US20200268446A1 - Method for controlling an electrosurgical generator - Google Patents

Abstract

A microwave ablation system includes a generator including a first energy source, a second energy source and a diplexer, the diplexer multiplexes a first energy from the first energy source and a second energy from the second energy source. The system also includes a cable including a center conductor and an outer sheath where the multiplexed energy is transmitted through the center conductor. In addition an antenna is provided that is operable to receive the multiplexed energy from the center conductor and to deliver the multiplexed energy to a region of tissue. The outer sheath acts as a return path of the second energy to the second energy source. A sensor is also provided that measures at least one parameter of the second energy generated by the second energy source and the second energy returned from the region of tissue.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a divisional of U.S. patent application Ser. No. 15/354,595, filed Nov. 17, 2016, which is a continuation of U.S. application Ser. No. 13/943,452, filed Jul. 16, 2013, now U.S. Pat. No. 9,504,524, which is a continuation of U.S. application Ser. No. 13/568,679, filed on Aug. 7, 2012, now U.S. Pat. No. 8,486,057, which is a divisional of U.S. application Ser. No. 12/468,718, filed on May 19, 2009, now U.S. Pat. No. 8,246,615.
INTRODUCTION
• The present disclosure relates generally to microwave ablation procedures that utilize microwave surgical devices having a microwave antenna which may be inserted directly into tissue for diagnosis and treatment of diseases. More particularly, the present disclosure is directed to measuring tissue impedance during a microwave ablation procedure.
BACKGROUND
• In the treatment of diseases such as cancer, certain types of cancer cells have been found to denature at elevated temperatures (which are slightly lower than temperatures normally injurious to healthy cells.) These types of treatments, known generally as hyperthermia therapy, typically utilize electromagnetic radiation to heat diseased cells to temperatures above 41° C., while maintaining adjacent healthy cells at lower temperatures where irreversible cell destruction will not occur. Other procedures utilizing electromagnetic radiation to heat tissue also include ablation and coagulation of the tissue. Such microwave ablation procedures, e.g., such as those performed for menorrhagia, are typically done to ablate and coagulate the targeted tissue to denature or kill the tissue. Many procedures and types of devices utilizing electromagnetic radiation therapy are known in the art. Such microwave therapy is typically used in the treatment of tissue and organs such as the prostate, heart, liver, lung, kidney, and breast.
• One non-invasive procedure generally involves the treatment of tissue (e.g., a tumor) underlying the skin via the use of microwave energy. The microwave energy is able to non-invasively penetrate the skin to reach the underlying tissue. However, this non-invasive procedure may result in the unwanted heating of healthy tissue. Thus, the non-invasive use of microwave energy requires a great deal of control.
• Presently, there are several types of microwave probes in use, e.g., monopole, dipole, and helical. One type is a monopole antenna probe, which consists of a single, elongated microwave conductor exposed at the end of the probe. The probe is typically surrounded by a dielectric sleeve. The second type of microwave probe commonly used is a dipole antenna, which consists of a coaxial construction having an inner conductor and an outer conductor with a dielectric junction separating a portion of the inner conductor. The inner conductor may be coupled to a portion corresponding to a first dipole radiating portion, and a portion of the outer conductor may be coupled to a second dipole radiating portion. The dipole radiating portions may be configured such that one radiating portion is located proximally of the dielectric junction, and the other portion is located distally of the dielectric junction. In the monopole and dipole antenna probe, microwave energy generally radiates perpendicularly from the axis of the conductor.
• The typical microwave antenna has a long, thin inner conductor that extends along the axis of the probe and is surrounded by a dielectric material and is further surrounded by an outer conductor around the dielectric material such that the outer conductor also extends along the axis of the probe. In another variation of the probe that provides for effective outward radiation of energy or heating, a portion or portions of the outer conductor can be selectively removed. This type of construction is typically referred to as a “leaky waveguide” or “leaky coaxial” antenna. Another variation on the microwave probe involves having the tip formed in a uniform spiral pattern, such as a helix, to provide the necessary configuration for effective radiation. This variation can be used to direct energy in a particular direction, e.g., perpendicular to the axis, in a forward direction (i.e., towards the distal end of the antenna), or combinations thereof.
• Invasive procedures and devices have been developed in which a microwave antenna probe may be either inserted directly into a point of treatment via a normal body orifice or percutaneously inserted. Such invasive procedures and devices potentially provide better temperature control of the tissue being treated. Because of the small difference between the temperature required for denaturing malignant cells and the temperature injurious to healthy cells, a known heating pattern and predictable temperature control is important so that heating is confined to the tissue to be treated. For instance, hyperthermia treatment at the threshold temperature of about 41.5° C. generally has little effect on most malignant growth of cells. However, at slightly elevated temperatures above the approximate range of 43° C. to 45° C., thermal damage to most types of normal cells is routinely observed. Accordingly, great care must be taken not to exceed these temperatures in healthy tissue.
• In the case of tissue ablation, a high radio frequency electrical current in the range of about 500 mHz to about 10 gHz is applied to a targeted tissue site to create an ablation volume, which may have a particular size and shape. Ablation volume is correlated to antenna design, antenna performance, antenna impedance and tissue impedance. The particular type of tissue ablation procedure may dictate a particular ablation volume in order to achieve a desired surgical outcome. By way of example, and without limitation, a spinal ablation procedure may call for a longer, narrower ablation volume, whereas in a prostate ablation procedure, a more spherical ablation volume may be required.
• Microwave ablation devices utilize thermocouples to determine when an ablation is complete. When the thermocouple reaches threshold temperature the ablation procedure is completed. Tissue impedance can also be used to determine when the ablation procedure is completed. Because ablated tissue blocks electrical signals due to non-conductive desiccated tissue, the tissue impedance can determine when the ablation procedure is completed. During application of energy, the current and voltage applied to the tissue can be measured and used to calculate impedance and the calculated impedance is stored. Based upon a function of the impedance it is determined whether the ablation procedure is complete.
• During an ablation procedure, if only one antenna is used, there is no easy way to determine a change in tissue impedance. The inability to determine the change in tissue impedance is due to losses in the coaxial cable used to deliver energy to the antenna. The coaxial cable can make it difficult to measure any reflection from the antenna that could be used to determine the tissue impedance.
• Additionally, antennas may use a coolant to provide improved ablation volume and shape. Any suitable medium may be used as a coolant such as deionized water, sterilized water, or saline. The coolant may have dielectric properties which may provide improved impedance matching between an antenna probe and tissue. Impedance matching is the practice of setting the probe impedance to the tissue impedance in order to maximize the power transfer and minimize reflections from the load. Due to the minimized reflections, if a water or dielectric buffer cooled antenna is used, the change in tissue impedance may be immeasurable.
SUMMARY
• The present disclosure provides a microwave ablation system. The microwave ablation includes a generator including a first energy source, a second energy source and a diplexer, the diplexer operable to multiplex a first energy from the first energy source and a second energy from the second energy source. A cable is also provided that includes a center conductor and an outer sheath. The multiplexed energy is transmitted through the center conductor. Also, an antenna operable to receive the multiplexed energy from the center conductor and to deliver the multiplexed energy to a region of tissue is provided. The outer sheath acts as a return path of the second energy to the second energy source. A sensor is also provided that measures at least one parameter of the second energy generated by the second energy source and the second energy returned from the region of tissue.
• The present disclosure also provides another microwave ablation system. The microwave ablation system includes a generator including a first energy source, a second energy source and a diplexer, the diplexer operable to multiplex a first energy from the first energy source and a second energy from the second energy source. A cable is also provided that includes a center conductor and an outer sheath. The multiplexed energy is transmitted through the center conductor. Also, an antenna operable to receive the multiplexed energy from the center conductor and to deliver the multiplexed energy to a region of tissue is provided. Additionally, a return pad is provided that is operable to receive the second energy outputted from the antenna. The return pad transmits the second energy to the second energy source. A sensor is also provided that measures at least one parameter of said second energy generated by said second energy source and the second energy returned from said return pad.
• The present disclosure also provides a method of ablating tissue using microwave energy. The method includes generating microwave energy, generating radio frequency (RF) energy, multiplexing the microwave energy and the RF energy and outputting the multiplexed energy to a tissue region. RF energy is returned from the tissue region and at least one parameter of the generated RF energy and the RF energy returned from said tissue region is measured. Based on the measured parameter the level of microwave energy that is generated is controlled.
BRIEF DESCRIPTION OF THE DRAWINGS
• The above and other aspects, features, and advantages of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings in which:
• FIG. 1 shows a representative diagram of a variation of a microwave antenna assembly in accordance with an embodiment of the present disclosure;
• FIG. 2 shows a cross-sectional view of a representative variation of a distal end of microwave antenna assembly in accordance with an embodiment of the present disclosure;
• FIG. 3 shows a cross-sectional view of a representative variation of a proximal end of microwave antenna assembly in accordance with an embodiment of the present disclosure;
• FIGS. 4A-4D show perspective views of the distal portion of a microwave antenna in various stages of assembly in accordance with an embodiment of the present disclosure;
• FIG. 5 is a schematic diagram of a microwave ablation system with a bipolar RF energy source according to an embodiment of the present disclosure;
• FIG. 6 is a diagram of a bipolar RF return path according to an embodiment of the present disclosure;
• FIG. 7 is a schematic diagram of a microwave ablation system with a monopolar RF energy source according to an embodiment of the present disclosure; and
• FIG. 8 is a diagram of a monopolar RF return path according to an embodiment of the present disclosure.
DETAILED DESCRIPTION
• Particular embodiments of the present disclosure are described hereinbelow with reference to the accompanying drawings; however, it is to be understood that the disclosed embodiments are merely exemplary of the disclosure and may be embodied in various forms. Well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present disclosure in virtually any appropriately detailed structure. Like reference numerals may refer to similar or identical elements throughout the description of the figures.
• Electromagnetic energy is generally classified by increasing energy or decreasing wavelength into radio waves, microwaves, infrared, visible light, ultraviolet, X-rays and gamma-rays. As used herein, the term “microwave” generally refers to electromagnetic waves in the frequency range of 300 megahertz (MHz) (3×108 cycles/second) to 300 gigahertz (GHz) (3×1011 cycles/second). As used herein, the term “RF” generally refers to electromagnetic waves having a lower frequency than microwaves. The phrase “ablation procedure” generally refers to any ablation procedure, such as microwave ablation or microwave ablation assisted resection. The phrase “transmission line” generally refers to any transmission medium that can be used for the propagation of signals from one point to another.
• FIG. 1 shows an embodiment of amicrowave antenna assembly100 in accordance with one embodiment of the present disclosure.Antenna assembly100 includes a radiatingportion12 that is connected by feedline110 (or shaft) viacable15 toconnector16, which may further connect the assembly10 to apower generating source28, e.g., a microwave or RF electrosurgical generator.Assembly100, as shown, is a dipole microwave antenna assembly, but other antenna assemblies, e.g., monopole or leaky wave antenna assemblies, may also utilize the principles set forth herein.Distal radiating portion105 of radiatingportion12 includes atapered end120 which terminates at atip123 to allow for insertion into tissue with minimal resistance. It is to be understood, however, thattapered end120 may include other shapes, such as without limitation, atip123 that is rounded, flat, square, hexagonal, or cylindroconical.
• An insulatingpuck130 is disposed betweendistal radiating portion105 andproximal radiating portion140.Puck130 may be formed from any suitable elastomeric or ceramic dielectric material by any suitable process. In embodiments, thepuck130 is formed by overmolding from polyether block amide, which is available under the tradename PEBAX® from Arkema of Puteaux, France; polyetherimide, available under the tradename ULTEM® from Sabic Innovative Plastics IP B.V. of Bergen Op Zoom, Netherlands; polyimide-based polymer available under the tradename VESPEL® from E.I. Du Pont De Nemours and Company of Wilmington, Del. As best illustrated inFIG. 2,puck130 includescoolant inflow port131 andcoolant outflow port133 to respectively facilitate the flow of coolant into, and out of,coolant chamber148 oftrocar122 as further described hereinbelow.
• With reference now toFIGS. 2, 3, and 4A-4D,distal radiating portion105 includes atrocar122 having a generally cylindroconical shape.Proximal radiating portion140 includes aproximal antenna member128 having a generally cylindrical shape. Additionally or alternatively,proximal antenna member128 may have a generally square or hexagonal shape.Trocar122 andproximal antenna member128 may be formed from a variety of biocompatible heat resistant conductive materials suitable for penetrating tissue, such as without limitation, stainless steel.Antenna assembly110 includes acoaxial transmission line138 having, in coaxial disposition, an innercoaxial conductor150, an intermediatecoaxial dielectric132, and an outercoaxial conductor134. Nominally,coaxial transmission line138 has an impedance of about 50 ohms. Innercoaxial conductor150 and outercoaxial conductor134 may be formed from any suitable electrically conductive material. In some embodiments, innercoaxial conductor150 is formed from stainless steel and outercoaxial conductor132 is formed from copper.Coaxial dielectric132 may be formed from any suitable dielectric material, including without limitation, polyethylene terephthalate, polyimide, or polytetrafluoroethylene (PTFE) (e.g., available under the tradename TEFLON®, from E. I. du Pont de Nemours and Company of Wilmington, Del., United States). Innercoaxial conductor150 may be electrically coupled totrocar122 and outercoaxial conductor134 may be electrically coupled toproximal antenna member128.
• Alongitudinal opening146 is defined withintrocar122 and opens to a proximal end thereof, and defines acooling chamber148 and a threadedsection145 withintrocar122. Coolingchamber148 may have a generally cylindrical shape and, additionally or alternatively, may have a stepped, tapered, conical, or other shape that is generally dimensioned in accordance with the shape of thetapered end120 of the cylindroconical profile oftrocar122 to permit the flow of coolant to more effectively reach the distal regions oftrocar122. Additionally or alternatively, cooling chamber may have a square, hexagonal, or any suitable shape. Additionally, the dielectric properties of sterile water or saline flowing through coolingchamber148 may enhance the overall ablation pattern ofantenna100.
• Acoolant inflow tube126 is in operable fluid communication at a proximal end thereof with a source of cooling fluid (not explicitly shown), and, at a distal end thereof,coolant inflow tube126 is in fluid communication withcooling chamber146 to provide coolant thereto.Coolant inflow tube126 may be formed from any suitable material, e.g., a polymeric material, such as without limitation, polyimide. In an embodiment,coolant inflow tube126 passes throughcoolant inflow port131. In some embodiments, acoolant outflow channel136 may be provided to facilitate removal of coolant from coolingchamber146, throughantenna assembly100, to a collection reservoir (not explicitly shown). The coolant may be any suitable fluid, such as without limitation water, sterile water, deionized water, and/or saline.
• Threadedsection145 oftrocar122 is configured to receivetrocar screw144.Trocar screw144 includes at the proximal end thereof anopening143 defined therein that is configured to accept the distal end of innercoaxial conductor150. In embodiments, distal end of innercoaxial conductor150 is fixed withinopening143 by any suitable manner of electromechanical attachment, such as without limitation welding, brazing, and/or crimping. As seen inFIG. 4A, aninflow groove147 and anoutflow groove149 are disposed longitudinally through the threaded portion oftrocar screw144 to respectively facilitate the flow of coolant into, and out of, coolingchamber148.Inflow groove147 andoutflow groove149 may be configured to accommodate the insertion ofcoolant inflow tube126 and/or a corresponding outflow tube (not explicitly shown). Areturn path156 in the antenna assembly may additionally or alternatively provide an exit conduit for the cooling fluid.
• In the illustrated embodiment,trocar122 andproximal antenna member128 include adielectric coating121,127, respectively, on the respective outer surfaces thereof. Thedielectric coating121,127 may include any suitable dielectric material, such as without limitation, ceramic material. In some embodiments,dielectric coating121,127 may be formed from titanium dioxide and/or zirconium dioxide.Dielectric coating121,127 may be applied totrocar122 and/orproximal antenna member128 by any suitable process, for example without limitation, plasma spraying or flame spraying. In embodiments,dielectric coating121,127 has a thickness in the range of about 0.005 inches to about 0.015 inches. During an ablation procedure, thedielectric coating121,127 may provide improved dielectric matching and/or improved dielectric buffering between the antenna and tissue, which may enable the use of higher power levels, which, in turn, may enable a surgeon to achieve greater ablation rates resulting in increased ablation size, reduced operative times, and/or improved operative outcomes.
• Anouter jacket124 is disposed about the outer cylindrical surface ofantenna assembly100, e.g., thedistal radiating portion105,puck130, andproximal radiating section140.Outer jacket124 may be formed from any suitable material, including without limitation polymeric or ceramic materials. In some embodiments,outer jacket124 is formed from PTFE.Outer jacket124 may be applied toantenna assembly100 by any suitable manner, including without limitation, heat shrinking.
• Continuing with reference toFIGS. 4A-4D, a method of manufacturingantenna assembly100 is disclosed wherein innercoaxial conductor150 is inserted into opening143 oftrocar screw144. Innercoaxial conductor150 is electrically fixed totrocar screw144 by any suitable manner of bonding, such as without limitation, laser welding, brazing, or crimping. Thecoaxial transmission line138 andtrocar screw144 subassembly is placed in a mold (not explicitly shown), such as without limitation an injection micro-mold, that is configured to overmold thepuck130. Advantageously,inflow groove147 andoutflow groove149 are aligned with mold features (not explicitly shown) corresponding tocoolant inflow port131 andcoolant outflow port133 such that, when molded, a continuous fluid connection is formed betweeninflow groove147 andcoolant inflow port131, and betweenoutflow groove149 andoutflow port133.
• Puck material e.g., ceramic; polyether block amide, available under the tradename PEBAX® from Arkema of Puteaux, France; polyetherimide, available under the tradename ULTEM® from Sabic Innovative Plastics IP B.V. of Bergen Op Zoom, Netherlands; polyimide-based polymer available under the tradename VESPEL® from E.I. Du Pont De Nemours and Company of Wilmington, Del., or any suitable polymer having dielectric properties, is shot into the mold, allowed to cool/and or set, and subsequently released from the mold to form an assembly that includespuck130,trocar screw144 andcoaxial transmission line138 as best illustrated inFIG. 4B. The formedpuck130 includes acenter section137 having an outer diameter corresponding to the outer diameters of trocar122 (inclusive of the thickness of dielectric coating121) and/or proximal antenna member128 (inclusive of the thickness of dielectric coating127).Puck130 further includes adistal shoulder141 having an outer diameter corresponding to the inner diameter oftrocar122, and aproximal shoulder139 having an outer diameter corresponding to the inner diameter ofproximal antenna member128.
• Trocar122 may then be threaded ontotrocar screw144 to form thedistal radiating section120, as best shown inFIG. 4C.Inflow tube126 may then be inserted intocoolant inflow port131.Proximal antenna member128 may then be positioned againstpuck130 such that the distal end ofproximal antenna member128 engages the proximal shoulder ofpuck130, thus forming a sealedproximal radiation section140.
• Tension may be applied to innercoaxial conductor150 and/or dielectric132 in a proximal direction, thereby drawing togetherdistal radiating section105,puck130, andproximal radiating section140, and placingpuck130 in a state of compression. Innercoaxial conductor150 and/or dielectric132 may be fixed in a state of tension at ananchor point151, by any suitable manner of fixation, including without limitation spot welding, brazing, adhesive, and/or crimping. In this manner, the antenna sections are “locked” together by the tensile force of innercoaxial conductor150 and/ordielectric132, which may result in improved strength and stiffness of the antenna assembly.
• Outer jacket124 may be applied to the outer surface of radiatingportion12 by any suitable method, for example without limitation, heat shrinking, overmolding, coating, spraying, dipping, powder coating, baking and/or film deposition.
• It is contemplated that the steps of a method in accordance with the present disclosure can be performed in a different ordering than the ordering provided herein.
• FIG. 5 is a schematic illustration of a microwave system, generally shown assystem500, according to an embodiment of the present disclosure.Antenna510 is used to ablate tissue on patient “P”.Antenna510 is coupled to coaxcable520 which has acenter conductor522 and anouter sheath524.Outer sheath524 is coupled to the ground terminal ofmicrowave generator530 which includes a microwave source535.Outer sheath524 is also coupled toRF generator540 via atransmission line526.RF generator540 includes anRF source542 andsensors544.Diplexer550 is coupled betweencenter conductor522 andRF generator540.Microwave generator530,RF generator540 anddiplexer550 may be provided as separate units or provided ingenerator28 as shown inFIG. 1.
• RF generator540 outputs RF energy to thediplexer550 which combines the RF energy with the microwave energy outputted bymicrowave generator530.Diplexer550 implements frequency domain multiplexing where two ports are multiplexed onto a third port. Thediplexer550 blocks the RF energy from getting into themicrowave generator530 and blocks microwave energy from getting into theRF generator540.Diplexer550 allows both the RF energy and the microwave energy to flow toantenna510 simultaneously throughcenter conductor522. The RF energy is outputted from the antenna to theablation zone610 as depicted inFIG. 6. The RF path is depicted bylines620 inFIG. 5B. The RF energy flows fromantenna510 to theablation zone610 and uses the same return path as the microwave energy by utilizing theouter sheath524.
• The RF energy returning from the ablation zone is used as a feedback signal and is provided to theRF generator540 viatransmission line526. The return RF energy is combined with the RF energy provided by theRF source542. The combined RF energy is then provided tosensors544 which measure the voltage, current and phase of the RF energy. A sensor may be operable to measure at least one parameter of the second energy generated by the second energy source and the second energy returned from the region of tissue. Such sensors are within the purview of those skilled in the art. The measured voltage, current, and/or the phase of the RF energy, is provided to acontroller560 which calculates the tissue impedance based on the measured voltage and current. Based on the tissue impedance, thecontroller560 controls the output of themicrowave generator530. Alternatively, thecontroller560 can calculate the tissue impedance and display the value on a display (not shown) so that a user may control the output of themicrowave generator530 or thecontroller560 can automatically adjust the output of the microwave generator by comparing the calculated tissue impedance to a predetermined impedance stored in the controller.
• Thecontroller560 may include a microcontroller operably connected to a memory, which may be volatile type memory (e.g., RAM) and/or non-volatile type memory (e.g., flash media, disk media, etc.). The microcontroller includes an output port that is operably connected to themicrowave generator530 allowing the microcontroller to control the output of themicrowave generator530. Those skilled in the art will appreciate that the microcontroller may be substituted by any logic controller (e.g., control circuit) adapted to perform the calculations discussed herein
• In another embodiment according to the present disclosure, and as shown inFIG. 7, anelectrosurgical system700 is provided with anRF return pad710 to receive a return RF signal from theablation zone810 as shown inFIG. 8. As shown inFIG. 8, theantenna510 outputs RF energy in a path indicated by820. The outputted RF energy is received by theRF return pad810 and provided as a feedback to theRF generator540 which is used to directly or indirectly control themicrowave generator530. TheRF return pad710 may have any suitable regular or irregular shape such as circular or polygonal.RF return pad710 may be a conductive pad that may include a plurality of conductive arranged in a regular or irregular array. Each of the plurality of conductive elements may be equally-sized or differently-sized and may form a grid/array on the conductive pad. The plurality of conductive elements may also be arranged in a suitable spiral or radial orientation on the conductive pad. The use of the term “conductive pad” as described herein is not meant to be limiting and may indicate a variety of different pads including, but not limited to, conductive, inductive, or capacitive pads.
• Although the above described embodiments describe agenerator28 having themicrowave generator530,RF generator540,diverter550 andcontroller560, it is to be appreciated by one skilled in the art that some or all of these elements may be included in a single device or may function as separate components that are interconnected when used during an ablation procedure. Further,controller560 may be included in thegenerator28 or it may be a separate computer or laptop connected to thegenerator28.
• The described embodiments of the present disclosure are intended to be illustrative rather than restrictive, and are not intended to represent every embodiment of the present disclosure. Various modifications and variations can be made without departing from the spirit or scope of the disclosure as set forth in the following claims both literally and in equivalents recognized in law.

Claims (21)

1-12. (canceled)

13. A method for controlling a microwave generator, the method comprising:

generating first energy at a first frequency at a first energy source;

generating second energy at a second frequency at a second energy source;

multiplexing the first and second energies to output multiplexed energy;

transmitting the multiplexed energy to a load;

receiving the second energy from the load;

measuring a parameter of the second energy; and

controlling the first energy source based on the measured parameter of the second energy.

14. The method according toclaim 13, wherein the first frequency is higher than the second frequency.

15. The method according toclaim 14, wherein the first energy source is a microwave generator and the second energy source is a radio frequency generator.

16. The method according toclaim 13, further comprising calculating an impedance of the load based on the measured parameter of the second energy.

17. The method according toclaim 16, further comprising controlling the first energy source based the impedance of the load.

18. The method according toclaim 13, wherein the measured parameter of the second energy is at least one of voltage or current.

19. The method according toclaim 13, wherein multiplexing the first and second energies to output multiplexed energy includes outputting the first energy and the second energy simultaneously while blocking the first energy from the second energy source and blocking the second energy signal from the first energy source.

20. The method according toclaim 13, wherein receiving the second energy from the load includes providing a return path for the second energy to the second energy source.

21. A method for controlling an electrosurgical energy source, the method comprising:

generating a first electrosurgical energy signal at a first frequency from a first electrosurgical energy source;

generating a second electrosurgical energy signal at a second frequency from a second electrosurgical energy source;

outputting the first and second electrosurgical energy signals simultaneously as a multiplexed signal while blocking the first electrosurgical energy signal from the second electrosurgical energy source and blocking the second electrosurgical energy signal from the first electrosurgical energy source; and

controlling the first electrosurgical energy source based on a measured parameter of the second electrosurgical energy signal.

22. The method according toclaim 21, further comprising transmitting the multiplexed signal to a load.

23. The method according toclaim 22, further comprising receiving, at the second electrosurgical energy source, the second electrosurgical energy signal from the load.

24. The method according toclaim 23, wherein receiving, at the second electrosurgical energy source, the second electrosurgical energy signal from the load includes providing a return path for the second electrosurgical energy signal to the second electrosurgical energy source.

25. The method according toclaim 22, further comprising determining an impedance of the load based on the measured parameter of the second electrosurgical energy signal.

26. The method according toclaim 25, further comprising controlling the first electrosurgical energy source based the impedance of the load.

27. The method according toclaim 21, wherein the measured parameter of the second electrosurgical energy signal is at least one of voltage or current.

28. The method according toclaim 21, wherein the first frequency is higher than the second frequency.

29. The method according toclaim 21, wherein the first electrosurgical energy source is a microwave generator and the second electrosurgical energy source is a radio frequency generator.

30. A method for controlling an electrosurgical energy source, the method comprising:

generating a first electrosurgical energy signal at a first frequency from a first electrosurgical energy source;

generating a second electrosurgical energy signal at a second frequency from a second electrosurgical energy source;

transmitting the first and second electrosurgical energy signals simultaneously as a multiplexed signal to a load while blocking the first electrosurgical energy signal from the second electrosurgical energy source and blocking the second electrosurgical energy signal from the first electrosurgical energy source; and

controlling the first electrosurgical energy source based on an impedance of the load.

31. The method according toclaim 30, wherein the first electrosurgical energy source is a microwave generator and the second electrosurgical energy source is a radio frequency generator.

32. The method according toclaim 30, further comprising receiving the second electrosurgical energy signal from the load at the second electrosurgical energy source.

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