Electrosurgical pharyngeal wand

Abstract

Bipolar electrosurgical wand for treating tissue along a patient's airway. The wand includes a tubular end effector having, at its distal end, an electrical insulation spacer, a return electrode, and an active electrode. The active electrode includes an annular portion and a tip projection extending distally therefrom. The annular portion may be coextensive with the insulation spacer, and the tip projection may extend distally beyond the most distal surface of the insulation spacer. The tip projection and the annular portion may both share a continuous upper planar surface. The annular portion includes a suction opening for removing tissue debris from the target site.

Description

Technical Field

[0001] (Cross - Reference to Related Applications) This application claims the benefit of, and is co - owned with, U.S. Provisional Patent Application No. 63 / 345,064, entitled "Electrosurgical Laryngeal Wand", filed on May 24, 2022, which is hereby incorporated by reference in its entirety. This application also claims the benefit of, and is co - owned with, U.S. Provisional Patent Application No. 63 / 344,798, entitled "Electrosurgical Laryngeal Wand", filed on May 23, 2022, which is hereby incorporated by reference in its entirety.

[0002] This application generally relates to methods and devices for accessing and treating tissue. More specifically, disclosed are devices and related methods for electro - surgically treating a wide range of pathological conditions that affect the anatomical structures of the pharynx and / or airway.

Background Art

[0003] Access to and treatment of areas along a patient's airway around the pharynx present a unique set of challenges. For example, the airway is narrow, which limits the size of the device. The airway is relatively long, requiring a device of a significant length. Visibility at the end of the device can also be limited. Some portions of the tissue along the airway are sensitive to energy - based treatment, and as a result, inadvertent treatment or simply contact with a hot surface can cause significant complications. For example, polyps may need to be removed from the vocal cords, and the vocal cords are particularly sensitive to heat. The tissue or pathology along the airway is generally small, and thus, over - treatment, including the application of excessive energy, is generally a risk. Some procedures require a combination of both a microsurgical incision and some more extensive debulking, and often require multiple devices for a single procedure. The device may be provided with suction to remove fluid and treated tissue from the treatment site to improve overall visibility, and the suction path is prone to blockage due to the overall size limitations of the device.

[0004] Accordingly, there is a need for a single device to address the above-mentioned drawbacks. There is a need for a single device that provides targeted tissue removal in narrow anatomical structures through the electrosurgical treatment of tissue. There is a need for a single device that provides access to narrow anatomical structures while improving visualization of the surgical field. There is a need for a single device that limits inadvertent tissue damage. There is a need for a device that accesses multiple pathologies along the airway, which may also provide multiple tissue treatment modes such as micro-incision and debulking. SUMMARY OF THE INVENTION

[0005] An improved electrosurgical wand for the treatment of various pathologies along a patient's airway, and more particularly along the pharynx and surrounding tissues. The improved wand may include a multi-functional treatment electrode capable of both micro-incising tissue and / or debulking tissue. The wand may cooperate with an electrosurgical controller to treat tissue by ablation as defined herein. A more detailed description of ablation is provided in U.S. Patent No. 5,697,882, by the same applicant, the entire disclosure of which is incorporated herein by reference.

[0006] This electrode may include a planar treatment surface configured to debulk tissue along the pharynx by ablation. This electrode may also include an edge surface and / or a distal projecting tip configured to incise tissue along the pharynx by ablation. The wand may deliver a conductive fluid to the target site and aspirate tissue, fluid, and plasma by-products therefrom. The wand may be a hand-held wand and thereby may be used directly by a clinician or may be configured to be controlled via a robotic-controlled surgical setup. The wand may include improvements to the suction openings and suction pathways to significantly reduce the likelihood of clogging the wand, as tends to occur with wands of the related art.

[0007] A first exemplary bipolar electrosurgical wand embodiment is disclosed herein, which includes an electrically insulating spacer, a return electrode, and a tubular end effector having an active electrode at its distal end. The insulating spacer supports the active electrode and electrically insulates it from the return electrode. The active electrode includes an annular portion and a tip projection extending distally from the annular portion. The annular portion is coextensive with the insulating spacer, and the tip projection extends distally beyond the most distal surface of the insulating spacer. Both the tip projection and the annular portion share a continuous upper planar (flat) surface. The annular portion includes a 360-degree bounded aperture therethrough that is a suction aperture for removing at least one of tissue, debris, and fluid therethrough.

[0008] In some exemplary embodiments, the tip projection may have a maximum lateral width that is less than half of the corresponding maximum lateral width of the annular portion. The active electrode may define an outermost peripheral edge surface that includes both side recessed edge surfaces that are coextensive with each other at the transition from the annular portion to the tip projection, and the both side recessed edge surfaces may be coextensive with the most distal end face of the insulating spacer.

[0009] In some exemplary embodiments, the suction aperture may extend at an inclination angle with respect to the planar upper surface from the planar upper surface of the active electrode to the lower surface of the active electrode. This inclination angle may deflect the aspirated tissue debris proximally into a suction conduit extending along the tubular end effector. This inclination angle may be oriented such that the edge boundary of the suction aperture that coincides with the lower surface is axially offset from the corresponding edge boundary of the suction aperture that coincides with the upper surface. The lower surface edge boundary may be offset proximally from the corresponding edge boundary of the suction aperture in the upper planar surface. This edge boundary that coincides with the lower surface provides an edge surface that further digests the aspirated tissue flowing through the suction aperture. This edge boundary at the lower surface may also include at least notches that are discharged along the suction aperture, and the notches provide supplementary edge surfaces for further digesting the aspirated tissue flowing through the suction aperture.

[0010] In some exemplary embodiments, the aspiration opening cross-section can include a most proximal apex having a first radius of curvature and a most distal curved end having a radius of curvature that is at least twice the first radius of curvature. These differences in radius can provide an opening large enough to aspirate tissue, yet have sufficient local confinement to manage tissue debris and blockage. The first radius of curvature can preferably reduce the plasma remote zone extending through the aspiration opening, and the second radius of curvature can preferably provide an extended surface area for further digestion of the tissue flowing through the aspiration opening.

[0011] In some exemplary embodiments, the return electrode can include side arms that can extend around the most distal end face of the insulating spacer and define a face facing distally of the return electrode having the same spread as the active electrode tip protrusion. These side arms can assist in plasma initiation at the tip protrusion.

[0012] Another bipolar electrosurgical wand embodiment disclosed herein can have a tubular end effector having a handle at its proximal end and, at its distal end, can include a return electrode, an insulating spacer, and an active electrode. The insulating spacer can support and electrically insulate the active electrode. The active electrode can include an annular portion having a tip protrusion extending distally from the annular portion, and both the annular portion and the tip protrusion share a continuous upper planar surface. The annular portion can define an aspiration opening and form a 360-degree bounded hole extending from the upper planar surface to the lower surface of the active electrode. This aspiration opening extends at an inclination angle with respect to the planar upper surface and defines a central axis. This aspiration opening inclination angle defines a surface and an edge surface that assist in further digestion of any tissue debris flowing through the aspiration opening and deflect the tissue debris toward an aspiration conduit extending proximally along the tubular end effector.

[0013] In some exemplary embodiments, the tilt angle extends proximally from the upper planar surface of the active electrode. The 360-degree bounded aperture may define a curved wedge cross-section, where the most proximal apex has a first radius of curvature and the most distal curved end has a radius of curvature that is at least twice the first radius of curvature.

[0014] In some exemplary embodiments, the tip protrusion may have a maximum transverse width that is less than half of the maximum transverse width of the annular portion. The tip protrusion may define a free-end protrusion that extends beyond the insulating spacer.

[0015] Examples of methods for electro-surgically treating tissue along a patient's airway are also disclosed. The method includes positioning an electro-surgical wand in a first orientation such that the upper planar surface of the active electrode engages a first target tissue along the patient's airway, the active electrode having a suction aperture that extends from the upper planar surface to the lower surface of the active electrode. The suction aperture may define a central axis that is oriented at a non-perpendicular angle to the upper planar surface such that the peripheral edge boundary of the suction aperture that coincides with the lower surface is axially offset from the corresponding peripheral edge boundary of the upper planar surface. While the wand is in the first orientation, electrical energy may be delivered to the active electrode and the return electrode of the electro-surgical wand sufficient to form a local plasma proximate to the planar surface of the active electrode in response to this energy. This may debulk the first target tissue by the local plasma to molecularly dissociate a portion of the first target tissue to form tissue debris. This tissue debris may be aspirated through the suction aperture and may be further molecularly dissociated via a local plasma formed at the peripheral edge boundary that coincides with the lower surface in response to the delivered energy as the tissue debris flows through the suction aperture.

[0016] In some exemplary methods, the wand may be moved to a second orientation such that the protruding tip of the active electrode is in direct proximity to a second target tissue along the patient's airway, and the protruding tip defines the most distal protrusion of the active electrode that extends parallel and continuously to the upper planar surface. While the electrosurgical wand is in this second orientation, electrical energy may be applied between the active electrode and the return electrode to form a local plasma proximate to the protruding tip in response to the energy. The second target tissue may be micro-incised by incising with the local plasma. While applying electrical energy between the active electrode and the return electrode to form a local plasma proximate to the protruding tip, a conductive fluid may flow out from a fluid delivery aperture spaced proximally from the active electrode along the distal end of the outer surface of the wand and around a portion of the return electrode facing distally and coextensive with the protruding tip. The distally facing portion and the protruding tip are in proximity to reduce the electrical bridge load to the conductive fluid, thereby reducing the time to initiate a local plasma proximate to the protruding tip.

[0017] In some exemplary methods, while applying electrical energy between the active electrode and the return electrode, adjacent tissue may be protected from inadvertent thermal effects adjacent to the back surface of the distal end of the wand, and the back surface is formed of a heat-shrinkable ceramic.

[0018] In some exemplary methods, tissue debris flowing through the suction aperture is deflected proximally and toward a suction conduit disposed along the electrosurgical wand, and the deflection has a distal sloped surface of the suction aperture. This distal surface may extend parallel to the central axis.

[0019] Another exemplary bipolar electrosurgical wand embodiment is disclosed herein, the wand including a tubular end effector carrying a bipolar electrode arrangement at its distal portion. The bipolar electrode arrangement can include a first active electrode, a second active electrode, and a return electrode. The first active electrode may have a most distal first active electrode treatment surface, the second active electrode may have a most distal second active electrode surface, and the first active electrode may slide axially between a first configuration and a second configuration relative to the second active electrode. In the first configuration, the most distal treatment surfaces of the first and second active electrodes may be axially adjacent to each other to form a single continuous tissue treatment surface that can electro-surgically treat tissue in a first mode. In the second configuration, the first active electrode is axially offset distally from the second active electrode and can form a discontinuous tissue treatment surface with the second active electrode. The first active electrode alone can electro-surgically treat tissue in a second mode different from the first mode while in the second configuration.

[0020] In some exemplary embodiments, the most distal surface of the first active electrode may be smaller than the most distal surface of the second active electrode. The most distal surface of the second active electrode can define a surface area that is at least twice the corresponding surface area of the most distal surface of the first active electrode. The first mode may be a debulking mode, and the second mode may be a micro-incision mode. The first mode may be a coagulation mode, and the second mode may be a cutting mode. In the second mode, the second active electrode may be inactive or electrically inert. In the first configuration, the outer peripheral edge of the most distal surface of the first active electrode may be completely bounded by the second active electrode.

[0021] Exemplary methods for electro-surgically treating tissue along a patient airway are also disclosed herein, the method including positioning an electro-surgical wand in a first orientation such that both a first active electrode treatment surface and a second active electrode treatment surface engage a first target tissue along the patient airway, the first and second active electrodes being arranged in an axially adjacent configuration. While in this first orientation and axially adjacent configuration, electrical energy is applied between the first and second active electrodes and a return electrode of the electro-surgical wand to form a local plasma proximate the first and second active electrode treatment surfaces in response to the energy, and the local plasma debulks a portion of the first target tissue. Next, the first active electrode treatment surface is axially adjusted to be distally spaced from the second active electrode treatment to define an axially offset configuration, and the electro-surgical wand is repositioned in a different orientation such that the first active electrode treatment surface is adjacent another target tissue along the patient airway. While the wand is in the second orientation and axially offset configuration, electrical energy is applied between the first active electrode and the return electrode of the electro-surgical wand to form a local plasma proximate the first active electrode treatment surface in response to the energy, and the local plasma makes a micro-incision in a portion of the other target tissue.

[0022] In some exemplary methods, the method may further include arranging the first and second active electrodes in an axially adjacent configuration, applying electrical energy between the first and second active electrodes and a return electrode of the electro-surgical wand, and coagulating a portion of the tissue of the patient airway in response to the applied energy. In some methods, while making the micro-incision, the second active electrode is inactive or electrically inert. In the axially adjacent configuration, an outer peripheral edge of the first active electrode treatment surface may be completely bounded by the second active electrode treatment surface.

[0023] These and other features and advantages will become apparent by reading the following detailed description and by referring to the associated drawings. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the aspects set forth in the claims.

[0024] Notation and Terminology Certain terms are used throughout the following description and the entire scope of the claims to refer to particular system components. As will be understood by those skilled in the art, companies that design and manufacture electrosurgical systems may refer to components by different names. This document is not intended to distinguish between components that have different names but perform the same function.

[0025] In the following discussion and the claims, the terms "comprising" and "including" are used in an open-ended fashion and should therefore be interpreted to mean "including, but not limited to." Also, the term "couple" or "couples" is intended to mean either an indirect or a direct connection. Thus, when a first device is coupled to a second device, that connection may be through a direct connection or through an indirect connection via other devices and connections.

[0026] References to items in the singular include the possibility that there are multiple identical items. More specifically, as used in this specification and the appended claims, the singular forms "a," "an," "said," and "the" include the plural unless the context clearly dictates otherwise. Further, note that the claims may be drafted to exclude any optional elements. Accordingly, this specification serves as a precedent basis for using such exclusive terms as "solely," "only," etc. in connection with the enumeration of elements of the claims or the use of "negative" limitations. Finally, unless defined otherwise, all technical and scientific terms used herein are to be understood as having the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

[0027] "Ablation" shall mean the removal of tissue based on the interaction of tissue with plasma.

[0028] "Ablation mode" shall refer to one or more characteristics of ablation. The absence of ablation (i.e., the absence of plasma) shall not be regarded as an "ablation mode." A mode that only performs coagulation shall not be regarded as an ablation mode.

[0029] "Debulking" shall refer to using ablation to remove tissue.

[0030] "Active electrode" shall mean the electrode of an electrosurgical wand that produces an electrically induced tissue change effect when in contact with or in proximity to the tissue to be treated.

[0031] "Return electrode" shall mean the electrode of an electrosurgical wand that serves to provide a current path for the charge to the active electrode and / or an electrode of the electrosurgical wand that itself does not produce an electrically induced tissue change effect on the tissue to be treated.

[0032] When a range of values is provided, all intervening values between the upper and lower limits of that range, as well as any other stated or intervening values within the stated range, are understood to be encompassed within the present invention. Also, any optional features of the described variations of the invention are contemplated to be described and claimed either independently or in combination with any one or more of the features described herein.

[0033] The present disclosure will be more fully understood by reference to the detailed description in conjunction with the following drawings.

Brief Description of the Drawings

[0034]

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[0035] In the following description, like components are given the same reference numerals regardless of whether they are shown in different examples. For the purposes of clarity and conciseness of the examples, the drawings are not necessarily to scale and certain features may be shown somewhat schematically. Features described and / or illustrated with respect to one example may be used in the same or a similar manner in one or more other examples and / or in combination with, or instead of, features in other examples.

[0036] As used in this specification and the claims, the terms "about" and "substantially" are used for the purpose of describing and defining the invention to represent the degree of inherent uncertainty that may arise from any quantitative comparison, value, measurement, or other representation. The terms "about" and "substantially" are also used in this specification to represent the degree to which a quantitative expression may vary from the stated reference without changing the basic function of the subject matter in question. The terms "comprising," "including," and / or their plurals are used in a non-limiting manner, including the recited members and capable of including additional members not recited. "And / or" is used in a non-limiting manner, including one or more of the recited members and combinations of the recited members. The use of the terms "upper," "lower," "upward," and the like is intended only to assist in the clear description of the disclosure and is not intended to limit the structure, positioning, and / or operation of the disclosure in any way.

[0037] The methods recited in this specification can be performed in any reasonable order of the recited events, as well as in the order of the recited events. Further, when a range of values is provided, all intervening values between the upper and lower limits of that range, and any other recited or intervening values within the recited range, are understood to be included within the invention. Additionally, any optional features of the described variations of the invention are contemplated to be described and claimed independently or in combination with any one or more of the features described in this specification.

[0038] All existing subject matter described in this specification (e.g., publications, patents, patent applications, and hardware) is hereby incorporated by reference in its entirety, except where the subject matter might conflict with the subject matter of the present invention (in which case, what is present in this specification prevails). The items being referenced are provided only for the purposes of their disclosure prior to the filing date of the present application. No provision of this specification shall be construed as an admission that the present invention does not have the right to antedate such material by virtue of prior invention.

[0039] References to items in the singular include the possibility that there may be a plurality of identical items. More specifically, as used in this specification and in the appended claims, the singular forms "a", "an", "said", and "the" include plural referents unless the context clearly dictates otherwise. Further, note that the claims may be drafted to exclude any optional elements. Accordingly, this specification is intended to serve as a precedent basis for using such exclusive terms as "solely", "only", etc. in connection with the recitation of elements of the claims or the use of "negative" limitations. Finally, unless otherwise defined, all technical and scientific terms used in this specification are to be understood as having the same meaning as commonly understood by one of ordinary skill in the art to which the present invention pertains.

[0040] Referring to FIG. 1, an exemplary electrosurgical system 11 for the treatment of tissue according to the present disclosure is described in detail herein. The electrosurgical system 11 generally includes an electrosurgical wand (hereinafter, “wand”) 10 that can be electrically connected to an electrosurgical controller (i.e., power supply) 28 (hereinafter, “controller”). The controller 28 provides a high-frequency voltage to the wand 10, thereby generally configured to provide the high-frequency voltage to a target tissue site. The system may also include a fluid source 21 for supplying a conductive fluid 50 to the wand 10 via fluid delivery tubes 15 / 16. Fluid delivery can be controlled by a pump 40 to provide a controlled fluid flow supply to the wand 10 via the delivery tube 16. The pump 40 may communicate with the controller 28 (shown as a dotted line) such that the selection of different electrosurgical power modes (described in detail later) can also communicate commands to the pump 40 to change the parameters of the pump 40 and adjust the fluid delivery rate. The pump 40 is shown as a separate enclosure, but may be part of the same enclosure as the controller 28. In addition, the electrosurgical system 11 may include a scope (not shown) that may include an optical fiber headlight for visualizing the surgical site, which is particularly useful for procedures in the back of the oral cavity. The scope may be integral with the wand 10 or a separate object. The scope may be a pharyngoscope. The system 11 may also include a suction or suction tube 42 that may be configured to couple to a vacuum source (not shown) such as wall suction. The tube 42 shown may be associated with the wand 10 to suction tissue debris and fluid from the target site. The tube 42 may also be operably coupled to a pump (not shown), such as a peristaltic pump, to control the suction flow rate.

[0041] The wand 10 generally comprises a handle 19 and an elongated tubular shaft 17 extending distally from the handle 19. The handle 19 typically comprises a plastic material that is easily molded into a suitable shape for handling by a surgeon. As shown, the connection cable 34 has a connector 26, and together they electrically couple the wand 10 to the controller 28. The controller 28 may have an operator-controllable energy / voltage level adjustment 30 for changing the applied voltage level observable on the display 32. The controller 28 may also include first, second, and third foot pedals 37, 38, 39, and a cable 36, which may be removably operably coupled to the controller 28. The foot pedals 37, 38, 39 may enable a surgeon to remotely adjust the voltage, mode, or energy level applied to the active electrode. In an exemplary embodiment, the first foot pedal 37 may be used to instruct the controller 28 to deliver energy to the wand 10 in an "ablation" mode, and the second foot pedal 38 may set the electrosurgical controller 28 to a thermal heating mode (i.e., contraction, coagulation, or other types of tissue modification without volumetric tissue removal / debulking). Alternatively, the second foot pedal may instruct the electrosurgical controller to supply energy in a "mixed" mode (a mixture of tissue removal or debulking and simultaneous hemostasis). The third foot pedal 39 (or in some embodiments, a foot activation button) may enable the user to adjust the voltage level within the mode. In other embodiments, a series of hand switches along the wand handle 19 may replace at least a portion of the foot pedals.

[0042] The electrosurgical system 11 of various embodiments can have various operating modes. One such mode may employ Coblation® technology. The assignee of the present invention owns and developed Coblation® technology. A more detailed description of this technology is set forth in U.S. Pat. Nos. 5,697,882, 6,355,032, 6,149,120, and 6,296,136, all of which are hereby incorporated by reference in their entirety. The electrosurgical system 11 may include a blend mode in which a blend of tissue debulking and thermal shrinkage can occur within the same mode. A more detailed description of this phenomenon can be found in U.S. Pat. No. 11,116,569, which is hereby incorporated by reference in its entirety. The electrosurgical system 11 may also include a pulsed thermal mode in which tissue is thermally treated to coagulate and shrink turbinate tissue and is intermittently pulsed with an ablation output, and the ionized vapor formed may be configured to reduce tissue adhesion.

[0043] In the thermal heating or shrinkage (coagulation) mode, the controller 28 applies a sufficiently low voltage to the active electrode to avoid vaporization of the conductive fluid and subsequent molecular dissociation of the tissue. The surgeon may alternatively step on the foot pedals 37, 38 respectively to automatically switch the controller 28 between the ablation mode and the thermal heating mode. Thereby, for example, the surgeon can quickly move back and forth between coagulation and ablation on the spot without having to divert their concentration from the surgical field or ask an assistant to switch the controller. As an example, when the surgeon cuts or incises soft tissue in the ablation mode, the wand can typically seal and / or coagulate small severed blood vessels within the tissue. However, larger blood vessels, or blood vessels with high fluid pressure (e.g., arterial blood vessels) may not be sealed in the ablation mode. Thus, the surgeon can simply step on the foot pedal 38 to automatically lower the voltage level below the threshold level for ablation and apply sufficient pressure to the severed blood vessels for a period sufficient to seal and / or coagulate the blood vessels. After this is completed, the surgeon may quickly return to the ablation mode by stepping on the foot pedal 37. As a second example, the surgeon may micro-incise a node or polyp along the patient's airway via the ablation mode and then coagulate any bleeding in the coagulation mode. In another embodiment, during a laryngectomy, the surgeon may use the high-voltage ablation mode to micro-incise a portion of the vocal cords and then reduce the voltage or select the "coagulation" mode to coagulate any resulting bleeding. In some procedures, the surgeon may select the high-voltage ablation mode to debulk inflamed or scar tissue along the subglottis to treat subglottic stenosis. Selecting each mode may also automatically adjust the fluid delivery rate to the distal end of the wand.For example, selecting the debulking mode may also instruct the controller 28 to operate the pump 40 to deliver fluid at a rate configured to support a target rate for debulking tissue, and selecting the thermal heating mode may instruct the controller 28 to operate the pump 40 to deliver fluid at a rate configured to support heating the tissue. The fluid delivery flow rate for debulking may be higher than the fluid delivery flow rate for thermal heating.

[0044] Figure 2 shows a side view of an electrosurgical wand 10 constructed in accordance with the principles of the present disclosure and configured to operate with the system 11. As shown in Figure 2, the wand 10 generally includes an elongated shaft 17 and a handle 19 coupled to the proximal end of the shaft 17. The handle 19 typically includes a plastic material that is easily molded into a suitable shape for handling by a surgeon. The handle 19 defines an inner cavity that may accommodate electrical wiring and connections (not shown). The housing may provide an interface suitable for connection to an electrical connection cable, such as cable 34. The inner cavity may also accommodate fluid conduits for aspiration and fluid delivery.

[0045] The fluid inlet 216 may form part of a fluid delivery conduit for the entire system, and the fluid delivery conduit defines a structure configured to deliver the conductive fluid 50 from the source 21 to the wand distal portion 120. The fluid inlet 216 may be the fluid coupling tube 16. The fluid inlet 216 may be fluid-coupled to the tube 16 by an operator, and the tube 16 may be provided separately from the handle 19 and the fluid source 50. In other exemplary embodiments, the wand 10 may include a pre-attached fluid delivery tube 16 such that the tube 16 can extend through the inlet 216, and the inlet 216 defines an opening through the handle 19 for receiving the tube 16 therethrough. The fluid delivery conduit may extend along the shaft 17 through the handle 19 (not shown). The fluid delivery conduit may be defined by the inner bore surface of the shaft 17. In some embodiments, the wand 10 may also include a valve, or equivalent structure (not shown), on the wand 10 or the tube 16 to control the flow rate of the conductive fluid delivered to the target site. In other embodiments, as disclosed herein, the flow rate may be controlled by the pump 40.

[0046] The fluid suction conduit may also extend through the opening 242 of the handle 19, and the fluid suction conduit defines a structure configured to remove fluid away from the wand distal end 120 and from the treatment site. The fluid suction conduit may extend from the wand distal working end 120 and therefrom remove fluid and debris. The fluid suction conduit may be fluidly coupled, or selectively coupled, to a tube 42 that may be coupled to a vacuum source. The fluid suction conduit includes a tube 390 (shown in FIG. 3E) that extends proximally from the wand distal working end 120 along the shaft 17 and the handle 19 to the tube 42. The tube 390 and the tube 42 may be different length portions of the same single component. Suction may be manually controlled via a switch 205 on the handle 19 that communicates with a valve (either mechanical or electrical). In other embodiments, suction may be automatically controlled via the controller 28, and the valve may be automatically actuated or adjusted while energy is being delivered to the wand distal working end 120.

[0047] The wand 10 is generally configured to improve access to tissue within a patient's airway that may be adjacent to the pharynx, and thus, the shaft 17 may include a bend, or curve 201. The curve 201 may be closer to the handle 19 than the distal working end 120. As shown, when the shaft is assigned to include a distal segment 17a and a proximal segment 17b, the bend 201 may angularly offset the proximal shaft segment 17b at an angle α between 30 and 55 degrees from the longitudinal axis (L-L) of the shaft distal segment 17a. This angular offset may improve access along the patient's airway and visualization of the target area. More preferably, the angle α may be approximately 35 degrees because the inventors have found that this shallow angle may allow some visibility of the distal tip of the active electrode while allowing more precise control of the distal working end 120 (discussed in more detail below). The shaft distal segment 17a may have a working length (X) that extends through the inner opening of the laryngoscope and is long enough to gain access to the target area, and may be at least 17 cm in length as measured from the apex of the bend 201. In some preferred embodiments, the distal segment 17a may be approximately 25 cm in length, which may improve subglottic access. The shaft 17 may be formed of annealed steel to add elastic flexibility to the shaft for improved manipulation along the patient's airway.

[0048] Figures 3A - 3E show the distal working end 120 of the first embodiment of the wand 10. The distal working end 120 may have a bipolar configuration and includes a return electrode 310 and an active electrode 330. An electrical insulation spacer 360 (hereinafter, "spacer") can support the active electrode 330 and electrically insulate the return electrode 310 from the active electrode 330. The spacer 360 may be formed of a plasma - resistant ceramic and may also define a portion of the back surface of the distal end 120 (as best seen in FIGS. 3C and 3D), and thermally isolate this side, as will be discussed in more detail below. Generally, the left side of the distal working end 120 is a mirror image of the right side, and thus features shown on one side, such as suction holes and notches, are essentially present although not specifically shown in the figures. The distal working end 120 may be configured to treat tissue via plasma generation around the active electrode 330 and can thus be formed of a material resistant to plasma decomposition. Exemplary materials include, but are not limited to, tungsten, titanium, molybdenum, stainless steel, aluminum, gold, copper, etc. The active electrode 330 may be a complex monolith with various edges on its surface, some of which are intended to control tissue effects, and the edges and surface are intended to assist in occluding or reducing resistance to the wand. Generally, the size of the active electrode 330 is overall minimized, thereby requiring a minimal amount of energy to treat delicate structures along the patient's airway. The small size also serves to limit the overall profile of the wand distal end 120. The active electrode 330 can be formed as a single molded body.

[0049] The return electrode 310 may be a tubular conductive material that can be an extension and an exposed portion of the shaft 17. The return electrode 310 may be formed on annealed stainless steel. Most of the shaft 17 is covered with an insulating shrink tube 370 to limit the exposed surface area of the return electrode and avoid inadvertent tissue damage along the patient airway proximal to the distal working end 120. The return electrode 310 may include openings 312, 314 that can be in fluid communication with a fluid delivery conduit, and the conduit extends within the shaft 17 and is coupled to the tube 16 as described above. A portion of the fluid delivery conduit may define a boundary formed by the inner surface of the shaft 17, or alternatively, may include a tube (not shown) extending along the shaft 17. Thus, the openings 312, 314 can function as fluid delivery openings for delivering the conductive fluid 50 to the outer surface of the distal working end 120. The opening 312 may define an extended 360-degree bounded aperture having a longer dimension that extends circumferentially around the tubular return electrode 310. The opening 312 may be centered with respect to the longitudinal axis of the working end 120. As best seen in FIG. 3B, the opening 312 has a maximum length dimension (W e ) that is greater than the corresponding maximum width dimension (W a ) of the active electrode 330. The fluid dispensed from the opening 312 can generally be drawn distally toward the active electrode 330 due to gravity and suction through the suction opening 380 (described in more detail later).

[0050] The openings 314 (only one shown) on both sides of the return electrode can complement the fluid 50 delivered through the opening 312 and serve to increase the wetted surface area of the return electrode exposed surface. Treatment along the patient airway is generally considered a dry environment for fluid-filled enclosed cavities, such as during arthroscopic surgery. Multiple spaced fluid delivery locations, such as through the openings 312 and 314, provide an environment where the conductive fluid 50 wets a larger surface area of the return electrode 310 and extends further around the perimeter of the active electrode. This provides an improved environment for uniform plasma formation.

[0051] The return electrode 310 may also include an opening 316 (best seen in FIG. 3D) on a wand with the side facing down, exposing the spacer 360. Thereby, the thermal footprint of the return electrode 310 is reduced, and inadvertent thermal damage can be limited if adjacent tissue contacts the back of the wand distal end 120. The spacer 360 can be formed or coated with a ceramic, a material that can act as a heat sink. The spacer 360 may include a radially projecting portion 362 that extends through the opening 316 to at least the outermost circumferential surface of the return 310, providing a smooth continuous outermost back surface. This reduces snagging and provides a preferred contact surface for engaging adjacent tissue on the back of the wand distal end 120, which can reduce inadvertent contact between this tissue and the return electrode 310.

[0052] The opening 316 may be bounded by the both-side arms 315a, 315b of the return electrode 310, and each arm 315a, 315b may surround the most distal surface of the spacer 360. The opening 316 may be formed by obtaining a return electrode 310 having both-side arms 315a, 315b in a substantially straight or spaced-apart orientation configured to receive the spacer 360 therebetween. Then, the spacer 360 may be assembled and disposed between the both-side arms 315a, 315b around the most distal surface of the spacer 360 before plastically deforming the both-side arms 315a, 315b toward each other. Thus, the return electrode 310 may be formed of a conductive material that can be easily plastically formed, such as annealed stainless steel. Wrapping these arms 315a, 315b may dispose a portion of the return electrode 310 to close the distal tip (340) of the active electrode 330 while maintaining a small distal end wand profile. In other embodiments, the opening 316 may be provided as a pre-formed 360-degree bounded hole, and the spacer 360 may snap into place. However, for assembly in this manner, the inventors have found that the distal end profile of the wand 10 may need to be made larger to enable this assembly and thus may not be very preferable.

[0053] Wrapping a portion of the return electrode (such as arms 315a, 315b) around the outermost surface of the spacer and having a tip 340 that protrudes distally directly adjacent to the active electrode 330 (without electrical contacts) can help initiate a rapid and uniform vapor layer and ultimately hasten plasma initiation at the protruding tip 340. Having the return electrode 310 directly below the protruding tip 340 can directly provide an increase in energy density between the active electrode protruding tip 340 and the return electrode 310 and can help initiate more rapid plasma formation at the distal protruding tip 340. Having proximity between the protruding tip 340 and the return electrode 310 (more specifically, arms 315a, 315b) also alleviates the burden on the sufficient conductive fluid between the electrodes. This burden results from having to flow sufficient conductive fluid from the delivery openings 312, 314 proximal to the entire active electrode 330 to around the outermost surface facing distally and near the tip 340, which can be unsatisfactory depending on various factors. For example, the fluid 50 can be drawn into the suction opening 380 through the active electrode 330 before reaching this outermost surface, or the fluid 50 can flow out of the wand 10 depending on the orientation of the wand 10. Second, moving sufficient fluid from the delivery openings 312, 314 proximal to the entire active electrode 330 to the outermost surface facing distally can be time-consuming and can cause an unsatisfactory time delay between actuating the fluid delivery and energy and the fluid reaching around the outermost surface facing distally and near the tip 340. This fluid 50 is the key to enabling plasma formation. Therefore, placing the return electrode 310 directly below and in the vicinity of the active electrode tip 340 can alleviate the burden of supplying sufficient conductive fluid within a reasonable time to electrically bridge the two electrodes necessary to form a uniform or consistent plasma. This reduced burden helps initiate the vapor layer immediately after the energy and fluid delivery actuation and ultimately provides plasma initiation at a reasonable time.

[0054] Furthermore, by wrapping the return electrode 310 around this distal end, the return electrode 310 can come into direct contact with tissue closer to the target tissue. This is because, around the distal radius, a more concentrated and more uniform electric field is formed, so when the wand distal surface contacts the tissue, the distance for some of the current to move through the tissue is smaller. This results in more tissue cutting by ablation and reduced resistive heating of the tissue. Thereby, a fine tissue incision by molecular dissociation with reduced heat diffusion is provided. This is important for pharyngeal applications to limit unintended thermal damage to the surrounding delicate airway anatomical structures.

[0055] Figure 3C shows a left side view of the distal working end 120. The distal working end 120 may have a longitudinal axis A-A that is angularly offset from the shaft longitudinal axis L-L by an angle β. The angle β may be between 5 and 30 degrees to enable visibility of the target tissue within the patient airway, more preferably about 20 degrees, and also conforms within the laryngoscope opening. The active electrode 330 may define an upper planar surface 331 that extends at an angle Ω with respect to the working end longitudinal axis A-A. The angle Ω may be between 5 and 10 degrees. The angle Ω is configured to enable the operator to visually recognize the protruding tip 340 of the active electrode while processing tissue within the patient airway. The angle β may angularly offset the distal working end 120, thereby angularly offsetting the active electrode planar surface 311 in a first direction with respect to the longitudinal axis L-L, and the angle Ω may angularly offset the active electrode plane in a second direction with respect to the longitudinal axis L-L, where the second direction is opposite to the first direction.

[0056] Figure 3B shows a top surface view of the distal working end 120 perpendicular to the upper surface 331 of the active electrode plane. The upper surface 331 of the active electrode may be planar along its entire length (best seen in FIG. 3C). In use, this planar surface 331 may be disposed on the target tissue and may debulk the target tissue upon application of electrosurgical energy. The active electrode 330 includes a proximal annular portion 332 that includes a 360-degree bounded suction opening 380 therethrough. The annular portion 332 may be axially coextensive with the spacer 360. The protruding tip 340 extends distally from the annular portion 332. The protruding tip 340 has an upper surface that forms a portion of the upper planar surface 331 of the active electrode. In other words, the protruding tip 340 has an upper planar surface that is continuous with and coplanar with the upper planar surface of the annular portion. The protruding tip 340 extends axially beyond the most distal surface of the spacer and may not be supported by the spacer 360. The protruding tip 340 may have a length between 0.010 and 0.065 inches. The protruding tip 340 is generally configured to micro-incise the target tissue through the formation of plasma along it, and by having a tip 340 that protrudes beyond the spacer 360, better access to and treatment of this target tissue is obtained, and a surface is provided on a plurality of sides (up to five sides) of the protruding tip 340.

[0057] The peripheral edge boundary 333 of the active electrode 330 may include double-sided recessed curves 334a, 334b that define the transition from the annular portion 332 and the protruding tip 340 (FIG. 4A). The protruding tip 340 may have a maximum lateral width W between 0.020 and 0.025 inches T while the maximum lateral width W of the annular portion a may be between 0.070 and 0.090 inches. The ratio of the maximum lateral width W a of the W T may be at least 2:1, more preferably at least 3:1. This provides an electrode planar surface 331 sufficient to debulk the tissue and a narrow protruding tip 340 sufficient to micro-incise the target tissue. The maximum lateral width W Tis the corresponding maximum aperture size W of the suction aperture 380, which can be between 0.035 and 0.045 inches e and can be less than

[0058] The suction aperture 380 is configured to suction plasma by-products, partially digested tissue, and fluid therethrough, and is fluidly coupled to the fluid suction conduit of the system 11. More specifically, the suction aperture 380 can be in direct fluid communication with a suction cavity 366 within the spacer 360, which is in direct fluid communication with a suction tube 390 extending along the shaft 17. The suction aperture 380 defines a complex aperture that extends from the upper planar surface 331 to the lower surface 336 of the active electrode 330, and the aperture 380 includes several structural features for efficiently suctioning plasma by-products and partially digested tissue therethrough while reducing the possibility of clogging the partially digested tissue along the suction conduit. If the suction aperture is too large, a larger sized tail, or string, of the partially digested tissue may enter the wand 10 and clog the suction conduit. Further, if the suction aperture is too large, it has been found to form a central untreated core of the tissue. However, if the suction aperture is too small, it may completely restrict suction and leave plasma by-products and partially digested tissue in the field. This complex aperture is configured to provide a sufficient aperture size for effective suction while managing the suctioned plasma by-products and partially digested tissue and avoiding clogging.

[0059] At least a portion of the means for managing aspirated tissue to reduce occlusion includes means for further digesting the partially digested tissue. This is best seen with reference to FIGS. 4A and 4B. First, when the partially digested tissue enters the opening 380, some of this tissue can further interact with the plasma formed along the inner surface 381 of the opening 380 and the recessed edge as the tissue flows along the opening 380. However, at the center of the opening 380, at a certain distance from this inner surface 381, the partially digested tissue may not interact with any plasma. This forms or defines a plasma-remote zone 386 along the opening 380 that is remote from the inner surface 381 and thus less affected by the plasma. Tissue debris that may contain plasma by-products within the plasma-remote zone 386 may be remote for further digestion as it is aspirated through the opening. In other words, the tissue debris may flow through the opening 380 spaced from the inner surface 381 and end in a cylindrical central zone 386, or tissue debris, that may not be further digested via the plasma.

[0060] A first means for reducing this zone 386 and further digesting the tissue is provided via the angle of the inner surface 381 (or boundary wall) of the aspiration opening. These inner surfaces 381 can extend along a central axis (C) that extends through the active electrode 330, through which they define a constant cross-section and extend inclined with respect to the upper planar surface 331. The central axis C is from an axis perpendicular to the upper planar surface 331 by about 20 degrees ( o) may extend proximally. The inclination angle serves to increase the effective length of the inner surface 381, thereby increasing the length available for further debris digestion by interacting with the plasma formed therealong. Additionally, the angled opening sets a 360-degree edge boundary 385 on the upper planar surface 331 that is axially offset from the corresponding 360-degree edge boundary 383 on the corresponding lower surface of the active electrode 330. The central axis C (and thereby the suction opening wall) may be inclined to extend proximally as the opening 380 extends through the active electrode 330 and away from the upper planar surface 331, such that the edge boundary 383 on the lower surface is offset proximally from the upper surface edge boundary 385. This axial offset serves to reduce the effective diameter (or size) of the zone 386 since the flow of tissue and debris is at least partially interrupted by the lower surface edge boundary 383. The inclination angle is configured to provide a larger overall opening dimension while limiting the zone 386.

[0061] The suction opening 380 may be non-circular and may be shaped as a rounded wedge. The suction opening 380 may define a 360-degree bounded aperture having a most proximal curve 382 that may be between 0.006 and 0.010 inches (R1), and may extend angularly and distally from the most proximal curve to a most distal curve 384 (R2) that may have a second radius of curvature between 0.015 and 0.025 inches, with two opposing straight edges. In some embodiments, the ratio of R2 to R1 may be at least 3:1. In some embodiments, the two opposing straight edges may extend at least 60 degrees (angle) relative to each other. This suction opening shape provides an aperture (defined by the most distal curve 384) large enough to remove sufficient tissue debris therethrough. The larger radius of curvature (R2) provides an increase in aperture size and also provides a larger surface area for additional digestion via plasma along the inner surface (381) of this most distal segment as the suctioned tissue flows along the suction opening. However, the narrower apex 382 limits the size proximal to zone 386 and thus reduces the zone cross-sectional size 386.

[0062] Furthermore, the notch 388 is formed along the lower surface edge boundary 383 to further digest the partially digested tissue aspirated into zone 386. Plasma may preferentially form, may be stronger, and may extend further away along the irregularities on the active electrode 330. Accordingly, the opposing notches 388 are formed along the lower surface boundary 383 and are axially aligned with the two opposing linear edges of the suction opening cross-section that are coextensive with the wider portion of zone 386.

[0063] Accordingly, tissue debris enters the suction opening 380 at an angle substantially perpendicular to the upper plane 331, as indicated by arrow A. Thus, when the tissue debris enters the opening 380, it can first be digested at the edge boundary 385, which includes the apex 382 and the straight edges on both sides. Further, the tissue debris can be further digested as it interacts with the plasma formed along the inner surface 381, which includes a large slanted distal portion of the inner surface. The slanted distal surface (angle β) can increase the contact length, thereby increasing the plasma interaction and improving tissue digestion. Finally, the partially digested tissue can interact with the bilateral notches 388 and further digest it before entering the spacer cavity 366.

[0064] This tilt angle β can also deflect the flow of tissue debris through the suction opening 380 away from the most distal wall 367 of the spacer cavity 366 to avoid the tissue debris being collected there. This tilt angle β directs the flow of tissue debris towards the suction tube 390.

[0065] FIG. 3E shows a side view of the distal end 120 with a portion removed to reveal the cross-section of the active electrode 330, the spacer 360, and the return electrode 310, as well as other components. FIG. 3E shows the curved suction cavity 366 within the spacer 360 that forms part of the suction conduit. The suction cavity 366 is in fluid communication between the suction opening 380 and the suction tube 390. The curved suction conduit tends to be inductive to the tissue that occludes the conduit. Thus, the angle 368 is rounded to increase the flow rate around this inner corner of the curve and can help prevent occlusion when moving debris around the corner.

[0066] Figures 5A-5B show the distal working end of another exemplary embodiment of the wand 10 according to the present disclosure. FIG. 5A shows the distal end 520 of an electrosurgical wand 10 having an active electrode 525 that defines the most distal surface of the wand 10. The active electrode 525 includes an annular portion 525a having a first leg 525b extending from a first side of the annular portion 525a and a second leg 525c extending from a second, opposite side of the annular portion 525a, and defines a planar, distally facing surface. The first leg 525b may extend distally from the annular portion 525a to its most distal edge. The first leg 525b may terminate proximally spaced from the most distal spacer. The second leg 525c may also be wrapped around the distal edge surface of the spacer 524 and extend proximally along the working distal end 520 and may provide a finer tissue incision by that region. The second leg 525c may form a protrusion, such as a triangular or toothed protrusion 525d, that is wrapped around the distal edge surface and extends radially away from the spacer surface to improve the fine incision of the target tissue. The toothed protrusion 525d may extend proximally along the wand distal end 520. The active electrode 525 may generally be oval, have a length greater than its maximum width, and the maximum width is perpendicular to the length. Similar to the previous embodiments, the return electrode 523 may be perforated with a plurality of fluid delivery ports 526 to provide a conductive fluid and bridge the active electrode 523 and the return electrode 523 to generate plasma.

[0067] The annular portion 525a may include a 360-degree bounded aperture that functions as a suction aperture 528, similar to other embodiments disclosed herein. The annular portion 525a may define the maximum lateral width portion of the active electrode 525 and may be at least 50% larger than the maximum corresponding width of the remaining portions (525b, 525c, 525d) of the active electrode.

[0068] In use, the planar surface facing distally of the active electrode 525 can be energized to engage the target tissue to debulk the tissue while ablating the tissue and removing the ablated tissue through the suction opening 528. For finer incisions, the second leg 525c and the protrusion 525d may preferably engage the target tissue and space the planar surface facing distally from the target tissue for incisions.

[0069] Figures 6A and 6B show another exemplary embodiment of the distal working end of the wand 10, including the active electrode 630, the return electrode 640, and the spacer 660. The return electrode 640 may include a plurality of openings 642 in fluid communication with a fluid delivery conduit, which is in fluid communication with the conductive fluid source 50 as disclosed herein. Further, the spacer 660 may form a bilateral break duct (indicating a saline port) 644 in fluid communication with the fluid delivery conduit and the source 50. The duct 644 may direct fluid delivery across the outer surface of the spacer 660 and towards the midline of the wand distal working end 620. The break duct 644 is shallow and can serve to keep the conductive fluid 50 in contact with the spacer 660 for any orientation of the wand. In use, the wand 10 may be inverted upside down to the target tissue, and the fluid 50 on the wand surface may tend to rapidly fall from the distal working end 620. By maintaining a wet surface around the working distal end, plasma generation and consistency are improved. The duct 644 is configured to direct a small amount of conductive fluid 50 along the working distal end 620, maintain contact, and resist separation therefrom, regardless of the orientation of the wand. Each duct 644 may define a tapered channel along the outer surface of the spacer 660, and the spacer 660 may be tapered in both depth and width as it extends distally. Each duct 644 may extend along a duct axis angled with respect to the longitudinal axis of the distal working end. The duct axes of the protrusions may intersect each other at the center of the distal working end at a point (P) that may be proximally spaced from the active electrode 630. The fluid delivery path may include flowing fluid in a generally distal direction along the duct 644, where the fluid is combined towards the center of the upper surface of the spacer 660 (by the axis of the duct) and then directed to flow generally axially and distally towards the suction opening. The duct 644 may also be in fluid communication with a fluid delivery conduit that is also in fluid communication with the openings 642.

[0070] Movable electrode Figures 7A - 7E show alternative embodiments of the electrosurgical wand distal end 720 that may be configured to electro - surgically treat tissue along a patient's airway. The wand distal end 720 may be coupled to the controller 28 and may include a suction conduit that may be fluidly coupled to the tube 42 and a fluid delivery conduit that may be fluidly coupled to the tube 16 (FIG. 1). The wand distal end 720 may include electrodes in a bipolar arrangement that may include a return electrode 710, a composite active electrode 730 that may include a first active electrode portion 730a and a second active electrode portion 730b, and a spacer 740 therebetween. The first active electrode portion (730a) may be axially movable between a first configuration and a second configuration. In the first configuration, the combined wand may be configured to debulk tissue, and the first and second portions may define a single continuous treatment surface that may be substantially in the same plane. In the second configuration, the first active electrode portion may be moved away from the remainder of the composite electrode, and this first portion 730a may be used to make a micro - incision in the target tissue.

[0071] Starting from FIG. 7A, the wand actuating distal end 720 can be angularly offset from the shaft by an angle β. In this embodiment, the angular offset β can be adjustable via at least one articulated shaft. The articulation connection may be provided by two tension wires 706 along the inner diameter of the angular offset, and the wires 706 are arranged under tension to articulately connect the working distal end 720. The spine 705 provides rigidity to the device and can be configured to bend as the wand articulates. The spine 705 may be passive with respect to the articulation, and the articulation may be provided only via the wires 706. In some embodiments, the spine 705 may include a plurality of cuts 707 sized and shaped to allow bending of the shaft 705 during articulation. The wires 706 and the spine 705 extend along the shaft 717 and can be coupled to actuation means associated with the handle 19 using means known in the art. The shaft 717 may include different materials along it to adjust the bending force and may include shape memory materials. The spine 705 and the wires 706 may be operably coupled to various actuation means such as a trigger, a thumb pusher (for contraction or extension of the microshaft), a button, or a combination of knobs, all of which may be located along the handle 19.

[0072] Shaft 717 includes a multi-lumen extruded tube 750, shown spaced apart from the remainder of wand 72 in FIG. 7B for clarity. The multi-lumen tube 750 can be formed of flexible PVC and / or silicone. Each lumen of the multi-lumen extruded tube 750 can provide a different function to the working distal end 720, such as at least one fluid and / or drug delivery conduit 751, at least one fluid suction conduit 752, at least one conductive wire conduit 753, a conduit 756 for wire 706 and spine conduit 755, etc. FIG. 7C illustrates the multi-lumen extruded tube 750 to which the active electrode 730 is assembled. The active electrode 730 may include a first active electrode 730a and a second active electrode 730b, and the second active electrode 730b may be a fixed electrode having a plurality of openings therethrough. These may include fluid delivery openings 731 that are in fluid communication with the fluid and / or drug delivery conduit 751. These may include a central opening 732 that can be in fluid communication with the suction conduit 752. The second active electrode 730b may include an opening 733 for receiving the first active electrode 730a therethrough. The opening 733 may define a 360-degree bounded aperture. The opening 733 may define an extended or elliptical shape that slidably receives the first active electrode 730a therethrough, which may be substantially the same shape as the bounded aperture.

[0073] The first active electrode 730a may define the distal exposed end of the spine 705. The first active electrode 730a may be axially movable to define an axial offset between the two active electrodes (730a, 730b) and at least partially define a tissue effect mode. Moving the first active electrode 730a axially may change the surface area and edge surface available for treating tissue, which, in combination with different energy outputs from the controller 28, can provide different treatment modes. The first and second active electrodes (730a, 730b) may together constitute the composite active electrode 730 in its entirety. In other embodiments, there may be third and fourth active electrodes, and they may all be independently axially movable to change the mode of tissue treatment.

[0074] In use, the composite active electrode 730 may have a first configuration, and the most distal treatment surfaces of the first and second active electrodes (730a, 730b) may be coextensive with each other. Referring to FIG. 7D, these most distal treatment surfaces may be coplanar with each other to define a continuous single distal-facing planar surface of the active electrode 730. In the first configuration, the active electrode 730 is configured to debulk the target tissue by engaging the distal surfaces of both the first and second active electrodes (730a, 730b) with the target tissue. Energy supplied from the controller 28 may be delivered to both active electrodes (730a, 730b) and may be configured to debulk the target tissue.

[0075] In a second configuration, the first active electrode 730a may be axially offset (along the longitudinal axis of the wand distal end 720). Stated another way, for example, if the angular offset β of the distal end 720 from the shaft longitudinal axis L-L is 30 degrees, the first active electrode 730a may also extend axially along the axis at approximately 30 degrees with respect to the longitudinal axis L-L. Here, the first active electrode 730a may provide a focused treatment electrode configured to micro-incise the target tissue or tissue adjacent thereto. The first active electrode 730a may define the terminus of a wand spine 705 that extends along a wand shaft within one of the pre-formed lumens. The first active electrode 730a is preferably moved to an axially advanced position (second configuration), after which energy is supplied to the wand distal end while the first active electrode 730a remains stationary. Next, when the operator desires to debulk the tissue, the first active electrode 730a is drawn by the operator into the first configuration and energy is supplied to the wand distal end to debulk the tissue while the first active electrode 730a remains in the first configuration.

[0076] The first active electrode 730a may have a substantially smaller cross-section than the second active electrode 730b. The first active electrode 730a and the second active electrode 730b may be electrically insulated from each other such that only the first active electrode or the second active electrode can be selectively coupled to an energy source. When the first active electrode 730a advances axially towards the second configuration, the second active electrode 730b may be in a resting state, or in other words, unable to electro-surgically treat tissue, for finer incisions. The spine 705 may be formed of a conductive material to provide electrical connection to the first active electrode 730a, but may be coated or covered along its length to prevent electrical communication between the first active electrode 730a and the second active electrode 730b.

[0077] The first active electrode 730a may advance axially along the longitudinal axis of the distal end 720 with respect to the second portion 730b. The first active electrode 730a may have a boundary or perimeter that can be completely surrounded by the second active electrode 730b when in the first configuration. In other words, in the first configuration, the first active electrode 730a may be completely surrounded by the second active electrode 730b, and the second active electrode 730b may define the outermost perimeter of the composite electrode 730 as a whole. In other exemplary configurations, when in the first configuration, the first active electrode 730a may have a boundary or perimeter that defines a portion of the boundary of the composite active electrode 730 as a whole (as shown in later embodiments). The first active electrode 730a may define a center offset from the center of the composite electrode and may be disposed towards the outside of the active electrode, where the outside is defined as the outer radial side surface of the radius of curvature, regardless of whether an angular offset is provided or the offset orientation can be articulated. The first active electrode 730a may extend between 1 and 15 mm from the second partial plane. This distance may be selectable or presetable. FIG. 7E shows another view of the wand distal end 720 in which the first active electrode portion 730a extends axially in the second configuration.

[0078] In alternative embodiments, these devices may be operably coupled and communicable with navigation means and a robot. Different operating options may be possible with simple operations and easy control for various cutting patterns. Manual operation may include multiple axes of motion (side by side, indicating flexion / extension). In some other embodiments, the composite active electrode 730 may include a third active electrode (not shown) that may be similar to the first active electrode 730a in that it can be axially positioned relative to the second active electrode 730b. Different material properties are included that can use bending force (or shape memory material) for various needs. The handle may be operated using various actuation means such as a trigger, a thumb pusher (for retracting or extending a microshaft), a button, or a combination of knobs.

[0079] Here, with reference to FIGS. 8A - 8D, this specification shows various diagrams of another exemplary wand distal end embodiment 820, similar to embodiment 720 described herein, unless otherwise described. Embodiment 820 may be an articulated wand or a fixed angle offset wand. The wand distal end 820 may include a multi-lumen shaft having a plurality of conduits therethrough, similar to the wand distal end 720. The shaft cross-section may be elongated or elliptical and include a return electrode collar 804 and an insulating spacer 802. The spacer 802 is configured to electrically insulate the return electrode collar 804 from the active electrodes (810 and 820). The spacer 802 may define a planar surface facing distally for supporting the second active electrode 810. The spacer 802 may have an elliptical cross-section having a length greater than its width. The spacer 802 may have a suction opening 803 therethrough that is in fluid communication with a fluid suction conduit extending along the wand shaft.

[0080] The active electrode may include a first active electrode 820 and a second active electrode 810. The first active electrode 820 may be axially movable relative to the second active electrode 810, similar to other embodiments described herein. The first active electrode 820 may be a tubular member having a chamfered open end 822. The distal edge of the first active electrode 810 may be continuous with the most distal surface of the second active electrode 820 during debulking and may advance axially during microincision (FIG. 8C), as shown in FIG. 8B.

[0081] The most distal surface of the second active electrode 810 may be planar and may include a bridge portion 810a and an annular portion 810b. The second active electrode 810 may be symmetrically disposed about a plane bisecting the wand distal end, the bisecting plane being parallel to the longest dimension of the distal end cross-section. The bridge portion 810a may extend from the annular portion 810b to the first active electrode 820. The annular portion 810b may be radially offset from the longitudinal axis of the wand. The annular portion 810b may be concentrically disposed with the spacer suction opening 825 and may define an inlet opening to the fluid suction conduit. The annular portion 810b may define, in combination with the largest cross-sectional width portion of the entire active electrode (810, 820), a large inlet opening therethrough for efficient fluid and tissue removal.

[0082] The bridge portion 810a can communicate electrically with the first active electrode 820. The bridge portion 810a can terminate in an opening, or channel, configured to slidably receive at least a portion of the first active electrode 820 therethrough while maintaining electrical communication. The first active electrode 820, when combined with the electrode 810, can define a portion of the outer peripheral surface of the entire active electrode. The first active electrode 820 can define the outer edge portion of the wand distal end. The first active electrode 820 can be connected to a spring configured to bias the position of the first active electrode 820 in a retracted configuration. The user can then intentionally activate an activation means (e.g., a lever near the handle, etc.) to extend the first active electrode 820 beyond the second active electrode 810, and release of the activation means can retract the first active electrode 820 via the tension from the spring. This can prevent inadvertent damage to tissue or the wand.

[0083] The tubular member (first active electrode 820) can be a rigid member and can have a limited axial length that is limited by any bendable or articulating portion towards the wand distal end. For example, the tubular member can be 30 mm in length. Thus, the articulation can occur proximally from the entire tubular member. Compared to the first embodiment shown, this avoids overcoming the friction associated with the shaft that slides along the entire length of the shaft. The tubular member (820) can be actuated by a small finger tab coupled to the proximal end of the tubular member near the distal end of the wand 800. In some embodiments, the tubular member can house a rod, or wire (wire), that axially slides relative to the tubular member and can more finely incise the target tissue. In some embodiments, the tubular member can have a solid cross-section. In some embodiments, the tubular member can define a channel for housing wiring that is in electrical communication with the active electrodes (810, 820).

[0084] In some alternative embodiments, the bridge portion 810a may be recessed within the spacer and may be embedded or covered so as to be completely electrically insulated from the tissue. In this embodiment, the exposed portion of the active electrode may include only the annular portion 810b and the first active electrode 820. When the first active electrode 820 retracts, the annular portion 810b may provide the only debulking surface in this embodiment. When the first active electrode 220 advances, finer incisions may be limited to the first active electrode 820 when expanded.

[0085] The wand 820 may be plastically deformed to allow the clinician to articulate outside the clinical space for reinsertion and access to the site of interest / tissue, or the above-described articulating wire (2) may be retracted during intraoperative use to allow left and right movement (one wire at a time) or to allow flexion (bending) (pulling both wires in simultaneously).

[0086] Those skilled in the art will understand that the present disclosure may be embodied in other specific forms without departing from its spirit or essential characteristics. Accordingly, the above examples are to be considered illustrative rather than restrictive in all respects of the disclosure described herein. Thus, the scope of the present disclosure is indicated by the appended claims rather than by the foregoing description, and it is intended that all changes within the meaning and scope of the claims be included therein.

Claims

**Claim 1** A bipolar electrosurgical wand, comprising: At its distal end, a tubular end effector including an electrical insulation spacer, a return electrode, and an active electrode, said insulation spacer supporting and electrically insulating said active electrode, said tubular end effector being provided; Said active electrode defining an annular portion and a tip protrusion extending distally from said annular portion, said annular portion being coextensive with said insulation spacer, said tip protrusion extending distally from the most distal surface of said insulation spacer, both said tip protrusion and the annular portion sharing a continuous upper planar surface; Said annular portion including a 360-degree bounded aperture therethrough, defining a suction aperture configured to remove at least one of tissue, tissue debris, or fluid therethrough, said bipolar electrosurgical wand. **Claim 2** The bipolar electrosurgical wand according to claim 1, wherein said tip protrusion has a maximum lateral width that is less than half of the corresponding maximum lateral width of said annular portion. **Claim 3** The bipolar electrosurgical wand according to claim 1, wherein said active electrode defines an outermost peripheral edge surface including both side recessed edge surfaces that are coextensive with each other at the transition from said annular portion to said tip protrusion, said both side recessed edge surfaces being coextensive with the most distal end face of said insulation spacer. **Claim 4** The bipolar electrosurgical wand according to claim 1, wherein said suction aperture extends from the upper planar surface of said active electrode through the lower surface of said active electrode, defining an inner surface of the suction aperture that extends at an inclination angle with respect to said upper planar surface, said inner surface being configured to deflect the aspirated tissue debris proximally and into a suction conduit extending along said tubular end effector. **Claim 5** The bipolar electrosurgical wand according to claim 4, wherein said inclination angle is oriented such that the edge boundary of said suction aperture at said lower surface is axially offset proximally from the corresponding edge boundary of said suction aperture that coincides with said upper planar surface. **Claim 6** The bipolar electrosurgical wand according to claim 5, wherein the edge boundary at said lower surface is configured to further digest the aspirated tissue and tissue debris flowing through said suction aperture. **Claim 7** The bipolar electrosurgical wand according to claim 6, further comprising at least a notch, wherein the edge boundary on the lower surface is configured to further digest the aspirated tissue and tissue debris flowing through the suction opening.

8. The bipolar electrosurgical wand according to claim 1, wherein the suction opening defines a cross-section having a most proximal apex with a first radius of curvature and a most distal curved end with a radius of curvature at least twice that of the first radius of curvature.

9. The bipolar electrosurgical wand according to claim 8, wherein the first radius of curvature is configured to reduce the plasma remote zone through the suction opening, and the second radius of curvature is configured to provide an expanded inner surface area for further digesting tissue and tissue debris flowing through the suction opening.

10. The bipolar electrosurgical wand according to claim 1, wherein the return electrode has both-side arms extending around the most distal end surface of the insulating spacer, defines a surface facing distally of the return electrode that is coextensive with the active electrode tip protrusion, and the both-side arms are configured to assist in plasma initiation at the tip protrusion.

11. A bipolar electrosurgical wand, comprising a tubular end effector carrying a bipolar electrode arrangement at its distal portion, the bipolar electrode arrangement comprising a first active electrode, a second active electrode, and a return electrode, the first active electrode having a most distal treatment surface of the first active electrode, the second active electrode having a most distal surface of the second active electrode, and comprising a tubular end effector, wherein the first active electrode is configured to slide axially between a first configuration and a second configuration, in the first configuration, the most distal treatment surfaces of the first and second active electrodes define a single continuous tissue treatment surface, are axially adjacent to each other, and are configured to electro-surgically treat tissue in a first mode, and in the second configuration, the first active electrode is axially offset distally from the second active electrode, defines a discontinuous tissue treatment surface, and is configured to electro-surgically treat tissue in a second mode different from the first mode.

12. The bipolar electrosurgical wand according to claim 11, wherein the most distal surface of the first active electrode is smaller than the most distal surface of the second active electrode.

13. The bipolar electrosurgical wand according to claim 11, wherein the most distal surface of the second active electrode defines a surface area that is at least twice the corresponding surface area of the most distal surface of the first active electrode.

14. The bipolar electrosurgical wand according to claim 11, wherein the first mode is a debulking mode and the second mode is a micro-incision mode.

15. The bipolar electrosurgical wand according to claim 14, wherein in the second mode, the second active electrode is in a resting state.

16. The bipolar electrosurgical wand according to claim 11, wherein in the first configuration, the outer peripheral edge of the first active electrode is completely bounded by the second active electrode.

17. The bipolar electrosurgical wand according to claim 11, wherein the first mode is a coagulation mode and the second mode is a cutting mode.

18. A bipolar electrosurgical wand, comprising a handle at its proximal end, a return electrode, an insulating spacer, and an active electrode at its distal end, and a tubular end effector, wherein the insulating spacer supports and electrically insulates the active electrode, the active electrode having an annular portion with a tip protrusion extending distally from the annular portion, the annular portion and the tip protrusion both sharing a continuous upper planar surface, the annular portion defining a 360-degree bounded aperture through which a suction opening is defined, the 360-degree bounded aperture extending from the upper planar surface of the active electrode to the lower surface, defining a central axis that extends at an inclination angle with respect to the planar upper surface, the inclination angle being configured to further digest any tissue debris flowing through the suction opening and deflect the tissue debris towards a suction conduit extending proximally along the tubular end effector.

19. The bipolar electrosurgical wand according to claim 18, wherein the inclination angle extends proximally from the planar upper surface of the active electrode.

20. The bipolar electrosurgical wand according to claim 18, wherein the 360-degree bounded aperture defines a curved wedge cross-section, the most proximal apex having a first radius of curvature and the most distal curved end having a radius of curvature that is at least twice the first radius of curvature.

21. The bipolar electrosurgical wand according to claim 18, wherein the tip protrusion has a maximum transverse width that is less than half of the maximum transverse width of the annular portion.

22. The bipolar electrosurgical wand according to claim 18, wherein the tip protrusion defines a free - end protrusion that extends beyond the insulating spacer.

23. A method for electro - surgically treating tissue along a patient airway, comprising: Positioning an electrosurgical wand in a first orientation such that an upper planar surface of an active electrode engages a first target tissue along the patient airway, wherein the active electrode has a suction opening that extends from the upper planar surface of the active electrode to a lower surface, and the suction opening defines a central axis that is oriented at a non - perpendicular angle to the upper planar surface such that a peripheral edge boundary of the suction opening at the lower surface is axially offset from a corresponding peripheral edge boundary at the planar surface; while the wand is in the first orientation, Applying electrical energy between the active electrode and a return electrode of the electrosurgical wand; Forming a local plasma proximate to the active electrode plane in response to the energy, and debulking the first target tissue with the local plasma to molecularly dissociate a portion of the first target tissue; Suctioning tissue and plasma by - products associated with the first target tissue through the suction opening; Further molecularly dissociating the tissue and plasma by - products associated with the first target tissue through the local plasma proximate to the peripheral edge boundary at the lower surface in response to the energy.

24. Positioning the electrosurgical wand in a second orientation such that a protruding tip of the active electrode is directly adjacent to a second target tissue along the patient airway, wherein the protruding tip defines the most distal protrusion of the active electrode that extends parallel and continuously with the upper planar surface; while the electrosurgical wand is in the second orientation, Applying electrical energy between the active electrode and a return electrode of the electrosurgical wand; The method according to claim 23, comprising forming a local plasma proximate to the protruding tip in response to the energy, and ablating the second target tissue with the local plasma to create a micro-incision.

25. Applying electrical energy between the active electrode and the return electrode, and delivering a conductive fluid from a fluid delivery aperture spaced proximally from the active electrode, along the wand distal end, and around a portion of the return electrode facing distally and coextensive with the protruding tip, such that a local plasma proximate to the protruding tip is formed in response to the energy, and the distally facing portion and the protruding tip are configured to reduce an electrical bridge load to the conductive fluid, thereby reducing the time to plasma initiation at the protruding tip. The method according to claim 24.

26. The method according to claim 24, protecting adjacent tissue from inadvertent thermal effects while applying electrical energy between the active electrode and the return electrode of the electrosurgical wand, adjacent to a rear side of the wand distal end formed of a ceramic heat sink.

27. The method according to claim 23, further comprising deflecting the tissue debris flowing proximally through the suction aperture and toward a suction conduit disposed along the electrosurgical wand, the deflection having a distal inner surface of the suction aperture, the distal inner surface extending parallel to the central axis.

28. A method of electro-surgically treating tissue along a patient airway, positioning an electrosurgical wand in a first orientation while a first active electrode treatment surface and a second active electrode treatment surface engage a first target tissue along the patient airway, the first and second active electrodes being in an axially adjacent configuration, and the wand being in a configuration axially adjacent to the first orientation; applying electrical energy between the first and second active electrodes of the electrosurgical wand and the return electrode; forming a local plasma proximate to the first and second active electrode treatment surfaces in response to the energy, and debulking and molecularly dissociating a portion of the first target tissue with the local plasma. Axially adjust the first active electrode treatment surface to be distally spaced from the second active electrode treatment surface, defining an axially offset configuration; Positioning the electrosurgical wand in a different orientation while the first active electrode treatment surface is adjacent to another target tissue along the patient airway and the wand is in the second orientation and axially offset configuration; Applying electrical energy between the first active electrode and the return electrode of the electrosurgical wand; Forming a local plasma proximate to the first active electrode treatment surface in response to the energy, and using the local plasma to micro-incise and molecularly dissociate a portion of the other target tissue. A method comprising the steps of: **Claim 29** The method of electro-surgically treating tissue according to claim 28, further comprising positioning the first and second active electrodes in an axially adjacent configuration, applying electrical energy between the first and second active electrodes and the return electrode of the electrosurgical wand, and coagulating in response to the energy of a portion of the tissue of the patient's airway. **Claim 30** The method of electro-surgically treating tissue according to claim 28, wherein the second active electrode is inactive during micro-incision. **Claim 31** The method of electro-surgically treating tissue according to claim 28, wherein in the axially adjacent configuration, the outer peripheral edge of the first active electrode treatment surface is completely bounded by the second active electrode treatment surface.

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