threshold voltage
between electrode 822 and the ablation electrodes (e.g. electrode
832a) adjacent to surface 822a than there is between the electrode
822 and ablation electrodes that are farther away (e.g. electrodes
832b-d. The dimensions of the electrode 822 and the voltage applied
to electrode 822 are such that a plasma can only be established
between the surface 822a and the electrodes it is close to. Thus,
for example, when surface 822a is adjacent to electrodes 832a as
shown in the drawings, the voltage threshold between the electrodes
822a and 832a is low enough that the voltage applied to electrode
822 will cause plasma conduction to electrodes 832a. However, the
threshold between electrode 822 and the other electrodes 832b-d
will remain above the voltage applied to electrode 822, and so
there will be no conduction to those electrodes.
[0094] This embodiment thus allows the user to selectively ablate
regions of tissue by positioning the electrode surface 822a close
to electrodes in contact with the regions at which ablation is
desired.
[0095] FIG. 14A shows a tenth embodiment of an ablation device
utilizing voltage threshold principles. The tenth embodiment
includes a housing 912 having a sealed distal end containing argon.
Ablation electrodes 932a-c are positioned on the exterior of the
housing 912. An internal electrode 22 is disposed in the sealed
distal end. Positioned between the internal electrode 922 and the
electrodes 932a-c is a conductive grid 933.
[0096] When electrode 922 is energized, there will be no conduction
from electrode 922 to electrodes 932a-c until the potential between
electrode 922 and the body tissue/fluid in contact with electrodes
932a-c reaches an initiating threshold voltage at which the argon
gas will form a conductive plasma. The exact initiating threshold
voltage is dependent on the argon pressure, its flowrate (if it is
circulating within the device), and the distance between electrode
922 and the tissue/body fluid in contact with the ablation
electrodes 932a-c.
[0097] Because the RF generator voltage output varies sinusoidally
with time, there are phases along the RF generator output cycle at
which the RF generator voltage will drop below the voltage
threshold. However, once the plasma has been ignited, the presence
of energized plasma ions in the argon will maintain conduction even
after the potential between electrode 922 and the body fluid/tissue
has been fallen below the initiating threshold voltage. In other
words, there is a threshold sustaining voltage that is below the
initiating threshold voltage, but that will sustain plasma
conduction.
[0098] In the embodiment of FIG. 14A, the grid 933 is spaced from
the electrodes 932a-c by a distance at which the corresponding
plasma ignition threshold is a suitable ablation voltage for the
application to which the ablation device is to be used. Moreover,
the electrode 922 is positioned such that once the plasma is
ignited, grid 933 may be deactivated and electrode 922 will
continue to maintain a potential equal to or above the sustaining
voltage for the plasma. Thus, during use, both grid 933 and
electrode 922 are initially activated for plasma formation. Once
the potential between grid 933 and body tissue/fluid reaches the
threshold voltage and the plasma ignites, grid 933 will be
deactivated. Because ions are present in the plasma at this point,
conduction will continue at the sustaining threshold voltage
provided by electrode 922.
[0099] The ability of ionized gas molecules in the argon to sustain
conduction even after the potential applied to the internal
electrode has fallen below the initiating threshold voltage can be
undesirable. As discussed, an important aspect of voltage threshold
ablation is that it allows for high voltage/low current ablation.
Using the embodiments described herein, a voltage considered
desirable for the application is selected as the threshold voltage.
Because the ablation electrodes are prevented from conducting when
the voltage delivered by the RF generator is below the threshold
voltage, there is no conduction to the ablation electrode during
the rise time from 0V to the voltage threshold. Thus, there is no
resistive heating of the tissue during the period in which the RF
generator voltage is rising towards the threshold voltage.
[0100] Under ideal circumstances, conduction would discontinue
during the periods in which the RF generator voltage is below the
threshold. However, since ionized gas remains in the argon
reservoir, conduction can continue at voltages below the threshold
voltage. Referring to FIG. 4A, this results in the sloping trailing
edge of the ablation voltage waveform, which approximates the
trailing portion of the sinusoidal waveform produced by the RF
generator (FIG. 3). This low-voltage conduction to the tissue
causes resistive heating of the tissue when only high voltage
ablation is desired.
[0101] The grid embodiment of FIG. 14A may be used to counter the
effect of continued conduction so as to minimize collateral damage
resulting from tissue heating. During use of the grid embodiment,
the trailing edge of the ablation voltage waveform is straightened
by reversing the polarity of grid electrode 933 after the RF
generator has reached its peak voltage. This results in formation
of a reverse field within the argon, which prevents the plasma flow
of ions within the argon gas and that thus greatly reduces
conduction. This steepens the slop of the trailing edge of the
ablation potential waveform, causing a more rapid drop towards 0V,
such that it approximates the waveform shown in FIG. 4B.
[0102] FIGS. 15A and 15B show an eleventh embodiment utilizing
principles of the present invention. As with the tenth embodiment,
the eleventh embodiment is advantageous in that it utilizes a
mechanism for steepening the trailing edge of the ablation
waveform, thus minimizing conduction during periods when the
voltage is below the threshold voltage. In the eleventh embodiment,
this is accomplished by circulating the argon gas through the
device so as to continuously flush a portion of the ionized gas
molecules away from the ablation electrodes.
[0103] The eleventh embodiment includes a housing 1012 having an
ablation electrodes 1032. An internal electrode 1022 is positioned
within the housing 1012 and is preferably formed of conductive
hypotube having insulation 1033 formed over all but the distal-most
region. A fluid lumen 1035 is formed in the hypotube and provides
the conduit through which argon flows into the distal region of
housing 1012. Flowing argon exits the housing through the lumen in
the housing 1012, as indicated by arrows in FIG. 15A. A pump 1031
drives the argon flow through the housing.
[0104] It should be noted that different gases will have different
threshold voltages when used under identical conditions. Thus,
during use of the present invention the user may select a gas for
the spark gap switch that will have a desired threshold voltage. A
single type of gas (e.g. argon) may be circulated through the
system, or a plurality of gases from sources 1033a-c may be mixed
by a mixer pump 1031a as shown in FIG. 15C, for circulation through
the system and through the spark gap switch 1035. Mixing of gases
is desirable in that it allows a gas mixture to be created that has
a threshold voltage corresponding to the desired treatment voltage.
In all of the systems using circulated gas, gas leaving the system
may be recycled through, and/or exhausted from, the system after it
makes a pass through the spark gap switch.
[0105] FIGS. 16A through 16D schematically illustrate the effect of
circulating the argon gas through the device of FIG. 15A.
Circulation preferably is carried out at a rate of approximately
0.1 liters/minute to 0.8 liters/minute.
[0106] Referring to FIG. 16A, during initial activation of the RF
generator, the potential between internal electrode 1022 and
ablation electrode 1032 is insufficient to create an argon plasma.
Argon molecules are thus non-ionized, and the voltage measured at
the load L is 0V. There is no conduction from electrode 1022 to
electrode 1032 at this time.
[0107] FIG. 16B shows the load voltage measured from internal
electrode 1022 across the body fluid/tissue to return electrode
1030. Once the RF generator voltage output reaches voltage
threshold V.sub.T of the argon, argon molecules are ionized to
create a plasma. A stream of the ionized molecules flows from
electrode 1022 to electrode 1032 and current is conducted from
electrode 1032 to the tissue. Because the argon is flowing, some of
the ionized molecules are carried away. Nevertheless, because of
the high voltage, the population of ionized molecules is increasing
at this point, and more than compensates for those that flow away,
causing an expanding plasma within the device.
[0108] After the RF generator voltage falls below V.sub.T, ion
generation stops. Ionized molecules within the argon pool flow away
as the argon is circulated, and others of the ions die off. Thus,
the plasma begins collapsing and conduction to the ablation
electrodes decreases and eventually stops. See FIGS. 16C and 16D.
The process then repeats as the RF generator voltage approaches
(-V.sub.T) during the negative phase of its sinusoidal cycle.
[0109] Circulating the argon minimizes the number of ionized
molecules that remain in the space between electrode 1022 and
electrode 1032. If a high population of ionized molecules remained
in this region of the device, their presence would result in
conduction throughout the cycle, and the voltage at the
tissue/fluid load L would eventually resemble the sinusoidal output
of the RF generator. This continuous conduction at low voltages
would result in collateral heating of the tissue.
[0110] Naturally, the speed with which ionized molecules are
carried away increases with increased argon flow rate. For this
reason, there will be more straightening of the trailing edge of
the ablation waveform with higher argon flow rates than with lower
argon flow rates. This is illustrated graphically in FIG. 17. The
upper waveform shows the RF generator output voltage. The center
waveform is the voltage output measured across the load (i.e. from
the external electrode 1032 across the body tissue/fluid to the
return electrode 1030) for a device in which the argon gas is
slowly circulated. The lower waveform is the voltage output
measured across the load for a device in which the argon gas is
rapidly circulated. It is evident from the FIG. 17 graphs that the
sloped trailing edge of the ablation waveform remains when the
argon is circulated at a relatively low flow rate, whereas the
trailing edge falls off more steeply when a relatively high flow
rate is utilized. This steep trailing edge corresponds to minimized
current conduction during low voltage phases. Flow rates that
achieve the maximum benefit of straightening the trailing edge of
the waveform are preferable. It should be noted that flow rates
that are too high can interfere with conduction by flushing too
many ionized molecules away during phases of the cycle when the
output is at the threshold voltage. Optimal flow rates will depend
on other physical characteristics of the device, such as the spark
gap distance and electrode arrangement.
[0111] It should also be noted that the distance between internal
electrode 1022 and external electrode 1032 also has an effect on
the trailing edge of the ablation potential waveform. In the graphs
of FIG. 18, the RF generator output is shown in the upper graph.
V.sub.PRFG represents the peak voltage output of the RF generator,
V.sub.T1 represents the voltage threshold of a device having a
large separation distance (e.g. approximately 1 mm) between
electrodes 1022 and 1032, and V.sub.T2 represents the voltage
threshold of a device in which electrodes 1022, 1032 are closely
spaced--e.g. by a distance of approximately 0.1 mm. As previously
explained, there is a higher voltage threshold in a device with a
larger separation distance between the electrodes. This is because
there is a large population of argon molecules between the
electrodes 1022, 1032 that must be stripped of electrons before
plasma conduction will occur. Conversely, when the separation
distance between electrodes 1022 and 1032 is small, there is a
smaller population of argon molecules between them, and so less
energy is needed to ionize the molecules to create plasma
conduction.
[0112] When the RF generator output falls below the threshold
voltage, the molecules begin to deionize. When there are fewer
ionized molecules to begin with, as is the case in configurations
having a small electrode separation distance, the load voltage is
more sensitive to the deionization of molecules, and so the
trailing edge of the output waveform falls steeply during this
phase of the cycle.
[0113] For applications in which a low voltage threshold is
desirable, the device may be configured to have a small electrode
spacing (e.g. in the range of 0.001-5 mm, most preferably 0.05-0.5
mm) and non-circulating argon. As discussed, doing so can produce a
load output waveform having a steep rising edge and a steep falling
edge, both of which are desirable characteristics. If a higher
voltage threshold is needed, circulating the argon in a device with
close inter-electrode spacing will increase the voltage threshold
by increasing the pressure of the argon. This will yield a highly
dense population of charged ions during the phase of the cycle when
the RF generator voltage is above the threshold voltage, but the
high flow rate will quickly wash many ions away, causing a steep
decline in the output waveform during the phases of the cycle when
the RF generator voltage is below the threshold.
[0114] A twelfth embodiment of a system utilizing principles of the
present invention is shown schematically in FIG. 19. The twelfth
embodiment allows the threshold voltage to be adjusted by
permitting the spark gap spacing (i.e. the effective spacing
between the internal electrode and the ablation electrode) to be
selected. It utilizes a gas-filled spark gap switch 1135 having a
plurality of internal spark gap electrodes 1122a, 1122b, 1122c.
Each internal electrode is spaced from ablation electrode 1132 by a
different distance, D1, D2, D3, respectively. An adjustment switch
1125 allows the user to select which of the internal electrodes
1122a, 1122b, 1122c to utilize during a procedure. Since the
threshold voltage of a spark gap switch will vary with the distance
between the internal electrode and the contact electrode, the user
will select an internal electrode, which will set the spark gap
switch to have the desired threshold voltage. If a higher threshold
voltage is used, electrode 1122a will be utilized, so that the
larger spark gap spacing D1 will give a higher threshold voltage.
Conversely, the user will selected electrode 1122c, with the
smaller spark gap spacing, if a lower threshold voltage is
needed.
[0115] It is useful to mention that while the spark gap switch has
been primarily described as being positioned within the ablation
device, it should be noted that spark gap switches may be
positioned elsewhere within the system without departing with the
scope of the present invention. For example, referring to FIG. 19,
the spark gap switch 1135 may be configured such that the ablation
electrode 1132 disposed within the spark gap is the remote proximal
end of a conductive wire that is electrically coupled to the actual
patient contact portion of the ablation electrode positioned into
contact with body tissue. A spark gap switch of this type may be
located in the RF generator, in the handle of the ablation device,
or in the conductors extending between the RF generator and the
ablation device.
[0116] FIGS. 20-26 illustrate additional embodiments of a surgical
probe that utilizes voltage threshold means for controlling
ablative energy delivery to tissue at a targeted site. In general,
FIG. 20 depicts an exemplary probe 1200 with handle portion 1202
coupled to extension member 1204 that supports working end 1205.
The working end 1205 can have any suitable geometry and orientation
relative to axis 1208 and is shown as an axially-extending end for
convenience. A hand-held probe 1200 as in FIG. 20 can be used to
move or paint across tissue to ablate the tissue surface, whether
in an endoscopic treatment within a fluid as in arthroscopy, or in
a surface tissue treatment in air. In this embodiment, the exterior
sheath 1206 is an insulator material (FIG. 21) and the probe is
adapted to function in a mono-polar manner by cooperating with a
ground pad 1208 coupled to the targeted tissue TT (see FIGS. 20 and
21). The system also can operate in a bi-polar manner by which is
meant the working end itself carries a return electrode, as will be
illustrated in FIG. 26 below.
[0117] Referring to FIGS. 20 and 21, the working end 1205 comprises
a microporous ceramic body 1210 that cooperates with an interior
voltage threshold mechanism or spark gap switch as described above.
In one embodiment in FIG. 21, the ceramic body 1210 has interior
chamber 1215 that receives a flowable, ionizable gas that flows
from a pressurized gas source 1220 and is extracted by a negative
pressure source 1225. In this embodiment, it can be seen that gas
flows through interior lumen 1228 in conductive sleeve 1230. The
gas is then extracted through concentric lumen 1235 that
communicates with negative pressure source 1225 as indicated by the
gas flow arrows F in FIG. 21. Any suitable spacer elements 1236
(phantom view) can support the conductive sleeve 1230 within the
probe body to maintain the arrangement of components to provide the
gas inflow and outflow pathways. As can be seen in FIG. 21, the
conductive sleeve 1230 is coupled by electrical lead 1238 to
electrical source 1240 to allow its function and as electrode
component with the distal termination 1241 of sleeve 1230 on one
side of a spark gap indicated at SG.
[0118] The interior surface 1242 of ceramic body 1210 carries an
interior electrode 1244A at the interior of the microporous
ceramic. As can be seen in enlarged cut-away view of FIG. 22, the
ceramic has a microporous working surface 1245 wherein a micropore
network 1248 extends through the thickness TH of the ceramic body
surface overlying the interior electrode 1244A. The sectional view
of FIG. 21 illustrates the pore network 1248 extending from working
surface 1245 to the interior electrode 1244A. The function of the
pore network 1248 is to provide a generally defined volume or
dimension of a gas within a plurality of pores or pathways between
interior electrode 1244A and the targeted tissue site TT. Of
particular importance, the cross-sectional dimensions of the pores
is selected to insure that the pores remain free of fluid ingress
in normal operating pressures of an underwater surgery (e.g.,
arthroscopy) or even moisture ingress in other surgeries in a
normal air environment. It has been found that the mean pore
cross-section of less than about 10 microns provides a suitable
working surface 1245 for tissue ablation; and more preferably a
mean pore cross-section of less than about 5 microns. Still more
preferably, the mean pore cross-section is less than about 1
micron. In any event, the microporous ceramic allows for electrical
energy coupling across and through the pore network 1248 between
the interior electrode 1244A and the targeted tissue site TT, but
at the same time the microporous ceramic is impervious to liquid
migration therein under pressures of a normal operating
environment. This liquid-impervious property insures that
electrical energy will ablatively arc through the pore network 1248
rather than coupling with water or moisture within the pore network
during operation.
[0119] In FIG. 21, it also can be seen that working surface 1245 is
defined as a limited surface region of the ceramic that is
microporous. The working end 1205 has a ceramic glaze 1250 that
covers the exterior of the ceramic body except for the active
working surface 1245. Referring now to FIG. 22, the thickness TH of
the microporous ceramic body also is important for controlling the
ablative energy-tissue interaction. The thickness TH of the ceramic
working surface can range from as little as about 5 microns to as
much as about 1000 microns. More preferably, the thickness TH is
from about 50 microns to 500 microns.
[0120] The microporous ceramic body 1210 of FIGS. 20-22 can be
fabricated of any suitable ceramic in which the fabrication process
can produce a hard ceramic with structural integrity that has
substantially uniform dimension, interconnected pores extending
about a network of the body--with the mean pore dimensions
described above. Many types of microporous ceramics have been
developed for gas filtering industry and the fabrication processed
can be the same for the ceramic body of the invention. It has been
found that a ceramic of about 90%-98% alumina that is fired for an
appropriate time and temperature can produce the pore network 1248
and working surface thickness TH required for the ceramic body to
practice the method the invention. Ceramic micromolding techniques
can be used to fabricate the net shape ceramic body as depicted in
FIG. 21.
[0121] In FIGS. 21 and 22, it can be understood how the spark gap
SG (not-to-scale) between conductor sleeve 1230 and the interior
electrode 1244A can function to provide cycle-to-cycle control of
voltage applied to the electrode 1244A and thus to the targeted
treatment site to ablate tissue. As can be understood in FIG. 22, a
gas flow F of a gas (e.g., argon) flows through the interior of the
ceramic body to flush ionized gases therefrom to insure that
voltage threshold mechanism functions optimally, as described
above.
[0122] FIG. 23 illustrates another embodiment of working end that
included multiple conductor sleeves portions 1230 and 1230' that
are spaced apart by insulator 1252 and define different gap
dimensions from distal surface 1241 and 1241' to interior electrode
1244A. It can be understood that the multiple conductor sleeves
portions 1230 and 1230', that can range from 2 to 5 or more, can be
selected by controller 1255 to allow a change in the selected
dimension of the spark gap indicated at SG and SG'. The dimension
of the spark gap will change the voltage threshold to thereby
change the parameter of ablative energy applied to the targeted
tissue, which can be understood from the above detailed
description.
[0123] FIG. 24 illustrates a greatly enlarged cut-away view of an
alternative microporous ceramic body 1210 wherein the interior
electrode 1244B also is microporous to cooperate with the
microporous ceramic body 1210 in optimizing electrical energy
application across and through the pore network 1248. In this
embodiment, the spark gap again is indicated at SG and defines the
dimension between distal termination 1241 of conductor sleeve 1230
and the electrode 1244B. The porous electrode 1244B can be any thin
film with ordered or random porosities fabricated therein and then
bonded or adhered to ceramic body 1210. The porous electrode also
can be a porous metal that is known in the art. Alternatively, the
porous electrode 1224B can be vapor deposited on the porous surface
of the ceramic body. Still another alternative that falls within
the scope of the invention is a ceramic-metal composite material
that can be formed to cooperate with the microporous ceramic body
1210.
[0124] FIG. 24 again illustrates that a gas flow indicated by
arrows F will flush ionized gases from the interior of the ceramic
body 1210. At the same time, however, the pores 1258 in electrode
1244B allow a gas flow indicated at F' to propagate through pore
network 1248 in the ceramic body to exit the working surface 1245.
This gas flow F' thus can continuously flush the ionized gases from
the pore network 1248 to insure that arc-like electrical energy
will be applied to tissue from interior electrode 1244B through the
pore network 1248--rather than having electrical energy coupled to
tissue through ionized gases captured and still resident in the
pore network from a previous cycle of energy application. It can be
understood that the percentage of total gas flow F that cycles
through interior chamber 1215 and the percentage of gas flow GF'
that exits through the pore network 1248 can be optimized by
adjusting (i) the dimensions of pores 1258 in electrode 1244B; (ii)
the mean pore dimension in the ceramic body 1210, the thickness of
the ceramic working surface and mean pore length, (iv) inflow gas
pressure; and (v) extraction pressure of the negative pressure
source. A particular probe for a particular application thus will
be designed, in part by modeling and experimentation, to determine
the optimal pressures and geometries to deliver the desired
ablative energy parameters through the working surface 1245. This
optimization process is directed to provide flushing of ionized gas
from the spark gap at the interior chamber 1215 of the probe, as
well as to provide flushing of the micropore network 1248. In this
embodiment, the micropore network 1248 can be considered to
function as a secondary spark gap to apply energy from electrode
1224B to the targeted tissue site TT.
[0125] In another embodiment depicted in FIG. 25, it should be
appreciated that the spark gap interior chamber 1215' also can be
further interior of the microporous ceramic working surface 1245.
For example, FIG. 25 illustrates a microprobe working end 1260
wherein it may be impractical to circulate gas to a
needle-dimension probe tip 1262. In this case, the interior chamber
1215' can be located more proximally in a larger cross-section
portion of the probe. The working end of FIG. 25 is similar to that
of FIG. 21 in that gas flows F are not used to flush ionized gases
from the pore network 1248.
[0126] FIG. 26 illustrates another embodiment of probe 1270 that
has the same components as in FIGS. 22 and 24 for causing
electrical energy delivery through an open pore network 1248 in a
substantially thin microporous ceramic body 1210. In addition, the
probe 1270 carries a return electrode 1275 at an exterior of the
working end for providing a probe that functions in a manner
generally described as a bi-polar energy delivery. In other words,
the interior electrode 1244A or 1244B comprises a first polarity
electrode (indicated at (+)) and the return electrode 1275
(indicated at (-)) about the exterior of the working end comprises
a second polarity electrode. This differs from the embodiment of
FIG. 21, for example, wherein the second polarity electrode is a
ground pad indicated at 1208. The bi-polar probe 1270 that utilizes
voltage threshold energy delivery through a microporous ceramic is
useful for surgeries in a liquid environment, as in arthroscopy. It
should be appreciated that the return electrode 1275 can be located
in any location, or a plurality of locations, about the exterior of
the working end and fall within the scope of the invention.
[0127] The probe 1270 of FIG. 26 further illustrates another
feature that provided enhanced safety for surgical probe that
utilizes voltage threshold energy delivery. The probe has a
secondary or safety spark gap 1277 in a more proximal location
spaced apart a selected dimension SD from the interior spark gap
indicated at SG. The secondary spark gap 1277 also defines a
selected dimension between the first and second polarity electrodes
1230 and 1275. As can be seen in FIG. 26, the secondary spark gap
1277 consists of an aperture in the ceramic body 1210 or other
insulator that is disposed between the opposing polarity
electrodes. In the event that the primary spark gap SG in the
interior chamber 1215 is not functioning optimally during use, any
extraordinary current flows can jump the secondary spark gap 1277
to complete the circuit. The dimension across the secondary spark
gap 1277 is selected to insure that during normal operations, the
secondary spark gap 1277 maintains a passive role without energy
jumping through the gap.
[0128] Several embodiments of voltage threshold ablation systems,
and methods of using them, have been described herein. It should be
understood that these embodiments are described only by way of
example and are not intended to limit the scope of the present
invention. Modifications to these embodiments may be made without
departing from the scope of the present invention, and features and
steps described in connection with some of the embodiments may be
combined with features described in others of the embodiments.
Moreover, while the embodiments discuss the use of the devices and
methods for tissue ablation, it should be appreciated that other
electrosurgical procedures such as cutting and coagulation may be
performed using the disclosed devices and methods. It is intended
that the scope of the invention is to be construed by the language
of the appended claims, rather than by the details of the disclosed
embodiments.
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