CN102639076A - Single aperture electrode assembly - Google Patents

Abstract

Systems and methods for securing a screen-type active electrode to the distal tip of an electrosurgical device used for selectively applying electrical energy to a target location within or on a patient's body. A securing electrode is disposed through the screen electrode and mechanically joined to an insulative support body while also creating an electrical connection and mechanical enagement with the screen electrode. The electrosurgical device and related methods are provided for resecting, cutting, partially ablating, aspirating or otherwise removing tissue from a target site, and ablating the tissue in situ. The present methods and systems are particularly useful for removing tissue within joints, e.g., synovial tissue, meniscus, articular cartilage and the like.

Description

The monopolar electrode assembly

The cross reference of related application

The application be submitted on August 13rd, 2008 and title continue for the part of the U. S. application of " Systems and Methods for Screen Electrode Securement " number 12/190,752, this application is incorporated this paper thus by reference into.

Technical field

The present invention relates generally to electrosurgical field, and relate more specifically to be used to apply the apparatus and method of high frequency voltage with ablation tissue.More specifically, the present invention relates to be used for smooth basically plate active electrode (screen-type active electrode) is fixed to the apparatus and method of distal end of the axostylus axostyle of electrosurgical instrument.

Background technology

Conventional electrosurgical method is widely used, because they realize hemostasis and the minimizing patient's bleeding relevant with organizing cutting operation usually, improves the visibility of surgeon to area for treatment simultaneously.A lot of electrosurgical equipment utilizations of in electrosurgery, using are generally from cutting of a slice conductive material or etched plate active electrode.Yet these electrosurgical equipment and process have a lot of shortcomings.For example, the plate active electrode distal end that generally need be fixed to insulating body and be fixed to equipment itself someway.Plate electrode (screen electrode) fails suitably to be fixed to insulating body possibly cause incorrect functions of the equipments and possible patient's injury during the electrosurgical process.

Before make great efforts to relate to machinery, heat and chemical devices or its various combinations with what dull and stereotyped active electrode was fixed to insulating body.A lot of mechanical fixation forms are utilized, and binding agent is used as chemical type of attachment, and welding plate can provide a kind of thermally coupled method.These mechanical connection methods also can comprise the use of the plastic or expendable distortion that just is being used to fixed material.Yet even combine with other method of attachment, the method for listing above that is used for fixing also only provides the more or less effective solution of generally in the operating period that prolongs, being challenged.

Therefore, the insulating body that needs the smooth dull and stereotyped active electrode of permission to be fixed to the electrosurgical instrument is kept the equipment and the method for electrical connection simultaneously through insulating body.The dull and stereotyped active electrode that particularly, need be used to provide electrical connection is to the reasonable and persistent fixing mechanical means that enhanced electrosurgical operating parameter is provided simultaneously at the insulating body at the distal end place of electrosurgical equipment.

Summary of the invention

The invention provides and be used for plate active electrode is mechanically secured to system, apparatus and method at the insulating body at the distal end place of electrosurgical equipment.Particularly, provide and be used in the operating period that prolongs the method and apparatus of fixed flat planar electrode reliably.In addition, method and system of the present invention is to providing expansion and enhanced electrosurgical operating parameter particularly useful.

In one aspect of the invention, fixing means comprises that the passage or the groove that are passed in plate electrode and the insulating body insert fixed electrode.Be insulated in the configuration of body supports at plate electrode, fixed electrode works plate electrode mechanically is coupled to insulating body, and works via electric connector plate electrode to be electrically coupled to high frequency electric source.Fixed electrode can be by the leg portion characterization of the extension that has protuberance (tab) at one end, and channel engagement or face in protuberance and the insulating body connect, thereby prevents the axially-movable of fixed electrode.Therefore, fixed electrode provides and plate electrode is connected to insulating body simultaneously also provides electrical connection the RF energy is transmitted into the mechanical means of plate electrode through insulating body.

Another configuration according to electrosurgical equipment of the present disclosure comprises active plate electrode, and it has at least two bilateral passages that pass it.Pass the passage setting of plate electrode and insert at least two double-side fastening electrodes respectively.In addition, equipment comprises the insulation supporting member that has correspondingly with respect at least two bilateral passages of plate electrode channel location.The double-side fastening electrode passes supporting member and the plate electrode passage inserts, and can be directed symmetrically, thereby allows the establishment of the RF zone of ablation between these two fixed electrodes.In addition, each has the leg portion that has protuberance at one end bilateral plate electrode, and wherein protuberance slides in the latched position in the supporting member so that plate electrode is fixing in position.

In some configuration, fixed electrode can be by the crenellation pattern characterization on upper surface.In addition, fixed electrode can form the shape of staple or bridge, thereby allows the establishment of another RF zone of ablation in the space between staple shape fixed electrode and plate electrode.In these configurations, the additional edge that on fixed electrode, forms can cause the electric current density that increases, therefore promotes the formation of improved RF zone of ablation.

In another configuration, active electrode comprises conducting plate, and it has single hole and is positioned at respect to the distal openings of suction chamber on the insulating body at distal end place of electrosurgical equipment.In representative embodiment, plate electrode is by the insulation support member support, makes single hole and suction chamber register on the flat board, thereby permission is aspirated unwanted tissue and electrosurgical by-product from target site.In addition, dull and stereotyped distal openings with suction chamber can be positioned on the cross side of instrument (for example, towards spending from 90 of instrument axis).

In opening procedure, system also can comprise and being used for the FLUID TRANSPORTATION element of conductive fluid transport to active electrode and target site.The FLUID TRANSPORTATION element can be arranged in instrument for example fluid cavity or pipe, or it can be the part of independent instrument.Alternatively, Signa Gel or for example spray saline electrolysis liquid or other Signa Gel can be coated to tissue.In addition, in the arthroscopy process, target site will be immersed in the conduction irrigation usually, promptly in the saline.In these embodiments, device can not have the FLUID TRANSPORTATION element.In these two embodiments, conductor fluid will be preferably provided in the electric current flow path between active electrode terminal and the refurn electrode.In exemplary, refurn electrode is positioned on the instrument, and with the spaced apart enough distances of active electrode terminal to avoid or to minimize short circuit current therebetween in fact and to isolate refurn electrode and the tissue of target site.

In another aspect of this invention; Method comprises one or more active electrodes (it can comprise active plate electrode and fixed electrode) is positioned at the target site in the patient body, and suction is applied to organizational structure moves organizational structure to active electrode.High frequency voltage then is applied between active electrode and the one or more refurn electrode so that organizational structure melts.Usually, organizational structure comprises flexibility or elastic [connective, for example joint tissue.Such tissue is difficult to use conventional mechanical and electrosurgical technology to remove usually, because tissue is away from the instrument obstruction that moves and/or in the rotation incision tip of mechanical doctor or little cleanser, become.By contrast, the present invention pulls to Elastic tissue with active electrode, and then uses said mechanism to make this ablation of tissue.

Description of drawings

Fig. 1 is the perspective view that merges the electrosurgical system of power supply and electrosurgical probe;

Fig. 2 is the perspective view of another electrosurgical system that merges power supply, electrosurgical probe and be used to transport fluid into the conductor fluid source of supply of target site;

Fig. 3 is the side view that is used to melt and remove the electrosurgical probe of tissue;

Fig. 4 is the viewgraph of cross-section of the electrosurgical probe of Fig. 3;

Fig. 5 illustrates the detailed view that melts of explanation tissue;

Fig. 6 is the amplification detailed view of distal end part of embodiment of the probe of Fig. 3;

Fig. 7 A and 7B are the fixed electrode that in the electrosurgical probe of Fig. 6, utilizes and the detailed view of plate electrode;

Fig. 8 is the exploded view of distal portions of the probe of Fig. 6;

Fig. 9 is the perspective view of distal portions of the probe of Fig. 6;

Figure 10 is the perspective view of fixed electrode and plate electrode;

Figure 11 A is the perspective view according to the single hole plate electrode on the distal portions of electrosurgical probe of at least some embodiments;

Figure 11 B is the perspective view of circular port plate electrode; And

Figure 12 A-H illustrates the plate electrode with inlet hole according at least some embodiments.

The specific embodiment

The invention provides be used for optionally with electric energy be applied in the patient body or on the system and method for target location.The present invention tissue site flooded by conductor fluid or buried process for example particularly useful in the arthroscopy operation of knee joint, shoulder, ankle, buttocks, elbow, hands or foot.In other process, the present invention maybe to be used for individually or the volume of conjunctive tissue remove the process of treat target tissue collagen contraction, melt and/or stop blooding useful.More specifically, embodiment as herein described provides electrosurgical equipment, and it is by the smooth basically dull and stereotyped active electrode characterization at the distal end place that is arranged in this equipment.In addition, this embodiment comprises the apparatus and method of insulating body that are used for plate electrode is mechanically secured to the distal end place of the equipment of being positioned at.This mechanical fixation method of plate electrode can prolong the electrosurgical operation of equipment phase through safer method of attachment is provided.

Before describing the present invention in detail, should be understood that to the invention is not restricted to certain variations as herein described, because can carry out various variations or revise and replaceable equivalents and without departing from the spirit and scope of the present invention to said invention.As will be tangible when having read the disclosure to those skilled in the art; Described herein with shown in each separate embodiments have discrete parts and characteristic; It can be easily with other several embodiments in any characteristic separate or make up, and do not depart from scope of the present invention or spirit.In addition, can much revise with the process action of the composition that adapts to specific situation, material, material, process, target or step, the spirit or scope of the present invention.All such modifications mean in the scope of claim as herein described.

Can carry out method as herein described by any order of the logically possible incident of being stated and the order of being stated of incident.In addition, in the occasion that the scope of value is provided, should be understood that each intervenient value between the upper and lower bound of this scope and any other regulation in this prescribed limit or intervenient value be included in the present invention.In addition, should imagine, any optional characteristic of described inventive variations can be by independently or combine any in the characteristic as herein described or a plurality ofly describe and advocate.

All existing themes that this paper mentions (for example; Publication, patent, patent application and hardware) all incorporated into this paper by reference, except this theme maybe with situation that theme of the present invention conflicts under (content that proposes at this paper in this case should be preponderated).The term of being quoted is only to they openly being provided before the application's submission day.Have no things to be interpreted as the present invention at this paper and do not have qualification according to existing the admitting prior to such material in time of inventing.

Mentioning of singular references comprised the probability that has a plurality of current identical terms.More specifically, as at this paper with in accompanying claims, use, singulative "/kind (a) ", " one/kind (an) ", " said (said) " and " should (the) " comprise plural indicant, only if context regulation clearly in addition.Be further noted that claim can be drafted to getting rid of any optional element.Therefore, this statement means with going ahead of the rest of the use of oppose the exclusiveness term relevant with the statement of claim element for example use or " negating " restriction of " only ", " having only " etc.s basic.At last, only if it should be understood that in addition regulation, otherwise all technology that this paper uses and scientific terminology have with the present invention under the field in the identical meaning of those of ordinary skill common sense.

The electrosurgical equipment of current embodiment can have aforesaid various configuration.Yet at least one modification of embodiment as herein described is used the therapeutic equipment of utilization technology.

As stated, assignee of the present invention has been developed

technology.

technology relates to applying of high-frequency electrical pressure reduction between one or more active electrodes and one or more refurn electrode, near destination organization, to strengthen high electric field intensity.High electric field intensity can produce through applying high frequency voltage, and high frequency voltage is enough in the end of active electrode and the zone between the destination organization, evaporate conductor fluid at least a portion at active electrode.Conductor fluid can be fluid or gas, for example be transported to target site or Already in target site isotonic saline solution, blood, extracellular or cell inner fluid or be coated to the viscous fluid example gel of target site.

When conductor fluid is made atom must condense when faster than them from surface evaporation by abundant heating again, gas forms.When this gas is made atom collide each other by abundant heating and when in this process, causing the release of electronics, Ionized gas or plasma form (so-called " the 4th state of matter ").In general, can pass its electric current and this gas of ionizing or through radio wave transmission is formed plasma in gas through heated air and through driving.These methods that plasma forms provide energy directly for the free electron in the plasma, and then the electron-atom collision discharges more electronics, and this process divides multistage carrying out, up to the ionizing that realizes expected degree.Can in the Plasma Physics of the R.J.Goldston of Plasma Physics Laboratory of Princeton University (1995) and P.H.Rutherford, find the more complete description of plasma, complete open this paper that incorporates into by reference of the document.

When the density of plasma or vapor film become enough low (that is, for aqueous solution less than about 1020 atom/cm ³The time), the electronics mean free path increase so that subsequently injected electrons can cause the knock-on ionization in vapor film.In case the ion particle in the plasmasphere has enough energy, they just quicken towards destination organization.The energy that high energy electron (for example, 3.5eV is to 5eV) radiates can bombard molecule and its key that fractures subsequently, makes molecular dissociation become free radical, and free radical then is combined into final gas or liquid substance.Usually, electronics carries electric current or radio wave absorbing, and therefore than ion heat.Therefore, the electronics of transporting towards refurn electrode from tissue is along with its most of warm that transmits plasma, allows ion to make the tissue element disassociation with non-thermal type in fact.

By means of this molecular dissociation (rather than thermal evaporation or carbonization), through bigger organic molecule to less molecule and/or atom for example the molecule cracking of hydrogen, oxygen, oxycarbide, Hydrocarbon and nitrogen compound targeted tissue structure carried out volume remove.Organizational structure is removed in this molecule cracking fully, and makes the organization material dehydration opposite through the fluid of removing in the cells of tissues with the extracellular fluid, as usually about electrosurgical dry with the situation of evaporating.The more detailed description of these phenomenons can find in the U.S. Patent number 5,697,882 of co-assigned, complete open this paper that incorporates into by reference of this patent.

During technological some are used at

; High frequency (RF) electric energy is applied in the conducting medium environment to shrink or to remove (that is, excise, cut or melt) organizational structure and be sealed in the crosscut vascular in the zone of destination organization.

technology is bigger to sealing to be that arteries on the order of magnitude of about 1mm also is useful at diameter for example.In such application; High frequency electric source with ablation mode and coagulation mode is provided; First voltage is applied to active electrode in ablation mode; Be enough to realize molecular dissociation or the cracking organized, and the second lower voltage is applied to active electrode (same electrode or different electrode) in coagulation mode, is enough to heat, the vascular of the cut-out in the shrinkage tissue and/or realize the hemostasis of the vascular of in-house cut-out.

The amount of the energy that is produced by

equipment can change through regulating various factors, and these factors for example are: the quantity of active electrode; Electrode size and interval; Electrode surface area; Uneven and sharp edges on electrode surface; Electrode material; Voltage that is applied and power; Current limiting device is inducer for example; Conductivity with the electrode fluid in contact; Fluidic density; And other factors.Therefore, these factors can be handled the energy level of controlling electrons excited.Because different organizational structuries has different molecular links, the configurable one-tenth of

equipment produces the molecular link of certain tissue that is enough to rupture but the energy of the molecular link of another tissue that is not enough to rupture.For example, fatty tissue (for example, Animal fat) has and need be higher than two keys that 4eV ruptures to the energy level of 5eV (generally approximately the order of magnitude of 8eV) in fact.Therefore,

equipment does not melt usually or removes such fatty tissue; Yet it can be used for melting effectively cell to discharge the fat inside content with liquid form.Certainly, factor can change, and makes that these pairs key is also available to be ruptured with the similar mode of singly-bound (for example, increase voltage or change the electric current density that electrode is configured to be increased in the electrode end place).The more complete description of these phenomenons can be found in the U.S. Patent number 6,355,032,6,149,120 and 6,296,136 of co-assigned, complete open this paper that incorporates into by reference of these patents.

The active electrode of

equipment can be near the inorganic insulation supporting member the far-end that is positioned at the instrument shaft bar or by the inorganic insulation support member support.Refurn electrode can be positioned on the instrument axostylus axostyle, on another instrument or on patient's the outer surface (that is, dissipate pad).The near-end of instrument will comprise and be used for refurn electrode and active electrode are coupled to the for example suitable electrical connection of electrosurgical generator of high frequency electric source.

Use the further discussion of

The Application of Technology and equipment in following patent, to find: the United States Patent (USP) 6 of the issue of all incorporating into by reference; 296; 638 and 7; 241,293.The unsettled U. S. application 11/612,995 that the Decembers in 2006 that are merged in were by reference submitted on the 19th.

In an example of

equipment that the embodiment that supplies current description is used; The refurn electrode of equipment general recently with the spaced apart suitable distance of active electrode, to avoid the having electrical short between the active electrode and refurn electrode under the conductor fluid.Under many circumstances, the spaced apart about 0.5mm of the proximal of the distal side edge of the exposed surface of refurn electrode and the exposed surface of active electrode is preferably about 1.0mm to 5.0mm to 25mm.Certainly, this distance can change along with different voltages with different scope, conductor fluid and according to the nearness of organizational structure and active electrode and refurn electrode.Refurn electrode will generally have the length of exposure in the scope of 20mm at about 1mm.

therapeutic equipment that uses according to this description can use single active electrode or the array of the active electrode opened in the distal surface spaced around of conduit or probe.In one embodiment of back; Electrod-array generally includes the active electrode of restriction of a plurality of electric currents independently and/or power control so that electric energy optionally is applied to destination organization, limit simultaneously from around conductor fluid for example the power consumption in blood, the normal saline etc. produce, electric energy applies the unwanted of surrounding tissue and environment.Can be through terminal being isolated from each other and each terminal being connected to the isolated independent power source of other active electrode to come active electrode is carried out Current Control independently.Alternatively, active electrode can be connected to the single electric wire that is coupled to power source each other with formation at the near-end or the far-end of conduit.

In some configuration; The independent active electrode of in electrod-array each can with all other active electrode electric insulations in the array in the instrument; And be connected to array in other active electrode in each isolated power source; Or when low resistivity material (for example, blood, conduction saline irrigation or Signa Gel) cause between refurn electrode and the independent active electrode than low impedance path the time be connected to restriction or interrupt the mobile circuit of electric current of active electrode.The isolated power source of the active electrode that each is independent can be the separate power source circuit with internal driving characteristic, and the internal driving characteristic is at the power that is restricted to relevant active electrode at the Low ESR return path when running into.As an example, isolating power source can be at user option constant current source.In this embodiment, will cause lower resistance heated level automatically than low impedance path, because heating is taken advantage of the square proportional of impedance with operating current.Alternatively, but the switch that single power source can be through independent startup or through the separate current limiting element for example inducer, capacitor, resistor and/or its make up and are connected to each active electrode.Can be in instrument, adapter, cable, controller or the conductive path of distal end along slave controller to instrument current limiting element is set.Alternatively, owing to form the oxide skin(coating) (for example, at metal for example lip-deep titanium of platinum or resistive coating) of selected active electrode, resistance and/or electric capacity can appear on the surface of active electrode.

equipment is not limited to electric isolated active electrode, or even a plurality of active electrode.For example, in certain embodiments, the array of active electrode can be connected to and pass the single lead that the conduit axostylus axostyle extends to the power source of high frequency electric.

The voltage difference that between refurn electrode and active electrode, applies will be at high frequency or radio frequency place; Generally approximately between 5kHz and the 20MHz; Usually approximately between 30kHz and the 2.5MHz; Preferably approximately between 50kHz and the 500kHz, usually less than 350kHz, and usually approximately between 100kHz and the 200kHz.In some applications, the applicant finds that the frequency of about 100kHz is useful, because tissue impedance is much bigger at this frequency place.As in heart or head and cervical region or in the process on every side, higher frequency (for example, possibly be desirable 400-600kHz), to minimize low-frequency current flowing in the nerve of heart or head and cervical region in other application examples.

The RMS that is applied (root-mean-square) voltage is usually in about 5 volts to 1000 volts scope; Preferably in about 10 volts to 500 volts scope; Usually in about 150 volts to 400 volts scope; Operator scheme or the expectation effect's (that is, shrink, condense, cut or melt) of depending on active electrode size, operating frequency and particular procedure to organizing.

Generally; Be used for that user's waveshape melts or the peak-to-peak voltage that cuts will be in 10 volts to 2000 volts scope; And preferably in 100 volts to 1800 volts scope; And more preferably in about 300 volts to 1500 volts scope, usually about 300 volts in the scope of 800 volts of peak-to-peak voltages (quantity, operating frequency and the operator scheme that once more, depend on electrode size, electronics).Lower peak-to-peak voltage will be used for the heating or the collagen contraction of coagulation of tissues, tissue; And will be generally from 50 to 1500, preferably 100 to 1000 and more preferably (once more, user's waveshape calculates these values) in the scope of 120 to 400 volts of peak-to-peak voltages.Higher peak-to-peak voltage for example be higher than about 800 volts peak-to-peak voltage maybe to harder material for example melting of skeleton be desirable, depend on other factors, for example the composition of geometric electrode structure and conductor fluid.

As stated; Voltage is usually with a series of potential pulses or (for example have sufficiently high frequency; Approximately 5kHz is to 20MHz) the form of alternative current of voltage amplitude of time variation be transferred; Make voltage applied (compare with the laser instrument that for example requires the little downright bad degree of depth, laser instrument is pulsed to 20Hz at about 10Hz usually) effectively continuously.In addition, with the pulse laser that generally has about 0.0001% dutycycle relatively, for the present invention, dutycycle (that is, be applied at energy any a second at interval in accumulated time) is on about 50% the order of magnitude.

Preferred power source of the present invention is carried and can be selected the high frequency electric of generation scope from several milliwatts of every electrode to tens of watts average power level, depends on the volume of the destination organization of just being treated and/or the temperature that the maximum that instrument tip is selected is allowed.Power source allows the user to select voltage levvl according to the specific needs of specific neurosurgery process, operation on heart, arthroscopy operation, dermatosis operation process, ophthalmic procedures, direct-view surgical operation or other endoscopic surgery process.For cardiac procedure with maybe be for neurosurgery, power source can have extra filter, it is used to filter the drain voltage at the frequency place that is lower than 100kHz, particularly the about voltage of 60kHz.Alternatively, can spuious low-frequency current possibly be use in debatable some process have higher operational frequency for example 300kHz to the power source of 600kHz.The description of a suitable power source can be found in the U.S. Patent number 6,142,992 and 6,235,020 of co-assigned, and the complete of these two patents openly incorporated this paper into for all purposes by reference.

Power source can be that electric current limits or otherwise control, makes destination organization or the undesirable heating of (non-target) tissue on every side not occur.In present embodiment preferred of the present invention; Electric current restriction inducer be placed to each independently active electrode connect; Wherein the inductance of inducer in the scope of 000uH, depends on electrical characteristics, the desirable tissue rate of heat addition and the operating frequency of destination organization at 10uH to 50.Alternatively, can use as in the past capacitor-inducer (LC) circuit structure of describing in 909, complete open this paper that incorporates into by reference of this patent at U.S. Patent number 5,697.In addition, can select current-limit resistor.Preferably; These resistors will have the big positive temperature coefficient of resistance; Make that the resistance of current-limit resistor obviously increases when any independent active electrode of levels of current pair and low resistance medium (for example, normal saline washing agent or blood) contact begins to rise; Thereby minimize the power delivery in (for example, normal saline washing agent or blood) from said active electrode to the low resistance medium.

With reference now to Fig. 1,, the excision that detailed description is used to organize, the exemplary electrical surgery systems that melts, condenses and/or shrink.As shown in, some embodiment of electrosurgical system generally includes the electrosurgical probe 20 that is connected to power supply 10, one or more electrode terminals that power supply is used on probe 20 provide high frequency voltage.Probe 20 is included in the connector shell 44 of its proximal end, and it is connected to the probe socket receptacle 32 of probe cable 22 removedly.The portions of proximal of cable 22 has adapter 34 at socket 36 places probe 20 is coupled to power supply 10.Power supply 10 has the controllable voltage levvl actuator 38 of operator to change at the voltage levvl display 40 observable voltage levvls that applied.Power supply 10 also comprises one or more pedals 24 and uses cable connector 28 to be coupled to the cable 26 of socket 30 removedly.Pedal 24 also can comprise the second pedal (not shown) that is used for remotely regulating the energy level that is applied to electrode terminal 42, and the 3rd pedal that is used between ablation mode and coagulation mode, switching (also not shown).

With reference now to Fig. 2,, now detailed description is used for the exemplary electrical surgery systems 211 of treatment at the tissue of " doing the field ".Certainly, system 211 also can use in " wet ", that is, target site is immersed in the conductor fluid.Yet this system is particularly useful in " doing the field ", and wherein fluid preferably is transported to target site through the electrosurgical probe.As shown in, electrosurgical system 211 generally includes electrosurgical handpiece or the probe 210 that is connected to power supply 228, power supply is used for to target site and fluid source 221 high frequency voltage being provided, fluid source is used for conductor fluid 250 is fed to probe 210 electrically.System 211 also can comprise and be used for being coupled to the vacuum source (not shown) that the suction chamber that is arranged in probe 210 (not shown) is used to aspirate target site via the connection tube (not shown) on the probe 210, like what discuss in more detail below.

As shown in, probe 210 generally includes proximal handle 219 and has the elongated axostylus axostyle 218 of the array 212 of electrode terminal 258 at its far-end.Connection cord 234 has the adapter 226 that is used for electrode terminal 258 is coupled to power supply 228.Electrode terminal 258 is electrically isolated from one, and each terminal 258 is connected to the active or Passive Shape Control network in the power supply 228 through a plurality of independent insulating inducer (not shown).Fluid supply tube 215 is connected to the fluid hose 214 of probe 210, is used for conductor fluid 250 is fed to target site.

Be similar to above-mentioned embodiment shown in Figure 1, power supply 228 has the controllable voltage levvl actuator 230 of operator to change at the voltage levvl display 232 observable voltage levvls that applied.Power supply 228 also comprises first, second and the 3rd pedal 237,238,239 and the cable 236 that is coupled to power supply 228 removedly.Pedal 237,238,239 allows the surgeon remotely to regulate the energy level that is applied to electrode terminal 258.In exemplary, first pedal 237 is used for power supply is placed " melting " pattern, and crus secunda pedal 238 places " condensing " pattern with power supply 228.The 3rd pedal 239 allows the user to regulate the voltage levvl in " melting " pattern.In ablation mode, enough voltage is applied to electrode terminal to set up condition to necessity of the molecular dissociation of tissue (that is, the part of evaporation conductor fluid, the charged particle in the ionizing vapor film, and these charged particles are quickened facing to tissue).As stated, will be to the voltage levvl of necessity of melting according to the quantity of electrode, size, shape and at interval, the electrode distance of extending from supporting member etc. change.In case the surgeon places power supply " melting " pattern, voltage levvl actuator 230 or the 3rd pedal 239 just can be used for degree or the erosiveness that the regulation voltage level melts with adjusting.

To recognize that power source voltage and mode can be by other input device controls.Yet the applicant finds, pedal is the method that makes things convenient for that the control power supply is kept probe simultaneously during the orthopaedic surgical operations operation process.

In coagulation mode, power supply 228 will enough low voltage be applied to electrode terminal (or coagulation electrode) with the evaporation of avoiding conductor fluid and the molecular dissociation of tissue subsequently.The surgeon can through step on respectively alternatively melting on the pedal 237,238 and coagulation mode between automatic conversioning power.This allow the surgeon former be in condense and melt between fast moving, and needn't shift his/her attention from the operation place, maybe needn't ask assistant's Switching power.As an example, when the surgeon moulds soft tissue in ablation mode, probe generally will seal simultaneously and/or coagulating tissue in the vascular of little cut-out.Yet big vascular or the vascular (for example, arteries) with high fluid pressure can be sealed in ablation mode.Therefore, the surgeon can only step on pedal 238, voltage levvl is reduced to automatically be lower than the threshold level that is used to melt, and in competent a period of time, enough pressure is applied on the vascular of cut-out with the sealing and/or the vascular that condenses.After this accomplished, the surgeon can return ablation mode through stepping on pedal 237 fast moving.

With reference now to Fig. 3 and 4,, show the exemplary electrical surgical probe 300 that merges active plate electrode 302.Probe 300 can comprise it can being the handle 306 of flexible or firm elongated axostylus axostyle 304, the near-end that is coupled to axostylus axostyle 304 and the electrode supporting member 308 that is coupled to the far-end of axostylus axostyle 304.Probe 300 also comprises active plate electrode 302 and fixed electrode 303.Refurn electrode 310 is recently spaced apart with plate electrode 302, and is provided for accomplishing the method for the current path between plate electrode 302 and the fixed electrode 303.As shown in, refurn electrode 310 preferably includes a little the annular exposed region near the axostylus axostyle 304 of insulation supporting member 308, generally is approximately 0.5 to 10mm, and more preferably be about 1 to arrive 10mm.Each is coupled to the adapter separately 328 (as shown in Figure 4) that is arranged in the handle 306 fixed electrode 303 and refurn electrode 310; Handle extends to the near-end of probe 300; Wherein adapter 328 suitably is electrically connected to power supply (for example, the power supply 228 among the power supply among Fig. 1 10 or Fig. 2).As shown in Figure 4, handle 306 defines the inner chamber 326 that holds electric connector 328, and is provided for being connected to the suitable interface that is electrically connected cable (for example, the cable 234 among the cable among Fig. 1 22 or Fig. 2).

Still with reference to figure 3 and 4; In certain embodiments; Plate electrode 302, fixed electrode 303 and insulation supporting member 308 are arranged such that plate electrode 302 and fixed electrode 303 (for example are positioned on the cross side of axostylus axostyle 304; Become 90 degree with the axostylus axostyle axis) contact from entering the mouth or the journal offset of the arthroscope opening tissue in the articular cavity to allow the doctor, axostylus axostyle 304 passes articular cavity during this process.In order to accomplish this, probe 300 can comprise the far-end that is coupled to axostylus axostyle 304 and have the electric insulation medicated cap 320 of transverse opening 322 that transverse opening is used to admit supporting member 308, plate electrode 302 and fixed electrode 303.

Axostylus axostyle 304 preferably includes the conductive material that is generally metal, and it is selected from the group that tungsten, stainless steel alloy, platinum or its alloy, titanium or its alloy, molybdenum or its alloy and nickel or its alloy are formed.Axostylus axostyle 304 can comprise electric insulation cover 309, forms one or more electric insulation crusts or coating, for example politef, polyimides etc. as the one of which.In that being set on the axostylus axostyle, the electric insulation cover prevents directly electrically contacting between these hardwares and any adjacent body structure or the surgeon.So directly electrically contacting between body structure and exposed electrodes possibly cause unwanted heating and the necrosis in the structure that causes downright bad contact point place.

Probe 300 also comprises the suction connection 314 that is used to be coupled to vacuum source and is used for from the internal suction chamber 312 (Fig. 4) of extra fluid, fragment of tissue of target site suction and/or the product (for example, foam) that melts.Preferably, connection tube 314 and suction chamber 312 fluid communication, thereby be provided at produce in the chamber 312 allow the surgeon with crumbly texture for example synovial tissue move the suction pressure of plate electrode 302 to.Generally, vacuum source is the standard hospital pump that suction pressure is provided to connection tube 314 and suction chamber 312.Shown in Fig. 3 and 4; Preferably including the internal suction chamber 312 of peeping pipe extends from connection tube 314 in handle 306; Pass the axially open 316 that axostylus axostyle 304 arrives in the supporting member 308, pass the transverse opening 318 that supporting member 308 arrives in the supporting member 308.It is adjacent with plate electrode 302 that transverse opening 318 is positioned to; Plate electrode also comprise on the surface that is arranged in plate electrode 302 and fluid be connected to transverse opening 318 to be used to allow to pass the suction inlet (not shown) of its suction, like what discuss in more detail below.

Fig. 5 is through using the removal that schematically shows destination organization according to the embodiment of electrosurgical probe 50 of the present disclosure in more detail.As shown in, high frequency voltage is enough to convert the conductor fluid (not shown) between destination organization 502 and active electrode terminal 504 to Ionized vapor film 512 or plasma.As the result of the voltage difference that is applied between electrode assemblie 504 and destination organization 502 (that is, the voltage gradient at plasmasphere 512 two ends), the charged particle 515 in plasma is accelerated.At sufficiently high voltage difference place, these charged particles 515 obtain the disassociation of the molecular link in enough energy cause with plasma field contacts the organizational structure.This molecular dissociation follows organized volume to remove (that is, melting distillation) and the for example generation of oxygen, nitrogen, carbon dioxide, hydrogen and methane of low-molecular-weight gas 514.Short range at the charged particle 515 of in-house acceleration is restricted to surface layer to minimize damage and the necrosis to lower-hierarchy 520 with the molecular dissociation process.

During this process, gas 514 passes suction opening and suction chamber is sucked into the vacuum source (not shown).In addition, extra conductor fluid is aspirated so that the surgeon watches from target site 500 with other fluid (for example, blood).During the melting of tissue, the residual heat that is produced by the current flux lines 510 between electrode terminal 504 and refurn electrode 511 (being generally less than 150 ℃) is enough to make the blood vessel of any cut-out at this position to condense usually.If no, the surgeon can switch to the power supply (not shown) in the coagulation mode through the level that reduces the voltage to the threshold value that is lower than fluid evaporator, as stated.This hemostasis simultaneously causes less hemorrhage and promotion surgeon to carry out the ability of this process.In case removed obturator, just rebulid and ventilate and drain, to allow organization healing and to turn back to its normal function.

With reference now to Fig. 6,, shows distal portions according to the preferred embodiment of electrosurgical probe of the present disclosure.Electrosurgical probe 600 comprises the active plate electrode 602 of the insulation supporting member 604 that is installed to the far-end that is arranged in elongated axostylus axostyle 601.Probe 600 also comprises the end of being coupled to axostylus axostyle 601 and is configured to admit plate electrode 602 and the electric insulation medicated cap 612 of supporting member 604.In preferred embodiments, fixed electrode 606 passes plate electrode 602 and extends plate electrode 602 is mechanically secured to supporting member 604 and electric insulation medicated cap 612 with supporting member 604.In some configuration, fixed electrode 606 can be by head 607, lower limb 608 and protuberance 610 characterizations.Preferably, head 607 contacts or engages the upper surface of plate electrode 602, thereby is provided for being transmitted in the electric installation of the RF energy between fixed electrode 606 and the plate electrode 602.Supporting member 604 can be by passage 609 and groove 611 characterizations, and wherein passage 609 is directed with respect to the axis normal ground of axostylus axostyle 601, and groove 611 is axially directed with respect to the axis of axostylus axostyle 601.Electric wire 613 at proximal extension, and is electrically connected to the electric connector (as stated) in the handle that is arranged in probe from groove 611.Refurn electrode 614 is spaced apart at near-end with plate electrode 602.As stated; In this embodiment; Plate electrode 602 and supporting member 601 are arranged such that plate electrode 602 (for example is positioned on the cross side of axostylus axostyle 601; Become 90 degree with the axostylus axostyle axis) contact from entering the mouth or the journal offset of the arthroscope opening tissue in the articular cavity to allow the doctor, axostylus axostyle 601 passes articular cavity during this process.

With reference now to Fig. 7 A,, shows the embodiment of fixed electrode 606.Fixed electrode 606 can use conductive material for example tungsten form, and the shape of fixed electrode 606 and section can be made via etching, cut or jet moulding.In some configuration, fixed electrode 606 can be formed lip-deep crenellation pattern 615 characterizations by the plasma of fixed electrode 606.The additional edge that in this configuration, on fixed electrode 606, is formed by crenellation pattern 615 can cause the electric current density that increases, promotes therefore to be used for that plasma forms and the formation in the improved zone that RF melts.

With reference now to Fig. 7 B,, plate electrode 602 will comprise conductive material, for example tungsten, titanium, molybdenum, rustless steel, aluminum, gold, copper etc.Plate electrode 602 will have at about 0.5 to 8mm, preferably about 1 diameter and about 0.05 to about 2.5mm, about 0.1 to 1mm thickness preferably in the scope of 4mm usually.Plate electrode 602 can have various shape, for example the shape shown in Fig. 7 B.Plate electrode can have the groove 616 that passes it, and can comprise suction opening 618, and it has the size and the configuration that can change according to certain applications.The exposed surface of plate electrode 602 is preferably normally planar, and not from the surface of plate electrode 602 or from the outthrust of the zones extension relevant with suction opening 618.Suction opening 618 generally passes suction accent 620 (see figure 8)s even as big as the fragment of tissue that allows to melt, and its diameter is generally about 2 to 30 mils, and diameter is preferably about 5 to 20 mils.In some applications, only the fluid that melts of suction and gaseous product (for example, foam) make the hole can be little must many cases as approximately less than 10 mils, usually possibly be desirable less than 5 mils.In some configuration, suction opening 618 can form zigzag or lightning shape.

Suction opening 618 preferably forms in the design such as zigzag or lightning shape, this design and the edge surface exposure that combines to provide along the border of suction opening 618 increase on every side even as big as the material that allows to be supposed to aspirate via enough open areas of suction accent entering suction chamber.Consistent with any distortion of the hole shape of selecting, suction opening 618 is by opening girth 619 and aperture area 620 characterizations.Opening girth 619 can be the exposure of delimiting to suction opening 618 edge surface length with, and aperture area 620 can be the two-dimensional in the zone of being delimited by the opening girth 619 of sealing.Alternatively, aperture area 620 can be in shape corresponding to the gross area of the exposed surface of the threedimensional solid of the projection of the area of suction opening 618.Discuss in more detail as following, preferably, the ratio of opening girth 619 and aperture area 620 is greater than the ratio of corresponding circular open girth with the circular open area, and wherein suction opening forms the shape of common circle.

With reference now to Fig. 8; Insulating electrode supporting member 604 preferably includes inorganic material; For example glass, pottery, silicon nitride, aluminium oxide etc., these inorganic material have been formed with horizontal and axial suction chamber opening 620,622 and have been formed with the one or more horizontal axial passageway 624 that is used to admit electric wire 613.Electric wire 613 extends from electric connector (that is, the electric connector 328 among Fig. 4), passes the path 624 in axostylus axostyle 601 and the supporting member 604, ends near the protuberance 610 of groove 611 and fixed electrode 606.Electric wire 613 is electrically connected to fixed electrode 606 (for example, through laser welding process), thereby fixed electrode 606 and plate electrode 602 are electrically coupled to high frequency electric source.With reference to figure 6, Fig. 7 B and Fig. 8, lower limb 608 can pass the groove 616 of plate electrode 602 and the passage 609 of supporting member 604 extends, and protuberance 610 can insert in the groove 611 of supporting member 604, makes protuberance 610 intervene or engage the part of supporting member 604.Make the placement of the fixed electrode 606 in protuberance 610 insertion grooves 611 create the mechanical means that fixed electrode 606 is connected to supporting member 604, thereby prevent that fixed electrode 606 from moving axially with respect to axostylus axostyle 601 and supporting member 604.In addition, the mechanical fixation method causes the catching of plate electrode 602 between fixed electrode 606 and supporting member 604.In addition, as stated, provide the RF energy fax that to pass supporting member 604 to be passed to the method for plate electrode 602 in the head 607 and the contact between the plate electrode 602 of fixed electrode 606.

In other embodiment; The mechanical connection method can be included in the passage 609 of supporting member 604 and the additional helical thread cutting in the lower limb 608 of fixed electrode 606 respectively, and wherein the lower limb 608 of fixed electrode 606 can operate the passage 609 that threadably engages supporting member 604.Other embodiment of the present disclosure can comprise that protuberance 610 forms barb or arrowhead form and is arranged to intervene the configuration of supporting member 604.And in other embodiment, protuberance 610 can be comprised in the supporting member 604 fully, and can further be fixed to supporting member 604 through epoxy resin.

With reference now to Fig. 9 and 10,, the distal portions of representative probe 600 is shown at least two double-side fastening electrodes 606 that have above that.In this configuration; Fixed electrode 606 can be directed symmetrically around the central axial line of axostylus axostyle 601; And can allow thus between directed symmetrically double-side fastening electrode 606 and the RF zone of ablation of between fixed electrode 606 and plate electrode 602, (that is, seeing Figure 10) or the establishment of plasma chamber 1000.The merging of symmetric fixed electrode 606 can allow the establishment by the space of plasma slab 1000 representatives that are used to realize that RF melts.

With reference now to Figure 11 A,, shows optional plate electrode configuration according at least some embodiments.Electrosurgical probe 1100 comprises the active plate electrode 1102 of the insulation supporting member 1104 that is installed to the far-end that is arranged in elongated axostylus axostyle 1101.Probe 1100 also comprises the end of being coupled to axostylus axostyle 1101 and is configured to admit plate electrode 1102 and the electric insulation medicated cap 1112 of supporting member 1104.In certain embodiments, at least one fixed electrode 1106 passes plate electrode 1102 and extends plate electrode 1102 is mechanically secured to supporting member 1104 and electric insulation medicated cap 1112 with supporting member 1104.Refurn electrode 1114 is spaced apart at near-end with plate electrode 1102.As stated; In this embodiment; Plate electrode 1102 and supporting member 1104 are arranged such that plate electrode 1102 (for example is positioned on the cross side of axostylus axostyle 1101; Become 90 degree with the axostylus axostyle axis) contact from entering the mouth or the journal offset of the arthroscope opening tissue in the articular cavity to allow the doctor, axostylus axostyle 1101 passes articular cavity during this process.

In certain embodiments, plate electrode 1102 can comprise conductive material, for example tungsten, titanium, molybdenum, rustless steel, aluminum, gold, copper etc.Plate electrode 1102 can have various shape and size, that is, can compare in the shape and size of the plate electrode embodiment shown in Fig. 7 B and Fig. 9 with this paper.In this embodiment, plate electrode can comprise suction opening 1118 (or inlet hole 1118), and it has the size and the configuration that can change according to certain applications.The exposed surface of plate electrode 1102 is preferably normally planar, and not from the surface of plate electrode 1102 or from the outthrust of the zones extension relevant with suction opening 1118.Inlet hole 1118 will generally pass suction/suction accent and/or suction/suction chamber (not shown) in the axostylus axostyle 1101 that is integrated into probe 1100 even as big as the fragment of tissue that allows to melt.

In the configuration according to this embodiment, inlet hole 1118 preferably forms in a kind of design, this design and the bore edges surface exposure that combines to provide increase even as big as the material that allows to be supposed to aspirate via enough bore regions of suction accent entering suction chamber.For example, inlet hole 1118 can preferably form the shape of star, asterisk, lightning etc.Consistent with the selected size and the shape of suction opening in the plate electrode 1102, inlet hole 1118 is by hole girth 1119 and hole area 1120 characterizations.In the configuration of describing according at least some embodiments, hole girth 1119 can be the exposure of delimiting to inlet hole 1118 edge surface length with, and hole area 1120 can be the two-dimensional in the zone of being delimited by blind bore girth 1119.Alternatively, hole area 1120 can be shown in shape the gross area corresponding to the exposed surface of the threedimensional solid of the projection of the area of inlet hole 1118.

In comparison and further describe this plate electrode hole design as an example; It gets into the edge surface that enough zones in the suction chamber combine to provide increase with making the material that is supposed to aspirate, in Figure 1B, illustrated have corresponding to hole area 1120 ' circumference 1119 ' the shape of circle in dispose corresponding and suitable inlet hole 1118 '.Inlet hole 1118 ' can be further is by the radius R definition, makes hole area 1120 ' have π R ²Value, and circumference 1119 ' the have value of 2 π R.Therefore, circumference 1119 ' with hole area 1120 ' ratio can be represented as

With reference to figure 11A and 11B, disclosure purpose is to have the design of the active plate electrode of the single non-circular hole that is used to aspirate the electrosurgical by-product.Therefore; For such plate electrode inlet hole design (itself and the bore edges surface that combines to have increase even as big as the enough bore regions in the permission material entering suction chamber) is provided; In preferred embodiments; If relevant hole area 1120 ' by round-shaped characterization, so inlet hole 1118 be arranged such that hole girth 1119 have basically greater than corresponding circumference 1119 ' value.Therefore, preferably, the shape of inlet hole 1118 can be by characterization, make and corresponding inlet hole 1118 ' comparison with shape of common circle, for the useful life longevity of plate electrode 1102 at least, the ratio of hole girth 1119 and hole area 1120 greater than

This circular shape have the circumference 1119 that value is 2 π R ' and with have π R ²The hole area 1120 ' relevant of value.

With reference now to Figure 12 A-H,, the other distortion of inlet hole configuration is illustrated as an example, and is not limited to current claim and disclosed theme.Any combination that can have the arc, angle, projection etc. of the exposed edge surface that limits inlet hole and hole girth according to the design of the inlet hole shape of at least some embodiments.Preferably, the plate electrode surface of exposure is normally planar in all embodiments, and not from the surface of plate electrode or from the outthrust of the zone relevant with inlet hole extension.For example, Figure 12 A illustrates the have formation plate electrode 1202A of inlet hole 1218A of shape of " type matrix S ".Inlet hole 1218A can be delimited by the hole girth 1219A that defines hole area 1220A.Figure 12 B illustrates the have formation plate electrode 1202B of inlet hole 1218B of shape of " many S curve ".Inlet hole 1218B can be delimited by the hole girth 1219B that defines hole area 1220B.Figure 12 C illustrates the have formation plate electrode 1202C of inlet hole 1218C of shape of " 4 arc stars ".Inlet hole 1218C can be delimited by the hole girth 1219C that defines hole area 1220C.Figure 12 D illustrates the plate electrode 1202D of the inlet hole 1218D of the shape with formation " double asterisk ".Inlet hole 1218D can be delimited by the hole girth 1219D that defines hole area 1220D.

Figure 12 E illustrates the plate electrode 1202E of the inlet hole 1218E of the shape with formation " four-leaf clover ".Inlet hole 1218E can be delimited by the hole girth 1219E that defines hole area 1220E.Figure 12 F illustrates the have formation plate electrode 1202F of inlet hole 1218F of shape of " multiple spot star ".Inlet hole 1218F can be delimited by the hole girth 1219F that defines hole area 1220F.Figure 12 G illustrates and has formation the plate electrode 1202G of inlet hole 1218G of the shape of " joining the alternative arc that repeats together ".Inlet hole 1218G can be delimited by the hole girth 1219G that defines hole area 1220G.Figure 12 H illustrates the have formation plate electrode 1202H of inlet hole 1218H of shape of " type matrix X ".Inlet hole 1218H can be delimited by the hole girth 1219H that defines hole area 1220H.

Can carry out other modification and variation with open embodiment, and not depart from the theme invention that limits in the claim below.For example, it should be noted that the electrod-array that the invention is not restricted to comprise a plurality of electrode terminals.The present invention's a plurality of refurn electrodes capable of using are for example in bipolar array etc.In addition, according to other condition, for example peak-to-peak voltage, electrode diameter etc., single electrode terminal can be enough to contact collagen tissue, ablation tissue etc.

In addition, active electrode and refurn electrode all can be adjacent to being positioned at each other on the distal tissue treatment surface.It is right that active electrode and refurn electrode can be positioned to active electrode/refurn electrode, or one or more refurn electrode can be positioned on the distal end with the isolated electrode terminal of a plurality of electricity.In these embodiments, can or can not use the nearside refurn electrode.For example, if hope to maintain the distal end current flux lines on every side of probe, then the nearside refurn electrode will not expected.

Though illustrate and described the preferred embodiments of the invention, those skilled in the art can carry out its modification and not depart from scope or the instruction of this paper.Embodiment as herein described only is exemplary and not restrictive.Because in the scope of this instruction, can much change and different embodiments; Equivalent structure or the material considered after being included in; And because in the embodiment that technical descriptive requirement is here detailed, can much revise; Should be understood that the details here should be interpreted as illustrative rather than on the meaning of restriction, explains.

Claims (22)

1. One kind be used in patient body or on target site remove the electrosurgical instrument of tissue, comprising:

   Axostylus axostyle, wherein said axostylus axostyle has proximal part and distal portions;

   Electrode assemblie, it comprises smooth basically active plate electrode on the said distal portions that is positioned at said axostylus axostyle, be positioned on the said axostylus axostyle and with isolated at least one refurn electrode of said active electrode and be positioned on the said distal portions of said axostylus axostyle and be electrically connected at least two fixed electrodes of said plate electrode;

   The electric insulation supporting member is equipped with said plate electrode above that, and said supporting member engages the part of said at least one fixed electrode that is used for fixing said plate electrode; And

   Wherein said plate electrode comprises the hole, and said hole has hole area and hole girth, and said hole girth is basically greater than corresponding circumference.
2. 2. instrument as claimed in claim 1, wherein said hole comprises starriness.
3. 3. instrument as claimed in claim 1, wherein said hole comprises the asterisk shape.
4. 4. instrument as claimed in claim 1, wherein said hole comprises the lightning shape.
5. 5. instrument as claimed in claim 1, the ratio of wherein said hole girth and said hole area is greater than the ratio of corresponding circumference with corresponding circular hole area.
6. 6. instrument as claimed in claim 1 also is included in the suction chamber in the said axostylus axostyle, and said suction chamber has and is coupled to said plate electrode with the obstruction that stops said chamber and the distal openings logical with said orifice flow bulk phase.
7. 7. instrument as claimed in claim 1, wherein said plate electrode is adjacent with buried organizational structure in conductor fluid, and said conductor fluid is accomplished the conductive path between said plate electrode and the said refurn electrode.
8. 8. instrument as claimed in claim 7; Wherein between said plate electrode and said refurn electrode, apply enough high-frequency voltage, with the said conductor fluid in the thin layer of evaporation at least a portion of said plate electrode to cause energy emitting from vapor film.
9. 9. instrument as claimed in claim 8, wherein energy is enough to form plasma from said the emitting of said vapor film.
10. 10. instrument as claimed in claim 8, wherein said vapor film contact said organizational structure and can melt the part of said organizational structure.
11. 11. instrument as claimed in claim 1 also comprises on the said distal portions that is positioned at said axostylus axostyle and is electrically connected at least one fixed electrode of said plate electrode.
12. 12. one kind be used in patient body or on target site remove the electrosurgical instrument of tissue, comprising:

    Axostylus axostyle, wherein said axostylus axostyle has proximal part and distal portions;

    Active electrode on said distal portions;

    Refurn electrode on said axostylus axostyle;

    The electric insulation supporting member, it separates said active electrode and said refurn electrode; And

    Wherein said active electrode comprises the hole, and said hole has hole area and hole girth, and said hole girth is basically greater than corresponding circumference.
13. 13. instrument as claimed in claim 12, wherein said hole comprises starriness.
14. 14. instrument as claimed in claim 12, wherein said hole comprises the asterisk shape.
15. 15. instrument as claimed in claim 12, wherein said hole comprises the lightning shape.
16. 16. instrument as claimed in claim 12, the ratio of wherein said hole girth and said hole area is greater than the ratio of corresponding circumference with corresponding circular hole area.
17. 17. instrument as claimed in claim 12 also is included in the suction chamber in the said axostylus axostyle, said suction chamber has and is coupled to said plate electrode with the obstruction that stops said chamber and the distal openings logical with said orifice flow bulk phase.
18. 18. instrument as claimed in claim 12, wherein said plate electrode is adjacent with buried organizational structure in conductor fluid, and said conductor fluid is accomplished the conductive path between said plate electrode and the said refurn electrode.
19. 19. instrument as claimed in claim 18; Wherein between said plate electrode and said refurn electrode, apply enough high-frequency voltage, with the said conductor fluid in the thin layer of evaporation at least a portion of said plate electrode to cause energy emitting from vapor film.
20. 20. instrument as claimed in claim 19, wherein energy is enough to form plasma from said the emitting of said vapor film.
21. 21. instrument as claimed in claim 19, wherein said vapor film contact said organizational structure and can melt the part of said organizational structure.
22. 22. instrument as claimed in claim 12 also comprises at least one fixed electrode that is electrically coupled to said active electrode and is fixed to said axostylus axostyle through said active electrode.

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