Electrosurgical pharyngeal wand

Abstract

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

Description

[Technical Field]

[0001] (Cross-reference of related applications) This application claims and co-owns the interests of U.S. Provisional Patent Application No. 63 / 345064, titled “Electrosurgical Laryngeal Wand,” filed on 24 May 2022, and is incorporated herein by reference in its entirety. This application also claims and co-owns the interests of U.S. Provisional Patent Application No. 63 / 344798, titled “Electrosurgical Laryngeal Wand,” filed on 23 May 2022, and is incorporated herein by reference in its entirety.

[0002] This application relates, in general, to methods and apparatus for accessing and processing tissue. More specifically, apparatus and related methods for electrosurgically treating a wide range of pathological conditions affecting the anatomical structures of the pharynx and / or airways are disclosed. [Background technology]

[0003] Accessing and treating areas along the patient's airway around the pharynx presents a unique set of challenges. For example, the airway is narrow, limiting the size of the device. The airway is relatively long, requiring a device of considerable length. Visibility at the ends of the device may also be limited. Some tissues along the airway are sensitive to energy-based treatment, and consequently, careless treatment, or simply contact with a hot surface, can lead to significant complications. For example, polyps may need to be removed from the vocal cords, which are particularly sensitive to heat. Tissues or pathologies along the airway are generally small, and therefore, overtreatment, including the application of excessive energy, can generally be a risk. Some procedures require a combination of microincisions and some larger debulking, and often multiple devices are required for a single procedure. The device may also be provided with suction to remove fluid and treated tissue from the treatment site and to improve overall visibility, but the suction pathway is prone to obstruction due to the overall size limitations of the device.

[0004] Therefore, there is a need for a single device to address the aforementioned shortcomings. There is a need for a single device to provide targeted tissue removal in narrow anatomical structures through electrosurgical processing of tissue. There is a need for a single device to provide access to narrow anatomical structures while improving visualization of the surgical field. There is a need for a single device to limit accidental tissue damage. There is a need for a device to access multiple pathologies along the airway, which may also provide multiple tissue processing modes, such as microincision and debulking. [Overview of the project]

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

[0006] The electrode may include a planar processing surface configured to debulk tissue along the pharynx via ablation. The electrode may also include a marginal surface and / or a distally projecting tip configured to incise tissue along the pharynx via ablation. The wand can deliver a conductive fluid to a target site from which tissue, fluid, and plasma byproducts can be aspirated. The wand may be a handheld wand, thereby being used directly by a clinician or configured to be controlled via a robot-controlled surgical setup. The wand may include improvements to the aspirator opening and aspirator path to significantly reduce the likelihood of wand clogging, as tends to occur with wands of related technology.

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

[0008] In some exemplary embodiments, the tip projection may have a maximum lateral width less than half the corresponding maximum lateral width of the annular portion. The active electrode may define an outermost periphery surface including two recessed edge surfaces that are co-extended with each other in the transition from the annular portion to the tip projection, and the two recessed edge surfaces may be co-extended with the most distal end face of the insulating spacer.

[0009] In some exemplary embodiments, the suction opening may extend from the planar upper surface of the active electrode to the lower surface of the active electrode at an angle of inclination with respect to the planar upper surface. This angle of inclination can deflect the aspirated tissue debris proximal to a suction conduit extending along the tubular end effector. This angle of inclination may be oriented such that the edge boundary of the suction opening coinciding with the lower surface is axially offset from the corresponding edge boundary of the suction opening coinciding with the upper surface. The lower surface edge boundary may be offset proximal to the corresponding edge boundary of the suction opening on the upper planar surface. This edge boundary coinciding with the lower surface provides an edge surface for further digesting the aspirated tissue flowing through the suction opening. This edge boundary on the lower surface may also include at least a notch that is discharged along the suction opening, the notch providing a supplementary edge surface for further digesting the aspirated tissue flowing through the suction opening.

[0010] In some exemplary embodiments, the suction opening cross section may include a proximal apex having a first radius of curvature and a distal curved end having a radius of curvature at least twice that of the first radius of curvature. These differences in radii may provide an opening large enough to aspirate tissue but with sufficient local limitations to manage tissue debris and blockage. The first radius of curvature may preferably reduce the plasma remote zone extending through the suction opening, and the second radius of curvature may preferably provide an expanded surface area for further digestion of tissue flowing through the suction opening.

[0011] In some exemplary embodiments, the return electrode may include side arms that may extend around the most distal end face of the insulating spacer, defining a distally facing surface of the return electrode having the same extent as the tip projection of the active electrode. These side arms may assist in plasma initiation at the tip projection.

[0012] Another embodiment of a bipolar electrosurgical wand disclosed herein may include a tubular end effector having a handle at its proximal end, and a return electrode, an insulating spacer, and an active electrode at its distal end. The insulating spacer may support and electrically insulate the active electrode. The active electrode may include an annular portion having a tip projection extending distally from the annular portion, both of which share a continuous upper planar surface. The annular portion may define a suction opening, forming a 360-degree bounded opening extending from the upper planar surface to the lower surface of the active electrode. This suction opening defines a central axis extending at an angle of inclination with respect to the upper planar surface. This suction opening inclination angle defines a surface and marginal surface that assists in further digesting any tissue debris flowing through the suction opening and deflects the tissue debris toward a suction conduit extending proximal along the tubular end effector.

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

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

[0015] An example of a method for electrosurgically treating tissue along a patient's airway is also disclosed. This method involves positioning an electrosurgical wand in a first orientation such that the planar upper surface of the active electrode engages with a first target tissue along the patient's airway, the active electrode having a suction opening extending from the planar upper surface to the lower surface of the active electrode. The suction opening may define a central axis oriented at a non-perpendicular angle to the planar upper surface such that the peripheral boundary of the suction opening, coinciding with the lower surface, is axially offset from the corresponding peripheral boundary of the planar upper surface. While the wand is in the first orientation, electrical energy can be delivered to the active electrode and return electrode of the electrosurgical wand in sufficient quantity to form a local plasma close to the planar surface of the active electrode in response to this energy. This local plasma can debulk the first target tissue to molecularly dissociate a portion of the first target tissue and form tissue debris. This tissue debris may be aspirated through a suction opening, and as the tissue debris flows through the suction opening, it may be further molecularly dissociated in response to the delivered energy via a local plasma formed at the peripheral boundary coinciding with the lower surface.

[0016] In some exemplary methods, the wand may be moved to a second orientation such that the protruding tip of the active electrode is directly adjacent to a second target tissue along the patient's airway, defining the most distal protrusion of the active electrode, which extends parallel and continuously to the planar upper surface. While the electrosurgical wand is in this second orientation, electrical energy can be applied between the active electrode and the return electrode to form a local plasma adjacent to the protruding tip in response to the energy. The second target tissue can be micro-incised by incising with the local plasma. While electrical energy is applied between the active electrode and the return electrode to form a local plasma adjacent to the protruding tip in response to the energy, the conductive fluid can flow out from a fluid delivery opening proximal to the active electrode, around the distally facing portion of the return electrode which extends coordinating with the protruding tip, along the distal end of the outer surface of the wand. The distally facing portion and the protruding tip are close together, reducing the electrical bridging load to the conductive fluid and thereby reducing the time to initiate the local plasma adjacent to the protruding tip.

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

[0018] In some exemplary methods, the tissue debris flowing through the suction opening is deflected proximally toward a suction conduit positioned along the electrosurgical wand, the deflection having a distally inclined surface of the suction opening. This distal surface may extend parallel to the central axis.

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

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

[0021] An exemplary method for electrosurgically treating tissue along a patient's airway is also disclosed herein, the method comprising positioning an electrosurgical wand in a first orientation such that both a first active electrode treatment surface and a second active electrode treatment surface engage with a first target tissue along the patient's airway, the first and second active electrodes being arranged in an axially adjacent configuration. While in this first orientation and axially adjacent configuration, electrical energy is applied between the first and second active electrodes and the return electrode of the electrosurgical wand to form a local plasma adjacent to the first and second active electrode treatment surfaces in response to the energy, and the local plasma debulks a portion of the first target tissue. Next, the first active electrode treatment surface is axially adjusted to be distally separated from the second active electrode treatment, defining an axially offset configuration, and the electrosurgical wand is positioned in a different orientation such that the first active electrode treatment surface is adjacent to another target tissue along the patient's airway. While the wand is in a second orientation and axially offset configuration, electrical energy is applied between the first active electrode and the return electrode of the electrosurgical wand. In response to the energy, a local plasma is formed close to the surface treated by the first active electrode, and this local plasma micro-incises a portion of the other target tissue.

[0022] In some exemplary methods, the method may further include arranging the first and second active electrodes in an axially adjacent configuration, applying electrical energy between the first and second active electrodes and the return electrode of an electrosurgical wand, and coagulating a portion of the patient's airway tissue in response to the applied energy. In some methods, the second active electrode is resting or electrically inactive while microincision is being made. In the axially adjacent configuration, the outer edge of the first active electrode treatment surface may be completely bounded by the second active electrode treatment surface.

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

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

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

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

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

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

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

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

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

[0032] Where a range of values ​​is provided, it is understood that all intervening values ​​between the upper and lower limits of that range, and any other descriptions or intervening values ​​within that range, are encompassed within the invention. Furthermore, any optional feature of any variation of the invention described herein is intended to be described and claimed independently or in combination with any one or more of the features described herein.

[0033] This disclosure will be better understood by referring to the detailed description in conjunction with the following drawings. [Brief explanation of the drawing]

[0034] [Figure 1] Figure 1 shows the electrosurgical system according to this disclosure. [Figure 2] Figure 2 shows an exemplary embodiment of the electrosurgical wand according to this disclosure. [Figure 3A] Figure 3A shows a perspective view of the distal end of the electrosurgical wand according to this disclosure. [Figure 3B] Figure 3B shows a top view of the electrosurgical wand according to this disclosure, perpendicular to the active electrode plane. [Figure 3C] Figure 3C shows a side view thereof as disclosed herein. [Figure 3D] Figure 3D shows a lower perspective view thereof as provided in this disclosure. [Figure 3E] Figure 3E shows a partial cross-section of the distal end of an electrosurgical wand according to this disclosure. [Figure 4A] Figure 4A shows a top view of the active electrode of the electrosurgical wand shown in Figure 3A, according to this disclosure. [Figure 4B] Figure 4B shows a cross-section of the active electrode according to this disclosure. [Figure 5A] Figure 5A shows a perspective view of the distal end of the electrosurgical wand according to this disclosure. [Figure 5B] Figure 5B shows a side view thereof as disclosed herein. [Figure 6A]Figure 6A shows a perspective view of the distal end of the electrosurgical wand according to this disclosure. [Figure 6B] Figure 6B shows a top view thereof as disclosed herein. [Figure 7A] Figure 7A shows a side view of the distal end of the electrosurgical wand according to this disclosure. [Figure 7B] Figure 7B shows an end view of the distal end of the electrosurgical wand shown in Figure 7A, without the active electrode. [Figure 7C] Figure 7C shows an end view of the distal end of the electrosurgical wand shown in Figure 7A, according to this disclosure. [Figure 7D] Figure 7D shows the distal end of the electrosurgical wand shown in Figure 7A, in the debulking configuration according to this disclosure. [Figure 7E] Figure 7E shows the distal end of the electrosurgical wand shown in Figure 7A, in a second or micro-incision configuration according to the present disclosure. Figure 7C shows an end view of the distal end of the electrosurgical wand shown in Figure 7A according to the present disclosure. [Figure 8A] Figure 8A shows various views of the distal end of the electrosurgical wand according to this disclosure, and the electrosurgical wand is in a debulking configuration. [Figure 8B] Figure 8B shows various views of the distal end of the electrosurgical wand according to this disclosure, and the electrosurgical wand is in a debulking configuration. [Figure 8C] Figure 8C shows various views of the distal end of the electrosurgical wand shown in Figure 8A, as disclosed herein, where the electrosurgical wand is in an incision configuration. [Figure 8D] Figure 8D shows various views of the distal end of the electrosurgical wand shown in Figure 8B, as disclosed herein, where the electrosurgical wand is in an incision configuration. [Modes for carrying out the invention]

[0035] In the following description, similar components are denoted by the same reference numerals, regardless of whether they are shown in different examples. For the sake of clear and concise illustration, the drawings are not necessarily to scale, and certain features may be shown somewhat schematically. Features described and / or illustrated in one example may be used in the same or similar manner in one or more other examples, and / or in combination with or in place of features in other examples.

[0036] When used herein and in the claims, the terms “about” and “substantially” are used to describe and define the present invention, and to express the degree of inherent uncertainty that may arise from any quantitative comparison, value, measurement, or other expression. The terms “about” and “substantially” are also used herein to express the degree to which a quantitative expression may vary from the stated criteria without altering the fundamental function of the subject matter in question. “Includes,” “equipped with,” and / or, each in its plural form, are used in an unrestricted manner and may include the enumerated members as well as additional members not enumerated. “And / or,” used in an unrestricted manner, may include one or more of the enumerated members and combinations of the enumerated members. The use of “upper,” “lower,” “upward,” and similar terms is intended solely to aid in the clear description of this disclosure and is not intended to limit in any manner the structure, positioning, and / or operation of this disclosure.

[0037] The methods enumerated herein may be carried out in any reasonably possible order of the enumerated events, as well as in the order of the enumerated events. Furthermore, where a range of values ​​is provided, it is understood that all intervening values ​​between the upper and lower limits of that range, and any other descriptions or intervening values ​​within the range described herein, are encompassed within the invention. In addition, any optional feature of any variation of the invention described herein is intended to be described independently or in combination with any one or more features described herein and may be claimed.

[0038] All existing subject matter described herein (e.g., publications, patents, patent applications, and hardware) is incorporated herein by reference in its entirety, unless the subject matter may conflict with the subject matter of the present invention (in which case the subject matter present herein shall prevail). The referenced items are provided solely for disclosure prior to the filing date of this application. Nothing in this specification should be construed as admitting that the present invention has no prior rights to such materials by prior invention.

[0039] References to singular items include the possibility of multiple identical items existing. More specifically, as used herein and in the appended claims, the singular “a,” “an,” “said,” and “the” include multiple references unless the context otherwise explicitly indicates. Furthermore, it should be noted that claims may be drafted to exclude any optional element. Thus, this specification is intended to serve as a precedent for using such exclusive terms as “single,” “only,” etc., in relation to the enumeration of elements in the claims or the use of “negative” limitations. Finally, unless otherwise defined, all technical and scientific terms used herein should be understood to have the same meaning as commonly understood by those skilled in the art to which the invention pertains.

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

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

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

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

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

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

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

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

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

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

[0050] The openings 314 on both sides of the return electrode (only one is shown) may complement the fluid 50 delivered through opening 312 and increase the moistened surface area of ​​the exposed surface of the return electrode. Processing along the patient airway is generally considered a dry environment compared to a fluid-filled surrounding cavity, such as during arthroscopic surgery. Multiple spaced fluid delivery locations, such as through openings 312 and 314, provide an environment in which the conductive fluid 50 moistens a larger surface area of ​​the return electrode 310 and extends further around the active electrode. This provides an improved environment for uniform plasma formation.

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

[0052] The opening 316 may be bounded by the side arms 315a, 315b of the return electrode 310, each arm 315a, 315b may surround the most distal surface of the spacer 360. The opening 316 can be formed by obtaining a return electrode 310 having side arms 315a, 315b in a substantially linear or spaced-apart orientation configured to receive the spacer 360 between them. The spacer 360 can then be assembled and positioned between the side arms 315a, 315b around the most distal surface of the spacer 360, before the side arms 315a, 315b are plastically deformed toward each other. Thus, the return electrode 310 can be formed from a conductive material that is easily plastically formed, such as annealed stainless steel. Winding these arms 315a, 315b allows a portion of the return electrode 310 to be positioned to close the distal end (340) of the active electrode 330 while maintaining a small distal end wand profile. In other embodiments, the opening 316 may be provided as a pre-formed 360-degree bounded hole, and the spacer 360 may snap into place. However, to assemble in this manner, the inventors have found that the distal end profile of the wand 10 may need to be larger to enable this assembly, and is therefore less desirable.

[0053] Having a portion of the return electrode (arms 315a, 315b, etc.) wrapped around the most distal surface of the spacer, and having a distally projecting tip 340 (without electrical contacts) directly adjacent to the active electrode 330, can help initiate a rapid and uniform vapor layer, ultimately accelerating plasma initiation at the projecting tip 340. Having the return electrode 310 directly below the projecting tip 340 can directly provide an increase in energy density between the active electrode projecting tip 340 and the return electrode 310, which can help initiate more rapid plasma formation at the distal projecting tip 340. Having proximity between the projecting tip 340 and the return electrode 310 (more specifically, arms 315a, 315b) also reduces the burden on sufficient conductive fluid between the electrodes. This load stems from the need to deliver sufficient conductive fluid from the delivery openings 312 and 314 proximal to the entire active electrode 330 to the periphery of the distal-facing surface and near the tip 340, which can be unsatisfactory depending on various factors. For example, the fluid 50 may be drawn into the suction opening 380 through the active electrode 330 before reaching this distal surface, or it may flow out of the wand 10 depending on the orientation of the wand 10. Secondly, moving sufficient fluid from the delivery openings 312 and 314 proximal to the entire active electrode 330 to this distal-facing surface can be time-consuming, causing an unsatisfactory time delay between the activation of fluid delivery and energy and the fluid reaching the periphery of the distal-facing surface and near the tip 340. This fluid 50 is key to enabling plasma formation. Therefore, positioning the return electrode 310 directly below and near the active electrode tip 340 can alleviate the burden of supplying sufficient conductive fluid within a reasonable time to electrically bridge the two electrodes necessary to form a uniform or consistent plasma. This reduced burden helps to initiate the vapor layer immediately after energy and fluid delivery operation, ultimately providing plasma initiation in a reasonable time.

[0054] Furthermore, by wrapping the return electrode 310 around this distal end, the return electrode 310 can make direct contact with tissue closer to the target tissue. This creates a more concentrated and uniform electric field around the distal radius, so that when the distal surface of the wand contacts the tissue, some of the current has to travel a smaller distance through the tissue. This results in more tissue cutting by ablation and reduced resistance heating of the tissue. This provides microtissue dissection by molecular dissociation with reduced thermal diffusion. This is important for pharyngeal applications to limit unintended thermal damage to the surrounding delicate airway anatomical structures.

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

[0056] Figure 3B shows an upper surface view of the distal working end 120, perpendicular to the planar upper surface 331 of the active electrode. The planar upper surface 331 of the active electrode may be planar along its entire length (most commonly seen in Figure 3C). During use, this planar surface 331 may be positioned over the target tissue and may debulk the target tissue when electrosurgical energy is applied. The active electrode 330 includes a proximal annular portion 332, which includes a 360-degree bounded aspiration opening 380 passing through it. The annular portion 332 may extend axially with a spacer 360. The projection tip 340 extends distally from the annular portion 332. The projection tip 340 has an upper surface that forms part of the planar upper surface 331 of the active electrode. In other words, the projection tip 340 has an upper planar surface that is continuous with and coplanar with the planar upper surface of the annular portion. The protruding tip 340 extends axially beyond the most distal surface of the spacer and does not necessarily have to be supported by the spacer 360. The protruding tip 340 may have a length between 0.010 and 0.065 inches. The protruding tip 340 is generally configured to micro-incise target tissue through the formation of plasma along it, and by having the tip 340 protruding beyond the spacer 360, surfaces are provided on multiple sides (up to five sides) of the protruding tip 340 that can better access and process this target tissue.

[0057] The peripheral edge boundary 333 of the active electrode 330 may include bilateral depression curves 334a, 334b ​​that define the transition from the annular portion 332 and the protruding tip 340 (Figure 4A). The protruding tip 340 has a maximum lateral width W between 0.020 and 0.025 inches. T It may have a maximum lateral width W of the annular portion, on the other hand. a It may be between 0.070 and 0.090 inches. Maximum horizontal width W a W T The ratio to may be at least 2:1, and more preferably at least 3:1. This may provide an electrode planar surface 331 sufficient for debulking tissue and a narrow protruding tip 340 sufficient for micro-incision of target tissue. Maximum lateral width W TThe corresponding maximum opening size W of the suction opening 380 can be between 0.035 and 0.045 inches. e It may be less than.

[0058] The suction opening 380 is configured to aspirate plasma byproducts, partially digested tissue, and fluid passing through it, and is fluid-coupled to a fluid suction conduit of system 11. More specifically, the suction opening 380 may be in direct fluid communication with a suction cavity 366 in spacer 360, which is in direct fluid communication with a suction tube 390 extending along shaft 17. The suction opening 380 defines a complex opening extending from the upper planar surface 331 to the lower surface 336 of the active electrode 330, and the opening 380 includes several structural features that provide a sufficiently large opening for efficiently aspirating plasma byproducts and partially digested tissue through it, while reducing the possibility of blockage with partially digested tissue along the suction conduit. If the suction opening is too large, larger tails or strings of partially digested tissue may enter the wand 10 and clog the suction conduit. Furthermore, it has been found that if the suction opening is too large, it can form an unprocessed core in the center of the tissue. However, if the suction opening is too small, it can completely restrict suction, leaving plasma byproducts and partially digested tissue in the field. This complex opening is configured to provide a sufficient opening size for effective suction while managing aspirated plasma byproducts and partially digested tissue to avoid blockage.

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

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

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

[0062] Furthermore, the notches 388 are formed along the lower surface edge boundary 383 to further digest the partially digested tissue drawn into zone 386. Plasma is preferentially formed and may be stronger and may extend further away along the irregularities on the active electrode 330. Thus, the bilateral notches 388 are formed along the lower surface boundary 383 and the notches 388 are axially aligned with the two bilateral linear edges of the suction opening cross section, which extend in tandem with the wider portion of zone 386.

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

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

[0065] Figure 3E shows a side view of the distal end 120, with a portion removed to reveal the cross-sections of the active electrode 330, the spacer 360, the return electrode 310, and other components. Figure 3E shows a curved suction cavity 366 within the spacer 360, which forms part of the suction conduit. The suction cavity 366 is in fluid communication between the suction opening 380 and the suction tube 390. The curved suction conduit tends to be inductive to tissue that obstructs the conduit, and therefore the corner 368 may be rounded to increase the flow around this inner corner of the curve, helping to prevent obstruction as debris moves around the corner.

[0066] Figures 5A–5B show the distal working end of another exemplary embodiment of the wand 10 according to the present disclosure. Figure 5A shows the distal end 520 of the electrosurgical wand 10, which has an active electrode 525 defining the most distal surface of the wand 10. The active electrode 525 defines a planar distal-facing surface including an annular portion 525a, which has a first leg 525b extending from a first side of the annular portion 525a and a second leg 525c extending from a second opposite side of the annular portion 525a. The first leg 525b may extend distally from the annular portion 525a to its most distal edge. The first leg 525b may terminate, spaced proximal to the most distal spacer. A second leg 525c may also wrap around the distal edge surface of the spacer 524 and extend proximal along the working distal end 520, providing finer tissue dissection in that region. The second leg 525c may wrap around the distal edge surface and extend radially away from the spacer surface to form projections such as triangular or toothed projections 525d, thereby improving the fine dissection of the target tissue. The toothed projections 525d may extend proximal along the distal end 520 of the wand. The active electrode 525 may generally be elliptical, having a length greater than its maximum width, with the maximum width perpendicular to the length. Similar to the embodiments described above, the return electrode 523 may be perforated with a plurality of fluid delivery ports 526 to provide conductive fluid, bridging the active electrode 523 and the return electrode 523 to generate plasma.

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

[0068] During use, the distally facing planar surface of the active electrode 525 can supply energy, configured to engage with the target tissue to debulk it, while simultaneously ablating the tissue and removing the ablated tissue through the suction opening 528. For finer incisions, the second leg 525c and projection 525d may preferably engage with the target tissue, separating the distally facing planar surface from the target tissue for incision.

[0069] Figures 6A and 6B show another exemplary embodiment of the distal working end of the wand 10, including an active electrode 630, a return electrode 640, and a spacer 660. The return electrode 640 may include a plurality of openings 642 that fluid-communicate with a fluid delivery conduit, the conduit fluid-communicate with a conductive fluid source 50, as disclosed herein. Furthermore, the spacer 660 may form bilateral rupture ducts (directing saline ports) 644 that fluid-communicate with the fluid delivery conduit and the source 50. The ducts 644 may direct fluid delivery across the outer surface of the spacer 660 toward the midline of the distal working end 620 of the wand. The rupture ducts 644 are shallow and may help to hold the conductive fluid 50 in contact with the spacer 660 for any orientation of the wand. During use, the wand 10 may be inverted to the target tissue, and the fluid 50 on the wand surface may tend to rapidly fall from the distal working end 620. Maintaining a wetted surface around the distal working end improves plasma generation and consistency. The duct 644 is configured to direct a small amount of conductive fluid 50 along the distal working end 620, maintaining contact and resisting separation from it regardless of the wand's orientation. Each duct 644 may define a tapered channel along the outer surface of the spacer 660, and the spacer 660 may be tapered in both depth and width as it extends distally. Each duct 644 may extend along a duct axis angled with respect to the longitudinal axis of the distal working end. The duct axes of the projection may intersect each other at the center of the distal working end at a point (P) that can be spaced proximal to the active electrode 630. The fluid delivery path may include flowing the fluid along the duct 644 in a general distal direction, where the fluid is combined (by the duct axis) toward the center of the upper surface of the spacer 660 and then directed to flow generally axially and distally toward the suction opening. The duct 644 may also be in fluid communication with a fluid delivery conduit that is also in fluid communication with the opening 642.

[0070] movable electrode Figures 7A–7E show alternative embodiments of the distal end 720 of an electrosurgical wand, which can be configured to electrosurgically process tissue along a patient's airway. The distal end 720 of the wand may be coupled to a controller 28 and may include a suction conduit that can be fluid-coupled to a tube 42 and a fluid delivery conduit that can be fluid-coupled to a tube 16 (Figure 1). The distal end 720 of the wand may include a bipolar arrangement of electrodes, including a return electrode 710, a composite active electrode 730 which may include a first active electrode portion 730a and a second active electrode portion 730b, and a spacer 740 between them. The first active electrode portion (730a) may be axially movable between the first and second configurations. In the first configuration, the combined wand may be configured to debulk tissue, and the first and second portions may define a single continuous processing surface which may be substantially on the same plane. In the second configuration, the first active electrode portion may be moved away from the rest of the composite electrode, and this first portion 730a may be used to micro-incise the target tissue.

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

[0072] The shaft 717 includes a multi-lumen extruder 750, as shown spaced apart from the rest of the wand 72 in Figure 7B for clarity. The multi-lumen extruder 750 may be formed of flexible PVC and / or silicone. Each lumen of the multi-lumen extruder 750 may provide different functions to the working distal end 720, such as at least one fluid and / or drug delivery conduit 751, at least one fluid suction conduit 752, at least one conductive wire conduit 753, conduit 756 for wire 706 and spine conduit 755, etc. Figure 7C illustrates the multi-lumen extruder 750 with an active electrode 730 assembled to it. The active electrode 730 may include a first active electrode 730a and a second active electrode 730b, the second active electrode 730b may be a fixed electrode having multiple openings through it. These may include a fluid delivery opening 731 that is in fluid communication with a fluid and / or drug delivery conduit 751. These may include a central opening 732 that is in fluid communication with a suction conduit 752. The second active electrode 730b may include an opening 733 for receiving the first active electrode 730a through it. The opening 733 may define a 360-degree bounded hole. The opening 733 may define an elongated or elliptical shape that slidably receives the first active electrode 730a through it, and this shape may be substantially identical to that of the bounded hole.

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

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

[0075] In the second configuration, the first active electrode 730a may be axially offset (along the longitudinal axis of the distal end 720 of the wand). In other words, for example, if the angular offset β of the distal end 720 from the longitudinal axis LL of the shaft is 30 degrees, the first active electrode 730a may also extend axially along the axis at approximately 30 degrees relative to the longitudinal axis LL. Here, the first active electrode 730a may provide a focusing electrode configured to micro-incise target tissue or adjacent tissue. The first active electrode 730a may define the end of a wand spine 705 extending along the wand shaft within one of the pre-formed lumens. Preferably, the first active electrode 730a is moved to an axially advanced position (second configuration), and then energy is supplied to the distal end of the wand while the first active electrode 730a remains stationary. Next, when the operator wishes to debulk the tissue, the first active electrode 730a is drawn into the first configuration by the operator, energy is supplied to the distal end of the wand, and the tissue is debulked, while the first active electrode 730a remains in the first configuration.

[0076] The first active electrode 730a may have a substantially smaller cross-section than the second active electrode 703b. The first active electrode 730a and the second active electrode 730b may be electrically insulated from each other so that only the first or second active electrode can be selectively coupled to the energy source. When the first active electrode 730a advances axially toward the second configuration, the second active electrode 730b may be in a dormant state, or in other words, unable to electrosurgically treat the tissue, for finer incisions. The spine 705 may be formed of a conductive material to provide an electrical connection to the first active electrode 730a, but may be coated or covered along its length to prevent electrical communication between the first active electrode 730a and the second active electrode 730b.

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

[0078] In alternative embodiments, these devices may be operablely coupled to and communicate with navigation means and a robot. Simple operation for various cutting patterns and easy control may enable different operation options. Manual operation may include multiple axes of motion (side by side, indicating bending / extension). In some other embodiments, the composite active electrode 730 may include a third active electrode (not shown) which may be similar to the first active electrode 730a in that it is axially positionable relative to the second active electrode 730b. Different material properties are encompassed, allowing bending force (or shape memory material) to be used for various needs. The handle may be operated using various actuation means, such as a trigger, a thumb pusher (for retracting or extending the microshaft), a button, or a combination of knobs.

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

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

[0081] The distal surface of the second active electrode 810 may be planar and include a bridge portion 810a and an annular portion 810b. The second active electrode 810 may be symmetrically arranged around a plane that bisects the distal end of the wand, the bisecting plane being parallel to the longest dimension of the distal end cross-section. The bridge portion 810a may extend from the annular portion 810b to the first active electrode 820. The annular portion 810b may be radially offset from the longitudinal axis of the wand. The annular portion 810b may be concentric with the spacer suction opening 825 and may define an inlet opening to the fluid suction conduit. The annular portion 810b may combine (810, 820) to define the widest cross-sectional portion of the entire active electrode for efficient fluid and tissue removal, maintaining a large inlet opening through it.

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

[0083] The tubular member (first active electrode 820) may be a rigid member and may have a limited axial length, which is either bendable toward the distal end of the wand or limited by an articulated joint. For example, the tubular member may be 30 mm long. Thus, the articulated joint may arise proximal to the entire tubular member. Compared to the first embodiment shown, this avoids overcoming the friction associated with the shaft, which slides along the entire length of the shaft. The tubular member (820) may be actuated by a small finger tab coupled to the proximal end of the tubular member near the distal end of the wand 800. In some embodiments, the tubular member may house a rod or wire that slides axially relative to the tubular member, which may allow for finer incisions of target tissue. In some embodiments, the tubular member may have a solid cross-section. In some embodiments, the tubular member may define a channel for housing wiring that is electrically in communication with the active electrodes (810, 820).

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

[0085] The wand 820 may be plastically deformed by the clinician to allow articular connection outside clinical space for reinsertion and access to site of interest / tissue, or the articular connection wire (2) described above may be retracted during intraoperative use to allow lateral movement (one wire at a time) or flexion (retracting both wires simultaneously).

[0086] Those skilled in the art will understand that this disclosure can be embodied in other specific forms without departing from its spirit or essential features. Therefore, the above examples should be considered in all respects as illustrative rather than limiting to the disclosure described herein. Thus, the scope of this disclosure is indicated not by the above description but by the appended claims, and therefore, all modifications within the meaning and equivalence of the claims are intended to be encompassed therein. [Additional note 1] It is a bipolar electrosurgical wand, The distal end of the tubular end effector includes an electrically insulating spacer, a return electrode, and an active electrode, wherein the insulating spacer supports and electrically insulates the active electrode. The active electrode defines an annular portion and a tip projection extending distally from the annular portion, the annular portion extending coexisting with the insulating spacer, the tip projection extending distally from the most distal surface of the insulating spacer, and both the tip projection and the annular portion sharing a continuous upper planar surface. A bipolar electrosurgical wand having a 360-degree bounded opening through which the annular portion defines a suction opening configured to remove at least one of tissue, tissue debris, or fluid passing through it. [Additional note 2] The bipolar electrosurgical wand according to Appendix 1, wherein the tip projection has a maximum lateral width such that the tip projection is less than half of the corresponding maximum lateral width of the annular portion. [Additional note 3] The bipolar electrosurgical wand according to Appendix 1, wherein the active electrode defines an outermost peripheral surface including both recessed edge surfaces that extend toward each other in the transition from the annular portion to the tip projection, and the both recessed edge surfaces extend toward the most distal end face of the insulating spacer. [Additional note 4] The bipolar electrosurgical wand according to Appendix 1, wherein the suction opening extends from the upper surface of the active electrode plane through the lower surface of the active electrode, defining an inner surface of the suction opening that extends at an inclined angle with respect to the upper surface of the plane, and the inner surface is configured to deflect the aspirated tissue debris proximally and into a suction conduit extending along the tubular end effector. [Additional note 5] The bipolar electrosurgical wand according to Appendix 4, wherein the inclination angle is oriented such that the edge boundary of the suction opening on the lower surface is axially offset proximal to the corresponding edge boundary of the suction opening that coincides with the upper planar surface. [Additional note 6] The bipolar electrosurgical wand according to Appendix 5, wherein the marginal boundary of the lower surface is configured to further digest the aspirated tissue and tissue debris that flow through the suction opening. [Additional note 7] The bipolar electrosurgical wand according to Appendix 6, further comprising at least a notch configured to further digest aspirated tissue and tissue debris flowing through the suction opening at the edge boundary of the lower surface. [Additional note 8] The bipolar electrosurgical wand according to Appendix 1, wherein the suction opening defines a cross-section having a proximal apex having a first radius of curvature and a distal curvature end having a radius of curvature at least twice that of the first radius of curvature. [Additional note 9] The bipolar electrosurgical wand according to Appendix 8, wherein the first radius of curvature is configured to reduce the plasma remote zone through the suction opening, and the second radius of curvature is configured to provide an expanded internal surface area for further digesting tissue and tissue debris flowing through the suction opening. [Additional Note 10] The bipolar electrosurgical wand according to Appendix 1, wherein the return electrode has side arms extending around the most distal end surface of the insulating spacer, defining a distal surface of the return electrode that extends in the same manner as the tip projection of the active electrode, and the side arms are configured to assist in plasma initiation at the tip projection. [Additional Note 11] It is a bipolar electrosurgical wand, A tubular end effector having a bipolar electrode arrangement supported in its distal portion, wherein the bipolar electrode arrangement comprises a first active electrode, a second active electrode, and a return electrode, the first active electrode having its most distal treated surface, and the second active electrode having its most distal surface, the tubular end effector comprises Each of the first active electrodes is configured to slide axially between the first and second components. A bipolar electrosurgical wand, wherein in the first configuration, the most distal processing surfaces of the first and second active electrodes define a single continuous tissue processing surface, are adjacent to each other in the axial direction, and are configured to electrosurgically process tissue in a first mode; and in the second configuration, the first active electrode is offset distally in the axial direction from the second active electrode, defines a discontinuous tissue processing surface, and is configured to electrosurgically process tissue in a second mode, different from the first mode. [Additional Note 12] The bipolar electrosurgical wand according to Appendix 11, wherein the most distal surface of the first active electrode is smaller than the most distal surface of the second active electrode. [Additional Note 13] The bipolar electrosurgical wand according to appendix 11, wherein the most distal surface of the second active electrode defines a surface area such that the surface area of ​​the most distal surface of the first active electrode is at least twice the corresponding surface area of ​​the first active electrode. [Additional Note 14] The bipolar electrosurgical wand described in Appendix 11, wherein the first mode is a debulking mode and the second mode is a micro-incision mode. [Additional Note 15] In the second mode, the bipolar electrosurgical wand as described in Appendix 14, wherein the second active electrode is in a resting state. [Additional Note 16] The bipolar electrosurgical wand according to Appendix 11, wherein the outer edge of the first active electrode is completely bounded by the second active electrode, in the first configuration. [Additional Note 17] The bipolar electrosurgical wand described in Appendix 11, wherein the first mode is a coagulation mode and the second mode is a cutting mode. [Additional Note 18] It is a bipolar electrosurgical wand, A tubular end effector having a handle at its proximal end and a return electrode, insulating spacer, and active electrode at its distal end, wherein the insulating spacer supports and electrically insulates the active electrode, The active electrode has an annular portion having a tip projection extending distally from the annular portion, and both the annular portion and the tip projection share a continuous upper planar surface. The aforementioned annular portion defines a 360-degree bounded pore passing through it, which defines the suction opening. A bipolar electrosurgical wand wherein the 360-degree bounded pore extends from the upper planar surface to the lower surface of the active electrode, defining a central axis that extends at an angle of inclination with respect to the upper planar surface, and the angle of inclination is configured to further digest any tissue debris flowing through the suction opening and deflect the tissue debris toward a suction conduit extending proximal along the tubular end effector. [Additional Note 19] The bipolar electrosurgical wand according to Appendix 18, wherein the inclination angle extends proximal to the upper planar surface of the active electrode. [Additional Note 20] The bipolar electrosurgical wand according to Appendix 18, wherein the 360-degree bounded opening defines a curved wedge cross-section, the most proximal apex having a first radius of curvature, and the most distal curved end having a radius of curvature at least twice the first radius of curvature. [Additional Note 21] The bipolar electrosurgical wand according to Appendix 18, wherein the tip projection has a maximum transverse width less than half the maximum transverse width of the annular portion. [Additional Note 22] The bipolar electrosurgical wand according to Appendix 18, wherein the tip projection defines a free end projection that extends beyond the insulating spacer. [Additional note 23] A method of electrosurgically treating tissue along the patient's airway, Positioning the electrosurgical wand in a first orientation such that the planar upper surface of the active electrode engages with a first target tissue along the patient's airway, wherein the active electrode has a suction opening extending from the planar upper surface to the lower surface of the active electrode, and the suction opening defines a central axis oriented at a non-perpendicular angle to the planar upper surface such that the peripheral edge boundary of the suction opening on the lower surface is axially offset from the corresponding peripheral edge boundary on the planar surface, and while the wand is in the first orientation, Applying electrical energy between the active electrode and the return electrode of the electrosurgical wand, In response to the aforementioned energy, a local plasma is formed adjacent to the active electrode plane, and the first target tissue is debulked by the local plasma, thereby molecularly dissociating a portion of the first target tissue. Through the aforementioned suction opening, tissue and plasma by-products related to the first target tissue are aspirated, A method comprising further molecularly dissociating the tissue and plasma byproducts related to the first target tissue via the local plasma adjacent to the peripheral edge boundary at the lower surface in response to the energy. [Additional note 24] Positioning the electrosurgical wand in a second orientation such that the protruding tip of the active electrode is directly adjacent to a second target tissue along the patient's airway, wherein the protruding tip defines the most distal protrusion of the active electrode, which extends parallel and continuously to the upper planar surface, and while the electrosurgical wand is in the second orientation, Applying electrical energy between the active electrode and the return electrode of the electrosurgical wand, The method according to Appendix 23, comprising forming a local plasma adjacent to the protruding tip in response to the energy, and ablating the second target tissue with the local plasma to perform micro-incision. [Additional note 25] The method according to Appendix 24, further comprising applying electrical energy between the active electrode and the return electrode, and in response to the energy, a local plasma being formed near the protruding tip, by delivering a conductive fluid from a fluid delivery opening spaced proximal to the active electrode, along the distal end of the wand, and around a distally facing portion of the return electrode that extends coordinating with the protruding tip, wherein the distally facing portion and the protruding tip are configured to reduce the electrical bridge load to the conductive fluid, thereby reducing the time to plasma initiation at the protruding tip. [Additional note 26] The method according to Appendix 24, wherein electrical energy is applied between the active electrode and the return electrode of the electrosurgical wand, while protecting adjacent tissue from inadvertent thermal effects, which is adjacent to the rear side of the distal end of the wand formed of a ceramic heat sink. [Additional note 27] The method according to Appendix 23, further comprising deflecting the tissue debris flowing proximal to the suction conduit positioned along the electrosurgical wand through the suction opening, wherein the deflection has a distal inner surface of the suction opening, and the distal inner surface extends parallel to the central axis. [Additional note 28] A method of electrosurgically treating tissue along the patient's airway, The first active electrode treated surface and the second active electrode treated surface engage with the first target tissue along the patient's airway, the first and second active electrodes are configured to be adjacent in the axial direction, and the wand is configured to be in the first orientation and adjacent in the axial direction, while the electrosurgical wand is positioned in the first orientation, Applying electrical energy between the first and second active electrodes and the return electrode of the electrosurgical wand, In response to the aforementioned energy, local plasmas are formed adjacent to the first and second active electrode treatment surfaces, and these local plasmas cause debulking, thereby molecularly dissociating a portion of the first target tissue. The first active electrode treatment surface is adjusted axially so as to be distally separated from the second active electrode treatment surface, thereby defining an axially offset configuration. The first active electrode treatment surface is adjacent to another target tissue along the patient's airway, and the wand is configured to be in the second orientation and axially offset configuration, thereby positioning the electrosurgical wand in a different orientation. Applying electrical energy between the first active electrode and the return electrode of the electrosurgical wand, A method comprising forming a local plasma adjacent to the first active electrode treatment surface in response to the energy, and using the local plasma to micro-dissect and molecularly dissociate a portion of the other target tissue. [Additional note 29] A method for electrosurgically treating tissue according to Appendix 28, further comprising positioning the first and second active electrodes in an axially adjacent configuration, applying electrical energy between the first and second active electrodes and the return electrode of the electrosurgical wand, and coagulating a portion of the tissue of the patient's airway in response to the energy. [Additional note 30] A method for electrosurgically treating the tissue described in Appendix 28, wherein the second active electrode is inactive while micro-incisions are being made. [Additional note 31] The method for electrosurgically treating tissue according to Appendix 28, wherein, in the axially adjacent configuration, the outer edge of the first active electrode treated surface is completely bounded by the second active electrode treated surface.

Claims

1. It is a bipolar electrosurgical wand, The distal end of the tubular end effector includes an electrically insulating spacer, a return electrode, and an active electrode, wherein the insulating spacer supports and electrically insulates the active electrode. The active electrode defines an annular portion and a tip projection extending distally from the annular portion, the annular portion having an upper planar surface, the insulating spacer having a planar surface on its upper part that is on the same surface as the upper planar surface of the annular portion and adjacent to the upper planar surface of the annular portion, the tip projection extending distally from the most distal surface of the insulating spacer, and both the tip projection and the annular portion sharing a continuous upper planar surface, A bipolar electrosurgical wand having a 360-degree bounded opening through which the annular portion defines a suction opening configured to remove at least one of tissue, tissue debris, or fluid passing through it.

2. The bipolar electrosurgical wand according to claim 1, wherein the tip projection has a maximum lateral width that is less than half of the corresponding maximum lateral width of the annular portion.

3. The bipolar electrosurgical wand according to claim 1, wherein the active electrode defines the outermost edge surface, and both sides of the outermost edge surface form concave edge surfaces.

4. The bipolar electrosurgical wand according to claim 1, wherein the suction opening extends from the upper planar surface of the active electrode through the lower surface of the active electrode, defines an inner surface of the suction opening that extends at an inclined angle with respect to the upper planar surface, and the inner surface is configured to deflect the aspirated tissue debris proximally and into a suction conduit extending along the tubular end effector.

5. The bipolar electrosurgical wand according to claim 4, wherein the inclination angle is oriented such that the edge boundary of the suction opening on the lower surface is axially offset proximal to the corresponding edge boundary of the suction opening that coincides with the upper planar surface.

6. The bipolar electrosurgical wand according to claim 5, wherein the marginal boundary of the lower surface is configured to further digest the aspirated tissue and tissue debris that flow through the aspirated opening.

7. The bipolar electrosurgical wand according to claim 6, further comprising at least a notch configured to further digest aspirated tissue and tissue debris flowing through the suction opening at the edge boundary of the lower surface.

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

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

10. The bipolar electrosurgical wand according to claim 1, wherein the return electrode has side arms extending around the most distal end surface of the insulating spacer, defining the distal surface of the return electrode, and the side arms are configured to assist in plasma initiation at the tip projection.

11. It is a bipolar electrosurgical wand, A tubular end effector having a handle at its proximal end and a return electrode, insulating spacer, and active electrode at its distal end, wherein the insulating spacer supports and electrically insulates the active electrode, The active electrode has an annular portion and a tip projection extending distally from the annular portion, the annular portion has an upper planar surface, the insulating spacer has a planar surface on its upper part that is on the same surface as the upper planar surface of the annular portion and adjacent to the upper planar surface of the annular portion, the tip projection extends distally from the most distal surface of the insulating spacer, and both the annular portion and the tip projection share a continuous upper planar surface. The aforementioned annular portion defines a 360-degree bounded hole passing through it, which defines the suction opening. A bipolar electrosurgical wand wherein the 360-degree bounded pore extends from the upper planar surface to the lower surface of the active electrode, defining a central axis that extends at an angle of inclination with respect to the upper planar surface, and the angle of inclination is configured to further digest any tissue debris flowing through the suction opening and deflect the tissue debris toward a suction conduit extending proximal along the tubular end effector.

12. The bipolar electrosurgical wand according to claim 11, wherein the inclination angle extends proximal to the upper planar surface of the active electrode.

13. The bipolar electrosurgical wand according to claim 11, wherein the 360-degree bounded hole defines a curved wedge cross-section, the most proximal apex having a first radius of curvature, and the most distal curved end having a radius of curvature at least twice the first radius of curvature.

14. The bipolar electrosurgical wand according to claim 11, wherein the tip projection has a maximum transverse width less than half of the maximum transverse width of the annular portion.

15. The bipolar electrosurgical wand according to claim 11, wherein the tip projection defines a free end projection that extends beyond the insulating spacer.

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