Estimated maximum temperature monitoring for perfusion ablation therapy

Abstract

To provide a method and a system for monitoring a temperature during ablation therapy, especially a maximum temperature achieved at a position away from an ablation element such as an ablation instrument or an RF electrode.SOLUTION: A method and system 1000 utilizing estimated maximum temperature monitoring for irrigated ablation therapy is described. In an embodiment, a method for resecting tissue includes positioning an elongate body 1002 in proximity to tissue, the elongate body including an ablative element and at least one temperature sensor coupled thereto. The method can include simultaneously delivering ablation energy to the tissue via the ablation element and delivering a liquid via the elongate body.SELECTED DRAWING: Figure 10

Description

[Technical Field]

[0001] [Government Rights] This invention was made with government support under Grant 1R44HL132746 awarded by the National Heart, Lung, and Blood Institute (NHLBI). The government has certain rights in this invention.

[0002] FIELD OF THE DISCLOSURE The present disclosure relates generally to ablation therapy and, more particularly, to estimated maximum temperature monitoring in ablation systems and methods employing irrigation to regulate the temperature of ablation elements in contact with tissue. [Background technology]

[0003] The use of thermal energy to destroy bodily tissues can be applied to a variety of therapeutic procedures, including, for example, the destruction of tumors and arrhythmogenic tissues. Thermal energy can be applied to target tissues using various forms of energy, such as radiofrequency electrical energy, microwave or light wave electromagnetic energy, or ultrasonic vibration energy. For example, radiofrequency (RF) ablation can be performed by placing one or more electrodes on or within the tissue to be treated and passing a high-frequency current through the tissue. The current can flow between closely spaced radiating electrodes or between the radiating electrodes and a larger common electrode located away from the tissue to be heated.

[0004] One drawback of these techniques is that maximum heating often occurs at or near the interface between the treatment tool and the tissue. In RF ablation, for example, maximum heating can occur in the tissue directly adjacent to the radiating electrode. This can decrease the tissue's conductivity and, in some cases, cause fluid within the tissue to boil and become vapor. If this process continues, the tissue impedance can increase, preventing current from entering surrounding tissue. Thus, conventional RF devices can limit the volume of tissue that can be treated.

[0005] To address these shortcomings of conventional RF ablation, irrigation ablation therapy can be used. In irrigation ablation therapy, a fluid is circulated through an ablation element, such as one or more of the electrodes described above, thereby preventing the maximum heating at the interface between the instrument and the tissue. There are various forms of irrigation ablation therapy, including closed-loop systems in which the fluid circulates within the instrument without being expelled, and open-loop systems in which the fluid is expelled from the instrument into the surrounding tissue, blood, etc., using, for example, one or more outlets formed within the instrument. In some cases, a temperature sensor, such as a thermocouple, can be used to directly monitor the temperature of the ablation element and to facilitate control of the fluid perfusion rate, etc.

[0006] However, regulating the temperature of the ablation element can result in maximum heating occurring at a distance from the instrument and / or ablation element itself. If such maximum heating occurs at a distance from the instrument, its ablation element, and / or its temperature sensor, the maximum temperature cannot be directly detected. This can be problematic if the treatment unintentionally creates an area of ​​tissue that is overheated with liquid approaching or exceeding 100°C. Tissue at such temperatures can be in a highly unstable state that can cause a sudden, explosive transformation from liquid to vapor (e.g., steam), an event known in the art as steam pop. Steam pop can rupture surrounding tissue and cause undesirable damage. Using irrigated ablation therapy, it can be difficult to deliver effective treatment (i.e., achieve a temperature high enough to cause desired tissue damage) while avoiding overheating that can cause steam pop. This is because the operator or other system controller is unaware that maximum temperature is being reached in tissue located at a distance from the temperature-regulated (e.g., liquid-cooled) ablation element.

[0007] Previous attempts to detect tissue temperature at locations remote from the ablation instrument have focused on remotely positioning the temperature sensor, for example, using tines or other structures to extend the sensor away from the instrument into the surrounding tissue. Such approaches can increase the complexity and cost of the instrument by introducing additional sensors, tines, extension mechanisms, etc.

[0008] Therefore, there is a need for improved methods and systems for monitoring temperatures during ablation therapy, particularly the maximum temperature achieved at locations remote from the ablation instrument or ablation element, such as an RF electrode. Summary of the Invention

[0009] The present disclosure is generally directed to methods and systems for monitoring temperature during ablation therapy, where a temperature sensor can estimate the maximum tissue temperature achieved at a location remote from an ablation instrument coupled to the instrument. In contrast to previous approaches that attempt to position a temperature sensor remote from the ablation instrument, for example, using tines or other extending structures, the methods and systems described herein employ a pause in the delivery of ablation energy and fluid to monitor the temperature of the instrument or its ablation element. Based on whether the measured temperature rises, falls, or remains the same during this brief pause, an inference can be made regarding the temperature of the tissue remote from the instrument, e.g., whether the tissue remote from the instrument is hotter, cooler, or at the same temperature as the tissue in contact with the instrument. As a result, the methods and systems according to the teachings provided herein can monitor the temperature of tissue remote from the instrument or ablation element without requiring additional temperature sensors or structures for positioning such sensors in the remotely located tissue.

[0010] In one aspect, a method for ablating tissue is provided. The method includes positioning an elongate body adjacent to tissue, the elongate body including an ablation element and at least one temperature sensor coupled thereto. The method can further include simultaneously delivering ablation energy to the tissue via the ablation element and delivering a liquid via the elongate body, pausing the delivery of the ablation energy and the liquid, and sensing a temperature of the ablation element while the delivery of the ablation energy and the liquid is paused. The method can further include either terminating the delivery of the ablation energy and the liquid or resuming the delivery of the ablation energy and the liquid based on a comparison of the sensed temperature with a reference temperature.

[0011] The methods, devices, and systems described herein can include several additional features and / or variations, all of which are within the scope of the present disclosure. In some embodiments, for example, positioning the elongate body adjacent to tissue can include inserting the elongate body into the tissue mass. In some such embodiments, the method can further include delivering a fluid into the tissue via at least one outlet formed in the elongate body.

[0012] However, in other embodiments, positioning the elongate body adjacent to tissue can include contacting the tissue with the distal portion of the elongate body without penetrating the tissue. In some such embodiments, the liquid dispensed through the elongate body can be expelled through at least one outlet formed within the elongate body. In other embodiments, the liquid dispensed through the elongate body can be recirculated without exiting the elongate body.

[0013] Based on a comparison of the sensed temperature with a reference temperature, several actions can be taken. For example, in some embodiments, the delivery of ablation energy and liquid can be terminated if the sensed temperature is higher than the reference temperature. In certain embodiments, the delivery of ablation energy and liquid can be terminated if the difference between the sensed temperature and the reference temperature is greater than a threshold amount. In still other embodiments, the delivery of ablation energy can be discontinued while the delivery of liquid is resumed to continue heat convection through the tissue. Still further, in some embodiments, the temperature of the liquid can be adjusted, for example, to cool overheated tissue.

[0014] In other embodiments, alternative actions may be taken. For example, in some embodiments, the supply of ablation energy and liquid may be resumed when the sensed temperature and the reference temperature are substantially equal. In some embodiments, resuming the supply of ablation energy and liquid may include adjusting at least one of the power level of the ablation energy, the temperature of the liquid, and the flow rate of the liquid. For example, in some embodiments, the power level of the ablation energy and at least one of the temperature of the liquid may be decreased when the sensed temperature is higher than the reference temperature. In other embodiments, the power level of the ablation energy and at least one of the temperature of the liquid may be increased when the sensed temperature is lower than the reference temperature. In still other embodiments, the flow rate of the liquid may be increased when the sensed temperature is higher than the reference temperature, while in some embodiments, the flow rate of the liquid may be decreased when the sensed temperature is lower than the reference temperature. That is, the power level and / or flow rate and / or liquid temperature may be adjusted up or down, or maintained without adjustment, based on the temperature detected while the supply of ablation energy and liquid is paused.

[0015] The step of pausing the delivery of ablation energy and liquid can be performed for any of a variety of periods and at various intervals to allow for efficient monitoring and treatment delivery. For example, in some embodiments, the delivery of ablation energy and liquid can be paused for approximately 1 second, while in other embodiments, the pause can be approximately 10 seconds. In some embodiments, the step of pausing the delivery of ablation energy and liquid can occur after approximately 15 seconds of simultaneous delivery of ablation energy and liquid. However, other embodiments can utilize alternative pause durations and / or intervals, including, for example, pauses of less than about 1 second, pauses of more than about 1 second, etc. Furthermore, in some embodiments, such pauses can occur after less than about 15 seconds of simultaneous delivery of ablation energy and liquid, while in some embodiments, such pauses can occur after more than about 15 seconds of simultaneous delivery of ablation energy and liquid.

[0016] In some embodiments, the method may further include heating the liquid within the elongate body. Various heating temperatures may be employed. For example, in some embodiments, the liquid may be heated to a temperature of from about 40° C. to about 80° C. Various liquid flow rates may also be employed. For example, in some embodiments, the liquid may have a flow rate of up to about 20 ml / min.

[0017] A number of different ablation elements and ablation energies can be employed. For example, in some embodiments, the ablation element can be an electrode and the ablation energy can be electrical energy, such as radiofrequency (RF) electrical energy. However, other embodiments can utilize other sources of ablation energy, including, for example, laser heating, ultrasonic heating, microwave heating, resistive electrical heating, etc.

[0018] In certain embodiments, pausing the ablation energy and fluid supply can include reversing the fluid flow to counteract compliance pressure. Reversing fluid flow in this manner can more effectively pause the ablation energy and fluid supply because pressure from compliance in the system can cause fluid flow to continue even after the pump or other fluid driver has stopped operating.

[0019] In other embodiments, the method may further include drawing liquid into the elongate body from outside the elongate body after ceasing delivery of the ablation energy and liquid. Drawing the liquid back into the elongate body may increase heat transfer by utilizing convection in addition to conduction, allowing the temperature sensor to more quickly come into equilibrium with the surrounding tissue during periods when delivery of the ablation energy is ceasing.

[0020] In another aspect, a method for ablating tissue is provided. The method can include positioning an elongate body adjacent to tissue, the elongate body including an ablation element and at least one temperature sensor coupled thereto. The method can further include simultaneously delivering ablation energy to the tissue via the ablation element and delivering a liquid via the elongate body for a first period of time, and pausing the delivery of the ablation energy and the liquid to the tissue for a second period of time. The method can also include monitoring the temperature sensor during the second period of time, and either terminating the delivery of the ablation energy and the liquid or resuming the delivery of the ablation energy and the liquid at the end of the second period of time in response to a temperature profile of the temperature sensor during the second period of time.

[0021] As with the above aspects, several additional features and / or variations can be included, all within the scope of the present disclosure. In some embodiments, for example, positioning the elongate body adjacent to tissue can include inserting the elongate body into the tissue mass. In some embodiments, the method can further include delivering a fluid into the tissue via at least one outlet in the elongate body.

[0022] In other embodiments, positioning the elongate body adjacent to tissue can include contacting the tissue with the distal portion of the elongate body without penetrating the tissue. In certain embodiments, the liquid dispensed through the elongate body can be expelled through at least one outlet formed within the elongate body. However, in some embodiments, the liquid dispensed through the elongate body can be recirculated without exiting the elongate body.

[0023] Depending on the temperature profile of the temperature sensor over the second time period, several different actions may be possible. In some embodiments, for example, the delivery of ablation energy and liquid may be terminated if the temperature profile increases over the second time period. Furthermore, in certain embodiments, the delivery of ablation energy and liquid may be terminated if the temperature profile increases by at least a threshold amount over the second time period.

[0024] Additionally, in some embodiments, the supply of ablation energy and liquid can be resumed when the temperature profile remains substantially constant over the second time period. In some embodiments, resuming the supply of ablation energy and liquid can include adjusting at least one of the power level of the ablation energy, the temperature of the liquid, and the flow rate of the liquid. For example, in certain embodiments, the power level of the ablation energy and the temperature of the liquid can be decreased when the temperature profile is increasing over the second time period. In some embodiments, the power level of the ablation energy and the temperature of the liquid can be increased when the temperature profile is decreasing over the second time period. As a further example, in certain embodiments, the flow rate of the liquid can be increased when the temperature profile is increasing over the second time period. In some embodiments, the flow rate of the liquid can be decreased when the temperature profile is decreasing over the second time period.

[0025] In different embodiments, the first period and the second period can be different. In some embodiments, for example, the first period can be about 15 seconds. Further, in some embodiments, the second period can be about 1 second. However, in other embodiments, the first period can be longer or shorter than about 15 seconds, and the second period can be longer or shorter than about 1 second.

[0026] In some embodiments, the method may further include heating the liquid within the elongate body. Such heating may be achieved using any of a variety of heating mechanisms disposed within the elongate body. Examples include single-wire and dual-wire radio frequency electric heating elements, resistive electric heating elements, ultrasonic heating elements, microwave energy heating elements, laser heating elements, etc.

[0027] Additionally, several different ablation elements and ablation energies can be utilized. For example, in some embodiments, the ablation element can be an electrode and the ablation energy can be electrical energy, such as radio frequency (RF) electrical energy. However, other embodiments can utilize other sources of ablation energy, including, for example, laser heating, ultrasonic heating, microwave heating, resistive electrical heating, etc.

[0028] In certain embodiments, pausing the delivery of ablation energy and fluid to the tissue can include reversing fluid flow to counteract compliance pressure. As noted above, reversing fluid flow in this manner can more effectively pause the delivery of ablation energy and fluid because pressure from compliance in the system can cause fluid flow to continue even after the pump or other fluid driver has stopped operating.

[0029] In other embodiments, the method further includes drawing liquid into the elongate body from outside the elongate body during the second period. As noted above, drawing liquid back into the elongate body can increase heat transfer by utilizing convection in addition to conduction, allowing the temperature sensor to more quickly come into equilibrium with the surrounding tissue during periods when delivery of ablation energy is paused.

[0030] In another aspect, a tissue ablation system is provided. The tissue ablation system includes an elongate body including an internal lumen, an ablation element coupled to the elongate body, a temperature sensor coupled to the elongate body, a liquid supply source in communication with the internal lumen of the elongate body and configured to supply a liquid through the internal lumen, and a controller. The controller can be configured to simultaneously supply ablation energy through the ablation element and supply the liquid through the elongate body, pause the supply of ablation energy and liquid, and sense the temperature of the ablation element while the supply of ablation energy and liquid is paused. The controller can be further configured to either discontinue the supply of ablation energy and liquid or resume the supply of ablation energy and liquid based on a comparison of the sensed temperature with a reference temperature.

[0031] As with the above aspects, several additional features and / or variations can be included, all within the scope of the present disclosure. In some embodiments, for example, the elongate body can include at least one outlet that allows fluid to flow from the internal lumen into a volume surrounding the elongate body. In certain embodiments, the elongate body can include a tissue-piercing distal tip. Such a tip can, for example, facilitate insertion of the elongate body into a tissue mass. However, in some embodiments, the elongate body can include a blunt distal tip. Such a tip can be used, for example, to abut a tissue wall without penetrating the tissue.

[0032] Any of the above features or variations may be applied to any particular aspect or embodiment of the present disclosure in several different combinations, and any particular combination is not explicitly listed solely to avoid repetition in this summary of the invention. [Brief explanation of the drawings]

[0033] The above-described aspects and embodiments of the present invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings.

[0034] [Figure 1] FIG. 10 is a graphical representation of simulated heating profiles for various forms of ablation.

[0035] [Figure 2] FIG. 1 is a graphical illustration of a temperature profile for one embodiment of a perfusion ablation therapy at various time intervals.

[0036] [Figure 3] 1 is a flow chart of one embodiment of a method for inferential temperature monitoring in accordance with the present disclosure.

[0037] [Figure 4] FIG. 1 is a graphical illustration of a temperature profile measured after cessation of one embodiment of perfusion ablation therapy.

[0038] [Figure 5A] 1 is a graphical illustration of a temperature profile during the administration of one embodiment of a perfusion ablation therapy, with tissue distant from the ablation element being cooler than the ablation element.

[0039] [Figure 5B] FIG. 5B is a graphical representation of the temperature profile of FIG. 5A after treatment has ceased.

[0040] [Figure 6A] 1 is a graphical illustration of a temperature profile during the administration of one embodiment of a perfusion ablation therapy, with tissue distant from the ablation element being hotter than the ablation element.

[0041] [Figure 6B] FIG. 6B is a graphical representation of the temperature profile of FIG. 6A after treatment has ceased.

[0042] [Figure 7A] 1 is a graphical illustration of a temperature profile during the administration of one embodiment of a perfusion ablation therapy, where the tissue distant from the ablation element is at substantially the same temperature as the ablation element.

[0043] [Figure 7B] FIG. 7B is a graphical representation of the temperature profile of FIG. 7A after treatment has ceased.

[0044] [Figure 8] FIG. 1B is a partially transparent side view of one embodiment of an ablation device having a closed-loop flow pattern.

[0045] [Figure 9] FIG. 1B is a partially transparent side view of one embodiment of an ablation device having an open-loop flow pattern.

[0046] [Figure 10] 1 is a diagram of one embodiment of a liquid-enhanced ablation system.

[0047] [Figure 11A] FIG. 1 is a perspective view of one embodiment of a laparoscopic device including an elongated body for use in liquid-enhanced ablation therapy.

[0048] [Figure 11B] FIG. 10 is a perspective view of another embodiment of a catheter device including an elongate body for use in fluid-enhanced ablation therapy.

[0049] [Figure 12] FIG. 10 is a diagram of one embodiment of an electrical circuit for driving an elongate body including a two-wire heating assembly.

[0050] [Figure 13]FIG. 10 is a diagram of one embodiment of an electrical circuit for driving an elongate body including a single-wire heating assembly. DETAILED DESCRIPTION OF THE INVENTION

[0051] Certain exemplary embodiments will now be described to provide a thorough understanding of the principles of the structure, function, manufacture, and use of the methods and systems disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will recognize that the methods and systems specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. Features shown or described in connection with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be within the scope of the present disclosure.

[0052] The terms "a" and "an" can be used interchangeably and are equivalent to the phrase "one or more" as used in this disclosure. The terms "comprising," "having," "including," and "containing" should be construed as open-ended terms (i.e., meaning "including, but not limited to") unless otherwise specified. The terms "about" and "approximately," when used with any numerical value or range, indicate the appropriate dimensional tolerances that will enable the composition, portion, or collection of elements to function for its intended purpose as described herein. Components described herein as being combined may be directly combined or indirectly combined through one or more intermediate components. The recitation of any range of values ​​herein, unless otherwise stated herein, is merely intended to serve as a shorthand method of individually referring to each separate value within the range, and each separate value is incorporated herein as if it were individually recited. Furthermore, to the extent that linear or circular dimensions are used in describing the disclosed methods and systems, such dimensions are not intended to limit the types of shapes that can be used in conjunction with such methods and systems. For any geometric shape, equivalents to such linear and circular dimensions can be determined. Furthermore, in this disclosure, like-numbered components of embodiments generally have similar characteristics. Still further, the size and shape of various devices and their components can depend at least on the environment in which the device is used, the size and shape of components used with the device, and the method and procedure in which the device is used.

[0053] Unless otherwise specified herein or clearly contradicted by context, all methods described herein can be performed in any suitable order. The use of any and all examples or exemplary language (e.g., "such as") provided herein is intended merely to facilitate understanding of the invention and does not impose limitations on the scope of the invention unless otherwise claimed. No language within the specification should be construed as indicating any non-claimed element as essential to the practice of the invention. Furthermore, to the extent that the term "saline" is used in connection with any embodiment herein, such embodiment is not limited to the use of "saline" as opposed to another liquid unless explicitly stated. Other liquids can generally be used in a similar manner.

[0054] As noted above, the present disclosure is generally directed to methods and systems for monitoring temperature during ablation therapy, where a temperature sensor can estimate the maximum tissue temperature achieved at a location remote from an ablation instrument coupled to the ablation instrument. In contrast to previous approaches that attempt to position a temperature sensor remote from the ablation instrument, for example, using tines or other extending structures, the methods and systems described herein employ a pause in the delivery of ablation energy and fluid to monitor the temperature of the instrument or its ablation element. Based on whether the measured temperature rises, falls, or remains the same during this brief pause, an inference can be made regarding the temperature of the tissue remote from the instrument, e.g., whether the tissue remote from the instrument is hotter, cooler, or at the same temperature as the tissue in contact with the instrument. As a result, the methods and systems according to the teachings provided herein can monitor the temperature of tissue remote from the instrument or ablation element without requiring additional temperature sensors or structures for positioning such sensors in the remotely located tissue.

[0055] Ablation generally involves the selective necrosis and / or removal of tissue through the application of high or low temperatures. In the case of hyperthermic ablation, delivery of therapeutic energy into the tissue can induce hyperthermia within the tissue, ultimately leading to necrosis. This temperature-induced selective destruction of tissue can be used to treat a variety of diseases, including tumors, fibroids, and arrhythmias (e.g., ventricular tachycardia). The thermal destruction of tissue achieved by ablation has a known time-temperature relationship. The threshold temperature for causing irreversible thermal damage to tissue is generally recognized to be approximately 41 degrees Celsius. It is also known that as therapeutic temperatures are increased above 41 degrees Celsius, the time required to achieve a particular level of cell necrosis decreases. While the exact time / temperature relationship varies by cell type, a general relationship exists across many cell types that can be used to determine the desired level of thermal dose. This relationship is commonly referred to as the equivalent time at 43 degrees Celsius and is expressed as follows:

number

[0056] While it may be desirable to raise tissue temperatures above 41°C to deliver effective ablation therapy, it may also be desirable to avoid overheating the tissue. For example, if tissue heating is not interrupted or regulated, regions of overheated tissue may be created within the tissue treatment volume. As tissue temperatures approach, reach, or exceed 100°C, the tissue may become unstable, and any liquid within the tissue (e.g., saline introduced during ablation therapy, as described below) may suddenly convert to vapor or steam—a “steam pop”—which can rupture surrounding tissue and cause undesirable complications. Therefore, ablation instruments often include temperature sensors coupled to them to measure the temperature of the ablation element and / or the tissue in contact therewith during treatment to prevent overheating.

[0057] FIG. 1 illustrates the performance profiles of several ablation techniques by showing simulated temperatures achieved at given distances from an ablation element, such as an RF electrode. A first profile 102 shows the performance of conventional RF ablation. As shown, tissue temperature reaches a maximum at the interface with the instrument and drops off very rapidly with distance from the electrode. For example, tissue at the instrument may be close to 100°C, while tissue temperatures within 10 millimeters of the ablation element may remain around body temperature (37°C), well below the treatment temperature. In addition to the risk of causing steam pop near the ablation instrument, hot tissue dries or burns more quickly. Once this occurs, tissue impedance rises dramatically, making it difficult to transfer energy to tissue further away from the ablation element. This limits the practical size of the tissue treatment volume that can be created using conventional ablation techniques.

[0058] Irfusion ablation therapy addresses the limitations of conventional ablation techniques described above by flowing a fluid over the ablation element (e.g., an RF electrode) to regulate its temperature. This prevents overheating of tissue in contact with the ablation instrument. For example, a second tissue temperature profile 104 was simulated based on a system similar to that described in U.S. Patent No. 5,431,649. In this system, an electrode is inserted into the tissue and a 400 kHz RF current flow of approximately 525 mA is applied to heat the tissue. Simultaneously, saline at body temperature (37°C) is infused into the tissue at a rate of 10 ml / min. The resulting tissue temperature profile 104 is more uniform than profile 102, with little overheating of the tissue in profile 102 adjacent to the instrument.

[0059] The third tissue temperature profile 106 illustrates the results of a simulation of a heated fluid irrigation ablation technique, such as that described in U.S. Patent Nos. 6,328,735 and 9,138,287, the entire disclosures of which are incorporated herein by reference. In the illustrated embodiment, an electrode formed from silver / silver chloride is inserted into tissue, and a 480 kHz RF current flow of 525 mA is applied to heat the tissue. Simultaneously, saline heated to 50°C is infused into the tissue at a rate of 10 ml / min. The resulting temperature profile 106 is uniform and significantly exceeds the 50°C therapeutic threshold for up to 15 millimeters from the electrode. Furthermore, because the temperature is substantially uniform within this volume, the delivered heat dose is also substantially uniform throughout this volume.

[0060] An important aspect of temperature profiles 104, 106 relative to profile 102 is that the maximum temperature of the treated tissue occurs at a location away from the ablation instrument and ablation elements that impart energy to the tissue. This means that a thermocouple or other temperature sensor in contact with the ablation element or otherwise coupled to the instrument would not detect the maximum temperature of the treatment volume of tissue as would be the case with conventional ablation therapy (e.g., profile 102).

[0061] Thus, the use of irrigated ablation techniques can result in unintentional overheating of tissue. As noted above, tissue heated to temperatures approaching and exceeding 100°C can become overheated, unstable, and at risk of steam pop, i.e., the sudden, explosive transformation of liquid to vapor or steam within the tissue. Due to the shape of the temperature profiles 104, 106, which reach a maximum value away from the ablation instrument and associated ablation element, a conventional temperature sensor would not directly detect the maximum temperature.

[0062] 2 illustrates one embodiment of tissue heating by showing simulated temperature profiles at various times after the initiation of a perfusion ablation technique, e.g., a liquid-enhanced ablation treatment technique using heated saline, as shown in profile 106 above. In the illustrated embodiment, treatment parameters were 62.5 W of RF power while infusing 65° C. at 10 ml / min. Profile 202 occurs after 2 seconds of treatment, profile 204 after 5 seconds of treatment, profile 206 after 10 seconds of treatment, and profile 208 after 30 seconds of treatment.

[0063] Comparing the profile in FIG. 2 with the temperature profile described above in connection with FIG. 1 can highlight the importance of using appropriate operating parameters (e.g., ablation element energy level, fluid temperature, fluid flow rate, treatment time, etc.) to perform ablation therapy. When parameters are properly selected, similar to profile 106 in FIG. 1, the temperature profile within the tissue can be isothermal or substantially isothermal and significantly exceed the treatment threshold throughout the desired treatment volume, e.g., up to about 15 millimeters from the electrode (other treatment distances are contemplated in other embodiments). However, if the treatment parameters are not properly configured, such as when the ablation energy power level is too high relative to the fluid flow rate and temperature being introduced into the tissue, the temperature within the tissue can rise rapidly away from the electrode or other ablation element. For example, the temperature profile in FIG. 2 shows a rapid increase in the temperature of the tissue away from the instrument or ablation element. The temperature exceeds 90°C within 5 seconds and approaches 100°C within 30 seconds at about 7 mm from the instrument. If treatment is continued in this manner for up to 60 seconds, a spherical shell approximately 7 to 9 mm from the device will exceed 100°C, and in some cases steam popping will occur.

[0064] 2 also shows that tissue temperature near the ablation instrument or ablation element reaches a steady state rapidly. For example, the temperature of tissue up to about 4 mm from the instrument achieves a steady-state value within about 5 seconds. Continuing treatment thereafter results in an increase in temperature only in tissue beyond about 4 mm from the instrument or ablation element.

[0065] The teachings of the present disclosure utilize these characteristics of tissue in contact with and adjacent to the ablation instrument or ablation element to detect the temperature of tissue further away from the ablation instrument. More specifically, the methods and systems described herein monitor the temperature of tissue adjacent to the instrument by temporarily pausing the delivery of ablation energy and fluid to the tissue and monitoring the temperature of the ablation element itself, for example. During such pauses, when the instrument is not applying additional thermal energy to the tissue, the tissue adjacent to the instrument will continue to increase in temperature if surrounded by hotter tissue, will begin to decrease in temperature if surrounded by cooler tissue, and will remain at a constant or substantially constant temperature if surrounded by tissue at the same or substantially the same temperature. Observing the temperature of tissue in contact with or closer to the ablation instrument may allow an estimate to be made regarding the maximum temperature achieved in tissue further away from the instrument. This estimate may be useful, for example, in determining whether treatment is progressing in a desired manner, similar to profile 106 of FIG. 1, or whether treatment parameters are misconfigured, resulting in insufficient heating of the target volume of tissue or causing overheating of the tissue, similar to FIG. 2.

[0066] 3 illustrates one embodiment of a method 300 for estimated temperature monitoring during perfusion ablation therapy. In some embodiments, the method can include positioning (302) an elongate body or other component of an ablation instrument or device relative to tissue. In some embodiments, this can include inserting the elongate body into the tissue mass, e.g., positioning an ablation element disposed along the elongate body, within the tissue mass or volume to be treated. In other embodiments, the elongate body or other component of the ablation instrument can include a blunt distal end configured to abut the tissue mass or tissue wall without penetrating it (e.g., a contact catheter device that can abut against a tissue wall or tissue mass).

[0067] The method may also include delivering (304) ablation energy and liquid to cause selective necrosis or destruction of tissue. As noted above, ablation energy can be delivered in many different ways, such as radiofrequency or other electrical energy, microwave or light wave electromagnetic energy (e.g., via a laser), or ultrasonic vibrational energy. Furthermore, delivery of the liquid can be accomplished in a variety of ways, including both open-loop and closed-loop device configurations, in which the liquid is delivered from the instrument into the surrounding tissue, or in which the liquid is recirculated within the instrument without being expelled into the tissue (e.g., the liquid is delivered to the distal end of the instrument and then recirculated proximally within the instrument). Furthermore, in some embodiments, delivery of the liquid may include heating the liquid, as described above, for example, to a therapeutic temperature where contact with tissue can cause hyperthermia and necrosis.

[0068] The method can further include ceasing the delivery of ablation energy and fluid, e.g., after a first period during which energy and fluid are delivered to treat the target volume of tissue. Ceasing the delivery of ablation energy and fluid can substantially stop the introduction of heat from the ablation instrument to the tissue, e.g., by ceasing the delivery of electrical or other ablation energy from any ablation elements and ceasing the flow of fluid (e.g., in some embodiments, heated fluid) into the tissue. In the case of a closed-loop ablation instrument, recirculation of fluid within the device can be ceasing to prevent the continued removal of heat from the ablation elements.

[0069] The pause in the delivery of ablation energy and liquid can be coordinated, for example, by a system controller or other component configured to control treatment operating parameters. In certain embodiments, the pause in the delivery of ablation energy and liquid can be simultaneous, or the energy or liquid can be paused before or after each other. The pause in the delivery of ablation energy and liquid can occur after a first period of energy and liquid delivery. The duration of the first period can be set to any of a variety of values. For example, in some embodiments, the first period can be about 2 seconds, about 5 seconds, about 10 seconds, about 15 seconds, and / or about 20 seconds or more. The duration of the pause can also be set to any of a variety of values. For example, in some embodiments, the duration of the pause can be less than 1 second, about 1 second, about 2 seconds, about 5 seconds, about 10 seconds, about 15 seconds, and / or about 20 seconds or more.

[0070] The method may also include detecting the temperature of tissue in contact with or adjacent to the ablation instrument. This can be accomplished using various temperature sensors, such as a thermocouple. The temperature sensor can be coupled to the elongate body or other components of the ablation instrument in various ways. For example, as described in more detail below, in some embodiments, a thermocouple or other temperature sensor can be placed in contact with the ablation element, e.g., an RF electrode, to detect the temperature of the electrode during treatment. The temperature sensor can also be used to detect the temperature of tissue in contact with the ablation element while the electrode is not delivering ablation energy. In other embodiments, one or more temperature sensors can be positioned along the ablation instrument (e.g., along its elongate body) and used to directly measure the temperature of tissue in contact therewith, or indirectly measure the temperature of such tissue by measuring the temperature of the portion of the elongate body or ablation instrument in contact with the tissue (e.g., when the temperature sensor is positioned within the internal lumen of the elongate body in contact with its sidewall). Exemplary embodiments in which various temperature sensors are combined with ablation instruments can be found in U.S. Patent Application Publication No. 2017 / 0238993, the entire contents of which are incorporated herein by reference.

[0071] The temperature detection or sensing at the elongate body or ablation instrument can also be performed at different times. For example, in some embodiments, detecting the tissue temperature can occur only once during a pause in the delivery of ablation energy and fluid. In such embodiments, the detected temperature can be compared to a reference temperature, e.g., a temperature detected during delivery of ablation energy and fluid, to determine whether and how the temperature of the tissue in contact with the instrument is changing during the pause in the delivery of ablation energy and fluid. In other embodiments, detecting the tissue temperature can occur multiple times during a pause in the delivery of ablation energy and fluid, e.g., every 1 second, 2 seconds, 5 seconds, 10 seconds, 20 seconds, etc. In some embodiments, a sufficiently short measurement interval, e.g., less than 1 second, can enable continuous or substantially continuous real-time monitoring of the temperature in contact with or adjacent to the elongate body or other component of the ablation instrument. As noted above, pauses in the delivery of ablation energy and fluid can be of various lengths. In some embodiments, the pause can be less than 1 second, e.g., about 0.5 seconds. In other embodiments, the pause can be about 1 second, about 2 seconds, about 3 seconds, and / or about 4 seconds or more. In some embodiments, the pause in energy and liquid delivery can last for any of about 5 seconds, about 10 seconds, about 15 seconds, and about 20 seconds or more. However, in some cases, as described below, pausing energy and liquid delivery for longer periods to monitor temperature may not be necessary to determine the temperature profile of the treatment volume of tissue and may unnecessarily extend the duration of the treatment.

[0072] By comparing the baseline temperature with the tissue temperature detected during a pause in the delivery of ablation energy and fluid, or by comparing multiple tissue temperatures detected over time during a pause in the delivery of ablation energy and fluid, a user or system controller can determine whether to terminate treatment (310), resume treatment (312), or adjust one or more operating parameters (314) before resuming treatment. By way of example, FIG. 4 illustrates temperature response profiles for two ablation therapies during a pause in the delivery of ablation energy and fluid following a period of energy and fluid delivery (e.g., 15 seconds of active delivery of energy and fluid to tissue). A first profile 402 illustrates tissue temperatures measured for an ablation therapy that achieves a desired isothermal treatment volume, while a second profile 404 illustrates tissue temperatures measured for an ablation therapy in which tissue distant from the ablation element is overheated in an undesirable manner. As shown, pausing treatment for even a short period of time, such as approximately one second, allows a user or system to distinguish between a desired isothermal profile in which the temperature remains substantially unchanged and a profile in which the surrounding tissue is overheated. For example, in the figure, after the ablation energy and liquid supply are turned off, the measured temperature rises to approximately 80° C. within 1 second.

[0073] Principles of heat transfer suggest that the temperature detected by, for example, a sensor in contact with an ablation element or other portion of the instrument will increase if the surrounding tissue is hotter than the temperature at the sensor, decrease if the surrounding tissue is cooler than the temperature at the sensor, and remain substantially unchanged if the surrounding tissue is at substantially the same temperature as the temperature at the sensor. This is illustrated by the constant temperature profile 402, because the temperature measured at the ablation element or other portion of the instrument does not change significantly from approximately 65°C. This suggests that tissue surrounding the temperature sensor and more distant from the temperature sensor is also approximately 65°C. If such a temperature profile is observed while the delivery of energy and liquid is paused, active delivery of ablation energy and liquid can be resumed (312) without changing operating parameters. Alternatively, the temperature profile 404 suggests that tissue more distant from the tissue adjacent to the temperature sensor is overheated because the sensed temperature increases rapidly and significantly during pauses in the delivery of ablation energy and liquid. This may indicate overheating within the target volume of tissue, which may cause a steam pop, for example, by bringing the temperature of the tissue surrounding the ablation instrument to a temperature near or above 100°C. If such a temperature history is observed, treatment may be terminated (310) or paused for a longer period to allow cooling within the target volume of tissue. In some embodiments, treatment may be terminated (310), for example, if the difference between the tissue temperature detected during a pause in energy and fluid delivery and the baseline temperature is greater than a threshold amount. The value of the threshold amount may be set according to a desired safety margin. Also, in some embodiments, the threshold may be set as an absolute temperature, rather than the difference between the measured temperature and the baseline temperature. For example, treatment may be terminated if the measured temperature rises above a certain value (e.g., 80°C or another desired maximum temperature).

[0074] Alternatively, one or more operating parameters of the treatment can be adjusted (314) to reduce or eliminate overheating and achieve the desired isothermal heating profile 402. Depending on the type of irrigation ablation therapy being used, there may be various parameters that can be adjusted before resuming energy and fluid delivery. For example, fluid-enhanced ablation, such as that described in U.S. Pat. No. 6,328,735, incorporated by reference above, can have several parameters that can be altered to adjust the temperature profile of the tissue being treated. For example, using such ablation techniques, an operator or control system can modify parameters such as the temperature of the saline solution (e.g., from about 40° C. to about 80° C.), the flow rate of the saline solution (e.g., from about 0 ml / min to about 20 ml / min), the power of the RF signal or other ablation energy (e.g., from about 0 W to about 100 W), and the duration of the treatment (e.g., from about 0 minutes to about 10 minutes) to adjust the temperature profile. As a further example, in some embodiments, the power level of the ablation energy can be reduced to deposit less energy into the tissue and reduce heating within the tissue. In some embodiments, the temperature of the liquid may also be reduced, or alternatively, the temperature of the liquid may be reduced to reduce the temperature of the surrounding tissue. In other embodiments, the flow rate of the liquid may be increased to cool the tissue and / or prevent heat from concentrating in a single area. Of course, the reverse can also be done if the temperature profile observed during pauses in the delivery of ablation energy and liquid indicates that sufficient heating is not occurring within the target volume of tissue. For example, if the temperature measured during pauses is lower than the baseline temperature during delivery of ablation energy and liquid, or if the series of temperatures measured during pauses in the delivery of energy and liquid exhibits a downward trend, one or more of the power level of the ablation energy and the temperature of the liquid may be increased, or the flow rate of the liquid may be reduced to ensure adequate heating of the surrounding tissue.

[0075] It should be noted that method steps 304-314 may be repeated at various intervals throughout the duration of the ablation procedure to prevent undesired tissue overheating. For example, after treatment is resumed 312, ablation energy and fluid may be delivered 304 for an additional period, such as 15 seconds or some other period as described above, before delivery can again be paused 306. During this additional pause, temperature may again be sensed 308, and treatment may be terminated, resumed under the current operating parameters, or resumed under different operating parameters.

[0076] 5A-7B show profiles of temperature (T) versus distance (D) from the ablation instrument 502 during delivery of ablation energy and fluid and during periods when the delivery of energy and fluid is paused. These figures illustrate the three basic scenarios discussed above: (1) insufficient heating of the target volume of tissue in FIGS. 5A and 5B, (2) overheating of the target volume of tissue in FIGS. 6A and 6B, and (3) isothermal heating of the target volume of tissue in FIGS. 7A and 7B.

[0077] 5A, the temperature profile 504 shown occurs during delivery of ablation energy and liquid in a first scenario in which heating is insufficient to bring the entire target volume of tissue to or above the desired treatment temperature 506 (e.g., 65°C, or some other desired treatment temperature as described herein). As shown, during delivery of ablation energy and liquid, the temperature of tissue in contact with or directly adjacent to instrument 502 may reach a maximum of the desired treatment temperature 506 (indeed, irrigation may be used to regulate the temperature of the ablation element to achieve this desired temperature), while the temperature of tissue more distant from the instrument may quickly drop below the desired temperature.

[0078] The temperature profile 508 shown in FIG. 5B may exist after treatment has been paused and no further energy is being imparted into the tissue by the instrument 502. At this point, the temperature at the instrument 502 may be lower than the desired treatment temperature 506, as indicated by a temperature drop 510. This may occur because cooler tissue surrounding the instrument 502 can draw heat from the tissue immediately adjacent to the instrument. If a temperature drop 510 is observed, for example, using a thermocouple or another temperature sensor sensing the temperature of the ablation element, treatment can be resumed to allow more time for heat to accumulate within the target volume of tissue. Alternatively, or additionally, one or more treatment parameters can be modified to increase the amount of energy imparted into the tissue to achieve the desired therapeutic heating of the entire target volume of tissue.

[0079] 6A and 6B illustrate a second scenario in which a target volume of tissue experiences potentially undesirable overheating, e.g., heating that could cause steam popping. FIG. 6A illustrates a temperature profile 602 that may exist during delivery of ablation energy and liquid in this scenario. Note that the temperature of tissue in contact with or directly adjacent to instrument 502 may be at the desired treatment temperature 506 because liquid irrigation can regulate the ablation element to the desired temperature. However, tissue farther away from instrument 502 may exceed the desired treatment temperature 506 and approach temperatures at or near 100° C., which could cause steam popping.

[0080] 6B shows a temperature profile 604 in the target volume of tissue while energy and fluid delivery from the instrument 502 is paused. At this point, the temperature near the ablation element is not being regulated by fluid irrigation and / or power management, and as a result, the temperature rises due to heat transfer from the hotter, more distant tissue. Thus, the temperature observed at the instrument 502 is higher than the desired treatment temperature 506, as indicated by temperature rise 606. If this temperature response is observed, the user or the system can either terminate the treatment, pause until sufficient cooling has occurred, and adjust one or more treatment parameters to provide further cooling, and / or reduce the energy delivered into the tissue to reduce induced heating.

[0081] 7A and 7B illustrate a third scenario in which desired isothermal heating occurs throughout a target volume of tissue. FIG. 7A illustrates a temperature profile 702 that may exist during delivery of ablation energy and fluid in this scenario. Similar to FIGS. 5A and 6A, during active therapy (e.g., delivery of ablation energy and fluid), the temperature of the tissue in contact with or directly adjacent to instrument 502 is adjusted to a desired treatment temperature 506 using fluid irrigation. However, with appropriate configuration of treatment operating parameters, the temperature of tissue throughout the target volume may reach the desired treatment temperature 506. As shown, although there may be some temperature variation due to the nature of the heating process, the target volume of tissue may achieve substantially the desired temperature throughout, without significantly overheated or underheated areas.

[0082] Figure 7B shows a temperature profile 704 in the target volume of tissue during a pause in the delivery of energy and fluid from instrument 502. Assuming that heating throughout the target volume of tissue is approximately isothermal, there is substantially no change in the temperature of the tissue in contact with or adjacent to instrument 502 during the pause period as a result of heat transfer from the more distant surrounding tissue, as shown in Figure 7A. Thus, the temperature measured at the instrument (e.g., by measuring the temperature of the ablation element) does not substantially change. If the user or system observes this response, the desired uniform heating is occurring and the delivery of ablation energy and fluid can be resumed at the current operating parameters.

[0083] As noted above, the methods and systems described herein can utilize various types of irrigated ablation instruments that utilize fluid flow to regulate the temperature of the ablation element, including both closed-loop and open-loop fluid flow devices. In closed-loop devices, fluid circulates internally without being ejected into the tissue, while in open-loop devices, fluid is ejected from the instrument into surrounding tissue, blood, etc. Figures 8 and 9 show exemplary embodiments of closed-loop and open-loop instruments, respectively.

[0084] Returning to FIG. 8 , one embodiment of a closed-loop perfused ablation device 800 is shown. The device 800 includes an elongate body 802, which may be rigid or flexible and formed from a variety of biocompatible materials. For example, the elongate body 802 may be a flexible catheter body or a rigid body disposed at the distal end of a catheter used to introduce the elongate body 802 to a treatment site. The elongate body 802 may also include an internal lumen 804 extending therethrough, which may be configured to provide a passageway for fluid flow through the elongate body. Furthermore, the particular size of the elongate body may depend on various factors, including the type and location of tissue to be treated. By way of example only, in one embodiment, a very small elongate body may be utilized to access a patient's heart. In such an embodiment, an appropriately sized elongate body may be, for example, a catheter having a diameter of approximately 8 French ("French" is a unit of measurement used in the catheter industry to describe catheter size and is equal to three times the diameter of the catheter in millimeters). The elongate body 802 can be formed from an electrically conductive material such that the elongate body can conduct electrical energy along the length of the elongate body to the cutting element 806 disposed thereon. Alternatively, the elongate body can be formed from or coated with an electrically insulating material, and any electrical communication between any components coupled thereto can be achieved via electrical connections running along or within the elongate body. In some embodiments, an electrically insulating paint can be combined with an elongate body formed from an electrically conductive material. For example, the electrically insulating paint can coat the conductive elongate body except for the portion of the elongate body configured to function as the cutting element.

[0085] As described above, the elongate body 802 can include an ablation element 806 disposed along its length adjacent its distal end. As shown, in some embodiments, the ablation element 806 can be positioned at the distal end of the elongate body 802. In certain embodiments, the ablation element 806 can be an electrode configured to deliver electrical energy, such as radiofrequency (RF) electrical energy. In such embodiments, the ablation element 806 can be formed from a variety of materials suitable for conducting electrical current. For example, any metal or metal salt can be used. In addition to stainless steel, exemplary metals can include platinum, gold, or silver, and exemplary metal salts can include silver / silver chloride. In one embodiment, the electrode can be formed from silver / silver chloride. One advantage of using a metal salt such as silver / silver chloride can be that it has a high exchange current density. As a result, large amounts of electrical current can be passed through such an electrode with only a small voltage drop into tissue, minimizing energy dissipation at this interface. Thus, electrodes formed from metal salts such as silver / silver chloride can help reduce excess energy generation at the tissue interface, thereby generating a more desirable temperature profile that requires less fluid flow to regulate.

[0086] The cutting element 806 can have a variety of shapes, but in some embodiments, it can be shaped to form a blunt distal end of the device 800. As such, the cutting element 806 can be configured to press against or be positioned adjacent to a tissue wall without penetrating the tissue wall. In other embodiments, the elongate body 802 can include a pointed distal end configured for insertion into the tissue mass, and the cutting element 806 can be disposed along the length of the elongate body such that it can be positioned within the tissue mass after the elongate body has been inserted therein (see FIG. 10 ).

[0087] In some embodiments, the internal lumen 804 of the elongate body 802 can include a supply lumen 808 configured to provide a path for fluid flow from the proximal end to the distal end, and a return lumen formed by an annular space between the supply lumen 808 and the internal wall of the internal lumen 804. The return lumen can be configured to receive fluid at its distal end and supply the fluid back to the proximal end of the elongate body 802. This allows fluid to circulate through the elongate body without having to expel the fluid into surrounding tissue. Like the elongate body 802, the supply lumen 808 can be formed from a variety of materials, including rigid, flexible, polymeric, metallic, conductive, or insulating materials. Furthermore, the supply lumen 808 can be positioned within the internal lumen 804 of the elongate body 802 such that the supply lumen does not move relative to the elongate body, or it can be free-floating within the elongate body 802. In some embodiments, the supply lumen 808 can be a hollow tube disposed within the internal lumen of the elongate body. Additionally, in certain embodiments, the return lumen can be a separate hollow tube disposed within the internal lumen 804 of the elongate body.

[0088] In some embodiments, the supply lumen 808 can house a heating assembly or heating element 812 disposed adjacent the distal end of the supply lumen and configured to heat the liquid flowing therethrough. The heating assembly 812 can be connected to a power supply and controller coupled to the proximal end of the elongate body 802. Several heating assemblies can be utilized to heat the liquid flowing through the supply lumen 808, including those described in U.S. Pat. Nos. 6,328,735 and 9,138,287, incorporated by reference above. For example, the heating element 812 can be a resistive coil disposed within the supply lumen 808. However, in other embodiments, the heating assembly 812 formed from one or more wires suspended within the supply lumen 808 can be used to transmit RF electrical energy to the liquid flowing therethrough, thereby heating the liquid due to its inherent electrical resistivity.

[0089] In certain embodiments, the supply lumen 808 may also house a temperature sensor 814 configured to detect the temperature of the liquid flowing through the supply lumen 808 after it has been heated by the heating assembly 812. Thus, in some embodiments, the temperature sensor 814 may be positioned distal to the heating assembly 812 and separated from the heating assembly by a distance sufficient to allow mixing of the liquid after it has passed through the heating assembly (e.g., about 1 mm). The temperature sensor 814 may have various forms and, in some embodiments, may be a fine-wire thermocouple. The temperature sensor 814 may be connected to a controller that can utilize the detected liquid temperature to adjust the heating assembly 812.

[0090] During use, a liquid (e.g., saline) can be pumped from the proximal end of supply lumen 808 through supply lumen 808 to the distal end positioned adjacent ablation element 806. The liquid passes by heating assembly 812 and can be heated to a desired temperature, e.g., any temperature below 100°C, or any temperature between about 40°C and about 90°C, about 50°C and about 80°C, or about 60°C and about 70°C. However, in some embodiments, lower temperature liquids can be employed, including liquid temperatures below body temperature. Indeed, in some embodiments, there may be no heating assembly 812 to regulate the temperature of the liquid. Also, in some embodiments, an additional temperature sensor (not shown) can be positioned within supply lumen 808 proximal to heating assembly 812 to determine the initial temperature of the liquid flowing through supply lumen 808 (and thereby determine the required power output of heating assembly 812). After being heated by heating assembly 812, the liquids may mix and exit supply lumen 808 near the distal end of elongate body 802 adjacent ablation element 806. As indicated by flow arrow 816, after contacting the interior surface of the ablation element, the liquid may be directed back through the return lumen toward the proximal end of elongate body 802. The movement of the liquid may regulate the temperature of ablation element 806 by removing heat from it. With sufficient flow rate, ablation element 806 may be regulated to approximately the same temperature as the liquid exiting supply lumen 808.

[0091] To verify the effectiveness of the temperature adjustment, device 800 can also include an external temperature sensor 818 positioned on the distal end of device 800. In some embodiments, temperature sensor 818 can be recessed within ablation element 806 so that it does not protrude from the distal end of device 800. In yet other embodiments in which ablation element 806 is formed from metal or other thermally conductive material, temperature sensor 818 can be positioned inside internal lumen 804, where it touches the surface of ablation element 806. Regardless of its location, temperature sensor 818 can be configured to detect the temperature at the interface between ablation element 806 and tissue surface 820. Detecting the temperature at this location can effectively measure the temperature of tissue surface 820 and confirm that ablation element 806 has cooled to the temperature of the liquid flowing from delivery lumen 808. Furthermore, temperature sensor 818 can be utilized to detect the temperature of the ablation element and the tissue in contact with / directly adjacent to it during periods of pause in the delivery of ablation energy and liquid, as described above.

[0092] Figure 9 illustrates another embodiment of an ablation device 900 having open-loop flow, as opposed to the closed-loop flow shown in Figure 8. As shown, device 900 may include several components in common with the device of Figure 8. For example, device 900 may have an elongate body 802 including an internal lumen 804, a supply lumen 808 disposed within internal lumen 804 and including its own internal lumen 810, a heating assembly 812, a temperature sensor 814 housed within internal lumen 810, and in some embodiments, one or more additional temperature sensors, such as temperature sensor 818.

[0093] Device 900 differs from device 800 in that it includes an ablation element 902 having multiple outlets or pores formed therein that communicate between the interior and exterior surfaces of the ablation element. As a result, when a liquid is introduced into an internal lumen 804 adjacent to the ablation element 902, the liquid can flow through the ablation element 902 and into the body cavity or tissue surrounding the device 900. The resulting open-loop flow pattern is indicated by flow direction arrows 904. As a result of the open-loop flow pattern, in some embodiments, device 900 can eliminate the separate supply lumen 808 and simply pump liquid unidirectionally through the internal lumen 804 of the elongate body 802. In such embodiments, a heating assembly and optional temperature sensor can be disposed within the internal lumen 804 of the elongate body 802.

[0094] The methods and systems described herein can also be used in conjunction with any of various types of perfusion ablation therapy, which uses a flow of liquid to regulate the temperature of the ablation element to prevent overheating of tissue in contact with or directly adjacent to the ablation element. This can include devices and systems that utilize body temperature or lower temperature saline or other liquids to cool the ablation element during treatment. However, in some embodiments, the teachings provided herein can be used in conjunction with fluid-enhanced ablation, such as the ablation technique described in U.S. Patent No. 6,328,735 and incorporated by reference above. Such techniques allow a liquid heated to a therapeutic temperature to be delivered into the tissue along with ablation energy. Figures 10-13 provide further details regarding exemplary embodiments of fluid-enhanced ablation therapy systems and devices that can be used in conjunction with the methods described herein.

[0095] FIG. 10 shows a diagram of an exemplary fluid ablation system 1000. The system includes an elongate body 1002 configured for insertion into a target volume of tissue. The elongate body can have a variety of shapes and sizes depending on the geometry of the target tissue. Furthermore, the specific size of the elongate body can depend on various factors, including the type and location of tissue to be treated, the size of the tissue volume to be treated, etc. By way of example only, in one embodiment, the elongate body can be a thin-walled stainless steel needle measuring approximately 16 gauge to approximately 18 gauge (i.e., an outer diameter of approximately 1.27 millimeters to approximately 1.65 millimeters) having a length L of approximately 25 cm (e.g., as shown in FIG. 11A ). The elongate body 1002 can include a pointed distal end 1004 configured to pierce tissue to facilitate introduction of the device into the target volume of tissue, although in other embodiments, the tip can be blunt and can have various other configurations for contacting and / or abutting tissue. The elongate body 1002 can be formed from a conductive material such that the elongate body can conduct electrical energy along its length to one or more ablation elements positioned along a distal portion of the elongate body. The emitter electrode 1005 is an example of an ablation element that can deliver RF energy from the elongate body.

[0096] In some embodiments, the emitter electrode 1005 can be part of the elongate body 1002. For example, the elongate body 1002 can be coated with an insulating material along its entire length, except for the portion representing the emitter electrode 1005. More specifically, in one embodiment, the elongate body 1002 can be coated with 1.5 mil (0.0381 mm) of the fluoropolymer Xylan™ 8840. The electrode 1005 can have a variety of lengths and configurations. In one embodiment, the electrode 1005 can be a 4 mm portion of the tubular elongate body that is exposed to the surrounding tissue. Furthermore, the electrode 1005 can be positioned anywhere along the length of the elongate body 1005 (and there can be more than one electrode positioned along the length of the elongate body). In one embodiment, the electrode can be positioned adjacent the distal end 1004. In other embodiments, the elongate body can be formed from an insulating material, and the electrode can be positioned around the elongate body or between portions of the elongate body. In other embodiments, the electrodes can be formed from a variety of other materials suitable for conducting electrical current. As noted above, for example, any metal or metal salt may be used.

[0097] 1 is configured as a continuous cylindrical band to accommodate unipolar current flow, the electrode may be formed in other shapes, such as a sphere or spiral, that form a continuous surface area, or the electrode may have multiple separate portions. The electrode may also be configured for bipolar operation, with one electrode (or portion of the electrode) functioning as a cathode and the other electrode (or portion of the electrode) functioning as an anode.

[0098] The electrode 1005 or other ablation element may include one or more outlets 1008 configured to deliver fluid from an internal lumen 1006 extending through the elongate body 1002 into surrounding tissue (as indicated by arrow 1009). Alternatively, the electrode 1005 may be positioned near one or more outlets 1008 formed in the elongate body 1002. In many embodiments, it may be desirable to position the electrode adjacent to one or more outlets 1008 to maximize the therapeutic effect of the flowing fluid. The outlets 1008 may be formed in various sizes, numbers, and pattern configurations. Additionally, the outlets 1008 may be configured to direct fluid in various directions relative to the elongate body 1002. These may include a normal orientation (i.e., perpendicular to the surface of the elongate body), as indicated by arrow 1009 in FIG. 10 , and orientations directed proximally and distally along the longitudinal axis of the elongate body 1002, including various orientations that promote circular or spiral fluid flow around the elongate body. Still further, in some embodiments, the elongate body 1002 can be formed with an open distal end that functions as an outlet. By way of example, in one embodiment, 24 equally spaced outlets 1008 having a diameter of approximately 0.4 mm can be created around the circumference of the electrode 1005 using electrical discharge machining (EDM). However, in other embodiments, alternative manufacturing methods can be used to create the outlets 1008. Additionally, in some embodiments, the outlets can be located along the portion of the elongate body adjacent to the electrode, rather than being located in the electrode itself. In still other embodiments, any of a variety of other outlet patterns can be employed, including, for example, those described in U.S. Pat. No. 9,743,984, the entire contents of which are incorporated herein by reference.

[0099] The internal lumen 1006, which is in communication with the outlet 1008, may also house a heating assembly 1010 configured to heat the liquid as it passes through the internal lumen 1006 just prior to being introduced into the tissue. A detailed description of various embodiments of heating assemblies 1010 suitable for use in the devices and methods of the present invention can be found in related U.S. Patent No. 9,138,287, previously incorporated by reference in its entirety.

[0100] The portion of the elongate body positioned distal to the electrode 1005 or other ablation element can be solid or filled such that the internal lumen 1006 terminates at the distal end of the electrode 1005. In one embodiment, the internal volume of the portion of the elongate body distal to the electrode can be filled with a plastic plug that can be epoxied in place or held with an interference fit. In other embodiments, the portion of the elongate body distal to the electrode can be formed from solid metal and attached to the proximal portion of the elongate body by welding, drawing, or any other technique known in the art.

[0101] Liquid can be supplied to the internal lumen 1006 and heating assembly 1010 from a liquid reservoir 1012. The liquid reservoir 1012 can be connected to the internal lumen 1006 via a liquid conduit 1014. The liquid conduit 1014 can be, for example, a length of flexible plastic tubing. The liquid conduit 1014 can also be a rigid tube or a combination of rigid and flexible tubing.

[0102] Liquid may be forced from liquid reservoir 1012 into internal lumen 1006 by pump 1016. Pump 1016 may be a syringe-type pump that generates a constant volumetric flow rate by advancing a plunger (not shown). An example of such a pump is the Model 74900 sold by Cole-Palmer Corporation of Chicago, Illinois. Other types of pumps, such as diaphragm pumps, may also be employed.

[0103] One type of fluid that can be used is sterile normal saline (defined as a salt-containing solution). However, other fluids, including Ringer's solution or concentrated saline, may also be used. The fluid can be selected to provide the desired therapeutic and physical properties when applied to the target tissue, and a sterile fluid is recommended to prevent tissue infection.

[0104] The pump 1016 can be controlled by a power supply and controller 1018. The power supply and controller 1018 provides electrical control signals to the pump 1016, causing it to produce a desired liquid flow rate. The power supply and controller 1018 can be connected to the pump 1016 via electrical connection 1020. The power supply and controller 1018 can also be electrically connected to the elongate body 1002 via connection 1022 and to the collecting electrode 1024 via connection 1026. Additionally, the power supply and controller 1018 can be connected to the heating assembly 1010 via similar electrical connections.

[0105] The collecting electrode 1024 can have a variety of forms. For example, the collecting electrode 1024 can be a large electrode that is positioned outside the patient's body. In other embodiments, the collecting electrode 1024 can be a return electrode that is positioned elsewhere along the elongate body 1002, or can be positioned on a second elongate body that is introduced into the patient's body.

[0106] During operation, the power supply and controller 1018 can drive the delivery of fluid into the target tissue at a desired flow rate, the heating of the fluid to a desired treatment temperature, and the delivery of therapeutic ablation energy via one or more ablation elements, such as the electrodes 1005. To do so, the power supply and controller 1018 itself can include several components for generating, regulating, and delivering the necessary electrical control and treatment energy signals. For example, the power supply and controller 1018 can include one or more frequency generators to generate one or more RF signals of given amplitudes and frequencies. These signals can be amplified with one or more RF power amplifiers to relatively high-voltage, high-amperage signals, e.g., 50 volts at 1 ampere. These RF signals can be supplied to the ablation elements via one or more electrical connections 1022 and the elongated body 1002, such that RF energy passes between the emitter electrode 1005 and a collecting electrode 1024, which can be positioned remotely on the patient's body. In embodiments in which the elongate body is formed from a non-conductive material, one or more electrical connections 1022 may extend through the interior lumen of the elongate body or along its exterior surface to supply electrical current to the emitter electrode 1005. Passing RF energy between the ablation element and the collecting electrode 1024 may heat the tissue surrounding the elongate body 1002 due to the tissue's inherent electrical resistivity. The power supply and controller 1018 may also include a directional coupler to supply a portion of one or more RF signals to, for example, a power monitor that allows the RF signal power to be adjusted to a desired therapeutic level.

[0107] It should be noted that the controller 1018 may also be configured to implement methods described herein that allow for monitoring temperature within tissue remote from the elongate body or instrument. For example, the controller may be configured to deliver ablation energy and fluid for a first period of time and then pause delivery of the ablation energy and fluid. During the pause, the controller may, for example, detect the temperature of and / or adjacent to the ablation element and determine whether treatment should be terminated, resumed, or resumed with modified operating parameters based on a comparison of the detected temperature to a baseline temperature. The controller 1018 may be automated to make various decisions, such as based on a desired safety margin, or may be configured to communicate detected values ​​and / or recommendations to a user via a user interface for direct user control.

[0108] The elongate body 1002 shown in FIG. 10 can be configured for insertion into a patient's body in a variety of ways. FIG. 11A shows one embodiment of a medical device 1100A having an elongate body 1102A disposed on its distal end configured for laparoscopic or direct insertion into a target region of tissue. In addition to the elongate body 1102A, the device 1100A can include a handle 1104A that allows an operator to manipulate the device. The handle 1104A can include one or more electrical connections 1106A that connect various components of the elongate body (e.g., the heating assembly and ablation element 1105A) to, for example, the power supply and controller 1018 described above. The handle 1104A can also include at least one fluid conduit 1108A for connecting a fluid source to the device 1100A.

[0109] While device 1100A is one exemplary embodiment of a medical device that may be adapted for use in fluid-enhanced ablation, several other devices may also be employed. For example, FIG. 11B illustrates an alternative embodiment of a catheter device 1100B configured for fluid-enhanced ablation. The devices and methods described herein may be used with any of a variety of surgical catheter devices, and device 1100B may be configured, for example, to deliver fluid-enhanced ablation therapy to a patient's heart. Device 1100B generally includes a catheter 1101 including a distal portion 1102B and a flexible portion 1104B. A proximal portion 1106B of the device includes a handle 1108B, a steering control 1110, a steering tension knob 1111, and an advancement mechanism 1112 for controlling extension of an elongate body from the distal end of catheter 1101. Tubes 1114, 1116 extend from the proximal end of the device to receive fluid for delivery during treatment and instrument cleaning, respectively. A further inlet 1118 at the proximal end of the device can accept any number of power and control cables.

[0110] The device 1100B can have a variety of different sizes depending on its intended use. For example, in some embodiments, the catheter 1101 can have a length of about 120 cm and a diameter of about 8 French, although any of a variety of other sizes can be utilized depending on the intended application, treatment site, etc. The catheter can be formed from any of a variety of materials known in the art, including, for example, polyurethane, nylon, and polyetheramides such as PEBAX®. The catheter 1101 can be flexible so that it can be steered through tortuous paths within the body using one or more steering cables, as described in more detail below.

[0111] 12 and 13 illustrate exemplary embodiments of electrical circuits for supplying ablation energy, e.g., RF electrical energy, to tissue surrounding elongate bodies 1202, 1302 and fluid flowing through their internal lumens. In the embodiment of FIG. 12, for example, two separate power sources 1214, 1216 are utilized to supply electrical energy, including, for example, RF energy. Power source 1214 can be connected to two wires 1211, 1212 running through internal lumen 1206 of elongate body 1202. By passing an electrical current through these wires, energy can be transferred through fluid flowing within internal lumen 1206 between exposed portions of wires 1211, 1212.

[0112] The power source 1216 can be connected to both the elongate body 1202 and the collecting electrode 1224. The collecting electrode 1224 can be located remotely on the patient's body, for example, under the patient's back on a surgical table. As noted above, in other embodiments, the collecting electrode 1224 can be located in the same location on the elongate body 1202 or on a second elongate body positioned near the elongate body 1202. Note that positioning the collecting electrode 1224 on the elongate body 1202 requires isolating the emitter electrode 1205 from the collecting electrode. This can be achieved in various ways, including, for example, forming the elongate body 1202 from a non-conductive material and providing two electrodes on the surface of the elongate body 1202. In such embodiments, the power source 1216 can be connected to the two electrodes by any suitable electrical connection, such as wires extending through the internal lumen of the elongate body 1202 or along its outer surface.

[0113] Referring again to the figure, power source 1216 can supply RF energy from electrode 1205 to collecting electrode 1224 by passing a current through elongate body 1202. The two power sources 1214, 1216 do not share a common electrical ground and therefore remain electrically isolated from one another. This ensures that power from source 1214 heats only the saline flowing within elongate body 1202, while power from source 1216 heats only the tissue surrounding elongate body 1202. Any of a variety of spacers 1210, 1210′ (and insulating materials) can be utilized to prevent shorting between the two wires 1211, 1212, which can result from them touching each other or simultaneously touching elongate body 1202.

[0114] FIG. 13 illustrates another embodiment of an electrical circuit for independently supplying RF energy to the fluid flowing within the internal lumen 1306 of the elongate body 1302 and to the tissue surrounding the elongate body. As shown, dual power sources 1314, 1316 may be used to supply energy to the fluid within the internal lumen 1306 and to the tissue surrounding the elongate body 1302, similar to the circuit shown in FIG. 12 . However, in the illustrated embodiment, the circuits formed by each power source 1314, 1316 may share the elongate body 1302 as a common electrode. That is, the power source 1314, configured to supply RF energy to the fluid flowing within the internal lumen 1306, may be connected to a wire 1311 disposed within the internal lumen 1306 and to the elongate body 1302 itself. The elongate body 1302 may then function as an electrode for the power source 1314. In the illustrated embodiment, spacers 1310, 1310′ may prevent the wire 1311 from contacting the elongate body 1302. Meanwhile, the power source 1316 can be connected to the elongate body 1302 and the collecting electrode 1324. Thus, the power source 1316 can deliver RF energy from the electrode 1305 into the tissue surrounding the elongate body 1302. As a result of the two power sources 1314, 1316 being connected only through the elongate body 1302 (i.e., connected only at one point with no back-and-forth connection), the power sources can operate independently and simultaneously without current flowing between them.

[0115] Whether utilizing the exemplary embodiment of the fluid-enhanced ablation therapy system described above or some other form of perfusion ablation therapy, in some configurations, compliance in the system's fluid supply conduits and fluid delivery mechanism may prevent measurement of temperature responses during pauses in the supply of ablation energy and fluid. For example, pausing the supply of fluid (similar to step 306 of the method shown in FIG. 3 ) may include stopping a pump configured to force fluid toward the distal end of the ablation instrument (e.g., for introduction into tissue or for recirculation within the instrument). However, stopping the pump does not necessarily completely stop fluid flow, as fluid flow may continue for a period of time due to pressure from the pump itself and / or compliance in the fluid conduits carrying fluid from the pump to the distal end of the instrument. As a further example, fluid pumps, including rotary impeller-driven pumps and linear syringe pumps, may continue to operate for a period of time after cessation of electrical current or other actuating or motive force. Additionally, pumps may include seals or other components that can compress during operation and require some time to return to an uncompressed state after the pump is stopped. Additionally, the liquid conduit typically has a degree of elasticity and can expand during operation of the pump as a result of the pressure buildup caused by the liquid flow. After the pump is stopped, the liquid conduit can contract to its original state, which allows the liquid pressure and flow to be maintained for a period of time.

[0116] This can have the net effect of continuing fluid flow for some period of time even after the delivery of ablation energy has been paused (e.g., step 306 of the method shown in FIG. 3). Continued fluid flow from the ablation instrument during pauses in treatment can unintentionally cool tissue in contact with the instrument, slowing heat transfer that would otherwise equalize the tissue in contact with the instrument with tissue located further away from the instrument. Assuming the pause period can be short (e.g., less than one second in some embodiments, as noted above), unintentional continued fluid flow due to system compliance can have a measurable effect.

[0117] To avoid unintentional continued flow of fluid from the ablation instrument after energy and fluid delivery has ceased, in some embodiments, the fluid pump can be reversed to create a negative pressure (e.g., suction) that offsets pressure created by compliance in the system. For example, a syringe-style linear pump can be reversed a short distance to ensure that fluid delivery actually ceases at the desired pause in active therapy, taking into account any compliance in the pump itself and / or in the fluid conduits leading from the pump to the ablation instrument.

[0118] Additionally, in some embodiments, by utilizing an open-loop instrument that delivers fluid into tissue surrounding the elongate body, the concept of ceasing fluid flow by reversing an operating fluid pump can be extended to create a suction force that draws fluid back into the internal lumen of the elongate body from the tissue immediately adjacent to the instrument. This can be achieved, for example, by simply reversing the operating pump to a greater extent than described above, simply to account for compliance in the ablation system components. Reversing fluid flow in this manner and drawing fluid back into the internal lumen of the elongate body from within the adjacent tissue accelerates heat transfer that equalizes the ablation element (and any associated temperature sensor) with the temperature of the surrounding tissue, thereby indicating whether the more distant tissue is hotter, cooler, or at the same temperature as the tissue immediately adjacent to the elongate body. That is, by physically moving fluid from outside the internal lumen to inside the internal lumen, convective heat transfer can be combined with conduction to more quickly bring the temperature sensor into equilibrium with the temperature of the surrounding tissue.

[0119] The characterization of the negative pressure required to achieve a momentary cessation of fluid flow or a reversal of fluid flow will depend on the particular configuration of the system being used. For example, the length of the fluid conduit used, the material of the fluid conduit, the pressure and flow rate of the fluid being delivered, the type of pump used, etc. can all affect the amount of system compliance. Furthermore, in closed-loop devices where the fluid is never introduced into the tissue and therefore is not available to transfer heat back toward the elongate body after a pause in active therapy, reversing the fluid flow may be undesirable. Furthermore, in embodiments where an open-loop device is not placed within the tissue mass being treated but is instead placed within a fluid-filled body cavity (such as a blood vessel), it may also be undesirable to draw fluid from outside the instrument. This is because the fluid surrounding the instrument in such embodiments will likely very quickly equalize with the temperature of any fluid flowing within the cavity, and not necessarily with the temperature of the tissue (e.g., the cavity wall) with which the instrument is in contact. However, in closed-loop or open-loop devices in a cavity or tissue, it may be desirable to pause the internal flow of fluid at an appropriate time, taking system compliance into account. This is because the continued flow of liquid will cool the ablation element and reduce any temperature rise that may be detected.

[0120] The devices disclosed herein can be designed to be discarded after a single use, or they can be designed for multiple uses. However, in either case, the devices can be reconditioned for reuse after at least one use. Reconditioning can include any combination of disassembly of the device, followed by cleaning or replacement of particular parts, and subsequent reassembly. In particular, the device can be disassembled, and any number of particular parts or portions of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular parts, the device can be reassembled for later use at a reconditioning facility or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will recognize that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting reconditioned devices, are all within the scope of the present invention.

[0121] The devices described herein can be processed before use in a surgical procedure. First, new or used instruments can be obtained and, if necessary, cleaned. Next, the instruments can be sterilized. In one sterilization technique, the instruments can be placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and its contents can then be placed in a radiation field that can penetrate the container, such as gamma rays, X-rays, or high-energy electrons. The radiation can kill bacteria on the instruments and within the container. The sterilized instruments can then be stored in a sterile container. The sealed container can keep the instruments sterile until they are opened in a medical facility. Other forms of sterilization known in the art are also contemplated. These can include beta or other forms of radiation, ethylene oxide, steam, or a liquid bath (e.g., cold soak). Depending on the materials utilized, the presence of electrical components, etc., certain forms of sterilization may be more suitable for use on different parts of the device.

[0122] All articles and publications cited herein are hereby incorporated by reference in their entirety. Further features and advantages of the present invention will be apparent to those skilled in the art based on the above embodiments. Therefore, the present invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. [Item 1] 1. A method for ablating tissue, comprising: positioning an elongate body adjacent to tissue, the elongate body including an ablation element and at least one temperature sensor coupled to the elongate body; simultaneously delivering ablation energy to the tissue via the ablation element and delivering a fluid via the elongate body; ceasing the delivery of ablation energy and fluid; sensing the temperature of the ablation element while the delivery of ablation energy and fluid is paused; and either terminating the supply of ablation energy and liquid or resuming the supply of ablation energy and liquid based on a comparison of the sensed temperature with a reference temperature. [Item 2] Item 10. The method of item 1, wherein positioning the elongate body adjacent to the tissue comprises inserting the elongate body into the tissue mass. [Item 3] Item 3. The method of item 2, further comprising supplying a fluid into the tissue through at least one outlet formed in the elongate body. [Item 4] 4. The method of any one of items 1 to 3, wherein positioning the elongate body adjacent to the tissue comprises contacting the tissue with a distal portion of the elongate body without penetrating the tissue. [Item 5] Item 5. The method of item 4, wherein the liquid supplied through the elongate body is expelled through at least one outlet formed in the elongate body. [Item 6] 6. The method according to item 4 or 5, wherein the liquid supplied through the elongate body is recirculated without flowing out of the elongate body. [Item 7] 7. The method of any one of items 1 to 6, wherein the supply of ablation energy and liquid is terminated if the sensed temperature is higher than a reference temperature. [Item 8] 8. The method of claim 7, wherein the delivery of ablation energy and liquid is terminated if the difference between the sensed temperature and the reference temperature is greater than a threshold amount. [Item 9] 9. The method of any one of items 1 to 8, wherein the supply of ablation energy and liquid is resumed when the sensed temperature and the reference temperature are substantially equal. [Item 10] 10. The method of any one of items 1 to 9, wherein resuming the supply of ablation energy and liquid further comprises adjusting at least one of a power level of the ablation energy, a temperature of the liquid, and a flow rate of the liquid. [Item 11] Item 11. The method of item 10, wherein at least one of the power level of the ablation energy and the temperature of the liquid is reduced if the sensed temperature is higher than the reference temperature. [Item 12] 12. The method of claim 10 or 11, wherein at least one of the power level of the ablation energy and the temperature of the liquid is increased if the sensed temperature is lower than the reference temperature. [Item 13] 13. The method of any one of items 10 to 12, wherein the flow rate of the liquid is increased if the sensed temperature is higher than the reference temperature. [Item 14] 14. The method of any one of items 10 to 13, wherein the flow rate of the liquid is reduced if the sensed temperature is lower than a reference temperature. [Item 15] 15. The method of any one of items 1 to 14, wherein the delivery of ablation energy and liquid is paused for about 10 seconds. [Item 16] 16. The method of any one of items 1 to 15, wherein the step of pausing the delivery of ablation energy and liquid occurs after about 15 seconds of simultaneous delivery of ablation energy and liquid. [Item 17] 17. The method of any one of items 1 to 16, further comprising heating the liquid within the elongate body. [Item 18] 18. The method of claim 17, wherein the liquid is heated to a temperature of about 40°C to about 80°C. [Item 19] 19. The method of any one of items 1 to 18, wherein the liquid flow rate is up to about 20 ml / min. [Item 20] 20. The method of any one of items 1 to 19, wherein the ablation element is an electrode and the ablation energy is electrical energy. [Item 21] 21. The method of any one of items 1 to 20, wherein the step of pausing the supply of ablation energy and fluid comprises the step of reversing the flow of fluid to counteract compliance pressure. [Item 22] 22. The method of any one of items 1 to 21, further comprising drawing liquid into the elongate body from outside the elongate body after ceasing the supply of ablation energy and liquid. [Item 23] 1. A method for ablating tissue, comprising: positioning an elongate body adjacent to tissue, the elongate body including an ablation element and at least one temperature sensor coupled to the elongate body; simultaneously delivering ablation energy via the ablation element and delivering a fluid via the elongate body to the tissue over a first period of time; suspending delivery of ablation energy and fluid to the tissue for a second period of time; monitoring the temperature sensor during a second period; and either terminating the supply of ablation energy and liquid in response to a temperature profile of the temperature sensor during the second period, or resuming the supply of ablation energy and liquid at the end of the second period. [Item 24] Item 24. The method of item 23, wherein positioning the elongate body adjacent to the tissue comprises inserting the elongate body into the tissue mass. [Item 25] 25. The method of claim 24, further comprising supplying a fluid into the tissue through at least one outlet in the elongate body. [Item 26] 26. The method of any one of items 23 to 25, wherein positioning the elongate body adjacent to the tissue comprises contacting the tissue with a distal portion of the elongate body without penetrating the tissue. [Item 27] Item 27. The method of item 26, wherein the liquid supplied through the elongate body is expelled through at least one outlet formed in the elongate body. [Item 28] 28. The method according to item 26 or 27, wherein the liquid supplied through the elongate body is recirculated without flowing out of the elongate body. [Item 29] 29. The method of any one of items 23 to 28, wherein the delivery of ablation energy and liquid is terminated when the temperature profile increases over a second period of time. [Item 30] 30. The method of claim 29, wherein the delivery of ablation energy and liquid is terminated when the temperature profile increases by at least a threshold amount over a second period of time. [Item 31] 31. The method of any one of paragraphs 23 to 30, wherein the supply of ablation energy and liquid is resumed when the temperature profile remains substantially constant during the second period of time. [Item 32] 32. The method of any one of items 23 to 31, wherein resuming the supply of ablation energy and liquid further comprises adjusting at least one of a power level of the ablation energy, a temperature of the liquid, and a flow rate of the liquid. [Item 33] Item 33. The method of item 32, wherein at least one of the power level of the ablation energy and the temperature of the liquid is decreased if the temperature profile is increasing over the second period of time. [Item 34] 34. The method of claim 32 or 33, wherein at least one of the power level of the ablation energy and the temperature of the liquid is increased if the temperature profile is decreasing over the second period of time. [Item 35] 35. The method of any one of items 32 to 34, wherein the flow rate of the liquid is increased when the temperature profile is increasing over a second period of time. [Item 36] 36. The method of any one of items 32 to 35, wherein the flow rate of the liquid is reduced when the temperature profile is decreasing over a second period of time. [Item 37] 37. The method of any one of items 23 to 36, wherein the first period of time is about 15 seconds. [Item 38] Item 38. The method of item 37, wherein the second period of time is about 1 second. [Item 39] 39. The method of any one of items 23 to 38, further comprising heating the liquid within the elongate body. [Item 40] 40. The method of any one of items 23 to 39, wherein the ablation element is an electrode and the ablation energy is electrical energy. [Item 41] 41. The method of any one of items 23 to 40, wherein the step of ceasing the supply of ablation energy and fluid to the tissue comprises the step of reversing fluid flow to counteract compliance pressure. [Item 42] Item 42. The method of any one of items 23 to 41, further comprising drawing liquid into the elongate body from outside the elongate body during a second period of time. [Item 43] an elongate body having an internal lumen; a cutting element coupled to the elongate body; a temperature sensor coupled to the elongate body; a fluid supply in communication with the internal lumen of the elongate body and configured to supply fluid through the internal lumen; a controller, The control unit simultaneously delivering ablation energy through the ablation element and delivering fluid through the elongate body; The supply of ablation energy and fluid is stopped; sensing the temperature of the ablation element while the delivery of ablation energy and fluid is paused; configured to either discontinue delivery of the ablation energy and the liquid or resume delivery of the ablation energy and the liquid based on a comparison of the sensed temperature with a reference temperature; Tissue ablation system. [Item 44] Item 44. The tissue ablation system of item 43, wherein the elongate body further comprises at least one outlet that allows fluid to flow from the internal lumen to a volume surrounding the elongate body. [Item 45] 45. The tissue excision system of claim 43 or 44, wherein the elongate body has a tissue-piercing distal end. [Item 46] 46. ​​The tissue excision system of any one of items 43 to 45, wherein the elongate body has a blunt distal end.

Claims

[Claim 1] 1. A method for ablating tissue, comprising: positioning an elongate body adjacent to tissue, the elongate body including an ablation element and at least one temperature sensor coupled to the elongate body; simultaneously delivering ablation energy to the tissue via the ablation element and delivering a fluid via the elongate body; ceasing the delivery of ablation energy and fluid; sensing the temperature of the ablation element while ablation energy and fluid delivery is paused; either terminating the supply of ablation energy and fluid or resuming the supply of ablation energy and fluid based on a comparison of the sensed temperature with a reference temperature; A method for providing the above.

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