US20140236143A1 - Electrosurgical electrodes - Google Patents
Electrosurgical electrodes Download PDFInfo
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- US20140236143A1 US20140236143A1 US14/136,017 US201314136017A US2014236143A1 US 20140236143 A1 US20140236143 A1 US 20140236143A1 US 201314136017 A US201314136017 A US 201314136017A US 2014236143 A1 US2014236143 A1 US 2014236143A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/149—Probes or electrodes therefor bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00274—Prostate operation, e.g. prostatectomy, turp, bhp treatment
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00184—Moving parts
- A61B2018/00196—Moving parts reciprocating lengthwise
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00505—Urinary tract
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00547—Prostate
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1213—Generators therefor creating an arc
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/126—Generators therefor characterised by the output polarity bipolar
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1407—Loop
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/16—Indifferent or passive electrodes for grounding
- A61B2018/162—Indifferent or passive electrodes for grounding located on the probe body
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Abstract
An electrode assembly is provided. The electrode assembly includes a proximal end that is adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end includes a cutting electrode having a loop configuration configured to cut tissue. The distal end includes a return electrode operably disposed adjacent the cutting electrode. A dielectric shield is operably disposed between the cutting electrode and return electrode. The dielectric shield extending distally past the cutting electrode to hinder current flow to the return electrode when the dielectric shield, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
Description
- The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/766,483 filed by Ward on Feb. 19, 2013, the entire contents of which hereby incorporated by reference.
- 1. Technical Field
- The present disclosure relates to electrosurgical electrodes and, more particularly, to electrosurgical electrodes that provide concentrated amounts of electrosurgical energy to tissue during an electrosurgical procedure.
- 2. Background of Related Art
- Currently, there are several surgical therapies utilized for treating benign prostate hyperplasia (BPH). At present, transurethral resection of the prostate (TURP) is predominant in the surgical therapy of BPH. Various alternative treatment devices, e.g., electrovaporization, needle ablation, laser, ultrasound, or microwave therapy have recently become available for treating BPH. However, for efficacy, TURP is still regarded as the reference standard by most clinicians, e.g., urologists.
- In some instances, monopolar electrocautery systems in which current passes through a patient's body from an active electrode associated with a resectoscope and back to a return electrode that is typically placed on a patient's leg is utilized during TURP. Disadvantages associated with monopolar electrocautery systems when employed in the treatment of BPH include collateral damage to adjacent tissue (e.g., heating of tissue that is deeper than tissue being treated), unwanted stimulation of the nervous and/or muscle system, and/or possible malfunction of therapeutic devices in operative contact with a patient (e.g., a pacemaker). Another disadvantage associated with monopolar electrocautery systems when employed in the treatment of BPH may include the absorption of hypoosmolar irrigation fluid by a patient (commonly referred to in the art as TUR or TURP syndrome), which is typically a result of extended TURP procedures.
- In view of the aforementioned disadvantages associated with monopolar electrocautery systems for treating BPH, bipolar electrocautery systems including a resectoscope with an active, e.g., cutting electrode, and one or more return electrodes placed on the same axis on the resectoscope have become increasingly popular in the treatment of BPH. More particularly, bipolar electrocautery systems typically provide high current densities to target tissue sites such that the aforementioned negative effects typically associated with the monopolar electrocautery systems are reduced and/or prevented. Moreover, bipolar electrocautery systems utilized for treating BPH typically use one or more types of physiological irrigation fluids, e.g., a solution of sodium chloride, such that the risk of TUR syndrome is reduced and/or eliminated.
- While bipolar electrocautery systems utilized for treating BPH alleviate some, if not all, of the disadvantages associated with monopolar electrocautery systems for treating BPH, there still exists some practical challenges with bipolar electrocautery systems to treat BPH. More particularly, the prostate is a highly vascular organ which bleeds during a resection procedure, e.g., TURP that utilizes either monopolar or bipolar electrocautery systems. Bleeding causes a decrease in visual clarity which, in turn, may lead to a variety of intraoperative difficulties with undesirable consequences, e.g., increased convalescence. In order to minimize bleeding (i.e., increase hemostatic efficacy to the target tissue resection site) electrosurgical energy, i.e., current density, may be maximized at the target tissue resection site. However, when the active electrode is positioned in a conductive medium (e.g., a conductive fluid such as saline) a significant fraction of the applied current passes through the saline to the return electrode(s) and not to the target tissue resection site. This fraction of applied current passing through the saline to the return electrode(s) results in decreased hemostatic efficacy at the target tissue resection site. The amount of current passing through the saline to the return electrode(s) is indirectly proportional to the amount of current passing through the target tissue resection site and, thus, indirectly proportional to the hemostatic efficacy at the target tissue resection site. Moreover, this fraction of the current passing through the saline to the return electrode(s) results in TURP procedures having high power output requirements (due to the reduction of a tissue current density, which, in turn, results in overall applied power being increased to the active electrode).
- In view thereof, electrosurgical electrode efficiency (i.e., improved transfer of current from the active or cutting electrode to the tissue resection site) would improve hemostatic efficacy at the tissue resection site during TURP and reduce the applied power requirements of a power source associated with the resection device and/or active electrode.
- An aspect of the present disclosure provides an electrode assembly. The electrode assembly includes a proximal end that is adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end includes a cutting electrode having a loop configuration configured to cut tissue. The distal end includes a return electrode operably disposed adjacent the cutting electrode. A dielectric shield is operably disposed between the cutting electrode and return electrode. The dielectric shield extending distally past the cutting electrode to hinder current flow to the return electrode when the dielectric shield, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- The dielectric shield may be disposed parallel to the longitudinal axis defined by the housing and above the cutting electrode. The dielectric shield may include a generally arcuate configuration and extend laterally across the electrode assembly. Moreover, the dielectric shield may be formed from flouropolymer, polyimide, polyamide, polyaryl sulfone and silicone plastic. Further, a thickness of dielectric shield may be in the range from about 0.005 inches to 0.100 inches.
- The cutting electrode may be a wire, which may be formed from a metal such as tungsten, tungsten alloys and stainless steel. A cross section of the cutting electrode may include a shape such as circular, hemicircular, square, rectangular, triangular, polygonal and combinations of the above. A cross-section diameter of the wire may range from about 0.25 mm to about 4 mm. The loop configuration of the cutting electrode may include a diameter that ranges from about 3 mm to about 10 mm.
- An aspect of the present disclosure provides an electrosurgical instrument. The electrosurgical instrument includes an elongated housing having a lumen defining a longitudinal axis therethrough. The electrosurgical instrument having distal and proximal ends. The proximal end adapted to connect to electrosurgical energy source. An electrode assembly includes a proximal end adapted to connect to the distal end of the elongated housing and a distal end including a cutting electrode having a loop configuration configured to cut tissue. The distal end including a return electrode operably disposed adjacent the cutting electrode. A dielectric shield is operably disposed between the cutting electrode and return electrode. The dielectric shield extending distally past the cutting electrode to hinder current flow to the return electrode when the dielectric shield, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- An aspect of the present disclosure provides an electrode assembly. The electrode assembly includes a proximal end that is adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end includes a cutting electrode having a loop configuration configured to cut tissue. The distal end includes a return electrode operably disposed adjacent the cutting electrode. An insulative material is operably disposed between the cutting electrode and return electrode to hinder current flow to the return electrode when the insulative material, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- The insulative material may be disposed parallel to the longitudinal axis defined by the housing and above the cutting electrode. A proximal end of the cutting electrode may include a pair of curved sections. The insulative material may be operably disposed along the pair of curved sections of the cutting electrode. The insulative material may be a flouropolymer, polyimide, polyamide, polyaryl sulfone, silicone plastic and polytetrafluoroethylene.
- An aspect of the present disclosure provides an electrode assembly adapted to connect to an electrosurgical instrument. A proximal end of the electrode assembly is adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end of the electrode assembly includes a cutting electrode having a loop configuration configured to cut tissue. The loop configuration of the cutting electrode has a non-uniform cross-section diameter. The distal end includes a return electrode that is operably disposed adjacent the cutting electrode. The non-uniform cross-section diameter of the cutting electrode hinders current flow to the return electrode when the cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- A top portion of the loop configuration of the cutting electrode may include a thicker diameter than a bottom portion of the loop configuration of the cutting electrode such that when the cutting electrode is energized current density adjacent the bottom portion and surrounding tissue is greater than current density at the top portion.
- Yet another aspect of the present disclosure provides an electrosurgical instrument. The electrosurgical instrument includes an elongated sheath including a sheath lumen, a distal end and a proximal end. An electrode assembly includes a proximal end adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end includes a cutting electrode having a loop configuration configured to cut tissue. The loop configuration of the cutting electrode has a non-uniform cross-section diameter. The distal end includes a return electrode that is operably disposed adjacent the cutting electrode. The non-uniform cross-section diameter of the cutting electrode hinders current flow to the return electrode when the cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- Another aspect of the present disclosure provides an electrode assembly adapted to connect to an electrosurgical instrument. A proximal end of the electrode assembly is adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end of the electrode assembly includes a cutting electrode having a loop configuration configured to cut tissue. The loop configuration of the cutting electrode having a surface finish minimizing the energy required for bubble nucleation on the cutting electrode and promoting vapor bubble adhesion. The surface finish may include a pitted finish or a hydrophobic finish. The distal end including a return electrode that is operably disposed adjacent the cutting electrode. The surface finish of the cutting electrode hinders current flow to the return electrode when the cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- Another aspect of the present disclosure provides an electrode assembly adapted to connect to an electrosurgical instrument. A proximal end of the electrode assembly is adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source. A distal end of the electrode assembly including a cutting electrode having a loop configuration configured to cut tissue. The distal end including a return electrode that is operably disposed adjacent the cutting electrode at a distance maximizing energy per volume and minimizing heating depth such that hemostasis is maximized at a target tissue site. The distance may be in the range from about 3 mm to about 10 mm. The distal end including a return electrode operably disposed adjacent the cutting electrode. The distance between the return electrode and the cutting electrode hinders current flow to the return electrode when the cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
- The cutting electrode and return electrode may be in fixed spaced-apart relation with respect to one another. The cutting electrode and return electrode may be in a selectably movable spaced-apart relation with respect to one another such that a variable tissue effect is achieved at the target tissue site. The return electrode may include two return electrodes operably disposed on a respective longitudinal section associated with the electrode assembly. The two return electrodes maybe slidably and axially movable with respect to each other and the cutting electrode.
- Various embodiments of the present disclosure are described hereinbelow with references to the drawings, wherein:
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FIG. 1 . is a schematic plan view of a power supply configured for use with a resectoscope intended for use with an electrode assembly in accordance with the present disclosure; -
FIG. 2 is an enlarged view of the area of detail illustrated inFIG. 1 ; -
FIG. 3A is a side, perspective view of an electrode assembly in accordance with an alternate embodiment of the present disclosure; -
FIG. 3B is a partial, side view of the electrode assembly depicted inFIG. 3A ; -
FIG. 4A is a side, perspective view of an electrode assembly in accordance with an alternate embodiment of the present disclosure; -
FIG. 4B is a graphical representation of a relationship between heating depth and energy per volume versus distance from a return electrode to an active electrode; -
FIG. 4C is a side, perspective view of an electrode assembly in accordance with an alternate embodiment of the electrode assembly depicted inFIG. 4A ; -
FIG. 5 is a side, perspective view of an electrode assembly in accordance with an alternate embodiment of the present disclosure; and -
FIG. 6 is a side, perspective view of an electrode assembly in accordance with an alternate embodiment of the present disclosure. - Particular embodiments of the presently disclosed electrosurgical electrode are described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. As used herein, the term “distal” refers to that portion of the electrosurgical electrode which is further from the user or surgeon while the term “proximal” refers to that portion of the electrosurgical electrode which is closer to the user or surgeon.
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FIG. 1 sets forth a side, perspective view of anelectrosurgical system 10 including anelectrosurgical instrument 20 intended for use with anelectrosurgical electrode assembly 100 constructed in accordance with one embodiment of the present disclosure. In the embodiment illustrated inFIG. 1 , the electrosurgical instrument is aresectoscope 20. Theresectoscope 20 may be any suitable type of resectoscope and may be operated in bipolar or monopolar modes. While the following description will be directed towards a resectoscope, it is envisioned that the features and concepts (or portions thereof) of the present disclosure can be applied to any electrosurgical type instrument, e.g., forceps, suction coagulators, wands, etc. - To facilitate understanding of the
electrode assembly 100, a description of theresectoscope 20 illustrated inFIG. 1 now follows. Briefly,resectoscope 20 includes an elongated sheath orhousing 22 with a sheath lumen extending substantially along the entire length ofsheath 22. A support frame connectselectrosurgical electrode assembly 100 to one or more suitable types of electrosurgical energy sources, e.g., electrosurgical generator “G.” The support frame provides structural support for theelectrode assembly 100 and/or one or more operative components associated with theresectoscope 20. To this end, support frame may be made of stainless or corrosion resistant material, and the like.Resectoscope 20 includes a workingelement 24 that is attached tosheath 22. Workingelement 24 ofresectoscope 20 may include astationary handle 28, amovable handle 26, an internal electrical interface, e.g., electrical socket, where aproximal end 106 of theelectrode assembly 100 is plugged into and secured for electric current connection and transmission, and an external electrical interface, e.g., external socket, for plugging in anexternal cable 30 that transmits electric current from the energy source “G.” All connections may be insulated to prevent dissipation of electric current. A portion of theelectrode assembly 100, e.g., a proximal end of the electrode assembly, extends into workingelement 24 and operably couples to a drive mechanism operably associated with one or more components, e.g., workinghead 24, associated with theresectoscope 20. The drive mechanism is configured for axial translation of theelectrode assembly 100 such that theelectrode assembly 100 is translatable from an initial position within thesheath 22 to a subsequent position outside thesheath 22. Alternatively, theelectrode assembly 100 may be fixedly coupled, i.e., non-translatable, to the distal end of thesheath 22. In one particular embodiment, a visualization apparatus fits into workingelement 24. - The
electrode assembly 100 of the present disclosure is configured to concentrate electrosurgical energy, i.e., current density, at specific points along a cuttingelectrode 102 associated with theelectrode assembly 100 when theelectrode assembly 100 is positioned adjacent a target tissue resection site. More particularly, whenelectrode assembly 100 or portion thereof, e.g., a distal end including a cuttingelectrode 102 and returnelectrode 104, is positioned adjacent the target tissue resection site and within a conductive medium (e.g., saline), one or more components or configurations associated with theelectrode assembly 100 improves hemostatic efficacy at the target tissue resection site by limiting the amount of current flowing back to thereturn electrode 104 such that a desired tissue effect is achieved at the target tissue resection site. - With reference now to
FIG. 2 , an embodiment of theelectrosurgical electrode assembly 100 is shown.Electrode assembly 100 may be fabricated from a conductive type material, such as, for example, stainless steel, tungsten, copper, etc. or may be coated with an electrically conductive material. In the embodiment illustrated inFIG. 2 ,electrode assembly 100 is fabricated from stainless steal.Electrode assembly 100 includes aproximal end 107 that is disposed in electrical communication with the generator “G” via the internal socket and external socket configuration described above. -
Electrode assembly 100 is defined by two laterally spaced-apartlongitudinal sections FIG. 1 ). Eachlongitudinal section distal tip 110 having a cuttingelectrode 102 with loop geometry. Eachlongitudinal section bent section Bent sections electrode 102 and provide a transition in the orientation of thelongitudinal sections electrode 102 is oriented in generally orthogonal relation with respect to thelongitudinal sections FIG. 2 .Bent sections bent sections electrode 102 and the cuttingelectrode 102 and returnelectrode 104 are submerged in a conductive medium; the significance of which described in greater detail below. Cuttingelectrode 102, as is conventional in the art, is in electrical communication with an outgoing electrical path of the generator “G.”Cutting electrode 102 receives electrosurgical energy from the generator “G” and is configured to generate a current at a target tissue resection site. To this end, cuttingelectrode 102 may have one or more suitable types of loop geometries.Suitable cutting electrode 102 loop geometries include but are not limited to radial, circular, elliptical, curved, rounded, bowed, arc, arch, crescent, semicircle, roller cylinder and so forth. The cutting electrode loop may also be malleable to form one or more of the aforementioned geometries. The loop size diameter of the cuttingelectrode 102 may range from about 3 mm to about 10 mm, or any size that will fit in a commercially available resectoscope. In the embodiment illustrated inFIGS. 1 and 2 , cuttingelectrode 102 includes a wire loop configuration. Alternatively, cuttingelectrode 102 may include a band loop configuration, wing loop configuration or other suitable loop configuration. Cross-section shapes of the wire loop configuration may include circular, hemicircular (or any portion of a circle), square, rectangular, triangular, or polygonal shapes such as hexagon, octagon, flat plate, and combinations of the foregoing. The cross-section diameter of the wire loop configuration of the cuttingelectrode 102 may range from about 0.25 mm to about 4 mm. In certain embodiments the cross-section diameter of the wire loop may vary, as described in greater detail below. - One or
more return electrodes 104 are operably disposed on theelectrode assembly 100 and in electrical communication with a return electrical path of the generator “G.” In the embodiment illustrated inFIG. 2 , a pair ofreturn electrodes electrode 102. More particularly, the pair ofreturn electrodes longitudinal section return electrode 104 may be operably disposed on one of the longitudinal sections, e.g.,longitudinal section 106. Each ofreturn electrodes bent section Return electrodes electrodes electrode 102. In one particular embodiment, returnelectrodes electrodes electrode 102. - A layer of
insulative coating 116 is operably disposed on a portion of theelectrode assembly 100. In the embodiment illustrated inFIGS. 1 and 2 , a layer ofinsulative coating 116 is operably disposed between thereturn electrodes electrode 102 and, more particularly, a layer of insulative coating is disposed along thebent sections Insulative coating 116 may be made from any suitable material including but not limited to Teflon®, Teflon® polymers, silicone and the like. - In use, initially,
electrode assembly 100 including cuttingelectrode 102 and returnelectrodes sheath 22 of the resectoscope.Sheath 22 is inserted into a urethra of a patient.Electrode assembly 100 including cuttingelectrode 102 and returnelectrodes movable handle 26 ofresectoscope 22 from within the sheath 22 (and submerged within the conductive medium, e.g., saline) to an area adjacent a target tissue resection site, e.g., prostate of a patient. Thereafter, electrosurgical energy is transmitted to the cuttingelectrode 102. It is noted, the radius of curvature typically associated with bent sections of conventional electrode assemblies is larger compared to a radius of curvature associated with cutting electrodes associated with the same electrode assemblies. Accordingly, in conventional electrode assemblies, the proximity of the bent sections with respect to one or more return electrodes associated with the electrode assemblies provide a return path of least resistance for current (when compared to the target tissue resection site) effectively shunting a fraction of the current to the return electrode(s). Shunting a fraction of the current through the return electrode(s) may decrease the current density at the cutting electrode, which, in turn, decreases the hemostatic efficacy provided by the electrode assembly during a resection procedure, e.g., a TURP procedure. In accordance with the present disclosure, providing aninsulative coating 116 in a manner as described herein, minimizes and/or prevents high current densities from developing adjacent thebent sections electrode 102. Accordingly, an optimum amount of current is shunted through thereturn electrodes electrode 102 such that hemostatic efficacy at the target tissue resection site and power transfer from the generator “G” to the cuttingelectrode 102 is maximized with theelectrode assembly 100. - With reference to
FIGS. 3A and 3B , an alternate embodiment ofelectrode assembly 100 is shown and designatedelectrode assembly 200.Electrode assembly 200 is substantially similar to that ofelectrode assembly 100 and so as not to obscure the present disclosure with redundant information, only those features that are unique toelectrode assembly 200 are described in detail herein.Electrode assembly 200 is described in terms of use withresectoscope 20. Accordingly, only those operative components associated withresectoscope 20 necessary to facilitate understanding of theelectrode assembly 200 are described in detail herein. - Electrode assembly includes a
dielectric shield 220.Dielectric shield 220 may be made from any suitable material including but not limited to, flouropolymer, polyimide, polyamide, polyaryl sulfone, silicone plastic and the materials described above with respect to theinsulative material 116.Dielectric shield 220 may have any suitable configuration. In the embodiment illustrated inFIGS. 3A and 3B ,dielectric shield 220 includes a generally arcuate or concave configuration.Dielectric shield 220 is operably coupled toelectrode assembly 200. More particularly,dielectric shield 220 operably couples to each of a pair oflongitudinal sections electrode assembly 200 adjacentbent sections 212 and 214.Dielectric shield 220 extends toward and past a cuttingelectrode 202 such thatdielectric shield 220 is positioned distally relative to the cuttingelectrode 202. Positioning thedielectric shield 220 distally relative to the cuttingelectrode 202 increases a return path for current through a conductive medium, e.g., saline, to one ormore return electrodes 204, e.g., returnelectrodes electrode assembly 200 when theelectrode assembly 200 including cuttingelectrode 202 and returnelectrodes return electrodes electrode 202 and adjacent the target tissue resection site.Dielectric shield 220 may be secured to theelectrode assembly 200 by any securement method(s) and/or device(s) including but not limited to soldering, brazing, welding, etc. In the embodiment illustrated inFIGS. 3A and 3B ,dielectric shield 220 is welded to each of thelongitudinal sections dielectric shield 220 may be operably associated with theresectoscope 20 and positionableadjacent cutting electrode 202 during a TURF procedure.Dielectric shield 220 may have any suitable dimensions, e.g., width, height, thickness, etc. In one particular embodiment, a thickness ofdielectric shield 220 ranges from about 0.005 inches to about 0.100 inches. - Operation of a
resectoscope 20 with anelectrode assembly 200 is substantially similar to that ofelectrode assembly 100. In use,electrode assembly 200 includingdielectric shield 220, cuttingelectrode 202 and returnelectrodes movable handle 26 ofresectoscope 22 from within the sheath 22 (and submerged within the conductive medium, e.g., saline) to an area adjacent a target tissue resection site.Dielectric shield 220 increases a return path for current through the saline to returnelectrodes return electrodes electrode 202 and adjacent the target tissue resection site. Accordingly, an optimum amount of current is shunted through thereturn electrodes electrode 202 such that hemostatic efficacy at the target tissue resection site and power transfer from the generator “G” to the cuttingelectrode 202 is maximized with theelectrode assembly 200. - With reference to
FIGS. 4A and 4B , and initially with reference toFIG. 4A , an alternate embodiment ofelectrode assemblies electrode assembly 300.Electrode assembly 300 is substantially similar to that ofelectrode assemblies electrode assembly 300 are described in detail herein.Electrode assembly 300 is described in terms of use withresectoscope 20. Accordingly, only those operative components associated withresectoscope 20 necessary to facilitate understanding of theelectrode assembly 300 are described in detail herein. - In accordance with the present disclosure, hemostasis is a combination of heating depth and energy per volume. Heating depth and/or energy per volume can both be modified by varying a distance “d” between a cutting electrode, e.g., a cutting
electrode 302, and one or more return electrodes, e.g., areturn electrode 304 including a pair ofreturn electrodes electrode 302 and returnelectrodes FIG. 4B . At a distance where “d” is equal to zero, e.g., “d0”, cuttingelectrode 302 and returnelectrodes electrode 302 and returnelectrodes FIG. 4B at distance “d3”) that includes a cutting electrode and one or more return electrodes positioned on a patient's body. At some intermediate distance “d” (e.g., a distance “d2” where “d1”<“d2”<“d3”), the energy volume is higher in a bipolar electrocautery system when compared to a monopolar electrocautery system. In accordance with the present disclosure, this behavior is utilized to develop anelectrode assembly 300 that maximizes hemostasis and energy per volume at a target tissue resection site, with minimal heating depth required at the target tissue resection site resulting in less collateral damage to adjacent tissue. - To this end, cutting
electrode 302 and returnelectrodes electrode 302 and returnelectrodes electrode 302 and returnelectrodes electrode 302 to build-up without interference from thereturn electrode 304, i.e., shunting effect of current through saline to thereturn electrodes - In an embodiment (
FIG. 4C ),electrode assembly 300 may be designed with a user-selectable distance “d” interface. In this instance, the distance between the cuttingelectrode 302 and returnelectrodes longitudinal sections internal portion elongated portions electrode 302. More particularly, a mechanical interface (e.g., a friction fit mechanical interface or a indent and detent interface between theinternal portions elongated portions electrode 302 in a substantially fixed, spaced-apart relation with respect to thereturn electrodes elongated portions FIG. 4C , one or more detents 320 (three detents shown for illustrative purposes) operably disposed along a length of each of theelongated portions internal sections electrode 302, theelongated portions elongated sections elongated portions longitudinal sections electrode 302 includingelongated portions internal portions longitudinal sections 306 and 308 (see directional arrow “F” inFIG. 4C , for example). - Operation of a
resectoscope 20 with anelectrode assembly 300 is substantially similar to that ofelectrode assemblies electrode assembly 300 including cuttingelectrode 302 and returnelectrodes movable handle 26 ofresectoscope 22 from within the sheath 22 (and submerged within the conductive medium, e.g., saline) to an area adjacent a target tissue resection site. Cuttingelectrode 302 and returnelectrodes electrode 302 to build-up without interference from the return electrode 304 (i.e., shunting effect of current through saline to thereturn electrodes return electrodes electrode 302 such that hemostatic efficacy at the target tissue resection site and power transfer from the generator “G” to the cuttingelectrode 302 is maximized with theelectrode assembly 300. - With reference to
FIG. 5 , an alternate embodiment of theelectrode assemblies electrode assembly 400.Electrode assembly 400 is substantially similar to that ofelectrode assemblies electrode assembly 400 are described in detail herein.Electrode assembly 400 is described in terms of use withresectoscope 20. Accordingly, only those operative components associated withresectoscope 20 necessary to facilitate understanding of theelectrode assembly 400 are described in detail herein. - Cutting
electrode 402 includes a cross-section loop diameter that varies. More particularly, atop portion 402 a of the cuttingelectrode 402 is thicker than abottom portion 402 b of the cuttingelectrode 402. In this instance,bottom portion 402 b of cuttingelectrode 402 provides a radius of curvature that is smaller than a radius of curvature of atop portion 402 a of the cuttingelectrode 402. Accordingly, an electric field at thebottom portion 402 b, i.e., having the smaller radius of curvature, is increased resulting in an increase in current density at thebottom portion 402 b and adjacent a target tissue resection site.Top portion 402 a andbottom portion 402 b may have any suitable diameter. In the embodiment illustrated inFIG. 5 ,bottom portion 402 b has a diameter that ranges from about 0.0012 inches to about 0.0016 inches at its thinnest point. As illustrated inFIG. 5 , the cross-section diameter of the cuttingelectrode 402 gradually increases from thebottom portion 402 b toward thetop portion 402 a. This gradual increase prevents “hot spots” from developing across portions of the cuttingelectrode 402. Varying the cross-section diameter of the cuttingelectrode 402 may provide one or more additional advantages when compared to certain conventional electrode assemblies. More particularly, the thickertop portion 402 a, which is less likely to “breakdown,” e.g., arc, of the cuttingelectrode 402 may be utilized for coagulating and thethinner bottom portion 402 b of the cuttingelectrode 102, which is more likely to arc, may be used for cutting. - Operation of a
resectoscope 20 with anelectrode assembly 400 is substantially similar to that ofelectrode assemblies electrode assembly 400 including cuttingelectrode 402 and areturn electrodes 404 includingreturn electrodes movable handle 26 ofresectoscope 22 from within the sheath 22 (and submerged within the conductive medium, e.g., saline) to an area adjacent a target tissue resection site.Bottom portion 402 b of cuttingelectrode 402 provides a radius of curvature that is smaller than a radius of curvature of atop portion 402 a of the cuttingelectrode 402. Accordingly, the electric field at thebottom portion 402 b is larger resulting in an increase in current density at thebottom portion 402 b and adjacent the target tissue resection site. Accordingly, an optimum amount of current is shunted through thereturn electrodes electrode 402 such that hemostatic efficacy at the tissue resection site and power transfer from the generator “G” to the cuttingelectrode 402 is maximized with theelectrode assembly 400. - With reference to
FIG. 6 , an alternate embodiment of the previously describedelectrode assemblies electrode assembly 500.Electrode assembly 500 is substantially similar to that ofelectrode assemblies - In conventional electrode assemblies, during initiation of a cutting pass of a cutting electrode, a delay is typically required for an arc discharge to develop at the cutting electrode. This delay may be attributed to a low impedance of the conductive medium, e.g., saline, surrounding the cutting electrode when the cutting electrode is initially submerged in the saline. In accordance with present disclosure, the cutting
electrode 502 includes one or more types of surface finishes that promotes and/or facilitates vapor bubble adhesion or minimizes the energy required for bubble nucleation on the cuttingelectrode 502, which, in turn, minimizes the time delay for an arc to develop at the cuttingelectrode 502. To this end, cuttingelectrode 502 includes a surface finish that includes a hydrophobic finish 520 (shown phantomly for illustrated purposes), a textured finish (e.g., a pitted finish 522), and/or combination thereof. In the embodiment illustrated inFIG. 5 a plurality ofpits 522 is operably disposed along a length of the cuttingelectrode 502 with ahydrophobic coating 520 substantially surrounding the cuttingelectrode 502 including the plurality ofpits 522. - Operation of a
resectoscope 20 with anelectrode assembly 500 is substantially similar to that ofelectrode assemblies electrode assembly 500 including cuttingelectrode 502 and a return electrode 504 (comprised ofreturn electrodes movable handle 26 ofresectoscope 22 from within the sheath 22 (and submerged within the conductive medium, e.g., saline) to an area adjacent a target tissue resection site. Cuttingelectrode 502 includes a surface finish that includes a combination of ahydrophobic finish 520 coating the cuttingelectrode 502 and plurality ofpits 522. The surface finish of the cuttingelectrode 502 promotes or facilitates vapor bubble adhesion or minimizes the energy required for bubble nucleation on the cuttingelectrode 502, which, in turn, minimizes the time delay for an arc to develop at the cutting electrode. Accordingly, an optimum amount of current is shunted through thereturn electrodes electrode 502 such that hemostatic efficacy at the tissue resection site and power transfer from the generator “G” to the cuttingelectrode 502 is maximized with theelectrode assembly 500. - From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, in an embodiment, a controller 600 (
FIG. 1 ) may be in operative communication with the generator “G” and/orresectoscope 20 with one or more of the previously described electrode assemblies, e.g.,electrode assembly 300, operably coupled to theresectoscope 20.Controller 600 may include one or more modules configured to monitor and/or control one or more electrical parameters (or other suitable parameters) associated with theelectrode assembly 300. More particularly, adistance control module 602 may be configured to “virtually” alter the distance between thereturn electrodes electrode 302 such that specific attributes associated with a desired point along a control curve, e.g., a control curve similar to the curve illustrated inFIG. 4B , may be obtained without actually moving either of the cuttingelectrode 302 or thelongitudinal sections return electrodes distance control module 602 may be configured to selectively open or close each of the return path segments such that the return path for current may be controlled. Thus, in an instance where a distance “d” needs to be increased, thedistance control module 602 may open one or more return path segments, e.g., a distal most return segment associated with each of thereturn electrodes return electrodes return electrodes electrode 302. - While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
Claims (15)
1. An electrode assembly, comprising:
a proximal end adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source;
a distal end including a cutting electrode having a loop configuration configured to cut tissue, the distal end including a return electrode operably disposed adjacent the cutting electrode; and
a dielectric shield operably disposed between the cutting electrode and return electrode, the dielectric shield extending distally past the cutting electrode to hinder current flow to the return electrode when the dielectric shield, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
2. An electrode assembly according to claim 1 , wherein the dielectric shield is disposed parallel to the longitudinal axis defined by the housing, and above the cutting electrode.
3. An electrode assembly according to claim 1 , wherein the dielectric shield includes a generally arcuate configuration and extends laterally across the electrode assembly.
4. An electrode assembly according to claim 1 , wherein the dielectric shield is formed from material selected from the group consisting of flouropolymer, polyimide, polyamide, polyaryl sulfone and silicone plastic.
5. An electrode assembly according to claim 1 , wherein a thickness of the dielectric shield ranges from about 0.005 inches to 0.100 inches.
6. An electrode assembly according to claim 1 , wherein the cutting electrode is a wire made from metal selected from the group consisting of tungsten, tungsten alloys and stainless steel.
7. An electrode assembly according to claim 6 , wherein a cross-section diameter of the wire ranges from about 0.25 mm to about 4 mm.
8. An electrode assembly according to claim 1 , wherein the loop configuration of the cutting electrode includes a diameter that ranges from about 3 mm to about 10 mm.
9. An electrode assembly according to claim 1 , wherein a cross section of the cutting electrode includes a shape selected from the group consisting of circular, hemicircular, square, rectangular, triangular, polygonal and combinations thereof.
10. An electrosurgical instrument, comprising:
an elongated housing having a lumen defining a longitudinal axis therethrough, the elongated housing having distal and proximal ends, the proximal end adapted to connect to an electrosurgical energy source;
an electrode assembly comprising:
a proximal end adapted to connect to the distal end of the elongated housing;
a distal end including a cutting electrode having a loop configuration configured to cut tissue, the distal end including a return electrode operably disposed adjacent the cutting electrode; and
a dielectric shield operably disposed between the cutting electrode and return electrode, the dielectric shield extending distally past the cutting electrode to hinder current flow to the return electrode when the dielectric shield, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
11. An electrode assembly, comprising:
a proximal end adapted to connect to an electrosurgical instrument including a housing defining a longitudinal axis therethrough and an electrosurgical energy source;
a distal end including a cutting electrode having a loop configuration configured to cut tissue, the distal end including a return electrode operably disposed adjacent the cutting electrode; and
an insulative material operably disposed between the cutting electrode and return electrode to hinder current flow to the return electrode when the insulative material, cutting electrode and return electrode are submersed in a conductive solution and the cutting electrode is energized, thereby concentrating current density at the cutting electrode.
12. An electrode assembly according to claim 11 , wherein the insulative material is disposed parallel to the longitudinal axis defined by the housing, and above the cutting electrode.
13. An electrode assembly according to claim 11 , wherein a proximal end of the cutting electrode includes a pair of curved sections.
14. An electrode assembly according to claim 13 , wherein the insulative material is operably disposed along the pair of curved sections of the cutting electrode.
15. An electrode assembly according to claim 11 , wherein the insulative material is selected from the group consisting of flouropolymer, polyimide, polyamide, polyaryl sulfone, silicone plastic and polytetrafluoroethylene.
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
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US14/136,017 US20140236143A1 (en) | 2013-02-19 | 2013-12-20 | Electrosurgical electrodes |
EP14154456.9A EP2767250B1 (en) | 2013-02-19 | 2014-02-10 | Electrosurgical electrodes |
US16/142,374 US11071580B2 (en) | 2013-02-19 | 2018-09-26 | Electrosurgical electrodes |
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US201361766483P | 2013-02-19 | 2013-02-19 | |
US14/136,017 US20140236143A1 (en) | 2013-02-19 | 2013-12-20 | Electrosurgical electrodes |
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US16/142,374 Division US11071580B2 (en) | 2013-02-19 | 2018-09-26 | Electrosurgical electrodes |
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WO2021010936A1 (en) * | 2019-07-18 | 2021-01-21 | Богдан Ярославович ГРИЩУК | Method for radiofrequency resection of the meniscus and arthroscopic instrument for the implementation thereof (variants) |
US20210045800A1 (en) * | 2019-08-12 | 2021-02-18 | Olympus Winter & Ibe Gmbh | Electrode instrument and resectoscope, protected against short circuit |
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Also Published As
Publication number | Publication date |
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US11071580B2 (en) | 2021-07-27 |
EP2767250A1 (en) | 2014-08-20 |
EP2767250B1 (en) | 2018-07-25 |
US20190021786A1 (en) | 2019-01-24 |
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