EP1075222A1 - Instrument de cryochirurgie - Google Patents

Instrument de cryochirurgie

Info

Publication number
EP1075222A1
EP1075222A1 EP99919422A EP99919422A EP1075222A1 EP 1075222 A1 EP1075222 A1 EP 1075222A1 EP 99919422 A EP99919422 A EP 99919422A EP 99919422 A EP99919422 A EP 99919422A EP 1075222 A1 EP1075222 A1 EP 1075222A1
Authority
EP
European Patent Office
Prior art keywords
probe
path
region
cryogen
tip
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP99919422A
Other languages
German (de)
English (en)
Inventor
Louise Cuff
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Spembly Medical Ltd
Original Assignee
Spembly Medical Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Spembly Medical Ltd filed Critical Spembly Medical Ltd
Publication of EP1075222A1 publication Critical patent/EP1075222A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A61B2018/0231Characteristics of handpieces or probes
    • A61B2018/0262Characteristics of handpieces or probes using a circulating cryogenic fluid
    • A61B2018/0268Characteristics of handpieces or probes using a circulating cryogenic fluid with restriction of flow
    • A61B2018/0281Characteristics of handpieces or probes using a circulating cryogenic fluid with restriction of flow using a tortuous path, e.g. formed by fins or ribs

Definitions

  • This invention relates to cryosurgical apparatus for producing cryogenic cooling by vaporization of a liquid cryogen, such as liquid nitrogen.
  • the invention is particularly suitable for probe apparatus including a cooled tip region, but the invention is not limited exclusively to such apparatus.
  • cryosurgical probe Many different designs have been proposed to generate cooling at a boiling region at, or adjacent to, a tip of the probe.
  • the heatsink device consists of a lobed insert defining parallel axial exhaust paths through which the cryogen is channeled as it leaves the boiling region, to improve the thermal efficiency of the probe.
  • one aspect of the present invention is to guide the cryogen along a tortuous cryogen flow path at or adjacent to the cooling region.
  • tortuous is used herein in a very broad sense to mean that the flow path is generally longer than the linear (and/or longitudinal) dimension of the means defining the tortuous path. With such a tortuous path, the cryogen flow will not be purely in a single linear direction as the cryogen flows through the means defining the tortuous path.
  • tortuous flow path can improve the thermal efficiency of the apparatus by increasing the path length through the cooling region, and thus increase the length of time that the cryogen spends at, or adjacent to, the cooling region.
  • contact area with the cryogen will generally be greater than an alternative arrangement employing a non-tortuous path, to promote greater thermal coupling between the cryogen and the surrounding walls defining the flow path.
  • the tortuous path may be at the boiling region itself, or it may be immediately upstream and/or immediately downstream of the boiling region, forming a part of the feed into, or the exhaust from, the boiling region.
  • the tortuous path is predetermined or is predeterminable.
  • the tortuous path is well defined, rather than being a random path through a porous medium. This can provide better control of the fluid flow, and predictable cooling behavior.
  • a single tortuous path may be provided, or a plurality of tortuous paths may be provided along side, or "in parallel" with, each other.
  • the number of such paths "in parallel" with each other is less than about 20, more preferably less than about 15, more preferably less than 10, more preferably less than 5, more preferably less than 4, and more preferably less than 3.
  • the effect of a tortuous flow path is to concentrate, at least to some extent, the cooling cryogenic effect in the region of the means defining the tortuous path. This effect can be used to control, in a unique manner:
  • the shape of the iceball (for example, if a non-spherical iceball is desired).
  • the tortuous path is in intimate contact with an external wall portion of the cooling region of the apparatus. This can provide optimum thermal coupling between the cryogen flow path and the external cooling surface of the apparatus.
  • the tortuous path is defined by one or more surfaces or walls of heat conductive material.
  • the tortuous path may be defined by one or more labyrinth walls, or by one or more baffles.
  • the tortuous path is defining by a helical wall.
  • the helical wall may comprise a strip, or wire, which is wound around an inner carrier.
  • the inner carrier preferably is one of a plurality of concentric conduits for feeding cryogen to, and exhausting cryogen from, the boiling region, the helical strip or wire being received between the two conduits for defining a helical path in the outer of the concentric flow paths.
  • the helical wall may be defined by a helical fin fitted to, or integrally formed with, one of the inner and outer conduits.
  • the invention provides a cryosurgical probe comprising a probe tip, a boiling region at or adjacent to the probe tip for generating cooling by vaporization of liquid cryogen supplied through the tip, and means located at or adjacent to the tip for defining a non-axial flow path, the flow path having a path length greater than the axial length of said means.
  • non-axial is used herein broadly to mean that the flow path past or through said means includes at least one component in a direction other than the axial direction (i.e. the flow path direction is not purely axial).
  • the invention provides cryosurgical apparatus comprising a cooling region which, in use, is cooled by vaporization of liquid cryogen, and means located at or adjacent to the cooling region and defining a substantially helical cryogen flow path.
  • the invention provides cryosurgical apparatus comprising a cooling region which, in use, is cooled by vaporization of liquid cryogen, and means located at or adjacent to the cooling region and defining a tortuous flow path for cryogenic fluid, such that, in use, the apparatus creates a non-spherical iceball shape.
  • the iceball is elongate and/or at least partly concave.
  • the invention provides cryosurgical apparatus comprising a cooling region which, in use, is cooled by vaporization of liquid cryogen, and means located at or adjacent to the cooling region and defining a tortuous flow path for cryogenic fluid, such that, in use, the position of the iceball is defined by the position in the apparatus of said means defining the tortuous flow path.
  • the invention provides cryosurgical apparatus comprising a cooling region which, in use, is cooled by vaporization of liquid cryogen, and means located at or adjacent to the cooling region and defining a tortuous flow path, the amount of tortuosity varying and being dependent on the position in the cooling region.
  • the tortuosity varies (abruptly) from a maximum at one position to a minimum (zero) at a second position.
  • Fig. 1 is a schematic cross-section through a first embodiment cryosurgical probe
  • Fig. 2 is a schematic view illustrating the construction of the helical path at the tip
  • Fig. 3 is a schematic view illustrating an alternative construction of helical path
  • Fig. 4 is a schematic view illustrating a further alternative construction of helical path
  • Fig. 5 is a schematic cross-section through the tip of a second embodiment of probe
  • Figs. 6a-6d illustrate how the position of the iceball can be controlled according to the design of the probe
  • Figs. 7a-7d illustrate how the shape of iceball can be controlled according to the design of the probe;
  • Fig. 8 illustrates an alternative member for defining a helical flow path;
  • Fig. 9 is a schematic view illustrating an alternative tortuous flow path.
  • a cryosurgical probe 10 comprises a handle portion 12, a stem portion 14, and a tip portion 16.
  • liquid cryogen for example, liquid nitrogen
  • inlet port 18 the probe handle 12
  • exhaust port 20 the probe handle 12
  • the stem includes first and second concentric conduits 22 and 24 defining an inner passage 26 and an outer passage 28 extending between the handle 12 and the probe tip 16.
  • the outer passage 28 provides a cryogen inlet path for delivery of cryogen liquid to the probe tip;
  • the inner passage 26 provides an exhaust passage for removal of exhaust cryogenic fluid from the tip region 16.
  • the inner conduit 22 extends from the probe tip 16 to the exhaust port 20 to provide a direct path for exhaust cryogenic fluid.
  • the outer conduit 24 extends from the probe tip 16 into the handle 14 to a first outlet of a transfer chamber 30.
  • the transfer chamber has an inlet 32 coupled to the cryogen inlet port 18, and a second outlet 34 coupled to a bypass exhaust port 36.
  • the purpose of the transfer chamber 30, and of the bypass path, is similar to that described in the above-mentioned GB patent publications.
  • the transfer chamber serves to enable the gas in the inlet passages to vent away through the bypass port 36. This improves the flow of liquid reaching the tip 16, and allows rapid "cool down" of the probe tip.
  • the difference in the diameters of the confronting surfaces of the inner and outer conduits 22 and 24 is typically of the order of 1 mm or less.
  • the total diametric spacing may be about 0.5 mm.
  • the cross-sectional area of the inlet passage 28 in the stem 14 is relatively small. It will be appreciated that the flow of liquid into such a narrow region could be severely disrupted by the presence of gas if the bypass port 36 were not provided.
  • the provision of the bypass port 36, and the design of the transfer chamber 30 promote separation and venting of the gas from the main flow of cryogenic liquid.
  • a helical guide 40 is located between the inner and outer conduits 22 and 24, to define a helical entry path into the tip region.
  • a helical path is an example of a tortuous path which functions to increase the thermal efficiency of the probe for the following reasons:
  • cryogenic liquid spends a greater amount of time in the tip region, thus providing longer for the cryogenic liquid to boil and to transfer its cooling energy to the tip;
  • the guide 40 provides additional surface area for heat transfer at the tip region, to allow better thermal coupling between the tip and the cryogenic fluid;
  • the tortuous path introduces swirling, or turbulent flow, thereby increasing thermal contact between the liquid and the surrounding tip.
  • the guide 40 is formed from metal wire, for example, stainless steel wire or aluminum wire, wound into a spring shape 42.
  • the spring shape 42 is mounted over the end of the inner conduit 22, and can be secured in position by any suitable means, for example, by welding.
  • the wire is dimensioned so that the guide 40 will be in intimate contact with both the inner conduit 22 and the outer conduit 24 when the probe is assembled.
  • the wire may also provide accommodation of tolerance variations by being able to be squeezed, to some extent, between the inner and outer conduits.
  • Such a construction of the guide 40 is extremely simple and cheap, and can be fitted to existing probe designs without requiring major re-designing of the probes.
  • the effect of the guide 40 has been observed. It has been found that the guide does improve (reduce) the cool down time of the probe noticeably. Also, in contrast to many existing probes, virtually no liquid was returned in the exhaust path. This indicates that the guide 40 provides extremely good thermal coupling between the cryogenic liquid, and the tip material.
  • the effect of the guide 40 was also observed by changing the position and length of the guide along the stem 14. It has been found that the guide 40 effectively concentrates the cooling region of the probe. This can enable the cooling region to be engineered more precisely to suit particular applications.
  • Figs. 6a-6d illustrate how, in use, the position of the frozen iceball 60 can be controlled by the position in the probe of the helical guide (shown schematically at 40). If the helical guide 40 is moved away from the tip, the iceball is centered about a position which also moves back from the tip (Figs. 6b and 6c). Similarly, if the helical guide 40 is moved towards the tip, the iceball center moves correspondingly forward (fig. 6d). The iceball position shown in Fig. 6c is especially significant and useful, because the frozen region extends exactly up to, but not beyond, the tip of the probe.
  • Figs. 7a-7d illustrate how the shape of the frozen iceball 60 can be controlled by the length and configuration of the helical guide 40.
  • Figs. 7a and 7b illustrate the variation in iceball length for different lengths of helical guide 40.
  • Fig. 7c illustrates how a waisted iceball region 60 can be created by using first and second helical guides 40 and 40 spaced apart to define two "focii" of freezing.
  • the amount of cooling generated in the region 62 between the helical guides 40 is smaller than the amount of cooling at each guide 40, and this leads to a waisted shape, or at least a shape which includes a generally non-convex region.
  • the shape has an axis of rotational symmetry, corresponding to the probe axis.
  • Figs. 7d illustrates an alternative helical guide arrangement for producing a waisted frozen iceball 60.
  • a single helical guide 40 is employed, but having a varying pitch.
  • the pitch is closely spaced at the end regions 64 of the guide to focus the cooling in those regions, and relatively wide spaced at the central region 66, providing relatively less cooling in the central region.
  • the invention can therefore provide the probe designer with great flexibility and versatility for a given design of probe.
  • Different iceball positions, sizes and shapes can be generated from the same basic probe design simply by fitting tortuous guides (for example helical guides) at one or more desired positions within the probe.
  • tortuous guides for example helical guides
  • FIG 8 illustrates an alternative form of helical guide 40.
  • the guide 40 is formed as an integral, rigid unit 70 having a tubular core 72 from which projects a helical fin 74.
  • the unit 70 can be slid on to the inner conduit 22 with an interference fit, or be welded in position.
  • the helical insert or helical wire constructions of guide 40 are presently preferred, other constructions are also envisaged.
  • the guide could be formed integrally as a helical fin 44 on the outer surface of the inner conduit 22.
  • the guide could be formed integrally as a helical rib 46 on the inner surface of the outer conduit 24.
  • the guide is in intimate contact with at least one of the conduits, and more preferably, with the outer conduit in particular (to provide optimum thermal contact with the tip region to be cooled).
  • the probe tip would preferably be manufactured to quite tight tolerances, in order to ensure that there is no (or only a very small) gap between the guide 44 or 46, and the confronting surface of the opposite conduit. Any gap might tend to reduce the effectiveness of the guide, since cryogenic liquid may be able to leak around the guide, and take a more direct (less tortuous) path to the probe tip.
  • the probe is of a type in which the outer passage 28 is for the cryogen inlet, and the inner passage 26 is for the cryogen exhaust.
  • the roles of the inner passage 26 and the outer passage 28 are reversed.
  • the same reference numerals are used where appropriate, and the numerals are suffixed to denote modifications, as explained below.
  • the transfer chamber 30' is modified to receive the inner conduit 22.
  • the construction of the transfer chamber 30' is very similar to that described in the abovementioned GB patent publications.
  • the exhaust port 20' communicates directly with the outer passage 28.
  • the guide 40 remains in the space between the inner conduit 22 and the outer conduit 24, such that the guide is now at the entry to the exhaust path. Nevertheless, the guide still functions in the same way as described above, to pro-long the time in which the cryogen is at, or adjacent to, the tip region and to increase the thermal coupling between the cryogenic fluid and the tip region of the probe.
  • Fig. 9 illustrates an arrangement of baffles 50 and 52 to provide a tortuous path in place of the guide 40. Alternate baffles 50 and 52 project from the upper and lower surfaces, respectively, of the inner conduit 24 to define a sinusoidal-type path. Other tortuous path arrangements may be used as desired.
  • a single tortuous channel for example, only one path through the helical shape
  • other embodiments may employ two or more channels (in parallel) as desired.
  • a multi-start helix shape may be used having multiple paths in a manner similar to a multi-start screw thread.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Otolaryngology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un instrument de cryochirurgie, tel qu'une sonde (10), dans lequel le refroidissement est assuré par la vaporisation d'un fluide cryogénique, tel que de l'azote liquide. Un dispositif (40) adjacent à la zone de refroidissement de la sonde définit un trajet d'écoulement tortueux pour le fluide cryogénique vers, à travers ou depuis la zone de refroidissement, afin d'améliorer le rendement thermique de la sonde. Dans l'un des modes de réalisation, le dispositif (40) est constitué d'un fil enroulé en forme de ressort, qui définit un trajet hélicoïdal entre les conduits concentriques (22, 24) définissant les conduits d'entrée et de sortie (26, 28) du fluide cryogénique.
EP99919422A 1998-04-30 1999-04-30 Instrument de cryochirurgie Withdrawn EP1075222A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
GB9809342A GB2336781B (en) 1998-04-30 1998-04-30 Cryosurgical apparatus
GB9809342 1998-04-30
PCT/GB1999/001354 WO1999056641A1 (fr) 1998-04-30 1999-04-30 Instrument de cryochirurgie

Publications (1)

Publication Number Publication Date
EP1075222A1 true EP1075222A1 (fr) 2001-02-14

Family

ID=10831303

Family Applications (1)

Application Number Title Priority Date Filing Date
EP99919422A Withdrawn EP1075222A1 (fr) 1998-04-30 1999-04-30 Instrument de cryochirurgie

Country Status (4)

Country Link
EP (1) EP1075222A1 (fr)
JP (1) JP2002513615A (fr)
GB (1) GB2336781B (fr)
WO (1) WO1999056641A1 (fr)

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US6592577B2 (en) 1999-01-25 2003-07-15 Cryocath Technologies Inc. Cooling system
US6468268B1 (en) 1999-01-25 2002-10-22 Cryocath Technologies Inc. Cryogenic catheter system
DE102008010477A1 (de) * 2008-02-21 2009-09-03 Erbe Elektromedizin Gmbh Kryochirurgisches Instrument
EP2303168A1 (fr) 2008-04-16 2011-04-06 Arbel Medical Ltd. Instrument cryochirurgical avec échange thermique amélioré
WO2010081062A1 (fr) * 2009-01-12 2010-07-15 Boston Scientific Scimed, Inc. Systèmes et procédés de fabrication et d'utilisation d'un tube de transfert de réfrigérant spiralé pour cathéter de système de cryo-ablation
US7967814B2 (en) 2009-02-05 2011-06-28 Icecure Medical Ltd. Cryoprobe with vibrating mechanism
WO2010105158A1 (fr) 2009-03-12 2010-09-16 Icecure Medical Ltd. Dispositif de cryothérapie et de curiethérapie combinées, et méthode afférente
EP3173041B1 (fr) * 2009-09-02 2019-02-20 Endocare, Inc. Système cryogénique
US7967815B1 (en) 2010-03-25 2011-06-28 Icecure Medical Ltd. Cryosurgical instrument with enhanced heat transfer
US7938822B1 (en) 2010-05-12 2011-05-10 Icecure Medical Ltd. Heating and cooling of cryosurgical instrument using a single cryogen
US8080005B1 (en) 2010-06-10 2011-12-20 Icecure Medical Ltd. Closed loop cryosurgical pressure and flow regulated system
CA2816072A1 (fr) * 2010-10-27 2012-05-03 Cryomedix, Llc Appareil de cryoablation avec zone d'echange de chaleur renforce et procede associe
WO2012154195A1 (fr) * 2011-05-11 2012-11-15 Icecure Medical Ltd. Échangeur de chaleur spiralé pour instrument cryochirurgical
GB2507613B (en) * 2012-10-30 2015-09-16 Nitro Medical Ltd Liquid cryogen cryosurgery apparatus
US10390871B2 (en) 2015-02-20 2019-08-27 Galil Medical Inc. Cryoneedle
WO2019092627A1 (fr) 2017-11-13 2019-05-16 Biocompatibles Uk Limited Système de cryoablation avec détection d'imagerie par résonance magnétique
US11633224B2 (en) 2020-02-10 2023-04-25 Icecure Medical Ltd. Cryogen pump

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Also Published As

Publication number Publication date
GB2336781B (en) 2001-03-07
GB2336781A (en) 1999-11-03
GB9809342D0 (en) 1998-07-01
JP2002513615A (ja) 2002-05-14
WO1999056641A1 (fr) 1999-11-11

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