Medical device with irrigation manifold

Abstract

To provide an irrigation manifold for a medical device.SOLUTION: The disclosed technology includes an irrigation manifold that routes irrigation fluid to an end effector for a medical device. The irrigation manifold includes a housing and a diverter that extend along a longitudinal axis and respectively connect with irrigation tubes. The end effector includes jackets that each define an irrigation conduit connecting with the irrigation manifold to allow an even distribution of irrigation fluid flow through the jackets.SELECTED DRAWING: Figure 3

Description

[Technical field]

[0001] The present technology relates generally to medical devices, particularly to medical probes having electrodes, and further, but not exclusively, to medical probes suitable for use to induce irreversible electroporation (IRE) of cardiac tissue. [Background technology]

[0002] Cardiac arrhythmias, such as atrial fibrillation (AF), occur when an area of ​​cardiac tissue abnormally conducts electrical signals to adjacent tissue. This disrupts the normal cardiac cycle and causes an asynchronous rhythm. Certain procedures that exist for treating arrhythmias include surgically destroying the source of the signals that cause the arrhythmia and destroying the conduction pathways of such signals. By selectively ablating cardiac tissue with the application of energy via a catheter, it is sometimes possible to stop or alter the propagation of unwanted electrical signals from one part of the heart to another.

[0003] Many current ablation approaches in the art utilize radiofrequency (RF) electrical energy to heat tissue. RF ablation can have certain risks associated with thermal heating that can lead to tissue charring, burning, steam popping, phrenic nerve paralysis, pulmonary vein stenosis, and esophageal fistula.

[0004] Cryoablation is an alternative approach to RF ablation that reduces the thermal risks typically associated with RF ablation. However, manipulating cryoablation devices and selectively applying cryoablation is generally more difficult compared to RF ablation, and thus cryoablation is not feasible in certain anatomical geometries that can be reached by electrical ablation devices.

[0005] Some ablation approaches use irreversible electroporation (IRE) to ablate cardiac tissue using a non-thermal ablation method. IRE delivers short pulses of high voltage to tissue, causing irreversible permeabilization of cell membranes. Delivery of IRE energy to tissue using multi-electrode probes has been previously proposed in the patent literature. Examples of systems and devices configured for IRE ablation are disclosed in U.S. Patent Application Publication Nos. 2021 / 0169550(A1), 2021 / 0169567(A1), 2021 / 0169568(A1), 2021 / 0161592(A1), 2021 / 0196372(A1), 2021 / 0177503(A1), and 2021 / 0186604(A1), each of which is incorporated herein by reference.

[0006] Irrigation is required to ensure that thrombosis does not occur while using IRE ablation, however ensuring uniform irrigation around the electrode is a challenge. Summary of the Invention [Problem to be solved by the invention]

[0007] Therefore, there is a need for improved techniques for evenly distributing irrigation fluid flow around each electrode. [Means for solving the problem]

[0008] In accordance with the disclosed technology, an irrigation manifold for a medical device is provided. The irrigation manifold can include a housing extending along a longitudinal axis and defining a housing lumen, and a housing conduit offset from the housing lumen, the housing conduit configured to connect with a main line irrigation tube. The irrigation manifold can include a flow diverter defining a flow diverter lumen that connects with the housing to define an irrigation chamber. The flow diverter can include a first shaft nested within the housing lumen. The flow diverter can include a flow diverter ring radially disposed about the longitudinal axis and defining a plurality of flow diverter conduits that connect with a distal end of the housing. Each flow diverter conduit is configured to connect with a flow diverter irrigation tube that delivers fluid to an end effector of the medical device.

[0009] According to the disclosed technology, an end effector for a medical device is further provided. The end effector may include an irrigation manifold, at least one spine, and an actuator rod. The irrigation manifold may extend along a longitudinal axis and include a housing and a flow diverter. The housing defines a housing lumen and a housing conduit. The flow diverter defines a flow diverter lumen and connects with the housing to define an irrigation chamber and to define at least one flow diverter conduit. Fluid is configured to flow into the irrigation chamber through the housing conduit and out of the irrigation chamber through the at least one flow diverter conduit. The at least one spine is connected to the irrigation manifold at a proximal end of the at least one spine and configured to bend radially outward from the longitudinal axis and move between an expanded configuration and a collapsed configuration. The at least one flow diverter conduit is configured to route fluid along the at least one spine. An actuator rod passes through the housing lumen and the diverter lumen and is connected to a distal end of the at least one spine, The actuator rod is configured to move the at least one spine between an expanded configuration and a collapsed configuration. [Brief description of the drawings]

[0010] [Figure 1] 1 is a schematic, pictorial diagram of a medical system including a medical device having a distal end including a medical probe having electrodes, in accordance with the disclosed technology; [Diagram 2] FIG. 1 is a schematic, pictorial diagram illustrating a perspective view of an end effector of a medical device in an expanded configuration, in accordance with the disclosed technology; [Diagram 3] FIG. 1 is a schematic, pictorial diagram showing a perspective view of an end effector 100 with sleeves, coils, and rings removed for clarity, in accordance with the disclosed technology. [Figure 4] FIG. 1 is a schematic, pictorial diagram showing a detailed perspective view of a distal end of a spine framework in accordance with the disclosed technology; [Diagram 5] FIG. 1 is a schematic, pictorial diagram showing a detailed perspective view of the proximal end of an end effector with the sleeve removed, in accordance with the disclosed technology; [Figure 6] FIG. 1 is a schematic, pictorial diagram of an exploded view of an irrigation manifold, main line irrigation tubing, and diverter irrigation tubing in accordance with the disclosed technology; [Figure 7] FIG. 1 is a schematic, pictorial diagram showing a perspective view of a proximal end of an end effector shown in cross-section to show certain features, in accordance with the disclosed technology; [Figure 8] FIG. 8 is a schematic, pictorial diagram illustrating a cross-sectional view of the proximal end of the end effector taken along line 8-8 of FIG. 2 in accordance with the disclosed technology. [Figure 9] FIG. 9 is a schematic, pictorial diagram illustrating a cross-sectional view of the proximal end of the end effector taken along line 9-9 of FIG. 2 in accordance with the disclosed technology. [Figure 10] FIG. 4 is a schematic, pictorial diagram illustrating a cross-sectional view of the proximal end of the end effector taken along line 10-10 of FIG. 3 in accordance with the disclosed technology. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] The following detailed description should be read with reference to the drawings, in which like elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict selected examples, and are not intended to limit the scope of the present disclosure. The detailed description illustrates, by way of example, but not by way of limitation, the principles of the disclosed technology. This description clearly enables a person skilled in the art to make and use the disclosed technology, and describes several embodiments, adaptations, variations, alternatives, and uses of the disclosed technology, including what is currently contemplated to be the best mode for carrying out the disclosed technology.

[0012] As used herein, the term "about" or "approximately" with respect to any numerical value or range indicates suitable dimensional tolerances that allow a portion or collection of components to function for the intended purpose described herein. More specifically, "about" or "approximately" may refer to a range of values ​​of ±20% of the recited value, e.g., "about 90%" may refer to a range of values ​​of 71% to 110%. Additionally, as used herein, the terms "patient," "host," "user," and "subject" refer to any human or animal subject, and while use of the subject technology in human patients represents a preferred embodiment, it is not intended to limit the system or method to human use. Similarly, the term "proximal" refers to a location closer to the operator or physician, while "distal" refers to a location farther from the operator or physician.

[0013] As discussed herein, the vascular system of a "patient," "host," "user," and "subject" may be that of a human or any animal. It should be understood that the animal may be of any of a variety of applicable types, including, but not limited to, mammals, veterinary animals, livestock animals, or pet animals. As an example, the animal may be a laboratory animal (e.g., rats, dogs, pigs, monkeys, etc.) that is specifically selected to have certain characteristics similar to humans. It should be understood that the subject may be, for example, any applicable human patient.

[0014] As discussed herein, an "operator" may include a physician, surgeon, technician, scientist, or any other individual or delivery instrument associated with the delivery of a multi-electrode catheter for the treatment of drug-refractory atrial fibrillation to a subject.

[0015] As discussed herein, the term "ablate" or "ablation", in the context of the devices and corresponding systems of the present disclosure, refers to components and structural features that are configured to reduce or prevent the generation of irregular cardiac signals within cells by utilizing non-thermal energy, such as irreversible electroporation (IRE), interchangeably referred to as pulsed electric field (PEF) and pulsed field ablation (PFA), throughout this disclosure. In the context of the devices and corresponding systems of the present disclosure, ablation or ablation is used throughout this disclosure with reference to non-thermal ablation of cardiac tissue in certain conditions, including, but not limited to, arrhythmias, atrial flutter ablation, pulmonary vein isolation, supraventricular tachycardia ablation, and ventricular tachycardia ablation. The term "ablate" or "ablation" also includes known methods, devices, and systems for achieving various forms of body tissue ablation, as will be understood by those skilled in the art.

[0016] As discussed herein, the terms "bipolar" and "monopolar", when used to refer to ablation schemes, describe different ablation schemes with respect to current paths and electric field distribution. "Bipolar" refers to an ablation scheme that utilizes a current path between two electrodes, both of which are placed at the treatment site. The current density and electric flux density are typically approximately equal at each of the two electrodes. "Monopolar" refers to an ablation scheme that utilizes a current path between two electrodes, where one electrode with a high current density and high electric flux density is positioned at the treatment site, and a second electrode with a relatively low current density and lower electric flux density is positioned remotely from the treatment site.

[0017] As discussed herein, the terms "tubular" and "tube" are to be interpreted broadly and are not limited to right cylindrical structures, or structures that are strictly circular in cross section, or that are of uniform cross section throughout their length. For example, a tubular / shaft structure is generally illustrated as a substantially right cylindrical structure. However, a tubular / shaft structure may have a tapered or curved exterior surface without departing from the scope of the present disclosure.

[0018] The present disclosure relates to a system, method, or use and device for IRE ablation of cardiac tissue to treat cardiac arrhythmia. Ablation energy is typically delivered to cardiac tissue by a distal portion of a catheter that can deliver the ablation energy along the tissue to be ablated. Some exemplary catheters include a three-dimensional structure at the distal portion and are configured to administer the ablation energy from various electrodes positioned on the three-dimensional structure. Ablation procedures incorporating such exemplary catheters can be visualized using X-ray fluoroscopy.

[0019] Ablation of cardiac tissue applying radio frequency (RF) energy and thermal techniques such as cryoablation to improve a failing heart is a well-known procedure. Typically, to successfully ablate using thermal techniques, cardiac potentials must be measured at various locations in the myocardium. In addition, temperature measurements during ablation provide data that allows for the effectiveness of the ablation. Typically, in ablation procedures using thermal techniques, electrode potentials and temperatures are measured before, during, and after the actual ablation. RF approaches may have risks that may lead to tissue charring, burning, steam popping, phrenic nerve paralysis, pulmonary vein stenosis, and esophageal fistula. Cryoablation is an alternative approach to RF ablation that can reduce some of the thermal risks associated with RF ablation. However, operating a cryoablation device and selectively applying cryoablation is generally more difficult compared to RF ablation. Thus, cryoablation is not feasible in certain anatomical geometries that can be reached by electrical ablation devices.

[0020] The present disclosure may include electrodes configured for irreversible electroporation (IRE), RF ablation, and / or cryoablation. IRE may be interchangeably referred to as pulsed electric field (PEF) ablation and pulsed field ablation (PFA) throughout this disclosure. IRE as discussed in this disclosure is a non-thermal cell death technique that can be used to ablate atrial arrhythmias. To ablate using IRE / PEF, biphasic voltage pulses are applied to destroy cellular structures of the myocardium. The biphasic pulses are non-sinusoidal waveforms and can be tailored to the target cells based on the electrophysiology of the cells. In contrast, to ablate using RF, a sinusoidal voltage waveform is applied to generate heat in the treatment area, indiscriminately heating all cells within the treatment area. Thus, IRE has the ability to spare adjacent heat-sensitive structures or tissues, which would be beneficial in reducing possible complications known with ablation or isolation modalities. Additionally or alternatively, monophasic pulses can be utilized.

[0021] Electroporation can be induced by applying a pulsed electric field to biological cells to cause the reversible (temporary) or irreversible (permanent) creation of pores in the cell membrane. Cells have a transmembrane electrostatic potential that increases above the resting potential upon application of the pulsed electric field. While the transmembrane electrostatic potential remains below a threshold potential, electroporation is reversible, meaning that the pores can close when the applied pulsed electric field is removed and the cell can self-repair and survive. If the transmembrane electrostatic potential increases above the threshold potential, electroporation is irreversible and the cell becomes permanently permeable. As a result, the cell dies due to loss of homeostasis, typically by apoptosis. In general, different types of cells have different threshold potentials. For example, cardiac cells have a threshold potential of nearly 500V / cm, while bone has a threshold potential of 3000V / cm. These differences in threshold potentials allow IRE to selectively target tissues based on the threshold potential.

[0022] The technology of the present disclosure includes systems and methods for applying electrical signals from a catheter electrode positioned in the vicinity of myocardial tissue to generate ablation energy for ablation of the myocardial tissue. In some examples, the systems and methods may be effective for ablating target tissue by inducing irreversible electroporation. In some examples, the systems and methods may be effective for inducing reversible electroporation as part of a diagnostic procedure. Reversible electroporation occurs when electricity applied at the electrode falls below the electric field threshold of the target tissue, allowing cells to repair. Reversible electroporation does not kill cells, but allows the physician to see the effect of reversible electroporation on the electrical activation signal in the vicinity of the target location. Exemplary systems and methods for reversible electroporation are disclosed in U.S. Patent Application Publication No. 2021 / 0162210, which is incorporated by reference in its entirety.

[0023] The pulsed electric field and its effectiveness in inducing reversible and / or irreversible electroporation can be influenced by the physical parameters of the system and the biphasic pulse parameters of the electrical signal. The physical parameters can include electrode contact area, electrode spacing, electrode shape, etc. The examples presented herein generally include physical parameters adapted to effectively induce reversible and / or irreversible electroporation. The biphasic pulse parameters of the electrical signal can include voltage amplitude, pulse duration, pulse interphase delay, interpulse delay, total application time, delivered energy, etc. In some examples, the parameters of the electrical signal can be adjusted to induce both reversible and irreversible electroporation given the same physical parameters. Examples of various systems and methods of ablation, including IRE, are provided in U.S. Patent Application Publication Nos. 2021 / 0169550(A1), 2021 / 0169567(A1), 2021 / 0169568(A1), 2021 / 0161592(A1), 2021 / 0196372(A1), 2021 / 0177503(A1), and 2021 / 0186604(A1), the entireties of each of which are incorporated by reference herein.

[0024] Please refer to FIG. 1, which illustrates an exemplary catheter-based electrophysiological mapping and ablation system 10. The system 10 includes multiple catheters that are percutaneously inserted by a physician 24 through the vascular system of a patient 23 and into a chamber or vasculature of a heart 12. Typically, a delivery sheath catheter is inserted into the left or right atrium near a desired location of the heart 12. The multiple catheters can then be inserted into the delivery sheath catheter to reach the desired location. The multiple catheters may include catheters dedicated to sensing Intracardiac Electrogram (IEGM) signals, catheters dedicated to ablation, and / or catheters dedicated to both sensing and ablation. An exemplary medical device / probe, e.g., catheter 14, configured to sense IEGMs is illustrated herein. The physician 24 brings the distal tip of the catheter 14 (i.e., in this case, basket assembly 28) into contact with the heart wall to sense a target site within the heart 12. The catheter 14 with a distal basket assembly may be referred to as a basket catheter. For ablation, physician 24 similarly delivers the distal end of an ablation catheter to the target site for ablation.

[0025] The catheter 14 is an exemplary catheter including one, and preferably multiple, electrodes 26 optionally distributed across multiple spines 104 in the basket assembly 28 and configured to sense IEGM signals. The catheter 14 may further include a position sensor embedded in or near the basket assembly 28 for tracking the position and orientation of the basket assembly 28. Optionally and preferably, the position sensor is a magnetic-based position sensor including three magnetic coils for sensing three-dimensional (3D) position and orientation.

[0026] The magnetic-based position sensor may operate in conjunction with a location pad 25 that includes a plurality of magnetic coils 32 configured to generate a magnetic field within a predetermined working volume. The real-time position of the basket assembly 28 of the catheter 14 may be tracked and sensed by the magnetic-based position sensor based on the magnetic field generated by the location pad 25. Details of magnetic-based position sensing technology are described in U.S. Patent Nos. 5,391,199, 5,443,489, 5,558,091, 6,172,499, 6,239,724, 6,332,089, 6,484,118, 6,618,612, 6,690,963, 6,788,967, and 6,892,091, each of which is incorporated herein by reference.

[0027] The system 10 includes one or more electrode patches 38 positioned for skin contact on the patient 23 to establish a positional reference for the location pads 25 and impedance-based tracking of the electrodes 26. For impedance-based tracking, a current is directed to the electrodes 26 and sensed at the electrode skin patch 38, so that the location of each electrode can be triangulated via the electrode patch 38. Details of impedance-based position tracking technology are described in U.S. Patent Nos. 7,536,218, 7,756,576, 7,848,787, 7,869,865, and 8,456,182, each of which is incorporated herein by reference.

[0028] Recorder 11 displays electrograms 21 captured by the body surface ECG electrodes 18 and intracardiac electrograms (IEGMs) captured by electrodes 26 of catheter 14. Recorder 11 may include pacing capability for pacing the cardiac rhythm and / or may be electrically connected to a stand-alone pacer.

[0029] The system 10 may include an ablation energy generator 50 adapted to deliver ablation energy to one or more of the electrodes at the distal tip of a catheter configured for ablation. The energy generated by the ablation energy generator 50 may include, but is not limited to, radiofrequency (RF) energy or pulsed-field ablation (PFA) energy, including unipolar or bipolar high-voltage direct current pulses, such as may be used to effect irreversible electroporation (IRE), or a combination thereof.

[0030] Patient interface unit (PIU) 30 is an interface configured to establish electrical communication between the catheters, electrophysiological equipment, a power source, and a workstation 55 that controls the operation of system 10. The electrophysiological equipment of system 10 may include, for example, multiple catheters, location pads 25, body surface ECG electrodes 18, electrode patches 38, an ablation energy generator 50, and a recorder 11. Optionally and preferably, PIU 30 additionally includes processing capabilities to implement real-time calculations of catheter positions and perform ECG calculations.

[0031] The workstation 55 includes a processor unit having a memory, a memory or storage device loaded with appropriate operating software, and a user interface function. The workstation 55 may optionally provide multiple functions, including: (1) modeling the endocardial anatomical structures in three dimensions (3D) and rendering a model or anatomical map 20 for display on the display device 27; (2) displaying activation sequences (or other data) compiled from recorded electrograms 21 in a representative visual display or image superimposed on the rendered anatomical map 20 on the display device 27; (3) displaying real-time positions and orientations of multiple catheters within the cardiac chambers; and (5) displaying sites of interest, such as where ablation energy has been applied, on the display device 27. One commercially available product embodying elements of the system 10 is available as the CARTO™ 3 system, available from Biosense Webster, Inc., 31 Technology Drive, Suite 200, Irvine, CA 92618, USA.

[0032] 2 is a schematic pictorial diagram showing a perspective view of an end effector of a medical device 14, such as a medical probe having an electrode 26. The medical device 14 includes an end effector 100 at its distal tip 28. The end effector 100 in the currently described example takes the form of a basket assembly including at least one spine 104. The spine 104 may have an elliptical (e.g., circular) or rectangular (which may appear flat) cross-section and may include a flexible, resilient material (e.g., a shape memory alloy such as nickel-titanium, also known as Nitinol) forming struts.

[0033] The end effector 100 is connected to the remainder of the medical probe 14 via an elongated shaft 200. The elongated shaft 200 may be tubular in shape and flexible, with certain portions being more flexible than others. For example, the tip portion may be made more flexible than the rest to allow the end effector 100 to be easily deflected. The elongated shaft 200 may be made from a flexible biocompatible electrically insulating material such as polyamide-polyether (Pebax) copolymer, polyethylene terephthalate (PET), urethane, polyimide, parylene, silicone, etc. In some examples, the insulating material may comprise a biocompatible polymer, including but not limited to polyetheretherketone (PEEK), polyglycolic acid (PGA), poly(lactic-co-glycolic acid) copolymer (PLGA), polycaprolactone (PCL), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly-L-lactide, polydioxanone, polycarbonate, and polyanhydride, with the ratio of specific polymers selected to control the degree of inflammatory response.

[0034] In some examples, the spine 104 may be integrally formed with the distal hub (referred to herein as crown 108), as seen in FIG. 3, to form a one-piece / monolithic spine framework 102. In other examples, the framework 102 may be formed from multiple spines 104 and crowns 108 that are formed separately and connected to one another. The framework 104 may be formed from a flat or cylindrical tube stock of material using any suitable method. For example, the framework 102 may be formed by cutting, laser cutting, stamping, etc.

[0035] The atraumatic ring 114 and the coil 116 are connected to the crown 108. In some examples, the coil 116 can include a single-axis sensor (SAS). In other examples, the coil 116 can include a dual-axis sensor (DAS) or a triaxial sensor (TAS). The coil 116 can include a conductive material wound around a coil, or a coil formed into a flexible circuit. The coil 116 can include a conductor for conducting a current induced on the coil to the patient interface unit 30. As will be appreciated, by attaching the coil 116 to the distal end of the end effector 100, it is possible to detect its position. In this manner, the physician 24 can more accurately determine the position of the distal end of the end effector 100 before applying ablation energy to tissue.

[0036] An insulating material, referred to herein as a jacket 106, is provided over each spine. Each jacket 106 functions to enhance the atraumatic nature of the end effector 100, to protect the subject from sharp edges, and for irrigation purposes, as described in more detail below. The jacket 106 may include a polymer. For example, the jacket 106 may be made from a flexible biocompatible electrically insulating material, such as polyamide-polyether (Pebax) copolymer, polyethylene terephthalate (PET), urethane, polyimide, parylene, silicone, or the like. In some examples, the insulating material may comprise a biocompatible polymer, including but not limited to polyetheretherketone (PEEK), polyglycolic acid (PGA), poly(lactic-co-glycolic acid) copolymer (PLGA), polycaprolactone (PCL), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly-L-lactide, polydioxanone, polycarbonate, and polyanhydride, with the ratio of specific polymers selected to control the degree of inflammatory response. Additionally, while the jacket 106 is shown in these figures as being tubular, the jacket 106 may be molded, scalloped, ribbed, ridged, concave, convex, or otherwise configured such that the overall contour of the jacket 106 provides the physical and / or mechanical properties, such as stiffness and flexion along multiple axes, required for the end effector 100 described above. Additionally, a flexible sleeve 146 is provided over the proximal end of the end effector 100 and the irrigation manifold 120 (FIG. 3), which will be described in more detail below.

[0037] The spine 104 is movable between an extended configuration and a collapsed configuration. The elongated shaft 200 connects the end effector 100 to a handle that can be manipulated by the operator 24 in use. An actuator rod 202 is connected to the crown 108 to facilitate the extension and collapse of the spine 104. For example, the rod 202 can be translated along the longitudinal axis A1 to extend / collapse the spine 104. In the extended configuration (FIG. 2) as well as the collapsed configuration, one or more spines 104 can bend radially outward from the longitudinal axis A1. The spine 104, the elongated shaft 200, and the actuator rod 202 are disposed generally along the longitudinal axis A1 when the elongated shaft 200 is not bent.

[0038] 3 is a schematic pictorial diagram illustrating a perspective view of the end effector 100, sleeve 146, coil 116, and ring 114, with portions removed for clarity. As shown, the framework 102 has a distal end 102A (including crown 108) and a proximal end 102B. The proximal end 102B is connected to an irrigation manifold 120 that delivers irrigation flow 300 via a fluid source 302 coupled to a main line irrigation tubing 140, which will be described in more detail below.

[0039] 4 is a schematic pictorial diagram showing a detailed perspective view of the framework distal end 102A. As shown, the actuator rod 202 extends into a lumen in the crown 108, and the ring 114 connects the actuator rod 202 to the crown 108 via a locking notch 110 defined in the crown 108. The actuator rod 202 also defines a lumen 204 that is coaxial with the longitudinal axis A1, and in use, various medical devices, such as a mapping catheter or a guidewire, can be extended therethrough.

[0040] Continuing to refer to FIG. 4, a pair of openings can be seen extending the length of the jacket 106. Specifically, each jacket 106 defines a spine channel 106A and an irrigation conduit 106B separated by a jacket wall 106C. Each spine channel 106A and irrigation conduit 106B can span the entire length of the jacket 106. The spine 104 extends from the crown 108 through the spine channel 106A and terminates at a spine proximal end 112 (FIG. 5) after exiting the spine channel 106A. The irrigation conduit 106B routes fluid along the spine 104 and will be described in more detail below.

[0041] FIG. 5 is a schematic pictorial diagram showing a detailed perspective view of the proximal end of the end effector 100. FIG. 6 is a schematic pictorial diagram of an exploded view of the irrigation manifold 120, the main line irrigation tubing 140, and the diverter irrigation tubing 142. In addition to the above, and with reference to FIGS. 5 and 6, the distal end 112 of the spine 104 is connected to a spine coupler 118 that is shaped to fit the shape of the distal end 112. The spine coupler 118 is connected to an irrigation manifold 120 that is designed to evenly distribute irrigation fluid 300 to the area where the end effector 100 is placed within the patient 23. The irrigation manifold 120 includes a manifold housing 122 and an irrigation diverter 128 that are connected to each other and extend along a longitudinal axis A1. Although shown as separate components, in some examples, the housing 122 and the diverter 128 can be integrally formed. Thus, the term "connected" can also be interpreted to mean "integral" in some examples. When connected, the housing 122 and the flow distributor 128 define an irrigation chamber 144 (FIGS. 7-10), which will be discussed in more detail below.

[0042] Figure 7 is a schematic, pictorial diagram showing a perspective view of the proximal end of the end effector 100, shown in cross section to illustrate certain features of the disclosed technology. Figure 8 is a schematic, pictorial diagram showing a cross-sectional view of the proximal end of the end effector 100 taken along line 8-8 in Figure 2. Figure 9 is a schematic, pictorial diagram showing a cross-sectional view of the proximal end of the end effector 100 taken along line 9-9 in Figure 2. Figure 10 is a schematic, pictorial diagram showing a cross-sectional view of the proximal end of the end effector 100 taken along line 10-10 in Figure 3.

[0043] 5-10, the manifold housing 122 is generally cylindrical in configuration and defines a housing lumen 124 as well as a hollow portion (to the right of the housing 122 relative to the orientation shown in FIGS. 8 and 9). The housing lumen 124 is parallel or coaxial with a longitudinal axis A1. Axially offset from the housing lumen is a housing conduit 126 which connects with the main line irrigation tubing 140. As can be seen particularly in FIGS. 6-8, the housing conduit 126 is formed in the proximal wall of the housing 122 adjacent the hollow portion.

[0044] Further to the above, the irrigation diverter 128 is generally cylindrical in configuration. The irrigation diverter 128 includes a first diverter shaft 130, a diverter ring 132, and a second diverter shaft 136, all of which are axially aligned along a longitudinal axis A1 and define a diverter lumen 138 therethrough. The first diverter shaft 130 and the second diverter shaft 136 are disposed on either side of the diverter ring 132 along the longitudinal axis A1. As particularly shown in Figures 5 and 7-9, the spine coupler 130 surrounds and connects the second diverter shaft 136 to the second diverter shaft.

[0045] As shown particularly in Figures 7-9, the first flow diverter shaft 130 is nested within the housing lumen 124. The flow diverter ring 132 has a larger outer diameter than the first flow diverter shaft 130 and the second flow diverter shaft 136 and defines one or more flow diverter conduits 134 radially disposed about and extending along the longitudinal axis A1 and spaced apart about the periphery of the flow diverter ring 132. In other words, the flow diverter conduits 134 are laterally offset from and extend parallel to the longitudinal axis A1.

[0046] A lip 132A is also formed on the outer surface of the diverter ring 132. As seen particularly in FIGS. 7-9, the lip nests with the inner annular surface of the manifold housing 122. Thus, due to the respective nesting of the first diverter shaft 130 and the diverter ring 132 with the manifold housing 122, the resulting space therebetween forms an irrigation chamber 144 that is annular in configuration. The irrigation chamber 144 fluidly connects the main line irrigation tube 140 with the diverter conduit, and will be described in more detail below. Additionally, due to the axially aligned lumens 124, 138 and the annular configuration of the irrigation chamber 144, an actuator rod 202 can pass through the lumens 124, 138 and extend at least partially through the elongated shaft 200.

[0047] Referring now primarily to Figures 5-10, each diverter conduit 134 is connected to a diverter irrigation tube 142. More specifically, the proximal end of each diverter irrigation tube 142 may be inserted into a respective diverter conduit 134 such that the diverter irrigation tube 142 extends away from the irrigation manifold 120 toward the distal end of the end effector 100. As seen particularly in Figure 6, the diverter irrigation tubes 142 are oriented parallel to each other and to the longitudinal axis A1. The diverter irrigation tubes 142 are positioned radially beyond the spine coupler 118 (Figures 5 and 7-9). In other words, the diverter irrigation tubes 142 are spaced farther from the longitudinal axis A1 than the distance from the spine coupler 118 to the longitudinal axis (i.e., the radius of the spine coupler 118). With reference to FIG. 5, the diverter irrigation tube 142 surrounds the spine coupler 118 and the second diverter shaft 136 .

[0048] 5-10, the diverter irrigation tubes 142 can be categorized into two subgroups of tubes. Specifically, the diverter irrigation tubes 142 include a first diverter irrigation tube 142A and a second diverter irrigation tube 142B. As best seen in FIG. 5, the diverter conduits 134 are generally grouped into sets of three, with the second diverter irrigation tube 142B sandwiched between two adjacent first diverter irrigation tubes 142A. Thus, in the disclosed example, the ratio of first diverter irrigation tubes 142A to second diverter irrigation tubes 142B is 2:1, although other ratios can be used without departing from the spirit and scope of the present disclosure.

[0049] As shown in particular in Figures 5 and 9, the distal end of each first diverter irrigation tube 142A is connected to / received by the irrigation conduit 106B of a respective jacket 106. This connection provides a continuous fluid path from the irrigation chamber 144 to the irrigation conduit 106B. As illustrated generally by dashed lines 300 in Figure 3, irrigation fluid 300 from a fluid source 302 passes through the main line irrigation tube 140 into the irrigation manifold 120 (specifically, the irrigation chamber 144), through each first diverter irrigation tube 142 (only one path is shown in Figure 3 for purposes of illustration), into each irrigation conduit 106B, and out to the patient 23 through or proximal to an electrode 26 disposed on each spine 104.

[0050] In the examples described herein, the electrodes 26 can be configured to deliver ablation energy (IRE and / or RF) to tissue within the heart 12. In addition to using the electrodes 26 to deliver ablation energy, the electrodes 26 can also be used to determine the position of the end effector 100 and / or measure physiological properties, such as local surface potentials, at respective locations on the tissue within the heart 12. The electrodes 26 can be biased such that a majority of the electrodes 26 points outwardly from the end effector 100, such that the electrodes 26 deliver a greater amount of electrical energy outwardly away from the end effector 100 (i.e., toward the tissue of the heart 12) than inwardly toward the end effector 100.

[0051] Examples of materials that are ideally suited for forming the electrodes 26 include gold, platinum, and palladium (and their respective alloys). These materials also have high thermal conductivity, which allows the minimal heat generated on the tissue (i.e., due to the ablation energy delivered to the tissue) to be conducted through the electrode to the back side of the electrode (i.e., the portion of the electrode inside the spine) and then to the blood pool within the heart 12.

[0052] The electrodes 26 may include one or more outlets 26A (FIG. 2) extending through the electrodes 26 or immediately proximal to the electrodes 26. When irrigation fluid 300 passes through the irrigation conduits 106B in use, a portion of the fluid 300 may be allowed to exit through the outlets 26A such that irrigation is provided directly to each electrode 26. In some examples, some irrigation fluid 300 may pass through the distal-most electrode 26 and continue all the way down the jacket 106 and exit proximal to the ring 114 (see FIG. 4 for reference). In other examples, the ring 114 or another element may be configured to occlude the distal end of the irrigation conduit 106 to block fluid flow, or may be adjustable to selectively allow fluid flow from the distal end as needed by the physician 24.

[0053] 5, 7 and 8 specifically, the distal end of each second diverter irrigation tube 142B is not received by the irrigation conduit 106B. Rather, the second diverter irrigation tube 142B terminates outside of the conduit 106B such that the irrigation fluid 300 is delivered directly to the patient 23 during use, as opposed to being routed through the conduit first. In the illustrated example, the distal end of the second diverter irrigation tube 142B terminates near the proximal end of the jacket 106 along the longitudinal axis A1. As shown in FIG. 8, the irrigation fluid 300 entering the irrigation chamber 144, in addition to being routed through the first diverter irrigation tube 142A, is routed through the second diverter irrigation tube 142B to irrigate near the proximal end of the end effector 100. In some examples, the second diverter irrigation tube 142B may be omitted.

[0054] As explained above, the irrigation manifold 120 and diverter tubes 142, along with the irrigation conduits 106B formed within the jacket 106, allow for even distribution of irrigation around the electrodes 26 while providing a method of providing irrigation directly into the patient 23. As will be appreciated, the presently disclosed technology can be modified in various ways without departing from the spirit and scope of the present disclosure.

[0055] The techniques of the present disclosure described herein can be further understood in accordance with the following clauses.

[0056] Clause 1. An irrigation manifold for a medical device, the irrigation manifold comprising: a housing extending along a longitudinal axis, the housing defining a housing lumen and a housing conduit offset from the housing lumen, the housing conduit configured to connect with a main line irrigation tubing; a diverter defining a diverter lumen connecting with the housing to define an irrigation chamber, the diverter ring comprising a first shaft nested within the housing lumen; and a diverter ring connecting with a distal end of the housing, the diverter ring defining a plurality of diverter conduits radially disposed about the longitudinal axis, each diverter conduit configured to connect with a diverter irrigation tubing that delivers fluid to an end effector of the medical device.

[0057] Clause 2. The irrigation manifold of clause 1, wherein the irrigation chamber is annular in shape.

[0058] Clause 3. The irrigation manifold of any one of clauses 1-2, wherein the flow diverter ring defines a lip that nests with the inner annular surface of the housing.

[0059] Clause 4. The irrigation manifold of any one of clauses 1-3, wherein the plurality of flow diverter conduits are spaced apart around the periphery of the flow diverter ring.

[0060] Clause 5. The irrigation manifold of any one of clauses 1 to 4, wherein the flow distributor further comprises a second shaft, the first shaft and the second shaft being disposed on opposite sides of the flow distributor ring.

[0061] Clause 6. An irrigation system for a medical device, the irrigation system comprising: an irrigation manifold comprising a housing defining a housing conduit and extending along a longitudinal axis, a diverter connecting with the housing to define an annular irrigation chamber and defining a plurality of diverter conduits; a main line irrigation tube connected to the housing conduit and configured to connect to a fluid source; and a plurality of diverter irrigation tubes each connected to a respective diverter conduit and configured to deliver fluid to an end effector of the medical device.

[0062] Clause 7. The irrigation system of clause 6, further comprising an end effector, the end effector comprising a plurality of spines arranged about a longitudinal axis, each spine having a proximal end connected to the irrigation manifold.

[0063] Clause 8. The irrigation system of clause 7, wherein the end effector further comprises a plurality of jackets, each jacket defining a spine channel receiving a respective spine of the plurality of spines and an irrigation conduit receiving a respective diverter irrigation tube of the plurality of diverter irrigation tubes.

[0064] Clause 9. The irrigation system of clause 8, wherein the plurality of diverter irrigation tubes comprises a first diverter irrigation tube and a second diverter irrigation tube, each first diverter irrigation tube being received by an irrigation conduit of a respective jacket of the plurality of jackets, and each second diverter irrigation tube having a distal end disposed outside the plurality of jackets.

[0065] Clause 10. The irrigation system of clause 9, wherein each second diverter irrigation tube is sandwiched by an adjacent first diverter irrigation tube.

[0066] Clause 11. An irrigation system as described in any one of clauses 8 to 10, wherein each spine channel and each irrigation conduit extends the entire length of each jacket.

[0067] Clause 12. The irrigation system of clause 11, further comprising a ring connected to the distal ends of the plurality of spines, the ring occluding a distal end of each irrigation conduit.

[0068] Clause 13. The irrigation system of clause 11, further comprising a ring connected to the distal ends of the plurality of spines, the ring configured to allow fluid to exit the distal end of each irrigation conduit.

[0069] Clause 14. The irrigation system of any one of clauses 7 to 13, further comprising at least one electrode connected to each spine, and at least a portion of the plurality of diverter irrigation tubes configured to deliver fluid through at least one outlet defined within or proximal to at least one electrode.

[0070] Clause 15. An irrigation system as described in any one of clauses 9 to 11, further comprising at least one electrode connected to each jacket, and each first diverter irrigation tube configured to deliver fluid through a respective irrigation conduit of the jacket to the at least one electrode.

[0071] Clause 16. The irrigation system of clause 15, further comprising an outlet defined within or positioned proximate to each electrode of the at least one electrode.

[0072] Clause 17. An end effector for a medical device, the end effector comprising: an irrigation manifold extending along a longitudinal axis, an irrigation manifold comprising: a housing defining a housing lumen and a housing conduit; a diverter defining a diverter lumen and connected to the housing to define an irrigation chamber and defining at least one diverter conduit, wherein fluid is configured to flow into the irrigation chamber via the housing conduit and out of the irrigation chamber via the at least one diverter conduit; at least one spine connected to the irrigation manifold at a proximal end of the at least one spine and configured to bend radially outward from the longitudinal axis and move between an expanded configuration and a collapsed configuration, the at least one diverter conduit configured to route fluid along the at least one spine; and an actuator rod passing through the housing lumen and the diverter lumen and connected to a distal end of the at least one spine, wherein the actuator rod is configured to move the at least one spine between the expanded configuration and the collapsed configuration.

[0073] Clause 18. The end effector of clause 17, wherein at least one spine is integrally formed from tubing stock.

[0074] Clause 19. An end effector described in any one of clauses 17 to 18, further comprising a distal hub integral with at least one spine, the actuator rod being connected to the distal hub.

[0075] Clause 20. An end effector described in any one of clauses 17 to 19, further comprising a spine coupler shaped to couple a proximal end of at least one spine to the flow diverter.

[0076] Clause 21. The end effector of clause 20, wherein the spine coupler surrounds at least a portion of the flow diverter.

[0077] Clause 22. An end effector described in any one of clauses 20 to 21, further comprising at least one diverter irrigation tube connected to the at least one diverter conduit and positioned radially beyond the spine coupler.

[0078] Clause 23. An end effector described in any one of clauses 17 to 22, further comprising at least one electrode connected to at least one spine, the at least one electrode having an outlet configured to allow fluid to exit through the interior.

[0079] Clause 24. An end effector described in any one of clauses 17 to 23, further comprising at least one jacket, the at least one jacket defining a spine channel receiving at least one spine and an irrigation conduit connecting with at least one diverter conduit.

[0080] Clause 25. The end effector of clause 24, wherein at least one jacket comprises a wall separating the spine channel and the irrigation conduit.

[0081] Clause 26. An end effector described in any one of clauses 17 to 25, wherein the actuator rod defines an actuator rod lumen coaxial with the longitudinal axis.

[0082] Clause 27. An end effector described in any one of clauses 17 to 26, wherein the actuator rod is configured to translate along the longitudinal axis and to move at least one spine between an extended configuration and a folded configuration.

[0083] Clause 28. An end effector described in any one of clauses 17 to 27, wherein the housing conduit and at least one diverter conduit are laterally offset from the longitudinal axis and extend parallel to the longitudinal axis.

[0084] The above-described embodiments are cited as examples, and the disclosed technology is not limited to what has been specifically shown and described in the above specification. Rather, the scope of the disclosed technology includes both combinations and subcombinations of the various features described above, as well as variations and modifications thereof that would occur to one skilled in the art upon reading the foregoing description and that are not disclosed in the prior art.

[0085] [Embodiment] (1) An irrigation manifold for a medical device, the irrigation manifold comprising: a housing extending along a longitudinal axis and defining a housing lumen and a housing conduit offset from the housing lumen, the housing conduit configured to connect with a main line irrigation tubing; a flow diverter defining a flow diverter lumen connecting with the housing to define an irrigation chamber, a first shaft nested within the housing lumen; An irrigation manifold comprising: a diverter; and a diverter ring connecting to a distal end of the housing, the diverter ring defining a plurality of diverter conduits arranged radially about the longitudinal axis, each diverter conduit configured to connect to a diverter irrigation tube that delivers fluid to an end effector of the medical device. (2) An irrigation manifold as described in embodiment 1, wherein the irrigation chamber is annular. (3) An irrigation manifold as described in embodiment 1, wherein the flow diverter ring defines a lip that nests with an inner annular surface of the housing. (4) An irrigation manifold as described in embodiment 1, wherein the plurality of flow diverter conduits are spaced around the periphery of the flow diverter ring. (5) The irrigation manifold of embodiment 1, wherein the flow diverter further comprises a second shaft, the first shaft and the second shaft being disposed on opposite sides of the flow diverter ring.

[0086] (6) An irrigation system for a medical device, the irrigation system comprising: 1. An irrigation manifold comprising: a housing defining a housing conduit and extending along a longitudinal axis; an irrigation manifold comprising: a flow diverter connected to the housing to define an annular irrigation chamber and defining a plurality of flow diverter conduits; a main line irrigation tube connected to the housing conduit and configured to connect to a fluid source; a plurality of diverter irrigation tubes, each connected to a respective diverter conduit, the plurality of diverter irrigation tubes configured to deliver fluid to an end effector of the medical device. (7) The irrigation system of embodiment 6, further comprising an end effector, the end effector comprising a plurality of spines arranged about the longitudinal axis, each spine having a proximal end connected to the irrigation manifold. (8) The end effector further comprises a plurality of jackets, each jacket having: a spine channel receiving each of the plurality of spines; and 8. The irrigation system of claim 7, further comprising an irrigation conduit for receiving each of the plurality of diverter irrigation tubes. (9) The irrigation system of embodiment 8, wherein the plurality of diverter irrigation tubes comprises a first diverter irrigation tube and a second diverter irrigation tube, each first diverter irrigation tube being received by the irrigation conduit of a respective jacket of the plurality of jackets, and each second diverter irrigation tube having a distal end disposed outside the plurality of jackets. (10) An irrigation system as described in embodiment 9, wherein each second diverter irrigation tube is sandwiched by an adjacent first diverter irrigation tube.

[0087] (11) An irrigation system as described in embodiment 8, wherein each spine channel and each irrigation conduit runs the entire length of each jacket. (12) The irrigation system of claim 11, further comprising a ring connected to a distal end of the plurality of spines, the ring occluding a distal end of each irrigation conduit. (13) The irrigation system of embodiment 7, further comprising at least one electrode connected to each spine, wherein at least a portion of the plurality of diverter irrigation tubes are configured to deliver the fluid through at least one outlet defined within or proximal to the at least one electrode. (14) The irrigation system of embodiment 9, further comprising at least one electrode connected to each jacket, each first diverter irrigation tube configured to deliver the fluid to the at least one electrode through a respective irrigation conduit of the jacket. (15) The irrigation system of embodiment 14, further comprising an outlet defined within or positioned proximal to each of the at least one electrode.

[0088] (16) An end effector for a medical device, the end effector comprising: an irrigation manifold extending along a longitudinal axis, a housing defining a housing lumen and a housing conduit; an irrigation manifold comprising: a diverter defining a diverter lumen and connecting with the housing to define an irrigation chamber and defining at least one diverter conduit, wherein fluid is configured to flow into the irrigation chamber through the housing conduit and out of the irrigation chamber through the at least one diverter conduit; at least one spine connected to the irrigation manifold at a proximal end of the at least one spine and configured to bend radially outward from the longitudinal axis and move between an expanded configuration and a collapsed configuration, the at least one flow diverter conduit configured to route the fluid along the at least one spine; an actuator rod passing through the housing lumen and the diverter lumen and connected to a distal end of the at least one spine, the actuator rod configured to move the at least one spine between the expanded configuration and the collapsed configuration. (17) The end effector of claim 16, further comprising at least one electrode connected to the at least one spine, the at least one electrode having an outlet configured to allow the fluid to exit through an interior thereof. (18) Further comprising at least one jacket, the at least one jacket comprising: a spine channel receiving the at least one spine; and An end effector as described in embodiment 16, defining an irrigation conduit connecting to the at least one diverter conduit. (19) The end effector of embodiment 18, wherein the at least one jacket comprises a wall separating the spine channel and the irrigation conduit. (20) The end effector of embodiment 16, wherein the housing conduit and the at least one diverter conduit are laterally offset from the longitudinal axis and extend parallel to the longitudinal axis.

Claims

1. 1. An irrigation manifold for a medical device, the irrigation manifold comprising: a housing extending along a longitudinal axis and defining a housing lumen and a housing conduit offset from the housing lumen, the housing conduit configured to connect with a main line irrigation tubing; a flow diverter defining a flow diverter lumen connecting with the housing to define an irrigation chamber, a first shaft nested within the housing lumen; An irrigation manifold comprising: a diverter; and a diverter ring connecting to a distal end of the housing, the diverter ring defining a plurality of diverter conduits arranged radially about the longitudinal axis, each diverter conduit configured to connect to a diverter irrigation tube that delivers fluid to an end effector of the medical device.

2. The irrigation manifold of claim 1 , wherein the irrigation chamber is annular.

3. The irrigation manifold of claim 1 , wherein the flow diverter ring defines a lip that nests with an inner annular surface of the housing.

4. The irrigation manifold of claim 1 , wherein the plurality of flow diverter conduits are spaced around a periphery of the flow diverter ring.

5. The irrigation manifold of claim 1 , wherein the flow diverter further comprises a second shaft, the first shaft and the second shaft being disposed on opposite sides of the flow diverter ring.

6. 1. An irrigation system for a medical device, the irrigation system comprising:

1. An irrigation manifold comprising: a housing defining a housing conduit and extending along a longitudinal axis; an irrigation manifold comprising: a flow diverter connected to the housing to define an annular irrigation chamber and defining a plurality of flow diverter conduits; a main line irrigation tube connected to the housing conduit and configured to connect to a fluid source; a plurality of diverter irrigation tubes, each connected to a respective diverter conduit, the plurality of diverter irrigation tubes configured to deliver fluid to an end effector of the medical device.

7. 7. The irrigation system of claim 6, further comprising the end effector, the end effector comprising a plurality of spines arranged about the longitudinal axis, each spine comprising a proximal end connected to the irrigation manifold.

8. The end effector further comprises a plurality of jackets, each jacket comprising: a spine channel receiving each of the plurality of spines; and The irrigation system of claim 7 , further defining an irrigation conduit receiving each of the plurality of diverter irrigation tubes.

9. 9. The irrigation system of claim 8, wherein the plurality of diverter irrigation tubes comprises a first diverter irrigation tube and a second diverter irrigation tube, each first diverter irrigation tube being received by the irrigation conduit of a respective jacket of the plurality of jackets, and each second diverter irrigation tube having a distal end disposed outside the plurality of jackets.

10. 10. The irrigation system of claim 9, wherein each second diverter irrigation tube is sandwiched by an adjacent first diverter irrigation tube.

11. The irrigation system of claim 8 , wherein each spine channel and each irrigation conduit spans the entire length of each jacket.

12. The irrigation system of claim 11 , further comprising a ring connected to a distal end of the plurality of spines, the ring occluding a distal end of each irrigation conduit.

13. 8. The irrigation system of claim 7, further comprising at least one electrode connected to each spine, wherein at least a portion of the plurality of diverter irrigation tubes are configured to deliver the fluid through at least one outlet defined within or proximal to the at least one electrode.

14. 10. The irrigation system of claim 9, further comprising at least one electrode connected to each jacket, each first diverter irrigation tube configured to deliver the fluid to the at least one electrode through a respective irrigation conduit of the jacket.

15. The irrigation system of claim 14 , further comprising an outlet defined within or disposed proximate to each of the at least one electrode.

16. 1. An end effector for a medical device, the end effector comprising: an irrigation manifold extending along a longitudinal axis, a housing defining a housing lumen and a housing conduit; an irrigation manifold comprising: a diverter defining a diverter lumen and connecting with the housing to define an irrigation chamber and defining at least one diverter conduit, wherein fluid is configured to flow into the irrigation chamber through the housing conduit and out of the irrigation chamber through the at least one diverter conduit; at least one spine connected to the irrigation manifold at a proximal end of the at least one spine and configured to bend radially outward from the longitudinal axis and move between an expanded configuration and a collapsed configuration, the at least one flow diverter conduit configured to route the fluid along the at least one spine; an actuator rod passing through the housing lumen and the diverter lumen and connected to a distal end of the at least one spine, the actuator rod configured to move the at least one spine between the expanded configuration and the collapsed configuration.

17. 17. The end effector of claim 16, further comprising at least one electrode connected to the at least one spine, the at least one electrode comprising an outlet configured to allow the fluid to exit therethrough.

18. Further comprising at least one jacket, the at least one jacket comprising: a spine channel receiving the at least one spine; and The end effector of claim 16 , further defining an irrigation conduit connecting to the at least one diverter conduit.

19. The end effector of claim 18, wherein the at least one jacket comprises a wall separating the spine channel and the irrigation conduit.

20. The end effector of claim 16 , wherein the housing conduit and the at least one diverter conduit are laterally offset from the longitudinal axis and extend parallel to the longitudinal axis.

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