US20040193150A1 - Surgical instrument for ablation and aspiration - Google Patents

Abstract

An electrosurgical aspiration instrument that permits aspiration of an area being treated by the instrument. The instrument is coupled at a proximal end to a power source and includes an energy application surface area at a distal end. The power source supplied energy to the energy application surface area such that the distal end of the instrument may apply energy to the treatment area to modify the characteristics of biological material, such as biological tissue in the area. An aspiration lumen is formed through the instrument with an opening through the energy application surface area. The energy application surface area is configured to reduce blockage of the opening. Accordingly, aspiration may be performed simultaneously with electrosurgical treatment whereby unwanted matter such as by-products, biological debris and excess fluid is removed from the treatment area. The electrosurgical aspiration instrument also permits both functions to be performed at different times, with the advantage of not requiring instruments to be switched on during the treatment procedure or removed from the treatment site.

Description

BACKGROUND
• The present invention relates to electrosurgical instruments and systems for treating a surgical site on a human or animal body such as biological tissue by the application of energy. More particularly, the invention relates to surgical devices and methods for applying high frequency energy to modify the characteristics of the tissue such as by ablation in combination with aspiration of any by-products from a surgical site.[0001]
• Numerous surgical instruments for the treatment of biological tissue through the application of energy in a wide variety of medical procedures are known in the art. For example, U.S. Pat. No. 4,593,691 to Lindstrom et al., U.S. Pat. No. 4,033,351 to Hetzel, and U.S. Pat. No. 5,403,311 to Abele et al. are examples of electrosurgical probes for use during an electrosurgical procedure such as for cutting or ablating tissue. U.S. Pat. No. 5,458,596 to Lax et al. shows an example of an electrosurgical probe for the contraction of tissue by delivering electrical energy to the treatment tissue. Also, U.S. Pat. No. 3,828,780 to Morrison and U.S. Pat. No. 5,277,696 to Hagen show electrosurgical instruments which deliver electrical energy for coagulation during surgical procedures.[0002]
• The use of these instruments typically involves the transmission of energy to a distal end of the electrosurgical probe or instrument. The distal end is inserted into the body to a surgical site of a patient to apply energy during the procedure. The frequency, power, and voltage generated by the electrical instrument and transmitted to the distal end are selected depending on the type of procedure for which the instrument is being used. For instance, such instruments are used for a variety of procedures such as heating, softening, shrinking, cutting and ablating tissue.[0003]
• Because such instruments may be used for different procedures, the tissue (or other body part) being treated may respond differently depending on the treatment being performed. For instance, if the instrument is used to ablate the tissue, smoke and charring may be generated during the procedure or residual tissue debris may remain after treatment. Unwanted air bubbles or excess fluid may also be present in the treatment area that may interfere with effective treatment of the tissue and should be removed from the surgical site during the procedure. Thus, it is desirable to provide an electrosurgical device for aspirating the region being treated to remove smoke, tissue debris, excess fluid and other unwanted matter from the tissue site being treated.[0004]
• During the usage of prior instruments, however, such as in numerous of the above-mentioned instruments, the removal of unwanted matter generally requires the separate provision of an aspiration device. The use of two separate instruments increases the treatment time because the suction instrument must be separately inserted into the surgical site, used, and removed from the site before and/or after the electrosurgical treatment instrument is inserted or used at the site. Additionally, a separate suction instrument may be inserted into the surgical site through another access point which creates another portal in the patient's body which possibly creates further complications such as infection and scarring.[0005]
• U.S. Pat. No. 5,520,685 to Wojciechowicz, U.S. Pat. No. 4,682,596 to Bales and U.S. Pat. No. 4,347,842 to Beale disclose suction devices in various combinations and configurations with the electrosurgical probe. U.S. Pat. No. 5,195,959 to Smith also discloses an electrosurgical device with suction and irrigation to supply electrically conductive fluid which adds even more material to the surgical site and would need to be removed during the procedure. Wojciechowicz, in particular discloses a suction coagulator with a suction lumen for the suction of by-products of electrosurgery through the instrument through a tip. Further, Hagen discloses a suction device for aspirating fluid through the surgical probe.[0006]
• However, the arrangement of the suction lumen in relationship to the electrosurgical portion is such that blockage or clogging of the suction lumen can occur which could complicate the surgical procedure and unwanted or unnecessary ablation could occur. Charred and ablated tissue and coagulated blood often clog the tips of electrosurgical devices.[0007]
• Therefore, it would be desirable to provide an instrument that may be used not only to treat a patient but also to aspirate the treatment area during treatment to simultaneously remove unwanted material. The surgical device and method should be simple and operate in a standard surgical environment. The electrosurgical instrument should provide the surgeon the ability to ablate, cut or coagulate in the same device while providing a suction means to aspirate surgical by-products from the surgical site. The suction and aspiration should be anti-clogging such that the device does not cause unwanted nor undesirable effects due to blockage. Such instrument and method should be able to precisely treat biological tissue with energy while efficiently allowing the surgeon to perform the medical procedure quickly without the need to utilize multiple instruments for the treatment.[0008]
SUMMARY
• It is, therefore, an object of the present invention to provide a surgical instrument and method for the application of energy to a treatment area of a patient and for the aspiration of unwanted matter, such as smoke, air bubbles and biological waste debris from the surgical site.[0009]
• It is a related object of the present invention to provide a combination of electrosurgical and aspiration instrument that provides an energy application surface area that applies energy uniformly over the treatment area and also permits aspiration therethrough so as to limit clogging.[0010]
• It is another object of the present invention to provide a combination electrosurgical and aspiration instrument having both an active electrode and a return electrode at a distal tip of the instrument such that energy distribution is substantially limited to the distal tip surface.[0011]
• These and other objects and features are accomplished in accordance with the principles of the present invention by providing a probe having a cannula with at least one electrode for the transmission and application of energy to a treatment site along an energy application surface as well as a suction lumen through which unwanted matter and surgical by-products may be aspirated from the treatment area. Preferably, at least one electrode, an active electrode is provided on a distal end of the probe. A return or indifferent electrode may located on the patients' body or on the probe. The instrument is coupled to an energy generator that preferable includes controls that may be used to regulate the power, frequency, and voltage applied to the instrument to vary the type of treatment for which the instrument is used. The regulation may include feedback controls.[0012]
• In one embodiment of the invention, the active electrode is provided with a plurality of small passages therethrough in a fluid communication with the suction lumen of the instrument. An active electrode with such aspiration passages may be in the form of a mesh, a disc having perforations therethrough, or plural conductors supported by an insulator with apertures therethrough. Thus, aspiration of the treatment area occurs through at least a portion of the energy application surface. If desired, both the active and return electrodes may be positioned in substantially the same plane such that energy distribution is substantially restricted to a substantially planar surface area, such as the surface area of the distal tip.[0013]
• In an alternative embodiment of the present invention, the surgical instrument has a shaft having distal and proximal ends. The shaft also defines at least one lumen. The lumen has at least one aspiration opening at the distal end. An active electrode is located at the distal end of the shaft which defines an energy application surface. The active electrode is electrically coupled to a power source. A return electrode is coupled to the power supply such that a current path from the active electrode to the return electrode passes over the aspiration opening to prevent clogging of the opening. The return electrode may be located on a portion of the body of a patient or on the shaft.[0014]
• As negative pressure is applied to the lumen, matter that is in the surgical site is aspirated through the aspiration opening. The opening is configured to prevent clogging of the aspirated matter at the distal end. The aspiration opening may be defined by the active electrode which is configured to prevent clogging of the aspiration opening and allow continued desiccation of the unwanted aspirated matter such that the matter will move easily through the aspiration lumen.[0015]
• These and other features and advantages of the present invention will be readily apparent from the following drawings and detailed description of the invention, the scope of the invention being set out in the appended claims.[0016]
BRIEF DESCRIPTION OF THE DRAWINGS
• The detailed description will be better understood in conjunction with the accompanying drawing, wherein like reference characters represent like elements, as follows:[0017]
• FIG. 1 is a perspective view of an electrosurgical aspiration instrument formed in accordance with the principles of the present invention;[0018]
• FIG. 2 is a cross-sectional view along axis A-A of FIG. 1;[0019]
• FIG. 3 is an end view of a distal tip of the instrument of FIG. 1;[0020]
• FIG. 4 is an end view of a distal tip of the instrument of FIG. 1 showing an alternative tip embodiment;[0021]
• FIG. 5 is a perspective view of an electrosurgical aspiration instrument according to the present invention with a distal tip active electrode having a convex configuration;[0022]
• FIG. 6 is a perspective view of an electrosurgical aspiration instrument according to the present invention with a distal tip active electrode having a concave configuration;[0023]
• FIG. 7 is a cross-sectional view of a basic distal tip portion of the instrument of FIGS. 5 and 6.[0024]
• FIGS. 8A and 8B are cross-sectional and end views, respectively, of an electrosurgical aspiration instrument showing one embodiment of an active electrode in a coil configuration with an internal return electrode;[0025]
• FIGS. 9A and 9B are cross-sectional and end views, respectively, of an electrosurgical aspiration instrument according to the present invention showing an active electrode in a ring configuration with an internal return electrode;[0026]
• FIGS. 10A and 10B are cross-sectional and end views, respectively, of an electrosurgical aspiration instrument according to the present invention showing one embodiment of an active electrode in a prong configuration with an internal return electrode;[0027]
• FIGS.[0028]11A-C are cross-sectional and perspective views, respectively, of an electrosurgical aspiration instrument according to present invention having a mechanical grating configuration of the active electrode with an external return electrode; FIG. 11A is a ring grating configuration; FIG. 11B is a rasp grating configuration;
• FIGS. 12A and 12B are cross-sectional and perspective views, respectively, of an electrosurgical aspiration instrument with an alternative embodiment showing an active electrode having a cross configuration for mechanical grating and delivery of energy;[0029]
• FIGS. 13A and 13B are cross-sectional and perspective views, respectively, of an alternate aspiration instrument of FIGS. 12A and 12B with an active electrode having an ashtray configuration for mechanical grating and energy delivery with an internal return electrode;[0030]
• FIGS. 14A and 14B are cross-sectional and perspective views, respectively, of the instrument of FIGS. 13A and 13B showing an external return electrode;[0031]
• FIGS.[0032]15A-C are detailed perspective, end, and cross-sectional views of the distal tip of an electrosurgical aspiration instrument according one embodiment of the present invention; FIG. 15A is a detailed perspective view of an active electrode with an aspiration opening; FIG. 15B is an end view of the active electrode; and FIG. 15C is a cross-sectional view along line A-A of the active electrode of FIG. 15B;
• FIGS. 16A and 16B are cross-sectional and perspective views of an alternative embodiment of the instrument present invention wherein the distal tip is a true bipolar configuration having a single aspiration opening;[0033]
• FIGS. 17A and 17B are perspective and cross-sectional views of an alternate embodiment of the instrument according to the present invention showing a true bipolar configuration of the distal tip having multiple aspiration openings;[0034]
• FIGS.[0035]18A-C are cross-sectional, end and perspective views of an alternative embodiment of the distal tip having a single aspiration opening with both active and return electrodes formed by loop prongs defining the energy application surface;
• FIG. 19 is a perspective view of the complete electrosurgical instrument of the present invention showing a probe having a handle and a shaft with a distal tip for treatment with a suction line and control; and[0036]
• FIGS. 20 and 21 are alternative embodiments of the distal end shaft of FIG. 19 according to the present invention having a pre-bent distal end in a 30 degree configuration and a 90 degree configuration, respectively.[0037]
DETAILED DESCRIPTION OF THE INVENTION
• An embodiment of an[0038]electrosurgical aspiration instrument10 capable of aspirating a patient treatment area within a standard surgical environment in accordance with the principles of the present invention is illustrated in FIGS. 1 and 2.Electrosurgical aspiration instrument10 is in the form of a probe having, generally, ashaft27 disposed along longitudinal axis A-A, adistal end12 at which treatments are performed and aproximal end14 at whichinstrument10 is coupled to a power source (not shown) viapower line16.Power line16 supplies energy todistal end12 for treatment. The power source preferably permits modification and adjustment of the power, frequency, and voltage of the energy transmitted todistal end12. Ahandle17 may be provided to facilitate grasping ofinstrument10 adjacentproximal end14. At least oneactuator18, such as an aspiration control valve or switch or a power button may be provided. In a preferred embodiment, a foot pedal (not shown) is provided to control power supplied todistal end12 andactuator18 controls aspiration through the instrument. Additional actuators or controllers, such as for adjusting the power, frequency, or voltage, may be provided either oninstrument10 itself or on the power source if desired.
• [0039]Electrosurgical aspiration instrument10 has an energy application surface orplane20 formed by at least one electrode that applies energy to the patient area to be treated. In one embodiment,instrument10 has at least two electrodes,active electrode22 and returnelectrode24 that cooperate to apply energy acrosssurface20.Electrodes22 and24 are formed from electrically conductive materials, for example a medical grade stainless steel, capable of withstanding the high temperatures resulting from use ofinstrument10. It will be appreciated that the material that is selected forelectrodes22 and24 has defined conductivity characteristics that affects the power necessary to achieve the desired treatment operation.
• As shown in FIGS. 1 and 2,[0040]active electrode22 is positioned at the open distal end ofshaft27 ofelectrosurgical aspiration instrument10. Althoughshaft27 may be a separate element, preferably, returnelectrode24 serves a dual purpose as both the return electrode that completes the energy circuit withactive electrode22 as well as the shaft ofinstrument10. It will be appreciated that the arrangement ofelectrodes22 and24 may be reversed, such that the active electrode is in the form of a shaft with an open distal end on which the return electrode is positioned. Alternatively, the return electrode may be located on a point external to the treatment site such as placing a grounding pad or plate on the body (not shown).
• Power is transmitted to[0041]active electrode22 frompower line16 via aconductive element26, such as a wire, as shown in FIG. 2.Return electrode24, as described above, is preferably in the form of an electrically conductive shaft, preferably formed from304 stainless steel or any other biocompatible conductive material, that extends fromdistal end12 ofinstrument10 toproximal end14. The end ofreturn electrode24 adjacentproximal end14 ofinstrument10 is coupled to the power source to communicate the power source atproximal end14 withdistal treatment end12 and thereby to complete the energy supply circuit ofelectrosurgical aspiration instrument10. If desired, the shaft forming areturn electrode24 may be formed from a malleable material so that it is shapeable by the user. However, the distal-most end ofinstrument10 should not be flexible. Additionally, any bend imparted toinstrument10 should not be so extreme as to close off the lumen formed therethrough and described in further detail below.
• [0042]Electrodes22 and24 are electrically isolated from each other such that electrical arcing betweenactive electrode22 and returnelectrode24 generates treatment energy alongenergy application surface20 that may be applied to the patient. Electrical isolation or insulation ofelectrodes22 and24 atenergy application surface20 may be accomplished by the provision ofinsulator28 therebetween.Insulator28 is formed from many desired insulative material, such as ceramic, teflon or pyrolytic carbon, that may withstand the high temperatures that may result upon application of energy atdistal end12 during use of theinstrument10. Preferably,active electrode22,return electrode24, andinsulator28 permit fluid communication throughinstrument10 from the treatment area at whichenergy application surface20 is applied toproximal end14, as described in further detail below.
• In addition,[0043]electrodes22 and24 must also be electrically isolated axially along longitudinal axis11 between proximal end14 (at whichinstrument10 applies treatment energy) so that power supply toenergy application surface20 is not shorted. Although insulation onwire26 is typically sufficient to electrically insulateactive electrode22 fromreturn electrode24,optional insulation30 on interior surface32 ofreturn electrode24 may be provided.Insulation30 is selected from biocompatible and electrically insulative material which could include nylon, polyimide or other shrink tubing and also functions to limit the heat transfer to the shaft. If active electrode22 (rather than return electrode24) is coupled to the power source via a conductive shaft as mentioned above and described with respect to the embodiments of FIGS. 8-11,insulation30 would be more desirable. Aninsulative cover34, such as formed from a teflon coating or a heat shrink cover, is provided over exterior surface36 ofreturn electrode24 to restrict the extent of arcing and hence energy supplied todistal treatment end12 ofinstrument10.
• [0044]Instrument10 may be substantially straight, or may have a slight bend atdistal end12 such thatenergy application surface20 is slightly offset form longitudinal axis11. As shown in FIGS. 1 and 2, theenergy application surface20 ofelectrosurgical aspiration instrument10 extends along distal end12 (approximately transverse to longitudinal axis A-A in a straight instrument). However, it will be appreciated thatelectrodes22 and24 may be provided at different positions atdistal end12 to alter the location ofenergy application surface20.
• [0045]Electrosurgical aspiration instrument10 may be used for a variety of electrosurgical treatments. On particular use ofinstrument10 is for ablation of human or animal tissue. Because ablation generally occurs at very high temperatures, e.g. 300-1000 degrees Celsius, smoke and/or vapor may be generated during ablation. It may be desirable to remove smoke; unwanted or excess gases, such as air bubbles; fluids, such as irrigation fluid required to irrigate or enhance conduction after treatment; from the treatment area during treatment. Moreover, debris or other materials or biological elements may remain after the ablation procedure that should be removed from the treatment area. Thus, in accordance with the principles of the present invention,instrument10 is also designed to aspirate such unwanted matter from the treatment area during the electrosurgical procedure performed thereby. It will be appreciated that aspiration may be performed either simultaneously with, before, or after electrosurgical treatment of an area. Further, it should be appreciated that a power source may be used which sequentially, or in a predetermined sequence, supplies power to the active electrode and then provides power for aspiration. Accordingly, anaspiration lumen50 is provided withinelectrosurgical aspiration instrument10 along longitudinal axis A-A.Aspiration lumen50 may be formed by interior wall or surface32 ofreturn electrode24 and is in fluid communication with aaspiration line52 which couplesproximal end14 ofinstrument10 with a vacuum source of other aspiration device (not shown).Aspiration line52 is preferably standard tubing for connection to a suction source and device.
• In order to facilitate aspiration during electrosurgical treatment, such as during ablation or coagulation,[0046]instrument10 is provided with an aspiration means which permits aspiration throughenergy application surface20. This is accomplished by providing at least one through-hole oraperture25 throughactive electrode22 which definessurface20. Alternatively, a plurality of through-holes or apertures throughactive electrode22 may be used to aid in aspiration of the electrosurgical probe. In the embodiment of FIGS. 1 and 2,active electrode22 is in the form of a wire mesh orscreen22A supported by an electricallyconductive ring22B.Mesh22A andring22B comprisingactive electrode22 are formed from a conductive materials, such as stainless steel, tungsten, or titanium or their alloys, that can withstand the high temperatures resulting from use ofinstrument10. The entire mesh and ring ofactive electrodes22 serves as the energy application surface and is powered by the power supply so that the electrosurgical application, such as ablation, occurs over the electrode. Thus, the active aspiration is approximately co-extensive withenergy application surface20. The preferred range of mesh sizes is from approximately 30 mesh to approximately 55 mesh.
• The interstices between the mesh permit fluid communication therethrough such that unwanted matter (e.g., ablated tissue, smoke, air bubbles, and other elements or biological debris) may pass through the mesh and into[0047]aspiration lumen50 for transport away form the treatment area. Moreover, because power is supplied substantially uniformly over the entire mesh ofactive electrode22, unwanted matter that is too large to fit through the interstices of the mesh are caught on the mesh and accordingly ablated thereby when power is applied to the electroconductive mesh. As the mesh heats up, the matter is ablated until it becomes small enough to fit through the mesh. It will be appreciated that the energy application surface has a uniform electrical potential being one piece across the surface of the mesh. Additionally, a blockage occurring at one portion of the mesh causes an increase in the suction force at unblocked portions of the mesh forming a non-uniform suction path. As the suction force increases in the unblocked areas, a differential axial suction force is created in which the blockage is turned and twisted to continue ablation and pass throughapertures25 to be aspirated throughaspiration lumen50. Thus,active electrode22 not only provides treatment energy but also permits aspiration therethrough, as well as destruction of larger pieces of unwanted matter during aspiration which might otherwise clog theaspiration lumen50.
• Moreover, in the present embodiment, return[0048]electrode24 is located onshaft27 proximal toactive electrode22. This defines a unipolar configuration where thereturn electrode24 has a larger surface area thanactive electrode22 functions as an indifferent return to the power source and the energy is diffuse aroundelectrode24. This provides theactive electrode22 with a higher current density such that treatment energy is crowded and the treatment effect is generally in the area of tissue in proximity toactive electrode22. In an alternative embodiment, however, returnelectrode24 may be located on a surface on the patient's body in the form of a grounding plate or pad. In this configuration, the return electrode functions to return the treatment energy to the power source to define a monopolar configuration.
• Referring to FIG. 3, the electrosurgical probe of FIGS. 1 and 2 is illustrated in an end view.[0049]Mesh22A ofactive electrode22 forms the energy application surface. The spacing between the mesh formmultiple apertures25 to allows for suction of unwanted matter through the distal end and aspiration opening. Although a substantially flat piece of mesh may be used, the mesh may be formed into any desired shape to vary the contour of the contact surface provided by the mesh. For instance, the mesh formingactive electrode22 may be domed to conform substantially with concave body parts to be treated byelectrosurgical aspiration instrument10. Pointed, convex, rippled, or other contours may be provided instead, depending on user preferences or other contours of the area to be treated.Insulator28 electrically isolatesactive electrode22 fromreturn electrode24.
• In FIG. 4, instead of providing[0050]active electrode22 in the form of a mesh,active electrode22 may take on an alternative form with apertures provided to permit aspiration therethrough. For example,active electrode22 may be in the form of a disc orconductive plate42 withperforations45 formed therethrough. In an exemplary embodiment, such a plate may be secured within the distal end ofannular insulator28 in place ofmesh electrode22 as shown in FIG. 2. In a preferred embodiment,perforations45 have a diameter of approximately 0.010-0.020 inches. In general, the perforations should be small enough to reduce particle size passing therethrough such that downstream clogging is minimized while large enough to provide effective aspiration without blockage of thedistal tip12. Likewise, any other type of conductive element formed as a honeycomb or other such shape that permits aspiration therethrough may be used.
• Alternative configurations of electrodes which define an energy application surface and permit aspiration therethrough are illustrated in FIGS. 5-7, as described below. It will be appreciated that the form of the active electrode may be modified as desired so long as external access to the internal lumen through the shaft of the electrosurgical aspiration instrument of the present invention is permitted. It will further be appreciated that the form and relative arrangement of the active electrode with respect to the return electrode may be modified as desired. However, it is desirable that the resulting energy application surface extends at least over a portion of the lumen opening to permit cooperation between the energy application surface and the process of aspiration. This provides for reduction in blockage.[0051]
• [0052]Electrosurgical instrument510 of FIG. 5 has a substantially centrally locatedelectrode522 and a ring-shapedelectrode524 both of which are positioned atdistal end512 ofinstrument510. One ofelectrodes522,524 is an active electrode and the other ofelectrodes522,524 is a return electrode. Both electrodes are supported and electrically isolated byinsulator528. A suitable insulative coating or covering534 is provided over the exterior surface ofinstruments10.Apertures525 permit aspiration as a suction force is applied toaspiration lumen550 to draw unwanted matter through apertures and through theinstrument510.
• As shown in FIG. 5,[0053]insulator528 has a convex working surface such thatcentral electrode522 is slightly distal of ring-shapedelectrode524 to form a unipolar configuration. However, it will be appreciated that a substantially flat working surface my be used instead such that the energy application ends of both electrodes are coplanar.
• Alternatively, a concave working surface may be used, as in[0054]electrosurgical instrument610 of FIG. 6, such that ring-shapedelectrode624 is slightly distal ofcentral electrode622. Theinstrument610 as shown in FIG. 6 includesapertures625 withininsulator628 for aspiration from thedistal tip612 throughaspiration lumen650.Outer insulation634 covers the instrument shaft.
• The arrangement and electrical connections of[0055]electrodes522 and524 ofelectrosurgical instrument510 may be appreciated with reference to FIG. 7. It will be understood that a similar arrangement may be used forelectrosurgical instruments510 and610 as well. In the exemplary embodiment, FIG. 7 illustrates a cross-section throughshaft727 showingelectrical power conductor716, in the form of a wire extending proximally from a power source (not shown) located atproximal end714 to distal712 of instrument710.Power conductor716 passes throughlumen750 and provides power tocentral electrode722.Electrical power conductor736 is in the form ofshaft727 being electrically conductive andconductor736 electrically coupled to return electrode724 viaextension736.Electrical conductors716,726, and736 are electrically isolated from each other in any desired manner, such as in with insulative material such asinterior insulation730 in a manner described above. An insulative coating or covering734 is provided on the exterior surface of instrument710, preferably to protect the patient from any energy discharge conducted throughelectrical conductor736.
• Apertures[0056]525,625, and725 are provided throughinsulator528,628 or728, respectively, such thatinstruments510,610, and710 also perform an aspiration function as previously described. In particular, the apertures provide for aspiration through the energy application surface which is defined by the electrode planes. It will also be appreciated that certain advantages in localized energy application may be realized due to the placement of both electrodes on the distal tip of the device.
• It should be appreciated that active electrode in FIGS. 5-7 can be sized appropriately, relative to return electrode or vice versa, such that application of power to the active electrode and use of the electrosurgical instrument approximates the effect delivered by a bipolar electrosurgical instrument. In a typical bipolar instrument, both electrodes are of the same size and approximately located with in the same proximity such that both electrodes equally affect the tissue area to which the instrument is applied. By sizing the active electrode and the return electrode to be of approximately equivalent sizes, a bipolar effect may be achieved with the present invention. It should further be appreciated that it is possible to size the electrodes in any of the embodiments of the present invention so as to achieve a bipolar effect. The return electrode of the present invention may also be located on the patient's body as discussed above.[0057]
• FIGS. 8A and 8B, FIGS. 9A and 9B and FIGS. 10A and 10B, illustrate similar embodiments of the electrosurgical aspiration instrument of the present invention. For the sake of simplicity, descriptions of elements or features of the embodiments of FIGS. 8-10 that are substantially the same (and thus referenced by the same reference numbers) are not repeated in detail, reference being made to the description provided in connection with similar elements described with reference to FIGS. 8-10.[0058]
• FIGS. 8A and 8B illustrate one alternative embodiment of[0059]electrosurgical instrument810 having anactive electrode822 in the form of a ringed coil ondistal tip812. The coil ofactive electrode822 may be preformed memory metal or a continuous wire which is looped ondistal tip812.
• FIG. 8A is a cross-sectional view showing coil[0060]active electrode822 ondistal end812. The outermost portion of coilactive electrode822 definesenergy application surface820 which forms both an energy treatment surface through the delivery of energy and a mechanical grating surface.Electrode822 is preferably electrically connected throughshaft827 to the power source throughconductor816.Electrode822 is in the form of a ring on the distal tip and definesaspiration aperture825.Insulative material830lines aspiration lumen850 to provide both electrical insulation from any stray electrical current and thermal insulation of the shaft.Return electrode824 is located internally withinaspiration lumen850 and is electrically isolated from theactive electrode822 byinsulator828 andinsulation material830.Return conductor826 connects thereturn electrode824 to the power source (not shown) atproximal end814.
• In this configuration, the[0061]internal return electrode824 forms a small boiling chamber whereby any matter being aspirated throughaperture825 and pastactive electrode822 increases the impedance to increase the delivery of energy in the region between the electrodes. As the energy output from the power source increases in response to the change in impedance, any matter located between the electrodes is ablated to prevent blockage of theaperture825 and facilitate aspiration throughaspiration lumen850. As smaller matter and debris and any excess fluid pass freely throughaperture825 and between the electrodes, the flow of material cools both electrodes to prevent any hot spots or unwanted ablative treatment effect.
• Further, the[0062]internal return electrode824 may provide a benefit of localized heating within thedistal end812 of thesurgical instrument810. As the suction force is applied throughaspiration lumen850 and fluid and surgical by-products flow throughaperture825, a pulling force is created within the local environment surrounding thedistal end812 andactive electrode822. Similar to the blockage and cooling described above, the high intensity energy delivery is limited to an area in close proximity to theaperture825. Thus, ablation and other surgical procedures can be more precise since energy delivery is limited to the area immediately surroundingaperture825. The surgeon can control the treatment by direct placement ofdistal end812 andelectrode822 on the biological tissue and limit the ablative effect to the tissue.
• FIGS. 9A and 9B illustrate another alternative embodiment of[0063]electrosurgical instrument810 having anactive electrode922 in the form of a ring electrode ondistal tip812. The ring electrode configuration ofactive electrode922 may be preformed memory metal or a solid metal tip ondistal tip812.Electrode922 is formed of any biocompatible material including stainless steel, tungsten, titanium or any of its respective alloys.
• FIG. 9A is a cross-sectional view showing ring[0064]active electrode922 ondistal tip812. The outermost portion of the ringactive electrode922 definesenergy application surface820 which forms both an energy treatment surface through the delivery of energy and a mechanical smoothing surface. In this embodiment, the rounded surface provides a more diffuse energy application surface thanelectrode822 of FIG. 8. This provides a surgeon with the ability to sculpt the body tissue by smoothing irregular areas by passing thecurved electrode922 over the tissue. Theelectrode922 may also be formed into a sharp edge to provide a mechanical scraping surface for the removal of unwanted tissue. The electrical current is then crowded for maximum ablative effect along the sharp edge.Electrode922 is preferably electrically connected throughshaft827 to the power source throughconductor816.Electrode922 is in the form of a ring on the distal tip and definesaspiration aperture825.Insulative material830lines aspiration lumen850 to provide both electrical insulation from any stray electrical current and thermal insulation of the shaft.Return electrode824 is located internally withinaspiration lumen850 and is electrically isolated from theactive electrode922 byinsulator828 andinsulation material830.Return conductor826 connects thereturn electrode824 to the power source (not shown) atproximal end814.
• FIG. 9B is an end view of the distal tip of the instrument of FIG. 9A.[0065]Active electrode922 is shown as a ring around the aspiration lumen to defineaperture825.Return electrode824 is shown within the aspiration lumen and is electrically isolated from theactive electrode922 byinsulator828.Internal return electrode824 functions to form a boiling chamber as described above.
• FIGS. 10A and 10B illustrate another alternative embodiment of[0066]electrosurgical instrument810 having anactive electrode1022 in the form of a double prong ondistal tip812. The double prong configuration ofactive electrode1022 may be preformed memory metal or a solid metal partial loop or coil ondistal tip812.Electrode1022 is formed of any biocompatible material including stainless steel, tungsten, titanium or any of its respective alloys.
• FIG. 10A is a cross-sectional view showing prong[0067]active electrode1022 withininsulator828. The prong is preferably fixed withininsulator828 such that one end is fixed within theinsulator828 and a portion of the prong passes overaperture825 to fix into the opposite side of theinsulator828. The outermost edge portion of the prongactive electrode1022 definesenergy application surface820 which forms both an energy treatment surface through the delivery of energy and a mechanical treatment surface. In this embodiment, a rounded prong surface provides a smoothing function as described above. The prongactive electrode1022 may also be formed into a sharp edge to provide a mechanical scraping surface for the removal of unwanted tissue. The electrical current is then crowded for maximum ablative effect along the sharp edge.Electrode1022 is preferably electrically connected throughshaft827 to the power source throughconductor816.Insulative material830lines aspiration lumen850 to provide both electrical insulation from any stray electrical current and thermal insulation of the shaft.Return electrode824 is located internally withinaspiration lumen850 and is electrically isolated from theactive electrode1022 byinsulator828 andinsulation material830.Return conductor826 connects thereturn electrode824 to the power source (not shown) atproximal end814.
• FIG. 10B is an end view of the distal tip of the instrument of FIG. 10A.[0068]Active electrode1022 is shown as a prong passing overaperture825. In this embodiment, two prongs pass over theaperture825 to prevent blockage of the aperture. Both electrode prongs are electrically connected to the power source through asingle conductor816 such that equal power is transmitted toactive electrode822 at the same time for equal effect. It will be appreciated that any number of prongs and the configurations may be use.Return electrode824 is shown within the aspiration lumen and is electrically isolated from theactive electrode922 byinsulator828.
• FIGS.[0069]11A-C illustrate yet another embodiment of the present invention in which theactive electrode1122 is formed from a portion ofshaft1127. FIG. 11A shows adistal end1112 withactive electrode1122 forming anenergy application surface1120 for treatment of body tissue at a surgical site. Atproximal end1114,conductor1116 connects the shaft to electrically activate theactive electrode1122.Return electrode1124 is located externally toshaft1127 and is electrically isolated from theactive electrode1122 byinsulator1128. Preferably,return electrode1124 is in the form of a ring electrode around a circumference of theshaft1127.Return conductor1126 connectsreturn electrode1124 to the power source. The return electrical path may also be located on the patient's body as discussed previously.Shaft insulation1134 covers shaft.1127. Theinterior suction lumen1150 may also be lined with an insulative material.
• An alternate embodiment of the active as shown in FIG. 11B is similar to the electrosurgical aspiration instrument of FIG. 11A where like elements are described with the same reference numbers. In this configuration,[0070]active electrode1122 hascutouts1129 to form a grating surface with cutout edges1180. By configuring the active electrode with cutout edges, theactive electrode1122 forms high current densities at theenergy application surface1120 such that current is crowded at theedges1180. Thus, maximum ablation in combination with a mechanical cutting and grating effect is achieved. Additionally, fluid may be delivered through the lumen to be delivered to the site when connected to a fluid delivery source and aspirated through thesame lumen1150 when connected to a suction source.
• FIG. 11C illustrates a perspective view of the electrosurgical instrument of FIG. 11B.[0071]Edges1180 protrude beyond the shaft andinsulator1128 for both delivery of treatment energy for ablation, cutting or coagulation and mechanical scraping for removal of unwanted tissue. As the current is crowded at theedges1180, the mechanical scraping and cutting is facilitated by providing an ablative effect at a precise cutting point along the tissue. In this embodiment, the treated tissue is then aspirated through the aspiration lumen away from the surgical site.
• FIGS. 12A and 12B illustrate another embodiment of the present invention in which the active electrode is formed into a cross-shape with aspiration provided through and around the arm extensions. FIG. 12A shows a cross-section view of the[0072]active electrode1222 ofelectrosurgical instrument1210. Theactive electrode1222 is located at thedistal end1212 ofshaft1227 ofinstrument1210.Shaft1227 may be covered byshaft insulation1234.Active electrode1222 is connected to a power source (not shown) byelectrical conductor1216. The arm extensions ofactive electrode1222 are mostly planar with the main body of the electrode and extend outward to form edges1280.Apertures1225 are formed between the arms ofactive electrode1222. A middle portion ofactive electrode1222 may also be raised from the main body to form amiddle edge1280. By raisingedges1280, the current is crowded along the edges for increased electrical density atedges1280 for an ablative effect.Edges1280 may also be configured and sharpened for a simultaneous mechanical scraping and grating effect at the surgical site.
• The placement of[0073]edges1280 also prevents blockage of theapertures1225 as current is delivered to the active electrode. As the current is crowded alongedges1280, any matter resulting from the surgical site which is blocking theaperture1225 increases the impedance betweenedges1280 causing an increase in power. As the power increases, the treatment energy ablates the unwanted matter into a smaller size to pass through the aperture. For example, if unwanted matter blocks one quadrant of theaperture1225, impedance is increased alongedge1280 near the blockage. Since the force of suction is equal through the apertures, the suction unequally increases at the other quadrants thereby pulling the blockage along various axial planes. The increased treatment energy delivery ablates portions of the blockage to a point in which the unwanted matter moves easily through any of the apertures. This effect is similar to the mesh configuration of FIG. 1 in which the ablative effect due to the electrode design across the aspiration aperture opening assists in further ablation of any blockage or unwanted material. The differential suction over the other non-blocked apertures creates a differential axial aspiration effect thereby assisting in removing the blockage.
• [0074]Return electrode1224 is located internally withinaspiration lumen1250 to form a boiling chamber as described above. The electrical energy is returned to the power source fromreturn electrode1224 byreturn conductor1226. Thereturn electrode1224 is electrically insolated fromactive electrode1222 byinsulator1228.
• FIG. 12B is a perspective view of the[0075]instrument1212 of FIG. 12A. In this embodiment, edges1280 are raised to form a cup or pocket for ablation.Edges1280 function as both a mechanical cutting surface edge and a current crowding edge for effective ablation.
• Another embodiment is illustrated by FIG. 13A in which[0076]electrosurgical instrument1310 has an ashtray configuration of theactive electrode1322.Active electrode1322 is located on thedistal end1312 ofshaft1327. The instrument shaft may be covered withshaft insulator1334.Active electrode1322 is in an ashtray configuration wherecutouts1329 are formed inenergy application surface1320. By formingcutouts1329, edges1380 are formed within theenergy application surface1320 ofactive electrode1322.Edges1380 form both a mechanical tissue removal surface simultaneously with a current crowding edge for maximum energy delivery effect. Blockage ofaperture1325 can also be prevented and eliminated by configuringactive electrode1322 withedges1380 near theaperture1325.Electrical conductor1316 electrically couples theelectrode1322 to the power source (not shown).Active electrode1322 is configured with acentral aperture1325 which communicates withaspiration lumen1350.Return electrode1324 is located withinaspiration lumen1350 and is proximal toactive electrode1322 to form a boiling chamber as described above.Insulator1328 insulateselectrodes1322 and1324. Aninternal lining1330 may also lineaspiration lumen1350 to function as both an electrical and thermal insulator.
• FIG. 13B is a perspective view of FIG. 13A in which the[0077]active electrode1322 is show in the ashtray configuration.Cutouts1329 within the electrode defineedges1380 for the mechanical and electrical effect as described above.Aperture1325 communicates throughinstrument1310 withaspiration lumen1350.
• FIG. 14A and 14B illustrate cross-sectional and perspective views of an alternative embodiment of the[0078]electrosurgical aspiration instrument1310 as described FIGS. 13A and 13B. Similar elements will be referenced to FIGS. 13A and 13B. In this embodiment,return electrode1424 is located external along theshaft1327. Return electrode1426 electrically completes the current path to the power source from theactive electrode1322. Thereturn electrode1424 is preferably a ring electrode located on the surface ofshaft1327 and is isolated from theactive electrode1322 byinsulator1328.
• FIGS.[0079]15A-C illustrate different views of ashtray electrode according to one alternative embodiment of the active electrode as described above. Like elements will be referenced by the same reference numbers. FIG. I5A shows a close-up perspective view ofactive electrode1522 in which at least oneaperture1525 is provided throughactive electrode1522.Active electrode1522 is configured to crowd the current creating a high current density along acircumferential edge1580.Edge1580 definesenergy application surface1520.Cutouts1529 form a pattern alongedge1580 to maximize the current crowding. As the current is crowded alongedges1580, a mechanical scraping and ablative effect occurs simultaneously. Current is also crowdededge1580 formed withinaperture1525 to prevent blockage of the aperture. As energy is applied to the active electrode, the sharp edge ofsurface1580 provides both a surface for the delivery of RF power for ablation while simultaneously providing a mechanical grating or scraping surface for scraping tissue at the surgical tissue site. It will be appreciated thatedge1580 ofelectrode1520 may be rounded such that a smoothing surface may be formed and sculpting may be performed with the instrument of the present invention.
• As by-products of ablation and/or coagulation are created at the surgical site, negative pressure created by suction through the lumen and electrosurgical instrument aspirates the additional matter through[0080]aperture1525. However, blockage and clogging of theaperture1525 may undesirably increase the ablation effect by reducing the flow of liquid and tissue throughaperture1525. By-products of surgery such as biological tissue debris could result from the ablation and cutting process. As this matter becomes dislodged and freely movable within the surgical site, the biological tissue may completely block any and all apertures into the instrument. Thus, the cooling effect due to the flow of matter and liquid is reduced thereby increasing the delivery of treatment energy to the site possibly causing unnecessary ablation and injury to the patient.
• To combat blockage and potential injury, edges[0081]1580 may be configured with reference to FIG. 12 wherein a portion ofedges1580 is configured and positioned near or withinaperture1525. As the impedance increases due to blocked tissue withinaperture1525, the tissue is further treated with energy atedges1580 whereby the tissue is further ablated to a size to fit throughaperture1525. The irregular shape ofaperture1525 in combination withedges1580 provides for non-uniform and non-round apertures such that both an electrical and mechanical effect combine to prevent blockage within the opening thereby increasing the efficiency of the electrosurgical instrument1510.
• FIG. 15B shows an end view of the distal electrode tip[0082]1512.Energy application surface1520 andedge1580 are shown withcutouts1529. It will also be appreciated that the number, sizes and placement ofcutouts1529 withinsurface1520 may vary to provide different ablation effects and patterns. The electrical current is crowded and has the greatest density atsurface1520 andedge1580 such that ablation, cutting and/or coagulation occurs alongedge1580.
• FIG. 15C is a cross-sectional view of the distal tip of FIG. 15B in which the[0083]active electrode1522 on distal end1512 is shown along Line A-A. Theenergy application surface1520 is shown in detail as asharp edge1580 with both an electrical effect for ablation and mechanical effect for scraping.Edge1580 is shown to be intruding into a portion ofaperture1525 which leads toaspiration lumen1550. With reference to FIG. 12 above, the effect of suction through a non-uniform configuration ofaperture1525 prevents the blockage and clogging of the aspiration opening such that the negative pressure pulls the blockage into the lumen across different axial planes. For example, as an unwanted by-product matter hitsaperture1525, it lodges on a portion ofedge1580. As the suction is applied to the lumen and through the opening, a portion of the matter is pulled on the portions away from the lodged portion alongedge1580. This allows the matter to twist and turn in different axial planes whereby the unwanted matter moves and has a different and more compatible physical orientation to move throughaperture1525.
• FIGS. 16A and B illustrate a further alternative embodiment of the present invention in which the active and return[0084]electrodes1622,1624 lie in substantially the same plane of the energy application surface1620 at thedistal end1612 ofinstrument1610 to define a true bipolar configuration. Such position ofelectrodes1622 and1624 may be accomplished by forming each electrode as an arcuate element positioned on thedistal end1612 ofinstrument1610.Electrodes1622 and1624 are supported byinsulator1628 which serves the additional function of electrically isolatingelectrodes1622 and1624. Cutouts1629 are formed ininsulator1628 to space apart and thus further electrically isolateelectrodes1622 and1624.Central opening1625 allows for aspiration.
• [0085]Electrodes1622 and1624 are separately coupled to the power source by separate respectiveconductive elements1616 and1626. Conductive elements preferably extend fromdistal end1612 to proximal end1614 ofinstrument1610 throughlumen1650. Althoughconductive elements1616 and1626 extend through thecentral opening1625 throughinsulator1628 to be coupled withelectrodes1622 and1624 on the distal-most end ofinsulator1628, it will be appreciated that other arrangements are also within the scope of the present invention. For instance,conductive elements1616 and1626 may extend through a passage formed throughinsulator1628 to communicatelumen1650 withelectrodes1622,1624.Lumen1650 may be used for aspiration as previously described.
• It will be appreciated that the above-described arrangements that provide an energy application surface area at the distal tip of the electrosurgical instrument may be applied to an instrument that is not capable of aspiration. Thus,[0086]insulator1628 ofinstrument1610 may be a substantially solid element with passages therethrough for the purpose ofelectrically coupling electrodes1622 and1624 to the power source but not for aspiration purposes. The arrangement of the active and return electrodes may be further modified as in FIGS. 10 and 11 to provide and energy application surface area that, although contoured (i.e., not completely planar), still remains at the distal end of the instrument, substantially transverse to the longitudinal axis, without extending along a distal portion of the side walls of the instrument (such as ininstrument10 of FIGS. 1 and 2).
• FIGS. 17A and 17B illustrate another embodiment of the[0087]electrosurgical aspiration instrument1710 of the present invention in which theactive electrode1722 and thereturn electrode1724 are comparably sized and located in close proximity to each other at thedistal end1712. This arrangement ofelectrodes1722 and1724 define a true bipolar configuration.Active electrode1722 is a single disc shaped electrode which is centrally located atdistal end1712 withininsulator1728.Return electrode1724 is a ring electrode located substantially along the same plane at the circumferential edge ofinsulator1728. The effective area size of both electrodes are similar such that the delivered treatment energy is equal between both electrodes.Apertures1725 are located withininsulator1828 and communicates withaspiration lumen1750. As the ablation, cutting and coagulation occur at theactive electrode1722, the suction applied to the aspiration lumen forces the by-products and excess fluid throughapertures1725.
• FIG. 17B shows a cross-sectional view in which the[0088]active electrode1722 is coupled to a power supply (not shown) at theproximal end1714 bypower conductor1716.Return electrode1724 is coupled to electricallyconductive shaft1727 byextension1736 to complete the circuit to the power supply.Shaft1727 is covered byshaft insulation1734.
• FIGS.[0089]18A-C illustrate a further alternative embodiment of theelectrosurgical aspiration instrument1810 of the present invention in which the active and returnelectrodes1822,1824 lie in the same plane at thedistal end1812. The active and return electrodes are substantially configured similarly such that the twoconductors1816 and1826 are electrically coupled throughshaft1827 to thedistal end1812.Electrodes1822 and1834 are electrically isolated byinsulator1828. Delivery of energy is equal to both electrodes such that an equal, bipolar effect occurs at the surgical site. Both electrodes extend from one side ofaspiration aperture1825 to a point across the aperture and return to the generator. One electrode serves as an active electrode and one electrode serves as a return electrode. It will be appreciated that either electrode may be an active or a return since the polarity of the power generator may be reversed. Because both electrodes are configured across theaspiration aperture1825, clogging and blockage of the aperture is prevented or reduced.
• FIG. 19 illustrates a perspective view of an[0090]electrosurgical aspiration instrument1910 according to the present invention.Aspiration line1952 is attached toproximal handle1917.Aspiration line1952 connects to a suction device and receptacle (not shown) which provides a negative pressure through the instrument in order to aspirate ablation by-products throughdistal tip1912 throughprobe shaft1927. Apower receptacle1914 connectsinstrument1910 to a power source (not shown). Anactuator1918 controls the amount and force of suction through theaspiration line1952 and is controlled by a roller.Vacuum line connector1957 connects to the aspiration receptacle. It will be appreciated that any device or mechanism to control the amount and force of suction may be used to aspirate surgical material through theinstrument1910.
• FIGS. 20 and 21 show two alternative embodiments of the[0091]distal end1912 of FIG. 19 of the present invention in which theshaft1927 ofdistal end1912 is pre-bent. As discussed above, it is preferable that theshaft1927 is not flexible such that the aspiration lumen is not pinched nor crimped thereby blocking suction. The reduction of the suction force as discussed above may lead to an increase in the ablation effect. FIG. 20 shows a 30 degree bend indistal end1912 and FIG. 21 is a 90 degree bend. While the degree of pre-bent angle is not limited to these specific degrees, it will be appreciated that the manufacture of the pre-bentdistal end1912 be optimized for access to a particular body position or part for a desired surgical procedure and corresponding ablation effect. For example, the 90 degree bend indistal end1912 as shown in FIG. 21 allows access to areas such as the subacromial space under the acromium in the shoulder. This allows for better access by a surgeon to the particular body part.
• The embodiments of the electrosurgical instrument of the present invention that permit an aspiration function in combination with an electrosurgical function are particularly useful for surgical procedures requiring ablation of tissue or other body parts. In order to perform an ablation function, the energy supplied to the electrosurgical aspiration instrument should be in the range of 100-500 KHz. This range may be varied depending on the materials used to form the instrument as well as depending on the particular application of the instrument in the surgical procedure. The lowest frequency used typically is selected such that use of the instrument does not interfere with other tissue nor stimulate nerves in the area, etc. Thus, isolated treatment of the selected tissue area is permitted. The highest frequency used typically is limited depending on the desired results that would be achieved by such frequency. For instance, at too high a frequency, appropriate ablation may not be achievable and blockage of the lumen by debris may occur.[0092]
• Power may be provided by commercially available RF energy sources. Such RF energy sources may include generators which control the temperature of the electrosurgical instrument. Power may also be regulated by feedback to prevent overpower and undesired ablation or coagulation as such.[0093]
• As mentioned above, the electrosurgical instrument of the present invention may be used for any of a variety of applications and procedures, depending on the nature of the energy supplied thereto by the power source. It will, therefore, be appreciated that the energy supplied to the electrosurgical instrument of the present invention may be varied depending on the application desired. The energy level may even be varied during use to perform a variety of functions, such as ablation followed or accompanied by cauterization or coagulation as necessary.[0094]
• While the foregoing description and drawings represent the preferred embodiments of the present invention, it will be understood that various additions, modifications and substitutions may be made therein without departing from the spirit and scope of the present invention as defined in the accompanying claims. In particular, it will be clear of those skilled in the art that the present invention may be embodied in other specific forms, structures, arrangements, proportions, and with other elements materials, and components, without departing from the spirit or essential characteristics thereof. The presently disclosed embodiments are, therefore, to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims and not limited to the foregoing descriptions.[0095]

Claims (55)

1-40. (Cancelled)

41. A surgical instrument comprising:

a shaft having distal and proximal ends, the shaft defining a lumen;

a conductive member disposed at the distal end of the shaft across the lumen and forming an electrode, the conductive member having an opening therethrough communicating with the lumen for aspirating material through the conductive member, the opening being smaller than a diameter of the lumen to avoid clogging of aspirated material downstream of the opening, the conductive member having an ashtray shape; and

a conductor connected to the conductive member.

42. The surgical instrument ofclaim 41 further comprising:

a second electrode disposed on the shaft proximally from the electrode; and

a second conductor connected to the second electrode.

43. The surgical instrument ofclaim 42 wherein the second electrode is disposed around the shaft proximally from the electrode.

44. The surgical instrument ofclaim 41 wherein the electrode further comprises a sharp edge forming a mechanical treatment surface.

45. The surgical instrument ofclaim 41 wherein the electrode includes a mechanical treatment surface having an edge configured to form a high current density at the edge for an ablative effect along the edge.

46. The surgical instrument ofclaim 41 wherein the lumen has multiple diameters.

47. A surgical instrument for use with a power source, the surgical instrument comprising:

a shaft having distal and proximal ends, the shaft defining a lumen;

a conductive member disposed at the distal end of the shaft across the lumen to define an energy application plane across the lumen and forming an electrode, the conductive member having an opening therethrough communicating with the lumen for aspirating material through the conductive member across the energy application plane, the opening being smaller than a diameter of the lumen to avoid clogging of aspirated material downstream of the opening, the electrode having an ashtray shape and having a mechanical treatment surface for the mechanical removal of tissue at a surgical site; and

a conductor connected to the conductive member and adapted for coupling to the power source.

48. The surgical instrument ofclaim 47 further comprising:

a second electrode disposed on the shaft proximally from the electrode; and

a second conductor connected to the second electrode.

49. The surgical instrument ofclaim 48 wherein the second electrode is disposed around the shaft proximally from the electrode.

50. The surgical instrument ofclaim 48 wherein one of the conductor and the second conductor is formed by the shaft.

51. The surgical instrument ofclaim 47 wherein the lumen has an insulative coating.

52. The surgical instrument ofclaim 47 further comprising a suction source coupled to the proximal end of the shaft for providing negative pressure to the lumen so as to cause matter to be aspirated through the opening of the conductive member.

53. The surgical instrument ofclaim 47 wherein the mechanical treatment surface is an edge, provided on the electrode, configured to form a high current density to provide an electrical and mechanical effect.

54. The surgical instrument ofclaim 47 wherein the mechanical treatment surface includes a sharp edge.

55. The surgical instrument ofclaim 47 wherein the electrode is concentrically disposed at the distal end of the shaft.

56. The surgical instrument ofclaim 47 wherein the proximal end of the shaft is mounted to a handle, the handle providing a connection for the conductor to a power supply and a connection for the lumen to a vacuum source.

57. The surgical instrument ofclaim 47 wherein the lumen has multiple diameters.

58. A surgical device comprising:

an elongated shaft defining a lumen;

a first electrode coupled to the elongated shaft and forming a tissue treatment surface configured to treat tissue, the tissue treatment surface defining at least part of a lumen opening in communication with the lumen; and

a second electrode coupled to the elongated shaft and electrically isolated from the first electrode.

59. The surgical device ofclaim 58 wherein the second electrode comprises an exposed portion not disposed around an entirety of a circumference of the elongated shaft, the exposed portion being disposed entirely proximal of the first electrode, and the surgical device further comprises an insulator extending longitudinally along an entire side of the elongated shaft such that non-target tissue adjacent the insulator is insulated during electrosurgery.

60. The surgical device ofclaim 58 wherein the second electrode includes an exposed portion not disposed around an entirety of a circumference of the elongated shaft.

61. The surgical device ofclaim 58 further comprising an insulator extending longitudinally along an entire side of the elongated shaft such that non-target tissue adjacent the insulator is insulated during electrosurgery.

62. The surgical device ofclaim 58 wherein the first electrode defines the entire lumen opening.

63. The surgical device ofclaim 58 wherein the surgical device comprises a distal end, and the lumen opening is at the distal end.

64. The surgical device ofclaim 58 wherein:

the lumen has at least one diameter including a minimum lumen diameter, and

the lumen opening is smaller than the minimum lumen diameter to avoid clogging of aspirated material downstream of the lumen opening.

65. The surgical device ofclaim 60 wherein the second electrode is not disposed at all around the circumference of the elongated shaft.

66. The surgical device ofclaim 60 wherein the second electrode is disposed within the lumen.

67. The surgical device ofclaim 60 wherein the surgical device includes a front face and the second electrode is disposed on the front face.

68. The surgical device ofclaim 58 wherein the first and second electrodes each face toward a common direction.

69. The surgical device ofclaim 68 wherein the common direction is forward.

70. The surgical device ofclaim 58 wherein the first electrode is forward-facing.

71. The surgical device ofclaim 58 wherein the first and second electrodes are not disposed on opposite sides of the elongated shaft.

72. The surgical device ofclaim 58 wherein the device has only two electrodes.

73. The surgical device ofclaim 61 wherein the insulator comprises a thermal and electrical insulator.

74. The surgical device ofclaim 61 wherein the insulator is disposed over at least 45 degrees of a circumference of the elongated shaft.

75. The surgical device ofclaim 61 wherein the surgical device defines a return path for current that does not go under the insulator.

76. The surgical device ofclaim 58 wherein the first electrode comprises a scraping surface configured to scrape tissue.

77. The surgical device ofclaim 76 wherein the first electrode is configured in an ashtray configuration and the scraping surface comprises an edge in the ashtray configuration.

78. The surgical device ofclaim 58 wherein:

the elongated shaft defines a longitudinal axis and comprises a distal portion, and

the first electrode is coupled to the distal portion of the shaft and is configured to contact tissue straight-on along the longitudinal axis.

79. The surgical device ofclaim 58 wherein:

the first electrode is configured to provide radio frequency energy to ablate tissue, and

the second electrode is configured to operate in a bipolar mode with the first electrode.

80. The surgical device ofclaim 58 wherein the second electrode comprises an exposed portion that is disposed entirely proximal of the first electrode.

81. The surgical device ofclaim 58 wherein the entire second electrode is disposed proximal of the first electrode.

82. A method of performing surgery, the method comprising:

applying electrical energy to a first electrode of a bipolar surgical device to perform electrosurgery on a target tissue, the first electrode being disposed on an elongated shaft of the bipolar device, the bipolar device further including a second electrode; and

transferring fluid through a lumen and a lumen opening of the surgical device, the lumen opening being in communication with the lumen and being defined at least in part by a tissue treatment surface formed by the first electrode.

83. The method ofclaim 82 wherein applying electrical energy comprises applying electrical energy to a first electrode of a bipolar surgical device in which the second electrode is not disposed around an entirety of a circumference of the elongated shaft.

84. The method ofclaim 83 further comprising providing an insulating surface extending longitudinally along an entire side of the elongated shaft, such that non-target tissue adjacent the insulating surface is shielded during the application of electrical energy to target tissue.

85. The method ofclaim 82 further comprising providing an insulating surface extending longitudinally along an entire side of the elongated shaft, such that non-target tissue adjacent the insulating surface is shielded during the application of electrical energy to target tissue.

86. The method ofclaim 85 wherein providing the insulating surface comprises providing a thermally and electrically insulating surface.

87. The method ofclaim 82 wherein applying electrical energy to perform electrosurgery comprises ablating the target tissue.

88. The method ofclaim 82 wherein transferring fluid through the lumen comprises aspirating fluid through the lumen.

89. The method ofclaim 82 further comprising scraping the target tissue using a scraping surface on the first electrode.

90. The method ofclaim 82 further comprising inserting the bipolar surgical device into a body such that the first electrode is adjacent the target tissue.

91. A surgical device comprising:

an elongated shaft defining a lumen, and the surgical device defining a lumen opening in communication with the lumen, the lumen opening being smaller than a diameter of the lumen to avoid clogging of aspirated material downstream of the lumen opening;

a first electrode coupled to the elongated shaft; and

a second electrode coupled to the elongated shaft and electrically isolated from the first electrode.

92. The surgical device ofclaim 91 wherein the second electrode is not disposed around an entirety of a circumference of the elongated shaft.

93. The surgical device ofclaim 91 further comprising an insulator extending longitudinally along an entire side of the elongated shaft such that non-target tissue adjacent the insulator is insulated during electrosurgery.

94. The surgical device ofclaim 58 wherein the lumen has multiple diameters.

Images