Tissue resection device

Abstract

To provide a system, device and method for lesion removal.SOLUTION: A tissue resection apparatus is provided which includes an outer tube with a helical coil disposed on a distal end. The coil is provided with a first electrode. A central tube has a distal edge profile comprising one or more surface segments. One of the surface segments includes a second electrode. The central tube is slidably disposed within the outer tube and positioned such that second electrode is opposed to at least a portion of the first electrode. A cutting tube is slidably disposed within the central tube and includes a cutting edge.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to Provisional Patent Application No. 62 / 712,545, filed July 31, 2018, which is incorporated herein by reference in its entirety.

[0002] This application claims priority to Provisional Patent Application No. 62 / 728,170, filed September 7, 2018, which is incorporated herein by reference in its entirety.

[0003] This application claims priority to Provisional Patent Application No. 62 / 744,797, filed October 12, 2018, which is incorporated herein by reference in its entirety.

[0004] This application claims priority to Provisional Patent Application No. 62 / 749,302, filed October 23, 2018, which is incorporated herein by reference in its entirety.

[0005] This application claims priority to Provisional Patent Application No. 62 / 756,234, filed November 6, 2018, which is incorporated herein by reference in its entirety.

[0006] FIELD OF THE INVENTION TECHNICAL FIELD This application relates to systems, devices, and methods for tissue ablation. More particularly, the present invention relates to systems, devices, and methods for lesion removal. [Background technology]

[0007] Cancer is not a single disease, but rather a collection of related diseases that can begin essentially anywhere in the body. What is common among all types of cancer is that the body's cells begin to divide uncontrollably, growing and potentially metastasizing into surrounding tissues. Under normal circumstances, cells grow and divide to form new cells as needed by the body, or they die when damaged or old, and new cells replace the damaged or old cells. However, cancer interferes with this process. In cancer, cells go awry, cells that should die do not die, and new cells are formed when they are not needed. These new cells can multiply or grow uncontrollably, forming a growth called a tumor.

[0008] Cancerous tumors are malignant, meaning they can metastasize or invade surrounding healthy tissue. In addition, cancer cells can break off and travel through the blood or within the lymphatic system to distant areas of the body. Benign tumors, unlike malignant tumors, do not metastasize or invade surrounding tissues. However, they can grow large and cause damage. Both malignant and benign tumors can be removed or treated. Malignant tumors tend to grow back, while benign tumors can grow back, but this is much less likely.

[0009] Cancer is a genetic disease in that it is caused by changes in genes that control how cells function, particularly how cells grow and divide. Genetic changes that cause cancer can be inherited, or they can occur over an individual's lifetime as a result of errors that occur when cells divide, or due to DNA damage caused by certain environmental exposures, such as industrial / commercial chemicals and ultraviolet light. Genetic changes that can cause cancer tend to affect three types of genes: proto-oncogenes, which are involved in normal cell growth and division; tumor suppressor genes, which are also involved in controlling cell growth and division; and DNA repair genes, which, as the name suggests, are involved in repairing damaged DNA.

[0010] More than 100 different types of cancer have been identified. Cancer types may be named for the organ or tissue in which they arise, e.g., lung cancer, or for the type of cells from which they form, e.g., squamous cell carcinoma. Unfortunately, cancer is the leading cause of death both in the United States and worldwide. According to the World Health Organization (WHO), the number of new cancer cases is expected to increase to 25 million per year over the next 20 years.

[0011] Lung cancer is one of the most common cancers today. According to the World Health Organization's (WHO) World Cancer Report 2014, lung cancer affects 14 million people and results in 8.8 million deaths worldwide, making it the leading cause of cancer-related deaths in men and the second leading cause of cancer-related deaths in women. Lung cancer, or lung carcinoma, is a malignant lung tumor that can metastasize to adjacent tissues and organs if left untreated. While the majority of lung cancers are caused by long-term tobacco smoking, approximately 10% to 15% of lung cancer cases are non-tobacco-related. These non-tobacco cases are most often caused by a combination of genetic factors and exposure to certain environmental conditions, such as radon gas, asbestos, secondhand smoke, other forms of air pollution, and other factors. The chances of surviving lung cancer, as well as other forms of cancer, depend on early detection and treatment. Summary of the Invention [Problem to be solved by the invention]

[0012] When a lesion is found in the lung, a biopsy is performed and sent for testing. If the lesion is determined to be cancerous, a second procedure may be performed to remove the cancer. If the biopsy does not reveal cancer, the biopsy may be accurate or it may not have picked up any cancer cells. Therefore, there is a need to remove the entire lesion in one single procedure so that an accurate diagnosis can be made. [Means for solving the problem]

[0013] The systems, devices, and methods for performing pulmonary lesion removal of the present invention overcome limitations associated with the prior art.

[0014] The present invention relates to systems, devices, and methods for performing lung lesion removal. Lung needle biopsies are typically performed when imaging tests, such as X-rays or CAT scans, reveal abnormalities. A lung needle biopsy involves removing a sample of lung tissue using a fine needle for microscopic examination to determine the presence of abnormal cells. Small (<6 mm) and intermediate nodules (6-12 mm) present a significant challenge for tissue diagnosis. CT-guided biopsies of peripheral lesions, either through the chest wall (80%) or by bronchoscopy (20%), yield only 0.001-0.002 cm2 of diagnostic tissue, and cancer, if present, is successfully identified in only 60% of small and intermediate nodules. Although bronchoscopy techniques and technologies continue to evolve, biopsy accuracy, specificity, and sensitivity remain limited when dealing with peripheral small and intermediate nodules in the lung.

[0015] If the lesion is determined to be cancerous, a second procedure may be performed to remove the lesion and then follow up with chemotherapy and / or radiation. The second procedure will most likely involve lung surgery. These procedures are typically performed through an incision between the ribs. Depending on the stage of the cancer, there are several possible procedures. Video-assisted thoracic surgery is a minimally invasive procedure for certain types of lung cancer. It is performed through a small incision using an endoscopic approach and is typically used to perform a wedge resection of smaller lesions closer to the surface of the lung. In a wedge resection, a portion of a lobe is removed. In a sleeve resection, a portion of a large airway is removed, thereby preserving more lung function.

[0016] Once a suspected cancer is identified, nodules deeper than 2–3 cm from the lung surface are difficult to localize and remove using laparoscopic or robotic lung-sparing techniques, despite preoperative image-guided biopsy and localization. Therefore, surgeons perform thoracotomy or lobectomy to remove lung nodules 2–3 cm from the lung surface. Thoracotomy is an open surgery that removes a portion of a lobe, the entire lobe, or the entire lung. In pneumonectomy, the entire lung is removed. This type of surgery is clearly the most aggressive. In lobectomy, the entire lung is removed and represents a less aggressive procedure than removal of the entire lung. All thoracoscopic lung surgeries require a trained and experienced thoracic surgeon and surgical experience to ensure favorable surgical outcomes.

[0017] Both of these types of lung surgery are major surgeries that can have complications depending on the extent of the surgery and the patient's overall health. In addition to the decreased lung function associated with any of these procedures, recovery can take weeks to months. Thoracotomy requires spreading the ribs, which increases postoperative pain. Video-assisted thoracic surgery is minimally invasive, but there can still be a significant recovery period. Additionally, once surgery is complete, full treatment may require systemic chemotherapy and / or radiation therapy.

[0018] As mentioned above, fine needle biopsies may not provide a complete diagnosis. The fine needle biopsy procedure involves navigating a needle in three-dimensional space under two-dimensional imaging. Therefore, physicians may miss the lesion, or even if the correct target is hit, the section of the lesion removed through the needle may not contain the cancerous cells or tissue necessary to assess the malignancy of the cancer. A needle biopsy removes enough tissue to form a smear on the slide. The device of the present invention is designed to remove the entire lesion or a substantial portion of it while minimizing the amount of healthy lung tissue removed. This offers several advantages. First, the entire lesion can be examined for a more accurate diagnosis without sampling error, loss of cell packing, or deterioration of the overall structure. Second, because the entire lesion is removed, secondary procedures such as those described above may not be necessary. Third, the cavity created by the lesion removal can be used to introduce local chemotherapy such as radiation and / or energy-based tumor removal.

[0019] In at least one embodiment, the present invention encompasses a tissue excision mechanism comprising an outer tube having a helical coil disposed on a distal end thereof, the coil including a first electrode. A central tube is provided having a distal edge profile including one or more surface segments, at least one of which includes a second electrode. The central tube is slidably disposed within the outer tube, with the second electrode positioned opposite at least a portion of the first electrode. A cutting tube includes a cutting edge slidably disposed within the central tube, the cutting tube configured to advance over at least one of the coil segments.

[0020] In another embodiment, the present invention encompasses a tissue excision mechanism comprising an outer tube having a helical coil disposed on its distal end, the coil including a first electrode. A central tube is provided having a distal edge profile including one or more surface segments, at least one of which includes a second electrode. The central tube is slidably disposed within the outer tube, with the second electrode positioned opposite at least a portion of the first electrode. First and second ligating electrodes are disposed within the central tube and exposed to the central tube lumen. A snare is disposed within the central tube between the first and second ligating electrodes. A cutting tube includes a cutting edge slidably disposed within the central tube, and the cutting tube is configured to advance over at least one of the coil segments.

[0021] In yet another embodiment, the present invention encompasses a tissue excision mechanism comprising an outer tube having a helical coil disposed on its distal end, the coil including a first electrode. A central tube is provided having a distal edge profile including one or more surface segments, at least one of which includes a second electrode. The central tube is slidably disposed within the outer tube, with the second electrode positioned opposite at least a portion of the first electrode. First and second ligating electrodes are disposed within the central tube and exposed to the central tube lumen. A cutting snare is disposed within the central tube, and the ligating snare is disposed within the central tube. The cutting tube includes a cutting edge slidably disposed within the central tube, and the cutting tube is configured to advance over at least one of the coil segments. [Brief explanation of the drawings]

[0022] The above and other features and advantages of the present invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings. [Figure 1] 1 illustrates a tissue excision device according to an embodiment of the present invention. [Figure 2] 2 illustrates a cross-sectional view of the tissue excision device of FIG. 1. [Figure 3] 1 shows a cross-sectional view of a tissue excision device according to an embodiment of the present invention. [Figure 4] 1 illustrates a cross-sectional view of a tissue excision device according to an embodiment of the present invention. [Figure 5] 1 illustrates an exemplary anchor that may be used in lesion removal methods according to embodiments of the present invention. [Figure 6] 1 illustrates a series of dissection blades for use in a lesion removal method according to an embodiment of the present invention. [Figure 7] 1 shows a tissue expander suitable for use in a lesion removal method according to an embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0023] The ablation devices of the present invention comprise an energy-based configuration capable of penetrating tissue toward a target lesion. In one embodiment illustrated in FIG. 1, the tissue ablation device 1100 includes an outer tube 1105 having a distal edge profile and an inner diameter ID 外側 The coil 1110 is provided having a tip 1115. The coil 1110 is attached to the outer tube 1105, with the coil turns spaced apart from and facing the distal end of the outer tube 1105. The coil 1110 preferably has a slightly blunt tip 1115 to minimize the possibility of penetrating blood vessels while being sharp enough to penetrate tissue such as the pleura and soft tissue. In some embodiments, the coil 1110 may take the form of a helix with a constant or variable pitch. The coil 1110 may also have a variable cross-sectional shape. The electrode 1130 is disposed on a surface or embedded within the coil 1110.

[0024] 1, coil 1110 can include multiple consecutive coil segments, such as coil segments 1120 and 1125. Coil segment 1120 has an inner diameter ID コイル and outer diameter OD コイルCoil segment 1125 comprises a helical member having a zero pitch, e.g., a generally planar open loop structure, with a pitch of 0. Coil segment 1125 comprises a helical structure of constant or variable pitch and constant or variable cross-sectional shape. In this embodiment, electrode 1130 may be disposed on a surface of coil segment 1120 or embedded therein.

[0025] One or more surface segments, with an outer diameter OD 中央 and inner diameter ID 中央 A central tube 1200 is provided having a distal end with an edge profile having a . As illustrated in FIG. 2, an electrode 1205 is disposed on or embedded within at least one of the surface segments. The central tube 1200 is slidably disposed within the outer tube 1105, and is positioned such that the electrode 1205 faces and overlaps at least a portion of the electrode 1130. The space between the electrode 1205 and the electrode 1130 is referred to as the tissue clamping region. In accordance with this aspect of the present invention, the OD 中央 is ID コイル Larger, OD コイル is ID 中央 In some embodiments, the OD 中央 OD コイル Thus, central tube 1200 can be advanced through the tissue clamping region towards coil 1110 so that electrode 1205 abuts electrode 1130.

[0026] The cutting tube 1300 is slidably disposed within the central tube 1200. The distal end of the cutting tube 1300 is provided with a knife edge to facilitate tissue cutting.

[0027] To enable tissue ablation, the ablation device 1100 can be inserted into tissue, and the outer tube 1105 can be advanced a predetermined distance toward the target. The coil segment 1125 allows the device to penetrate the tissue in a manner similar to a corkscrew. Once the coil segment 1125 penetrates the tissue, any blood vessels in its path are either moved to the planar coil segment 1120 or pushed away from the coil 1100 for subsequent winding. The coil tip 1115 is made blunt enough to minimize the possibility of penetrating a blood vessel, yet sharp enough to penetrate certain tissues, such as the lung pleura and parenchyma. The central tube 1200 can then be advanced a predetermined distance toward the target. Any blood vessels disposed within the tissue clamping region will be clamped between the electrode 1130 and the electrode 1205. The blood vessels can then be sealed by applying bipolar energy to the electrode 1130 and the electrode 1205. Once the vessel is sealed, the cutting tube 1300 is advanced to core the tissue to the depth reached in the outer tube 1105. The sealing and cutting process can be repeated to form a core of the desired size.

[0028] In accordance with aspects of the present invention, the ablation device may be further configured to incise a target lesion and seal tissue proximal to the incision point. To facilitate the incision and sealing, as illustrated in FIG. 3 , the central tube 1200 is provided with a ligating snare 1230, a first ligating electrode 1215, a second ligating electrode 1220, a cutting snare 1225, and a ligating snare 1230. As used herein, the term “snare” refers to a flexible line, such as a string or wire. The inner wall surface of the central tube 1200 includes an upper circumferential grooved channel 1212 and a lower circumferential grooved channel 1214 disposed proximal to the distal end. The first ligating electrode 1215 and the second ligating electrode 1220 are disposed on the inner wall of the central tube 1200 such that the lower circumferential groove 1214 is between them. Upper grooved channel 1212 is disposed axially above ligating electrodes 1215 and 1220 .

[0029] The ligating snare 1230 is disposed within the lower circumferential groove 1214, extends through the central tube 1200, and extends axially along the outer wall surface to a snare actuation mechanism (not shown). The cutting snare 1225 is disposed within the upper circumferential groove 1212, extends through the central tube 1200, and extends axially along the outer wall surface to a snare actuation mechanism (not shown). The outer surface of the central tube 1200 may be provided with a plurality of axially extending grooved passages that receive the cutting snare 1225, ligating snare 1230 and are in communication with the upper and lower circumferential grooved passages 1212, 1214. Additionally, electrode lead wires for the ligating electrodes 1215 and 1220 may extend to an energy source via the axially extending grooved passages.

[0030] During operation, the resection device of this embodiment can separate and seal a tissue core. The cutting tube 1300 can be retracted to expose the ligation snare 1230, which is preferably made of a flexible wire, such as a suture. The ligation snare 1230 can be engaged to anchor the tissue and pull it against the inner wall surface between the first ligation electrode 1215 and the second ligation electrode 1220. Bipolar energy is then applied to the first electrode 1215 and the second electrode 1220 to seal, i.e., cauterize, the tissue. Once sealed, the cutting tube 1300 can be further retracted to expose the cutting snare 1225, which can then be actuated to sever the tissue core upstream of the point where the tissue was sealed (the ligation point). In some embodiments, the cutting snare 1225 has a smaller diameter than the ligation snare 1230. The smaller diameter facilitates slicing of tissue. Thus, the resection device 1100 according to this embodiment both forms a tissue core and disengages the core from the surrounding tissue.

[0031] In an alternative embodiment, the resection device of the present invention is provided with a single snare disposed between ligating electrodes that both ligates and cuts tissue. In this embodiment, the single snare first pulls the tissue against the interior wall surface of the central tube 1200 between the ligating electrodes 1215 and 1220. Bipolar energy is then applied to the first electrode 1215 and the second electrode 1220 to seal, i.e., cauterize, the tissue. Once sealed, the snare is further pulled to sever the tissue core.

[0032] In yet another embodiment, cutting and sealing can be performed without the use of electrodes. In this embodiment, the ligation snare 1230 includes a pair of knots 1235 and 1240 that tighten under load, for example, as shown in FIG. 4. Ligation is performed by retracting the cutting tube 1300 to expose the ligation snare 1210 and activating the ligation snare 1230, which lassoes the tissue as the ligation knot tightens. Once the tissue is lassoed, the cutting tube 1300 can be further retracted to expose the cutting snare 1225, which can then be activated to sever the tissue core at the point where the tissue was lassoed.

[0033] The present invention also contemplates a method and system for removing a tissue lesion, e.g., a lung lesion, using an ablation device. The method generally includes immobilizing a targeted lesion for removal, forming a channel in the tissue leading to the target lesion, forming a tissue core containing the immobilized lesion, ligating the tissue core and sealing the surrounding tissue, and removing the tissue core containing the target lesion from the channel.

[0034] Anchoring can be achieved by any suitable structure for securing a device to the lung. Once the lesion is secured, a channel can be formed to facilitate insertion of the ablation device 1100. The channel can be formed by making an incision in the lung region and inserting a tissue expander and port into the incision. A tissue core containing the secured lesion can be formed. In accordance with the present invention, the ablation device 1100 can be inserted into the channel and used to create a tissue core, ligate the tissue core, seal the tissue core, and sever the tissue core from the surrounding tissue as described hereinabove. The tissue core can then be removed from the channel. In accordance with the present invention, a hollow port can be inserted into the channel to facilitate subsequent treatment of the target lesion site through energy-based tumor exposure, such as chemotherapy and / or radiation.

[0035] The anchor illustrated in FIG. 5 is suitable for use in performing the method for removing tissue lesions described herein. The anchor comprises an outer tube 1422 having edges sharp enough to pierce chest cavity tissue and lungs without causing excessive trauma, and an inner tube 1424 disposed within the outer tube 1422. One or more preformed tines or fingers 1426 formed from a shape-memory material, such as nitinol, are attached to the end of the inner tube 1424. The outer tube 1422 is retractably disposed over the inner tube 1424 such that when the outer tube 1422 is retracted, the tines 1426 assume their preformed shape as shown. In accordance with the present invention, the outer tube 1422 retracts after piercing the lung lesion, thereby causing the tines 1426 to engage the lung lesion. Other suitable anchors may include coil and suction-based structures.

[0036] The dissecting blade illustrated in Figure 6 is suitable for use in performing the methods for removing tissue lesions described herein. Once the anchor 1400 is set, it is preferable to make a small incision or cut to facilitate insertion of a chest wall tissue expander. Dissecting blade 1605 is used to create a wider incision. Successive dissecting blades 1605 include a central opening that allows them to be advanced coaxially along the anchor needle 1405 to create wider incisions in the chest wall, with each successive blade being larger than the previous blade, thereby increasing the width of the incision.

[0037] The tissue expander illustrated in FIG. 7 is suitable for use in performing the methods for removing tissue lesions described herein. The tissue expander may comprise any suitable device for forming a channel in organic tissue. In one exemplary embodiment, the tissue expander assembly includes a single cylindrical rod with a rounded end 1510, or a cylindrical rod with a rounded end and a rigid sleeve configuration 1515. Successive tissue expanders are advanced coaxially along the anchor needle to form a tissue tract or channel in the chest wall, with each successive expander being larger than the previous expander, thereby increasing the diameter of the channel. Once the final expander with the rigid sleeve is deployed, the inner rod 1505 is removed, leaving the rigid sleeve in the intercostal space between the ribs, creating a direct passage to the lung pleura.

[0038] Any tissue ablation device capable of penetrating lung tissue and forming a tissue core containing a target lesion is suitable for use in performing the methods for removing tissue lesions described herein. Tissue ablation device 1100 described previously herein is preferred.

[0039] Upon removal of the tissue ablation device 1100, a small channel within the lung emerges where the targeted lesion was removed. This channel can be used to introduce energy-based ablation devices and / or local chemotherapy, depending on the results of the tissue diagnosis. Thus, the methods and systems of the present invention can be used to ensure not only that an effective biopsy is performed, but also to completely remove the lesion with minimal removal of healthy lung tissue.

[0040] While the embodiments shown and described herein are considered to be the most practical and preferred embodiments, it will be apparent to those skilled in the art that variations from the specific designs and methods shown and disclosed herein will themselves be obvious to those skilled in the art and may be used without departing from the spirit and scope of the present invention. For example, the systems, devices, and methods described herein for removing lesions from the lungs. Those skilled in the art will understand that the devices and methods described herein are not limited to the lungs, but can be used for tissue ablation and lesion removal in other areas of the body. The present invention is not limited to the specific configurations described and illustrated, but should be constructed consistently with all modifications that may fall within the scope of the appended claims.

[0041] Implementation 1. A tissue ablation device comprising: an outer tube having a helical coil disposed on a distal end thereof, the coil including a first electrode; a central tube having a distal edge profile including one or more surface segments, at least one of the surface segments including a second electrode, the central tube being slidably disposed within the outer tube and positioned such that the second electrode faces at least a portion of the first electrode; a cutting tube including a cutting edge slidably disposed within a central tube, the cutting tube configured to advance to at least one of the coil segments. 2. The tissue excision device of aspect 1, wherein the coil comprises first and second contiguous coil segments, the first coil segment comprising the first electrode. 3. The tissue excision device of aspect 2, wherein the first coil segment comprises a generally planar open ring. 4. The tissue excision device of aspect 2, wherein the first coil segment is helical and has a pitch of zero. 5. The tissue excision device of aspect 2, wherein the second coil segment is helical and has a constant pitch. 6. The tissue excision device of embodiment 5, wherein the second coil segment has a variable pitch. 7. The tissue excision device of aspect 2, wherein the first coil segment is helical and has a first pitch, the second coil segment is helical and has a second pitch, and at least one of the first and second pitches is variable. 8. The tissue excision device of aspect 1, wherein the second coil segment comprises a blunt tip. 9. The tissue ablation device of aspect 1, wherein the first and second electrodes have substantially matching surface profiles. 10. The tissue excision device of aspect 2, wherein the first coil segment has an inner diameter and an outer diameter, and the central tube includes an inner diameter and an outer diameter, the outer diameter of the central tube being larger than the inner diameter of the first coil segment, and the outer diameter of the first coil segment being larger than the inner diameter of the central tube. 11. The tissue excision device of aspect 2, wherein the first coil segment has an outer diameter and the central tube has an outer diameter approximately equal to the outer diameter of the first coil. 12. A tissue ablation mechanism comprising: an outer tube having a helical coil disposed on a distal end thereof, the coil including a first electrode; a central tube having a distal edge profile including one or more surface segments, at least one of the surface segments including a second electrode, the central tube being slidably disposed within the outer tube and the second electrode positioned opposite at least a portion of the first electrode; first and second ligating electrodes disposed within the central canal and exposed to the central canal lumen; a snare disposed within the central tube between the first ligating electrode and the second ligating electrode; a cutting tube including a cutting edge slidably disposed within the central tube, the cutting tube configured to advance to at least one of the coil segments. 13. The tissue excision mechanism of aspect 12, wherein the central tube includes an inner surface having a circumferentially grooved path, and the snare is disposed within the circumferentially grooved path. 14. The tissue excision mechanism of aspect 13, wherein the central tube includes an outer surface having a plurality of axially extending grooved paths, at least one of the axially extending grooved paths communicating with a circumferential grooved path, and the snare extends axially from the circumferential grooved path along one of the plurality of axially extending grooved paths. 15. A tissue ablation mechanism for collecting, compressing, and sealing a fluid conduit, comprising: an outer tube having a helical coil disposed on a distal end thereof, the coil including a first electrode; a central tube having a distal edge profile including one or more surface segments, at least one of the surface segments including a second electrode, the central tube being slidably disposed within the outer tube and the second electrode positioned opposite at least a portion of the first electrode; first and second ligating electrodes disposed within the central canal and exposed to the central canal lumen; a cutting snare disposed within the central tube; a ligation snare disposed within the central canal; a cutting tube including a cutting edge slidably disposed within the central tube, the cutting tube configured to advance to at least one of the coil segments. 16. The tissue excision mechanism of aspect 15, wherein the ligating snare is disposed between the first ligating electrode and the second ligating electrode. 17. The tissue excision mechanism of aspect 15, wherein the ligation snare is a flexible wire having a first diameter. 18. The tissue resection mechanism of aspect 16, wherein the cutting snare is disposed proximal to the ligation snare. 19. The tissue excision mechanism of aspect 19, wherein the cutting snare comprises a flexible wire having a second diameter smaller than the first diameter. 20. The tissue resection mechanism of aspect 15, wherein the central tube includes an inner surface having first and second circumferential grooved pathways, the ligating snare being disposed within the first circumferential grooved pathway and the cutting snare being disposed within the second circumferential grooved pathway.

Claims

1. 1. An apparatus comprising: a coil having planar segments; a first electrode disposed on a surface of the planar segment of the coil; a second electrode disposed on a distal surface of the central tube, positioned proximal to the first electrode, facing at least a portion of the first electrode and configured to define a clamping region between the first electrode and the second electrode, the first electrode and the second electrode configured to apply energy to seal at least a portion of a vessel in tissue disposed within the clamping region; a cutting tube including a distal cutting edge slidably disposed within the central tube, the cutting tube configured to advance to cut at least a portion of the tissue disposed within the clamping region.

2. The apparatus of claim 1 , wherein the coil comprises contiguous first and second coil segments, the first coil segment comprising the planar segment.

3. The apparatus of claim 2 , wherein the first coil segment comprises a planar open loop and the second coil segment comprises a helical coil segment.

4. The apparatus of claim 1 , wherein the first electrode and the second electrode have substantially matching surface profiles.

5. 2. The device of claim 1, wherein the vessel is a blood vessel and the coil has a blunt tip configured to penetrate tissue distal to the coil without penetrating a blood vessel within the tissue distal to the coil.

6. 6. The device of claim 5, wherein the distal surface of the central tube is configured to advance through the clamping region toward the planar segment of the coil, whereby the first electrode and the second electrode clamp a portion of the tissue disposed within the clamping region therebetween.

7. A device further comprising an outer tube having the coil disposed at a distal end thereof, 6. The device of claim 5, wherein the central tube is configured to be movable relative to the outer tube such that the distal surface of the central tube advances toward the planar segment of the coil, thereby causing the first electrode and the second electrode to clamp a portion of the tissue disposed within the clamping region therebetween.

8. 8. The apparatus of claim 7, wherein the central tube is disposed within the outer tube and the cutting tube is disposed within the central tube.

9. the coil is configured to be advanced through tissue toward a target lesion, thereby disposing the portion of tissue within the clamping region; when the portion of tissue is positioned within the clamping region, the first electrode and the second electrode are configured to clamp and seal a vessel within the portion of tissue positioned within the clamping region; 8. The device of claim 7, wherein the cutting tube is configured to cut the portion of tissue disposed within the clamping region once the vessel within the portion of tissue within the clamping region is sealed.

10. 10. The device of claim 9, wherein the device is configured to repeat the sealing and the cutting until a core of tissue is formed within the interior volume of the central tube, the core of tissue comprising the target lesion.

11. 8. The device of claim 7, further comprising a snare element disposed in a groove in an interior wall near the distal end of the central tube, the snare element including a wire configured to pull a portion of tissue disposed within the interior volume of the central tube, the wire further configured to sever the portion of tissue disposed within the interior volume of the central tube.

12. The device described in claim 11, further comprising one or more ligating electrodes configured to seal the portion of tissue disposed within the internal volume of the central canal before the wires sever the portion of tissue.

13. The device of claim 12 , wherein the snare element severs the portion of tissue disposed within the interior volume of the central tube at a location upstream of where the portion of tissue was sealed.

14. 12. The device of claim 11, wherein the tissue is lung tissue, and the device is configured such that after the snare element severs the portion of tissue, the device is removed, thereby removing the portion of tissue disposed within the interior volume of the central tube from the lung.

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