1988results about "Surgical instruments for irrigation of substances" patented technology

A working end of a surgical instrument that carries first and second jaws for delivering energy to tissue. In a preferred embodiment, at least one jaw of the working end defines a tissue-engagement plane that contacts the targeted tissue. The cross-section of the engagement plane reveals that it defines (i) a first surface conductive portion or a variably resistive matrix of a temperature-sensitive resistive material or a pressure-sensitive resistive material, and (ii) a second surface portion coupled to a fixed resistive material that coupled in series or parallel to a voltage source together with the first portion. In use, the engagement plane will apply active Rf energy to ohmically heat the captured tissue until the point in time that a controller senses an electrical parameter of the tissue such as impedance. Thereafter, the controller switches energy delivery to the second surface portion that is resistively heated to thereby apply energy to tissue by conductive heat transfer.

Surgical devices, systems and methods for treating tissue are provided. An exemplary surgical device comprises a tip portion including first and second jaws each having a tissue grasping surface, at least one of the jaws being movable toward the other jaw. The tissue grasping surface of each jaw has includes an electrically insulative surface. The device also includes first and second electrodes connectable to different terminals of an RF generator to generate electrical current flow therebetween, with each of the electrodes having an electrode surface. One of the electrode surfaces is located on one of the jaws separated from one edge of the tissue grasping surface, and the other of the electrode surfaces is located on one or the other of the jaws separated from the other edge of the tissue grasping surface. The device also includes at least one fluid passage being connectable to a fluid source.

An embodiment of the invention provides a method for detecting and treating a tumor using tissue localized volumetric impedance measurement. The method includes providing an impedance measurement apparatus having a plurality of resilient members deployable with curvature and configured to sample tissue impedance through a plurality of conductive pathways. The apparatus is configured to be coupled to at least one of an energy delivery device, a power supply, a switching device or logic resources. The apparatus is then positioned at a selected tissue site and the impedance array deployed to define a sample volume. The impedance array is then utilized to make impedance measurements through a plurality of conductive pathways. Information from the impedance measurements is then utilized to determine a tissue condition of the sample volume. Energy is then delivered from the energy delivery device to ablate or necrose at least a portion of the tumor.

A method and apparatus for carrying our thermal ablation of target tissue is disclosed. The apparatus includes an RF ablation device having a multi-electrode electrode assembly designed to be deployed in target tissue, defining a selected-volume tissue region to be ablated, and having infusion channels for infusing a liquid into the target tissue during the ablation process. A control unit in the apparatus is operably connected to an RF energy source, for controlling the RF power level supplied to the electrodes, and to an infusion device, for controlling the rate of infusion of a liquid through the device into the tissue. During both electrode deployment and tissue ablation, impedance and or temperature measurements made within the tissue are used to control the RF source and infusion device, for optimizing the time and extent of tissue ablation.

An electrosurgical system comprises a radio frequency generator (1), an electrosurgical instrument (E1), and a fluid enclosure (42). The generator (1) has a radio frequency output for delivery of power to the electrosurgical instrument (E1) when immersed in an electrically-conductive fluid. The electrosurgical instrument (E1) has an electrode assembly (32) at the distal end thereof, the electrode assembly comprising a tissue treatment electrode (34), and a return electrode (38) axially spaced therefrom in such a manner as to define, in use, a conductive fluid path that completes an electrical circuit between the tissue treatment electrode and the return electrode. The fluid enclosure (42) is adapted to surround an operation site on the skin of a patient or an incision leading to a cavity surgically created within the patient's body. The fluid enclosure (42) includes sealing means (44) for sealing against the patient's tissue, and the fluid enclosure includes at least one port (50a, 52a) through which the electrosurgical (E1) is insertable, and through which the electrically-conductive fluid can enter and / or leave the enclosure.

An electrosurgical system comprises a radio frequency generator (1), an electrosurgical instrument (E1), and a fluid enclosure (42). The generator (1) has a radio frequency output for delivery of power to the electrosurgical instrument (E1) when immersed in an electrically-conductive fluid. The electrosurgical instrument (E1) has an electrode assembly (32) at the distal end thereof, the electrode assembly comprising a tissue treatment electrode (34), and a return electrode (38) axially spaced therefrom in such a manner as to define, in use, a conductive fluid path that completes an electrical circuit between the tissue treatment electrode and the return electrode. The fluid enclosure (42) is adapted to surround an operation site on the skin of a patient or an incision leading to a cavity surgically created within the patient's body. The fluid enclosure (42) includes sealing means (44) for sealing against the patient's tissue, and the fluid enclosure includes at least one port (50a, 52a) through which the electrosurgical (E1) is insertable, and through which the electrically-conductive fluid can enter and / or leave the enclosure. The fluid enclosure device of the present invention can also be used to treat tumours within the colon. The enclosure, which includes a proximal and a distal bung, is inserted into the colon in a deflated condition and then inflated with a conductive fluid or gas. The colon can be supported against the pressure of the fluid or gas with a pressure sleeve that has been inserted to surround the region of the colon being treated. An electrosurgical instrument is then inserted into the colon and manipulated to vaporize the tumor.

A system and method are disclosed for removing a uterus using a fluid enclosure inserted in the peritoneal cavity of a patient so as to enclose the uterus. The fluid enclosure includes a distal open end surrounded by an adjustable loop, that can be tightened, a first proximal opening for inserting an electrosurgical instrument into the fluid enclosure, and a second proximal opening for inserting an endoscope. The loop is either a resilient band extending around the edge of the distal open end or a drawstring type of arrangement that can be tightened and released. The fluid enclosure is partially inserted into the peritoneal cavity of a patient in a deflated condition and then manipulated within the peritoneal cavity over the body and fundus of the uterus to the level of the uterocervical junction. The loop is tightened around the uterocervical junction, after which the enclosure is inflated using a conductive fluid. The loop forms a pressure seal against the uterocervical junction to contain the conductive fluid used to fill the fluid enclosure. Endoscopically inserted into the fluid enclosure is an electrosurgical instrument that is manipulated to vaporize and morcellate the fundus and body of the uterus. The fundus and body tissue that is vaporized and morcellated is then removed from the fluid enclosure through the shaft of the instrument, which includes a hollow interior that is connected to a suction pump The fundus and body are removed after the uterus has been disconnected from the tissue surrounding uterus.

A method is disclosed for treating benign conditions, such as enlarged tonsils and / or adenoids located in a patient's throat or nasopharynx, or soft tissue lesions located in a patient's oropharynx or larynx. According to the method, a space containing the patient's nasopharynx, oropharynx or pharynx and larynx is isolated from the patient's trachea and lungs using an inflatable cuff tracheostomy tube or nasotracheal tube inserted in the patient's trachea. The cuff is inflated to occlude the trachea. The patient is placed in a supine position, whereupon at least a portion of the space containing the nasopharynx and / or oropharynx and larynx is filled with saline. An endoscope is then inserted into the space to view the operative site in which the tonsils or tissue lesion are to be treated. An electrosurgical instrument having an active tissue treatment electrode and a return electrode connected to an electrosurgical generator is then inserted into the space, either along side the endoscope or through the endoscope's working channel. The generator is then operated to apply a radio frequency voltage between the active and return electrodes of the electrosurgical instrument, whereby a conduction path is formed between the active and return electrodes, at least partially through the saline, whereupon the active electrode is manipulated to debulk or otherwise treat the soft tissue lesion or enlarged tonsils and / or adenoids.

A method and apparatus for carrying our thermal ablation of target tissue is disclosed. The apparatus includes an RF ablation device having a multi-electrode electrode assembly designed to be deployed in target tissue, defining a selected-volume tissue region to be ablated, and having infusion channels for infusing a liquid into the target tissue during the ablation process. A control unit in the apparatus is operably connected to an RF energy source, for controlling the RF power level supplied to the electrodes, and to an infusion device, for controlling the rate of infusion of a liquid through the device into the tissue. During both electrode deployment and tissue ablation, impedance and or temperature measurements made within the tissue are used to control the RF source and infusion device, for optimizing the time and extent of tissue ablation.

An embodiment of the invention provides a tissue biopsy and treatment apparatus that comprises an elongated delivery device that is positionable in tissue and includes a lumen. A sensor array having a plurality of resilient members is deployable from the elongated delivery device. At least one of the plurality of resilient members is positionable in the elongated delivery device in a compacted state and deployable with curvature into tissue from the elongated delivery device in a deployed state. At least one of the plurality of resilient members includes at least one of a sensor, a tissue piercing distal end or a lumen. The sensor array has a geometric configuration adapted to volumetrically sample tissue at a tissue site to differentiate or identify tissue at the target tissue site. At least one energy delivery device is coupled to one of the sensor array, at least one of the plurality of resilient members or the elongated delivery device.

Using the linear forces that are provided by an electromagnetic solenoid applied near the distal end of a medical catheter, various surgical instruments can be actuated or deployed for use in interventional medicine. The linear actuator uses the principles of magnetic repulsion and attraction as a means for moving a bobbin that can be attached to various types of moving components that translate linear movements into the actuation of a tool that is attached to the linear actuator. Using independent solenoid coils, movement modality is increased from two possible positions to three.

Method for carrying out the recovery of an intact volume of tissue wherein a delivery cannula tip is positioned in confronting adjacency with the volume of tissue to be recovered. The electrosurgical generator employed to form an arc at a capture component extending from the tip is configured having a resistance-power profile which permits recovery of the specimen without excessive thermal artifact while providing sufficient power to sustain a cutting arc. For the recovery procedure, a local anesthetic employing a diluent which exhibits a higher resistivity is utilized and the method for deploying the capture component involves an intermittent formation of a cutting arc with capture component actuation interspersed with pauses of duration effective to evacuate any accumulation or pockets of local anesthetic solution encountered by the cutting electrodes.

Method for carrying out the recovery of an intact volume of tissue wherein a delivery cannula tip is positioned in confronting adjacency with the volume of tissue to be recovered. The electrosurgical generator employed to form an arc at a capture component extending from the tip is configured having a resistance-power profile which permits recovery of the specimen without excessive thermal artifact while providing sufficient power to sustain a cutting arc. For the recovery procedure, a local anesthetic employing a diluent which exhibits a higher resistivity is utilized and the method for deploying the capture component involves an intermittent formation of a cutting arc with capture component actuation interspersed with pauses of duration effective to evacuate any accumulation or pockets of local anesthetic solution encountered by the cutting electrodes.

An ablation apparatus including a maneuvering mechanism, a conductive element attached to the apparatus, a sensor attached to the apparatus and an output device in communication with the sensor is provided. The sensor senses vibration during the ablation procedure and sends a signal to the output device to reduce power to the conductive element.

Tissue modification devices are provided. Aspects of the devices include an elongated member having a proximal end and a distal end. The distal end of the elongated member is dimensioned to pass through a minimally invasive body opening and includes a distal end integrated visualization sensor and tissue modifier. In some instances, the devices further include an integrated articulation mechanism that imparts steerability to at least one of the visualization sensor, the tissue modifier and the distal end of the elongated member. Also provided are methods of modifying internal target tissue of a subject using the tissue modification devices.

Medical devices, methods and systems for treating tissue are provided. An exemplary system comprises a fluid from a fluid from a fluid source at a fluid flow rate, a surgical device which provides power and the fluid to the tissue and a control mechanism which changes a fluid flow rate provided from the surgical device and changes a power level provided from the surgical device. The fluid flow rate changes between at least two-zero flow rates and the power level changes between at least two non-zero levels. An exemplary method comprises providing a fluid from a fluid source at a fluid flow rate, providing a surgical device which provides power and the fluid to the tissue, and changing the fluid flow rate of fluid provided from the surgical device with a change in power level provided from the surgical device.

A medical treatment device to treat and join body tissues, includes at least a pair of holding members which is configured to hold the body tissues to be treated, an energy output portion provided in at least one of the pair of holding members and connected to an energy source to form a joined portion by supplying energy to the body tissues held by the pair of holding members to join the body tissues, and a discharge portion which is configured to discharge a substance to cover a surface layer of the joined portion of the body tissues with the substance which prevents infiltration of a fluid into the joined portion after the joined portion is formed.

The present invention provides systems, apparatus, and methods for dissecting, resecting, severing, cutting, contracting, coagulating, or otherwise modifying a tissue or organ of a patient. An apparatus of the invention includes an electrosurgical probe configurable between an open configuration and a closed configuration, the probe including an active electrode terminal, a fixed return electrode disposed proximal to the active electrode terminal, and a movable return electrode configured to move linearly with respect to the active electrode terminal between the open configuration and the closed configuration. A method of the present invention comprises clamping a blood vessel between the active electrode terminal and the movable return electrode, coagulating the clamped blood vessel by application of a first high frequency voltage, and severing the coagulated blood vessel by application of a second high frequency voltage.

The present invention provides an apparatus and a method for producing a virtual electrode within or upon a tissue to be treated with radio frequency alternating electric current, such tissues including but not limited to liver, lung, cardiac, prostate, breast, and vascular tissues and neoplasms. An apparatus in accord with the present invention includes a supply of a conductive or electrolytic fluid to be provided to the patient, an alternating current generator, and a processor for creating, maintaining, and controlling the ablation process by the interstitial or surficial delivery of the fluid to a tissue and the delivery of electric power to the tissue via the virtual electrode. A method in accord with the present invention includes delivering a conductive fluid to a predetermined tissue ablation site for a predetermined time period, applying a predetermined power level of radio frequency current to the tissue, monitoring at least one of several parameters, and adjusting either the applied power and / or the fluid flow in response to the measured parameters.

Apparatus and methods for treating an intervertebral disc by ablation of disc tissue. A method of the invention includes positioning at least one active electrode within the intervertebral disc, and applying at least a first high frequency voltage between the active electrode(s) and one or more return electrode(s), wherein the volume of the nucleus pulposus is decreased, pressure exerted by the nucleus pulposus on the annulus fibrosus is reduced, and discogenic pain of a patient is alleviated. In other embodiments, a curved or steerable probe is guided to a specific target site within a disc to be treated, and the disc tissue at the target site is ablated by application of at least a first high frequency voltage between the active electrode(s) and one or more return electrode(s). A method of making an electrosurgical probe is also disclosed.

According to the present invention, a catheter having at least one multi-purpose lumen formed through the catheter terminates proximal a relatively complex-shaped distal portion thereof. In one form of this embodiment, the relatively complex-shaped distal portion comprises a looped portion having diagnostic- and / or ablation-type electrodes coupled thereto and an elongated diameter-adjusting member coupled proximal the distal end of the looped portion. The multi-purpose lumen may be used to alternately accommodate a variety of dedicated materials; such as, (i) a guide wire for initial deployment or later repositioning of the catheter, (ii) a volume or flow of a contrast media and the like, (iii) a deployable hollow needle or tube and the like used to biopsy adjacent tissue or dispense a therapeutic agent into a volume of tissue, and (iv) a cooling fluid, such as saline solution and the like dispensed at least during therapeutic tissue ablation procedures.

Apparatus and methods for treating an intervertebral disc by ablation of disc tissue. A method of the invention includes positioning at least one active electrode within the intervertebral disc, and applying at least a first high frequency voltage between the active electrode(s) and one or more return electrode(s), wherein the volume of the nucleus pulposus is decreased, pressure exerted by the nucleus pulposus on the annulus fibrosus is reduced, and discogenic pain of a patient is alleviated. In other embodiments, a curved or steerable probe is guided to a specific target site within a disc to be treated, and the disc tissue at the target site is ablated by application of at least a first high frequency voltage between the active electrode(s) and one or more return electrode(s). A method of making an electrosurgical probe is also disclosed.

A method for treating obstructive sleep disorders includes accessing the interior of the tongue through an incision made in the skin in the vicinity of the jaw of a patient; advancing an instrument through the incision into the interior of the tongue; and removing an amount of tissue from the interior of the base of the tongue with the instrument. The present invention includes forming a cavity or plurality of channels in the tongue. The cavity may be collapsed using a suture, fastener or bioadhesive. An emplaced suture may be provided to hold the cavity in a collapsed position thereby reducing the degree of obstruction. Additionally, thermal energy may be applied to the tissue surface immediately surrounding the channels to cause thermal damage to the tissue surface, thereby creating hemostasis and stiffening the surrounding tissue structure.

Apparatus and methods for reducing nerve stimulation in electrosurgical instruments utilizing electrically isolated pairs of electrodes are disclosed. At least two pairs of electrodes may be configured to create at least two opposing currents which effectively cancel one another such that a net current flow is inhibited from developing within surrounding tissue structures to mitigate or eliminate undesired electrical stimulation of the tissue.

A system and method for creating lesions and assessing their completeness or transmurality. Assessment of transmurality of a lesion is accomplished by monitoring the impedance of the tissue to be ablated. Rather than attempting to detect a desired drop or a desired increase impedance, completeness of a lesion is detected in response to the measured impedance remaining at a stable level for a desired period of time, referred to as an impedance plateau. The mechanism for determining transmurality of lesions adjacent individual electrodes or pairs may be used to deactivate individual electrodes or electrode pairs, when the lesions in tissue adjacent these individual electrodes or electrode pairs are complete, to create an essentially uniform lesion along the line of electrodes or electrode pairs, regardless of differences in tissue thickness adjacent the individual electrodes or electrode pairs.

Disclosed herein is a new arthroscopic probe with a concave distal tip which simultaneously constrains and cuts tissue. It is particularly adapted to cutting ligaments and tendons. Also disclosed is a thermal energy delivery apparatus which includes (a) a probe means with a distal end and a proximal end, wherein the distal end has a concave tip; (b) a first electrode means positioned at the distal end of the probe means, wherein the first electrode means is configured to deliver sufficient thermal energy to cut ligaments or tendons; and (c) a cabling means coupled to the proximal end of the probe means. In another embodiment of the invention a controller for controlling the delivery of energy and liquid to a surgical instrument with a temperature sensor is disclosed. The energy is supplied by an energy source and the liquid is supplied by a pump. The controller includes a temperature and a flow regulator. The temperature regulator is coupled to the energy source and coupled to the pump. The temperature regulator is responsive to a first temperature indication from the temperature sensor to determine that the first temperature indication exceeds a setpoint and to reduce an energy level from the energy source. The flow regulator is coupled to the pump and coupled to the temperature regulator. The flow regulator includes responsiveness to the first temperature indication to increase a flow of the liquid from the pump.

A catheter adapted for mapping and ablating epicardial tissue from the pericardial cavity includes a catheter body and an electrode assembly that has a tip section and a loop member lying generally within a plane, wherein the tip section includes an ablation electrode exposed on one side of the loop member and an insulation member exposed on an opposite side of the loop member. The catheter also includes a intermediate section between the catheter body and the electrode assembly, wherein the intermediate deflects the loop member and the tip section bi-directionally within the same plane. So arranged, the catheter can be safely maneuvered in the pericardial sac and swept in a side to side motion over the epicardium with the ablation electrode reliably facing and making contact with the epicardium. The tip section can include a balloon that is inflatable to push away surrounding pericardial tissue. The catheter may further include an injection needle whose distal end can extend outside of the tip section to puncture epicardial tissue. A lumen in the injection needle allows for delivery to agents directly to the punctured tissue and thermocouple wires can be carried in the lumen for temperature sensing at the treatment site.

An excisional biopsy system includes a tubular member that has a proximal end and a distal end in which one or more windows are defined. A first removable probe has a proximal portion that includes a cutting tool extender and a distal portion that includes a cutting tool. The first removable probe may be configured to fit at least partially within the tubular member to enable the cutting tool to selectively bow out of and to retract within one of the windows when the cutting tool extender is activated. A second removable probe has a proximal section that includes a tissue collection device extender and a distal section that includes a tissue collection device. The second removable probe may also be configured to fit at least partially within the tubular member to enable the tissue collection device to extend out of and to retract within one of the windows when the tissue collection device extender is activated. A third removable probe may also be provided. The third removable probe may also be configured to fit at least partially within the tubular member and may include an imaging device, such as an ultrasound transducer, mounted therein. By selectively activating the cutting tool and the tissue collection device while rotating the excisional device, a tissue specimen may be cut from the surrounding tissue and collected for later analysis.

An end effector assembly for use with an instrument for sealing vessels and cutting vessels includes a pair of opposing first and second jaw members which are movable relative to one another from a first spaced apart position to a second position for grasping tissue therebetween. Each jaw member includes an electrically conductive tissue contacting surface connected to an electrosurgical energy source. At least one of the jaw members includes an electrically conductive cutting element disposed within an insulator defined in the jaw member. At least one channel is included in the insulator which is configured to deliver fluid between the jaw members.

A surgical cutting and tissue vaporizing instrument, also referred to as an electrosurgical instrument, is in the form of a scalpel or scissors. The scalpel has a handle portion and a blade portion mounted on the handle portion. The blade portion has a smaller front section which acts as an active electrode, a larger rear section which acts as a return electrode, and an insulating middle section separating the two electrodes. A plurality of ports and conduits are formed in the blade portion, with the conduits extending through the handle portion, so that saline may be supplied to the handle and blade portions and out of the ports to the targeted area for tissue transection, and so that excess saline may be drawn by suction through other ports formed on the blade portion. The scissors include two cross-pivotally joined blades, each having a tip portion functioning as either an active electrode or as a return electrode. Ports and conduits are formed in each blade to elute saline onto the targeted area for tissue transection and to remove by suction excess saline from the targeted area.