Fluid delivery systems and treatments

Abstract

A treatment system includes a liquid cooling supply system for cooling a liquid coolant and delivering the liquid coolant to a patient. The liquid cooling supply system includes a cooling device and a heat exchanger device. The heat exchanger device is biased to the cooling device and is in fluid communication with a treatment device within the patient. The liquid cooling supply system includes at least one biasing mechanism to provide a given biasing force between the heat exchanger device and the cooling device to enable and improve heat transfer. The liquid coolant can be circulated to an energy delivery device positioned in the patient's respiratory tract to preserve tissue. A control system is configured to circulate the liquid coolant at a given temperature and pressure for a given amount of time during pulmonary treatment of the patient.

Description

[0001] Related applications

[0002] This application claims the benefit of U.S. Provisional Application No. 61 / 779,371, filed March 13, 2013, which is incorporated herein by reference in its entirety. Technical Field

[0003] The present invention generally relates to systems and related methods for delivering cooled fluids during patient treatment. Background Art

[0004] Several conventional medical treatments involve supplying cooled liquids directly to the human body. For example, cooled liquids can be supplied to the bloodstream to cool organs, such as the brain, thereby protecting the organs from damage.

[0005] Other conventional medical treatments include devices that use a cooled liquid supply to treat the human body. For example, several methods for effectively treating lung diseases are disclosed in the following patents: U.S. Patent No. 8,088,127, entitled "Systems, Components, and Methods for Treating the Bronchial Tree," and U.S. Publication No. 2011 / 0152855, entitled "Delivery Device with Coolable Energy-Emitting Component." In one exemplary treatment described in these documents, a lung treatment system delivers energy to damage nerve trunks extending along a patient's respiratory tract. In this embodiment, energy is delivered to the coolable energy-emitting component, and simultaneously, cooled liquid is delivered to the energy-emitting component to cool the energy-emitting component, thereby avoiding or limiting damage to non-target tissue.

[0006] Conventional coolant supply systems typically include a pump that pumps liquid coolant from a reservoir to the patient and / or treatment device. Depending on the type of treatment being performed, conventional liquid coolant supply systems may include a larger reservoir holding as much as five gallons of liquid coolant, from which the liquid coolant is supplied to the thermal therapy catheter. In most cases, the liquid coolant contained in the large reservoir is simply maintained at room temperature. Other conventional liquid coolant supply systems utilize closed-loop systems, where liquid is drawn from the reservoir, circulated through the device within the patient, and then returned to the reservoir. Summary of the Invention

[0007] It has been recognized that delivering liquid coolant to a treatment site within a patient's body during treatment can present challenges for the operator. For example, it may be necessary to maintain a desired temperature at the treatment site within the patient's body for a desired period during treatment. This is due, in part, to potential heat losses from the time the liquid is cooled to the time it is delivered to the patient for treatment of the tissue.

[0008] It has been recognized that conventional liquid coolant supply systems fail to provide a sufficiently compact and efficient closed-loop system to allow for control of the temperature and pressure of liquid coolant provided to a therapeutic device positioned within a patient. Furthermore, conventional liquid coolant supply systems can be expensive and, in some cases, can require thorough and time-consuming sterilization between patient treatments. However, it has been recognized that conventional liquid coolant supply systems may not be ideal for use during certain treatments, such as the pulmonary treatments described above, due to requirements related to the size of the insertion device, the temperature at the treatment site, the duration of treatment, the controllability of the system, and other requirements that may be specific to certain patient treatments.

[0009] According to one aspect of the present disclosure, a treatment system includes a liquid cooling supply system for treating a patient, and is configured to cool a liquid and circulate the cooled liquid through a treatment device, such as an energy delivery device, disposed within the patient's body. The liquid cooling supply system may include (or be coupled to) a liquid reservoir containing a liquid or coolant. The liquid cooling supply system may include a cooling device having a thermally insulating plate for thermally treating the liquid. A heat exchanger may be removably coupled to the cooling device with a given biasing force to enable heat transfer from or through the liquid in the heat exchanger. The heat exchanger may be a replaceable or disposable heat exchanger cartridge comprising a heat-conducting surface and a flow channel extending through the cartridge. At least a portion of the flow channel in the cartridge is disposed adjacent to the heat-conducting surface. During thermal treatment of the liquid by the cooling device, the flow channel allows the liquid to pass through. Thus, when the cartridge is coupled to the cooling device, the heat-conducting surface and the thermally insulating plate are biased toward each other, allowing the cooling device to operate to extract heat from the liquid contained in the flow channel of the cartridge. The cooled liquid may then be provided to the patient for treatment.

[0010] In one aspect, the heat exchange cartridge is a flexible and preferably disposable thermoformed tray that is bonded to a plate having a heat conductive surface. The flexible thermoformed tray includes a recessed, circuitous structure that defines a flow channel when the tray is bonded to the plate. A first end of the channel includes an inlet port for coupling to an inlet supply line, and a second end of the channel includes an outlet port for coupling to an outlet supply line. The depth and width of the recessed, circuitous structure are determined based on a desired residence time of the liquid exiting the cartridge, which is calculated based on the liquid flow rate and a desired temperature change of the liquid from the cartridge inlet to the outlet.

[0011] In other aspects, the heat exchanger is a bag removably coupled to a cooling device with a given biasing force to achieve heat transfer from a liquid contained in or passing through the bag. The bag can be removably coupled to the cooling device via a plate so that the bag is positioned between the cooling device and the plate, or the bag can be attached via other attachment means. A common feature of achieving appropriate heat transfer to achieve a desired liquid temperature is ensuring that a given biasing force of the heat exchanger is applied to the cooling device. Thus, the bag can be biased to the cooling device by a clip, a plate with a fastener, or other such means. The bag can include a flow channel extending through the bag and winding throughout the bag. At least a portion of the bag is positioned adjacent to the cooling device and biased relative to the cooling device so that operation of the cooling device extracts heat from the liquid contained in the flow channel of the bag. The cooled liquid can then be provided to the patient for treatment.

[0012] The liquid cooling supply system may also include a pump for supplying the amount of liquid to the patient and / or circulating the amount of liquid. At least one controller may be coupled to the cooling device and the pump for regulating the amount of heat transfer provided to the patient as well as the pumping volume and pressure. The liquid cooling supply system may also include a supply path and a return path, which may include a series of lines or tubes or liquid channels. The supply path originates from a liquid reservoir, where the liquid passes through a heat exchanger cartridge for cooling the liquid, and then passes to a therapeutic device within the patient for cooling at the treatment point. The return path originates from the therapeutic device within the patient, and then the return path may pass back to the liquid reservoir for continuous circulation of the liquid through the system. Thus, the liquid reservoir, the supply and return tubes, the flow path of the cartridge, and the therapeutic device are all in fluid communication with each other. Thus, the cooling device cools the liquid that is circulated throughout the system by the pump during patient treatment.

[0013] As can be understood in any aspect of the present disclosure, the liquid cooling supply system can be a closed-loop system or an open-loop system. In a closed-loop system, liquid is continuously supplied from a liquid reservoir for recirculation and is continuously returned to the liquid reservoir. In an open-loop system, liquid is supplied from a liquid reservoir to a treatment device and then discarded after circulating through the treatment device.

[0014] For certain components of the liquid cooling supply system described above and according to certain aspects, the liquid reservoir can be a bag or other device capable of holding a liquid. In a closed-loop system, the liquid reservoir can be a collapsible bag (e.g., an IV bag used to hold and deliver saline or other liquids) having a supply port for providing the liquid and a return port for receiving the liquid once it has been circulated through the system. The use of a collapsible bag can advantageously accommodate changes in liquid pressure caused by pumping liquid from the liquid reservoir through the system, regardless of whether the pump is in forward or reverse mode.

[0015] In certain aspects, the liquid reservoir can be fluidically connected to the closed-loop system via a coaxial bag-nail assembly. The coaxial double-nail can include a hypotube that is inserted into and passes through the lumen of the female Luer interface, thereby defining a coaxial arrangement of an internal channel and an external channel. The assembly can also include a bag-nail adapter having two ports for connecting the liquid supply line and the liquid return line to the internal channel and the external channel of the assembly. For example, the internal channel is in fluid communication with the return line, and the external channel is in fluid communication with the supply line. In an alternative embodiment, the external channel is in fluid communication with the return line, and the internal channel is in fluid communication with the supply line. Therefore, by allowing liquid to flow out of and into the liquid reservoir simultaneously, the coaxial bag-nail assembly avoids the need for separate supply and return nails. This also allows standard commercially available IV bags to be used as coolant reservoirs.

[0016] The cooling device can be any suitable cooling device, such as a thermoelectric cooler (hereinafter "TEC"), which has a thermal plate for efficiently transferring heat from a liquid when a heat exchanger is coupled to the thermal plate. TECs are commonly used to cool medications and control the amount of heat transferred from a material or liquid, as is well known in the art. TECs use the Peltier effect (or thermoelectric effect) to create a heat flow between the junction of two different types of materials. Thus, a typical TEC includes a "hot plate" and a "cold plate" having a plurality of p-type and n-type semiconductors sandwiched between the plates. When a voltage is applied across the semiconductors, the TEC transfers heat from the cold plate to the hot plate, and the heat from the hot plate is dissipated, for example, via a heat sink and fan. Therefore, the cooling device described herein is preferably a TEC having a hot (cold) plate offset relative to a heat exchanger cartridge to remove heat from the liquid contained in the cartridge. It should be understood that other cooling devices or systems can be used to cool the liquid to achieve the same result, such as a refrigeration system or other cooling system coupled to or including a heat exchanger.

[0017] The pump is configured to supply and circulate the cooled liquid through the therapeutic device. The pump can also be configured to regulate the amount and pressure of the liquid passing through the system. In some aspects, the pump is a peristaltic pump coupled near the cooling device and the cartridge. A peristaltic pump has the ability to draw and push liquid through a tube without contacting the liquid to maintain its sterility. In one embodiment, the pump is positioned in the supply path between the heat exchanger cartridge and the patient (or downstream of the cartridge), so that the pump draws liquid through the cartridge under negative pressure and supplies the cooled liquid to the therapeutic device under positive pressure. Placing the pump downstream of the cartridge in this manner offers several advantages. For example, the negative pressure generated in the cartridge allows for greater material flexibility and greater cartridge design options. Smaller or thinner components can be used for the cartridge, resulting in greater heat transfer from the liquid during system operation. In some aspects, the positive pressure provided to the energy delivery device is at least 80 psi, and the liquid returns from the therapeutic device to the liquid reservoir and / or cartridge at a pressure equal to or less than 10 psi, but the pressure in the system can vary beyond this value based on the requirements of the system and the patient.

[0018] In certain aspects, the pump is configured to circulate the liquid through the system at a liquid flow rate of between 100 ml and 160 ml per minute, although the flow rate can vary beyond this range. Preferably, the flow rate is 100 ml per minute. In certain aspects, the pump is configured to supply the cooled liquid to the therapeutic device at a pressure of between 25 psi and 150 psi, although the flow rate can vary beyond this range. Preferably, the pressure is between 80 psi and 100 psi.

[0019] In certain aspects, the pump includes a forward gear and a reverse gear. The reverse gear is adapted to reverse the flow of liquid through the system to remove gas from the system before or during patient treatment. Removing gas or bubbles from the system allows for a continuous supply of liquid during treatment and maximizes cooling of the liquid in the cartridge. The cartridge can also be arranged substantially vertically relative to a horizontal plane and include an inlet port disposed at an upper portion of the cartridge and an outlet port disposed at a lower portion of the cartridge. With this arrangement, reversing the direction of the pump drives the liquid back through the system, thereby removing gas from the cartridge's flow path. In particular, gas rises vertically through the cartridge and ultimately enters a liquid reservoir for discharge. The pump can then engage its forward gear to supply cooled liquid during patient treatment. Even during normal forward operation of the pump, gas that may be present in the cartridge may tend to rise upward due to the specific arrangement and configuration of the cartridge.

[0020] In certain aspects, the flow channel includes at least one corner portion near a transition between a first sidewall and a second sidewall of the flow channel. The at least one corner portion is configured such that bubbles are not trapped near or adjacent to the at least one corner portion during operation of the system. The corner portion can have a radius or chamfer at the transition between the first and second sidewalls of the channel. Additionally, the flow channel can have a cross-sectional profile having rounded corners at upper and lower corners of the cross-sectional profile. These features that reduce the vertically oriented cross-sectional area of the flow channel can help overcome surface tension forces of bubbles that might otherwise become trapped in the corners due to the vertical orientation of the barrel.

[0021] In one aspect, a heat exchanger cartridge comprises a first plate and a second plate coupled to each other. The first plate comprises a heat-conducting surface that can be made of copper, aluminum, and / or stainless steel. The heat-conducting surface is preferably made of copper, more preferably of a plated or anodized metal such as anodized aluminum or silver-plated copper. The second plate comprises a thermally insulating material, such as a polymer or plastic, and includes a circuitous groove that defines at least a portion of the flow channel. The circuitous groove can have a generally flat profile relative to the insulating plate to maximize heat transfer from the liquid. The cartridge can include an input port coupled to a liquid reservoir for supplying liquid and an output port coupled to a therapeutic device for supplying cooled liquid. Thus, the input port and the output port are in fluid communication with the flow channel and the therapeutic device. In certain aspects, the cartridge includes a variable volume reservoir contained within the cartridge so that liquid is drawn only from the variable volume reservoir, rather than from any other source. In this aspect, the liquid can then be discarded after circulating through the therapeutic device (open-loop system), or the liquid can be returned to the inlet of the variable volume reservoir (closed-loop system). In certain aspects, the return flow passage extends through a portion of the cartridge, with at least a portion of the return flow passage disposed adjacent the thermally conductive surface so that liquid in the return flow passage is pre-cooled before returning to the liquid reservoir for recirculation.

[0022] In one aspect, the liquid cooling supply system may include at least one biasing mechanism to provide a sufficient and given biasing force between the barrel and the cooling device. The biasing mechanism may be at least one magnet configured to removably couple the barrel to the cooling device. The at least one magnet may be magnetically coupled to at least one corresponding magnet near the thermal insulation plate of the cooling device, or may be magnetically coupled to a magnetic attraction element of the cooling device. The at least one biasing mechanism may include two pairs of magnets, the two pairs of magnets being arranged on opposite ends of the barrel, and each pair of magnets being coupled to a corresponding pair of magnets near the thermal insulation plate. The corresponding pairs of magnets may be fastened to a biasing frame coupled to the thermal insulation plate of the cooling device. The biasing frame may extend around the periphery of the thermal insulation plate. The corresponding pairs of magnets of the biasing frame are aligned with the pair of magnets of the barrel and may be attracted to the pair of magnets of the barrel to provide a given biasing force to bias the barrel to the thermal insulation plate. The result of utilizing naturally occurring devices and mechanisms is that most or all of the surface area of the heat conductive surface of the cartridge is biased relative to most or all of the surface area of the insulating plate of the cooling device at a given biasing force to effectively and efficiently transfer heat from the liquid during cooling of the liquid.

[0023] In several aspects of the present disclosure, a cooling system includes features for biasing a cartridge toward a cooling device with sufficient and defined force to achieve and improve heat transfer from a liquid. Significantly, the achievable TEC is limited by the amount of heat that can be dissipated through the TEC; thus, in some applications, the desired heat transfer from the liquid can be somewhat limited. Furthermore, TECs are known to be somewhat less efficient than other cooling devices, so it is important to mitigate system efficiency in other aspects, such as the design of the cartridge and the configuration of other components within the system, such as the pump arrangement. Furthermore, sufficient biasing force between the thermally conductive surface of the cartridge and the insulating plate of the cooling device is crucial due to the nature of the materials used to offset the surfaces. The thermally conductive surface can be copper, while the insulating plate is typically a ceramic substrate. Microscopically, even the smoothest copper and ceramic surfaces exhibit numerous ridges and valleys, which can affect thermal conductivity between the two materials if sufficient biasing force is not applied and maintained during heat transfer. Therefore, the present disclosure provides effective devices and various mechanisms for adequately biasing the cartridge toward the cooling device to increase surface-to-surface contact between the offset surfaces, thereby effectively cooling the liquid during patient treatment. This improved surface contact ultimately reduces heat loss in the system, allowing for a constant and controllable liquid temperature to be provided to the therapeutic device within the patient. This is particularly important when operating the cooling system during pulmonary treatment, where constant liquid temperature and constant liquid pressure are required at certain intervals for a specific duration during the treatment session.

[0024] In one aspect, the barrel can be formed and provided in a prestressed configuration to improve heat transfer and reduce heat loss. Thus, the barrel can be manufactured into a first state (prestressed) when detached from the cooling device, and a second state when attached to the cooling device. The first state is achieved by forming the barrel to have a convex profile relative to the cooling device's insulation board, so that the barrel's side arc extends from the left side of the barrel to the right side of the barrel. Therefore, when the barrel is attached to the insulation board by virtue of the convex shape and the force of the magnets (i.e., by utilizing a pair of magnets on the left and right sides of the barrel), the barrel's heat-conducting surface will have a generally flat profile relative to the insulation board because the magnets on the sides of the barrel will tend to "flatten" the barrel's profile. This prestressed configuration tends to prevent the barrel from being subjected to slight "buckling," resulting in the concave barrel not being fully or adequately biased toward the cooling device. Therefore, the prestressed configuration of the barrel provides greater surface-to-surface contact between the heat-conducting surface and the insulation board, resulting in improved heat transfer while reducing heat loss in the system. This is particularly important when operating the cooling system during patient treatment, as this particular lung treatment requires the patient to be kept out of the treatment session at certain intervals for specific periods of time.

[0025] A method is provided for attaching or removing a heat exchanger cartridge to or from a cooling system used for patient treatment. In certain aspects, the method includes biasing a heat exchanger cartridge, such as a cartridge and cooling device having the same or similar features as those discussed in this disclosure, against a thermal insulation plate of a cooling device. The method includes removing the heat exchanger cartridge from the cooling device, which may be performed after treatment or a course of treatment for one or more patients. The method includes biasing a replacement heat exchanger cartridge against the thermal insulation plate of the cooling device. The step of biasing the cartridge may include engaging a magnet or other biasing mechanism so that a given biasing force is applied to the cartridge to achieve efficient heat transfer from the liquid. In a preferred configuration, the given biasing force is at least 10 pounds of force, and between 10 and 60 pounds of force, but the given biasing force may exceed this value and range. The given biasing force provided by the magnet allows the heat-conducting surface of the cartridge to be biased against the thermal insulation plate of the cooling device. Due to this configuration of the magnet, biasing the cartridge against the cooling device occurs automatically, so that the cartridge is positioned at approximately the same location on the cooling device with each replacement cartridge. This provides a system advantage of maintaining consistency in the position of each replaceable cartridge coupled to the cooling device, thereby providing consistency in the efficiency of cooling the liquid in the cartridge through repeated use of the system and replacement of the cartridge. The method may also include pumping the liquid through the heat exchanger cartridge to deliver the liquid to the patient before removing the heat exchanger cartridge from the cooling device. The method also includes supplying the cooled liquid to a treatment device (e.g., an energy delivery device) located near the patient's lung tissue during pulmonary treatment.

[0026] On the other hand, the liquid cooling supply system can include a cooling device with a heat preservation plate for cooling liquid, a disposable heat exchanger cartridge removably coupled to the heat preservation plate, and at least one biasing mechanism coupled to the cartridge and the cooling device to transfer heat from the liquid contained in the cartridge. The cartridge can include a first plate and a second plate coupled to each other, wherein the first plate includes a heat-conducting surface, such as copper, aluminum and / or stainless steel, and the second plate includes a thermal insulation material, such as polymer, ABS, nylon or polycarbonate. The second plate can include a circuitous groove that limits a flow channel, similar to the cartridge discussed with reference to magnetically attractable cartridges. In one configuration, the cartridge includes an upper inclined surface and a corresponding lower inclined surface that will be received in the front plate for being biased to the cooling device. The cartridge can include a handle at the end of the cartridge for easily removing and replacing the cartridge. The back side of the second plate can include a plurality of recesses for improving the heat transfer of the liquid via the cooling device.

[0027] The barrel can include a liquid reservoir for supplying liquid through the system; the liquid reservoir can be entirely contained in the barrel or can be coupled to an outer portion of the barrel. Therefore, the second plate includes a liquid reservoir that is connected to the flow channel fluid and is arranged at the upper portion of the barrel. In this regard, the liquid reservoir can be a collapsible bag arranged in a cavity in the second plate. The liquid is provided to the treatment device from the liquid reservoir and can be returned to the liquid reservoir in a closed-loop system or discarded as waste in an open-loop system. Providing a liquid reservoir inside the barrel itself provides the advantage of reducing the number of components and the steps of creating and operating the system because it reduces the risk of human error caused by incorrect installation and use of non-sterile components, so the sterility of the liquid can be ensured. It also provides the advantage of cooling the liquid in the reservoir by a cooling device during operation, as opposed to providing room temperature liquid from an external liquid reservoir.

[0028] At least one biasing mechanism can be a cam system having a first position for engaging the tube to the cooling device and a second position for disengaging the tube from the cooling device. As discussed in the present disclosure, providing a biasing mechanism (such as this cam system) provides an effective way to fully bias the heat-conducting surface of the tube relative to the cooling device insulation board insulation board by sufficient and given force, thereby increasing the surface-to-surface contact between the tube and the cooling device. In some aspects, the front plate is coupled to the front portion of the housing containing the cooling device. The cam system, the front plate and the tube operate together to bias the tube to the insulation board. The front plate includes an opening to receive the insulation board of the cooling device and facilitate biasing the tube to the insulation board. The front plate can have a slot sized to slidably receive the tube. The slot of the front plate includes an upper biasing surface and a lower biasing surface. Each of the upper biasing surface and the lower biasing surface is not parallel to the insulation board and can correspond to the upper inclined surface and the lower inclined surface of the tube. Therefore, the slot can have a trapezoidal cross-sectional profile that corresponds to the trapezoidal cross-sectional profile of the tube. Thus, when the cam system is disengaged (or unlocked), the cartridge can be slidably received in the slot of the front plate. Once the cartridge is disposed in the slot, the cam system can be engaged to apply a given biasing force to the cartridge relative to the cooling device, thereby achieving cooling of the liquid during system operation.

[0029] In some configurations, the cam system includes a cam rod, a camshaft having at least one cam lobe, an actuating member coupled to the barrel, and at least one actuating device coupled to the actuating member and coupleable to the cam lobe. The cam rod is directly attached to the camshaft or dynamically associated with the camshaft. In some configurations, the four cam lobes are formed along the length of the camshaft and are spatially separated from each other, but the four cam lobes can be a single cam lobe or cam device. Corresponding to the positions of the four cam lobes can be four actuating devices, coupled to the actuating member, and arranged near the corresponding cam lobes. When the camshaft is rotated by moving the cam rod from a disengaged state to an engaged state, the four actuating devices are actuated downwardly by the corresponding cam lobes. The actuating member has a lower actuating surface, which can be formed to be at a certain angle, and the certain angle can correspond to the angle of the upper inclined surface of the barrel. Thus, engaging the cam system will bias the lower actuating surface to the upper inclined surface of the barrel, which will tend to apply a slightly downward and inward force to the barrel toward the cooling device because, when the cam system is engaged, the trapezoidal shape profile of the slot and barrel and the angle of the lower actuating surface together tend to bias the barrel in the lateral direction relative to the cooling device by a given biasing force.

[0030] A method is provided for providing a replaceable heat exchanger cartridge to a cooling device using a cam system. The method may include biasing the cartridge toward the cooling device by actuating the cam system to an engaged state. The method may include actuating the cam system to a disengaged state to release the biasing force on the cartridge. The method may include removing the cartridge and replacing it with a replacement cartridge, which may be biased toward the cooling device by the cam system during patient treatment.

[0031] In another aspect, at least one biasing mechanism can be a hinged door hingedly coupled to the cooling device and biased toward a closed position, thereby clamping the cartridge between the hinged door and the cooling surface of the cooling device. In this embodiment, one or more magnets can be used on opposing surfaces of the door and / or the cooling device to provide sufficient force to increase surface-to-surface contact between the cartridge and the cooling device. In one aspect, the cartridge can be configured with one or more notches defined on at least one side of the cartridge for alignment with one or more keys of the cooling device to ensure that the cartridge is inserted in the proper operating orientation.

[0032] According to certain aspects of the present disclosure, a method of cooling liquid for patient treatment is provided. The method may include drawing coolant through a heat exchanger at negative pressure to cool the coolant. The method may also include positioning a treatment device inside the patient's bronchus and supplying coolant to the treatment device to transfer heat from the patient during treatment. The method may include supplying coolant from a reservoir in a closed loop system and returning the liquid to the reservoir. Alternatively, the method may include supplying coolant from a reservoir in an open loop system and discarding the liquid after transferring heat from the patient to the liquid. The method may include supplying the liquid to the treatment device in a positive pressure. The method may include regulating the amount of heat transferred from the coolant by a controller coupled to the cooling device, and regulating the volume of liquid provided for patient treatment by a controller coupled to a pump.

[0033] According to certain aspects of the present disclosure, a method for cooling liquid for use in treating a patient is provided. The method may include positioning a heat exchanger relative to a cooling device. The heat exchanger may include some or all of the features of the cartridge discussed in the present disclosure. The method may include positioning the heat exchanger in a generally vertical orientation so that gas rises in the heat exchanger. The method may include positioning a pump on a downstream side of the heat exchanger and pumping liquid through the heat exchanger in a reverse manner to substantially remove gas from the heat exchanger and the system. The method may also include some or all of the steps discussed in the present disclosure for providing cooled liquid to the patient.

[0034] In certain aspects according to the present disclosure, a system for treating a patient is provided. The system may include a liquid cooling supply configured to draw liquid through a heat exchanger under negative pressure to cool the liquid and deliver the cooled liquid to the patient under positive pressure. The liquid cooling supply may include some or all of the features discussed in this disclosure, such as a cooling device, a pump, a controller, a housing, and a front plate. Similarly, the heat exchanger may include some or all of the features of the cartridge discussed in this disclosure. The system may include an energy delivery device disposed within the patient and coupled to the liquid cooling supply, such that the liquid cooling supply circulates cooled liquid through the energy delivery device to cool the energy delivery device during treatment of the patient. The energy delivery device may include electrodes adapted to deliver energy to target tissue of the patient. The energy delivery device may include a cooling member disposed proximate to the electrodes. The cooling member may be configured to circulate liquid from the liquid cooling supply. The electrodes and cooling member are disposed proximate to the patient's airway wall such that energy delivered to the electrodes and circulation of the cooled liquid through the cooling member damage neural tissue, thereby weakening neural signals within the patient while preserving the tissue. The system can include a pump downstream of the cooling device and configured to circulate the fluid under positive pressure through the energy delivery device. The method can also include some or all of the steps discussed in this disclosure for providing cooled fluid to the patient.

[0035] In certain aspects of the present disclosure, the temperature of the liquid supplied by the liquid cooling supply system (or by any other system and method described herein) can be provided at a given temperature or range at the location of the energy delivery device or other therapeutic device. Preferably, the temperature at the energy delivery device is maintained at or below 20°C during patient treatment. In a preferred configuration, the temperature at the energy delivery device is maintained between 20°C and -5°C during patient treatment. In a more preferred configuration, the temperature at the energy delivery device is maintained between 5°C and -2°C during patient treatment. However, the temperature can vary beyond this range based on the system and patient requirements. In certain aspects, the liquid is provided to the patient at a given temperature for a selected amount of time during the treatment portion of the patient's treatment or for the entire duration of the patient's treatment. In certain configurations, the selected amount of time for a particular treatment portion is up to 120 seconds to provide the liquid at the given temperature. In certain configurations, the selected amount of time for a particular treatment portion is less than 60 seconds. In certain configurations, the selected amount of time for a particular treatment portion is between 60 seconds and 120 seconds to provide the liquid at the given temperature. In some configurations, the amount of time selected by the physician for a particular treatment portion is at least 120 seconds to provide the fluid at a given temperature. However, the selected amount of time may vary beyond this value and range based on the system and patient requirements. In some configurations, the fluid contained within the heat exchanger cartridge may be cooled to a temperature of at least 20°C upon exiting the cartridge, and more preferably, the fluid is cooled to a temperature between 5°C and -5°C upon exiting the cartridge, although the temperature of the fluid within the cartridge may vary beyond this value or range.

[0036] In certain aspects, a method of treating a patient is provided. The method may include providing a cooling device having a liquid heat exchanger to deliver liquid to the patient, such as the cooling device and heat exchanger cartridge discussed in the present disclosure. The method may include positioning a resection assembly of the delivery device within the patient's airway so that the resection assembly is positioned against a wall of the airway. The resection assembly may include electrodes suitable for delivering energy. The method may include coupling the liquid heat exchanger to the resection assembly so that the two are in fluid communication with each other. The method may include providing a cooling device to cool liquid in the liquid heat exchanger and treating tissue by circulating the liquid from the liquid heat exchanger through the delivery device. The method may include simultaneously delivering energy from the electrodes of the resection assembly to the treated tissue near the patient's airway. Thus, the method may include damaging neural tissue of a nerve trunk near the airway, thereby attenuating nervous system signals transmitted to a portion of the bronchial tree. As discussed in the present disclosure, the liquid may be drawn through the liquid heat exchanger under negative pressure and provided to the delivery device under positive pressure. During treatment, the liquid in the heat exchanger is cooled at a given temperature by the cooling device and provided to (or circulated through) the delivery device at the given temperature and for a selected amount of time, as discussed in this disclosure.

[0037] As will be understood by one of ordinary skill in the art upon reading this disclosure in detail, methods and systems relating to liquid cooling supply systems and heat exchanger cartridges may be combined into various aspects while still achieving the result of circulating cooled liquid through a therapeutic device disposed within a patient during patient treatment, as discussed herein. BRIEF DESCRIPTION OF THE DRAWINGS

[0038] Figure 1 is a perspective view of a treatment system having a liquid cooling delivery system according to one aspect.

[0039] Figure 2 is a partially exploded view of a liquid cooling delivery system according to one aspect.

[0040] Figure 3 is a schematic diagram of a liquid cooling delivery system coupled to a patient.

[0041] Figure 4 is a front view of a liquid cooling delivery system and a schematic diagram of a treatment system during a treatment session according to one aspect.

[0042] Figure 5 is a schematic diagram of a liquid cooling delivery system coupled to an energy delivery device positioned within a patient during a treatment session according to one aspect.

[0043] Figure 5A It is along Figure 5 The line 5A-5A gives Figure 5 Cross-sectional view of the supply lumen and return lumen of a treatment device.

[0044] Figure 6A is a perspective view of a heat exchanger cartridge according to one aspect.

[0045] Figure 6B is an exploded view of a heat exchanger according to one aspect.

[0046] Figure 6C is an exploded view of a heat exchanger according to one aspect.

[0047] Figure 6D Is along the side view Figure 6A The line 6D-6D is obtained Figure 6A Cross-sectional side view of a heat exchanger.

[0048] Figure 6E yes Figure 6D A cutaway view of a portion of a heat exchanger.

[0049] Figure 7A is a side view of a heat exchanger according to one aspect, showing a cartridge in a first state disengaged from a cooling device.

[0050] Figure 7B yes Figure 7A FIG. 1 is a side view of a heat exchanger of FIG. 1 , showing the heat exchanger in a second state and coupled to a cooling device.

[0051] Figure 8 is a perspective view of a liquid cooling delivery system during a treatment session according to one aspect.

[0052] Figure 9 is a partially exploded view of a liquid cooling delivery system according to one aspect.

[0053] Figure 10 is a schematic diagram of a liquid cooling delivery system during a treatment session according to one aspect.

[0054] Figure 11A is a rear perspective view of a portion of a liquid cooling delivery system according to one aspect, showing the cam system disengaged and the heat exchanger removed.

[0055] Figure 11B yes Figure 11A Rear perspective view showing the cam system engaged and the heat exchanger installed.

[0056] Figure 12A According to one aspect Figure 11A Side view of the front plate.

[0057] Figure 12B It is along Figure 11B The line 12B-12B gives Figure 11BA side cross-sectional view of a portion of a liquid cooling delivery system.

[0058] Figure 13A yes Figure 11A A perspective view of a heat exchanger cartridge.

[0059] Figure 13B yes Figure 11A A perspective view of the interior of a heat exchanger cartridge.

[0060] Figure 13C It is along Figure 13A The line 13C-13C is obtained Figure 13A Cross-sectional view of a heat exchanger.

[0061] Figure 14 is a perspective view of a treatment system having a liquid cooling delivery system according to one aspect.

[0062] Figure 15 is an elevational view of a liquid cooling delivery system and a schematic diagram of the treatment system during a treatment session according to one aspect.

[0063] Figure 16 is a partially exploded view of a liquid cooling delivery system according to one aspect.

[0064] Figure 17 is a rear perspective view of a hinged door assembly according to one aspect.

[0065] Figure 18 is a schematic diagram of a liquid cooling delivery system coupled to an energy delivery device positioned within a patient during a treatment session according to one aspect.

[0066] Figure 19A is a front perspective view of a heat exchanger cartridge according to one aspect.

[0067] Figure 19B is a rear perspective view of a heat exchanger cartridge according to one aspect.

[0068] Figure 20 is a rear perspective view of a coaxial double nail assembly according to one aspect. DETAILED DESCRIPTION

[0069] According to this disclosure, Figure 1-7B A first aspect of a treatment system having a liquid cooling supply system for treating a patient is shown, Figure 8-13C A second aspect of a treatment system having a liquid cooling supply system for treating a patient is shown, and Figure 14-20 A third aspect of a treatment system with a liquid cooling supply system for treating a patient is shown. It should be understood that the various configurations described with reference to the first and second aspects can be combined into further configurations and aspects, which will be discussed further in this disclosure with respect to specific configurations.

[0070] Figure 1 and 2 System 10 is shown including a liquid cooling supply system 12 coupled to a treatment system 17 . Figure 2 Show Figure 1 A partially exploded view of certain components of the liquid cooling supply system 12 is shown.

[0071] exist Figure 1 In an embodiment, the liquid cooling supply system 12 is coupled to a treatment system 17. The treatment system 17 can be at least partially disposed within the patient ( Figure 4 ). The liquid cooling supply system 12 is configured to cool liquid, pump liquid, and supply liquid through the treatment system 17. In a closed-loop system, the liquid cooling supply system 12 may include a liquid reservoir 22, liquid 24, a cooling system 26, a heat exchanger cartridge 28, and a supply line 14 and a return line 16 that work together to circulate the cooled liquid through the treatment system 17 during treatment. The supply line 14 originates at the liquid reservoir 22 and extends through the cartridge 28 and along the pump 30. The supply line 14 may extend through a pulsation dampener 37 for dampening vibrations of the supply line 14 during operation of the pump 30. Finally, the supply line 14 extends into the treatment system 17, which may be positioned in the patient. The return line 16, in fluid communication with the supply line 14, originates at the treatment system 17 and extends from the patient and back to the reservoir 22 for recirculating the liquid during treatment.

[0072] Figure 2 1 and 2. Further shown is an exploded view of portions of the cooling system 26. The cooling system 26 may include a housing 32, a cooling device 36, a heat exchanger cartridge 28, a controller 42, and a pump 30. The housing 32 includes a first portion 31, a second portion 33, and a front plate 34 coupled to the first portion 31. The first portion 31 and the second portion 33 of the housing 32 are removably attached to each other and are configured to structurally support and house various components of the system. The cooling device 36 has a thermal plate 38 that extends at least partially through the front plate 34. The front plate 34 is secured to a front region of the first portion 31 of the housing 32. The front plate 34 and the housing 32 cooperate to structurally support the cooling device 36 and to position the thermal plate 38 generally vertically. The front plate 34 includes an opening 34a for receiving the thermal plate 38 of the cooling device 36 and for facilitating biasing the cartridge 28 to the thermal plate 38 ( Figure 7B The housing 32 further includes a spacer 40 disposed between the cooling device 36 and the front plate 34 for additionally supporting the cooling device 36 and allowing the thermal insulation plate 38 to pass through the front plate 34 .

[0073] The cooling device 36 can be, for example, a conventional TEC including a thermal plate 38, an additional thermal plate 39, a heat sink 46, and a fan 48. The front portion 31 of the housing includes an opening 35 for receiving the cooling device 36 so that the thermal plate 38 extends out of the housing 32. A support plate 47 for the cooling device 36 can be fastened to the first portion 31 of the housing 32 to properly position the cooling device 36. The support plate 47 can also be fastened to the spacer 40 and the front plate 34 for additional structural support.

[0074] The spacer 40 is coupled between the front plate 34 and the cooling device 36. The spacer 40 includes an opening 40a to allow the thermal insulation board 38 to exit and be positioned adjacent to the opening 34a of the front plate 34. The spacer 40 extends around the periphery of the thermal insulation board 38 and the heating plate 39. Thus, the outer surface 49 of the spacer 40 and the planar surface 51 of the thermal insulation board 38 are substantially coplanar with each other ( Figure 7B ) so that the cylinder 28 can be biased to the insulation plate 38.

[0075] The heat exchanger cartridge 28 includes a first plate 41 and a second plate 43. The magnet 99 is disposed in the second plate 43 ( Figure 6A ). The spacer 40 includes four magnets 53 disposed at corresponding locations to engage the magnets 99 of the heat exchanger cartridge 28. Thus, the magnets 99 of the second plate 43 magnetically couple to the magnets 53 in the spacer 40 to removably couple the cartridge 28 to the thermal plate 38. Thus, the first plate 41 is biased to the planar surface 51 of the thermal plate 38 by a given biasing force to effect heat transfer to the liquid contained in the cartridge 28 ( Figures 6A-6C and 7B).

[0076] A controller board 55 can be secured to a front area of the first portion 31 of the housing 32. The controller board 55 can include an opening 57 for receiving the pump 30. The pump 30 can be a peristaltic pump having a cover 50 and a rotating device 59, which is coupled to the supply line 14, for example, via an available peristaltic pump. The liquid supply tube is placed in the pump in contact with the rotating device. Cam surfaces on the rotating device cause the liquid in the liquid supply line to be pressurized periodically. The pump 30 can include clamping mechanisms on its upstream and downstream sides to ensure that the liquid supply line is not pulled into the rotating device when the pump direction is reversed. In this embodiment, the pump 30 is disposed downstream of the barrel 28 so that during normal operation of the treatment system, the barrel 28 is subjected to negative liquid pressure and the treatment system 17 is subjected to positive liquid pressure.

[0077] Pulsation dampener 37 can be removably attached to controller board 55. Damper 37 can be, for example, a chamber with an inlet and an outlet. The chamber accumulates a large volume of liquid immediately downstream of the pump. The dampener acts similarly to a capacitor in a signal filtering device, smoothing out pressure oscillations generated by the pump's rotating mechanism.

[0078] The controller system 60 includes the controller 42 and a control device 62 for controlling the temperature, pressure, and velocity of the liquid. The control device 62 is disposed on the controller board 55 and is coupled to the controller 42. An operator can operate the control device 62 to control the system. The controller 42 can be operably coupled to the pump 30 to adjust the speed and direction of the pump 30, thereby adjusting the flow direction and volume of the liquid circulated through the system ( Figure 3 The controller 42 may also be operably coupled to the cooling device 36 for regulating the temperature of the fluid in the cartridge 28, thereby regulating the temperature of the fluid circulating through the treatment system 17, and thereby further regulating the temperature of the treatment device and / or patient tissue ( Figure 4 Performance can be optimized based on feedback from sensors (e.g., pressure sensors, temperature sensors, thermocouples, tactile sensors, etc.) that detect fluid and tissue temperature, tissue impedance, and the fluid supplied to the treatment device. Thus, if the surface temperature of the patient's tissue becomes too hot, fluid cooling can be increased via the cooling device 36 and / or electrode power can be reduced to produce deep lesions while protecting surface tissue.

[0079] Figure 3 FIG1 is a schematic diagram of a treatment system 101 according to one aspect of the present disclosure. Treatment system 101 includes a liquid cooling supply system 12 having a cooling system 26, a heat exchanger 28, and a liquid reservoir 22. Liquid cooling supply system 12 includes a cooling device 36, a controller 42, and a pump 30. Heat exchanger 28 is coupled to liquid reservoir 22, cooling device 36, and pump 30. A supply path 66 and a return path extend from liquid cooling supply system 12 and are coupled to treatment device 20, which may be positioned within patient 64. Supply path 66 originates at liquid reservoir 22, extends through heat exchanger 28, and then passes through pump 30 before extending into patient 64 and coupling to treatment device 20. Return path 68 originates at treatment device 20 and terminates at liquid reservoir 22 for recirculation of liquid through system 101. Alternatively, return path 68 may be coupled to waste reservoir 67 in an open-loop system.

[0080] In the embodiment shown, the pump 30 draws liquid from the liquid reservoir 22 and under negative pressure through the heat exchanger 28. As the liquid passes through the heat exchanger 28, it is cooled by the cooling device 36. The liquid is then provided to the treatment device 20 by the pump 30 via the supply path 66 under positive pressure. The liquid circulates through and returns from the treatment device 20. In some aspects, the heat exchanger 28 may include a liquid reservoir 22 ( Figure 6C ).

[0081] In this embodiment, the pump 30 includes a forward gear and a reverse gear, as shown by arrow P. The forward gear draws liquid from the liquid reservoir 22 and through the heat exchanger 28 to circulate the cooling liquid through the treatment device 20. Conversely, the reverse gear pushes the liquid back through the heat exchanger 28 to expel gas that may be present in portions of the system 101. In some aspects, the pump 30 is coupled to a controller for variably controlling the speed of the pump so as to control the amount of liquid delivered to the treatment device. Thus, the size of the treatment device and the parallel pressure can be controlled by the variable speed controller. Moreover, a contactless pressure measuring device can be electrically coupled to the pump and disposed near the high pressure side of the liquid path to regulate the system pressure, for example by varying the speed of the pump in response to the pressure measured by the contactless pressure measuring device.

[0082] In certain aspects, pump 30a is positioned downstream of treatment device 20 to draw fluid from treatment device 20. Thus, pump 30 and supplemental pump 30a act in concert to circulate cooling fluid through the system. Pump 30a can draw fluid from treatment device 20 at pressures up to 14 psi. Consequently, the pressure downstream of treatment device 20 can be lower, e.g., approximately 10-20 psi, while the pressure upstream of treatment device 20 can be higher, e.g., approximately 80-100 psi. Providing an additional pump downstream of the treatment device improves cooling of the treatment area in the patient because the flow rate through the treatment device is increased by simultaneously pushing fluid through one pump while another pump draws fluid. Furthermore, by drawing fluid from treatment device 20 via pump 30a, lower fluid pressure can occur within treatment device 20 compared to a situation without the additional pump. In certain aspects, pump 30a is the only pump or device circulating fluid through the system. This configuration can further reduce fluid pressure downstream of the treatment device.

[0083] Figure 4A treatment system 201 according to one aspect of the present disclosure is shown. The treatment system 201 may include a liquid cooling supply system 12 and a lung treatment system 19. The liquid cooling supply system 12 may be coupled to the lung treatment system 19 via a supply line 14 and a return line 16. The lung treatment system 19 may include a flexible bronchoscope 18 having a control portion 68, a steering mechanism 70, and a video system 72. The flexible bronchoscope 18 may include an insertion tube 74 that extends from a control section 76 outside the patient's body, through a trachea 78, and to a treatment device 20 at a treatment point within a left mainstem bronchus 80 of the patient's lung 81. The treatment device 20 may be positioned in the left mainstem bronchus 80, or at other locations, such as the right mainstem bronchus, a lobar bronchus, and the bronchus intermedius. The treatment device 20 may be guided through tortuous airways to perform a wide range of different procedures, such as denervation of a portion of a lobe, an entire lobe, multiple lobes, or one or both lungs. In some embodiments, a lobar bronchus is treated to denervate the lobe. Based on the effectiveness of the treatment, the physician may treat other lobes in parallel or sequentially.

[0084] The steering mechanism 70 can be coupled to the bronchoscope 18 and can receive the supply line 14 and the return line 16 to allow the lines to exit to the bronchoscope 18 and ultimately to the treatment device 20 ( Figure 5 The bronchoscope 18 can be coupled to a video system 72 that allows the operator to observe the advancement of the insertion tube 74 through the patient on a monitor 82 while manipulating the insertion tube 74 with the aid of the control portion 68. The video system 72 can allow the operator to determine whether fluid is being provided to the treatment device 20. The bronchoscope 18 can be coupled to the control portion 68 to control some or all aspects of the treatment, such as the amount of energy delivered to the treatment device 20.

[0085] The liquid cooling supply system 12 may have the same Figure 1-3 The liquid cooling supply system 12 has the same or similar features as those described herein. The supply line 14 of the liquid cooling supply system 12 originates at the liquid reservoir 22 and passes through the heat exchanger 28 and through the pump 30. The supply line 14 extends through the damper 37 and then through the operating mechanism 70 for supplying liquid to the treatment device 20. The return line 16 originates at the treatment device 20 and extends from the operating mechanism 70 back to the liquid reservoir 22. Thus, the pump 30 can draw liquid from the liquid reservoir 22 and pass through the heat exchanger 28, while the liquid is cooled by the cooling device 36 ( Figure 3). The liquid can pass through flow path 114 of heat exchanger 28. The liquid can then be provided to treatment device 20 under positive pressure via supply line 14. The liquid can circulate through treatment device 20 in a closed loop system and return from treatment device 20 to liquid reservoir 22. Cooling device 36 and pump 30 can be manually controlled by controller device 62.

[0086] Figure 5 A treatment system 301 according to aspects of the present disclosure is shown. The system 301 includes a liquid cooling supply system 12 coupled to a treatment device 20' for circulating liquid through the treatment device 20' disposed within a patient. For purposes of illustration, the treatment device 20' is shown in side elevation disposed within a bronchus 80. For example, Figure 3 A schematic diagram of the liquid cooling supply system 12 is shown having a supply path 66 and a return path 68 in fluid communication with the treatment device 20'. The liquid cooling supply system 12 is not referenced. Figure 5 Detailed description is given as it may include, for example, reference to Figure 3 and reference Figure 8 Some or all of the same features as described.

[0087] In certain aspects, treatment device 20 ′ includes an expandable member 82 extending from a distal end of an elongated member 91 . Figure 5A A cross-sectional view of elongated member 91 taken along line 5A-5A is shown. Elongated member 91 may include a supply lumen 93 and a return lumen 95. Supply lumen 93 is in fluid communication with supply path 66 of liquid cooling supply system 12, and return lumen 95 is in fluid communication with return path 68. A liquid supply passage 97 also extends from the distal end of elongated member 91, around a portion of the circumference of expandable member 82, to the distal end of expandable member 82. The proximal end of liquid supply passage 97 is in fluid communication with supply lumen 93, and the distal end of liquid supply passage 97 is in fluid communication with the interior of expandable member 82. Return lumen 95 is in fluid communication with the interior of expandable member 82 at the proximal end of expandable member 82. Return lumen 95 may surround supply lumen 93 in elongated member 91. The liquid in supply lumen 93 is at a higher pressure and a lower temperature than the cooling liquid in return lumen 95. Advantageously, locating supply lumen 93 in return lumen 95 reduces the delivery size of treatment device 20' and reduces heat loss in supply lumen 93. Electrodes 90 are applied to the outside surface of a fluid supply channel 97 to form a lesion 92 adjacent a bronchus 80 of the patient.

[0088] The liquid cooling supply system 12 circulates liquid through the treatment device 20' during energy delivery to the electrode 90. The liquid circulates serially from the supply lumen 93, through the liquid supply channel 97, into the expandable member 82, and then out of the return lumen 95. The liquid circulating through the liquid supply channel 97 and the expandable member 82 protects the area of tissue between the inner wall of the respiratory tract and the target treatment area (located within the wall of the respiratory tract and radially spaced from the inner wall of the respiratory tract). In this embodiment, the treatment device 20 uses energy to damage the target area. As used herein, the term "energy" is broadly interpreted to include, but is not limited to: thermal energy, cryogenic energy (e.g., cooling energy), electrical energy, acoustic energy, (e.g., ultrasonic energy), radiofrequency energy, pulsed high voltage energy, mechanical energy, ionizing radiation, optical energy (e.g., light energy), microwaves and combinations thereof, and other types of energy suitable for treating tissue. In some embodiments, the treatment device delivers energy and one or more substances (e.g., radioactive particles, radioactive materials, etc.), therapeutic agents, etc. Figure 5 and 5A In the illustrated embodiment, the therapeutic device may include one or more electrodes 90, each of which is operable to output ultrasound, microwaves, electrical energy, and / or radio frequency (RF) energy.

[0089] In certain aspects, liquid is circulated through the liquid cooling supply system 12 in close proximity to the electrode 90. Thus, supply and return lumens can be positioned proximate to the electrode 90, which can provide a high mass flow rate of cooling liquid across the surface of the electrode 90.

[0090] In another embodiment, the energy delivery portion is within an expandable member configured to circulate a cooled liquid. For example, an ultrasound energy delivery device or a microwave antenna can be located within an expandable balloon through which the cooled liquid is circulated.

[0091] The continuous flow of cooling liquid through the energy delivery device allows the energy delivery portion to form deeper lesions while delivering the same amount of energy through the patient's tissue. Thus, treatment is more rapid and effective at the target area because the neural tissue at the target area is more effectively and efficiently damaged than would be the case without the continuous flow of cooling liquid throughout the treatment apparatus described herein.

[0092] As mentioned above, reference Figure 1-5AThe heat exchanger discussed herein may alternatively be an elastomer, such as a bag, removably coupled to the cooling device with a given biasing force to enable heat transfer from the liquid contained in or passing through the bag. The bag may include the same or similar features as the cartridge discussed herein. For example, the bag may have a flow channel with a serpentine pattern. The bag may have an outlet port in fluid communication with a therapeutic device disposed within the patient. At least one biasing mechanism may be coupled to the bag and configured to bias the bag with a given force to cool the liquid to a selected temperature for delivery to the patient, such as further described elsewhere in this disclosure. The at least one biasing mechanism may be removably attached to the cooling device and the plate so that the bag is disposed between the cooling device and the plate, or the bag may be biased to the cooling device by other attachment devices, such as a clip or other device that imparts a biasing force toward the subject. The bag may include a film disposed adjacent to the cooling device and having a thickness of 2 mm to 4 mm, although the thickness may be less than 2 mm depending on the bag material. Additionally, the bag can be positioned horizontally on the cooling device, and a weight, such as a metal plate, can be placed on the bag to provide sufficient biasing force to cool the liquid to the desired liquid temperature. The given biasing force between the bag and the cooling device can be 5-10 pounds of force, or can be varied beyond this range.

[0093] In other embodiments, a cartridge and a bag may be used together. For example, the cartridge may have a slot to receive a bag configured to contain a liquid. For example, the bag may be inserted into the slot and the liquid may be inserted into the bag, thereby expanding the bag within the slot, which provides a sufficient given biasing force between the bag and the hot surface of the cartridge to achieve heat transfer of the liquid through the cooling device relative to which the cartridge is positioned adjacent.

[0094] Figure 6A and 6B A heat exchanger cartridge 28 is shown according to one aspect of the present disclosure. Figure 6A The barrel 28 is shown with a first plate 41 and a second plate 43 secured to each other. The first plate 41 is preferably composed of a thermally conductive material such as copper and includes a thermally conductive surface 98 ( Figure 1 and 2 ). The first plate 41 can include a 0.5 to 1 micron silver material on a copper material to improve heat transfer between the heat exchanger barrel 28 and the liquid in the cooling device 36. This also provides a biocompatible and inert surface for contacting the liquid in the heat exchanger barrel 28. The second plate 43 is preferably composed of an insulating material such as a polymer, ABS, nylon, or polycarbonate. Insulating foam or natural cork insulation can be placed inside the barrel 28 or on the outer surface of the barrel 28 to thermally isolate the liquid from the temperature of the ambient atmosphere around the barrel 28.

[0095] The barrel 28 can have at least one biasing mechanism, which can include four magnets 99 secured to the barrel. The magnets 99 can be secured into holes 100 at each corner of the second plate 43. Alternatively, one long magnet or multiple magnets can be secured along various portions of the barrel to apply the same biasing force to the cooling device, as discussed further in this disclosure. Securing the magnets 99 at the four corners of the barrel 28 provides improved surface-to-surface contact between the thermally conductive surface 98 of the first plate 41 and the thermally insulating plate 38 of the cooling device 36 because, as biased to the thermally insulating plate 38, the magnets tend to provide a uniform biasing force along most or all of the surface area of the thermally conductive surface 98, thereby improving and maintaining consistent and efficient heat transfer from the fluid during treatment. Figure 7B ).

[0096] Cartridge 28 also includes an inlet port 102 disposed at an upper portion 104 of a first end 106 of second plate 43, and an outlet port 108 disposed at a lower portion 110 of a second end 112 of second plate 43. Inlet port 102 can be coupled to a fluid reservoir, and outlet port 108 can be coupled to a therapeutic device disposed within a patient.

[0097] Continue to refer to Figure 6B , the second plate 43 includes a flow channel 114 in fluid communication with the inlet port 102 and the outlet port 108. The flow channel 114 meanders through the entire barrel in a vertical manner from the upper portion 104 to the lower portion 110, so that any gas in the system tends to rise toward the upper portion of the flow channel 114. The flow channel 114 is formed to have a generally flat cross-sectional area ( Figure 6D This provides an advantage of improving heat transfer from the liquid during treatment because the liquid passes in a thin or flat manner near the first plate 41, which can maximize heat transfer from the liquid by thermodynamic principles. The second plate 43 also includes a peripheral recess 116 formed to receive the first plate 41 so that the thermally conductive surface 98 is generally flush or coplanar with the offset surface 118 of the second plate 43. The peripheral recess 116 may include a sealing channel 120 that can receive an adhesive to secure the first plate 41 and the second plate 43 ( Figure 6D and 6E ). Thus, the first plate 41 can be secured to the second plate 43 at various portions of the first plate 41, which can prevent or reduce expansion or deformation of the first plate 41 due to attractive forces or other forces. Thus, heat transfer is increased because greater surface-to-surface contact is maintained between the first plate 41 and the insulating plate 38 due to the particular configuration of the cartridge.

[0098] Figure 6C A heat exchanger cartridge 28' is shown according to one aspect of the present disclosure. The cartridge 28' may include reference Figure 6A and 6BThe barrel 28' comprises a first plate 41', a second plate 43', and four magnets 99 disposed in holes 100 at respective corners of the second plate 43'. Thus, the barrel 28' comprises a number of reference Figure 6A and 6B Regarding the same or similar features discussed above, at least one significant difference is that second plate 43' includes a liquid reservoir 122, which is entirely contained within cavity 124 of cartridge 28', thus eliminating the need for an external liquid reservoir to operate the liquid cooling supply system. Through liquid reservoir 122, flow channel 114' snakes vertically throughout the cartridge from top to bottom, so any gas in the system tends to rise toward the upper portion of flow channel 114' and liquid reservoir 122. Providing liquid reservoir 122 internally within cartridge 28' offers the advantage of improved sterility, as it eliminates the need for an external reservoir with various supply tubes and connections that must be handled and connected and disconnected by the operator between treatments. Providing liquid reservoir 122 internally within cartridge 28' also offers the advantage of a disposable cartridge that can be easily manufactured and provided to the operator, allowing for quick attachment to the cooling device, sterile use of the liquid during treatment, and easy detachment and replacement of the cartridge between treatments. In certain aspects, a pouch can be positioned within cavity 124 and coupled to flow channel 114'. In this manner, the liquid pressure remains constant in the flow channel 114' during operation because the bag will collapse as liquid exits the bag.

[0099] In some embodiments, the corner portions of the flow channels in each cartridge discussed in this disclosure may have a larger radius, such as in Figure 6C The corner portions are shown hatched above. The corner portions provide a gradual transition between the horizontal and vertical sidewalls of the flow channel to help overcome the surface tension of bubbles that might otherwise become trapped in the corners of the flow channel. This increases the liquid pressure in the barrel because fewer bubbles will be able to operate in the flow channel than if the barrel had smaller radius corners, for example.

[0100] Figure 6D Shown along Figure 6A A cross-sectional view of the heat exchanger cartridge 28 is obtained along line 6D-6D. Figure 6E Show Figure 6D part of. Figure 6D and 6E The features shown may include reference Figure 6CThe barrel 28 includes a first plate 41 and a second plate 43 that are fastened to each other. The second plate 43 includes a flow channel 114 that meanders through the barrel 28 near the first plate 43. The second plate 43 includes a sealing channel 1206 and a peripheral recess 11 that can receive an adhesive to fasten the first plate 41 and the second plate 43. Therefore, the first plate 41 can be fastened to the second plate 43 at various portions of the first plate 41, which can prevent or reduce expansion or deformation of the first plate 41 due to attraction or other forces. Reference Figure 1-5 The configuration shown and discussed allows for a thinner first plate 41 (as discussed further herein), which will improve heat transfer from the liquid in the cooling liquid flow channel 114 .

[0101] First plate 41 can have a thickness T to maintain a generally flat surface between cylinder 28 and insulating plate 38. If first plate 41 is too thin for a particular metal, when placed under vacuum, the first plate may exhibit a wrinkled surface along the locations where flow channels 114 are provided. This can cause air pockets to form between planar surface 51 of insulating plate 38 and thermally conductive surface 41, resulting in poor heat transfer from the liquid. In some embodiments, thickness T of first plate 41 is between 0.005 inches and 0.01 inches, although thickness T can vary beyond this range. Preferably, thickness T is 0.01 inches.

[0102] In addition, compared with the case with a right-angle profile ( Figure 6D ), the cross-sectional profile of the flow channel 114 may include a corner R ( Figure 6E ). For illustration, angle R shows the corner portion of the lower portion of the sub-channel; angle R is ideally formed in the upper portion of the channel to prevent bubbles from being trapped at other right-angled corners, especially near the upper corner where the channel transitions from a vertical channel portion to a horizontal channel portion ( Figure 6C ). Providing rounded corners may increase the pressure of the liquid in the cartridge because, for example, there will be fewer air bubbles in the flow channel than if the channel had right-angled corners.

[0103] Figure 7A and 7B A top view of a heat exchanger cartridge 28 is shown according to one aspect. The cartridge 28 may have the same Figure 1-6E Thus, the barrel may include a first plate 141 and a second plate 143 secured to each other. The first plate 141 may include a heat conducting surface 98. The magnet 99 may be secured to the barrel 28 at opposite ends thereof. Similarly, the cooling device 36 having the insulating plate 38 and the heating plate 39 may also have the same or similar features as the reference Figure 1-4 The insulating plate 38 includes a planar surface 51 to offset the heat conducting surface 98 of the cartridge 28. The spacer 40 may extend around the perimeter of the insulating plate 38 and the heating plate 39 ( Figure 2 ). The spacer 40 may include magnets 53 disposed at corresponding positions relative to the barrel's magnets 99. The spacer 40 may include an outer surface 49 that is generally coplanar with the planar surface 51 of the insulating plate 38 to collectively provide a flush surface area upon which the barrel 28 may be biased.

[0104] The cartridge 28 may be manufactured or formed to be in a first state A ( Figure 7A ), and is in the second state B ( Figure 7B ).therefore, Figure 7A The cartridge 28 is shown in a first state A (prestressed configuration), which is achieved by forming the first and second plates 141, 143 of the cartridge 28 to have a convex profile relative to the planar surface 51 of the insulating panel 38. Thus, the first and second ends 106, 112 of the cartridge 28 may be positioned slightly away from the central region 115 of the cartridge, as indicated by the distance X shown on the ends 106, 112 of the cartridge 28. Figure 7B As shown, when the cartridge 28 is engaged to the cooling device 36, the cartridge 28 is biased flush to the thermal plate 38 due to the prestressed shape and the magnetic force. Thus, the cartridge 28 has a generally flat profile relative to the thermal plate 38 because the cartridge 28 tends to flatten due to the magnetic force. This configuration and biasing arrangement provides improved surface-to-surface contact between the heat loss conductive surface 98 of the first plate 141 and the thermal plate 38 of the cooling device 36, thereby resulting in improved heat transfer while reducing heat loss. Improved heat transfer and reduced heat loss are important during patient treatment because certain treatment systems (such as the pulmonary treatment systems discussed in the present disclosure) may require a given fluid temperature and a given fluid pressure for a given amount of time during treatment.

[0105] Figure 8 and 9 A therapeutic system 210 is shown according to one aspect of the present disclosure. Figure 8 A treatment system 210 is shown having a liquid cooling supply system 212 and a lung treatment system 217 coupled to one another via a supply line 214 and a return line 216 . Figure 9 Show Figure 8 A partially exploded view of certain components of the liquid cooling supply system 12 is shown.

[0106] Figure 8-13B The therapeutic system 210 shown may have the same Figure 1-7BThe pulmonary treatment system 217 may include the same or similar features as those described and shown. Thus, the pulmonary treatment system 217 may include a flexible bronchoscope 18 having a treatment device 20, a control portion 68, a steering mechanism 70, and a video system 72. The flexible bronchoscope 18 may include an insertion tube 74 that extends from a control section 76 outside the patient's body, through a trachea 78, and to a treatment point within a left main bronchus 80 of the patient's lung 81. The treatment device 20 may be positioned in the left main bronchus 80, or in other locations, such as the right main bronchus, a lobar bronchus, and a bronchus intermedius. The treatment device 20 can be guided through tortuous airways to perform a wide range of different procedures, such as denervation of a portion of a lobe, an entire lobe, multiple lobes, or one or both lungs. In some embodiments, a lobar bronchus is treated to denervate the lobe. Based on the effectiveness of the treatment, the physician may treat other lobes in parallel or sequentially.

[0107] The steering mechanism 70 can be coupled to the bronchoscope 18 and can receive a supply line 214 and a return line 216 to allow the lines to exit the bronchoscope 18 and ultimately to the treatment device 20. The bronchoscope 18 can be coupled to a video system 72 that allows the operator to observe the advancement of the insertion tube 74 through the patient on the monitor 82 while manipulating the insertion tube 74 with the aid of the control portion 68. The video system 72 can also allow the operator to determine whether liquid is being supplied from the liquid cooling supply system 212 to the treatment device 20. In addition, the bronchoscope 18 can be coupled to the control portion 68 to control some or all aspects of the treatment, such as the amount of energy delivered to the treatment device 20. Thus, the treatment device 20 of the bronchoscope 18 is in fluid communication with the supply line 214 and the return line 216 of the liquid cooling supply system 212. Thus, the liquid cooling supply system 212 is adapted to refrigerate, pump, and circulate liquid through the treatment device 20.

[0108] Continue to refer Figure 8 and 9 In some aspects, the liquid cooling supply system 212 may include: a housing 232 having a front plate 234; a cooling device 236 having an insulating plate 238 extending through the front plate 234; a pump 230 for pumping liquid; a heat exchanger cartridge 228 coupled to the front plate 234 and biased to the cooling device 236; a cam system 237 coupled to the front plate 234 for biasing the cartridge 228 to the insulating plate 238; and a controller 242 coupled to the pump 230 and the cooling device 236.

[0109] The housing 232 may include a first portion 231 and a second portion 233 that are secured to each other and structurally support and house the various components of the system. The first portion 231 may include an opening 235 for receiving and supporting a front portion of a cooling device 236. The cooling device 236 includes a thermal plate 238, a heating plate 239, fins 246, and a fan 248, similar to a commonly available TEC. The thermal plate 238 may include a planar surface 251 for biasing against the barrel 228. The cooling device 236 may include a support plate 247 secured to the first portion 231 of the housing 232. A spacer 240 may be secured between the cooling device 236 and the front plate 234 to provide additional support for the cooling device 236 and allow the thermal plate 238 to pass through the front plate 234.

[0110] In certain aspects, the cartridge 228 is slidably coupled to the front plate 234 and is biased relative to the thermal plate 238 of the cooling device 236 ( Figure 11A and 11B ). As discussed further below, the cartridge 228 can include a liquid reservoir 222 contained within the cartridge 228, or the system can have an external liquid reservoir located outside the cartridge 228 and in fluid communication with the cartridge 228. In the illustrated aspect, the cartridge includes an outlet port 208 coupled to a supply line 214. The supply line 214 is also coupled to the treatment device 20 within the patient along a pump 230 and then through the bronchoscope 18. Thus, the supply line 214 is in fluid communication with the treatment device 20, and a return line 216, also in fluid communication with the treatment device 20, extends from the insertion tube 74 back to the cartridge 228 for recirculating the liquid during treatment in a closed-loop system. Alternatively, the return line 216 can extend to a waste reservoir 219 in an open-loop system.

[0111] Continue to refer Figure 9, a front plate 234 is attached to the front portion 231 of the housing 232. The front plate 234 and the housing 232 cooperate to structurally support the cooling device 236 and the pump 230. The front plate 234 includes an opening 243 for receiving the insulating plate 238 of the cooling device 236 and for facilitating biasing the cartridge 228 toward the cooling device 236. The front plate 234 may include an opening 244 for receiving a portion of the pump 230. The pump 230 may include a cover 250 and a swivel 259 for coupling to the supply line 214. Importantly, the pump 230 is positioned downstream of the cartridge 228 so that during normal operation of the treatment system, the fluid in the cartridge 228 is subjected to a negative fluid pressure and the fluid provided to the treatment device 20 is subjected to a positive fluid pressure. The front plate 234 may include a control device 262 coupled to the controller 242 for controlling aspects of the system. The controller 242 can be coupled to the pump 230 to regulate the speed and direction of the pump 230, thereby regulating the direction and amount of fluid circulating through the system. The controller 242 can also be coupled to the cooling device 236 to regulate the temperature of the fluid in the cartridge 228, thereby further regulating the temperature of the fluid circulating through the treatment device 20 and thereby regulating the temperature of the patient's tissue during treatment. It should be understood that reference to Figure 8 and 9 The therapeutic device 20 discussed may include the Figure 1-7B Especially the reference Figure 5 The same or similar features as discussed.

[0112] Figure 10 A schematic diagram of a treatment system 310 is shown, according to one aspect, which may include Figure 8 and 9The treatment system 310 includes a liquid cooling supply system 212 coupled to a treatment device 20 positioned within a patient 264. The liquid cooling supply system 212 includes a cooling device 236, a heat exchanger 228, a pump 230, and a controller 242. The controller 242 can be coupled to the cooling device 236 and the pump 230 to regulate temperature and liquid circulation. The heat exchanger 228 can be removably coupled to the cooling device 236. A supply path 266 originates at the liquid reservoir 222, which is entirely contained within the heat exchanger 228. The supply path 266 extends through the heat exchanger 228 and through the pump 230, and terminates at the treatment device 20 to supply cooled liquid to the patient 264. A return path 268 originates at the treatment device 20 and can return to the liquid reservoir 222 or waste reservoir 219 for recirculation. Thus, liquid can be drawn from the reservoir 222 by the pump 230 through the heat exchanger 228 under negative pressure. As the liquid passes through heat exchanger 228, it is cooled by cooling device 236. The liquid is provided to treatment device 20 under positive pressure by pump 230. The liquid can then circulate through treatment device 20 and from treatment device 20 back to the exterior of patient 264.

[0113] The pump 230 may include forward gears and reverse gears, as indicated by arrows P, to draw and push liquid forward through the heat exchanger 228 during treatment. The forward gears draw liquid from the heat exchanger 228 during normal operation of the system 310. Conversely, the reverse gears may push liquid in the opposite direction through the heat exchanger 228 to remove gas that may be present in the system 310. The speed and direction of the pump 230 may be controlled by the controller 242.

[0114] In certain aspects, the pump 230 is coupled to a controller for variably controlling the pump speed to control the amount of fluid delivered to the therapeutic device. Thus, the size of the therapeutic device and the parallel pressure can be controlled by the variable speed controller. Furthermore, a non-contact pressure measurement device can be electrically coupled to the pump and positioned near the high-pressure side of the fluid path to regulate system pressure, for example by varying the pump speed in response to the pressure measured by the non-contact pressure measurement device.

[0115] Figures 11A-13C Certain aspects of the front plate 234, cam system 237, and cartridge 228 of the liquid cooling supply system 212 are shown. Figure 11A and 11B A rear perspective view is shown of the front plate 234 and cartridge 228. The front plate may include a cam system 237 that allows removal of the cartridge 228 when actuated between the engaged state E and the disengaged state D. Figure 12A A side view of the front plate 234 is shown, and Figure 12B Shown along Figure 11BA cross-sectional view of the front plate 234, cam system 237, barrel 228 and cooling device 236 is obtained along line 12B-12B. Figures 13A-13C Various views of cartridge 228 are shown.

[0116] Continue to refer Figure 11A and 11B The barrel 228 includes a first plate 241 and a second plate 243 secured to each other. The first plate 241 includes a heat conducting surface 298 for biasing to the heat preservation plate ( Figure 9 and 12B ). The front plate 234 includes an opening 243 and a receiving surface 245. The opening 243 can be sized to facilitate biasing the cartridge 228 toward the thermal insulation plate of the cooling device 236. The receiving surface 245 is sized to receive a portion of the cooling device 236 so that the thermal insulation plate 238 can extend partially through the opening 243. The front plate 234 can also have an opening 244 to receive a pump for pumping liquid through the cartridge 228. The front plate 234 can include and support a cam system 237 for biasing the cartridge 228 toward the cooling device. In certain configurations, the cam system 237 includes a cam rod 338 coupled to a cam shaft 340 having four cam lobes 342. The cam rod 338 can be directly attached to the cam shaft 340, or it can be dynamically associated with the cam shaft 340 in other configurations. The four cam lobes 342 are formed along the length of the cam shaft 340 and are spatially separated from each other. The cam system 237 can include an actuating member 334 and an actuating device 346. Each actuating device 346 may be composed of a piston rod 354 and a spring 356 disposed under the corresponding piston rod 354. The actuating device 346 may be at least partially disposed in a corresponding hole 348 of the actuating member 334 and may be disposed near a corresponding cam protrusion 342 ( Figure 12B ) so that rotation of cam lobe 342 actuates piston 354 in a downward direction.

[0117] When the cam system 237 is in the disengaged state D, the cam system 237 is configured to allow the front plate 234 to slidably receive the cartridge 228. Once the cartridge 228 is fully engaged in the front plate 234, the cam system 237 can be actuated to the engaged state E by rotating the cam lever 338 and cam shaft 340 in the downward rotational direction shown by arrow C to secure the cartridge 228 in the front plate 234 and bias the cartridge 228 toward the insulating plate 38 ( Figure 12B Thus, when moved to the engaged state E, the cam lobe 342 is simultaneously biased relative to the corresponding piston rod 354 of the actuating device 346, which tends to apply a downward force in the direction indicated by arrow F to the actuating device 346, tending to apply a force to the actuating member 334 relative to the barrel 228 approximately in the direction indicated by arrow G, which will be discussed further below ( Figure 12BConversely, when the cam system 237 is moved from the engaged state E to the disengaged state D for removal of the cartridge 228 by actuating the cam lever 338 in the direction indicated by arrow B, the cam shaft 340 and cam lobe 342 rotate in a similar direction, which tends to remove the force applied to the actuating device 346, tending to remove the force applied by the actuating member 334, so that the cartridge 228 can be removed ( Figure 11A As previously discussed, providing a given and sufficient biasing force between the cartridge and the cooling device improves the surface-to-surface contact between the cartridge and the cooling device, which will help effectively and efficiently cool the fluid passing through the cartridge for provision to the patient.

[0118] Figure 12A According to one aspect of the present disclosure Figure 11A 25. The front plate 234 includes a slot 358 sized to loosely receive the cartridge 228 when the cam system 237 is in the disengaged state D. The front plate 234 includes an upper biasing surface 360 and a lower biasing surface 362 sized to tightly receive the cartridge 228. The upper biasing surface 360 is formed at an angle (not substantially parallel) to the planar surface 251 of the insulation board 238. Figure 12B ). Likewise, the lower offset surface 362 is formed at an angle that is substantially non-parallel to the planar surface 251 of the insulation board 238. Thus, the slot 358 may have a trapezoidal cross-sectional profile to receive the cartridge 228, and the cartridge 228 may also have a corresponding trapezoidal cross-sectional profile ( Figure 13C ). Figure 12A Also shown are the cam lever 338 in the disengaged state D and the recessed portion 364 ( Figure 8 and 9 ).

[0119] Figure 12BA cross-sectional view of the front plate 234, the barrel 228 disposed therein, the cooling device 236 and the thermal plate 238 disposed adjacent the barrel 228, and the cam system 237 are shown in an engaged state E. With respect to the cam system 237, the actuating member 334 includes a lower actuating surface 366 that is angled relative to the planar surface 251 of the thermal plate 238. As discussed above, when the cam system 237 is engaged via the cam rod 338 and the cam shaft 340, the cam lobe 342 exerts a downward force on the actuating device 346, which in turn exerts a downward force on the actuating member 334 in the direction indicated by arrow F. Consequently, the lower actuating surface 366 biases the upper inclined surface 368 of the barrel 228, and simultaneously, the lower biasing surface 362 tends to bias the lower inclined surface 374 of the barrel 228, tending to exert an inward force on the barrel 228 in the direction indicated by arrow G. This configuration and operation biases the cartridge 228 relative to the thermal plate 238 in an approximately transverse direction with a given force to achieve heat transfer from the liquid and improve surface-to-surface contact between the cartridge 228 and the cooling device 236. This is achieved in part because of the trapezoidal profiles of the cartridge 228 and the slot 358, and because of the sloped surfaces of the actuating member 334, which collectively tend to "slide" the cartridge 228 along the corresponding angled surfaces and into position in the direction indicated by arrow G. Thus, the cam system 237, the front plate 234, and the cartridge 228 are sized to operate in conjunction to bias the cartridge 228 toward the thermal plate 238, thereby achieving heat transfer from the liquid contained in the cartridge 228.

[0120] Figure 13A A front perspective view of a cartridge 228 according to one aspect of the present disclosure is shown. The cartridge 228 includes a handle 370 disposed at the left end of the cartridge to easily insert the cartridge 228 into the slot 358 of the front plate 234 or remove the cartridge 228, as previously discussed. The cartridge 228 includes an upper slope 368 and a lower slope 374 formed at respective angles to allow the cartridge 228 to be inserted into the front plate 234. The cartridge 228 also includes a plurality of cavities 372 defined by a plurality of cross members 375. The cavities 372 are shaped and formed along the front portion of the cartridge to improve heat transfer from the liquid in the cartridge 228 during system operation.

[0121] Figure 13B A rear perspective view of a cartridge 228 according to one aspect of the present disclosure is shown. The cartridge 228 includes a first plate 241 and a second plate 243 attached to each other. The first plate 241 is preferably composed of a copper material and includes a thermally conductive surface 298 ( Figure 12B). The first plate 241 can include 0.5 to 1 micron of silver material on the copper material to improve heat transfer between the liquid in the heat exchanger barrel 228 and the cooling device 236. This also provides a biocompatible and inert surface for contacting the liquid in the heat exchanger barrel 228. The second plate 43 is preferably composed of an insulating material such as ABS, nylon or polycarbonate. Insulating foam or natural cork insulation can be placed inside the barrel 28 or on the outer surface of the barrel 28 to thermally isolate the liquid from the temperature of the ambient atmosphere around the barrel 28. The second plate 243 includes a liquid reservoir 322 arranged at the upper portion 376 of the barrel 228. The flow channel 314 is formed on the second plate 234 and is in fluid communication with the liquid reservoir 322. The flow channel 314 meanders through the entire barrel in a vertical manner from top to bottom, so that any gas in the system can tend to rise to the upper portion 376 of the flow channel 314 and enter the liquid reservoir 322. The second plate 243 may include a sealing surface 240 that is recessed to receive the first plate 241. The sealing surface 240 may receive an adhesive to secure the first plate 241 to the second plate 243. Thus, the first plate 241 is secured to the second plate 243 at portions of the first plate 241, which may prevent or reduce deformation of the copper plate due to attractive forces or other forces acting on the first plate 241.

[0122] The second plate 243 may include an outlet port 308 disposed at a lower portion 378 of the barrel 228 and in fluid communication with the flow channel 314 and the liquid reservoir 322. A supply line for supplying liquid to the patient may be coupled. In some aspects, the barrel 228 may include an inlet port 302 in fluid communication with the liquid reservoir 322. The outlet portion 302 may be coupled to a return line for returning liquid from the patient. In some aspects, the liquid reservoir 322 may include a collapsible bag in fluid communication with the flow channel 314 and the outlet port 308 to reduce or minimize the liquid pressure forces on the system. In some aspects, the barrel 228 may not have the liquid reservoir 322 included in the barrel; it may simply have the flow channel coupled to an external reservoir, for example Figure 1 shown.

[0123] Figure 13C Shown along line 13C-13C Figure 13A and 13B 2. A cross-sectional view of a cartridge 228 is shown. The cartridge 228 includes a first plate 241 and a second plate 243 attached to each other. The first plate 243 includes a heat conductive surface 298 disposed adjacent to a liquid reservoir 322 and a flow channel 314. The second plate 243 includes a liquid reservoir 322 disposed at an upper portion 376 of the cartridge 228 and a flow channel 314 in fluid communication with the liquid reservoir 322. The cartridge 228 may include a plurality of cavities 372 ( Figure 13A). Cavity 372 is shaped and formed along the front portion of the barrel to reduce the average thickness of the second plate, thereby improving heat transfer from the liquid in the barrel 228 during operation of the cooling system. The barrel 228 includes an upper slope 368 and a lower slope 374. The profile of the barrel 228 allows the barrel 228 to be inserted into the slot 358 of the front plate 234 to allow for biasing to the cooler 236, as further discussed above.

[0124] First plate 241 can have a thickness T to maintain a flat surface between cylinder 228 and insulating plate 238. If first plate 241 is too thin for a particular metal, when placed under vacuum, first plate 241 may exhibit a wrinkled surface at locations along which flow channels 314 are provided. This can create air pockets between heat-conducting surface 251 and insulating plate 238, resulting in poor heat transfer from the liquid. In some embodiments, thickness T of first plate 241 is between 0.005 inches and 0.01 inches, although thickness T can vary beyond this range. Preferably, thickness T is 0.01 inches.

[0125] As mentioned above Figure 1-5A As discussed, reference Figure 8-13C The heat exchanger cartridge discussed may alternatively be an elastomer, such as a bag, removably coupled to a cooling device with a given biasing force to enable heat transfer from a liquid contained in or passing through the bag. The bag may include the same or similar features as the cartridge discussed herein. For example, the bag may have a flow channel having a serpentine pattern. The bag may have an outlet port in fluid communication with a therapeutic device disposed within the patient. At least one biasing mechanism may be coupled to the cooling device, the cooling device being configured to bias the bag with a given force to cool the liquid to a selected temperature for delivery to the patient, such as further described elsewhere in this disclosure. The at least one biasing mechanism may be a cam system 237 as described above. Thus, a bag having a liquid chamber for holding a liquid may be inserted into the slit, and a biasing member, such as a plate, may be actuated by the cam system to bias the biasing member relative to the bag, thereby biasing the bag relative to the cooling device with a given biasing force by the skull. Thus, by disengaging the cam system and the biasing plate from the bag, thereby allowing the bag to be removed, another bag may be used in place of the bag, as described with reference to Figure 8-13C Similar or identical descriptions.

[0126] Figure 14-20 System 410 is shown including a liquid cooling supply system 412 coupled to a treatment system 417 . Figure 14-20 The therapeutic system 410 shown may have the same Figure 1-7B The same or similar features as the system described and shown in 8-13C.

[0127] exist Figure 14In an embodiment, the liquid cooling supply system 412 is coupled to the treatment system 417. As previously described, the treatment system 417 can be at least partially disposed within the patient 464 ( Figure 15 ). The liquid cooling supply system 412 is configured to cool, pump, and supply liquid through the treatment system 417. In a closed-loop system, the liquid cooling supply system 412 may include a liquid reservoir 422, liquid 424, a cooling system 426, a heat exchanger cartridge 428, and a supply line 414 and a return line 416 that work together to circulate the cooled liquid through the treatment system 417 during treatment. The supply line 414 originates at the liquid reservoir 422 and extends through the cartridge 428 and along the pump 430. The supply line 414 may extend through a pulse dampener (not shown) for dampening vibrations of the supply line 414 during operation of the pump 430. Finally, the supply line 414 extends into the treatment system 417, which may be positioned in the patient. The return line 416, in fluid communication with the supply line 414, originates at the treatment system 417 and extends from the patient's body and back to the reservoir 422 for recirculating the liquid during treatment. In some embodiments, the supply line 414 and the return line 416 are connected by a coaxial double nail 423 ( Figure 15-16 ) is connected to a liquid reservoir 422, which will be discussed in more detail below.

[0128] Reference Figure 15 Similar to the description of the previous embodiments, in certain aspects, the pulmonary treatment system 417 can include a flexible bronchoscope 418 having a treatment device 420, a control section 468, a steering mechanism 470, and a video system 472. The flexible bronchoscope 418 can include an insertion tube 474 that extends from a control section 476 outside the patient's body, through a trachea 478, and to a treatment site within the left mainstem bronchus 480 of the patient's lung 481. The treatment device 420 can be positioned in the left mainstem bronchus 480, or at other locations, such as the right mainstem bronchus, a lobar bronchus, or the bronchus intermedius. The treatment device 420 can be guided through the tortuous airways to perform a wide range of different procedures, such as denervation of a lobe, an entire lobe, multiple lobes, or one or both lungs. In some embodiments, a lobar bronchus is treated to denervate the lobe. Based on the effectiveness of the treatment, the physician can treat other lobes in parallel or sequentially.

[0129] Steering mechanism 470 can be coupled to bronchoscope 418 and can receive supply line 414 and return line 416 to allow the lines to exit bronchoscope 418 and ultimately to treatment device 420. Bronchoscope 418 can be coupled to video system 472, which allows an operator to observe the advancement of insertion tube 474 through the patient on monitor 482 while manipulating insertion tube 474 with the aid of control portion 468. Video system 472 can also allow an operator to determine whether liquid is being supplied to treatment device 420 by liquid cooling supply system 412. Furthermore, bronchoscope 418 can be coupled to control portion 468 to control some or all aspects of treatment, such as the amount of energy delivered to treatment device 420. Thus, treatment device 420 of bronchoscope 418 is in fluid communication with supply line 414 and return line 416 of liquid cooling supply system 412. Thus, liquid cooling supply system 412 is adapted to refrigerate, pump, and circulate liquid through treatment device 420.

[0130] Reference Figure 16 , showing Figure 14-15 436 ; a heat exchanger cartridge 428 removably coupled to the front plate 434 and biased to and in contact with the cooling device 436; a hinged door 437 hingedly coupled to the front plate 434 of the housing 423 for biasing the cartridge 428 to the thermal plate 438; and a controller 442 coupled to the pump 430 and the cooling device 436. Figure 18 ).

[0131] The housing 432 may include a first portion 431 and a second portion 433 that are secured to each other and structurally support and house the various components of the system. The first portion 431 may include an opening 435 for receiving and supporting a front portion of a cooling device 436. The cooling device 436 may include a thermal plate 438, a heating plate 439, fins 246, and a fan 448, similar to a commonly available TEC. The thermal plate 438 may include a planar surface 451 for biasing against the barrel 428. The cooling device 436 may include a support plate 447 secured to the first portion 431 of the housing 432.

[0132] Front plate 434 may include an opening 444 for receiving a portion of pump 430. Pump 430 may include a cover 450 and a swivel 459 for coupling to supply line 414. Pump 430 is disposed downstream of cartridge 428 so that during normal operation of the treatment system, fluid in cartridge 428 is subject to a negative fluid pressure and fluid provided to treatment device 420 is subject to a positive fluid pressure.

[0133] Continue to refer Figure 16 , a front plate 434 can be attached to the front portion 431 of the housing 432. The front plate 434 and the housing 432 cooperate to structurally support the cooling device 436 and the pump 430. The front plate 434 can include an opening 443 for receiving the insulating plate 438 of the cooling device 436. In some embodiments, a hinged door 437 pivots relative to the front plate 434 between an open position and a closed position. In the open position, the cartridge 428 can be inserted into or removed from the opening 443. In the closed position, the cartridge 428 is biased relative to the insulating plate 438 of the cooling device 436.

[0134] Figure 17 1 shows a rear perspective view of a hinged door assembly 440 according to one aspect of the present disclosure. In some embodiments, the hinged door 437 can have at least one biasing mechanism that can include a plurality of magnets 453 ( Figure 17 ). Magnet 453 can be fastened to hole 455 defined in hinged door 437. Alternatively, one long magnet or multiple magnets can be fastened along portions of hinged door 437 or front plate 434 to achieve the same biasing force as discussed in this disclosure. The biasing force provides improved surface-to-surface contact between heat exchanger cartridge 428 and insulating plate 438 of cooling device 436, thereby improving and maintaining consistent and efficient heat transfer from the fluid during treatment.

[0135] The hinged door assembly 440 may also include a plurality of hinges 460 to couple the hinged door 437 to the front panel 434 or the first portion 431 of the housing 432. In one embodiment, the hinged door assembly 437 may include two hinges 460 to allow the hinged door 437 to be pivotally displaced relative to the front panel 434 or the first portion 431 of the housing 432 between an open position and a closed position.

[0136] In one embodiment, the hinged door 437 can be defined by a cutout 461 sized to receive and accommodate a portion of the heat exchanger cartridge 428. In one embodiment, the hinged door 437 can include one or more cutouts 462 sized to receive and accommodate the inlet and outlet ports 402, 408 and associated bubble traps of the heat exchanger cartridge 428.

[0137] Figure 18 A schematic diagram of a treatment system 410 is shown according to one embodiment of the invention and is similar to Figure 5 The therapeutic system 410 includes a liquid cooling supply system 412 coupled to a therapeutic device 420 disposed within a patient 464. In one embodiment and similar to Figure 5 , the treatment device 420 may include one or more electrodes 90, each of which is operable to output ultrasound, microwaves, electrical energy and / or radio frequency (RF) energy.

[0138] Liquid cooling supply system 412 includes a cooling device 436, a heat exchanger 428, a pump 430, and a controller 442. Controller 442 can be coupled to cooling device 436 and pump 430 to regulate temperature and liquid circulation. Heat exchanger 428 can be removably coupled to cooling device 436. Liquid supply line 414 originates at liquid reservoir 422. Liquid supply line 414 continues to heat exchanger 428 and through pump 430, terminating at treatment device 420 to supply cooled liquid to patient 464. Liquid return line 416 continues from treatment device 420 and can return to liquid reservoir 422 for recirculation and / or to waste reservoir 419. Thus, liquid can be drawn from reservoir 422 by pump 430 through heat exchanger 428 under negative pressure. As the liquid passes through heat exchanger 428, it is cooled by cooling device 436. Liquid is then supplied to treatment device 420 under positive pressure by pump 430. The fluid may then circulate through the treatment device 420 and from the treatment device 420 back outside the patient 464 .

[0139] Control section 468 ( Figure 15 ) can be coupled to a controller 442 for controlling aspects of the system. The controller 442 can be coupled to the pump 430 for regulating the speed and direction of the pump 430, thereby regulating the direction and amount of fluid circulating through the system. The controller 442 can also be coupled to the cooling device 436 to regulate the temperature of the fluid in the cartridge 428, thereby further regulating the temperature of the fluid circulating through the treatment device 420, and thereby regulating the temperature of the patient's tissue during treatment.

[0140] The pump 430 may include forward and reverse gears, as indicated by arrows P, to draw and push liquid forward through the heat exchanger 428 during treatment. The forward gear draws liquid from the heat exchanger 428 during normal operation of the system 410. Conversely, the reverse gear may push liquid in the opposite direction through the heat exchanger 428 to remove gas that may be present in the system 410. The speed and direction of the pump 430 may be controlled by a controller 442.

[0141] In certain aspects, the pump 430 is coupled to a controller for variably controlling the pump speed to control the amount of fluid delivered to the therapeutic device. Thus, the size of the therapeutic device and the parallel pressure can be controlled by the variable speed controller. Furthermore, a non-contact pressure measurement device can be electrically coupled to the pump and positioned near the high-pressure side of the fluid path to regulate system pressure, for example by varying the pump speed in response to the pressure measured by the non-contact pressure measurement device.

[0142] Figure 19A and 19B A front perspective view and a rear perspective view, respectively, of a thermoformed heat exchanger cartridge 428 according to one aspect of the present disclosure are shown. The heat exchanger cartridge 428 includes a flexible thermoformed tray 443 coupled or bonded to a first plate 441. The tray 443 coupled to the plate 441 defines a flow channel 450 for fluidly coupling an inlet supply line 414a (uncooled liquid) and an outlet supply line 414b (cooled liquid) for introduction into a therapeutic device.

[0143] The first plate 441 is preferably composed of a copper material and includes a thermally conductive surface 498 ( Figure 16 ). For example, the first plate 441 may include a conductive material, wherein the conductive material is deposited on the copper material (e.g., by plating, coating (e.g., conductive ink or coating) and / or lamination (e.g., film) to improve and optimize heat transfer between the heat exchanger cartridge 428 and the liquid in the cooling device 436. The conductive material may include silver, parylene, aluminum, or a combination thereof. The first plate 441 may have a thickness T to maintain a flat surface between the cartridge 428 and the insulating plate 438. If the first plate 441 is too thin for a particular metal, when placed under vacuum, For example, when the pump is reversed, the first plate 441 may exhibit a wrinkled surface at the location along which the flow channel 450 is located. This may form air pockets between the first plate 441 and the insulating plate 438, resulting in poor contact and, therefore, poor heat transfer from the liquid. It may also cause the recess of the tray to collapse completely, thereby blocking the flow channel. In some embodiments, the thickness T of the first plate 441 is 0.005 inches to 0.015 inches, but the thickness T can vary beyond this range. Preferably, the thickness T is approximately 0.010 inches (or 10 mils).

[0144] In one particular embodiment, plate 441 comprises a copper plate having a thickness of approximately 10 mils and coated with 0.5 to 1 micron of silver material. This also provides a biocompatible and inert surface for contacting the liquid in heat exchanger cartridge 428. Optionally, a parylene coating is provided on at least a portion of the silver material to provide barrier properties and aid in sealing or bonding tray 443 to plate 441.

[0145] Thermoformed tray 443 is preferably composed of a transparent or translucent thermoformed material, such as polyvinyl chloride (PVC) or polyethylene terephthalate (PET). The material of tray 443 is sufficiently flexible so that it adheres to plate 441 in high-temperature applications such as sterilization. The thickness of tray 443 is optimized so that tray 443 is sufficiently rigid so that when the system is reversely pressurized, such as by a vacuum, the tray does not deform and wrinkle, thereby lest the heat exchange characteristics of cartridge 428 be damaged or significantly reduced. Optionally, insulating foam or natural cork insulation (not shown) can be placed inside cartridge 428 or on the outer surface of cartridge 428 to thermally isolate the liquid from the temperature of the ambient atmosphere surrounding cartridge 428.

[0146] The tray 443 also includes an edge or recess 452 that is spaced internally from the perimeter of the tray 443 by a sealing surface or flange 440. The sealing surface 440 can receive an adhesive, such as a UV activated or curing adhesive or epoxy, to secure the plate 441 and the tray 443 together. Any excess adhesive is collected in the recess 452 so that it does not interfere with the flow channel 450. Thus, the first plate 441 is secured to the tray 443 at each peripheral portion of the first plate 441 and the copper plate is prevented from being deformed by suction or other forces acting on the first plate 441. In one embodiment, the first plate 441 and the tray 443 are bonded by using a UV curing adhesive and exposing the assembly to UV radiation. The transparency of the tray material allows for sufficient exposure to UV radiation to fully cure the adhesive.

[0147] The flow channel 450 is defined as the space between the recessed area formed by the tray 443 and the first plate 441. The flow channel is used to provide fluid communication between the liquid reservoir 422 and the pump 430, and ultimately between the liquid reservoir 422 and the therapeutic device 420, while simultaneously cooling the liquid passing through the flow channel 450. In one embodiment, the flow channel 450 snakes through the barrel 428 a desired number of times, such as seven passes as shown. The number of passes and the depth and width of the channel 450 are selected based on the desired residence time of the liquid within the barrel 428 to cool the liquid to a desired temperature. For example, the dimensions of the liquid reservoir 450 provide sufficient residence time for a coolant, such as saline, to cool from room temperature to a temperature of approximately 0.1°C to 10°C, more specifically, to a temperature of approximately 1°C to 6°C, and even more specifically, to approximately 3°C to 5°C, at a flow rate of approximately 100 mL / min.

[0148] Reference Figure 19AInlet port 402 is formed at second end 450a of flow channel 450 and is in fluid communication with inlet supply line 414a, which is in fluid communication with liquid reservoir 422. Outlet port 408 is formed at second end 450b of flow channel 450 and is in fluid communication with outlet supply line 414b. This portion of supply line 414 is in fluid communication with pump 430 and then passes through bronchoscope 418 and to treatment device 420 within the patient. In certain aspects, inlet port 402 and outlet port 408 can have a sloped profile, starting at a depth greater than the depth of flow channel 450 and sloping downward to a depth equal to the depth of the flow channel. This allows for the convergence of inlet liquid with a headspace, which is useful for collecting bubbles in the system. In other words, any gas in the system tends to rise to the headspace of ports 402 and 408.

[0149] The heat exchanger cartridge 428 is contoured to allow the cartridge 428 to be inserted into the space between the hinged door 437 and the insulating plate 438 of the cooling device 436. For example, in use, when the hinged door 437 is open, the cartridge 428 is inserted into the opening 443. When the hinged door 437 is closed, the cartridge 428 is biased relative to the insulating plate 438 of the cooling device 436, thereby sandwiching the cartridge 428 between the hinged door 437 and the insulating plate 438 of the cooling device 436, as further discussed above. In certain embodiments, the cartridge 428 can also be positioned on either side of the opening 443 defined by the front plate 434. In some embodiments, the heat exchanger cartridge 428 can include one or more notches 479 defined on one or more edges of the cartridge 428. The notches 479 can be sized to receive the keys 481 of the front plate 434 to ensure that the cartridge 428 is inserted in an orientation that allows normal operation.

[0150] Now refer to Figure 20 , shows a perspective view of a coaxial bag-staple assembly 423 for coupling a liquid reservoir 422 to a system 410 according to one aspect of the present disclosure. In some embodiments, the supply line 414 and the return line 416 can be coupled via the coaxial bag-staple assembly 423 (see also Figure 15-16 ) are connected to the liquid reservoir 422 in a single location. In this embodiment, the return line 416 is fluidly connected to the internal channel 425, and the supply line 414 is fluidly connected to the external channel 427, which is coaxial with the internal channel 425. The internal channel 425 and the external channel 427 are fluidly connected to the liquid reservoir 422 and the liquid 424 therein, but are isolated from each other. However, the reverse configuration is also contemplated.

[0151] In one embodiment, assembly 423 includes a hypotube 429 having an inner diameter 431 inserted through the lumen of an injection molded non-venting spike female luer 500, wherein the inner diameter 502 of the luer 500 is larger than the inner diameter 431 of the hypotube 429 to form a coaxial outer passage 427 and inner passage 425. Assembly 423 may also include an injection molded venting spike cap 504 coupled to a first end of the female luer 500 to fluidly connect the liquid reservoir 422 with the outer and inner passages 425. Assembly 423 also includes an injection molded bag spike adapter 506 having a first port 508 for coupling the inlet supply line 414 to the outer passage 427 and a second port 510 for coupling the outlet supply line 316 to the inner passage 425 of the hypotube 429. The reverse configuration (ie, coupling the inlet supply line 414 to the second port 510 and the outlet supply line 416 to the first port 508 ) is also contemplated.

[0152] The inner diameter 431 of the hypotube is preferably sized to control back pressure in the treatment system 417 and / or to generate pressure in the expandable member of the treatment device. Optionally, various clamps (not shown) may be used anywhere along the supply line 414 and / or return line 416 to further regulate the flow of liquid to and / or from the reservoir 422. Thus, the coaxial dual spikes 423 avoid the need for separate supply and return spikes by allowing liquid 424 to flow into and out of the liquid reservoir at the same location on the reservoir 422 simultaneously.

[0153] Each embodiment as above and aspect can be combined to provide further embodiment and aspect.Can carry out these changes and other changes to embodiment according to above-mentioned detailed description.Aspect described herein, embodiment, feature, system, equipment, material, method and technology can be similar to U.S. Patent number 8,088,127, the PCT application number PCT / US2010 / 056424 (publication number WO2011 / 060200) submitted to on November 11, 2010, the U.S. application number 12 / 913 submitted to on October 27, 2010, the U.S. application number 12 / 944 submitted to on November 11, 2010, the U.S. application number 13 / 081,406 and U.S. provisional application number 61 / 543,759 of describing in some embodiments.Each of these applications is fully incorporated into this paper by reference. In addition, in certain embodiments, the aspects, embodiments, features, systems, devices, materials, methods and techniques described herein can be applied to or used in conjunction with any one or more of the embodiments, features, systems, devices, materials, methods and techniques disclosed in the above-mentioned applications and patents.

[0154] Throughout the specification and claims, unless the context requires otherwise, the word "comprise" and variations thereof (eg, "comprises" and "comprising") are to be construed in an open, inclusive sense, that is, to mean "including, but not limited to."

[0155] Generally, in the claims, the terms used should not be construed to limit the claims to the specific embodiments and aspects disclosed in the specification and claims, but should be construed to include all possible embodiments and aspects, along with the full scope of equivalents to such claims. Therefore, the claims are not limited by this disclosure.

Claims

1. A disposable heat exchanger cartridge for use in conjunction with a cooling device for thermally treating a fluid used to treat a patient, the cooling device comprising a thermal insulation plate, the cartridge comprising: a heat-conducting surface and a flow channel extending through the cartridge, at least a portion of the flow channel being disposed adjacent the heat-conducting surface, wherein: The cartridge includes a first port adjacent to and in fluid communication with a first end of the flow channel, the first port configured to connect to a liquid supply line along an axis parallel to the flow channel and offset from the flow channel at the first end.

2. The cartridge of claim 1 , further comprising at least one biasing mechanism configured to removably couple the cartridge to the thermally conductive plate of the cooling device so that the thermally conductive surface conductively cools the liquid. in, The at least one biasing mechanism includes two pairs of magnets, each pair of magnets being disposed on opposite ends of the cartridge and each pair of magnets being attractable to the cooling device to improve surface-to-surface contact between the cartridge and the cooling device, thereby increasing heat exchange efficiency.

3. The cartridge according to claim 1, wherein The cartridge is in a first state when disengaged from the cooling device and in a second state when engaged with the cooling device.

4. The cartridge according to claim 3, wherein The first state includes the barrel having a generally convex profile, and wherein the second state includes the barrel having a generally rectangular profile.

5. The cartridge of claim 1 , further comprising at least one biasing mechanism configured to removably couple the cartridge to the thermally conductive plate of the cooling device so that the thermally conductive surface conductively cools the liquid. in, The at least one biasing mechanism is comprised of a plurality of magnets that are attracted to the cooling device such that a given biasing force is applied to the cartridge to effect heat transfer from the liquid.

6. The cartridge of claim 1, further comprising a first plate and a second plate coupled to each other, wherein The first plate includes the thermally conductive surface, the first plate having a thickness at least equal to or less than 0.01 inches.

7. The cartridge of claim 6, wherein The second plate is composed of a thermally insulating material and includes a groove defining a portion of the flow channel.

8. A coaxial bag nail assembly comprising: The cartridge according to claim 1; as well as Coaxial bag nails, including: a first tubular member having a structure defining a first lumen therethrough, the first lumen having a first inner diameter; and a second tubular member having a structure defining a second lumen therethrough, the second lumen having a second inner diameter smaller than the first inner diameter, wherein the second tubular member is disposed within the first lumen of the first tubular member such that the first lumen and the second lumen are coaxial and thereby define a first passageway and a second passageway, and wherein one of the first channel and the second channel is fluidly connected to a liquid return line of a cooling device and a liquid reservoir, so that the coolant returns to the reservoir via the first cavity or the second cavity corresponding to the one of the first channel and the second channel, and the other of the first channel and the second channel is fluidly connected to a flow channel of the cartridge and the liquid reservoir, so that the coolant is provided from the reservoir to the flow channel of the cartridge.

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