Apparatus and methods for electrosurgical ablation and resection of target tissue
An electrosurgical system and method for ablating, resecting, or cutting body structures, with minimal or no damage to tissue adjacent to the treatment site. The system includes an electrosurgical probe having a shaft with a shaft distal end bifurcated to provide first and second arms. First and second electrode supports are disposed on the first and second arms, respectively. At least one active electrode, in the form of a loop or partial loop, is arranged between the first and second electrode supports. A return electrode, also in the form of a loop or partial loop, is arranged between the first and second electrode supports distal to the active electrode. The active and return electrodes are configured to promote substantially high electric field intensities and associated high current densities between the active portion and the target site when a high frequency voltage is applied to the electrodes. These high current densities are sufficient to break down the tissue by processes including molecular dissociation of tissue components. In one embodiment, the high frequency voltage imparts energy to the target site to effect the vaporization and volumetric removal of a layer of tissue without causing substantial tissue damage beyond the layer of tissue ablated. In another embodiment, a fragment of target tissue is removed, with minimal or no damage to surrounding tissue, by a process including the molecular dissociation of tissue components, and the tissue fragment is retrieved for biopsy.
1. An electrosurgical probe for treating a target tissue of a patient, comprising:
a probe proximal end and a probe distal end; an elongate body including a first shaft, the first shaft located at the probe distal end, and the first shaft bifurcated to provide a first arm and a second arm;
a first electrically insulating electrode support disposed on the first arm distal end, and a second electrically insulating electrode support disposed on the second arm distal end;
an active electrode disposed between the first and second electrode supports wherein the active electrode is configured to promote high electric field intensities at a surface of the active electrode when a high frequency voltage is applied to the active electrode; and
a wire return electrode disposed between the first and second electrode supports at a location distal to the active electrode wherein the return electrode has a larger effective surface area than said active electrode and is configured to promote low electric field intensities at a surface of the return electrode, said low electric field intensities less than said high electric field intensities and wherein a ratio of said effective surface area of the return electrode to that of the active electrode is in the range of 1.1 to 4.
2. The probe of claim 1 , wherein the first and second electrode supports are disposed axially on the first and second arms, respectively.
3. The probe of claim 1 , wherein the active electrode comprises an active electrode filament and active electrode first and second ends, the active electrode first and second ends coupled to the first and second electrode supports, respectively.
4. The probe of claim 3 , wherein the active electrode filament is arcuate.
5. The probe of claim 1 , wherein the return electrode comprises a return electrode filament and return electrode first and second ends, the return electrode first and second ends coupled to the first and second electrode supports, respectively.
6. The probe of claim 1 , wherein the active electrode and the return electrode are separated by an electrode gap in the range of from about 0.010 to about 0.100 inches, and the electrode gap is substantially the same over the entire distance between the first and second electrode supports.
7. The probe of claim 1 , wherein each of the first and second electrode supports includes a curved portion, the active electrode and the return electrode emanating from the curved portion.
8. The probe of claim 7 , wherein each of the curved portions includes a proximal curved portion and a distal curved portion, the active electrode emanating from the proximal curved portion, and the return electrode emanating from the distal curved portion, and wherein the proximal curved portion is longer than the distal curved portion.
9. The probe of claim 8 , wherein the return electrode includes a return electrode filament and the active electrode includes an active electrode filament, and the return electrode filament is longer than the active electrode filament.
10. The probe of claim 3 , wherein the active electrode first and second ends lie in a first plane, and the return electrode first and second ends lie in a second plane, and the first and second planes are substantially parallel to each other.
11. The probe of claim 1 , wherein the active electrode and the return electrode are arranged at an angle in the range of from about 45° to 85° with respect to the longitudinal axis of the probe.
12. The probe of claim 1 , wherein the active electrode and the return electrode are separated by an electrode gap in the range of from about 0.010 to about 0.100 inches.
13. The probe of claim 1 , wherein the active electrode and the return electrode are separated by an electrode gap, and the electrode gap is substantially the same over the entire distance between the first and second electrode supports.
14. The probe of claim 1 , wherein the first shaft includes a first bend and a second bend.
15. The probe of claim 1 , wherein each of the first arm and the second arm includes a first bend and a second bend.
16. The probe of claim 14 , wherein the first bend is at a first angle and the second bend is at a second angle, and the first and second angles are substantially the same.
17. The probe of claim 16 , wherein the first angle is in the range of from about 10° to 30°.
18. The probe of claim 14 , wherein the first bend is distal to a point of bifurcation of the first shaft, and the second bend is distal to the first bend.
19. The probe of claim 1 , further comprising an attachment unit for removably affixing the probe to a surgical instrument, the attachment unit disposed on the elongate body.
20. The probe of claim 19 , wherein the surgical instrument is an endoscope.
21. The probe of claim 20 , wherein the endoscope is a resectoscope.
22. The probe of claim 1 , wherein each of the active electrode and the return electrode includes a filament, each filament comprising a metal wire.
23. The probe of claim 1 , wherein the active electrode comprises a wire having a substantially rectangular cross-section, and having a width in the range of from about 0.005 to about 0.050 inches.
24. The probe of claim 1 , wherein the active electrode comprises a wire having a substantially rectangular cross-section, and the long axis of the rectangle lies substantially parallel to the longitudinal axis of the probe.
25. The probe of claim 1 , wherein the return electrode comprises a round wire having a diameter in the range of from about 0.005 to about 0.050 inches.
26. The probe of claim 1 , wherein the active electrode and the return electrode comprise a metal selected from the group consisting of: molybdenum, platinum, iridium, titanium, tantalum, tungsten, stainless steel, nickel, and their alloys.
27. The probe of claim 26 , wherein the metal comprises an alloy selected from the group consisting of: platinum/tungsten, platinum/iridium, and platinum/molybdenum.
28. The probe of claim 1 , wherein the active electrode is coated with a material selected from the group consisting of chromium and titanium nitride.
29. The probe of claim 1 , wherein the active electrode comprises a rectangular wire having a width in the range of from about 0.010 to 0.020 inches, and the return electrode comprises a round wire having a diameter in the range of from about 0.015 to 0.030 inches.
30. The probe of claim 1 , wherein the active electrode is adapted for ablating the target tissue via a cool ablation process involving molecular dissociation of the target tissue components.
31. The probe of claim 1 , wherein the probe is adapted for removing a fragment of the target tissue for biopsy, wherein the fragment is removed via a cool ablation process involving molecular dissociation of the target tissue components.
32. The probe of claim 1 , wherein the first and second electrode supports each comprise an electrically insulating material selected from the group consisting of: a silicone rubber, a ceramic, and a glass.
33. An electrosurgical probe for treating a target tissue of a patient, comprising:
a probe proximal end and a probe distal end;
an elongate body including a first shaft, the first shaft located at the probe distal end, and the first shaft bifurcated to provide a first arm and a second arm;
a first electrically insulating electrode support disposed on the first arm distal end, and a second electrically insulating electrode support disposed on the second arm distal end wherein each of the first and second electrode supports comprises a curved portion wherein each of the curved portions comprises a proximal curved portion and a distal curved portion;
an active electrode disposed between the first and second electrode supports;
a return electrode disposed between the first and second electrode supports at a location distal to the active electrode; and
the active electrode emanating from the proximal curved portion, and the return electrode emanating from the distal curved portion, and wherein the proximal curved portion is longer than the distal curved portion.
34. The probe of claim 33 , wherein the return electrode comprises a return electrode filament and the active electrode comprises an active electrode filament, and the return electrode filament is longer than the active electrode filament.