Electrosurgical Instruments

Abstract

The electrosurgical instrument (120) is for delivering pressurized fluid to biological tissue and for delivering radio frequency (RF) electromagnetic (EM) energy and / or microwave frequency EM energy to biological tissue. The electrosurgical instrument (120) includes a flexible shaft (112) having an instrument tip (118) coupled to a distal end thereof. The instrument tip (118) includes a planar body made of a first dielectric material for delivering EM energy to biological tissue, the first dielectric material separating a first conductive element from a second conductive element. The instrument tip has a nozzle (141) for delivering pressurized fluid directly to biological tissue. An outer sleeve (146) extends over the flexible shaft (112) and a proximal section of the instrument tip (118) and strengthens the flexible shaft and the joint between the flexible shaft and the instrument tip.

Description

[Technical field]

[0001] The present invention relates to a surgical instrument for injecting pressurized fluid into tissue. The surgical instrument may be an electrosurgical instrument for delivering electromagnetic energy (e.g., radio frequency and / or microwave frequency energy) to living tissue for cutting the tissue and / or for hemostasis (i.e., promoting blood clotting). For example, the present invention may be applied to instruments sized to be suitable for insertion through the instrument channel of a standard surgical endoscope. [Background technology]

[0002] Surgical resection is a technique for removing parts of organs from the human or animal body. Such organs may be highly vascular. When tissue is cut (divided or transected), tiny blood vessels called arterioles are damaged or ruptured. An initial hemorrhage is followed by a clotting cascade in which blood is converted into a clot in an attempt to plug the bleeding point. During surgery, it is desirable for the patient to lose as little blood as possible, and therefore various devices have been developed in an attempt to provide a hemorrhage-free cut. Also, in the case of endoscopic procedures, bleeding is undesirable and needs to be addressed in an appropriate manner, as blood flow may obstruct the operator's view, which may prolong the operation and may require the procedure to be terminated, forcing the use of alternative methods, e.g., laparotomy, instead.

[0003] Electrosurgical generators are common in hospital operating rooms and are often used in open and laparoscopic procedures, and are increasingly being used with surgical scope devices such as endoscopes. In endoscopic procedures, electrosurgical accessories are typically inserted through a lumen inside the endoscope. Considering an equivalent access channel in laparoscopic procedures, such a lumen would have a relatively smaller inner diameter and a longer length.

[0004] Instead of sharp blades, it is known to use radio frequency (RF) energy to cut biological tissue. Cutting using RF energy works on the principle that as an electric current (aided by the ionic content of the cells and intercellular electrolytes) passes through the tissue matrix, heat is generated by the impedance to the flow of electrons across the tissue. In practice, the instrument is arranged to apply an RF voltage across the tissue matrix, which is sufficient to generate heat in the cells and evaporate the water in the tissue. However, this increased desiccation can result in a loss of direct physical contact between the tissue and the instrument, especially adjacent to the RF emission area of ​​the instrument (where the current path through the tissue has the highest current density). When the applied voltage appears as a voltage drop across this small void, ionization occurs within the void and a plasma is generated. The plasma has a very high volume resistivity compared to tissue. The energy supplied to the instrument maintains the plasma, i.e., completes the electrical circuit between the instrument and the tissue. Volatile materials vaporize when they enter the plasma, which can lead to the perception of a tissue-dissociating plasma.

[0005] GB2 523 246 describes an electrosurgical instrument for applying RF electromagnetic energy and / or microwave frequency EM energy to biological tissue. The instrument comprises a shaft insertable through an instrument channel of a surgical scope apparatus. At the distal end of the shaft is an instrument tip including a planar transmission line formed from a sheet of a first dielectric material having first and second conductive layers on opposing surfaces thereof. The planar transmission line is connected to a coaxial cable carried by the shaft. The coaxial cable is arranged to deliver either microwave or RF energy to the planar transmission line. The coaxial cable includes an inner conductor, an outer conductor coaxial with the inner conductor, and a second dielectric material separating the outer conductor and the inner conductor, the inner conductor and the outer conductor extending beyond the second dielectric material at a connection interface and overlapping opposing surfaces of the transmission line and in electrical contact with the first and second conductive layers, respectively. The instrument further includes a protective outer shell with a smoothly contoured convex underside facing outwardly from the planar transmission line. The underside includes a longitudinally extending concave channel formed therein. A retractable needle is mounted within the instrument and is operable to extend through the recessed channel and protrude from the distal end of the instrument The needle can be used to inject fluid into the treatment zone prior to application of RF or microwave energy.

[0006] The present invention has been devised in light of the above considerations. Summary of the Invention [Problem to be solved by the invention]

[0007] The present invention provides a development of the concepts discussed in GB 2 523 246.

[0008] It is desirable to reduce the size of the instruments, for example by making them thinner and / or shorter. A compact arrangement can provide several advantages. For example, a compact arrangement may allow the instruments to be used in narrower scoping devices and / or smaller biological structures, may allow the instruments to be more easily manipulated, and / or may help improve control and precision at the instrument tip.

[0009] However, it is difficult to reduce the size of an instrument while maintaining its functionality.

[0010] For example, the ability to reduce the size of the device is limited by the size of the retractable needle and its associated structures (e.g., the underside of the contour of the protective shell). One option is to try to reduce the size of the needle. However, it is difficult to reduce the size significantly while maintaining the ability to deliver an effective amount of fluid at a reasonable rate. Furthermore, a small needle can be prone to clogging or obstruction, for example, when attempting to apply a relatively viscous fluid to the treatment zone. In order to reduce the size of the device, the inventors have sought to develop a system that can omit the retractable needle entirely. However, doing so is difficult because the needle provides a function that allows the fluid to be delivered to the treatment site, i.e., by piercing the tissue (such as the mucosa and / or submucosa) before injecting the fluid into the tissue. This ability to inflate the treatment zone to form a convex shape by injecting the fluid can make it easier to cut (compared to an uninjected treatment zone, which has a relatively low contour), for example by cutting around the base of the convex shape and removing the tissue above it.

[0011] Most generally, inventors have developed systems that utilize high pressure fluid rather than needles to puncture tissue. However, it can be difficult to convey high pressure fluid through the instrument without it damaging the instrument (e.g., by bursting) or affecting its motion (e.g., by affecting rotation / bending). Moreover, it is difficult to address these issues (e.g., by making the instrument strong and robust) while keeping the instrument small in size. [Means for solving the problem]

[0012] The inventors have developed a modified device suitable for delivering high pressure fluid to a treatment site to puncture tissue, which can advantageously be more compact than prior art devices, as well as robust to withstand the high pressures exerted by the fluid.

[0013] A first aspect of the present invention provides a surgical instrument (e.g., an electrosurgical instrument) for delivering pressurized fluid to living tissue, the surgical instrument comprising a flexible shaft having a first fluid channel for carrying the pressurized fluid, an instrument tip coupled to a distal end of the flexible shaft, the instrument tip having a second fluid channel for receiving the pressurized fluid from the first fluid channel, the second fluid channel comprising a nozzle at its distal end for delivering the pressurized fluid directly to the living tissue, and an outer sleeve extending over a proximal section of the flexible shaft and the instrument tip to strengthen the flexible shaft and the junction between the flexible shaft and the instrument tip.

[0014] Advantageously, the surgical instrument may use pressurized fluid to inject fluid directly into tissue from a nozzle, rather than requiring a needle to deliver the fluid to the tissue. For example, the fluid pressure may be high enough to puncture or penetrate biological tissue (e.g., mucosal and / or submucosal tissue). Alternatively, the pressurized fluid may be used to irrigate or lift tissue in an area that has already been punctured (e.g., by another instrument or another needle on the surgical instrument that is not connected to the second fluid channel).

[0015] The flexible shaft may include a cannula tube having a lumen for transporting fluid. To provide a torque transmission function, the cannula tube may be formed of a braided tube, for example, including a braided wire (e.g., stainless steel) wrap attached between a radially inner polymer layer and a radially outer polymer layer, the polymer being, for example, Pebax®. Alternatively, the cannula tube may be formed of a coiled tube, for example, an Asahi® torque coil. Arrangements such as these may be particularly susceptible to stretching under the forces of fluid pressure.

[0016] Because the outer sleeve extends over the flexible shaft, it can help to strengthen the outer surface of the shaft and can help prevent the flexible shaft from deforming (e.g., expanding, stretching, or bursting) as pressurized fluid passes through it. Additionally, because the outer sleeve extends further beyond the instrument tip, it can help to seal the junction between the flexible shaft and the instrument tip, thereby helping to prevent relative motion of the flexible shaft with respect to the instrument tip and helping to prevent leakage of pressurized fluid from the junction. Thus, the "outer sleeve" can also be referred to as a "reinforcing sleeve," a "sealing sleeve," or an "encapsulating sleeve."

[0017] The second fluid channel may be fixed (eg, non-retractable) relative to the flexible shaft.

[0018] The distal end of the second fluid channel may form a nozzle, ie, the nozzle may be integrally formed with the remainder of the second fluid channel.

[0019] As used herein, a "nozzle" may be configured to direct a controlled jet of pressurized fluid from the second fluid channel directly at tissue. As used herein, "direct" fluid delivery may refer to an arrangement in which the fluid does not flow along its flow path through any intermediate structure.

[0020] The nozzle may be positioned and shaped to avoid inadvertently puncturing or otherwise damaging tissue. For example, the nozzle may have a relatively blunt or blunt (non-sharp) fluid outlet for injecting pressurized fluid into tissue. For example, the nozzle may be cylindrical and / or have a round (e.g., circular) outlet. The nozzle may be fixed (e.g., non-retractable) relative to the flexible shaft. The nozzle may have an aperture that is flush with or proximal to the surface of the instrument tip (e.g., the distal face of the instrument tip) so as not to protrude from the instrument.

[0021] Because the second fluid channel includes a nozzle at its distal end for delivering pressurized fluid directly to the biological tissue, the instrument may not require a retractable needle to pierce the biological tissue and transfer fluid from the second fluid channel to the biological tissue. Furthermore, the flexible shaft may not require a push rod, control wires, or other means to control the deployment of such a retractable needle in the second fluid channel. Thus, the instrument may have a relatively simple construction and a smaller profile than instruments requiring a retractable needle.

[0022] The term "needle" as used herein may refer to a tube (e.g., a metal tube) having a sharp tip at its distal end for piercing tissue. A "retractable needle" may be longitudinally movable relative to a flexible sheath between a retracted configuration and a deployed configuration, for example, by using a control means, such as a push rod extending through the flexible sheath to the needle. When in the retracted configuration, the sharp distal end of the retractable needle may be disposed proximal to the distal end of the instrument tip such that it does not protrude from the instrument tip. When in the deployed configuration, the sharp distal end may protrude from the instrument tip to pierce tissue.

[0023] Optionally, the instrument tip may not include any retractable needle for puncturing biological tissue. Optionally, neither the flexible shaft nor any retractable needle for puncturing tissue. Further optionally, the instrument tip may not include any needle for puncturing biological tissue. Further optionally, neither the flexible shaft nor any needle for puncturing tissue. Alternatively, in some embodiments, the instrument (e.g., the instrument tip or the flexible shaft) may include a retractable needle, but may not be coupled to a second fluid channel to deliver fluid from the second fluid channel into biological tissue. For example, in some embodiments, the instrument may include a retractable needle that is used (only) to puncture tissue. The second fluid channel may then be used to inject pressurized fluid into the already punctured tissue, without needing a needle to do so. In some embodiments, the flexible shaft may include a separate retractable needle, which may pass through the instrument tip (only) when in the deployed state.

[0024] According to a first aspect, the surgical instrument is an electrosurgical instrument for delivering electromagnetic (EM) energy to tissue. In particular, the surgical instrument is an electrosurgical instrument for applying radio frequency (RF) EM energy and / or microwave frequency EM energy to biological tissue, the instrument tip includes a planar body made of a first dielectric material separating a first conductive element on a first surface thereof from a second conductive element on a second surface thereof, the second surface facing in a direction opposite to the first surface, the flexible shaft further includes a coaxial feed cable having an inner conductor, an outer conductor coaxial with the inner conductor, and a second dielectric material separating the inner and outer conductors, the coaxial feed cable for carrying RF and / or microwave signals, the inner conductor electrically connected to the first conductive element and the outer conductor electrically connected to the second conductive element, and the instrument tip is capable of receiving the RF and / or microwave signals.

[0025] The instrument may thus advantageously provide a dual function for treating tissue by both using pressurized fluid and by using EM signals: the pressurized fluid may be used to puncture and / or inject fluid into tissue, and the RF and / or microwave signals may be used to cut tissue and / or cause hemostasis.

[0026] This arrangement can help prevent the electrosurgical instrument from deforming under high pressure for reasons similar to those described above. Additionally, the outer sleeve can help to better protect the electrical connection between the flexible shaft and the instrument tip by encapsulating and sealing the electrical junction between these components.

[0027] Optionally, the outer sleeve (e.g., a shrink fit layer of the outer sleeve) may extend over at least a proximal portion of the planar body of the instrument tip. For example, the outer sleeve may extend over 20% or more of the length of the planar body of the instrument tip, more preferably over 30% or more of the length of the planar body, and more preferably over 40% or more of the length of the planar body. Thus, the outer sleeve may extend to a central region of the instrument tip. Increasing the extension of the outer sleeve layer may increase its adhesion strength to the instrument tip, which may provide a better grip on the instrument and help prevent deformation.

[0028] Thus, the outer sleeve may include a distal retention portion that may have a different (e.g., smaller) shape and / or size than a more proximal portion of the outer sleeve (e.g., the portion extending over the distal end of the flexible shaft). For example, the outer sleeve may have a distal retention portion with a planar shape, and the more proximal portion of the outer sleeve may have a circular shape with a diameter greater than the thickness of the distal retention portion. These arrangements may help the outer sleeve to grip on the instrument tip and prevent movement of the instrument tip relative to the flexible shaft. The improved grip may help prevent longitudinal distortion of the instrument by helping to prevent the flexible shaft or instrument tip from stretching or propelling longitudinally or distally due to the forces of the pressurized fluid (which may be at particular risk, for example, when the flexible shaft comprises a coiled or braided structure). As a result, these arrangements may also help reduce the risk of leakage between the shaft and the instrument tip.

[0029] In an alternative arrangement, the surgical instrument may not be configured to deliver EM energy to tissue; for example, the surgical instrument may be intended only to deliver pressurized fluid to tissue.

[0030] Optionally, the coaxial feed cable further includes an innermost insulating layer, the innermost insulating layer being hollow and defining the first fluid channel, the first fluid channel thus extending through the center of the coaxial feed cable.

[0031] Advantageously, this arrangement may facilitate fluid delivery by ensuring that the coaxial cable does not impede fluid flow through the shaft, and may also allow the device to be more compact, as compared to an arrangement in which, for example, the fluid channel and coaxial cable are side-by-side within a flexible shaft.

[0032] In an alternative embodiment, the flexible shaft may carry fluid directly therein, i.e., the flexible shaft may be considered to define a first fluid channel and the coaxial feed cable may extend through the first fluid channel. Alternatively, the coaxial feed cable and the first fluid channel may extend side-by-side through the flexible shaft.

[0033] Preferably, the instrument includes an electrical potting for sealing the electrical joint between the coaxial feed cable and the instrument tip, and the shrink fit layer extends over the potting. The electrical potting may include an adhesive, such as a UV curable glue. The potting may also help prevent moisture ingress from causing damage to the electrical joint.

[0034] Optionally, the outer sleeve may include a shrink fit layer extending over the flexible shaft and a proximal section of the instrument tip to strengthen the joint between the flexible shaft and the instrument tip, for example, the shrink fit layer may extend over the proximal section of the planar body, as described above.

[0035] Because the shrink fit layers are formed by starting with a sleeve (or tube) that can slide over the shaft and instrument tip and shrinking the sleeve to fit over the shaft and instrument tip, they can be tightly gripped and then very difficult to disengage or slide over the instrument. By using a shrink fit layer, the outer sleeve can closely conform to the surfaces of the flexible shaft and / or instrument and grip tightly on these surfaces without significantly increasing the size of the instrument. Thus, the shrink fit layer can help achieve the above benefits while preventing leakage of fluids from the deformed and / or modified instrument and maintaining a relatively small size.

[0036] As used herein, the term "shrink fit" may refer to a layer formed from heat shrink material and / or cold shrink material, which may have insulating properties and may be considered to be "molded" to the surface of the flexible shaft.

[0037] Preferably, the shrink fit layer comprises a heat shrink layer (e.g., formed from a thermoplastic). Advantageously, the heat shrink layer may allow for improved control of the fit of the outer sleeve to the shaft, for example by allowing an increased heating temperature during shrink fit to improve the fit of the outer sleeve in certain zones (e.g., near the flexible shaft and / or engagement structures on the instrument tip).

[0038] Optionally, the shrink fit layer includes fluorinated ethylene propylene (FEP). FEP is a particularly useful heat shrink material that can help the device withstand relatively high pressures while maintaining a relatively small profile. For example, an FEP overcoat having a thin profile of 50 microns or less, preferably 30 microns or less, can be applied to strengthen the device. Alternatively, the outer sleeve can include another shrink fit material, such as a polyester shrink material.

[0039] Optionally, the outer sleeve extends over the entire length of the flexible shaft. Optionally, the outer sleeve (e.g., the shrink fit layer and / or additional reinforcing layer) extends beyond the proximal end of the flexible shaft, e.g., overhangs the proximal end of the flexible shaft. Thus, the outer sleeve can be used to reinforce the proximal joint between the flexible shaft and an additional device for conveying pressurized fluid to the flexible shaft (e.g., an interface joint, or a fluid delivery device such as a high pressure syringe). This arrangement can help prevent deformation and / or fluid leakage at the distal joint with the instrument tip along the entire length of the flexible shaft, not just at the proximal end of the flexible shaft.

[0040] As used herein, a "proximal" region of the outer sleeve refers to the region located away from the instrument tip, such as near the pressurized fluid delivery device (e.g., a syringe). Conversely, a "distal" region of the outer sleeve refers to the region located closer to the instrument tip.

[0041] Optionally, the outer sleeve is configured to increase in thickness toward the proximal region of the instrument. The instrument may include a distal portion that extends through the scoping device during use, and a remaining portion that expands in diameter so that it is outside the scoping device during use. Providing a larger diameter in the proximal region of the outer sleeve (which may be outside the scoping device during use) may stiffen the instrument and improve rotational control in this region, for example, by reducing the risk that the shaft may wrap around the outside of the scoping device. Additionally, providing a smaller diameter in the distal region of the outer sleeve may allow the instrument to be inserted through a relatively small scoping device while maintaining these advantages, facilitating maneuverability of the instrument tip around the target tissue. Thus, providing a variable diameter along the length of the outer sleeve may improve instrument maneuverability and help better translate the clinician's motion at the distal end of the instrument into motion of the instrument tip (e.g., by preventing wrapping around the outside of the instrument).

[0042] Optionally, the outer sleeve may be smoothly tapered to gradually increase its thickness toward the proximal region of the instrument. Alternatively, the outer sleeve may be configured with a step to gradually increase its thickness toward the proximal region of the instrument. Thus, the outer sleeve may include two or more sections distributed along the length of the instrument that increase in diameter from the distal region to the proximal region. This may be accomplished, for example, by the outer sleeve including one or more reinforcing layers that each extend across a proximal portion of the flexible shaft and each terminate at an intermediate region of the flexible shaft, increasing the thickness of the outer sleeve toward the proximal region of the instrument.

[0043] This arrangement may provide several advantages. Because the reinforcing layers are located at the proximal portion of the flexible shaft and each terminate at the mid-region of the flexible shaft (i.e., do not extend the entire shaft), they may effectively reinforce (i.e., reduce its flexibility) the proximal portion of the instrument by their effect of increasing the thickness of the outer sleeve in that portion. The use of one or more reinforcing layers may provide a convenient way to vary the diameter in a stepped manner along the instrument. Additionally, stepped diameters may further accentuate the above advantages associated with providing different diameters for portions of the instrument that seat inside or outside the scoping device by more clearly delineating different zones of the instrument that are configured for different purposes (e.g., insertion into or use outside of the scoping device).

[0044] The one or more reinforcing layers may include any suitable material. For example, the one or more reinforcing layers may include a shrink fit material (e.g., a thermoplastic such as FEP or a polyester shrink material). This may help optimize the balance between improving robustness while maintaining a relatively small diameter. Additionally or alternatively, one or more of the reinforcing layers may not include a shrink fit material and may include, for example, a relatively thick tubing. This may be useful to provide a significantly reinforced zone in the proximal region of the instrument compared to the distal region of the instrument. Optionally, one or more of the reinforcing layers may include a torque transmission layer, which may further help transmit torque along the device. For example, the one or more reinforcing layers may include a torque transmission coil (e.g., Asahi® torque coil) or a braided layer (e.g., Optinova® braided shaft). It is understood that the torque transmission coil of the reinforcing layer may be added to a braided flexible shaft or cannula tube.

[0045] Optionally, the outer sleeve may include two or more reinforcing layers. Preferably, when two or more reinforcing layers are provided, they terminate at respective intermediate regions along the flexible shaft, providing a staggered variation in thickness along the length of the outer sleeve. Thus, the outer sleeve may include three or more sections (or "zones") that increase reinforcing stiffness toward the proximal region. Optionally, the outer sleeve may include four or more of these sections, optionally five or more. Thus, the intermediate region of the instrument (which may be located either inside or outside the scoping device in use) may have an intermediate thickness, which may help both to prevent wrapping when outside the scoping device, and to provide a relatively small profile to fit into the scoping device if desired. Thus, providing three or more sections may help to improve the maneuverability of the instrument, i.e., to vary the range of insertion of the instrument through the scoping device, as well as to improve rotational control of the instrument.

[0046] In some embodiments, the "step" between the (thicker) proximal / mid section of the instrument and the (thinner) distal section of the instrument may act as a stop and prevent the proximal or mid section of the instrument from entering the scoping device. This may help prevent over-extension of the instrument through the scoping device.

[0047] Optionally, the outer sleeve may include different materials along its length to increase stiffness (reduce flexibility) toward the proximal region of the instrument. For example, the outer sleeve may include a shrink fit layer that extends over the distal portion of the instrument (for placement inside the scoping device during use) but optionally does not extend over the remaining (proximal) portion of the instrument. For example, the proximal portion of the instrument may have a reinforcing layer that includes a stiffer material than the shrink fit layer that extends over the instrument tip.

[0048] Optionally, the outer sleeve may include adjacent layers formed from complementary materials that can be readily bonded (e.g., by heating) or otherwise attached to one another. Providing a multi-layer outer sleeve formed from multiple materials may help to further improve its robustness and / or improve adhesion between the different materials.

[0049] Alternatively or additionally, rather than utilizing a variation in thickness along the length of the instrument, the outer sleeve may be configured in other ways to increase stiffness (i.e., decrease flexibility) toward its proximal region, for example, by being formed from two or more different materials that are arranged to be stiffer near the proximal end than near the distal end. Optionally, this may be provided without the need for a decrease in thickness toward the distal end, but instead by maintaining a relatively uniform thickness along the length of the outer sleeve.

[0050] Optionally, the outer sleeve includes a tie layer configured to chemically bond to the flexible shaft under heat (e.g., during heat shrinking), which may help to prevent relative movement of adjacent layers, thereby improving deformation / stretch resistance of the device.

[0051] The bonding layer may include a polymer coating or a heat shrink material. For example, the bonding layer may include Pebax, which may be chemically bonded to the outer surface of the flexible shaft (e.g., the outer surface of the Asahi® torque coil). This may help prevent fluid leakage from the flexible shaft, for example, by reducing coil stretch and helping to bond the strands of the torque coil together. The outer sleeve may further include a shrink fit layer (e.g., an FEP layer), which may clamp onto the Pebax to further improve the strength of the device. In alternative embodiments, different materials may be used to form the chemical bond between the flexible shaft and the outer sleeve.

[0052] Although the bonding layer is described in this specification as being constituted by the outer sleeve, because the bonding layer is configured to be chemically bonded to the flexible shaft, the bonding layer may equally be described as being constituted by the flexible shaft rather than by the outer sleeve.

[0053] Optionally, the instrument includes an adhesive layer between the outer sleeve and the flexible shaft and / or the instrument tip, (mechanically) bonding the outer sleeve to the flexible shaft and / or the instrument tip. This may further increase the strength of the attachment between the outer sleeve and the flexible shaft and / or the instrument tip, helping to prevent deformation of the instrument. Suitable adhesives may include, for example, UV adhesives or epoxy adhesives. The adhesive layer may provide similar benefits as the bonding layer described above, may eliminate the need to apply heat to bond different layers, and may optionally be used to bond the outer sleeve directly to the instrument tip.

[0054] Optionally, the distal end of the flexible shaft may include an attachment collar configured to mechanically attach to a complementary interface section of the instrument tip.

[0055] The attachment collar may be a relatively rigid (e.g., solid metal) structure (e.g., a tube) that is attached (e.g., by welding) to or integral with the remaining (distal) section of the flexible shaft (e.g., an Asahi coil or Nitinol tubing) and may be mechanically attached to the instrument tip.

[0056] The mechanical attachment may be provided by an attachment collar that may have a complementary shape, size, and / or configuration with the interface section of the instrument tip to form a male / female mating connection with the interface section. For example, the attachment collar may form a mechanical connection with the interface section of the instrument tip in any suitable manner, including, for example, a press-fit attachment, a rotatable (screw) attachment, or a snap-fit ​​attachment.

[0057] The mechanical attachment between the collar and the interface section may provide several advantages. First, it may provide a convenient method for coupling the flexible shaft to the instrument tip without requiring equipment to weld these components together, for example. Furthermore, because the attachment collar may form a male / female fit with the interface section, it may help provide a fluid-tight connection along a longer section of the joint, as compared to an arrangement in which, for example, only the end face of the instrument tip is welded to the end face of the flexible shaft.

[0058] Similarly, the flexible shaft may include a collar at its proximal end for interfacing with a complementary interface section of another device for receiving a fluid (eg, a fluid delivery device or an interface joint).

[0059] Optionally, the distal end of the flexible shaft may be welded to the instrument tip. A welded connection may be provided in addition to the attachment collar to increase the strength of the connection of the instrument tip to the instrument shaft and help prevent deformation or fluid leakage. For example, a collar may be press-fitted onto the instrument tip and then tack-fitted together with a laser weld, which may help prevent the risk of fluid leakage from the joint between the flexible shaft and the instrument tip.

[0060] Similarly, the proximal end of the flexible shaft may be welded to another device for receiving fluid (eg, a fluid delivery device or an interface joint).

[0061] In an alternative embodiment, the flexible shaft may not include a collar, and instead the instrument tip may be attached (e.g., welded) directly to the flexible shaft. The instrument may include a sealing layer over the weld to seal the joint, which may be further covered by an outer sleeve. For example, the sealing layer may be formed of a polymer tube (e.g., Pebax®) that is reflowed over the weld during heat shrinking of the heat shrink layer of the outer sleeve to seal the joint.

[0062] Optionally, the flexible shaft and / or the instrument tip include one or more engagement structures mated with the outer sleeve, which may help to effectively grip the outer sleeve and prevent movement of the outer sleeve relative to the flexible shaft and / or the instrument tip, thereby further strengthening their connection and helping to mitigate any stretching or deformation.

[0063] For example, the outer sleeve may include a shrink-fit layer that may mate with one or more of the engagement structures, as described above. For example, the outer sleeve may include a heat shrink layer that may be heated during manufacture to shrink against and mate with one or more of the engagement structures. By increasing the temperature applied to the shrink-fit layer, the strength of this attachment may be further improved.

[0064] The one or more engagement structures may include protrusions (such as ribs) or recesses (such as grooves, apertures, or other indentations / depressions) for interlocking with the shrink-fit layer.

[0065] Optionally, the one or more engagement structures may extend along a circumferential length (e.g., periphery) of the flexible shaft and / or the instrument tip. For example, the one or more engagement structures extend around (at least a portion of) the periphery of the flexible shaft or the interface section of the instrument tip. This may advantageously provide an elongated engagement structure that extends (at least partially) transversely to the longitudinal axis of the flexible shaft to better help prevent longitudinal stretching of the flexible shaft.

[0066] Optionally, the flexible shaft and / or the instrument tip may have an indented surface pattern that defines one or more engagement structures. For example, the flexible shaft may include a coil (e.g., an Asahi Intecc 3-layer torque coil) that includes ridges and grooves on its outer surface that act as engagement structures for interfacing with a shrink fit layer.

[0067] Alternatively or additionally, the device may include an attachment collar that includes engagement structure, for example in the form of ribs or grooves.

[0068] Alternatively or additionally, the instrument tip may include one or more engagement structures. For example, the proximal section of the instrument tip may include a first section and a second section, the first section disposed proximally of the second section and configured to interface (e.g., by an interference fit, a snap fit, and / or a weld) with the distal end of the flexible shaft, and the second section may have one or more engagement structures (e.g., recesses) for mating with a shrink fit layer of the outer sleeve.

[0069] In some embodiments, the distal end of the flexible shaft (e.g., its collar) may be configured to provide a smooth (flush) junction with the instrument tip (e.g., by having substantially the same outer diameter as the second section). In alternative embodiments, the flexible shaft may be coupled to the instrument tip at a stepped junction, which may act as an engagement structure by which the outer sleeve may be effectively "locked" in place upon shrink fitting.

[0070] Optionally, the instrument further includes an extension limit wire extending through the flexible shaft to limit the maximum extension length of the flexible shaft.

[0071] The telescopic limit wire can further help to strengthen the flexible shaft against deformation and stretching without significantly increasing the thickness of the device. For example, the telescopic limit wire can have a diameter of 0.4 mm or less, preferably 0.3 mm or less, preferably 0.2 mm or less. The telescopic limit wire can be particularly useful for flexible shafts having a telescopic configuration (e.g., a coiled structure) because the telescopic limit wire can help prevent the flexible shaft from being propelled by the pressurized fluid to stretch in the distal direction.

[0072] In alternative embodiments, the stretch limiting wire may be omitted, for example, as other elements of the device may also constrain stretch (eg, via an outer sleeve and / or engaging formations).

[0073] As an additional advantage, in embodiments having another cable (e.g., a coaxial feed cable) running through or next to the first fluid channel, the stretch limit wire can help press the coaxial cable against the side of the flexible shaft, thereby helping to provide an uninterrupted flow path along the length of the first fluid channel. Optionally, the stretch limit wire can also help to prevent bending or curving of the coaxial cable relative to the flexible shaft near the instrument tip, by pressing the coaxial cable against a region of the flexible shaft that is aligned with the coaxial input section of the instrument tip. The stretch limit wire can also help protect the instrument's electrical connections by helping to prevent any excessive force (such as stretching or bending forces) from being applied to the coaxial cable or its electrical connections.

[0074] Optionally, the instrument tip is configured such that the second fluid channel decreases in diameter from the proximal end to the distal end. The second fluid channel may be configured to taper to decrease in diameter towards its distal end, or may have a stepped profile to have a smaller diameter at its distal end than at its proximal end. The smaller diameter at the distal end may aid in pressurizing the fluid to puncture the tissue. For example, the distal section of the second fluid channel (e.g., a 1 mm section at the distal end of the second fluid channel) may have a diameter of 0.3 mm or less, more preferably 0.2 mm or less, while the proximal section of the second fluid channel (e.g., the remaining section proximal to the distal section) may have a larger diameter of 0.4 mm to 0.7 mm, e.g., 0.5 mm, and may be coupled to a first fluid channel having a gradually increasing diameter (e.g., inner diameter of the flexible shaft).

[0075] Optionally, the instrument tip may include a bridge tube configured to bridge the junction between the first and second fluid channels (thereby bridging the fluid junction between the flexible shaft and the instrument tip). The bridge tube may extend through at least a distal portion of the first fluid channel and at least a proximal portion of the second fluid channel. The bridge tube may help prevent adhesives (e.g., epoxy adhesives that may be used to seal the distal end of a coaxial cable from fluids) from blocking the flow path at the distal end of the flexible shaft. Optionally, the bridge tube may be formed of a flexible material, such as a flexible polymer like polyimide.

[0076] Optionally, the instrument tip includes a hypotube forming at least a portion of the second fluid channel, which may also serve to generate a controlled water jet from the tip of the device to pierce tissue.

[0077] The distal end of the hypotube may include a nozzle, and the entire hypotube may be considered to function as a nozzle. Preferably, the hypotube is aligned (e.g., flush) with or proximal to the distal end of the instrument tip (e.g., the distal end of the planar body) so as not to protrude relative to the planar body. The hypotube may be a metal tube (e.g., Nitinol or stainless steel). The hypotube may extend into the first fluid channel and thus function as a bridging tube bridging the junction between the instrument tip and the flexible shaft. In contrast to a needle, the hypotube may be fixed (non-retractable) relative to the instrument tip and may have a blunted distal end. The second fluid channel and hypotube may provide a convenient and compact arrangement for controllably injecting fluid into tissue without the need for a needle.

[0078] In some embodiments, the hypotube may be disposed (only) at the distal end of the second fluid channel, reducing the diameter of the second fluid channel at the instrument tip compared to the (more proximal) remainder of the second fluid channel. This arrangement may further aid in controllably pressurizing the fluid for injection into tissue. In alternative embodiments, the hypotube may extend throughout the instrument tip.

[0079] In other embodiments, the instrument tip may not include a hypotube, for example, instead, a hole may be drilled through the instrument tip (e.g., through the protective shell of the instrument tip) to form a nozzle directly on the instrument tip.

[0080] Optionally, the proximal section of the instrument tip may be narrower than the distal section of the instrument tip and may terminate at the interface with the distal section in one or more notches to accommodate (seat) the distal end of the outer sleeve. This may help to provide a smooth (e.g., flush) transition between the distal end of the outer sleeve (covering the proximal section of the instrument tip) and the distal section of the instrument tip (not covered by the outer sleeve). A smooth outer surface may aid in maneuverability of the device and may help to allow the flexible shaft to be as small as possible while maintaining a preferred (e.g., wider) width at the distal end of the instrument tip. For example, the instrument tip may include a planar body with a pair of notches, with the outer sleeve extending along the instrument tip to the notches, and the outer sleeve and notches may be sized relative to one another to provide a substantially uniform diameter across the interface with the distal section.

[0081] Optionally, the instrument is sized for insertion through an instrument channel of a surgical scoping apparatus, the instrument channel having a diameter of 3.7 mm or less, more preferably 3.2 mm or less, more preferably 2.8 mm or less. For example, the distal section of the instrument inserted through the scoping apparatus may have a diameter of 3 mm or less, preferably 2.5 mm or less, preferably 2.1 mm or less.

[0082] Optionally, the instrument tip may have a length of 10.0 mm or less. For example, the planar body may have a length of less than 9 mm. For example, the planar body may have a length of 8 mm.

[0083] Optionally, the instrument tip may have a width of 1.9 mm or less. The instrument tip may include a variation in width along its length (e.g., may have a tapered distal region to form a blade). For example, the planar body may have a maximum width of 1.8 mm. Thus, the planar body may be relatively narrower than previous configurations.

[0084] Preferably, the instrument tip has a length that is greater than its maximum width.

[0085] Advantageously, the surgical instruments described herein may be used to deliver fluids at a variety of pressures, e.g., high pressure. For example, the instruments may be used to deliver fluids at a pressure of at least 100 psi, optionally at least 150 psi, optionally at least 200 psi, and optionally at least 250 psi. The specific pressure used may be selected taking into consideration the tissue characteristics at the target area. For example, a higher pressure may be required to puncture the mucosa (e.g., to form an initial incision around the lesion) than to puncture the submucosa (e.g., to refill the lesion with fluid after puncturing the mucosa). For example, 100 psi may provide a pressure useful for puncturing the submucosa. Additionally, tissues of some organs (e.g., the GI tract) may be easier to puncture than other organs (e.g., the stomach) and therefore may require lower pressures. For example, the instruments may deliver fluids in the range of 250-300 psi to puncture tissues in the lower GI tract and fluids in the range of 400-500 psi to puncture tissues in the stomach. Additionally, the pressure at which the instrument is inserted may be selected taking into account the configuration of the instrument itself, for example to offset any known pressure losses that may occur along the instrument, or to account for the size of the nozzle at the instrument tip, and may be controlled or reduced to avoid using too much pressure for a particular application or body area, such as to reduce the risk of unintended perforation.

[0086] According to a second aspect of the invention, there is provided a kit of parts for forming an electrosurgical instrument as described above, the kit of parts including a flexible shaft, an instrument tip, and an outer sleeve. The kit of parts may include any of the features described above. The outer sleeve may be separate from (i.e. not yet applied to) the flexible shaft and the instrument tip, but may be suitable to extend over the proximal section of the flexible shaft and the instrument tip in the manner described above. Additionally, the kit of parts may include a collar (as described above), which may be integral with the flexible shaft or may be separately provided for attachment, such as by welding, to another remaining portion of the flexible shaft (e.g. the cannula of the flexible shaft).

[0087] According to a third aspect of the present invention there is provided a method for forming an electrosurgical instrument for delivering pressurized fluid to biological tissue and for delivering radio frequency (RF) electromagnetic (EM) energy and / or microwave frequency EM energy to biological tissue, the method comprising providing a flexible shaft having a first fluid channel for carrying pressurized fluid, coupling an instrument tip to a distal end of the flexible shaft, the instrument tip having a second fluid channel, and engaging an outer sleeve extending over the flexible shaft and over a proximal section of the instrument tip to strengthen the flexible shaft and a joint between the flexible shaft and the instrument tip, the instrument tip comprising a planar body made from a first dielectric material, the first dielectric material separating a first conductive element on a first surface thereof from a second conductive element on a second surface thereof, the second surface faces in an opposite direction to the first surface, the flexible shaft includes a coaxial feed cable, the coaxial feed cable including an inner conductor, an outer conductor coaxial with the inner conductor, and a second dielectric material separating the inner conductor and the outer conductor, the coaxial feed cable for transmitting RF and / or microwave signals, and coupling the instrument tip to a distal end of the flexible shaft includes electrically connecting the inner conductor to the first conductive element and electrically connecting the outer conductor to the second conductive element to enable the instrument tip to receive RF and / or microwave signals, and coupling a second fluid channel to the first fluid channel to enable the second fluid channel to receive pressurized fluid from the first fluid channel, the second fluid channel comprising a nozzle at a distal end thereof for delivering pressurized fluid directly to biological tissue.

[0088] Additionally, the method may further include one or more steps of providing any of the features / components described above in relation to the electrosurgical instrument and / or kit of parts.

[0089] The present invention includes combinations of the aspects and preferred features described herein, except where such combinations are clearly unacceptable or clearly avoided. For example, the features described above in relation to the connection at the distal end of the flexible shaft (the interface with the instrument tip) may optionally be applied to the connection at the proximal end of the shaft (the interface with the fluid delivery device or interface joint) unless such combinations are clearly unacceptable or explicitly avoided.

[0090] DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Exemplary embodiments illustrating the principles of the present invention will now be described with reference to the accompanying drawings, in which like numerals refer to like elements and in which: FIG. [Brief description of the drawings]

[0091] [Figure 1] 1 is a schematic diagram of a complete electrosurgical system in which the present invention may be applied; [Diagram 2] 1 is a side cross-sectional view of an electrosurgical instrument in accordance with an embodiment of the present invention. [Diagram 3] 3 is a cross-sectional view of the electrosurgical instrument of FIG. 2 taken along line AA. [Figure 4] FIG. 3 is a perspective view of the instrument tip of the electrosurgical instrument of FIG. 2. [Diagram 5] FIG. 3 is a perspective view of the electrosurgical instrument of FIG. 2 with a view through the outer sleeve. [Figure 6] FIG. 3 is a perspective view of the electrosurgical instrument of FIG. 2. [Figure 7] FIG. 3 is a plan view of the electrosurgical instrument of FIG. 2. [Figure 8] FIG. 3 is a side view of the electrosurgical instrument of FIG. 2. [Figure 9] FIG. 3 is a side view of the electrosurgical instrument of FIG. 2 coupled to an interface joint and a torque transfer unit. [Figure 10] FIG. 13 is a side view of another embodiment of an electrosurgical instrument coupled to an interface joint and a torque transfer unit. [Figure 11] FIG. 13 is a side view showing the proximal end of the flexible shaft at its connection to the interface joint. [Figure 12] FIG. 12 is a side view of the flexible shaft of FIG. 11 coupled to an interface joint. [Figure 13] 1 is a cross-sectional view of a flexible shaft of an electrosurgical instrument in accordance with an embodiment of the present invention. [Figure 14] FIG. 14 is a side view of the flexible shaft of FIG. [Figure 15] FIG. 14 is a perspective view of the flexible shaft of FIG. 13. [Figure 16] FIG. 1 is a perspective view of a flexible shaft of an electrosurgical instrument in accordance with an embodiment of the present invention. [Figure 17] FIG. 17 is a side view of the flexible shaft of FIG. [Figure 18] 1A to 1C are a top view, a side view, and a bottom view, respectively, of a distal end portion of an electrosurgical instrument according to an embodiment. [Figure 19] A side-by-side comparison of three electrosurgical instruments. [Figure 20] 1A-E are top views showing various stages in assembling an electrosurgical instrument in an embodiment that does not include an attachment collar. [Figure 21] FIG. 1 is an exploded view of an embodiment of an electrosurgical instrument having an attachment collar. [Figure 22] 22A-22C are side views showing various stages in assembling the electrosurgical instrument of FIG. 21. [Figure 23] 22A-22D are perspective views showing various stages in assembling the electrosurgical instrument of FIG. 21. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0092] Aspects and embodiments of the present invention will now be described with reference to the accompanying drawings. Further aspects and embodiments will be apparent to those skilled in the art. All documents mentioned in this text are incorporated herein by reference.

[0093] 1 is a schematic diagram of a complete electrosurgical system 100 capable of selectively delivering any or all of RF energy, microwave energy and fluid, such as saline or hyaluronic acid, to the distal end of an invasive electrosurgical instrument. The system 100 includes a generator 102 for controllably delivering electromagnetic (EM) energy. In this embodiment, the EM energy includes RF EM energy and / or microwave frequency EM energy. Suitable generators for this purpose are described in WO2012 / 076844, which is incorporated herein by reference.

[0094] The generator 102 is connected to an interface joint 106 by an interface cable 104. The interface joint 106 is also coupled to receive a pressurized fluid supply from a fluid delivery device 108 via a fluid supply cable 107. The function of the interface joint 106 is to combine the inputs from the generator 102 and the fluid delivery device 108 to a single flexible shaft 112 that extends from a distal end of the interface joint 106. It will be appreciated that the shaft 112 may form part of the interface joint 106.

[0095] The flexible shaft 112 is insertable through the entire length of the instrument (working) channel of the surgical scoping device 114. A torque transfer unit 116 may be attached to the proximal length of the shaft 112 between the interface joint 106 and the surgical scoping device 114. If present, the torque transfer unit 116 engages the shaft and allows it to rotate within the instrument channel of the surgical scoping device 114.

[0096] The flexible shaft 112 has an electrosurgical instrument tip 118 shaped to pass through an instrument channel of a surgical scope device 114 (e.g., an endoscope) and protrude (e.g., inside the patient) at the distal end of the instrument channel. The instrument tip includes an active tip for delivering RF EM energy and / or microwave EM energy to living tissue, and an aperture for delivering pressurized fluid (e.g., saline, Gelofusine, and / or hyaluronic acid with added marker dyes). These combined technologies provide a unique solution for cutting and destroying unwanted tissue, as well as the ability to seal blood vessels around the target area. By applying pressure to the fluid, the surgeon can inject the fluid between the tissue layers to expand and mark the location of the lesion to be treated. Injecting the fluid in this manner lifts and separates the tissue layers, facilitating both resection around the lesion and flattening the submucosa, reducing the risk of perforation of the bowel wall and unnecessary thermal damage to the muscle layer.

[0097] The instrument tip 118 further includes a protective shell disposed beneath the active tip to aid in tissue planarizing type cutting actions, which also protects against inadvertent perforation and helps ensure viability of remaining tissue, which in turn promotes more rapid healing and post-operative recovery.

[0098] The structure of the instrument tip 118 may be specifically designed for use with conventional steerable flexible endoscopes having working channels with inner diameters of at least 2.2 mm and working lengths of 60 cm to 170 cm. Thus, the majority of relatively small diameter instruments are contained within the much larger, primarily polymeric isolator, i.e., the lumen, of the flexible endoscope channel. In practice, only 5 mm to 25 mm of the distal assembly protrudes beyond the distal end of the endoscope channel so as not to obstruct the field of view or adversely affect camera focusing. The protruding portion of the distal assembly is the only portion of the instrument that comes into direct contact with the patient.

[0099] At the proximal end of the working channel of the endoscope, which is typically held 50-80 cm away from the patient, the flexible shaft 112 exits the working channel port and extends a further 30-100 cm to the interface joint 106. In use, the interface joint 106 is typically held by a gloved assistant throughout the procedure. The interface cable 104 connects to the generator 102 using a QMA type coaxial interface designed to allow continuous clockwise or counterclockwise rotation. This allows the interface joint 106 to rotate with the torque transfer unit 116 under the control of the user. The assistant supports the interface joint 106 throughout the procedure to assist the user in rotating instruments by resonance and injecting fluids.

[0100] Figures 2 to 8 show details of an electrosurgical instrument 120 according to an embodiment of the present invention. In particular, Figure 2 is a side cross-sectional view showing details of electrosurgical instrument 120, and Figure 3 shows another cross-sectional view of electrosurgical instrument 120 taken along line AA shown in Figure 2.

[0101] As can be seen in FIGS. 2 and 3, the electrosurgical instrument 120 includes a flexible shaft 112 and an instrument tip 118 .

[0102] The flexible shaft 112 includes a first fluid channel 122 for carrying pressurized fluid from a proximal end of the flexible shaft (e.g., interface joint 106 shown in FIG. 1) to the instrument tip 118. In this embodiment, the flexible shaft 112 includes a cannula tube and a polymer layer reflowed onto the braided tube. For example, the cannula tube may be formed of braided tubing (e.g., Asahi torque coil), and the flexible shaft may further include a thin layer of Pebax (e.g., 0.10-0.15 mm, e.g., 0.14 mm) reflowed onto the cannula tube. In this embodiment, the flexible shaft 112 carries fluid directly therethrough, i.e., the flexible shaft 112 directly defines the first fluid channel 122. However, in alternative embodiments, the flexible shaft may carry a separate lumen that defines the first fluid channel.

[0103] The flexible shaft may further include a stretch limit wire 123 (shown in FIG. 3 ), which may extend therethrough and limit the extension of the flexible shaft 112. The stretch limit wire 123 is not visible in FIG. 2 because it is located behind the coaxial cable 124. As shown in FIG. 3 , the stretch limit wire 123 may be positioned next to the coaxial cable 124 to offset the coaxial cable 124 to the side of the flexible shaft (e.g., toward the right as shown in FIG. 3 ) and help provide an uninterrupted flow path through the flexible shaft 112. In an alternative embodiment, the stretch limit wire 123 may be configured to offset the coaxial cable 124 to the side of the shaft 112 that is aligned with the electrical input section 142 of the instrument tip 118 (e.g., by placing the stretch limit wire below the shaft from the perspective shown in FIG. 3 ).

[0104] The flexible shaft 112 does not include a control means for controlling the retractable needle to pierce the tissue and deliver fluid from the first fluid channel to the tissue.

[0105] The flexible shaft 112 further includes a coaxial feed cable 124 (or simply "coaxial cable") for transmitting RF and / or microwave electromagnetic signals (e.g., from the generator 102 of FIG. 1) to the instrument tip 118. The coaxial feed cable 124 includes an inner conductor 126, an outer conductor 128 coaxial with the inner body, and a dielectric material 130 separating the inner and outer conductors. The coaxial feed cable 124 further includes an outer sheath 132 for separating the outer conductor 128 from the fluid supply channel 122.

[0106] The flexible shaft 112 is electrically connected to the instrument tip 118 and transmits the EM signal from the coaxial feed cable 124 to the biological tissue. In particular, the instrument tip 118 includes an active tip having a planar body 134 made of a dielectric material (e.g., alumina) having a first conductive element 136 and a second conductive element 137 on its upper and lower surfaces, respectively. For example, the first and second conductive elements may be formed of gold.

[0107] The inner conductor 126 of the coaxial cable 124 is electrically connected to a first conductive element 136 (shown in FIGS. 4-6) and the outer conductor 128 of the coaxial cable 124 is electrically connected to a second conductive element 137, enabling the instrument tip to receive EM signals. More specifically, at the distal end of the coaxial cable 124, its outer sheath 132 is removed to expose a length of the outer conductor 128. The inner conductor 126 of the coaxial cable 124 extends beyond the distal end of the outer conductor 128. The coaxial cable 124 and the instrument tip 118 are attached relative to one another such that a protruding portion of the inner conductor 126 overlies the first conductive element 136 of the active tip while the outer conductor 128 is electrically connected to the second conductive element 137 by a conductive adapter element. The first conductive element 136 is separated from the outer conductor 128 and the second conductive element 137 is separated from the inner conductor 126.

[0108] FIG. 4 shows a perspective view of the instrument tip 118 including an interface section 138 having a retractable wire input 139 for connecting to the retractable wire 123, an input end of a (second) fluid channel 140 for connecting to the (first) fluid channel 122 of the flexible shaft 112, and an electrical input section 142 for connecting to the coaxial cable 124 of the flexible shaft 112.

[0109] Returning to Figure 2, the flexible shaft 112 further includes an attachment collar 144 at its distal end for connection to the instrument tip 118. In particular, the attachment collar 144 is configured to form an interference fit with the interface section 138 of the instrument tip 118.

[0110] When interface section 138 is attached to attachment collar 144, instrument tip 118 is capable of receiving and delivering pressurized fluid and electromagnetic signals from flexible shaft 112 to living tissue.

[0111] Optionally, the device may further include a bridge tube 143 (e.g., a polyimide tube) that extends across the junction between the first fluid channel 122 and the second fluid channel 140. In this embodiment, the bridge tube 143 is located only within the proximal section of the second fluid channel 140, i.e., does not extend to the distal end of the second fluid channel 140. The bridge tube 143 may help prevent an adhesive (such as an epoxy adhesive) used to seal the coaxial cable 124 from fluids from blocking the flow path between the first fluid channel 122 and the second fluid channel 140.

[0112] To deliver pressurized fluid into tissue, the second fluid channel 140 extends through the instrument tip 118 to a nozzle 141. As shown in FIG. 2, the second fluid channel 140 has a stepped inner diameter, such that the distal section of the second fluid channel 140 (including the nozzle 141) has a smaller diameter than the proximal section of the second fluid channel 140 (including the bridging tube 143). The distal section of the second fluid channel 140 has or forms a nozzle at its distal end. In other embodiments, the instrument tip may include a hypotube, which has or forms a nozzle at its distal end. These features aid the instrument tip in applying a controlled jet of pressurized fluid to tissue. Thus, the instrument tip 118 does not require a retractable needle to pierce the biological tissue and deliver fluid from the second fluid channel 140 to the biological tissue.

[0113] 2 and 3, electrosurgical instrument 120, when fully assembled, further includes an outer sleeve 146 with a shrink fit layer 148 that extends over and grips flexible shaft 112 and a proximal section of instrument tip 118. For example, the shrink fit layer may be formed from FEP heat shrink material. The shrink fit layer may be relatively thin, for example between 0.02 mm and 0.1 mm, for example between 0.04 mm and 0.07 mm, for example 0.05 mm.

[0114] The shrink fit layer 148 extends over the instrument tip 118 sufficiently to cover the exposed portion of the inner conductor 126, and thus the electrical junction between the inner conductor 126 and the first conductive element 136. An electrical potting 150 is included in the instrument to fill the gap between the active tip and the shrink fit layer 148 and further encapsulate and seal this electrical junction.

[0115] The shrink fit layer 148 extends over the flexible shaft 112 and over the proximal section of the instrument tip 118, and therefore also over the attachment collar 144 and interface section 138, thereby joining the flexible shaft 112 and the instrument tip 118. To increase the strength of attachment of the shrink fit layer 148 to these components, the attachment collar 144 and interface section 138 each include respective engagement structures for mating with the shrink fit layer 148.

[0116] The attachment collar 144 includes an engagement structure 152 in the form of a groove extending circumferentially around the collar 144. Additionally, the interface section 138 includes an aperture 153 in which optional further engagement structures may be provided. Upon shrinking onto the surface of the flexible shaft 112 and the instrument tip 118, the shrink fit layer 148 may conform to the engagement structure 152 and aperture 153, thereby forming a stronger grip on the device and helping to prevent relative movement between the instrument tip 118 and the flexible shaft 112. Additionally, the shrink fit layer may further interlock with surface features along the length of the flexible shaft, such as its coiled or braided structure.

[0117] Aperture 153 may also serve as a soldering hole for attaching coaxial cable 124 to interface section 138 of instrument tip 118. As shown in FIG. 4, interface section 138 may also include apertures 155A and 155B, which may serve as weld points for coupling telescopic wire 123 to interface section 138.

[0118] In this embodiment, shrink fit layer 148 includes a heat shrink layer that is not heated sufficiently in the region of apertures 153 or 155A and 155B to engage the apertures, but the heat shrink layer will function as engagement structure 152 when it is further heated in the region of engagement structure 152 to engage (or penetrate) into the circumferential grooves.

[0119] The instrument tip 118 further includes a seating structure for receiving the distal end of the outer sleeve 146. More specifically, the proximal section of the instrument tip includes a constricted section that terminates at a distal end in a notch 154 (also called a step) having a depth substantially equal to the thickness of the outer sleeve (e.g., 0.05 mm). Upon contraction onto the surface of the instrument tip 118, the distal end of the outer sleeve 146 seats within the constricted section with the distal end of the outer sleeve 146 aligned with the notch 154. Thus, the outer sleeve 146 may form a smoother (substantially flush) interface with the instrument tip 118.

[0120] In this embodiment, the instrument tip 118 is narrowed along the lower and side edges of its proximal section to form a flush transition in these regions (as can be seen in Figures 2, and 5-8), although various other configurations of narrowed sections are possible to accommodate the outer sleeve along various regions of the instrument tip.

[0121] 9, the outer sleeve 146 is configured to increase in thickness toward the proximal end of the instrument 120. The outer sleeve 146 includes a distal section 156 and a proximal section 158, each having a different thickness. During use, the proximal section 158 may be disposed between the interface joint 106 and the torque transfer unit 116, and the distal section 156 may be disposed (at least partially) within the surgical scoping apparatus 114.

[0122] The distal section 156 may be suitable for insertion through a surgical scoping device having a working length of 1020 mm to 1100 mm. For example, the distal section 156 may have a working length of 1240 mm. The distal section 156 may be constructed in the manner described above without further layers. For example, the distal section 156 may include (e.g., only include) a cannula tube formed of a torque coil (e.g., Asahi torque coil) coated with a thin layer of polymer (e.g., Pebax) and a shrink fit layer 148, e.g., having FEP heat shrink (e.g., 0.05 mm thick). The distal section may have a maximum outer diameter of, e.g., 2.1 mm. Thus, the distal section may be suitable for insertion through a scoping device having an inner diameter of 2.2 mm or more, e.g., a 2.8 mm scoping device.

[0123] The proximal section 158 may be configured similarly to the distal section 156, but further includes (e.g., further includes only) a reinforcement layer to strengthen the cable between the torque transfer unit 116 and the interface joint 106. For example, the reinforcement layer may include a braided shaft (e.g., an Optinova braided shaft) that is attached (e.g., glued) to the interface joint 106. This reinforcement layer in the proximal section 158 may help to avoid wrapping and provide better rotational control. The proximal section may have a diameter of, for example, 2.65 mm. Because the proximal section 158 is relatively thick and robust compared to the distal section 156, the shrink fit layer 148 may be optionally omitted and still be able to withstand high pressures through the flexible shaft.

[0124] 10 illustrates an alternative embodiment of an instrument 220 having an outer sleeve 246 that is configured to increase in thickness toward the proximal end of the instrument. The outer sleeve 246 includes a distal section 256, a proximal section 258, and an intermediate section 260 located between the distal and proximal sections.

[0125] Distal section 256 may be configured similarly to distal section 156 of FIG. 9, but may be shorter to ensure that a majority of distal section 256 is inserted into a scoping device during use. For example, distal section 256 may have a length of approximately 1155 mm, such that during use, it is nearly fully inserted into a surgical scoping device having a working length of 1020 mm to 1100 mm.

[0126] The mid-section 260 is located between the distal section 256 and the torque transfer unit 116, i.e., in the portion of the instrument that may vary while being located either inside or outside the surgical scope device during use. The mid-section 260 may have the same structure as the distal section 256, but is further strengthened relative to the distal section 258 to provide strain relief and help prevent the risk of the shaft wrapping just outside the scope device while remaining thin enough to fit inside the instrument channel of the scope device. The mid-section 260 may also provide the advantage of allowing the device to be used with a variety of surgical scope devices (e.g., having a variety of lengths and diameters). For example, the mid-section may have a maximum diameter of 2.5 mm (e.g., a maximum diameter of 2.25 mm), while the distal section may have a maximum diameter of 2.2 mm (e.g., a maximum diameter of 2.1 mm).

[0127] In an embodiment, mid-section 260 includes a reinforcing layer that includes a shrink-fit material, which can help maintain a low profile, if desired, avoiding the risk of the reinforcing layer affecting insertion through a scoping device.

[0128] For example, the distal section may include a FEP shrink fit material (which may extend entirely between the torque transfer unit 116 and the instrument tip) and the mid-section may include the same FEP shrink fit material in addition to one or more reinforcing layers. For example, the mid-section may include two or more layers of shrink fit material, arranged in a staggered pattern along various lengths of the device to provide two or more sub-mid-sections of increasing reinforcing stiffness toward the proximal end of the instrument. For example, the mid-section 260 may include a first reinforcing layer (e.g., including a polyester shrink fit material) extending along the entire mid-section, and a second reinforcing layer (e.g., including a polyester shrink fit material) extending along a shorter length of the mid-section, each material may extend to the torque transfer unit 116. The material properties of the various layers of the outer sleeve 148 may be selected to provide a strong grip on one another.

[0129] The proximal section 258 is constructed differently than the proximal section 158 of FIG. 9. Rather than including a braided structure, the proximal section 258 includes a reinforcement layer including multiple shrink-wrap or reflowed polymer layers, but has a greater overall thickness than the mid-section 260. The proximal section 258 may not include the same FEP shrink-fit layer that extends across the mid-section 260 and the distal section 256. For example, the proximal section 258 may include (only) two or more polyester shrink-wrap layers (e.g., each having a thickness of 0.0127 mm) covered by a relatively thick reflowed Pebax layer (e.g., having a thickness of 2.9 mm). This may provide a relatively thick reinforcement section having a diameter of 2.9 mm.

[0130] Figures 11 and 12 show in further detail the proximal end of the device, in accordance with an embodiment of the present invention. This arrangement is described with reference to outer sleeve 246 in Figure 10, but may alternatively be applied to any of the other embodiments.

[0131] As shown in FIG. 11, the flexible shaft 212 is welded at its proximal end to the hypotube 262. The outer sleeve 246 extends beyond the proximal end of the flexible shaft 212, e.g., a shrink fit layer extends beyond the joint 264 connecting the flexible shaft 212 to the hypotube 262. As shown in FIG. 12, a seal component 266 (e.g., a Y-piece) of the interface joint 106 is attached (e.g., glued) onto the outer sleeve 246 and / or the hypotube 262, connecting the flexible shaft 212 to the interface joint (e.g., interface joint 106 of FIG. 1). The seal component 266 overlies the proximal section of the outer sleeve and extends across the joint 264, helping to further strengthen the proximal end of the instrument.

[0132] 13-15 show details of a flexible shaft 312 of an electrosurgical instrument 320, according to an embodiment of the present invention.

[0133] In contrast to flexible shaft 112 (shown, for example, in FIG. 3), flexible shaft 312 includes a coaxial cable 324 and defines a fluid channel 322 through its center.

[0134] Coaxial cable 324 includes an inner conductor 326, an outer conductor 328, and a dielectric material 330 separating the inner and outer conductors. Inner conductor 326 is hollow and has an insulating layer 331 disposed on the interior of inner conductor 326 to form fluid channel 322.

[0135] This arrangement can help ensure that the coaxial cable does not impede fluid flow along the flexible shaft, because the coaxial cable defines the fluid channel 322. Additionally, this arrangement can be more compact than embodiments in which the coaxial cable is conveyed through or next to a fluid channel in the flexible shaft.

[0136] The outer sleeve 346 directly surrounds the coaxial cable 324. In this embodiment, the outer sleeve 346 includes a shrink fit layer 348 formed of FEP heat shrink material and has a diameter of 1.85 mm when applied to the flexible shaft 312. Additionally, the inner conductor 326 includes a superelastic Nitinol tubing and has a diameter of 0.55 mm. However, in alternative embodiments, the inner conductor and / or the outer sleeve may be formed of other materials and / or have various diameters, for example, the outer sleeve may be any other outer sleeve described in connection with the other embodiments.

[0137] 16 and 17 show a flexible shaft 412 having a different configuration. The flexible shaft 412 is generally similar to that of FIGS. 13-15 and includes like reference numbers indicating like features. However, the flexible shaft 412 further includes a metal sheath 413 (e.g., a superelastic Nitinol tubing) in an interference fit between the coaxial cable 324 and the outer sleeve 348. The interference fit metal sheath may serve to further aid in strengthening the shaft (e.g., preventing bursting) and may have elastic properties to aid in manipulation of the distal end of the instrument while maintaining a relatively low profile.

[0138] 18A-18C show top, side, and bottom views, respectively, of an electrosurgical instrument 520 including a flexible shaft 512 and an outer sleeve 546 attached to an instrument tip 518. Electrosurgical instrument 520 includes other features similar to those described above with respect to electrosurgical instrument 120, and similar reference numerals such as attachment collar 544, electrical potting 550, and notch 554. However, outer sleeve 546 extends further distally onto the instrument tip 518 than outer sleeve 148. While outer sleeve 148 extends across approximately one-quarter of the planar body of the instrument tip, outer sleeve 546 extends across approximately one-half of the planar body of the instrument tip, that is, to the point where the instrument tip begins to taper inwardly to provide a blade-like function. By extending the outer sleeve 546 further along the instrument tip 518, its fit to the instrument tip can be increased, which can further help prevent deformation or stretching of the flexible shaft 512 relative to the instrument tip 518.

[0139] 18C, a hypotube is inserted into the distal section of instrument tip 518 and includes or forms a nozzle 541 at the distal end of fluid channel 540. The hypotube may be fixed relative to flexible shaft 512 and may have a blunted distal end.

[0140] FIG. 19 shows a side-by-side comparison of a non-embodiment reference electrosurgical instrument 20, an embodiment electrosurgical instrument 520 of FIGS. 18A-18C, and another embodiment electrosurgical instrument 620.

[0141] The reference electrosurgical instrument 20 includes an instrument tip 18 having a retractable needle (not shown) and a flexible shaft 12. The flexible shaft 12 includes a cannula tube that surrounds the coaxial cable, a fluid passage, and a push rod for deploying and retracting the needle. An insulating layer 48 covers the cannula tube but does not extend onto the planar body of the instrument tip 18. Rather, the flexible shaft 12 is bonded to the active tip and protective shell by applying an epoxy adhesive over the portion of the inner conductor of the coaxial cable that protrudes from the outer conductor. This epoxy adhesive also serves to form an end plug, i.e., a fluid-tight seal, for the outer cannula tube, meaning that the only exit for fluid injected into the interface joint is through the retractable needle in the instrument tip 18. The reference electrosurgical instrument may be adapted for use with a scope device having, for example, an inner diameter of 3.8 mm.

[0142] The electrosurgical instrument 620 includes a flexible shaft 612 and an instrument tip 618 that does not include a retractable needle. The flexible shaft 612 includes a cannula tube that encloses the coaxial cable and the fluid passage, but does not include a push rod or other control means for deploying the needle. Additionally, the electrosurgical instrument 620 replaces the insulating layer 48 on the exterior of the reference electrosurgical instrument 20 with an outer sleeve 648 that includes a shrink fit layer that extends over the proximal end of the planar body of the electrosurgical instrument tip 618. Thus, the electrosurgical instrument 620 can withstand higher fluid pressures than the electrosurgical instrument 20, even at its smaller size. The instrument tip 618 is welded directly to the cannula tube (not shown) of the flexible shaft, and the joint is covered with a reflow polymer layer (further described in connection with Figures 20A-20E). The electrosurgical instrument 620 may be adapted for use with a scope device having, for example, an inner diameter of 3.2 mm.

[0143] Electrosurgical instrument 520 is similar to electrosurgical instrument 620, but includes an attachment collar 544 and further modifies the flexible shaft to provide an interference fit with instrument tip 518. Instrument 520 is able to be more compact than instrument 620 because it does not include the reflow polymer layer of instrument 620. This allows for a further reduction in instrument size while maintaining the ability to withstand higher pressures. Electrosurgical instrument 520 may be adapted for use with a scoping device having, for example, an inner diameter of 2.8 mm.

[0144] 20A-20E show various stages in the assembly of electrosurgical instrument 620. FIG.

[0145] FIG. 20A shows the instrument tip 618 in an initial configuration, where the conductive elements have been formed on the planar body and the hypotubes have been inserted into the fluid channels of the instrument tip.

[0146] FIG. 20B shows a flexible shaft 612 having a coaxial cable 624 that is inserted through an interface section 638 at the instrument tip and attached to a conductive element on the instrument tip 618.

[0147] 20C shows the instrument tip 618 welded to the distal end of the flexible sleeve 612. In this embodiment, the interface section 638 of the instrument tip is welded directly to the distal end of the cannula tube of the flexible shaft. In an alternative embodiment, an attachment collar may instead be welded to the distal end of the cannula tube of the flexible shaft and coupled (e.g., by an interference fit) to the interface section 638 of the instrument tip.

[0148] Figure 20D shows a polymer layer (e.g., Pebax) inserted over the joint between the instrument tip 618 and the flexible shaft 612. The polymer layer may be reflowed to seal the joint and covered with a shrink fit layer (e.g., a heat shrink layer such as FEP heat shrink), as shown in Figure 20E.

[0149] 21 illustrates an exploded view of another embodiment of the present invention, electrosurgical instrument 720. Electrosurgical instrument 720 is generally similar to electrosurgical instrument 120, but does not include a constricted section that terminates in notch 154 for seating the distal end of the outer sleeve.

[0150] Further, in contrast to electrosurgical instrument 620, electrosurgical instrument 720 includes a flexible shaft 712 configured to couple to instrument tip 718 via an attachment collar 744. In particular, flexible shaft 712 includes a cannula tube configured to attach (e.g., by welding) to the attachment collar. The flexible shaft further includes a polymer coating (e.g., Pebax) that extends around the cannula tube and over a majority of the collar 744.

[0151] 22, the attachment collar 744 can be attached to the interface section 738 of the instrument tip 718 with an interference fit. Optionally, the interface section 738 can also be welded to the attachment collar 744 to further secure the attachments. The attachment collar allows for easier assembly compared to, for example, directly welding the instrument tip to a flexible sleeve.

[0152] 23 shows the electrosurgical instrument 720 in a further assembled state, including the coaxial cable and active tip. An outer sleeve (not shown) may then be applied over the flexible shaft and the proximal section of the instrument tip.

[0153] The features disclosed in the foregoing description, or in the following claims, or in the accompanying drawings, and presented in a particular form or in terms of means for performing a disclosed function, or a method or process for achieving a disclosed result, may be used separately or in any combination of such features, as appropriate, to realize the invention in its diverse forms.

[0154] Although the present invention has been described in conjunction with the above exemplary embodiments, many equivalent modifications and variations will be apparent to those skilled in the art given this disclosure. Accordingly, the above exemplary embodiments of the present invention are considered to be illustrative and not limiting. Various changes to the described embodiments may be made without departing from the spirit and scope of the present invention.

[0155] For the avoidance of doubt, the theoretical explanations provided herein are provided for the purpose of enhancing the understanding of the reader, and the inventors do not wish to be bound by any of these theoretical explanations.

[0156] Any section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described.

[0157] Throughout this specification, including the claims which follow, unless the context specifically requires, the words "comprise" and "comprises", "including" and "comprising" and the like are understood to imply the inclusion of a stated integer value or step, or group of integer values ​​or steps, but not the exclusion of other integer values ​​or steps, or group of integer values ​​or steps.

[0158] It should be noted that, as used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Ranges may be expressed herein as from "about" one particular value and / or to "about" another particular value. When such a range is expressed, another embodiment includes from the one particular value and / or to the other particular value. Similarly, when values ​​are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment. The term "about" in connection with numerical values ​​is arbitrary and may mean, for example, + / - 10%. [Explanation of symbols]

[0159] 100 Electrosurgical System 102 Generator 104 Interface cable 106 Interface Joint 262 Hypotube 266 Seal Components 120 Electrosurgical Instruments 112 Flexible shaft 122 First Fluid Channel 123 Telescopic limiting wire 144 Color 152 Engagement structure 264 Joint 118 Instrument tip 140 Second Fluid Channel 141 Nozzle 143 Cross-linked tube Proximal Section 154 Notch 138 Interface Section 139 Telescopic Wire Input Section 142 Electrical Input Section 153 Aperture 155A,B Aperture Active tip 134 Planar body made of a first dielectric material 136 First conductive element 137 Second Conductive Element 124 Coaxial Feed Cable 126 Inner conductor 128 Outer Conductor 130 Dielectric 132 Outer sheath 331 Insulating Layer 146 Outer Sleeve 148 Shrink-fit layer 156 Distal Section 158 Proximal Section 260 Mid Section 107 Fluid supply cable 114 Surgical scope device 116 Torque transmission unit 108 Fluid delivery device

Claims

1. 1. An electrosurgical instrument for delivering pressurized fluid to living tissue and for delivering radio frequency (RF) electromagnetic (EM) energy and / or microwave frequency EM energy to said living tissue, comprising: a flexible shaft having a first fluid channel for conveying the pressurized fluid; an instrument tip coupled to a distal end of the flexible shaft, the instrument tip having a second fluid channel for receiving the pressurized fluid from the first fluid channel, the second fluid channel having a nozzle at its distal end for delivering the pressurized fluid directly to the living tissue; Including, the instrument tip includes a planar body made of a first dielectric material separating a first conductive element on a first surface thereof from a second conductive element on a second surface thereof, the second surface facing away from the first surface; the flexible shaft includes a coaxial feed cable having an inner conductor, an outer conductor coaxial with the inner conductor, and a second dielectric material separating the inner conductor and the outer conductor, the coaxial feed cable being for carrying RF and / or microwave signals; the inner conductor is electrically connected to the first conductive element and the outer conductor is electrically connected to the second conductive element, allowing the instrument tip to receive the RF signal and / or the microwave signal; The electrosurgical instrument further includes an outer sleeve that extends over the flexible shaft and a proximal section of the instrument tip to strengthen the flexible shaft and the joint between the flexible shaft and the instrument tip.

2. 2. The electrosurgical instrument of claim 1, wherein the outer sleeve includes a shrink fit layer extending over the flexible shaft and the proximal section of the instrument tip to strengthen the flexible shaft and the joint between the flexible shaft and the instrument tip.

3. The electrosurgical instrument of claim 2 , wherein the shrink fit layer comprises fluorinated ethylene propylene (FEP).

4. The electrosurgical instrument of claim 1 , wherein the outer sleeve extends the entire length of the flexible shaft and extends beyond the proximal end of the flexible shaft.

5. The electrosurgical instrument of claim 1 , wherein the outer sleeve is configured to increase in thickness toward a proximal region of the instrument.

6. 6. The electrosurgical instrument of claim 5, wherein the outer sleeve includes one or more reinforcing layers, each extending across a proximal portion of the flexible shaft and each terminating at an intermediate region of the flexible shaft, increasing the thickness of the outer sleeve toward the proximal region of the instrument.

7. The electrosurgical instrument of claim 1 , wherein one of the outer sleeve and the flexible shaft includes a bonding layer configured to chemically bond to the other of the outer sleeve and the flexible shaft upon application of heat.

8. The distal end of the flexible shaft is fitted with a complementary interface section of the instrument tip. The electrosurgical instrument of claim 1 , including an attachment collar configured to mechanically attach to the electrosurgical instrument.

9. The electrosurgical instrument of claim 1 , wherein the flexible shaft and / or the instrument tip include one or more engagement structures that mate with the outer sleeve.

10. The electrosurgical instrument of claim 1 , further comprising an extension limit wire extending through the flexible shaft to limit a maximum extension length of the flexible shaft.

11. The electrosurgical instrument of claim 1 , wherein the instrument tip is configured such that the second fluid channel decreases in diameter from the proximal end to the distal end.

12. The electrosurgical instrument of claim 1 , wherein the instrument tip includes a hypotube that forms at least a portion of the second fluid channel.

13. 2. The electrosurgical instrument of claim 1, wherein the proximal section of the instrument tip is narrower than the distal section of the instrument tip, the proximal section terminating in a notch at its interface with the distal section for receiving the distal end of the outer sleeve.

14. 10. The electrosurgical instrument of claim 1, wherein the instrument is sized for insertion through the instrument channel of a surgical scope apparatus, the instrument channel having a diameter of 3.7 mm or less, more preferably 3.2 mm or less, more preferably 2.8 mm or less.

15. A kit of parts for forming an electrosurgical instrument according to any one of claims 1 to 14, comprising: the flexible shaft; the instrument tip, and the outer sleeve; The kit of parts.

16. 1. A method for forming an electrosurgical instrument for delivering pressurized fluid to biological tissue and for delivering radio frequency (RF) electromagnetic (EM) energy and / or microwave frequency EM energy to said biological tissue, comprising: providing a flexible shaft having a first fluid channel for conveying said pressurized fluid; coupling an instrument tip to the distal end of the flexible shaft, the instrument tip having a second fluid channel; fitting an outer sleeve over the flexible shaft and over a proximal section of the instrument tip to strengthen the flexible shaft and the junction between the flexible shaft and the instrument tip; Including, the instrument tip includes a planar body fabricated from a first dielectric material, the first dielectric material separating a first conductive element on a first surface thereof from a second conductive element on a second surface thereof, the second surface facing away from the first surface; the flexible shaft includes a coaxial feed cable, the coaxial feed cable including an inner conductor, an outer conductor coaxial with the inner conductor, and a second dielectric material separating the inner conductor and the outer conductor, the coaxial feed cable being for carrying RF and / or microwave signals; Coupling the instrument tip to the distal end of the flexible shaft includes: The instrument tip receives the RF and / or microwave signals. electrically connecting the inner conductor to the first conductive element and the outer conductor to the second conductive element to enable connecting the second fluid channel to the first fluid channel to enable the second fluid channel to receive the pressurized fluid from the first fluid channel, the second fluid channel comprising a nozzle at a distal end thereof for delivering the pressurized fluid directly to the living tissue; The method comprising:

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