Devices and methods for combined radiofrequency and cryogenic ablation processes

Abstract

A probe for performing an ablation process includes a housing defining an outer surface, a cooling path including an inflow path and a return path for a cryogen, and at least one radio frequency (RF) transmitter. The probe is used to provide combined radio frequency (RF) and low temperature processing during a common procedure.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims the benefit of and priority to U.S. Patent Application No. 17 / 845,597, filed on June 21, 2022. The entire disclosure of the above application is incorporated herein by reference. Technical Field

[0003] The present disclosure relates to devices and methods for combined radiofrequency (RF) and cryogenic ablation treatments. More particularly, the present disclosure relates to devices and methods that can include and / or allow for both RF and cryogenic cycling in an ablation treatment. Background Art

[0004] This section provides background information related to the present disclosure which is not necessarily prior art.

[0005] Systems and methods for providing ablative treatment generally include introducing a probe at or near a target tissue of a patient. The target tissue may be abnormal or undesirable tissue, such as a tumor. The ablation treatment is performed to destroy the target tissue. In addition to destroying the target tissue, it is also desirable to minimize damage or injury to healthy tissue that may be located near the target tissue.

[0006] One type of ablation treatment is a cryogenic ablation treatment. The cryogenic ablation treatment may include a cryogenic ablation probe introduced at or near the target tissue of the patient. The cryogenic ablation system may include an extremely cold cryogen (liquid, gas, or mixed phase) that passes through a probe in thermal contact with the target tissue. Heat from the tissue is transferred from the tissue to the cryogen through the probe, and the cryogen removes the heat from the target tissue. This removal of heat causes the tissue to freeze, thereby causing destruction of the target tissue. When the tissue is frozen, the ice is typically formed in the form of an ice ball. The ice ball may be spherical, ellipsoidal, or other shapes. It is desirable to perform the cryogenic ablation treatment so that the target tissue is completely frozen and the freezing of surrounding tissue and / or body structures is minimized.

[0007] In other treatments, radio frequency (RF) energy can be used to ablate target tissue and / or provide pain relief. During such treatments, a probe can be inserted into a patient at or near a target tissue. The probe can emit or deliver RF energy to the target tissue. In some examples, the RF energy can heat the target tissue to a high temperature that can damage the tissue. In other examples, RF energy can be delivered to provide pain relief to the affected area or target tissue.

[0008] Conventional or existing systems and methods have various disadvantages. Some of these disadvantages may be due to the extreme temperatures used to create the ice ball during a cryoablation freezing cycle or the elevated temperatures used in an RF ablation treatment. For example, after a freezing cycle, it may be difficult to restore the tissue temperature to a more moderate temperature. The time required to heat the tissue and / or bring the tissue to a moderate temperature may be longer than desired. In other examples, the tissue may be dehydrated during the RF treatment, which results in a reduction in the effectiveness of the treatment. As a result, the treatment time may be longer than desired, and subsequent procedures may need to be performed in additional treatment sessions rather than in a single treatment. Therefore, there is a need for improved ablation devices, systems, and methods that allow for more efficient treatment. Summary of the invention

[0009] This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

[0010] In various embodiments of the present disclosure, apparatus, systems, and methods for performing ablation treatments and radio frequency (RF) treatments are provided. The apparatus, systems, and methods may include improvements for combined radio frequency (RF) and cryogenic treatments that may include heating and cooling cycles performed by a single probe. Such combined RF-cryogenic probes may be components of a combined RF-cryogenic ablation system that may be used to address several shortcomings of existing and conventional ablation treatments.

[0011] In some embodiments of the present disclosure, a probe for performing an ablation process is provided. The combined RF-cryogenic probe may include a housing defining an outer surface and a cooling path, the cooling path including an inflow path and a return path each positioned radially inward of the housing, the cooling path being configured to be coupled to a cryogen source. The probe may also include at least one radio frequency (RF) transmitter, the RF transmitter being configured to be coupled to a radio frequency (RF) source.

[0012] In one aspect, the cooling path can include a supply conduit, an inner surface of the supply conduit defining an inflow path, and an outer surface of the supply conduit and an inner surface of the housing defining an outflow path.

[0013] In another aspect, the cooling path may be configured to move liquid or gaseous nitrogen, argon, or oxygen through the probe.

[0014] In another aspect, at least one radio frequency (RF) transmitter includes a plurality of RF electrodes, and the plurality of electrodes may be positioned on the housing.

[0015] In another aspect, at least one radio frequency (RF) transmitter can include a first RF electrode positioned at a first axial position relative to the distal end of the probe, and a second RF electrode positioned at a second axial position relative to the distal end of the probe.

[0016] In another aspect, the at least one radio frequency (RF) transmitter can include a first RF electrode and a second RF electrode, each positioned at the same axial position on the housing of the probe.

[0017] The first RF electrode may be positioned at a different circumferential position than the second RF electrode.

[0018] In another aspect, at least one radio frequency (RF) transmitter includes a microwave antenna.

[0019] In one embodiment there is provided a probe as defined in the claims.

[0020] In some embodiments according to the present disclosure, a combined RF-cryogenic system is provided. The system may include a combined RF-cryogenic probe and an RF-cryogenic controller configured to control operating characteristics of a cryogen and characteristics of a radio frequency (RF) signal provided to at least one radio frequency (RF) transmitter.

[0021] In one aspect, the RF-cryogenic controller can include at least one RF-cryogenic computing device and a data bus.

[0022] In another aspect, the RF-cryocontroller is positioned in a housing that includes one or more connectors for connecting the probe.

[0023] In one embodiment, there is provided an ablation system as defined in the claims.

[0024] In some embodiments of the present disclosure, a method of performing an ablation treatment is provided. The method may include cooling target tissue by moving a cryogen through a probe, and heating the target tissue by emitting radio frequency (RF) energy from a radio frequency (RF) transmitter in the probe.

[0025] In another aspect, the steps of cooling the target tissue and heating the target tissue are performed during a common treatment.

[0026] In another aspect, the step of cooling the target tissue includes forming an ice ball at the target tissue.

[0027] In another aspect, the cryogen may comprise liquid or gaseous nitrogen, argon or oxygen. Preferably, the cryogen comprises liquid and / or gaseous nitrogen.

[0028] In another aspect, a radio frequency transmitter (RF) may include an RF electrode.

[0029] In another aspect, the RF transmitter includes a microwave antenna.

[0030] In another aspect, the step of heating the target tissue may include performing a coagulation treatment.

[0031] In another aspect, the step of heating the target tissue may include denaturing proteins at or near the target tissue.

[0032] In another aspect, the step of heating the target tissue may include ablating the target tissue.

[0033] In another aspect, the method may further include adding cement to the body structure when the temperature of the body structure is above a predetermined temperature, and wherein the method is performed during a common process.

[0034] In one embodiment, there is provided a method as defined in the claims.

[0035] Further areas of applicability will become apparent from the description provided herein.The description and specific examples in the present disclosure are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. BRIEF DESCRIPTION OF THE DRAWINGS

[0036] The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.

[0037] Figure 1 is a schematic diagram illustrating an example RF-cryoablation system according to some embodiments of the present disclosure.

[0038] Figure 2 is a schematic diagram illustrating an example RF-cryoablation unit according to some embodiments of the present disclosure.

[0039] Figure 3 is a side view of an example RF-cryoprobe according to some embodiments of the present disclosure.

[0040] Figure 4 is a graphical representation of various example duty cycles that may be used by the RF-cryoablation systems of the present disclosure.

[0041] Figure 5 is a graphical representation of various RF signals that may be used in the RF-cryoablation system of the present disclosure.

[0042] Figure 6 is a flow chart illustrating an example method of performing an ablation treatment according to some embodiments of the present disclosure.

[0043] Figure 7is a flow chart illustrating another example method of performing an ablation treatment according to some embodiments of the present disclosure.

[0044] Figure 8 is a schematic diagram illustrating an example computing device that may be used in one or more cryoablation systems of the present disclosure.

[0045] Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings. DETAILED DESCRIPTION

[0046] Example embodiments will now be described more fully with reference to the accompanying drawings.

[0047] Example embodiments are provided to make the present disclosure comprehensive and fully convey its scope to those skilled in the art. Many specific details, such as examples of specific components, devices, and methods, are set forth to provide a comprehensive understanding of the embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be adopted, and that the example embodiments may be implemented in many different forms, and none of them should be construed as limiting the scope of the present disclosure. In some example embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail.

[0048] The terms used herein are only used to describe specific example embodiments and are not intended to be limiting. As used herein, the singular forms "one", "an", "said", and "the" may also be intended to include plural forms unless the context clearly indicates otherwise. The terms "comprises", "comprising", "including", and "having" are inclusive, thus specifying the presence of stated features, wholes, steps, operations, elements, and / or components, but do not exclude the presence or addition of one or more other features, wholes, steps, operations, elements, components, and / or combinations thereof. The method steps, processes, and operations described herein should not be interpreted as necessarily requiring them to be performed in the particular order discussed or shown, unless specifically identified as an execution order. It should also be understood that additional or alternative steps may be adopted.

[0049] When an element or layer is referred to as being "on," "engaged to," "connected to," or "coupled to" another element or layer, it may be directly on, engaged to, connected to, or coupled to another element or layer, or there may be intermediate elements or layers. Conversely, when an element is referred to as being "directly on," "directly engaged to," "directly connected to," or "directly coupled to," there may be no intermediate elements or layers. Other words used to describe relationships between elements should be interpreted in a similar manner (e.g., "between" versus "directly between," "adjacent" versus "directly adjacent," etc.). As used herein, the term "and / or" includes any and all combinations of one or more of the associated listed items.

[0050] Although the terms first, second, third, etc. can be used herein to describe various elements, components, regions, layers and / or sections, these elements, components, regions, layers and / or sections should not be limited by these terms. These terms are only used to distinguish an element, component, region, layer or section from another region, layer or section. Unless the context clearly indicates, terms such as "first", "second" and other numerical terms do not imply order or sequence when used in this article. Therefore, the first element, component, region, layer or section discussed below can be referred to as the second element, component, region, layer or section without departing from the teaching of the exemplary embodiment.

[0051] For ease of description, spatially relative terms such as "inside", "outside", "below", "below", "lower", "on", "upper", etc. may be used herein to describe the relationship of one element or feature to another (one or more) elements or (one or more) features shown in the figures. In addition to the orientations shown in the figures, spatially relative terms may be intended to cover different orientations of the device in use or operation. For example, if the device in the figure is turned over, the elements described as "below" other elements or features will be oriented "above" the other elements or features. Therefore, the example term "below" can include both above and below orientations. The device can be oriented in other ways (rotated 90 degrees or other orientations), and the spatially relative descriptors used herein are interpreted accordingly.

[0052] In some embodiments of the present disclosure, a combined RF-cryoablation system is provided. The combined RF-cryoablation system may allow both radio frequency (RF) treatment and cryogen treatment to be performed separately using a common probe. The probe may include, for example, an RF transmitter, such as an RF electrode and / or a microwave antenna. The probe may also include a cryogen flow path that allows a cryogen (e.g., a combination of liquid, gaseous, or liquid and gaseous nitrogen, argon, or oxygen) to pass through the probe. Such probes may be used, for example, to perform separate heating and freezing cycles with a single probe. Therefore, heating and freezing cycles may be performed during treatment, which may be used, for example, for ablation and / or pain relief of target tissue. The apparatus, system, and method of the present disclosure provide improvements to existing systems by allowing two operating modes using a common probe. Such systems and methods provide various improvements, including the ability to perform treatments in a shorter treatment time than existing or conventional systems and methods. The systems and methods of the present disclosure may also improve the effectiveness of treatments and reduce damage to healthy tissues, which will be further described below. In addition, the systems and methods of the present disclosure may allow a wider range of treatments to be performed during a single treatment, rather than having to perform multiple treatments and subjecting the patient to multiple medical procedures.

[0053] In one example treatment, the devices, systems, and methods of the present disclosure can be used to eliminate the need to perform subsequent treatment after a cryogenic ablation treatment or reduce the possibility of subsequent treatment. In some cryogenic ablation treatments, a cryogenic ablation probe can be used to form an ice ball at a target tissue (e.g., a tumor, lesion, or other abnormal tissue). If the target tissue is located at or near a bone or other supporting structure in the patient's body, its structural integrity will be compromised if the bone or supporting structure is subjected to the low temperature of the cryogenic treatment. Without additional treatment, the bone or supporting structure may fail. Adhesives or other repair substances can be applied to the bone or supporting structure to address this situation. Because the tissue at or near the target tissue and the ice ball formed may require a considerable amount of time to return to normal body temperature, such applications of adhesives or other repair substances are applied in subsequent procedures after the cryogenic treatment.

[0054] The combined RF-cryogenic system and probe of the present disclosure can be used in such cases to increase the speed at which the target tissue and surrounding tissue return to normal body temperature. For example, the RF functionality of the probe of the present disclosure can be used to heat the target tissue and surrounding body structures using the cryogenic functionality of the probe after a freezing cycle. The RF functionality can restore bones or other body structures at or near the ice ball site to a temperature at which cement or other repair materials can be applied during the same treatment period. In this way, the patient does not need to undergo subsequent treatment to repair the bone or body structure. Such improvements can reduce the need for multiple treatments and can increase the likelihood of successful treatments without causing undesirable damage to the patient's healthy tissues.

[0055] In another example environment, an ablation process in which a probe is inserted at or near a target tissue may be performed. The ablation process may cause bleeding to occur in the target tissue and / or surrounding tissue. The RF functionality of the systems and probes disclosed herein may be used to heat tissue at the bleeding site to induce coagulation and reduce or stop bleeding. This functionality is an improvement over existing systems and methods. In many existing or conventional systems and methods, particularly for cryogenic ablation systems and probes, coagulation processes are impossible or ineffective. Compared to existing systems and methods, the systems and methods disclosed herein may use RF energy to more quickly heat and coagulate bleeding that may occur. Such improvements may increase the effectiveness of the treatment and reduce undesirable bleeding that may occur.

[0056] In another example case, a probe inserted at or near the target tissue may need to be repositioned. For example, during a cryoablation treatment, a probe may be inserted at or near the target tissue. If the needle / probe is not positioned at the desired location (as can be confirmed using imaging techniques), the probe may be moved or otherwise repositioned to the desired location. When the probe is removed and / or repositioned, the tissue in which the probe is placed may become contaminated. In order to prevent contamination and / or reduce the possibility of contamination, the RF functionality of the systems and probes disclosed herein can be used to heat tissue and denature proteins in the tissue. This functionality is not possible using existing systems and conventional cryogenic treatment methods.

[0057] In another example environment, multiple probes can be used for a single cryoablation treatment. Multiple probes can be used to form an ice ball of predetermined size and / or shape at the target tissue. At the end of the cryocycle, the probes need to be removed from the patient. Due to the presence of ice on the target tissue, removal of the probes may be difficult. In such cases, the RF functionality of the systems and probes of the present disclosure can be used to heat the probes and / or surrounding tissue to allow removal of the probes. The RF functionality of the probes of the present disclosure can heat the ice at a faster rate than existing or conventional systems and methods. This in turn can reduce the length of the ablation treatment, which is generally desired to minimize the overall length of the ablation procedure.

[0058] In another example, an RF ablation procedure can be used to destroy target tissue. An RF transmitter (e.g., an RF electrode or a microwave antenna) can be used to raise the temperature of the target tissue to a predetermined temperature level that destroys the tissue. As the temperature of the tissue increases, the tissue may dehydrate. This situation can change the conductivity or other properties of the tissue, thereby causing the rate of increase in tissue temperature to decrease. Therefore, dehydration of the tissue during RF ablation may cause the need for more power and / or increase the length of the RF ablation heating cycle. In some examples according to the present disclosure, a combined RF-cryogenic system and probe can first be used in a cryogenic operating mode to generate ice at the target tissue. Then, the system and probe can be used in an RF operating mode to quickly raise the temperature of the target tissue. In such methods, the amount of dehydration that occurs at the tissue can be reduced. Therefore, RF ablation can be performed with less power and / or in a shorter time.

[0059] The above examples briefly describe possible scenarios for improving existing systems and methods and related methods that can be used. It should be understood that the combined RF-cryogenic system and probe of the present disclosure can also be used in other situations to perform other methods and processes.

[0060] Now go to Figure 1 , an example combined RF-cryogenic system 100 is shown. The combined RF-cryogenic system 100 may include an RF-cryogenic controller 104 coupled to an RF-cryogenic computing device 106 and an RF-cryogenic probe 102. The combined RF-cryogenic system 100 may be configured to operate in an RF mode and a cryogenic mode to provide ablation and other treatments to a patient 120. The RF-cryogenic controller 104 may include a cryogenic delivery system 108 and an RF delivery system 110, which will be further described.

[0061] The cryogenic delivery system 108 can deliver a cryogen to the probe 102. When the probe 102 is positioned at a desired position on or in the patient 120, the cryogen can remove heat from the probe and tissue that can be located near the probe 102. The probe 102 can be positioned at or near, for example, a target tissue (such as a tumor, lesion, or other abnormal tissue). The cryogenic delivery system 108 can cause an ice ball (of various suitable shapes and sizes) to be generated at the distal end of the probe 102, which destroys the target tissue. The cryogen can be various suitable fluids. In one example, the cryogenic delivery system 108 is configured to deliver liquid and / or gaseous nitrogen, argon, or oxygen to the probe 102.

[0062] The RF delivery system 110 can be configured to deliver RF energy to the probe 102. The RF delivery system 110 can deliver an electrical current to the probe 102, for example, which can be transferred to surrounding tissue of the patient 120 via one or more RF electrodes 112. The RF electrodes 112 can be positioned at or near the distal end of the probe 102. In this manner, RF energy can be transferred to the target tissue and, in turn, heat the tissue at the distal end of the probe 102. As desired, heat can be generated using various duty cycles and / or via various power curves to raise the temperature of the tissue to destroy the tissue, coagulate bleeding, and / or restore the tissue to normal body temperature.

[0063] In the example shown, the probe 102 includes one or more RF electrodes 112. In other examples, the probe 102 may include a microwave antenna. The antenna may be positioned at the distal end of the probe 102. The RF delivery system 110 may deliver an electric current to the antenna (e.g., via a coaxial cable in the probe) to cause microwave emission. The microwaves may then heat tissue at or near the distal end of the probe 102 to destroy tissue, coagulate bleeding conditions, and / or restore tissue to normal body temperature. In other examples, the RF electrodes and / or microwave antennas may be used to treat a patient's pain condition via the delivery of RF energy. In the present disclosure, the term RF transmitter is used to describe various structures that use RF energy to heat tissue at the distal end of the probe 102. Such various structures may include RF electrodes, microwave antennas, and the like.

[0064] The combined RF-cryogenic system 100 may also include an RF-cryogenic computing device 106 coupled to the RF-cryogenic controller 104. Figure 1 Although shown as separate elements in the drawings, it should be understood that these elements (and other elements) can be combined into a single structure or further separated from the structures shown and described.

[0065] The RF-cryogenic computing device 106 may be a variety of suitable processing devices, such as computers, servers, laptops, tablets, workstations, circuits, etc., to provide the described functionality. The RF-cryogenic computing device 106 may also include a display and / or other input-output devices to allow a user to interact, control, view, and otherwise configure the operation of the combined RF-cryogenic system 100.

[0066] Figure 2Another example combined RF-cryogenic system 200 is shown. The RF-cryogenic system 200 is similar to the previously described system 100, and can operate in a similar manner to provide both cryogenic freezing cycles and RF heating cycles via an RF-cryogenic probe 202. The RF-cryogenic system 200 can include an RF-cryogenic controller 204, which can be coupled to an RF-cryogenic computing device 206 and the RF-cryogenic probe 202. The RF-cryogenic controller 204 can be configured as a portable device contained in a housing 240. The chamber 240 can include walls for housing various internal components, and include ports, connectors, plugs, wires, conduits, etc. to connect to the RF-cryogenic computing device 206 and the RF-cryogenic probe 202.

[0067] As shown, the RF-cryocontroller may be coupled to the RF-cryo computing device 206 via both a medical power supply 228 and a data bus 224. The medical power supply 228 may provide power to various elements of the RF-cryocontroller 204 and may be coupled to an external power source via an isolation transformer 230 and a power outlet and filter 232. The housing 240 may include an emergency button 234 that may allow an operator to interrupt power to the RF-cryocontroller 204. A fan 236 may also be positioned in the housing 240 to provide airflow and / or cooling to electronic components within the RF-cryocontroller 204.

[0068] The data bus 224 may extend within the housing 240 and be coupled to various elements that control and acquire data and information used during treatment. As shown, the data bus 224 may be coupled to a central ablation control system unit 210 and an ablation sensing, monitoring, pump, heating power, and pain control unit 218. The central ablation control system unit 210 may in turn be coupled to an RF power and lead control 212, a cryogenic interface module 214, and a temperature, impedance, pressure interface module 216. The central ablation control system unit 210 may control the operation of the RF system and / or the cryogenic system to operate the RF-cryogenic system 200 in an RF mode and / or a cryogenic mode.

[0069] For example, when the RF-cryogenic system 200 is operated in the cryogenic mode, the central ablation control system unit 210 can control the elements that deliver the cryogen to the RF-cryogenic probe 202. The control system unit 210 can interface with the cryogenic interface module 214, the ablation sensing, monitoring, pump, heating power, pain control unit 218 to operate a pump that can be connected to a liquid or gas cryogenic material (e.g., cryogen) 222. The control system unit 210 can operate the pump, heater, valve, and / or other elements of the cryogenic system to deliver the cryogen at a desired temperature, pressure, flow rate, pulse rate, frequency, etc., so as to form an ice ball at the distal end of the probe 202.

[0070] The central ablation control system unit 210 may also control elements that deliver appropriate power to cause the RF transmitter in the probe 202 to heat the probe and / or tissue at or near the distal end of the probe 202. For example, the control system unit 210 may send or receive a signal or current via the RF frequency power and lead control device 212 and the ablation sensing, monitoring, pump, heating power, pain control unit 218 to send a power signal to the RF transmitter in the probe 202. The power signal may have a predetermined duty cycle, frequency, pulse width, power profile, power level, etc. to cause a desired amount of heating to occur at the distal end of the probe 202.

[0071] The control system unit 210 and / or the ablation sensor monitoring unit 218 may interact with one or more electrical leads, impedance sensors, temperature sensors, pressure sensors, or other sensors located on the probe 202 to collect various measurements related to the patient's condition and / or operating parameters of the combined RF-cryo system 200. The measurement data from the aforementioned sensors may be routed to the RF-cryo computing device 206 via the data bus 224 for processing, storage, etc. In some cases, the measurement data may be compared to predetermined operating parameter ranges, operating parameter limits, etc., and the RF-cryo computing device may adjust the operating parameters of the combined RF-cryo system 200 to achieve desired operating conditions during treatment.

[0072] Although not shown, the RF-cryo computing device 206 may be connected to other data sources, data repositories, etc. via wireless or wired connections. The RF-cryo computing device 206 may obtain a treatment plan and / or preferred operating conditions for a particular patient, treatment procedure, etc. The RF-cryo computing device 206 may also store measurement data in a local or remote database, which may be collected during a procedure or treatment for further use and / or processing.

[0073] The housing 240 of the RF-cryocontroller 204 may also include a speaker 226 and / or a door controller 238. The speaker 226 may be coupled to the data bus 224 and may be controlled to provide audible alarms or messages regarding the operation of the RF-cryocontroller 200. The door controller 238 may operate all connections of the RF-cryoprobe 202. The door controller 238 may also allow a user to open the door for repair or maintenance. The door controller 238 may include a door sensor for providing a signal when the door is in an open or closed position. The door controller 238 may also include a light emitting diode (LED) that may be controlled to provide an indication and / or alarm of the operating condition of the RF-cryocontroller 204 to the user.

[0074] Reference now Figure 3 , an example RF-cryogenic probe 300 is shown. The probe 300 can be operated in RF mode and cryogenic mode. The probe 300 may include a housing 302, which may form a needle of the probe 300, which may be inserted at or near the target tissue. The probe 300 may include a cryogen conduit 304, through which cryogen may be moved from a Dewar or other cryogen source to a distal end 306 of the probe 300. The cryogen may move along a cryogen path in the probe 300, the cryogen path including an inflow path such as the conduit 304 and an outflow path defined by the inner surface of the housing 302 and the outer surface of the conduit 304. A pump may be used to move the cryogen from the cryogen source through the cryogen path. The probe 300 may employ various suitable cooling methods, including Joules-Thompson cooling, critical cooling, and / or near-critical cooling processes. Any suitable liquid or gaseous cryogen may be used, such as nitrogen, argon, or oxygen.

[0075] The probe 300 also includes one or more RF transmitters that can deliver RF energy to the target tissue. In this example, the probe 300 includes a first RF pad 308, a second RF pad 310, a third RF pad 312, a fourth RF pad 314, a fifth RF pad 316, and a sixth RF pad 318. Each RF pad can be positioned at a different position on the housing 302 of the probe 300. In this example, the first RF pad 308 and the second RF pad 310 are positioned at a first axial position away from the distal end 306. Although the first RF pad 308 and the second RF pad 310 are positioned at the same axial position as each other, each of the first pad 308 and the second pad 310 is positioned at a different circumferential position around the outer surface of the probe 300. The third RF pad 312 and the fourth RF pad 314 are positioned at an axial position different from the first RF pad 308 and the second RF pad 310, which is closer to the distal end 306. The fifth RF pad and the sixth RF pad are positioned closest to the distal end 306. The example probe 300 only shows an example layout of the RF pads on the probe. In other examples, the probe 300 can include more than six RF pads or less than six RF pads. In addition, the RF pads can be positioned at other locations to provide the desired functionality.

[0076] Each of the RF pads can be connected to an RF system that can provide RF energy and / or deliver measurements to the RF-cryogenic controller. The first RF pad can be coupled to the RF-cryogenic controller via a first lead 320. The second RF pad 310 can be coupled to the RF-cryogenic controller via a second lead 322. The third RF pad 312 can be coupled to the RF-cryogenic controller via a third lead 324. The fourth RF pad 314 can be coupled to the RF-cryogenic controller via a fourth lead 326. The fifth RF pad 316 can be coupled to the RF-cryogenic controller via a fifth lead 328. The sixth RF pad 318 can be coupled to the RF-cryogenic controller via a sixth lead 330. Each of the leads 320, 322, 324, 326, 328, 330 can be a length of lead or other conductive path and can extend through the housing 302 or extend inside the housing 302. In other examples, the leads may be embedded in housing 302 , or secured or embedded in a layer on the outside or inside of housing 302 .

[0077] In some examples, pads and / or leads can be added to housing 302 in a separate layer that can be added to the outer surface of probe 300. In other examples, probe 300 can be created using a 3D printing process and / or an additive manufacturing process. In other examples, pads and / or leads can be components of a flexible circuit that is added or fixed to the outer surface of probe 300. Probes with flexible circuits are described in U.S. Patent Application No. 17 / 845,647, filed on the same day as the present application, by Varian Medical Systems, Inc., with the invention name "Ablation Probes Including Flexible Circuits for Heating and Sensing". The entire contents of the above-mentioned application are incorporated herein by reference.

[0078] Each of the pads 308, 310, 312, 314, 316, 318 can be operated independently of each other to deliver RF energy to tissue, thereby causing heating of the local area as desired. For example, the pads can be controlled by the previously described RF-cryogenic controller 104, 204. In other examples, each of the pads 308, 310, 312, 314, 326, 318 can be configured to measure individual impedance or other measurements from the local area.

[0079] The RF energy delivered to pads 308, 310, 312, 314, 316, 318 by leads 320, 322, 324, 326, 328, 330, respectively, can have various characteristics and can be independently controlled as desired. For example, the RF energy delivered to each pad can independently have a predetermined energy level, current, frequency, duty cycle, amplitude, pulse width, etc. The characteristics of the RF energy delivered to the pads can be based on the type of tissue, the desired level of heating, the desired pain relief, the size of the target tissue, the desired ablation area, etc. The predetermined characteristics of the RF energy can be determined, for example, using experimental data and / or historical processing data to develop algorithms, processing models, etc.

[0080] Reference now Figure 4 and Figure 5 , showing different control examples that can be used in conjunction with the probe of the present disclosure. The control examples can be used in conjunction with the aforementioned probe 300. However, it should be understood that the control examples can be used with variations of the probe 300 and other example probes described herein.

[0081] like Figure 4As shown, an example control can use RF frequency control. RF-cryogenic controller 104, 204 can use various frequencies and / or duty cycles to control and / or provide RF energy to the pads / electrodes of probe 300. In an example curve 402, the frequency of the RF signal can be changed according to the clinical, heating and / or pain relief needs of a particular treatment. In another example 404, the duty cycle of the RF signal can be changed according to the clinical, heating and / or pain relief needs of a particular treatment. In yet another example 406, the amplitude modulation of the RF signal can be used and changed according to the clinical, heating and / or pain relief needs of a particular treatment. Any of these or other controls of the RF signal can be used to deliver a common RF signal to one or more pads / electrodes in the pads / electrodes of probe 300. Different RF signals using any combination of control examples 400 can also be used to independently deliver different RF signals to different pads / electrodes of probe 300.

[0082] Now turn to Figure 5 , an example control 500 is shown. In this example, RF signal curves 502, 504 can be delivered to one or more pads / electrodes of the pads / electrodes of the probe 300. In some examples, the same RF signal profile can be delivered to a group of pads / electrodes. For example, RF signal curve 502 can be delivered to pads / electrodes 308, 312, and RF signal curve 504 can be delivered to pads / electrodes 310, 314. Due to the differences in tissues that can be located at a specific area of ​​the probe 300, different RF signal profiles may need to be delivered to different pads / electrodes and / or different pad groups / electrode groups. The probe 300 may also be located near healthy tissue on one side or at an area of ​​the probe 300. Therefore, the RF signal delivered to a specific pad / electrode may be different at a location close to healthy tissue. In another example, different pads / electrodes can perform different functions during a common treatment. For example, some pads / electrodes can heat a tissue location, while other pads / electrodes can provide pain relief and / or other pads / electrodes can perform a coagulation process at another tissue location. Various RF profiles may be used to perform these different functions, as well as for other functions described herein or known to those skilled in the art.

[0083] Reference now Figure 6 , an example method 600 of performing a process is shown. The method 600 may be performed using one of the combined RF-cryogenic systems of the present disclosure including the combined RF-cryogenic system 100, 200 and the probe 300. Although a particular combined RF-cryogenic system is used to help describe the method 600, it should be understood that other RF-cryogenic systems may also be used and that the method is not limited to a particular system, probe, or apparatus.

[0084] The method 600 may begin at step 602. At step 602, the combined RF-cryogenic treatment may begin with the collection of measurement data. The measurement data may include temperature, impedance, images, pressure, flow, and other monitoring of the patient and the combined RF-cryogenic system conditions. At step 604, impedance and temperature data collection may occur. Impedance and temperature data may be collected from the probe 300. The probe 300 may include pads and / or sensors capable of collecting temperature and impedance measurements. The measurement data may be sent to or obtained by the RF-cryogenic controller 104, 204.

[0085] At step 608, the RF-cryogenic system 100, 200 may be initialized with predetermined or initial operating parameters. Such parameters may be determined as part of a treatment plan, which may be obtained by the RF-cryogenic controller 104, 204. Various parameters such as the characteristics of the RF signal, the temperature of the cryogen, the pressure of the cryogen, the flow rate of the cryogen, etc. may be included in the initial operating parameters.

[0086] At step 610, a user may establish or configure a treatment plan. For example, the user may use a user interface on the RF-cryogenic computing device 106, 206 to interact with the RF-cryogenic controller 104, 204 interface. The user may modify, change, or adjust the treatment plan and / or modify operating parameters of the RF-cryogenic system 100, 200 as desired. In some cases, the process may be initiated and moved to step 612. In other cases, the method 600 may proceed to step 606.

[0087] When the circumstances of a particular treatment, such as tissue conditions, patient conditions (e.g., pain and health conditions), or other conditions, indicate that the treatment plan requires further modification or revision, the method 600 may move to step 606. In this case, the treatment plan may be revised and input to the RF-cryocontroller 104, 204. Such changes may include different heat and / or pain control methods and / or other treatment modifications. Depending on the clinical application and user needs, such as tissue location, impedance, blood flow, temperature, tissue material (muscle, fat, bone, etc.), different ablation parameters such as microwave frequency, cryoablation pressure / duration, on / off time, duty cycle, etc. may be utilized, and may be automatically and adaptively adjusted and operated based on user perception (such as comfort indicators) and physician feedback (operation time, temperature estimation, ice ball size estimation, pain level, etc.). In addition, the control of some parameters may be based on calculated indicators, such as impedance change, temperature change rate, and patient pain level change. After step 606, the method 600 may return to step 604 and continue as described.

[0088] If the method proceeds to step 612 after step 610, treatment may be initiated and a cryogenic or RF cycle may be initiated. At step 612, the RF-cryogenic controller 104, 204 and / or the RF-cryogenic computing device 106, 206 may determine whether tissue bleeding is occurring. For example, such determination may be made using impedance measurements obtained from the probe 300. For example, a bleeding condition may be determined by comparing the impedance measurement to a predetermined bleeding impedance range. A bleeding condition may also be determined by measuring impedance changes and comparing the impedance changes to a predetermined range or threshold. If tissue bleeding is observed, the method 600 may move to step 616. If tissue bleeding is not observed, the method 600 may move to step 614.

[0089] At step 616, the RF-cryocontroller 104, 204 may adjust the operating parameters of the RF-cryosystem 100, 200 to take remedial action to address the bleeding condition. For example, the RF-cryocontroller may adjust and / or send an RF signal to an RF transmitter (e.g., an RF pad or electrode) in the detected bleeding area to initiate a coagulation cycle. Such a cycle may heat the area where the bleeding is detected to increase coagulation in that area. Such corrective actions or adjustments may be performed locally using one or more RF pads of the probe 300. After step 616, the method 600 may return to step 604 to re-execute the steps of the method 600 as previously described. In this manner, the RF-cryocontroller 104, 204 may perform actions to address changes that may occur during treatment, such as a bleeding condition.

[0090] At step 614, the RF-cryogenic controller 104, 204 and / or the RF-cryogenic computing device 106, 206 may determine whether a pain condition of the patient is observed. The RF-cryogenic controller 104, 204 may determine whether a pain condition exists. Different parameters and / or indicators may be used, determined, or developed for the patient's pain level and comfort level based on clinical needs and estimates of medical professionals. Patient feedback on pain level may be used during the procedure to adjust operating parameters such as microwave power, frequency, and temperature. In addition, various measurements and / or indicators may be used to determine pain levels or pain conditions. These indicators may include patient heart rate, muscle reaction, facial reflexes, respiratory rate, etc. These indicators and / or other vital signs and patient reaction mechanical and bioelectric signals may also be used to determine and quantify the patient's pain and comfort level. These measurements, indicators, and signals may be compared with predetermined levels, ranges, or other thresholds to determine whether a pain condition exists. If a pain condition is detected, the method 600 may move to step 616. If a pain condition does not exist, the method 600 may move to step 618.

[0091] At step 616, the RF-cryocontroller 104, 204 may make changes, modifications, or other revisions to the operating conditions of the RF-cryosystem 100, 200 to address the pain condition. For example, the RF-cryocontroller 104, 204 may cause an RF signal to be delivered to the target tissue via one or more of the RF pads / electrodes on the probe 300. The RF signal may be suitable for alleviating and / or reducing the detected pain condition. After the RF-cryocontroller takes such changes, adjustments, and / or remedial actions at step 616, the method 600 may return to step 604 to re-execute the aforementioned steps of the method 600. Thus, the RF-cryosystem 100, 200 may also take actions in addition to the other functionalities described to alleviate the pain condition.

[0092] In step 618, the RF-cryogenic controller 104, 204 can determine whether the needle or probe needs a thawing or heating cycle. In some example processes, such thawing or heating cycles can be performed after the freezing cycle. A thawing or heating cycle can be performed to allow the probe 300 to be removed from the ice ball and / or frozen tissue that can be formed during the freezing cycle. In other examples, a heating cycle can be performed to restore the frozen tissue to normal body temperature. As previously described, if a cement or other repair material is needed to repair a body structure, such a heating cycle may be required. In other examples, a heating or thawing cycle can be performed to coagulate or denature proteins at the probe position to prevent and / or reduce the possibility of contamination of the treatment position. The RF-cryogenic controller 104, 204 can determine whether to perform a thawing or heating cycle by retrieving such information from the treatment plan. In other examples, the RF-cryogenic controller 104, 204 can receive such information from an input device. If a thawing or heating cycle is needed, the method 600 can proceed to step 616. If a thawing or heating cycle is not required, method 600 may proceed to step 620 .

[0093] At step 616, the RF-cryogenic controller 104, 204 may adjust the operating parameters of the RF-cryogenic system 100 to perform the desired thawing or heating cycle. The RF-cryogenic controller 104, 204 may initiate delivery of appropriate RF signals to one or more corresponding RF pads / electrodes to perform the thawing or heating cycle. After taking such actions, the method 600 may return to step 604 to re-execute the steps of the method 600 previously described.

[0094] At step 620, the RF-cryocontroller 104, 204 may determine whether RF ablation is desired in addition to cryoablation. The treatment plan may specify whether such RF ablation cycles are to be performed. The RF-cryocontroller 104, 204 and / or the RF-cryocomputing device 106, 206 may retrieve such information. The information may be retrieved from a database or may be retrieved from an input device into which a medical professional may enter or provide such information. If RF ablation is desired or expected, the method 600 may proceed to step 616. If RF ablation is not desired or expected, the method 600 may proceed to step 622.

[0095] At step 616, the RF-cryocontroller 104, 204 may initiate RF ablation by changing, adjusting, or initiating the operation of one or more elements of the RF-cryocontroller 100, 200. For example, the RF-cryocontroller 104, 204 may cause appropriate RF signals to be sent to the RF pads / electrodes to initiate RF ablation. After step 616, the method 600 may return to step 604 to re-execute the steps of the method 600 as previously described.

[0096] At step 622, additional treatments, additional thawing, purging, or freezing cycles may be performed. For example, the treatment plan may detail repeated freezing cycles and / or repeated heating cycles. The specific needs and conditions of the tissue and patient may determine the details of the treatment plan.

[0097] At step 624, the RF-cryocontroller 104, 204 may determine whether the treatment meets the clinical goals. The RF-cryocontroller 104, 204 may make this determination by comparing the measurement data with expected measurement data. Imaging data may also be collected, which may measure aspects of the treatment, such as the position of the probe 300, the size and position of the puck, and / or other aspects of the treatment. This information may be used to determine whether the treatment meets the clinical goals. If the clinical goals have been achieved, the method may end. If the clinical goals have not been achieved, the method may proceed to step 626.

[0098] At step 626, changes may be made to the treatment plan, operating parameters, and / or clinical procedures. The RF-cryocontroller 104, 204 and / or the RF-cryocomputing device 106, 206 may recommend such changes and present such recommendations to the user or medical professional. The method may move to step 606 after step 626 to implement such recommendations and / or changes to the treatment plan, operating parameters, and / or clinical procedures. The method may then return to step 604 to re-execute the steps as previously described, except for the changes determined at step 626.

[0099] Reference now Figure 7, another example method 700 for performing combined RF-cryogenic processing is shown. The method 700 may be performed, for example, using various systems and probes described in the present disclosure, such as the RF-cryogenic systems 100, 200 and the probe 300. However, it should be understood that other systems and devices may also be used.

[0100] The method 700 begins at step 702. At step 702, the RF-cryocontroller 104, 204 and / or the RF-cryocomputing device 106, 206 may confirm the position of the probe 300 at the target tissue. The position of the probe 300 may be confirmed using an imaging device, which may provide imaging data to the RF-cryocontroller 104, 204 and / or the RF-cryocomputing device 106, 206. At the desired location, the probe 300 may be inserted into or proximate to the target tissue, such as a tumor, lesion, or other abnormal tissue.

[0101] At step 704, tissue may be cooled using the combined RF-cryoprobe 300. The RF-cryocontroller 104, 204 and / or the RF-cryo computing device 106, 206 may initiate a flow of cryogen from a cryogen source to the probe 300. The flow of cryogen may begin to cool and freeze target tissue at or near the distal end of the probe 300. An ice ball may begin to form at the distal end of the probe 300. The RF-cryocontroller 104, 204 and / or the RF-cryo computing device 106, 206 may initiate the cryogen flow using predetermined operating characteristics of the RF-cryosystem 100, 200, such as temperature, pressure, flow rate, pulse width, or characteristics of the cryogen flow.

[0102] At step 706, the RF-cryogenic controller 104, 204 and / or the RF-cryogenic computing device 106, 206 may then heat the target tissue and / or the probe 300 using an RF transmitter (e.g., the aforementioned RF pad) in the combined RF-cryogenic probe 300. In other examples, the tissue may be heated using a microwave antenna included in the probe 300. The RF-cryogenic controller 104, 204 and / or the RF-cryogenic computing device 106, 206 may heat the target tissue at a desired location relative to the probe 300 in a desired manner according to the desired results. The heating of step 706 may be performed to thaw an ice ball that has formed at the probe so that the probe 300 can be removed. The heating in step 706 may be performed to restore the target tissue or adjacent body structures such as bones to normal body temperature so that structural cement or other repair procedures may be performed. The heating in step 706 may be performed to cause coagulation of a bleeding state. For example, if the probe 300 is repositioned in the tissue, the heating in step 706 may also be performed to denature the protein at the location of the probe 300.

[0103] As previously described, the RF-cryogenic controller 104, 204 and / or the RF-cryogenic computing device 106, 206 may deliver various RF signals to one or more RF transmitters and / or one or more groups of RF transmitters in the probe 300. In this way, the heating cycle of step 706 may have different heating conditions at different locations on the probe 300.

[0104] The method 700 and / or various steps of the method 700 may be repeated to allow for various treatments to be performed, including multiple cryoablation cycles, multiple RF ablation cycles, coagulation treatments, pain relief treatments, denaturation processes, etc. In addition, the method 700 may be performed using a single combined RF-cryoprobe such as the probe 300. This allows for multiple treatment cycles to be performed during a common treatment. This reduces the number of procedures that need to be performed on a patient and reduces the impact of the treatment on the patient's healthy tissue.

[0105] Reference now Figure 8 , an example computing device 800 is shown. The combined RF-cryoablation system 100, 200 may include one or more computing devices 800. For example, the RF-cryoablation computing device 106, 206 may have Figure 8 The methods of the present disclosure, such as method 700 , may be performed by computing device 800 , or the steps of these methods may be performed by computing device 800 .

[0106] As shown, computing device 800 may include one or more processors 802, working memory 804, one or more input / output devices 806, instruction memory 808, transceiver 812, one or more communication ports 814, and display 816, all operably connected to one or more data buses 810. Data bus 810 allows communication between various devices. Data bus 810 may include wired or wireless communication channels.

[0107] The processor 802 may include one or more different processors, each having one or more cores. Each different processor may have the same or different structures. The processor 802 may include one or more central processing units (CPUs), one or more graphics processing units (GPUs), application specific integrated circuits (ASICs), digital signal processors (DSPs), etc.

[0108] The processor 802 may be configured to perform a specific function or operation by executing a code stored on the instruction memory 808, thereby implementing the function or operation. For example, the processor 802 may be configured to perform one or more of any functions, steps, methods, or operations disclosed herein.

[0109] The instruction memory 808 may store instructions that may be accessed (e.g., read) and executed by the processor 802. For example, the instruction memory 808 may be a non-transitory, computer-readable storage medium such as a read-only memory (ROM), an electrically erasable programmable read-only memory (EEPROM), a flash memory, a removable disk, a CD-ROM, any non-volatile memory, or any other suitable memory.

[0110] The processor 802 may store data to, and read data from, the working memory 804. For example, the processor 802 may store a set of working instructions to the working memory 804, such as instructions loaded from the instruction memory 808. The processor 802 may also use the working memory 804 to store dynamic data created during operation of the RF-cryogenic computing device 106. The working memory 804 may be a random access memory (RAM), such as a static random access memory (SRAM) or a dynamic random access memory (DRAM), or any other suitable memory.

[0111] Input-output devices 806 may include any suitable device that allows data to be input or output. For example, input-output devices 806 may include one or more of a keyboard, a touchpad, a mouse, a stylus, a touch screen, physical buttons, a speaker, a microphone, or any other suitable input or output device.

[0112] Communication port(s) 814 may include, for example, a serial port, such as a universal asynchronous receiver / transmitter (UART) connection, a universal serial bus (USB) connection, or any other suitable communication port or connection. In some examples, communication port(s) 814 allow programming of executable instructions in instruction memory 808. In some examples, communication port(s) 814 allow transfer (e.g., upload or download) of data, such as measurement data, etc.

[0113] The display 816 may display a user interface 818. The user interface 818 may enable a user to interact with the RF-cryogenic computing device 106. For example, the user interface 818 may be a user interface that allows an operator to interact, communicate, control, and / or modify different messages, settings, or features that may be presented or otherwise displayed to the user. The user interface 818 may include a slider, dialog box, or other input field that allows a user to control, communicate, or modify settings, limitations, or inputs used in a cryogenic ablation process. In addition, the user interface 818 may include one or more input fields or controls that allow a user to modify or control optional features or customizable aspects of the RF-cryogenic computing device 106 and / or operating parameters of the combined RF-cryogenic system 100. In some examples, a user may interact with the user interface 818 by using an input-output device 806. In some examples, the display 816 may be a touch screen, wherein the user interface 818 is displayed on the touch screen. In other examples, the display 816 may be a computer display that can be interacted with using a mouse or keyboard.

[0114] The transceiver 812 allows for communication with a network. In some examples, the transceiver 812 is selected based on the type of communication network in which the RF-cryogenic computing device 106 will operate. The processor(s) 802 are operable to receive data from or send data to a network, such as a wired or wireless network coupling elements of the cryoablation system 100.

[0115] For the purpose of illustration and description, the foregoing description of the embodiments is provided. It is not intended to be exhaustive or limit the present disclosure. The individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but in applicable cases, even if not specifically shown or described, they are also interchangeable and can be used in selected embodiments. This can also be changed in many ways. Such variations should not be considered as departing from the present disclosure, and all such modifications are intended to be included within the scope of the present disclosure.

Claims

1. A probe for performing an ablation treatment, comprising: Shell, defining the outer surface; a cooling path, including an inflow path and a return path for a refrigerant; as well as At least one radio frequency (RF) transmitter. 2 . The probe of claim 1 , wherein the cooling path comprises a supply conduit, an inner surface of the supply conduit defining the inflow path, and an outer surface of the supply conduit and an inner surface of the housing defining the outflow path.

3. The probe according to claim 1 or 2, wherein the cooling path is located radially inwardly of the housing.

4. A probe according to claim 1, 2 or 3, configured to move liquid or gaseous nitrogen, argon or oxygen through the probe.

5. The probe according to any one of the preceding claims, wherein the at least one radio frequency (RF) transmitter comprises a plurality of RF electrodes.

6. A probe according to any of the preceding claims, wherein the at least one radio frequency (RF) transmitter comprises a first RF electrode positioned at a first axial position relative to the distal end of the probe, and a second RF electrode positioned at a second axial position relative to the distal end of the probe.

7. A probe according to any one of claims 1-6, wherein the at least one radio frequency (RF) transmitter includes a first RF electrode and a second RF electrode, wherein the first RF electrode and the second RF electrode are each positioned at the same axial position on the housing of the probe, and the first RF electrode is positioned at a different circumferential position from the second RF electrode.

8. A probe according to any preceding claim, wherein the at least one radio frequency (RF) transmitter comprises a microwave antenna.

9. An ablation system, comprising: The probe according to any one of claims 1 to 8; as well as An RF-cryocontroller is configured to control operating characteristics of the cryogen and characteristics of a radio frequency (RF) signal provided to the at least one RF transmitter.

10. The system of claim 9, wherein the RF-cryogenic controller comprises at least one RF-cryogenic computing device and a data bus.

11. The system of claim 9 or 10, wherein the RF-cryocontroller is located in a housing, the housing comprising one or more connectors for connecting the probe.

12. A system according to claim 9, 10 or 11 for performing an ablation treatment.

13. A method comprising: Moving cryogen through the probe; as well as Radio frequency (RF) energy is emitted from a radio frequency (RF) transmitter in the probe.

14. The method of claim 13, comprising cooling the target tissue by moving the cryogen through the probe and heating the target tissue by emitting radio frequency (RF) energy from a radio frequency (RF) transmitter in the probe.

15. The method of claim 14, wherein the steps of cooling the target tissue and heating the target tissue are performed during a common treatment.

16. The method of claim 14 or 15, wherein the step of cooling the target tissue comprises forming an ice ball at the target tissue.

17. A method according to any one of claims 13 to 16, wherein the cryogen comprises liquid or gaseous nitrogen, argon or oxygen.

18. The method of any one of claims 13-17, wherein the radio frequency (RF) transmitter comprises an RF electrode.

19. The method of any one of claims 13 to 18, wherein the radio frequency (RF) transmitter comprises a microwave antenna.

20. The method of any one of claims 14 to 19, wherein the step of heating the target tissue comprises performing a coagulation process.

21. The method of any one of claims 14 to 20, wherein the step of heating the target tissue comprises denaturing proteins at or near the target tissue.

22. The method of any one of claims 14 to 21, wherein the step of heating the target tissue comprises ablating the target tissue.

23. The method of any one of claims 13 to 22, further comprising adding cement to a body structure when the temperature of the body structure is above a predetermined temperature, and wherein the method is performed during a common treatment.

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