Electrosurgical Instruments and Devices

Abstract

Various embodiments provide an electrosurgical instrument comprising: an elongated probe including a coaxial cable for carrying radio frequency (RF) and / or microwave frequency electromagnetic (EM) energy and a probe tip connected to the distal end of the coaxial cable for receiving RF and / or microwave energy; a gas passageway for carrying gas through the elongated probe to the probe tip; and a debridement device for debridement of biological tissue. The coaxial cable comprises an inner conductor, an outer conductor, and a dielectric material separating the inner conductor from the outer conductor. The probe tip comprises a first electrode connected to the inner conductor of the coaxial cable and a second electrode connected to the outer conductor of the coaxial cable. The first and second electrodes are configured to generate an electric field from the received RF and / or microwave EM energy across a flow path of gas received from the gas passageway to generate a thermal or non-thermal plasma in a region outward from the probe tip.

Description

[Technical field]

[0001] The present invention relates to an electrosurgical device that uses radio frequency and / or microwave frequency energy to sterilize biological tissue via non-thermal plasma and to reconstruct biological tissue via thermal plasma. In addition, the electrosurgical device includes a means for debriding biological tissue, for example, prior to sterilization and / or reconstruction. Certain embodiments are also capable of reconstructing biological tissue using non-ionizing radiation. Various embodiments may be suitable for use in open surgery or for insertion into an instrument channel of a scope device, such as a laparoscope or endoscope. [Background technology]

[0002] Argon plasma coagulation (APC) or argon beam coagulation (ABC) is a known surgical technique for controlling superficial bleeding that does not require physical contact between the surgical probe that delivers the plasma and the lesion. APC can be performed endoscopically, where a jet of argon gas is directed through a probe passed through an endoscope. When released, the argon gas ionizes to produce plasma, which induces coagulation.

[0003] To strike the plasma, a high electric field (e.g., by applying a high voltage directly or by establishing a high impedance state in which a high voltage is present) is desired. Typically, this is done by applying a high RF voltage pulse (e.g., 500V-2kV) for a short duration, e.g., in the range of 1ms-10ms, between an active electrode and a return electrode that are separated by a small distance, e.g., less than 1mm. The high electric field can break down the gas and generate a plasma. In one embodiment discussed in WO2009 / 060213, the high voltage (high impedance) state is established using a flyback circuit that uses a low frequency (e.g., radio frequency) oscillator circuit, e.g., one operating at 100kHz, and a transformer whose primary winding is connected to the low frequency oscillator circuit by suitable drivers and switching devices (e.g., gate drive chips and power MOSFETs or BJTs). This configuration creates a high voltage pulse or spike that strikes or otherwise causes the plasma to strike. After strike, the impedance drops and the plasma may be maintained by supplying microwave energy.

[0004] Sterilization is the act or process of destroying or eliminating all forms of living organisms, especially microorganisms. During the process of plasma sterilization, active agents are generated. These active agents are high-intensity ultraviolet photons and free radicals, which are chemically atoms or clusters of atoms with unpaired electrons. An attractive feature of plasma sterilization is that it is possible to achieve sterilization at relatively low temperatures, such as body temperature. Plasma sterilization also has the advantage of being safe for operators and patients.

[0005] Tissue reconstruction or re-epithelialization is the process by which skin and mucous membranes replace superficial epithelial cells that are damaged or lost in a wound. Epithelial cells at the wound edge proliferate almost immediately after injury to cover the exposed area. Epithelialization is a key component of wound healing and is used as a defining parameter for successful wound closure. A wound is not considered healed unless re-epithelialization is present.

[0006] Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing chances of remaining healthy tissue. Removal can be surgical, mechanical, chemical, and autolytic (self-digesting). Debridement is an important part of the healing process of burns and other serious injuries.

[0007] There is a continuing need for improved instruments and devices for treating wounds and reducing wound healing times, as well as for improved instruments and devices for debridement, sterilization, and reconstruction of living tissue. Summary of the Invention [Means for solving the problem]

[0008] Most generally, the present invention provides an electrosurgical instrument that includes a means for delivering non-thermal and thermal plasma to living tissue. The instrument also includes a means for debridement of living tissue. As such, the electrosurgical instrument can be a wound treatment apparatus or device for debridement, sterilization, and reconstruction of wounds. Additionally or alternatively, the electrosurgical instrument can find utility in other treatment (e.g., debridement, sterilization, and / or re-epithelialization) applications, for example, in the treatment of body infections such as ear infections (e.g., otitis media) or urinary tract infections. Furthermore, the electrosurgical instrument can find utility in the treatment (e.g., debridement, sterilization, and / or reconstruction) of body treatment sites for receiving medical implants, such as metallic implants, as well as for debridement and / or sterilization of such implants.

[0009] The means for debridement may include one or more of an adhesive area for scraping or rubbing the biological tissue, a deployable debridement tool for scraping or rubbing the biological tissue, and a liquid passageway for injecting / extracting liquid into / from the biological tissue. This functionality may be useful for removing dead, damaged, or infected tissue from the wound, and for removing foreign matter (e.g., dirt, sand, contaminants) from the wound. Such functionality may aid in wound healing. In addition, this functionality may be useful for removing infected tissue and / or mucus from an infected site, e.g., the ear or urinary tract. Furthermore, this functionality may be useful for removing infected tissue from a treatment site on the body to receive a medical implant, and from the implant itself.

[0010] Non-thermal plasma functionality can be useful for sterilizing living tissue. For example, after debridement of a wound, non-thermal plasma can be used to kill or greatly reduce bacteria within the wound. Such functionality can aid in wound healing. In addition, this functionality can be useful for removing or reducing bacteria from infected sites of the body, such as infected sites of the ear or urinary tract. Furthermore, this functionality can be useful for removing or reducing bacteria at implantation sites of the body, such as those for receiving medical implants, and for removing or reducing bacteria on the implant itself.

[0011] Thermal plasma functionality can be useful for the reconstruction (aka re-epithelialization) of biological tissue. For example, after debridement and then sterilization of the wound, thermal plasma can be used to reconstruct the wound, to close the wound bed, and to promote wound healing.

[0012] Additionally, the instrument may include a means for delivering non-ionizing microwave radiation to biological tissue. This functionality may be used to remodel biological tissue to promote wound healing. For example, the non-ionizing radiation may produce a surface ablation effect that remodels tissue. Non-ionizing microwave energy may be used as an alternative to thermal plasma. For example, after debridement and then sterilization of a wound, non-ionizing microwave energy may be used to remodel the wound to promote wound healing.

[0013] In accordance with the present invention, an electrosurgical instrument (e.g., wound treatment device) is provided comprising an elongated probe having a coaxial cable for carrying radio frequency (RF) and / or microwave frequency electromagnetic (EM) energy and a probe tip connected at a distal end of the coaxial cable for receiving RF and / or microwave energy, a gas passage for carrying gas through the elongated probe to the probe tip, and a debridement apparatus for debridement of living tissue (e.g., in an area outward from the probe tip, i.e., at or near the distal end of the probe tip), the coaxial cable being connected to the probe tip. An electrosurgical instrument is provided, wherein the probe tip comprises an inner conductor, an outer conductor, and a dielectric material separating the inner conductor from the outer conductor, the probe tip comprises a first electrode connected to the inner conductor of the coaxial cable and a second electrode connected to the outer conductor of the coaxial cable, the first electrode and the second electrode configured to generate an electric field from received RF and / or microwave EM energy across a flow path of a gas received from the gas passage to generate a thermal or non-thermal plasma in a region outward from the probe tip (e.g., a region at or near the distal end of the probe tip). In use, the probe tip is connected to receive radio frequency (RF) and / or microwave frequency energy from a generator and also defines a gas flow path.

[0014] In a first configuration, the probe tip defines a bipolar (e.g., coaxial) structure for generating a high electric field from the received RF and / or microwave frequency energy across the flow path to strike and sustain the plasma in the gas. For example, a short pulse (e.g., 10 ms or less in duration, e.g., between 1 ms and 10 ms) of RF energy can be used to strike the plasma. The plasma outlet is at the distal end of the probe tip, so that the plasma is delivered to a region outward from the probe tip.

[0015] The first electrode and the second electrode may be movable relative to one another to a second configuration in which the first electrode extends distally beyond the second electrode to form a radiating structure for emitting a microwave EM field outwardly from the probe tip. In the second configuration, the probe tip defines an antenna structure that emits non-ionizing microwave energy into tissue. This non-ionizing microwave energy may be used, for example, to reconstruct tissue after it has been debrided and / or sterilized. The antenna structure may be a radiating monopole antenna, which may take the form of a cylinder, sphere, wire, or helical or turnstile antenna that can emit an electric field from received microwave frequency energy outwardly (i.e., away from the probe). Thus, in the first configuration, the device may use one or both of RF and microwave energy, while in the second configuration, the device primarily uses microwave energy. The waveform of the RF energy used to impinge the plasma may be a high amplitude pulse.

[0016] A non-ionizing microwave field may be possible to generate without relative movement of the first and second electrodes, for example, by simply delivering microwave energy in the absence of a gas. However, if the second electrode is recessed from the first electrode, i.e., the first electrode projects distally from the second electrode, a more uniform field effect may be produced in the area enclosed by the loop.

[0017] The first electrode and the second electrode form active and return electrodes for the RF signal carried by the coaxial cable.

[0018] In a first configuration, the plasma may be struck using RF or microwave energy. Microwave energy may be used to maintain the plasma after it is struck. This configuration may be advantageous over RF plasmas used in conventional electrosurgical systems where the electric field may collapse due to loading caused by cable capacitance and tissue variability.

[0019] The impedance of the plasma is preferably matched to the impedance of the applicator (and energy delivery system) at the frequency of the microwave energy so that the microwave energy generated by the microwave source can be efficiently transferred to the plasma. When using microwave energy, the applicator and / or generator may be adjusted (statically or dynamically) to ensure that the plasma is matched to the load presented by the tissue. At microwave frequencies, the cable forms a distributed element transmission line, where the impedance match between the applicator and the energy source is determined by the source impedance of the microwave generator, the characteristic impedance of the cable (transmission line), the impedance of the applicator structure itself, and the impedance of the tissue. If the characteristic impedance of the cable is the same as the output impedance of the source, all of the microwave power is delivered to the applicator, minus the attenuation caused by the cable (dielectric and conductor losses). If the impedance of the applicator and tissue is the same as the characteristic impedance of the cable, the maximum power available at the source is transferred to the plasma / tissue load. To maintain the best impedance match between the applicator and the plasma / tissue load, the applicator structure may be adjusted, as described below. Tuning may also be performed at the connection between the generator or the distal end of the first cable and the proximal end of the second (instrument) cable. These tuning may be in the form of changes in the capacitance and / or inductance of the matching network, i.e., stub tuning.

[0020] The gas may be argon or any other suitable gas, for example carbon dioxide, helium, nitrogen, air, and mixtures of any of these gases, i.e., 10% air / 90% helium. A high electric field for impinging plasma may be induced by creating a high impedance state at the probe tip to either RF EM or microwave EM energy. This may be achieved through the selection of suitable geometries of the first and second electrodes. For example, a piece of insulating dielectric material, such as quartz or other similar low-loss material, may be placed between the first and second electrodes in the first configuration. This reduces the electric field within the insulating dielectric material and increases the electric field in the gas-filled gap next to the insulating dielectric material. In the first configuration, the second electrode may be configured to extend beyond the first conductor (e.g., distal to the first conductor) so that non-ionizing radiation is not emitted.

[0021] In a preferred embodiment, the instrument is capable of receiving both RF and microwave EM energy. The RF EM energy may be for plasma impaction and may be received as high voltage pulses. The microwave EM energy is for plasma maintenance, i.e., for delivering power to the plasma to maintain the ionized state. It may also be received as pulses. The plasma may be repeatedly impacted in a manner that produces a quasi-continuous beam of plasma. The advantage of this configuration over conventional APC devices that use only RF EM energy is that the plasma does not collapse due to capacitive loading or environmental changes from dry to wet. Additionally, the dual configuration nature of the instrument allows it to be switched to a state suitable for tissue reconstruction using non-ionizing microwave energy, in which the second electrode (and insulating dielectric material) is pulled away exposing the first electrode such that it acts as a radiating microwave monopole antenna structure, as described below.

[0022] In conventional RF plasma devices, cable capacitance and high voltages require high RF drive currents to sustain the plasma. For example, the well-known equation

[0023]

number

[0024] can be applied to a quarter cycle of 400 kHz, where dt is (2.5 / 4) μs = 625 ns. If the cable capacitance is 300 pF and the required peak voltage is 400 V, then I = 300 × 400 / 625 = 0.192 A, which is a relatively high value. The voltage of the microwave signal is much lower, for example, about 20 V, thus overcoming this drawback.

[0025] It may also be possible to strike the plasma using microwave frequency energy, for example, by using a microwave resonator or an impedance transformer, i.e., a quarter-wave transformer, that converts a low voltage to a higher voltage to strike the plasma using a higher impedance transmission line that is a quarter wavelength (or an odd multiple thereof) long at the operating frequency. This high impedance line may be switched on to strike the plasma, and switched off (i.e., back to the lower impedance line) when the plasma is struck and needed to maintain the plasma. It may be preferable to use a power PIN or varactor diode to switch between the two states, but it may also be possible to use a coaxial or waveguide switch.

[0026] The elongated probe may include a sleeve surrounding the coaxial cable. The sleeve may serve to protect the coaxial cable, but may also define a gas passageway, e.g., as a space between an inner surface of the sleeve and an outer surface of the coaxial cable. The gas passageway may have an input port disposed at a proximal end of the sleeve for connection to a gas source (e.g., a pressurized gas canister, etc.).

[0027] Additionally, the sleeve may be a means for inducing relative movement between the first and second electrodes. Relative movement between the first and second electrodes may be achieved by sliding a conductive (e.g., metallic) catheter over the microwave coaxial cable, the outer conductor of which may also be metallic. In this configuration, the inner surface of the catheter (or the tube that slides over the coaxial cable) must be in good electrical contact with the outer conductor of the coaxial cable. This may be achieved by providing a gas-permeable conductive structure that is slidable against the second electrode or the outer electrode of the coaxial cable and allows gas to flow. The gas-permeable conductive structure may be any one of a conductive mesh, a cage of radially extending conductive wires or springs, and a plurality of circumferentially spaced radially protruding teeth. Thus, the gas-permeable conductive structure may provide multiple (e.g., four or more) circumferential connections or otherwise require point contacts to ensure good electrical connection for the microwave signal. This solution also allows for a balance between having enough connection points to create a suitable environment for microwave energy to propagate, allowing sufficient gas flow, and allowing the outer catheter to move relatively easily over the coaxial cable.

[0028] In one embodiment, a second electrode may be attached or formed at the distal end of the sleeve, and the sleeve may be retractable relative to the coaxial cable. In other words, the sleeve may be retractable to expose the first electrode at the probe tip. The sleeve may be coaxial with the coaxial cable. The first and second electrodes may thus be coaxial with each other in the first configuration. The second electrode may be an annular band of conductive material at the distal end of the sleeve. The dielectric material mentioned above may be a quartz collar attached on the sleeve and inwardly of the annular band. Alternatively or additionally, the dielectric material may be part of the inner electrode, as described below.

[0029] The retractable sleeve may comprise two or more retractable sections. The retractable sections may have a liquid-tight seal between them to prevent gas leakage. A mechanical or electromechanical system, i.e., a mechanical slider, linear motor, or stepper motor configuration, may be used to retract or extend the slidable outer sleeve. As described below, the position of the outer sleeve relative to the outer conductor of the coaxial cable may be determined using a detector(s) in the generator or in the probe, reflected power or forward and reflected power measurements, return loss or impedance match / mismatch measurements made using a reflectometer or VSWR bridge measurements.

[0030] The first electrode may be a microwave radiating monopole antenna structure coupled to receive RF and / or microwave EM energy from a coaxial cable. The outer conductor of the coaxial cable may be grounded to form an unbalanced feed to the antenna, or may be floated to form a balanced feed to the antenna, i.e., the voltage across both conductors rises and falls. Preferably, the first electrode may be shaped to act as a microwave antenna to emit a microwave field corresponding to the received microwave EM radiation. For example, the monopolar radiating structure may comprise a cylinder of dielectric material having a hemispherical distal end and surrounding the length of the inner conductor of the coaxial cable, which projects beyond the outer conductor and extends through the dielectric material of the cylinder at its hemispherical distal end. Other distal end shapes are possible, e.g., a sphere or a flat end. The cylinder may be made of a low-loss ceramic material. The presence of the dielectric cylinder may improve energy delivery into the tissue, e.g., by reducing the amount of reflected power. The ends of the length of the inner conductor that protrudes from the hemispherical distal end of the cylinder may be rounded, for example hemispherically shaped, to provide a more uniform emission field.

[0031] The probe may be used in open surgery (e.g., handheld) or laparoscopically, or may be sized to be insertable through a scoping device, e.g., through an instrument channel of an endoscope, gastroscope, or bronchoscope. For example, the coaxial cable may have a diameter of 2.5 mm or less, preferably 2.2 mm or less. The sleeve may have an outer diameter of less than 2.6 mm, preferably less than 2.5 mm. For larger laparoscopic instruments, the outer diameter may be 3 mm or more, and larger diameter coaxial cables may be used. In an embodiment, the probe may be about 30 cm long.

[0032] The debridement device may include an abrasive region on the outer surface distal to the probe tip of the instrument for debridement of biological tissue in an area outward from the probe tip (i.e., at or near the probe tip). For example, an operator may manipulate the position and / or orientation of the probe tip to bring the abrasive region into contact with biological tissue requiring debridement, for example, in a wound or other treatment site (e.g., an infected site on the body or an implant site on the body). The abrasive region may be used to scrape or scratch the surface of biological tissue for debridement. The abrasive region may be a coating applied directly to the outer surface of the instrument. Alternatively, the abrasive region may be a patch that is manufactured separately and then bonded (e.g., via adhesive or mechanical fastening) to the instrument. The abrasive region may be any shape, for example, square, rectangular, circular, oval, regular, or irregular. Also, the abrasive region may cover the entire circumference of the instrument and thus be substantially annular or ring shaped. Alternatively, the abrasive region may cover only a portion of the circumference. The abrasive region may be on the distal face of the probe tip and may include abrasive elements having sharp points or edges for grasping and removing biological material and foreign bodies for cleaning a wound or other treatment site (e.g., an infected site of the body or an implant site of the body).

[0033] Additionally or alternatively, the debridement device may include a deployable debridement tool, such as a brush or pad. In an embodiment, the probe tip includes a holder (e.g., a recess or cavity) for receiving the debridement tool, which is movable between a stored position in which the debridement tool is enclosed (e.g., housed, contained) in the holder and a deployed position in which the debridement tool protrudes from the probe tip to an area outside the probe tip to debride the living tissue. In this case, the sleeve may include a rotatable braided cable to allow adjustment of the orientation of the debridement device. The opening of the holder may be at the distal end face of the elongated probe, such that the debridement tool is deployed directly to an area outside the probe tip, i.e., the area where the plasma (thermal or non-thermal) or non-ionizing radiation is delivered. The debridement tool and holder may be housed in a guiding structure bonded to the outer surface of the elongated probe. Alternatively, the holder and debridement tool may be integrated into the internal structure of the elongated probe. In embodiments, the electrosurgical instrument includes a deployment mechanism for moving the debridement tool between the stowed and deployed positions. The deployment mechanism may comprise an actuator, such as a lever, pull wire or pull arm, located at the proximal end of the probe, such as a sliding or rotating mechanism that is moved manually (e.g., via a handle). However, it is also contemplated herein to control the movement of the deployable debridement tool in an automated manner, for example, using electromechanical mechanisms (including, for example, linear motors, stepper motors, piezoelectric actuators, and magnetostrictive actuators). For example, in one embodiment, there may be a controller configured to automatically move the debridement tool.

[0034] Additionally or alternatively, the debridement device may include a liquid passageway for carrying liquid through the elongated probe and into or out of the area outside the probe tip to debride the living tissue. The liquid injected or delivered to the treatment site may be water, saline, or some other liquid suitable for debridement, for example, for irrigating / irrigating the treatment site (e.g., wound, infected site, implant site) by removing dead, damaged, or infected tissue, or foreign bodies such as sand, dirt, and other contaminants that may impede healing. Thus, the liquid extracted from the treatment site includes solids such as dead, damaged, or infected tissue, or foreign bodies such as sand, dirt, and other contaminants. In one embodiment, the elongated probe comprises a jacket surrounding the sleeve, and the liquid passageway is the space between the inner surface of the jacket and the outer surface of the sleeve. The jacket may be structurally similar to the sleeve, i.e., the sleeve may provide an inner sleeve and the jacket may provide an outer sleeve. The liquid passage may have an input port located at a proximal end of the jacket for connection to a source of liquid (e.g., a tank or container, etc.). The jacket may have a structure similar to the sleeve described above to allow the first electrode to move relative to the second electrode. That is, the jacket and sleeve may move together when the first electrode moves relative to the second electrode. Specifically, the jacket may be coaxial with the coaxial cable, and the jacket may be retractable relative to the coaxial cable. The retractable jacket may comprise two or more retractable portions. The retractable portions may have a liquid-tight seal therebetween to prevent liquid leakage. A mechanical or electromechanical system, i.e., a mechanical slider, a linear motor, or a stepper motor configuration, may be used to retract or extend the slidable outer jacket.

[0035] In another embodiment where the jacket is not present, the space between the inner surface of the sleeve and the outer surface of the coaxial cable is partitioned or divided into a gas passage and a liquid passage. For example, one or more partition structures or elements may be present inside the space to partition the space into a gas passage and a liquid passage, thereby preventing fluid from being transferred from the gas passage to the liquid passage or vice versa. In this case, the gas and liquid passages may be connected to respective ports at the proximal end of the probe. Such a configuration may be advantageous when the outer profile of the probe needs to be kept as small (e.g., thin) as possible, for example, when the probe is inserted into an instrument channel of an endoscopic device. It will be understood that if a jacket is present, the jacket may define the outer profile of the instrument. However, if no jacket is present, the sleeve may define the outer profile of the instrument.

[0036] Additionally, the liquid passageway may be divided or partitioned into two or more channels, at least some of which (also known as first channels) are for conveying liquid from the proximal end of the elongated probe to the distal end of the elongated probe and from the distal end of the probe tip to a treatment site in an area outside the probe tip, and at least some of the channels (also known as second channels) are for conveying liquids and solids (e.g., biological material or foreign matter) from a treatment site in an area outside the probe tip to the distal end of the probe tip and through the elongated probe from its distal end to its proximal end.

[0037] The invention may also be expressed as an electrosurgical apparatus comprising: a radio frequency (RF) electromagnetic (EM) signal generator for generating RF EM radiation having a first frequency; a microwave signal generator for generating microwave EM radiation having a second frequency higher than the first frequency; an electrosurgical instrument connected to receive the RF EM radiation and the microwave EM radiation as described above; a delivery structure for conveying the RF EM radiation and the microwave EM radiation to an elongate probe, the delivery structure comprising an RF channel for connecting the elongate probe to the RF signal generator and a microwave channel for connecting the elongate probe to the microwave signal generator; and a gas delivery connected to supply gas to the electrosurgical instrument, wherein the apparatus is operable to debride biological tissue in an area outward from the probe tip (e.g., at or near the distal end of the probe tip); and the apparatus is operable to deliver thermal or non-thermal plasma into an area outward from the probe tip (e.g., to sterilize tissue (via non-thermal plasma) or to reconstruct tissue (via thermal plasma)).

[0038] The first electrode and the second electrode may be movable relative to one another to a second configuration in which the first electrode extends distally beyond the second electrode forming a radiating structure for emitting the microwave EM field outwardly from the probe tip, and the apparatus is operable to emit a non-ionizing electric field outwardly from the probe tip when the first electrode and the second electrode are in the second configuration in which no gas is supplied.

[0039] The apparatus may include a collision signal generating circuit configured to cause the probe to deliver a pulse (or multiple pulses) of RF EM radiation to generate a high electric field across the flow channel to strike the plasma, the collision signal generating circuit including control circuitry configured to trigger the generation of the pulse of RF EM radiation using a detectable characteristic of the pulse of microwave EM radiation on the microwave channel. In this manner, the RF EM radiation is used to strike the plasma, while the microwave EM radiation is used to maintain the plasma. As described above, by coordinating the delivery of the RF collision pulse relative to the pulse of microwave EM radiation, the apparatus can more reliably strike the plasma.

[0040] The apparatus may further comprise a microwave signal detector for sampling the forward and reflected power on the microwave channel and generating a microwave detection signal from the microwave channel indicative of microwave power being delivered by the probe, and a controller in communication with the microwave signal detector for receiving the microwave detection signal, the controller being operable to select a first energy delivery profile for the microwave EM radiation, the first energy delivery profile for the microwave EM radiation being for sterilization of tissue (via non-thermal plasma generation), the controller comprising a digital microprocessor programmed to output a first microwave control signal for the microwave signal generator, the first microwave control signal for setting the energy delivery profile of the microwave EM radiation, and the controller configured to determine a state of the microwave control signal based on the received microwave detection signal. This configuration may be used to measure the reflected microwave signal, whereby the microwave detection signal is indicative of whether or not a plasma has been struck. The signal detector may also be configured to continuously monitor the forward and reflected microwave EM radiation to ensure that the best impedance match is maintained while delivering the plasma. The microwave signal detector may comprise a forward and reflected signal detector (e.g., a suitable directional power coupler on the microwave channel). The detectors may be configured to detect only signal strength, e.g., they may be diode detectors. Alternatively, the detectors may be configured to detect strength and phase, e.g., they may be heterodyne detectors. Thus, the microwave detection signal may represent return loss or impedance matching information. The relative position of the first and second electrodes of the electrosurgical instrument may be adjustable by the controller in a sterilization mode (i.e., when a non-thermal plasma is being generated) until a set return loss threshold is reached, i.e., 8 dB, 10 dB, or 12 dB.

[0041] The controller may be operable in a similar manner to select a second energy delivery profile for tissue reconstruction via thermal plasma generation. Specifically, the controller may be operable to select a second energy delivery profile of microwave EM energy, the second energy delivery profile of microwave EM energy for tissue reconstruction (via thermal plasma generation). The digital microprocessor may also be programmed to output a second microwave control signal for the microwave signal generator, the second microwave control signal for setting the second energy delivery profile of microwave EM energy.

[0042] The controller may be operable in a similar manner to select a third energy delivery profile for tissue reconstruction via non-ionizing radiation (i.e., gas free). In an embodiment, the third energy delivery profile may be the same as the first energy delivery profile.

[0043] The controller may be operable in a similar manner to select an energy delivery profile for the RF EM energy. Available profiles for the RF EM energy may include striking pulses to generate high electric fields across the flow path to strike the plasma.

[0044] The device may include a movement mechanism for causing relative movement between the first electrode and the second electrode, and the controller is configured to communicate a control signal to the movement mechanism based on the received microwave detection signal. The movement mechanism may be mechanical and may be manually controlled, for example, by an operator of the instrument. The movement mechanism may comprise an actuator, for example a lever or pull arm, located at the distal end of the instrument, for example a sliding or rotating mechanism that is moved by hand.

[0045] However, it is also contemplated herein to control the relative movement of the first and second electrodes (i.e., to set the first and second configurations) in an automated manner, for example, using an electromechanical mechanism. For example, in one embodiment, there may be a set controller configured to automatically move the sleeve (and jacket, if present) and manipulate the gas supply.

[0046] Additionally, the controller may be configured to automatically operate the movement mechanism as a means for controlling impedance matching to the plasma. The position of the outer catheter (or sleeve) relative to the inner coaxial cable (or inner electrode attached to the coaxial cable) may be controlled by manual movement or by means of an electromechanical actuator (PZT actuator, magnetostrictive actuator, stepper motor, linear motor) based on return loss measurements or impedance matching using reflected and forward power measurements on the microwave channel.

[0047] A setting controller may be connected to the valve to control the gas supply, for example, to shut off the supply when the instrument is moved to the second configuration and to start the supply when the instrument is moved to the first configuration. The valve may be part of the instrument, for example integrated between the sleeve and the coaxial cable, or it may be located outside the instrument, for example in the gas inlet.

[0048] Further, in combination with the microwave signal detector described above, the setup controller may be configured to control the position of the sleeve in the first configuration when plasma is present based on the microwave detection signal to minimize reflected microwave signals. In other words, the setup controller includes a feedback arrangement for precisely adjusting the position of the sleeve in the first configuration to facilitate efficient delivery of plasma.

[0049] As described above, the instrument is configured to generate non-thermal plasma for sterilization and thermal plasma for tissue reconstruction. When the coaxial applicator structure has a plasma generation area with a diameter of 3 mm to 5 mm, i.e., the inner diameter of the outer conductor in the coaxial structure is 3 mm to 5 mm, and a quartz tube with a wall thickness of 0.25 mm to 1 mm that fits snugly inside, and the outer diameter of the inner conductor is 0.75 mm to 4 mm (allowing space for gas flow in the area between the inner conductor and the inner wall of the quartz tube), non-thermal plasma suitable for disinfection or sterilization can be generated by operating the generator in a pulsed mode with a duty cycle of less than 40%, e.g., 28%. In one embodiment, the effective power of a single microwave pulse is 50 W, and the pulse ON time is 40 ms for one period of 140 ms, i.e., the average power delivered to the plasma is 14.28 W at 2.45 GHz. In an embodiment, this signal for generating non-thermal plasma is the aforementioned first energy delivery profile of microwave EM energy. When the RF crash pulse was used in this configuration, the duration of the RF crash pulse was about 1 ms and the frequency of the sinusoidal oscillation was 100 kHz. The amplitude was about 1 kV (707 Vrms) peak. The RF power was less than 10% of the microwave power. The RF pulse was synchronized to the microwave burst or pulse and triggered on the rising edge of the microwave burst or pulse.

[0050] For this particular applicator geometry, the duty cycle may be increased, e.g., to 50%, or the continuous wave (CW) and / or running power level may be increased, e.g., to 75W or 100W, to generate a thermal plasma (if the geometry is decreased or increased, the microwave power and RF impinging pulse amplitude will be adjusted accordingly). In an embodiment, this signal to generate a thermal plasma is the second energy delivery profile described above for microwave EM energy. The percentage of RF microwave power is preferably kept constant, e.g., less than 10%, for non-thermal and thermal plasmas.

[0051] The electrosurgical device may further include a fluid inlet connected to supply fluid to or extract fluid from the electrosurgical instrument. The device is also operable to supply fluid to or extract fluid from an area exterior to the probe tip for debridement of biological tissue. The fluid inlet may include a container or tank for holding (i) the fluid to be injected into the treatment site, and (ii) the fluid and solids (e.g., foreign bodies, biological material) to be extracted from the treatment site. The fluid inlet may also include a fluid supply for conveying fluid between the container and the electrosurgical instrument. Additionally, the fluid inlet may include a control valve for controlling the direction and rate of fluid flow to / from the electrosurgical instrument. The control valve may be part of the instrument, for example, incorporated between the sleeve and the coaxial cable (if no jacket is present) or between the jacket and the sleeve (if a jacket is present), or the valve may be located outside the instrument, for example, in the fluid supply.

[0052] In addition, the fluid delivery section may further include an injection device for supplying fluid to the electrosurgical instrument via a first channel of the fluid passageway, and an aspiration device for extracting fluid from the electrosurgical instrument via a second channel of the fluid passageway. The injection device may include a compressor or pump that pumps fluid to the electrosurgical instrument at a relatively high pressure so that the fluid has sufficient force to dislodge foreign bodies (e.g., sand, dirt, contaminants) or biological material (dead, damaged, or infected tissue or cells) from a treatment site (e.g., wound, infection site, implant site). The force with which the injection device injects fluid into the electrosurgical instrument may be computer-controllable, for example, via a controller of the EM energy and gas generating equipment. The aspiration device may include a compressor or pump that forcibly aspirates fluid (and solids) from the treatment site into the distal tip of the electrosurgical instrument. For example, a first step of injecting liquid may be used to remove material from a treatment site (e.g., a wound, an infected site, an implant site) and clean the treatment site, and then a second step of aspirating liquids and solids may be used to aspirate the dirty liquid along with the material that was removed from the treatment site.

[0053] In embodiments, the electrosurgical device includes a deployment mechanism for operating a deployable debridement tool on the electrosurgical instrument. For example, the controller may be configured to communicate a debridement signal to the deployment mechanism to move the debridement tool between a stowed position and a deployed position. That is, the deployment mechanism may be computer controlled. Alternatively, however, the debridement mechanism may be manually operated, for example, via a pull wire and a handle. The deployment mechanism may be partially or entirely part of the instrument. Alternatively, the deployment mechanism may be partially or entirely located outside of the instrument.

[0054] As used herein, radio frequency (RF) may mean a stable fixed frequency in the range of 10 kHz to 300 MHz, and microwave frequency may mean a stable fixed frequency in the range of 300 MHz to 100 GHz. RF energy should have a frequency high enough to prevent the energy from causing nerve stimulation and low enough to prevent the energy from causing tissue bleaching or unwanted thermal margins or damage to tissue structures. Preferred spot frequencies for RF energy include any one or more of 100 kHz, 250 kHz, 400 kHz, 500 kHz, 1 MHz, 5 MHz. Preferred spot frequencies for microwave energy include 915 MHz, 2.45 GHz, 5.8 GHz, 14.5 GHz, 24 GHz.

[0055] Hereinafter, an embodiment of the present invention will be described with reference to the accompanying drawings. [Brief description of the drawings]

[0056] [Figure 1] There are known power delivery systems suitable for use with the present invention. [Diagram 2] 1 is a schematic diagram of an electrosurgical device according to an embodiment of the present invention; [Figure 3A] 1 is a schematic cross-sectional view of an electrosurgical instrument according to an embodiment of the present invention; [Figure 3B] 3B is a schematic cross-sectional view of the electrosurgical instrument of FIG. 3A taken along line AA. [Figure 4A] 1 is a schematic cross-sectional view of an electrosurgical instrument according to another embodiment of the invention in a first configuration. [Figure 4B] 4B is a schematic cross-sectional view of the electrosurgical instrument of FIG. 4A in a second configuration. [Figure 5A] 1 is a schematic cross-sectional view of an electrosurgical instrument according to a further embodiment of the present invention in a stored configuration; [Figure 5B] 5B is a schematic cross-sectional view of the electrosurgical instrument of FIG. 5A in a deployed configuration. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0057] FIG. 1 shows a schematic diagram of a power delivery system 100 suitable for use in the present invention, as disclosed in WO2012 / 076844.

[0058] The system 100 comprises an RF lineup 102 and a microwave lineup 104, which form parts of an RF channel and a microwave channel, respectively.

[0059] The RF lineup 1002 includes components for generating and controlling an RF frequency electromagnetic signal at a power level suitable for striking a plasma, as described below. In this embodiment, the RF lineup 1002 includes an RF oscillator 1001, a power controller 1002, an amplifier unit (here comprising a driver amplifier 1003 and a power amplifier 1004), a transformer 1005, and an RF signal detector 1006.

[0060] The microwave lineup 104 includes components for generating and controlling microwave frequency electromagnetic signals at power levels suitable for treating (e.g., sterilizing and reconstructing) living tissue. In this embodiment, the microwave lineup 104 includes a phase-locked oscillator 1007, a signal amplifier 1008, an adjustable signal attenuator (e.g., an analog or digital PIN diode attenuator) 1009, an amplifier unit (here a driver amplifier 1010 and a power amplifier 1011), a forward power coupler 1012, a circulator 1013, and a reflective power coupler 1014. The circulator 1013 isolates the forward signal from the reflective signal to reduce undesired signal components in the couplers 1012, 1014, i.e., to increase the directivity of the couplers. The circulator also protects the transistors in the high power output stage, e.g., power GaN or GaAs transistors. It is desirable to have as much isolation as possible between Port 1 to Port 3, Port 2 to Port 1, and Port 3 to Port 2, ie, greater than 15 dB, and more preferably greater than 20 dB.

[0061] The RF lineup 102 and the microwave lineup 104 communicate with a controller 106, which may comprise a signal processing and general interface circuit 108, a microcontroller 110, and a watchdog 1015. The watchdog 1015 may monitor a range of potential error conditions that would cause the system to fail to perform its intended specifications, i.e., the system delivering an incorrect amount of energy to the patient's tissue due to a power output or treatment time greater than that requested by the user. The watchdog 1015 comprises a microprocessor independent of the microcontroller 110 to ensure the microcontroller functions correctly. The watchdog 1015 may, for example, monitor voltage levels from a DC power supply or the timing of pulses determined by the microcontroller 110. The controller 106 is configured to communicate control signals to the components of the RF lineup 102 and the microwave lineup 104. In this embodiment, the microprocessor 110 transmits RF control signals C, C, and C, respectively. RF to the power controller 1002, and a microwave control signal C M to an adjustable signal attenuator 1009. These control signals are used to set the energy delivery profile of the RF EM radiation output from the RF lineup 102 and the microwave EM radiation output from the microwave lineup 104, respectively. In particular, the power controller 1002 and the adjustable signal attenuator 1009 are capable of controlling the power level of the output radiation. Additionally, the power controller 1002 and the adjustable signal attenuator 1009 may include switching circuitry capable of setting the waveform (e.g., pulse width, duty cycle, and amplitude, etc.) of the output radiation.

[0062] The microprocessor 110 generates an RF control signal C based on the signal information from the RF signal detector 1006 and the forward and reflected power couplers 1012, 1014. RF and microwave control signal C MThe RF signal detector 1006 is programmed to output a signal or signals S indicative of the voltage and current (and optionally the phase difference between the voltage and current) of the RF EM radiation on the RF channel. RF In this embodiment, the RF and microwave generators may be controlled solely by measurements of phase information that may be obtained from the RF channel (from sampled current and voltage information) or the microwave channel (from sampled forward and reflected power information). The forward power coupler 1012 outputs a signal S which is indicative of the forward power level. M1 and the reflected power coupler 1014 outputs a signal S indicating the reflected power level. M2 The signal S from the RF signal detector 1006 and the forward and reflected power couplers 1012, 1014 is RF , S M1 , S M2 is transmitted to a signal processing and general purpose interface circuit 108 where it is adapted to a suitable form for passing to a microprocessor 110.

[0063] A user interface 112, e.g., a touch screen panel, keyboard, LED / LCD display, membrane keypad, foot switches, etc., communicates with the controller 106 to provide a user (e.g., a surgeon) with information regarding the treatment and to allow various aspects of the treatment (e.g., the amount of energy delivered to the patient, or the energy delivery profile) to be manually selected or controlled, e.g., via suitable user commands. A conventional foot switch 1016 may be used to operate the device, and is also connected to the controller 106.

[0064] The RF and microwave signals generated by the RF lineup 102 and the microwave lineup 104, respectively, are input to a signal combiner 114, which conveys the RF and microwave EM radiation separately or simultaneously along a cable assembly 116 to a probe 118. In this embodiment, the signal combiner 114 comprises a duplexer-diplexer unit that enables energy at microwave and RF frequencies to be transmitted along the cable assembly 116 (e.g., a coaxial cable) to the probe (or applicator) 118 from which the energy is delivered (e.g., radiated) into patient anatomy, into an instrument channel of a scope, e.g., an endoscope, or onto another surface.

[0065] The signal combiner 114 also passes reflected energy returning from the probe 118 along the cable assembly 116 through the microwave and RF lineups 102, 104 for detection, for example, by an internal detector. As described below, the device may include a low pass filter 146 on the RF channel and a high pass filter 166 on the microwave channel, such that only reflected RF signals enter the RF lineup 102 and only reflected microwave signals enter the microwave lineup 104.

[0066] Finally, the device includes a power supply unit 1017 which receives power from an external power source 1018 (e.g. mains power) and converts it into DC power signals V1-V6 for the components within the device. Thus, the user interface receives power signal V1, the microprocessor 110 receives power signal V3, the RF line-up 102 receives power signal V3, the microwave line-up receives power signal V4, the signal processing and general interface circuit 108 receives power signal V5 and the watchdog 1015 receives power signal V6.

[0067] 2 shows a schematic diagram of an embodiment of the present invention, an electrosurgical device 200. The device 200 includes an electrosurgical instrument 202 capable of delivering plasma or non-ionizing electromagnetic (EM) radiation from its distal end. An example of the structure of the instrument 202 is described below.

[0068] The instrument 202 is connected to a power delivery system, which may be as described with reference to Figure 1. However, in the embodiment of Figure 2, the power delivery system comprises a radio frequency (RF) radiation source 204 and a microwave radiation source 206 connected to deliver power to a proximal end of the instrument 202 via an input structure 208. The input structure 208 may include a signal combiner unit 210 as described above. The RF source 204 and the microwave source 206 each receive a control signal C from a controller (not shown). RF and C M The RF and microwave signals may be output based on the

[0069] The instrument 202 is also connected to receive gas, for example, via a supply line 212 from a pressurized gas source 214. A control valve 216 on the supply line 212 is actuated by a control signal C, for example, from a controller. g The system may be configured to control the flow rate of gas received by instrument 202 based on the measured gas flow rate. Because gas must be present in the plasma formation region before a plasma can be generated, it may be desirable to activate the gas control valve and / or flow controller before activating the RF and / or microwave energy source to ensure that gas is present when the energy source is activated. It may be preferable to include a gas sensor in the plasma formation region and use a signal from the sensor to control the gas flow valve. This system also helps control gas utilization and prevents the patient from being embolized with argon (or other) gas.

[0070] The RF and microwave measurement information may also be used to control a gas controller, i.e., close the gas control valve if no RF and / or microwave power is detected using voltage / current and / or forward / reflected power monitoring circuits within the generator. It may be preferable to wait a set time, i.e., 20 ms or 200 ms, before cutting off the gas supply. This configuration serves as a safety mechanism and as a means of controlling gas usage.

[0071] The instrument 202 is also connected to receive liquids (e.g., water, saline) from a tank or container 218, for example, via a supply line 220. The instrument 202 may also be configured to provide liquids and solids (e.g., biological material and foreign bodies removed from the treatment site) to the container 218 via the supply line 220. A control valve 222 on the supply line 220 may be configured to control the flow of liquids received by the instrument 202 from the container 218 and / or the flow of liquids (and solids) received by the container 218 from the instrument 202. The control valve 222 may be operable to control the direction and / or rate of flow. For example, the direction and magnitude of flow may be controlled by a control signal C from a controller. L In this manner, the instrument 202 can inject liquid (e.g., water, saline) from the container 218 to a treatment site at the distal end of the instrument 202. The liquid may be used to debride biological tissue at the treatment site (e.g., wound, infection site, implant site). Additionally or alternatively, debridement may include extracting liquid, foreign bodies, and / or biological material (e.g., tissue, cells) from the treatment site to the container 218. The container 218 and supply line 220 may be partitioned into two or more zones, a first zone for providing liquid from the liquid container 218 to the instrument 202 and a second zone for providing liquid and solids from the instrument 202 to the container 218. The first zone may be separated from the second zone to prevent solids and / or liquids from one zone from entering the other zone.

[0072] The instrument 202 may include an outer sleeve or jacket 221 that carries coaxial cables and gas from the proximal end to the distal end of the instrument 202 for delivery of plasma (e.g., non-thermal and heat) or non-ionizing radiation to biological tissue at a treatment site at or just beyond the distal end of the instrument 202. The sleeve or jacket 221 may also transport liquids (including solids) between its proximal and distal ends for debridement purposes. Additionally, the instrument 202 may include an abrasive region 226 on its distal outer surface for debridement of biological tissue within the treatment site. That is, the abrasive region 226 may be used to scrape off dead, damaged, infected tissue, and / or foreign material (e.g., sand, dirt, contaminants) from the treatment site (e.g., wound, infection site, implant site). The abrasive region 226 may cover the entire circumference of the distal tip of the instrument (e.g., it may be approximately annular or ring shaped) or may cover only a portion thereof (e.g., as shown in FIG. 2). Although the abrasive region 226 is shown as being substantially rectangular, in some other embodiments it may be a different shape, for example, circular, oval, triangular, regular, or irregular. The abrasive region 226 may be positioned on a side or end surface of the probe tip.

[0073] Figure 3A shows a first embodiment of an electrosurgical instrument 300 in accordance with the present invention. The instrument 300 comprises an elongated probe consisting of a central coaxial cable 302 surrounded by a tubular sleeve 318. The proximal end of the coaxial cable 302 (shown on the left side of Figure 3A) terminates in a suitable connector 306 that is adapted to connect to a feed structure that provides the RF and microwave signals. The coaxial cable 302 carries the RF and microwave signals to the distal end of the instrument (on the right side of Figure 3A).

[0074] The distal end of the coaxial cable 302 terminates in an insulating element 308, such as a glass bead or ceramic disk, positioned between the body of the coaxial cable and the cylindrical cap to prevent short circuits or dielectric breakdown from occurring. Alternatively, the dielectric 311 of the cable 302 may extend beyond the outer conductor 310 of the cable 302, for example, by 0.1 mm to 0.2 mm. The outer conductor 310 of the coaxial cable stops at the insulating element 308, but the inner conductor 312 of the cable 302 continues through the insulating element 308 and protrudes beyond the insulating element 308 by a length selected (using simulations) to give the best impedance match for tissue reconstruction. The protruding length is surrounded by a cylindrical ceramic (or other suitable dielectric or magnetic material) cap 314, which terminates at its distal end in a dome 316, e.g., a hemisphere. The inner conductor 312 protrudes slightly beyond the dome 316. The inner conductor 312 and the cylindrical cap serve as the first electrode of the instrument.

[0075] The sleeve 318 surrounds the coaxial cable 302 and defines an annular space 320 between the outer surface of the coaxial cable 302 and the inner surface of the sleeve 318. A radial support element or spacer (not shown) may be used to position the coaxial cable 302 within the sleeve. The annular space 320 may be used to transport gas to the distal end of the instrument. The base piece 318 has a port 322 on its side that is connected to a gas supply line. To minimize gas leakage, a gas-tight seal 324 is provided at the junction between the sleeve 318 and the connector 306, which may be an O-ring or the like. Thus, gas introduced into the port 322 flows along the annular space 320 to exit the instrument at the distal end of the instrument.

[0076] The sleeve 318 has a conductive inner surface 321 along its length to its distal end. For example, the sleeve may comprise a stainless steel shaft with a polyimide liner on its outer surface. The conductive inner surface 321 is electrically connected to the outer conductor 310 of the coaxial cable 302. In this embodiment, this is done by a conductive mesh 328 mounted within the annular space 320. The mesh is porous and therefore allows gas to pass through while at the same time providing an electrical connection. This can also be achieved using a spring or multiple small wires that are electrically connected, i.e. soldered or crimped or captured, on one or both sides of the conductors or electrodes 310 and 321. By providing at least two, and ideally at least four, peripheral contacts around the conductor(s), one can ensure a sufficiently good electrical contact for the microwave energy to propagate unimpaired. It may also be possible and preferable to place multiple teeth or partial crimps (e.g., about half) in / on one of the conductors to establish the necessary electrical contact while at the same time allowing gas to flow to the plasma generation region or distal end of the device where the plasma is formed.

[0077] The conductive inner surface 321 of the sleeve is further covered by an insulating tube 330 (e.g., made from quartz, ceramic, etc.) along its distal length, which may longitudinally overlap the cylindrical cap 314. The conductive inner surface 321 and the insulating tube 330 act as the second electrode of the instrument.

[0078] The tubular sleeve 318 is surrounded by an outer jacket 340 that surrounds the sleeve 318 and defines an annular space 342 between the outer surface of the sleeve 318 and the inner surface of the jacket 340. As before, radial support elements or spacers (not shown) can be used to position the sleeve 318 within the jacket 340. The annular space 342 may be used to transport liquids to the distal end of the instrument (e.g., to a treatment site at the distal end). In addition, the annular space 342 may be used to transport liquids (e.g., water, saline) and / or solids (e.g., foreign bodies (e.g., sand), biological material (e.g., cells)) from the distal end of the instrument (e.g., from a treatment site at the distal end) to the proximal end. The jacket 340 has a port 344 on its side that is connected to a liquid supply line. To minimize liquid leakage, a liquid-tight seal 346 is provided at the junction between the jacket 340 and the connector 306, which may be an O-ring or the like. Thus, liquid introduced into port 344 flows along annular space 342 and exits the instrument at the distal end of the instrument. Specifically, one or more outlets 348 are provided at the distal end of annular space 342 to allow liquid to flow from instrument 300 to a treatment site at the distal end of the instrument. In addition, liquids and solids may be aspirated into annular space 342 via outlets 348. Outlets 348 may be generally circular and substantially uniformly spaced circumferentially. However, it will be appreciated that any shape, number, or distribution of outlets 348 may be possible, provided that outlets 348 allow liquid to flow out of the distal end of the instrument and allow liquids and solids (e.g., foreign matter (e.g., sand, dirt, contaminants) and biological material (e.g., tissue, cells)) to flow into the distal end.

[0079] FIG. 3B is a cross-sectional view taken along line AA of FIG. 3A. As can be seen in FIG. 3B, the annular space 342 is divided or partitioned into multiple channels. In the embodiment shown, dividing elements or structures or dividers 347A and 347B divide the annular space 342 into two channels. In this way, one of the channels may be used to transport liquids (and solids) from the treatment site to the distal end of the instrument and back to a container or tank (e.g., container 218) for storage and / or disposal. Also, the other of the channels may be used to transport liquids from the container or tank through the instrument from the distal end to the treatment site. In this way, liquids may be injected into the treatment site, for example, to debride a wound or an infected / implanted site at the treatment site, and then the dirty liquid containing solids (e.g., foreign bodies (e.g., sand or dirt) and biological material (e.g., cells or tissue)) may be sucked out of the treatment site to clean the wound or infected / implanted site. It will be appreciated that in some other embodiments, the annular space 342 may be divided into more than two channels, for example, 4, 6, 8, or 10 channels, where one or more channels may introduce liquid to the treatment site and / or one or more channels may extract liquid (and solids) from the treatment site. Additionally, in some embodiments, the annular space 342 is not divided, but instead provides a single channel that is used to both introduce liquid to the treatment site and extract liquid or solids from the treatment site.

[0080] Jacket 340 is provided with an outer protective sheath 304, formed, for example, of polyimide or the like. Protective sheath 304 terminates at its distal end. In an embodiment, the termination may include an annular structure made from a suitable insulator, such as, for example, low loss microwave ceramic, PTFE, PEEK, or nylon.

[0081] The instrument is configured to generate a plasma (e.g., a non-thermal or thermal plasma) in a region outward from the probe tip (e.g., a treatment site at or just beyond the probe tip) by performing the following steps.

[0082] - Supplying gas to the distal region of the instrument (i.e., the region between the quartz tube 330 and the cylindrical cap 314) - Sending a pulse of RF energy through the coaxial cable to impinge plasma on the gas in the distal region by generating a high electric field in the distal region. - Sending pulses of microwave energy through the coaxial cable to maintain or sustain the plasma and ensure proper treatment is occurring.

[0083] The RF pulse may be automatically triggered by a characteristic of the microwave pulse (e.g., a rising edge) so that the impingement and maintenance of the pulse are always synchronized. The RF pulse is configured to have a voltage suitable to set up an electric field for impinging the plasma. The voltage may be between 150V and 1500V peak value, more preferably between 250V and 750V peak value. The frequency of the RF pulse may be between 100kHz and 1MHz, and may include windows or bursts of sinusoidal waveforms or signals that are time-gated (e.g., based on the detected microwave pulse) having durations between 0.5μs and 10ms, for example.

[0084] The delivered microwave power may be monitored (eg, by measuring the forward and reflected microwave signals) to check the condition of the plasma.

[0085] In the above embodiment, the plasma is struck by an RF signal. In other embodiments, the plasma may be struck by a microwave signal alone, since the close distance between the inner and outer conductors allows a high electric field to be generated from the microwave signal. For example, if it is possible to deliver 25 W of CW microwave power to the distal end of the instrument, this may create a sufficiently high electric field. One possible means of plasma strike using a microwave field is to reduce the distance between the two conductors in the plasma generation region when the plasma strikes, and then increase the distance again after the plasma strikes to create an optimal environment (impedance) to sustain the plasma.

[0086] The electrosurgical instrument 300 may provide a wound treatment device. First, the instrument 300 may be used to perform wound debridement. For example, an operator may instruct a controller (e.g., controller 106, via user interface 112) to actuate a liquid control valve (e.g., valve 222) to inject liquid (e.g., water, saline) from a container (e.g., 218), via a supply line (e.g., 220), into the distal end of the instrument 300 at port 344. The liquid is then transported within the annular space 342 and exits the instrument at the distal tip via outlet 348. The outflow liquid is thereby infused into a treatment site disposed outwardly from the distal end, e.g., at or just beyond the distal end. The infused liquid may be used to debride the wound at the treatment site. For example, the infused liquid may remove dead, damaged, or infected tissue from the wound. The injected liquid may also remove foreign matter (e.g., dirt, sand, contaminants) from the wound. This operation may be sufficient to complete the debridement process. However, in some circumstances, further operations may be preferred or necessary. For example, either sequentially or simultaneously, the operator may have the device further control the liquid control valve such that liquid (and solids) are aspirated from the wound into the distal end of the instrument 300 via the outlet 348. This mixture of liquid and solids may then be transported through the instrument in the annular space 343 and returned to the container (e.g., the container 218). In an embodiment, the same fluid passage is used firstly to inject liquid into the wound and secondly to extract liquid and solids from the wound. However, as described above with reference to FIG. 3B, the annular space 342 may be partitioned into multiple channels, whereby different channels are used (sequentially or simultaneously) for injecting liquid and extracting liquid (with solids). The supply lines, liquid control valves, and vessels may also have separate spaces or zones for injecting liquid and extracting liquid (with solids).

[0087] After debridement, the instrument 300 may then be used to sterilize living tissue, for example, to sterilize a wound at a treatment site. Specifically, an operator (e.g., via the controller 106 and the user interface 112) may control the RF lineup (e.g., the lineup 102) and the gas inlet (e.g., the gas container 214, the valve 216, and the gas supply 212) to couple the gas with the impinging signal at the distal end of the instrument (e.g., between the first and second electrodes) to impinge a plasma. A microwave lineup (e.g., the microwave lineup 104) may then be used to maintain the non-thermal plasma.

[0088] For example, non-thermal plasma suitable for disinfection or sterilization can be generated by operating the MW generator in a pulsed mode with a duty cycle of less than 40%, e.g., 28%. In one embodiment, the effective power of a single microwave pulse is 50 W, with a pulse ON time of 40 ms over a period of 140 ms, i.e., the average power delivered to the plasma is 14.28 W at 2.45 GHz. When an RF impingement pulse is used in this configuration, the duration of the RF impingement pulse may be about 1 ms, and the frequency of the sinusoidal oscillation may be 100 kHz. The amplitude may be about 1 kV (707 Vrms) at peak. The RF power may be less than 10% of the microwave power. The RF pulse may be synchronized to the microwave burst or pulse and triggered on the rising edge of the microwave burst or pulse.

[0089] In this manner, non-thermal plasma can be generated at the distal end of the instrument 300 and delivered to a treatment site at or just beyond the distal end. Thus, the non-thermal plasma can be directed at a freshly debrided wound to sterilize or clean the wound, for example, by killing bacteria within the wound. This process of wound sterilization helps reduce the likelihood of the wound becoming infected, which can increase the likelihood of the wound healing.

[0090] After debridement and sterilization, the instrument 300 can then be used to reconstruct biological tissue, for example, to reconstruct the wound at the treatment site. Specifically, the operator (e.g., via the controller 106 and the user interface 112) can control the microwave line-up (e.g., the microwave line-up 104) and the gas inlet (e.g., the gas container 214, the valve 216, and the gas supply 212) to form the thermal plasma. As before, this step can be followed by a step of striking the plasma. To generate the thermal plasma, the duty cycle can be increased, for example, to 50%, or the continuous wave (CW) and / or the running power level can be increased, for example, to 75W or 100W (the microwave power and the amplitude of the RF striking pulse will need to be adjusted based on the exact geometry / dimensions of the instrument 300). The percentage of RF microwave power is preferably kept constant, for example, less than 10%, for non-thermal and thermal plasmas.

[0091] In this manner, thermal plasma can be generated at the distal end of the instrument 300 and delivered to a treatment site at or just beyond the distal end. In response, the thermal plasma can be directed to a freshly sterilized wound to reconstruct the wound. This process of wound reconstruction is useful for accelerating wound healing as compared to simply waiting for natural wound healing to occur.

[0092] In view of the above, the electrosurgical instrument 300 provides a wound treatment device capable of performing wound debridement, sterilization, and reconstruction. It will be appreciated that the transition from sterilization to reconstruction involves a transition from the generation / application of a non-thermal plasma to the generation / application of a thermal plasma. It will be further appreciated that this transition from non-thermal plasma to thermal plasma can be performed by increasing the duty cycle and / or increasing the power of the pulsed microwave energy signal used to form the plasma. For example, a duty cycle below 40% may be used to generate a non-thermal plasma, while a duty cycle above 50% may be used to generate a thermal plasma. Additionally or alternatively, a pulse power below 50 W (or below 15 W average power) may be used to generate a non-thermal plasma, while a pulse power above 75 W (or above 30 W average power) may be used to generate a thermal plasma.

[0093] 3A and 3B can be used for wound treatment, and the instrument may also find utility in other applications, such as treating infected sites in the ear and urinary tract. For example, the liquid passage 342 may be used to extract infected tissue and / or mucus from an infected site. Additionally, the liquid passage 342 may be used to extract infected tissue from medical implants (e.g., metallic implants) and corresponding implant sites in the body. The infected site, implant site, and / or implant may then be sterilized using non-thermal plasma.

[0094] Figures 4A and 4B are schematic cross-sectional views of another embodiment of the present invention, an electrosurgical instrument 350. Components in common with Figure 3A are given the same reference numerals and will not be described again.

[0095] The embodiment of Figures 4A and 4B differs from the embodiment of Figures 3A and 3B in that the first electrode and the second electrode are movable relative to one another.

[0096] In this embodiment, the sleeve 318 and jacket 340 are configured to slide longitudinally relative to the coaxial cable 302. To accomplish this, the sleeve 318 is slidably mounted in a telescoping manner within the proximal base piece 354. An O-ring 325 may be attached to the sliding connection to maintain a fluid (e.g., gas) seal. The jacket 340 is also slidably mounted in a telescoping manner within the proximal base piece 354. An O-ring 358 may be attached to the sliding connection to maintain a fluid (e.g., liquid) seal. Pull wires (not shown) may extend through the connector 306 to aid in positioning the sleeve 318 and jacket 340 relative to the coaxial cable. The pull wires may be manually operated or may be connected to an automatic control mechanism, such as a stepper motor or linear motor, which may automatically control the position of the sleeve 318 and jacket 340 based on control signals, for example, from a controller. The sleeve 318 and jacket 340 may move together as one single unit.

[0097] The slidable sleeve and jacket allow the instrument to adopt two configurations. In the first configuration, as shown in FIG. 4A, the conductive inner surface 321 of the sleeve 318 is longitudinally aligned with the cylindrical cap 314. In this configuration, a high impedance region is established that exhibits a high electric field when an RF or microwave signal is supplied to the instrument. In this configuration, the instrument may be adapted to deliver plasma from the distal end of the probe, for example, thermal plasma for reconstruction or non-thermal plasma for sterilization. This mode of operation corresponds to the device shown in FIG. 3A.

[0098] A microprocessor (e.g., microprocessor 110) may be configured to output control signals to adjust the position of the sliding sleeve and jacket relative to the coaxial cable based on the detected return loss or impedance mismatch determined by the controller from the microwave detection signal. This control may be done, for example, when the plasma is generated to maintain a predetermined required match or return loss, e.g., 10 dB (90% of the microwave energy is delivered to the plasma).

[0099] In a second configuration, as shown in FIG. 4B, the sleeve 318 and jacket 340 slide down over the coaxial cable 302 to expose a length of the cylindrical cap 314 at the distal end of the device. The exposed end acts as a radiating monopole microwave antenna. In this configuration, a microwave signal is fed into the coaxial cable in the absence of gas. The microwave signal is emitted in a non-ionizing radiation field. The level of non-ionizing microwave power delivered at the distal radiating monopole may be between 2.5W and 50W of continuous wave power. The level may depend on the characteristics of the tissue being reconstructed, for example, the depth of the treatment site (e.g., wound or infection / implant site). The power level also depends on the characteristics of the microwave transmission cable used to deliver the microwave energy from the generator to the applicator or antenna.

[0100] The microwave energy may be delivered as a series of pulses or bursts of microwave energy whereby the mechanical force follows or is embedded within the burst of microwave coagulation energy. For example, one activation profile may include the application of 10 W of microwave power for 10 seconds.

[0101] The distal end of the cylindrical cap 314 may terminate in a conductive dome, which helps to ensure that the power density in the region outside the probe tip is not excessively concentrated at the distal end of the cylindrical cap 314.

[0102] In view of the above, in addition to or instead of reconstruction via thermal plasma (i.e., ionized gas), instrument 300 may be used to generate non-ionizing microwave energy or radiation for tissue reconstruction. In this case, the device may be controlled (e.g., via controller 106 and user interface 112) to shut off the gas inlets (e.g., gas container 214, valve 216, and gas supply 212) so that gas is not provided to the distal end of instrument 300. In addition, the microwave line-up (e.g., microwave line-up 104) may be controlled (e.g., via controller 106 and user interface 112) to provide a non-ionizing radiation field at the distal tip. In an embodiment, the same microwave signal used to generate non-thermal plasma (with gas) may be used to generate a non-ionizing radiation field (without gas). This type of microwave signal or microwave energy profile may be desirable, for example, because it is weaker compared to the signal used to generate thermal plasma. A weaker signal may be beneficial for reconstruction, as a stronger signal may result in a level of coagulation (e.g., shallow or deep) that may impede healing. However, as noted above, it will be appreciated that in some other embodiments, different forms of microwave energy profiles may be used, such as pulsed signals having a duty cycle greater than 40% and / or a pulse power greater than 50 W (or average power greater than 15 W).

[0103] In view of the above, the electrosurgical instrument 350 provides a wound treatment apparatus or device capable of performing wound debridement and sterilization, as well as reconstruction via two separate and distinct mechanisms: thermal plasma and non-ionizing microwave energy.

[0104] Figures 5A and 5B are schematic cross-sectional views of a further embodiment of the present invention, an electrosurgical instrument 400. Components in common with Figure 3A are given the same reference numerals and will not be described again.

[0105] The embodiment of Figures 5A and 5B differs from the embodiment of Figure 3A in that the instrument includes a deployable debridement tool 402. Specifically, the instrument 400 includes a cavity, recess, or holder 404 for receiving the debridement tool 402. In the embodiment of Figures 5A and 5B, the holder 404 is at the distal end of the instrument 400 and has an opening at the distal end face that faces substantially the same direction that the plasma and non-ionizing radiation are emitted. However, it will be understood that in some other embodiments, the holder 404 can be located elsewhere on the instrument 400. The instrument 400 further includes a pull wire 406 that extends from the debridement tool 402 to a handle 408 at the proximal end of the probe. As shown in Figures 5A and 5B, the pull wire 406 may be attached to the exterior of the instrument 400 and housed within a guiding structure 407 that prevents the wire from getting caught on objects during use. However, in another embodiment, the guiding structure 407 may be integrated with the jacket 340 or sleeve 318 such that the outer profile of the instrument 400 is unchanged compared to the embodiment of Figures 3A-4B. In either case, the handle 408 may be manipulated by a user to move the debridement tool 402 relative to the holder 404. That is, the user may move the handle 408 longitudinally (as indicated by arrow 410) relative to the instrument 400 to cause a corresponding longitudinal movement (indicated by arrow 412) of the debridement tool 402 relative to the holder 404. In this manner, the handle 408 may be used to move the debridement tool 402 between a stowed position (as indicated in Figure 5B) in which the debridement tool 402 is enclosed within the holder 406, and a deployed position (as indicated in Figure 5A) in which the debridement tool 402 projects into an area outward from the probe tip for debridement of living tissue. In an embodiment, the holder 404 is sized such that in the stowed position, the debridement tool 402 is fully enclosed within the holder 402, i.e., none of the tool protrudes from the holder, and in an embodiment, the pull wire 406 is sized such that the debridement tool 402 is fully spaced from the holder 402, i.e., the entire tool protrudes from the holder.However, in some other embodiments, the various components may be dimensioned such that the tool only partially protrudes from the holder in the deployed position.

[0106] In Figures 5A and 5B, the debridement tool comprises a brush having a plurality of elastically deformable bristles. When in the deployed position, the bristles may be used to remove dead, damaged, or infected tissue from a treatment site (e.g., wound, infected / implant site, implant), e.g., via a brushing or scraping action. The bristles may also be used to remove foreign matter (e.g., sand, dirt, contaminants) from a treatment site, e.g., via a brushing or scraping action. However, in some other embodiments, the debridement tool may be other than a brush, e.g., a deployable member (e.g., a pad) having an abrasive coating or surface, or a deployable member coated with a gauze-type material. In such cases, the method of debridement using the debridement tool is the same as for a brush.

[0107] In the embodiment of Figures 5A and 5B, the deployment mechanism of the deployable tool 402 includes a pull wire 406 and a handle 408. Thus, the deployment mechanism of Figures 5A and 5B is a manual deployment mechanism. However, it will be appreciated that in some other embodiments, an automatic or computer-controlled deployment mechanism may be provided. For example, such an automatic deployment mechanism may include an electromechanical actuator (PZT actuator, magnetostrictive actuator, stepper motor, linear motor) operably coupled to a controller (e.g., controller 106), which may be configured in use to move the debridement tool 402 between a stowed position and a deployed position based on a control signal from the controller. The actuator may mechanically move the tool using a pull wire similar to the pull wire 406.

[0108] The embodiment of Figures 5A and 5B has both a deployable debridement tool 402 and a liquid passageway 342 for injecting / extracting debridement liquid. Thus, the embodiment of Figures 5A and 5B has two separate and distinct mechanisms for debridement of a treatment site (e.g., wound, infection / implantation site, implant). However, it will be appreciated that when a deployable tool 402 is provided, the liquid passageway 342 and all associated mechanisms for injecting and extracting liquid are optional, i.e., they may not be present.

[0109] It will be appreciated that one or more features from one of the above-described embodiments may be combined with one or more features from one or more other of the above-described embodiments to form new embodiments within the scope of the appended claims. For example, the embodiment of FIG. 2 includes an abrasive region 226 at the distal end of the instrument for debridement of a treatment site (e.g., wound, infection / implant site). It will be appreciated that any one or more of the embodiments of FIGS. 3A, 3B, 4A, 4B, 5A, and 5B may also include an abrasive region 226. Furthermore, the above-described embodiments disclose three separate debridement devices: (i) an abrasive region at the distal end of the instrument (e.g., FIG. 2), (ii) liquid passages for injecting / extracting debridement liquids and solids (e.g., FIGS. 3A-5B), and (iii) a deployable debridement tool (e.g., FIGS. 5A and 5B). It will be appreciated that in some embodiments, only one of these debridement devices may be present. However, in some other embodiments, any two may be present, and in some further embodiments, all three may be present. It will be appreciated that if no liquid passageways are present, the exterior surface of the instrument may be defined by the sleeve 318 rather than by the jacket 340. Additionally, in another embodiment, the movable electrodes of the embodiment of Figures 4A and 4B may be included in the deployable debridement tool embodiment of Figures 5A and 5B.

[0110] The features disclosed in the foregoing description, or in the following claims, or in the accompanying drawings, and presented in a particular form or in terms of means for performing a disclosed function, or a method or process for achieving a disclosed result, may be used separately or in any combination of such features, as appropriate, to realize the invention in its various forms.

[0111] While the present invention has been described in conjunction with the above exemplary embodiments, many equivalent modifications and variations will be apparent to those skilled in the art given this disclosure. Accordingly, the above exemplary embodiments of the present invention are deemed to be illustrative and not limiting. Various changes to the described embodiments may be made without departing from the spirit and scope of the present invention.

[0112] For the avoidance of doubt, the theoretical explanations provided herein are provided for the purpose of enhancing the understanding of the reader, and the inventors do not wish to be bound by any of these theoretical explanations.

[0113] Throughout this specification, including the claims which follow, unless the context requires otherwise, the terms "have," "comprise," and "include," as well as variations such as "having," "comprises," "comprising," and "including," are understood to imply the inclusion of a stated element or step, or group of elements or steps, but not the exclusion of other elements or steps, or group of elements or steps.

[0114] It should be noted that, as used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Ranges may be expressed herein as from "about" (one particular value) and / or to "about" (another particular value). When such a range is expressed, another embodiment includes from (one particular value) and / or to (the other particular value). Similarly, when values ​​are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment. The term "about" in connection with numerical values ​​is optional and means, for example, ±10%.

[0115] The terms "preferred" and "preferably" are used herein to refer to embodiments of the invention that may provide certain advantages, under some circumstances. It will be recognized, however, that other embodiments may be preferred, under the same or different circumstances. The recitation of one or more preferred embodiments does not imply or imply that other embodiments are not useful, and is not intended to exclude other embodiments from the scope of the disclosure or from the scope of the claims.

Claims

1. 1. An electrosurgical instrument comprising: an elongated probe comprising a coaxial cable for carrying radio frequency (RF) and / or microwave frequency electromagnetic (EM) energy and a probe tip connected to a distal end of the coaxial cable for receiving the RF and / or microwave frequency EM energy; a gas passage for conveying gas through the elongated probe to the probe tip; a debridement device for debridement of biological tissue, the debridement apparatus comprising a debridement tool; the probe tip comprises a holder for receiving the debridement tool; the debridement tool is movable between a stowed position in which the debridement tool is enclosed within the holder and a deployed position in which the debridement tool projects outwardly from the probe tip for debridement of living tissue; the coaxial cable comprising an inner conductor, an outer conductor, and a dielectric material separating the inner conductor from the outer conductor; the probe tip comprises a first electrode connected to the inner conductor of the coaxial cable and a second electrode connected to the outer conductor of the coaxial cable; The electrosurgical instrument, wherein the first electrode and the second electrode are configured to generate an electric field from the received RF and / or microwave frequency EM energy across a flow path of gas received from the gas passage to generate a thermal or non-thermal plasma in the region outward from the probe tip.

2. The electrosurgical instrument of claim 1, wherein the first electrode and the second electrode are movable relative to one another to a second configuration in which the first electrode extends distally beyond the second electrode to form a radiating structure for emitting a microwave EM field outwardly from the probe tip.

3. The electrosurgical instrument of claim 1 or 2, wherein the debridement apparatus includes an abrasive region on a distal outer surface of the probe tip for debridement of living tissue at the probe tip.

4. The electrosurgical instrument of any one of claims 1 to 3, wherein the elongated probe includes a sleeve surrounding the coaxial cable, the gas passage being a space between an inner surface of the sleeve and an outer surface of the coaxial cable.

5. The electrosurgical instrument of claim 4, wherein the second electrode is formed on a distal end of the sleeve, the sleeve being retractable relative to the coaxial cable.

6. The electrosurgical instrument of claim 4 or 5, wherein the sleeve includes a rotatable braided cable allowing adjustment of the orientation of the debridement apparatus.

7. 7. The electrosurgical instrument of any one of claims 1 to 6, wherein the debridement apparatus comprises a fluid passageway for conveying fluid through the elongate probe and into or out of the region outside the probe tip for debridement of living tissue.

8. The electrosurgical instrument of claim 7, wherein the elongated probe includes a jacket surrounding a sleeve, the fluid passageway being a space between an inner surface of the jacket and an outer surface of the sleeve.

9. The electrosurgical instrument of claim 7, wherein a space between an inner surface of a sleeve and an outer surface of the coaxial cable is partitioned into the gas passageway and the liquid passageway.

10. 10. The electrosurgical instrument of claim 7, wherein the fluid passageway is partitioned into a first channel for conveying fluid through the elongate probe to the region outboard of the probe tip, and a second channel for conveying fluid through the elongate probe from the region outboard of the probe tip.

11. The electrosurgical instrument of any preceding claim, wherein the first electrode is a radiating microwave monopole antenna structure coupled to receive RF and / or microwave frequency EM energy from the coaxial cable.

12. The electrosurgical instrument of any preceding claim, wherein the first electrode and the second electrode form active and return electrodes for an RF signal carried by the coaxial cable.

13. 13. The electrosurgical instrument of any one of claims 1 to 12, wherein an outer electrode of the coaxial cable is slidable relative to the second electrode or the outer electrode of the coaxial cable and is connected to the second electrode by a gas permeable conductive structure that allows gas to flow through the coaxial cable.

14. The electrosurgical instrument of any preceding claim, wherein the probe is insertable through an instrument channel of a scope device.

15. 1. An electrosurgical device comprising: a radio frequency (RF) signal generator for generating RF electromagnetic (EM) radiation having a first frequency; a microwave signal generator for generating microwave EM radiation having a second frequency higher than the first frequency; An electrosurgical instrument according to any one of claims 1 to 14, connected to receive the RF EM radiation and the microwave EM radiation; a feed structure for delivering the RF EM radiation and the microwave EM radiation to the elongated probe, the feed structure comprising an RF channel for connecting the elongated probe to the RF signal generator and a microwave channel for connecting the elongated probe to the microwave signal generator; a gas delivery connected to supply gas to the electrosurgical instrument; the device is operable to debride the area of ​​body tissue outwardly from the probe tip; The electrosurgical device, wherein the device is operable to deliver a thermal or non-thermal plasma to the region outward from the probe tip.

16. a fluid inlet connected to supply fluid to or extract fluid from the electrosurgical instrument; The electrosurgical device of claim 15, wherein the device is operable to supply liquid to or extract liquid from the area outward from the probe tip for debridement of living tissue.

17. The liquid feeder is an infusion device for supplying fluid to the electrosurgical instrument via a first channel; The electrosurgical apparatus of claim 16, further comprising: a suction device for extracting liquid from the electrosurgical instrument via a second channel.

18. the first electrode and the second electrode are movable relative to one another to a second configuration in which the first electrode extends distally beyond the second electrode to form a radiating structure for emitting a microwave EM field outwardly from the probe tip; 18. The electrosurgical device of claim 15, wherein when the first and second electrodes are in the second configuration in which no gas is supplied, the device is operable to emit a non-ionizing electric field outwardly from the probe tip.

19. a strike signal generating circuit configured to cause the probe to deliver a pulse of RF EM energy to generate a high electric field across the flow passage to strike the plasma; Electrosurgical device according to any one of claims 15 to 18, wherein the impingement signal generating circuitry includes control circuitry configured to use a detectable characteristic of a pulse of microwave EM radiation on the microwave channel to trigger generation of the pulse of RF EM energy.

20. a microwave signal detector for sampling forward and reflected power on said microwave channel and generating a microwave detection signal from said microwave channel indicative of microwave power delivered by said probe; a controller in communication with the microwave signal detector to receive the microwave detection signal; the controller is operable to select a first energy delivery profile of the microwave frequency EM energy, the first energy delivery profile of the microwave frequency EM energy for sterilization of tissue; the controller comprises a digital microprocessor programmed to output a first microwave control signal for the microwave signal generator, the first microwave control signal for setting the first energy delivery profile of the microwave frequency EM energy; The electrosurgical device of any one of claims 15 to 19, wherein the controller is configured to determine a state of the first microwave control signal based on the received microwave detection signal.

21. the controller is operable to select a second energy delivery profile of the microwave frequency EM energy, the second energy delivery profile of the microwave frequency EM energy being for tissue reconstruction; 21. The electrosurgical device of claim 20, wherein the digital microprocessor is programmed to output a second microwave control signal for the microwave signal generator, the second microwave control signal for setting the second energy delivery profile of the microwave frequency EM energy.

22. a moving mechanism for causing relative movement between the first electrode and the second electrode; The electrosurgical device of claim 20 or 21, wherein the controller is configured to communicate control signals to the movement mechanism based on the received microwave detection signal.

23. The electrosurgical device of claim 22, wherein the movement mechanism comprises one of a linear motor, a stepper motor, a piezoelectric actuator, and a magnetostrictive actuator.

24. a deployment mechanism for causing relative movement between the debridement tool and the holder; The electrosurgical device of any one of claims 20 to 23, wherein the controller is configured to communicate a debridement signal to the deployment mechanism to move the debridement tool between the stowed position and the deployed position.

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