JP2019111422A - Electrosurgical systems and methods - Google Patents

Abstract

To provide systems and methods of an electrosurgical controller having multiple modes of operation that are configured for treatment of a specific targeted tissue type and an electrosurgical effect desired.SOLUTION: The treatment and effect are provided by a single controller and an electrosurgical probe. The electrosurgical controller includes an integrated fluid control apparatus or pump where activation of the controller allows for selective energy delivery and corresponding fluid volume flow rates. The electrosurgical probe includes a fluid transport lumen and is in communication with the controller and the pump for operation of the probe in the various user selected modes with accompanying energy delivery and fluid control directed to the desired treatment and surgical effect.SELECTED DRAWING: Figure 1

Description

  Electric surgery systems are used by surgeons to perform specific functions in a surgical procedure.

  Within the scope of these medical procedures, it may be necessary to treat more than one type of tissue or to generate tissue effects in more than one way. Existing electrosurgical systems are typically designed with limited functionality and are not always particularly effective for treating various types of tissue. In the event that a medical procedure needs to treat more than one type of tissue, the use of a single device can have adverse consequences in certain aspects of the medical procedure, and the user can obtain the desired surgery. It may be necessary to utilize or switch between several surgical devices in order to obtain the desired result. For example, certain electrosurgical procedures at the knee or shoulder may require several different modes of operation to effectively treat different types of tissue. Each mode utilizes different amounts of energy, and in the related art each mode may involve the use of different electrosurgical wands and different types of electrosurgical controllers. In some cases, if the use of multiple electrosurgical wands would have resulted in better treatment results, the surgeon should correct the wand and reduce the cost of the medical procedure. And / or may refrain from using the electrosurgical controller.

U.S. Pat. No. 5,697,882 U.S. Pat. No. 6,355,032 U.S. Pat. No. 6,149,120 U.S. Pat. No. 6,296,136 U.S. Pat. No. 8,192,424 U.S. Pat. No. 6,142,992 U.S. Pat. No. 6,235,020 U.S. Pat. No. 8,257,350

Plasma Physics, by R. J. Goldston and P. H. Rutherford, the Plasma Physics Laboratory of Princeton University (1995)

  Any benefit that makes the surgeon easier to treat and can achieve better results will offer advantages.

  For a detailed description of the exemplary embodiments, reference is made to the following attached drawings.

1 illustrates an electrosurgical system in accordance with at least some embodiments. FIG. 10A shows an elevation view of an electrosurgical wand in accordance with at least some embodiments. FIG. 10A shows a cross-sectional elevation view of an electrosurgical wand in accordance with at least some embodiments. FIG. 10A shows an elevated view of a screen electrode and a perspective view of the distal end of an electrosurgical wand including the screen electrode, in accordance with at least some embodiments. FIG. 7 shows an electrical block diagram of a controller in accordance with at least some embodiments. FIG. 7 shows an exemplary graph associated with various modes of output RF energy and suction flow in accordance with at least some embodiments.

Nomenclature and Nomenclature Specific terms are used throughout the following description and claims to refer to particular system components. As those skilled in the art will appreciate, companies designing and manufacturing electrosurgical systems may refer to components by different names. This specification is not intended to distinguish between components that differ in name but not function.

  In the following description and claims, the terms "comprise" and "comprising" are used in the sense of being non-limiting, and thus should be interpreted as meaning "including but not limited to" . Similarly, the term "couple" is intended to mean either an indirect connection or a direct connection. Thus, if the first device couples to the second device, the connection may be through a direct connection or through an indirect connection through another device or connection.

  Reference to a single item includes the possibility that more than one of the same item may be present. More specifically, as used in the present specification and the appended claims, "a", "an" and "the" indicating singular are expressly intended to indicate otherwise. If not explicitly stated, it includes multiple. Furthermore, it should be noted that the claims may be stated without any additional components. Thus, this reference acts as an antecedent to the use of exclusive phrases such as "simply", "only" and so on with respect to the recitation of the elements of the claims and the use of "negative" limitations. Finally, unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It should be understood to have

  "Ablative" shall mean removing tissue based on its interaction with plasma.

  "Ablation mode" shall refer to one or more characteristics of ablation. The “absent absence” (ie the absence of plasma) shall not be considered as the “ablation mode”. The mode in which coagulation is performed is not considered as "ablation mode".

  "Active electrode" shall mean an electrode of an electrosurgical wand that produces an effect of altering the electrically introduced tissue when brought into contact with or in close proximity to the targeted tissue for treatment .

  The "return electrode" serves to provide a current path for the charge to the active electrode and / or the electrode itself of the electrosurgical wand and the tissue which is electrically introduced into the target tissue for treatment By electrodes of an electrosurgical wand that does not produce a varying effect is meant.

  "Electric motor" shall include alternating current (AC) motor, direct current (DC) motor and stepping motor.

  "Control of fluid flow" means control of volumetric flow rate. Controlling the applied pressure to maintain a set pressure (e.g. suction pressure) independently of the volumetric flow rate of liquid caused by the applied pressure shall not be considered as "control of fluid flow". However, changing the applied pressure to maintain the set volumetric flow rate of the liquid is considered as "control of fluid flow".

  "Substantially" shall mean, with respect to the exposed surface area of the electrodes, that the exposed surface area between the two electrodes is not equal, or differ by more than 25 percent.

  The fluid conduits considered to be "inside" the long shaft are not only the individual fluid conduits physically present in all or part of the internal volume of the long shaft, but the internal volume of the long shaft itself is the fluid conduit It also includes situations where certain or individual fluid conduits are connected along or part of the length of the long shaft.

  When a range of values is provided, all values intervening between the upper and lower limits of the range and any other existing or intervening values within the declared range are encompassed within the scope of the invention It is understood that Also, any optional features of the variations of the described invention are described and claimed independently or in combination with any one or more of the features described herein.

  All objects present (e.g. documents, patents, patent applications and hardware) mentioned herein may contradict that of the present invention (in which case such objects exist here) Is incorporated by reference in its entirety, except where preferred. The referenced items are provided solely for disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present invention can not precede such materials by the effect of the prior invention.

DETAILED DESCRIPTION Before the detailed description of the various embodiments, various modifications and improvements may be made without departing from the spirit and scope of the present invention, and equivalents may be substituted. It should be understood that it is not limited to the particular variations described. It will be apparent to those skilled in the art who have read the present disclosure that each of the specific embodiments described and illustrated herein may be some other embodiments without departing from the scope or spirit of the present invention. Have separate components and features that can be easily separated from or combined with any feature of Furthermore, many modifications may be made to adapt a particular situation, material, composition of matter, process, process operation or steps, to the objective, spirit or scope of the present invention. All such modifications are intended to be within the scope of the claims made by the present invention.

  Various embodiments are directed to methods of electrosurgery and related electrosurgery systems. In particular, various embodiments are directed to an electrosurgical system having multiple modes of operation configured for treatment of a specific type of targeted tissue or desired electrosurgical effect Implemented by a surgical wand and a single electrosurgical controller. In the exemplary embodiment, the plurality of operating modes are implemented by a single active electrode of the electrosurgical wand. This specification first refers to an exemplary system to guide the reader.

  FIG. 1 illustrates an electrosurgical system 100 in accordance with at least some embodiments. Specifically, the electrosurgical system 100 includes an electrosurgical wand 102 (hereinafter “wand 102”) coupled to a controller 104 (hereinafter “controller 104”) for electric surgery. Wand 102 includes an elongated shaft 106 that defines a distal end 108. The long shaft 106 further defines a handle or proximal end 110 where the surgeon grasps the wand 102 during the surgical procedure. The wand 102 further includes a flexible multi-conductor cable 112 containing one or more electrical leads (not specifically shown in FIG. 1), which terminate within the wand connector 114. . As shown in FIG. 1, the wand 102 is coupled to the controller 104, such as by the controller connector 120 on the outer surface of the housing 122 (front side in the case of the exemplary FIG. 1).

  Although not visible in FIG. 1, in some embodiments the wand 102 has one or more internal fluid conduits coupled to the externally accessible tubular member. As shown, wand 102 has a flexible tubular member 116 used to provide suction at the distal end 108 of the wand. According to various embodiments, tubular member 116 is coupled to peristaltic pump 118, which is exemplarily shown as an internal component with controller 104 (ie, at least within housing 122 of controller 104). Partially located). In other embodiments, the housing of peristaltic pump 118 may be separate from the housing for controller 104 (as shown by the dotted line in the figure), but in any event, the peristaltic pump operates on controller 104 Combined possible.

  Peristaltic pump 118 includes a rotor portion 124 (hereinafter simply referred to as “rotor 124”) and a stator portion 126 (hereinafter simply referred to as “stator 126”). The flexible tubular member 116 is coupled between the rotor 124 and the stator 126 within the peristaltic pump 118, such that movement of the rotor 124 relative to the flexible tubular member 116 causes fluid to move towards the outlet 128. Although the exemplary peristaltic pump 118 is shown with a rotor 124 having two heads, various types of peristaltic pumps 118 may be used (eg, a peristaltic pump having five heads). In various embodiments, the peristaltic pump 118 generates volume-controlled aspiration from the surgical area at the distal end 108 of the wand 102, and control is based on the speed of the rotor 124 as commanded by the controller 104.

  With further reference to FIG. 1, a display or interface device 130 can be viewed through the housing 122 of the controller 104, and in some embodiments, the user can control the controller 104 by means of the interface device 130 and / or the associated button 132. Can select the operation mode of For example, using one or more buttons 132, the surgeon may use a low power mode that may be used to remove a portion of the cartilage, an intermediate power mode that may be used to remove the meniscus, tissue An ablation mode may be selected, such as a high power mode for large removal, and a vacuum mode for removal of free and / or trapped tissue. The various modes of operation are described more fully below.

  In some embodiments, the electrosurgical system 100 also includes a foot pedal assembly 134. The foot pedal assembly 134 may include one or more pedal devices 136 and 138, a flexible multi-conductor cable 140 and a pedal connector 142. Although only two pedal devices 136 and 138 are shown, one or more pedal devices may be implemented. Housing 122 of controller 104 may include a corresponding connector 144 coupled to pedal connector 142. The surgeon may use the foot pedal assembly 134 to control various aspects of the controller 104, such as the ablation mode. For example, the pedal device 136 may be used for on-off control of the application of radio frequency (RF) energy to the wand 102, and more particularly for controlling energy in the ablation mode. Additionally, pedal device 138 may be used to control and / or set the ablation mode of the electrosurgical system. For example, actuation of the pedal device 138 may switch between the energy levels generated by the controller 104 and switch the aspiration volume generated by the peristaltic pump 118. In particular embodiments, control of various operational or performance aspects of controller 104 may be activated by selectively depressing a button on a finger located on handle 110 of wand 102.

  The electrosurgical system 100 of various embodiments may have various modes of operation that employ Coblation® technology. Specifically, the assignee of the present disclosure is the owner of the Coblation® technology. Coblation® technology involves the application of radio frequency (RF) signals between one or more active electrodes of wand 102 and one or more return electrodes to generate high electric field strength in the vicinity of the target tissue. The electric field strength may be sufficient to evaporate the conductive fluid over at least a portion of the one or more active electrodes in the region between the one or more active electrodes and the target tissue. The conductive fluid may be inevitably present in the body, such as blood, or in some cases extracellular or intracellular fluid. In other embodiments, the conductive fluid may be a liquid or gas, such as an electrolytic salt. In some embodiments, such as surgical procedures involving knees, shoulders, etc., the conductive fluid is provided by the delivery system separated and spaced from the system 100 near the location of the active electrode and / or target.

  Gas is formed when energy is applied to the conducting fluid to the point where the atoms of the fluid evaporate, which is faster than atomic reaggregation. When sufficient energy is applied to the gas, the atoms collide with each other causing electrons to desorb during the process to form an ionized gas or plasma (the so-called "fourth state of matter"). Otherwise, the plasma may be formed by heating the gas and ionizing the gas by passing an electric current through the gas or by introducing an electromagnetic wave into the gas. The method of plasma formation gives energy directly to the free electrons in the plasma, and electron-atom collisions release more electrons and processes occur one after another until the desired degree of ionization is reached. A more complete description of plasma is described in [1], the complete disclosure of which is incorporated herein by reference.

If the density of the plasma is sufficiently low (ie, less than about 10 ²⁰ atoms / cm ³ for an aqueous solution), the mean free path of the electrons is increased, and subsequently introduced electrons cause impact ionization in the plasma. If the ion particles in the plasma layer have sufficient energy (e.g., 3.5 electron volts (eV) to 5 eV), collision of the ion particles with molecules forming the target tissue destroys the molecular bonds in the target tissue The molecules are broken down into free radicals, which are then combined into gaseous or liquid species. By molecular decomposition (as opposed to thermal evaporation or carbonization), the target tissue is made up of larger organic molecules into smaller molecules and / or atoms such as hydrogen, oxygen, oxides of carbon, hydrides of carbon and nitrogen compounds It is removed volumetrically by molecular decomposition. Molecular degradation completely removes tissue structure as opposed to dehydration of tissue material by removal of the intracellular or extracellular fluid of the tissue, which causes electrosurgical drying and evaporation in the related art. A more detailed description of molecular degradation is described in U.S. Pat. No. 5,958,015, the complete disclosure of which is incorporated herein by reference.

  The energy density generated by the electronic surgery system 100 at the distal end 108 of the wand 102 can be varied by adjusting various factors, such as, for example, the number of active electrodes, the size and spacing of the electrodes Electrode surface area, electrode surface roughness and / or sharp edges, electrode material, applied voltage, current limiting of one or more electrodes (eg, by placing an inductor in series with the electrodes), the electrodes It is the conductivity of the contacting liquid, the density of the conducting fluid and other factors. Thus, these factors are operable to control the energy level of the excited electrons. Because different tissue structures have different molecular bonds, electrosurgical system 100 generates energy that is sufficient to break the molecular bonds of a particular tissue but not enough to break the molecular bonds of other tissues It may be configured to For example, fatty tissues (eg, fat) have double bonds that require more than 4 to 5 eV (ie, on the order of about 8 eV) energy to cleave. Thus, the Coblation® technology in some modes of operation can not ablate such fatty tissue. However, at lower energy levels, the Coblation® technology can be used to effectively ablate cells to release internal fat content in the form of a liquid. Other modes of operation may have increased energy such that double bonds can be broken as well as single bonds (eg, increasing voltage or changing electrode configuration to increase current density at the electrode) To do). A more complete description of the various phenomena is described in commonly assigned U.S. Patents 2-4, the complete disclosure of which is incorporated herein by reference.

  The inventor now presents a theoretical basis to explain how multiple modes of operation can be implemented on a single wand 102 and a single controller 104. However, the theoretical basis is presented only as one possible explanation and should not be read as a limitation on the operation of the various embodiments. The intention of the other theoretical basis to be presented equivalently and to explain the operation of the device with a different theoretical basis excludes such a device from being included in the appended claims. It is not a thing. Specifically, the plasma formed in relation to the active electrode of the wand, the fluid between the active electrode and the return electrode, and the electrode circuit comprising the electrode-fluid interface are energy directed from the active electrode towards the return electrode It has or exhibits a certain amount of impedance to the flow. The impedance exhibited by the electrode circuit may depend on many factors, but such factors include the thickness and volume of the plasma itself, the surface area of the active electrode in direct contact with the conductive fluid, not covered by the vapor layer, and the plasma Including but not limited to volumetric flow rates of fluid and / or gas away from the position of

  In related art devices, only the vacuum pressure used for aspiration is controlled (eg, the vacuum available at the wall socket connection in the hospital operating room). However, the vacuum available at the wall socket connection can vary widely from room to room, and in many cases it can vary significantly over time in the same room. Furthermore, control of the applied vacuum pressure does not imply control of the suction volume. As such, devices of the related art may control vacuum pressure (or may specify a suitable vacuum pressure) while they do not control the volumetric flow rate of suction.

  By controlling the fluid flow rate at suction rather than just controlling the applied vacuum pressure, various operating modes are implemented at least in part and in certain embodiments. In some embodiments, and as shown in FIG. 1, control of fluid flow is by peristaltic pump 118, but other mechanisms for controlling flow, including pressure modulation, may equally be used. In part by controlling the fluid flow rate of the aspiration, the impedance in the electrode circuit can be at least partially controlled. Other parameters can also affect the impedance, but the inventor has found that the lower the volumetric flow rate of the suction fluid, the larger the plasma is generated and the active electrode does not come in direct contact with the conductor flow, so the impedance of the electrode circuit It has been found that the higher the energy dissipation, the lower the energy dissipation, and the higher the volumetric flow rate of the suction fluid, the lower the impedance and the higher the energy dissipation. Higher volumetric flow reduces the size of the plasma and thus increases the strength of the electric field in the plasma.

  The inventors have found that the relationship between fluid flow volume of suction and energy dissipation is contrary to the prevailing understanding. That is, the related art devices and methods generally operate under the assumption that high flow rates propagate energy more rapidly, thus reducing the thermal aspect of ablation. In contrast, the inventor has found that higher volumetric flow rates for suction tend to result in overall higher energy dissipation. That is, a high volumetric flow rate lowers the impedance of the electrode circuit and energy dissipation increases as the impedance decreases. In addition, high volumetric flow rates cause the plasma to "flicker". Consider an analogy in the form of a candle. If the candle is burning with little air movement in the room, the flame can maintain a stable shape, size and position. However, in the presence of a stream of air (e.g. a ceiling fan) the flame will "sway". During the plasma annihilation period (ie the absence of the plasma), more energy is dissipated in the thermal mode to the surrounding fluid and tissue, causing a "swinging" plasma (rapid annihilation and reformation caused by high volumetric flow rates) The plasma) increases the energy dissipation to the tissue and the surrounding fluid rather than decreasing it. That is, the "swinging" plasma will exhibit a lower average impedance, so that not only energy dissipation will be higher, but also the thermal mode dominant in the momentary plasma annihilation appearing in "swinging", the period during which the plasma is present Cause higher energy dissipation.

  Thus, the embodiments described herein can calculate impedance (or impedance) at the electrodes so that the plasma field can be controlled as desired for a particular type of tissue or medical procedure. The invention relates to a system that can be used and RF current applied to the active electrode is monitored and used as a parameter to control the volumetric flow rate of suction. For example, if it is observed that the impedance at the active electrode is reduced at some point during the medical procedure (which may indicate plasma instability), the control module of the system will use the suction pump to It may be instructed to lower the aspiration flow rate to be stable. From another point of view, it is preferable to measure the RF current applied to the active electrode and adjust the suction flow rate to maintain the current at a predetermined and desired level associated with the user's operation selection It is possible. Furthermore, in certain medical procedures it may be desirable to sacrifice the flow rate instead of stabilizing the plasma field to reduce heat dissipation at the treatment site and to further protect the tissue. Reference is made to U.S. Pat. No. 5,956,095, assigned to the assignee entitled "Electrosurgical system with suction control device, system and method", the complete disclosure of which is incorporated herein by reference for all purposes. Conversely, it may be desirable in certain types of medical procedures to sacrifice plasma field stability to have an overall higher suction flow rate volume to remove bubbles and debris from the surgical field. It is possible.

  Based on the previous theoretical basis, various embodiments of the electrosurgical procedure in some embodiments use a single wand (in some cases a single active electrode) with a single controller. It is directed to systems and related methods that implement at least two operating modes in between. In certain embodiments, a "low power mode" that may be used for treatment and removal of damaged tissue such as a portion of a joint cartilage, "intermediate output that may be used for treatment and removal of a meniscus Four different operating modes are implemented, such as “mode”, “high power mode” for strong removal of any type of tissue, and “vacuum mode” for removal of floating and / or trapped tissue sell. Further details regarding exemplary modes of ablation are provided below, following a discussion of exemplary wands 102 and internal components of controller 104.

  FIG. 2 shows an elevation view of wand 102 in accordance with an exemplary system. Specifically, the wand 102 includes an elongated shaft 106, which may be flexible or rigid, a handle 110 coupled to the proximal end of the elongated shaft 106, and an electrode support 200 coupled to the distal end of the elongated shaft 106. . Also visible in FIG. 2 is the flexible tubular member 116 and the multiconductor cable 112 extending from the wand 102. The wand 102 includes an active electrode 202 disposed at the distal end 108 of the long shaft 106. Active electrode 202 may be coupled to an active or passive control network in controller 104 (FIG. 1) by one or more isolated electrical connectors (not shown) in multi-conductor cable 112. Active electrode 202 is electrically isolated from common electrode or return electrode 204 located on the shaft proximate to active electrode 202 and within one millimeter (mm) to 25 mm of the distal end in an exemplary system Ru. Near the distal end, the return electrode 204 is concentric with the long shaft 106 of the wand 102. The support member 200 is disposed distal to the return electrode 204 and may be made of an electrically insulating material such as epoxy, plastic, ceramic, silicone, glass or the like. The support member 200 extends from the distal end 108 of the elongate shaft 106 (usually about 1 to 20 mm) to provide support for the active electrode 202.

  FIG. 3 shows a cross-sectional elevation view of wand 102 in accordance with an illustrative embodiment. Specifically, the wand 102 includes a suction tube 206 defined within the elongated shaft 106. In the exemplary wand 102 of FIG. 3, the inner diameter of the long shaft 106 defines a section tube 206, but in other cases the separated tubular portion within the long shaft 106 defines a suction tube 206. May be Aspiration tubing 206 may be used to aspirate excess fluid, foam, tissue debris and / or removal products from the target location in the vicinity of active electrode 202. The suction tube 206 extends into the handle 110 and is fluidly coupled to the flexible tubular member 116 for coupling to the peristaltic pump 118. The handle 110 also defines an internal cavity 208 within which the electrical conductors 210 reside, which may extend into the multiconductor cable 112 and ultimately couple to the controller 104. Similarly, the conductor extends through the long shaft and couples to the return electrode 204 and the active electrode 202, respectively, but the conductor 210 is within the long shaft 106 so as not to overcomplicate the figure. Not shown as.

  FIG. 4 shows an elevation view of an exemplary active electrode (left) with a perspective view (right) of the distal end of wand 102 in accordance with an exemplary system. Specifically, active electrode 202 may be an active screen electrode 400 as shown in FIG. The screen electrode 400 may include a conductive material such as tungsten, titanium, molybdenum or platinum. The screen electrode 400 has a diameter of about 0.5 to 8 mm, in some cases about 1 to 4 mm, and about 0.05 to about 2.5 mm, in some cases about 0.1 to 1 mm It may have a thickness. The screen electrode 400 may include a plurality of openings 402 configured to be disposed over the distal opening 404 of the aspiration tube. The opening 402 is designed to allow the passage of excess fluid, foam and gas aspirated from the ablation site and is large enough to allow ablation of ablated tissue debris through the aspiration tube 206 (FIG. 3). ). As shown, the screen electrode 400 has an irregular shape that increases the ratio of edge to surface area of the screen electrode 400. Screens that generate and maintain a plasma layer in the conductor fluid, as the ratio of edge to surface area is high, the current density at the edge is higher and the large surface area electrode tends to dissipate the power in the conductive medium It will increase the capacity of the electrode 400.

  In the exemplary embodiment shown in FIG. 4, the screen electrode 400 includes a main body 406 that rests on the insulating support member 200 and the distal opening 404 for the aspiration tube 206. The screen electrode 400 further includes claws 408, and five claws 408 are shown in the exemplary screen electrode 400 of FIG. The claws 408 may be placed on, fixed to and / or embedded in the insulating support member 200. In a particular embodiment, an electrical connector extends through the insulating support member 200 to secure the screen electrode 400 to the insulating support member 200 and to electrically couple the screen electrode 400 to the controller 104 (FIG. 1), Coupled to one or more of the claws 408 (ie, via gluing, brazing, welding, etc.). In the exemplary system, the screen electrode 400 forms a substantially planar tissue treatment surface to ablate, ablate and scrape meniscal, cartilage and other tissues. In remodeling cartilage and menisci, the surgeon often desires to smooth out the irregular rough surface of the tissue leaving a substantially smooth surface. For these applications, the substantially flat screen electrode treatment surface provides the desired effect. The present specification now provides a more detailed description of the controller 104.

FIG. 5 illustrates an electrical block diagram of controller 104 in accordance with at least some embodiments. Specifically, controller 104 includes processor 500. The processor 500 may be a microcontroller, such that the microcontroller includes a read only memory (ROM) 502, a random access memory (RAM) 504, a digital to analog converter (D / A) 506, an analog to digital converter A / D) 514, digital output (D / O) 508 and digital input (D / I) 510 may be integrated. Processor 500 may further provide one or more externally available peripheral buses, such as a serial bus (eg, I ² C), a parallel bus or other bus and a corresponding communication mode. Processor 500 may be further integrated with communication logic 512 such that processor 500 can communicate with external devices such as display device 130 as well as internal devices. In some embodiments, processor 500 may be implemented in the form of a microcontroller, and in other embodiments processor 500 may be separate RAM, ROM, communication, A / D, D / A, D / O and D. / I device may be implemented as a stand-alone central processing unit in combination with communication hardware and the like for communicating with devices and peripheral devices.

  The ROM 502 stores instructions that can be executed by the processor 500. Specifically, the ROM 502 may include a software program that, when executed, causes the controller to implement more than one operating mode. RAM 504 may be a working memory for processor 500, where data is temporarily stored, from which instructions may be executed. Processor 500 may include digital to analog converter 506 (eg, to RF generator 516 in some embodiments), digital output 508 (eg, to RF generator 516 in some embodiments), digital input 510 (eg, a push button switch) Coupling to other devices within controller 104 by communication device 512 (eg, to display device 130) and interface devices such as 132 and foot pedal assembly 134 (FIG. 1).

  Voltage generator 516 generates an alternating current (AC) voltage signal that is coupled to active electrode 202 of wand 102. In some embodiments, the voltage generator couples to the electrical pin 520 in the connector 120 of the controller, to the electrical pin 522 in the wand connector 114, and defines an active terminal 518 that ultimately couples to the active electrode 202. . Similarly, the voltage generator couples to the electrical pin 526 in the connector 120 of the controller, to the electrical pin 528 of the wand connector 114, and defines a return terminal 524 that ultimately couples to the return electrode 204. Additional active and / or return terminals may be used. Active terminal 518 is the terminal at which voltage and current are introduced by voltage generator 516, and return terminal 524 provides a return path for current. The return terminal 524 can provide the same common or ground as the common or ground (e.g., common 530 used for push button 132) within the balance of controller 104, but in other embodiments, voltage generator 516 is The balance of controller 104 may be in an electrically "floating" state, so that return terminal 524 may indicate a voltage as measured relative to common or ground (eg, common 530). However, the potential of the voltage reading at the return terminal 524 relative to the electrically floating voltage generator 516 and thus to earth ground does not invalidate the state of the return terminal of the terminal 524 to the active terminal 518.

  The AC voltage signal generated and applied by the voltage generator 516 between the active terminal 518 and the return terminal 524, in some embodiments, has a frequency between about 5 kilohertz (kHz) and 20 megahertz (MHz). And in some cases between about 30 kHz and 2.5 MHz, in other cases between about 50 kHz and 500 kHz, usually less than 350 kHz, and usually between about 100 kHz and 200 kHz. It is an RF energy. In some applications, the target tissue impedance is so large at 100 kHz that a frequency of about 100 kHz is useful.

  The RMS (root mean square) voltage generated by the voltage generator 516 may be in the range of about 5 volts (V) to 1800 V, and in some cases in the range of about 10 V to 500 V, to the size of the active electrode. Depending, it may usually be between about 10V and 400V. In some embodiments, the peak-to-peak voltage generated by the voltage generator 516 for ablation is a peak-to-peak voltage in the range of 10V to 2000V, in some cases in the range of 100V to 1800V, in other cases Is a square wave in the range of about 28 V to 1200 V, usually in the range of about 100 V to 320 V peak-to-peak.

  The voltage and current generated by the voltage generator 516 are compared to the laser for shallow necrosed tissue which is pulsed so that the voltage is applied efficiently and continuously (e.g. about 10 Hz to 20 Hz) ) May be supplied as a series of voltage pulses or AC voltage (eg, about 5 kHz to 20 MHz) having a sufficiently high frequency. In addition, the duty cycle of the square wave voltage generated by voltage generator 516 (ie, the cumulative time between any first and second intervals at which energy is applied) has a duty cycle of approximately 0.0001%. In some embodiments, as much as about 50% as compared to the pulsed laser that can be included. Although a square wave is generated and provided in some embodiments, the AC voltage signal can be improved to include features such as voltage spikes at the pulse rise or fall of each half cycle, or the AC voltage The signal can be refined to take a particular form (eg, sine wave, triangle wave, etc.).

  The voltage generator 516 provides an average power level ranging from a few milliwatts to a few hundred watts per electrode, depending on the ablation mode and the state of the plasma close to the active electrode. The voltage generator 516, in combination with the processor 500, initializes the energy output of the voltage generator 516 based on the ablation mode selected by the surgeon (eg, by controlling the output voltage), in the selected ablation mode , Configured to change control to compensate for changes caused by the use of the wand. Changes in control are discussed further below, following further discussion of peristaltic pump 118. A description of various voltage generators 516 is set forth in commonly assigned US Pat. Nos. 5,985,859 and 6,087,015, the complete disclosures of which are incorporated herein by reference for all purposes. Reference is also made to commonly assigned US Pat. No. 5,956,015 entitled “Method and system for electrosurgical controller with corrugation”, the full disclosure of which is fully incorporated herein by reference. Is incorporated herein by reference.

  In some embodiments, various operating modes implemented at least partially by voltage generator 516 may be controlled by processor 500 using digital to analog converter 506. For example, processor 500 may control the output voltage by providing one or more various voltages to voltage generator 516, and the voltage provided by digital to analog converter 506 is generated by voltage generator 516. It is proportional to the voltage. In other embodiments, processor 500 may be configured with one or more digital output signals from digital output converter 508, or with communication device 512 (an embodiment of a communication system is such that FIG. 5 is not unduly complicated. (Not shown) may communicate with the voltage converter by packet based communication.

  With further reference to FIG. 5, in some embodiments, controller 104 further includes a mechanism for sensing the current supplied to the active electrode. In the exemplary case of FIG. 3, the sense current supplied to the active electrode may be by the current sense transformer 532. Specifically, the current sensing transformer 532 may have the conductor of the active terminal 518 mounted through the transformer such that the active terminal 518 has a single turn on the primary side. The current on the primary side of a single turn induces a corresponding voltage and / or current on the secondary side. As such, an exemplary current sense transformer 532 is coupled to a digital to analog converter 514 (denoted by the letter A). In some cases, the current sense transformer may be coupled directly to the analog to digital converter 514, and in other cases additional circuitry such as amplification circuitry and protection circuitry may be used with the current sense transformer 532 and the digital analog converter It may be interposed between 514 and. The current sensing transformer is merely illustrated as any suitable mechanism for sensing the current supplied to the active electrode, and other systems are possible. For example, a small resistance (eg, 1 ohm, 0.1 ohm) may be placed in series with the active terminal 518, and a voltage drop introduced through the resistance may be used as a current indicator. In still other cases, the current sensing circuit may measure the current in any suitable form, and the measured current values may be other than analog signals, for example, packet based communication at communication port 512 (see FIG. (Not shown) so as not to complicate the

  When the voltage generator 516 is in an electrically floating state, the mechanism for sensing current is not limited to the active terminal 518 alone. As such, in yet further embodiments, a mechanism for sensing current may be implemented for the return terminal 524. For example, an exemplary current sense transformer 532 may be mounted on the conductor associated with the return terminal 524.

  In some embodiments, the single feedback parameter used only by the processor for voltage generator 516 is the amount of current. For example, in a system where the voltage generator can accurately generate the output voltage independently of the impedance of the loaded load, the processor 500 with set point control for the voltage generated by the voltage generator 516 It may be sufficient (eg, to calculate a value indicative of the impedance of the plasma close to the active electrode). However, in other cases the voltage may also be a feedback parameter. As such, in some cases, the active terminal 518 may be electrically coupled to the digital to analog converter 514 (shown as B). However, additional circuitry, such as various step down transformers, protection circuitry and circuitry that takes into account the electrically floating nature of the voltage generator 516, may be placed between the active terminal 518 and the digital to analog converter 514. It may be intervened. Such additional circuitry is not shown so as not to overly complicate the figure. In still other cases, the voltage sensing circuit may measure the voltage, and the measured voltage value may for example be packet based communication on the communication port 512 by methods other than analog signals (the diagram may be overly complex). (Not shown) may be provided.

  With further reference to FIG. 5, the controller 104 in accordance with various embodiments further includes a peristaltic pump 118. Peristaltic pump 118 may be at least partially within housing 122. The peristaltic pump includes a rotor 124 mechanically coupled to the shaft of the electric motor 534. In some cases, as also shown, the rotor of the electric motor may be directly coupled to the rotor 124, while in other cases the various gears, pulleys and / or belts may be an electric motor 534. And the rotor 124. Electric motor 534 may take any suitable form, such as an AC motor, a DC motor and / or a stepping motor. The electric motor 534 may be coupled to a motor speed control circuit 536 to control the speed of the shaft of the electric motor 534 and to control the speed of the rotor 124 (and the volumetric flow rate in the wand). In the exemplary case of an AC motor, motor speed control circuit 536 may control the voltage and frequency applied to electric motor 534. In the case of a DC motor, motor speed control circuit 536 may control the DC voltage applied to electric motor 534. In the case of a stepping motor, the motor speed control circuit 536 may control the current flowing to the poles of the motor, but the stepping motor may have a sufficient number of poles or the rotor 124 moves smoothly. To be controlled.

  The processor 500 is coupled to a motor speed control circuit 536 (denoted C) by a digital to analog converter 506 or the like. Processor 500 may be coupled by other methods such as packet based communication on communication port 512. Thus, the processor 500 executes the program, reads the current supplied to the active terminal 518, reads the voltage supplied to the active terminal 518, and sends the speed command to the motor speed control circuit 536 accordingly. A change in speed control (and hence a change in volumetric flow rate) may be performed. The motor speed control circuit 536 then implements the speed control change. The speed control change may include changing the speed of the rotor 124 if desired, stopping the rotor 124 if desired, and in some embodiments, temporarily reversing the rotor 124. It should be noted that the rotor 124 of the peristaltic pump does not have to be rotated by the electric motor before processing. While electric motors may be more easily implemented in electrical control systems, other types of motors (e.g., pneumatic motors) may also be used equally where the speed of the output shaft is controllable.

  The specification now turns to a more detailed description of the various modes of operation that may be implemented by the electrosurgical system. Each operation mode is exemplarily named based on the strength of ablation. However, it is possible to ablate all the types of tissue specifically identified in each and every mode, thus providing a specification of the type of tissue considered to be ablated in each mode. It should not be read as limiting the applicability of a particular mode. Ablating tissue in a mode not specifically designed for tissue can result in side effects such as discoloration of the target tissue and removal of too much volume. The available modes of operation of the system provide improved performance thereby, and management of energy output coupled with control of aspiration flow rate is surgical outcome in each mode directed to the target tissue or type of electrosurgical procedure Generate

  According to various embodiments, the electrosurgical controller 100 can dynamically modulate the flow rate near the active electrode such that the power of the RF energy can be adjusted. In the following embodiments, "low power mode" which may be used for treatment, ablation and removal of part of cartilage, "intermediate power mode" which may be used for meniscus treatment, ablation and removal, tissue It implements four operating modes, "high power mode", which can be used for strong ablation and removal of and "vacuum mode" for removal of free and / or trapped tissue. Each exemplary mode of operation may be characterized by an initial energy setting for the voltage generator 516 and an initial volumetric flow rate setting by the peristaltic pump 118, this initialization being a specific desired impedance of the plasma generated during ablation. Can result in While operating in a particular mode, the energy provided by voltage generator 516 and the volumetric flow rate provided by peristaltic pump 118 may vary based on the operating conditions at the distal end 108 of the wand, but such The change should not remove the condition that is in a particular mode of operation. The following table is a feature of the four exemplary modes of operation at a high level.

  We will now discuss each mode.

  The low power mode of operation is specifically designed for the treatment and selective ablation of cartilage or other highly vulnerable tissue in joints. This low power mode of operation is particularly suitable for finishing or scraping chondroplasty and menisci. However, the cartilage does not grow back, so the amount of cartilage ablated by the surgeon in chondroplasty is very small in most procedures. The main concern of the surgeon may be to carefully remove the damaged cartilage while reducing the damage to the cartilage tissue left behind at the same time. For these reasons, the exemplary low power mode is characterized by low energy supplied to the active electrode, as well as low volume flow rate of suction. Specifically, in this mode of operation, it is desirable that energy delivery during treatment maximize cell viability and reduce instantaneous energy dissipation and heat generation in the vicinity of the area to be treated. For this mode of operation, reduced suction flow and low volumetric flow rates can result in plasma and electrode circuits having higher overall impedance.

  Collapse of the vapor layer and short spikes of current are prevented if possible in the low power mode, so control of the volumetric flow rate in the low power mode is to control the volumetric flow to maintain the effectiveness and stability of the plasma While slowing the rate (ie, reducing the speed of the rotor 124 of the peristaltic pump 118), a strong control action may be implemented. In some cases, the control action may be an instantaneous reversal of the direction of the rotor 124 of the peristaltic pump 118. Reversal of the rotor of the peristaltic pump 118 will reverse the volumetric flow rate at the active electrode 202 (taking into account the elasticity of the tube 116), but nevertheless the controller 104 thereby causes the controller 104 to It may be possible to quickly reduce or stop the volumetric flow rate at the active electrode if it senses that it is collapsing. It may be desirable to reduce the suction volume flow to near zero while the RF energy is activated in low power mode to reduce thermal damage to the surrounding tissue. The control action then provides a baseline value of volumetric flow rate when the RF is turned off to remove debris that has peeled away from the surgical field to improve visibility and to remove bubbles.

  For voltage generator 516, the low power mode is characterized by low energy, and in some cases, controller 104 implements an upper limit on the amount of energy provided to active electrode 202. With respect to the voltage generator 516 that generates a constant RMS voltage, the amount of current provided to the active electrode 202 may be controlled. With respect to the voltage generator 516, which controls the voltage output, both the RMS voltage and the RMS current may be controlled to implement a low energy supply.

  In the low power mode of operation, controller 104 controls voltage generator 516 and peristaltic pump 118 to implement a relatively high target impedance to the plasma and electrode circuitry to prevent plasma collapse. The control action associated with reducing the impedance (as calculated based on the current and / or voltage applied to the active electrode) reduces the energy supplied by the voltage generator 516 and slows down the peristaltic pump 118 And / or stop. In some embodiments, the change in electrical energy generated by voltage generator 516 may be implemented to be more rapid than the change in speed of peristaltic pump 118, so in some embodiments, The initial response to the measured plasma impedance drop may momentarily raise the energy density supplied, subsequently reduce the pump speed, and lower the supplied energy again.

  The intermediate output mode of operation is specifically designed for ablation of fibrocartilage tissue, such as meniscal tissue, although other types of tissue may also be ablated in the intermediate output mode. This intermediate output mode of operation may also be suitable for electrosurgical treatment of lip tissue. When ablating the meniscus, the surgeon may be interested in ablating more tissue volume than in the case of cartilage, but the resulting oxidation or “browning” of the remaining meniscus Both are not preferable. For at least this reason, the exemplary intermediate power mode features moderate energy delivered to the active electrode, as well as moderate volumetric flow rates of suction to preserve tissue constancy. Specifically, in this mode of operation, energy delivery during treatment improves the protection of the tissue matrix and may cause changes in the tissue matrix or mechanical changes, with or without discoloration of the tissue. Designed to prevent cross-linking of collagenous tissue. A moderate volumetric flow rate can result in a plasma with lower impedance than the low power mode with relatively low heat dissipation in the area of the treatment site.

  Plasma decay is not desirable in the medium power mode, but occasional plasma decay and short current spikes may be tolerated to implement a slightly stronger tissue ablation rate. As such, the control action on the volumetric flow rate in meniscal mode may be stronger than the low power mode, and the minimum volumetric flow rate for aspiration may be implemented even though such a minimum leads to plasma collapse .

  With respect to the voltage generator 516, the intermediate power mode is characterized by slower changes that correspond to changes in the impedance of the plasma. With respect to the voltage generator 516 generating a constant peak voltage, the amount of current supplied to the active electrode 202 may be averaged and controlled to generate a predetermined average current. With respect to the voltage generator 516 that controls the voltage output, the average energy may be controlled.

  In the intermediate power mode of operation, controller 104 controls voltage generator 516 and peristaltic pump 118 to implement an intermediate target impedance for the plasma electrode circuit. The control action (as calculated based on the current and / or voltage applied to the active electrode) corresponding to the drop in impedance changes the energy supplied by the voltage generator 516 and the speed of the peristaltic pump 118 Lower and / or stop. In some embodiments, controller 104 may provide a predetermined energy, and for impedance values falling within a predetermined range, controller 104 may control the impedance based only on changes in the velocity of peristaltic pump 118 . The method of control may also be based on the energy supplied by the voltage generator 516, also with regard to changes in impedance that fall outside of the predetermined range.

  The exemplary high power operating mode is designed to remove tissue particularly rapidly. By way of example, this high power mode of operation may be used for acromoid decompression treatment or ACL stump debridement. As such, the exemplary high power mode features high energy delivered to the active electrode, as well as high volumetric flow rates for aspiration. Specifically, in this mode of operation, the delivery of energy during the procedure removes tissue with a continuous suction flow volume to aspirate tissue near the wand to reduce ablation rate and heat dissipation more efficiently. Adjusted to increase. High volumetric flow rates result in plasmas with lower impedance and constant (but uncontrolled) plasma decay. Therefore, plasma collapse is expected to be in high power mode based on strong suction flow, but high power mode has minimal volumetric flow rate and hence minimal peristaltic pump speed, such minimal speed leads to plasma collapse Or may be implemented.

  With respect to the voltage generator 516, the high power mode is characterized by slower changes to changes in the plasma's impedance. The change in energy provided to the wand electrode is slow, but the voltage generator 516 rapidly reduces or completely shuts down the energy when the predetermined high output energy level is reached (eg, greater than 2 amperes) May be implemented as With respect to the voltage generator 516 generating a constant RMS voltage, the amount of current provided to the active electrode 202 may be controlled to be a predetermined amperage. With respect to the voltage generator 516 that controls the voltage output, the average output may be controlled.

  In the high power mode of operation, controller 104 controls voltage generator 516 and peristaltic pump 118 to implement a low target impedance for the plasma. The control action in response to the drop in impedance (as calculated based on the current and / or voltage applied to the active electrode) is accompanied by a drop in the speed of the peristaltic pump 118, but up to a predetermined minimum volumetric flow rate . In some embodiments, controller 104 may provide a predetermined energy, and for impedance values falling within a predetermined range, controller 104 may also control the impedance based solely on changes in the velocity of peristaltic pump 118. Good. Control may be based on changes in the energy supplied by the voltage generator 516, with respect to changes in impedance that fall outside of a predetermined range.

  Plasma collapse is expected, but in high power mode the exact timing of plasma collapse is not controlled. In certain embodiments, the controller 104 collects or counts the amount of time the plasma is in proximity to the active electrode and the total time (for any suitable period of time, such as one second). For example, the controller may assume that a plasma is present if the current is lower than a predetermined threshold (e.g., 500 milliamps) (as a higher current will flow if there is no impedance associated with the plasma) . Depending on the time of collection of the plasma mode, the controller 104 takes a value indicating the "duty cycle" of the plasma relative to the time the plasma is absent, such as by taking the ratio of time that the plasma is present to the total time of the period You may decide. If the value indicated by the duty cycle indicates more than a predetermined amount of operation outside the plasma mode (e.g. less than 25% of the time), a change in control may be made, such as reducing the aspiration flow rate.

  An exemplary vacuum mode of operation is specifically designed to rapidly remove suspended tissue or tissue fragments within the surgical field. Thus, the exemplary vacuum mode is characterized by the various energies being delivered to the active electrode, along with the highest volumetric flow rate of the various modes (if suction is operating). Specifically, in this mode of operation, energy delivery in the procedure is to be optimized for rapid degradation of debris in the surgical field, with high volumetric flow rates, so that debris can be attracted to the wand tip. It is designed. A high volumetric flow rate results in a plasma with lower impedance.

  In the vacuum mode based on high volume flow rate of suction, plasma collapse is expected. In some cases, the flow rate volume will be set and maintained unchanged through the use of the mode. In other cases, the vacuum mode alternates between a maximum volumetric flow rate for strong tissue removal and a lower volumetric flow rate that allows the extinguished plasma to be "reignited". A pulse volume flow rate may be implemented. For example, in one exemplary pulsatile flow embodiment, a high volumetric flow rate may be implemented for 0.5 seconds and then a low volumetric flow rate may be implemented for 0.5 seconds. Other times are also possible, such as high flow rates ranging between 0.1 and 1.0 seconds and low volumetric flow rates ranging between 0.1 and 1.0 seconds. Furthermore, high volumetric flow rates and low volumetric flow rates do not have to be balanced.

  With respect to voltage generator 516, the vacuum mode is characterized by slower changes in response to changes in the plasma and electrode circuit impedance. The change in the energy supplied is slow, but with reaching a predetermined high energy level (for example exceeding 2 amperes), the voltage generator 516 rapidly reduces the energy or stops it completely May be implemented as With respect to the voltage generator 516 that generates a constant peak voltage, the amount of current provided to the active electrode 202 may be controlled to be a predetermined amperage. With respect to the voltage generator 516 that controls the voltage output, the average output may be controlled.

  In the vacuum operating mode, the controller 104 may not change control of the operation (except to implement pulsing of the aspiration flow). In other words, a change in plasma impedance may not result in a change in current and / or energy settings provided by processor 500 to voltage generator 516. In other cases, the change in energy supply is slower than in other modes of operation, with occasional drops and / or interruptions in the energy associated with the predetermined high energy flow.

  FIG. 6 relates to the possible ranges for the suction flow rate of the output RF energy (shown as the pump speed setpoint) for the three exemplary operating modes, low power mode, medium power mode, high power mode The graph is shown. Specifically, for each mode of operation, the electrosurgical controller 104 is programmed to operate within the range of operating parameters for output RF energy and suction flow rate. For example, in the "low power mode of operation" described above, the controller 104 allows only the output RF energy in the range of 25 to 50 watts and the suction flow rate settings from "-1" (ie motor reverse direction) to The aspiration flow rate settings may be in some cases aspiration flow rates in the range of 0 to 45 ml / min. With regard to the aforementioned exemplary "intermediate power mode of operation", the controller 104 can only output RF energy in the range of 50 to 150 watts and a suction flow rate of, for example, "0" (ie, peristaltic motor is stopped) to "5" It may be pre-programmed to allow rate settings. For the exemplary "high power operating mode" described above, the controller 104 is preprogrammed to allow only output RF energy in the range of 150 to 400 watts and suction flow rate settings of, for example, "1" to "5". May be done.

  Each mode may be characterized by a specific energy and volumetric flow rate, but the volumetric flow rate may initially be low to help initially establish the plasma, as well as the gas phase of the fluid near the active electrode. The voltage of the applied energy may also be low to help establish the Furthermore, and regardless of the mode of operation, if the plasma is formed with a low volumetric flow rate and applied voltage, the voltage and volumetric flow rate can rise synchronously to the initial settings for the mode of operation. According to at least some embodiments, the generated voltage 516 is such that a low resistivity material (eg, blood, saline or conductive gel) forms a lower impedance path between the return electrode and the active electrode. Configured to limit or shut off current. Still further, in some embodiments, the voltage generator 516 is configured to be a constant current source by the user (ie, the output voltage changes as a function of the impedance appearing at the wand 102).

  The foregoing discussion is understood to be illustrative of the principles and various embodiments of the present invention. Many variations and modifications are possible. It is intended that the following claims be interpreted to embrace all such variations and modifications. For example, although FIG. 6 shows that the output RF energy does not overlap between the exemplary modes of operation, the range is merely an example. In other situations, the output RF energy of the operating mode may overlap (e.g., the lower output RF energy of the intermediate power mode may overlap with the upper output RF energy of the lower power mode, so this is the case). The specification should not be construed as requiring that the various exemplary modes of operation require a range of mutually exclusive output RF energy.

  While the preferred embodiments of the present disclosure have been shown and described, modifications thereof can be made by one skilled in the art without departing from the scope and teachings herein. The embodiments described herein are merely exemplary and not limiting. Many different embodiments may be implemented within the scope of the inventive concept including equivalent structures, materials or methods thereof, and many modifications are detailed herein according to the requirements described in the Act. It should be understood that the details herein should be construed as illustrative and not in a limiting sense, as it may be performed in the embodiments described in.

DESCRIPTION OF SYMBOLS 100 electrosurgical system 102 electrosurgical wand 104 electrosurgical controller 106 long shaft 108 distal end 110 proximal end 112 multiconductor cable 114 wand connector 116 tubular member 118 peristaltic pump 120 controller connector 122 housing 124 rotor 126 stator 128 discharge Part 130 Interface device 132 Button 134 Foot pedal assembly 136, 138 Pedal device 140 Multiconductor cable 142 Pedal connector 144 Connector 200 Electrode support part 202 Active electrode 204 Return electrode 206 Suction tube part 208 Internal cavity 210 Conductor 400 Active screen electrode 402 Opening 404 Distal Opening 406 Body 408 Claw 500 Processor 02 read-only memory 504 random access memory 506 digital-to-analog converter 508 digital output 510 digital input 512 communication logic circuit 514 analog-to-digital converter 516 voltage generator 518 active terminal 520, 522, 526, 528 electric pin 524 return terminal 530 common 532 Current sensing transformer 534 Electric motor 536 Motor speed control circuit

1 illustrates an electrosurgical system in accordance with at least some embodiments. FIG. 10A shows an elevation view of an electrosurgical wand in accordance with at least some embodiments. FIG. 10A shows a cross-sectional elevation view of an electrosurgical wand in accordance with at least some embodiments. FIG. 10A shows an elevated view of a screen electrode and a perspective view of the distal end of an electrosurgical wand including the screen electrode, in accordance with at least some embodiments. FIG. 7 shows an electrical block diagram of a controller in accordance with at least some embodiments. FIG. 7 shows an exemplary graph associated with various modes of output RF energy and suction flow in accordance with at least some embodiments. FIG. 6 illustrates, in block diagram form, a method in accordance with at least some embodiments.

The foregoing discussion is understood to be illustrative of the principles and various embodiments of the present invention. Many variations and modifications are possible. It is intended that the following claims be interpreted to embrace all such variations and modifications. For example, although FIG. 6 shows that the output RF energy does not overlap between the exemplary modes of operation, the range is merely an example. In other situations, the output RF energy of the operating mode may overlap (e.g., the lower output RF energy of the intermediate power mode may overlap with the upper output RF energy of the lower power mode, so this is the case). The specification should not be construed as requiring that the various exemplary modes of operation require a range of mutually exclusive output RF energy.
FIG. 7 is a block diagram and describes a method that may begin at block 700, which implements at least two modes of operation in an electrosurgical procedure and is for electrosurgery coupled to an electrosurgical controller Controlling the flow of fluid into the opening adjacent to the first electrode or controlling the impedance at the distal end of the electrosurgical wand with an implementation with the first active electrode of the wand (block 702) (Block 704) and control of the energy supplied to the first active electrode by the electrosurgical controller, or control of the impedance (block 706). The method may then end at block 708.

Claims (40)

An implementation of at least two modes of operation in an electrosurgical procedure, including an implementation with a first active electrode of an electrosurgical wand coupled to a controller for electrosurgical operation,
Controlling the flow of fluid that enters the opening near the first electrode at the distal end of the electrosurgical wand;
Controlling the energy supplied to the first active electrode by the electrosurgical controller.   The implementation further includes an implementation of at least two operating modes with respective operating modes characterized by steady state with different combinations of volumetric flow rate entering the opening and energy supplied to the first active electrode. The method of claim 1.   The implementation of at least two modes of ablation further includes a low power mode for use in ablation of cartilage, an intermediate power mode for use in ablation of fibrocartilage, a high power mode for ablation of soft tissue, and suspension. The method of claim 1, comprising the implementation of an ablation mode selected from the group consisting of: vacuum mode for removal of tissue.   The implementation according to claim 1, wherein the implementation further comprises an implementation of at least three ablation modes in the electrosurgical procedure, the at least three ablation modes being implemented with the first active electrode of the electrosurgical wand. the method of.   The at least three ablation modes are a low power mode to ablate cartilage, an intermediate power mode to ablate a meniscus, a high power mode to ablate soft tissue, and a vacuum to remove suspended tissue 5. The method of claim 4, wherein the ablation mode is at least three ablation modes selected from the group consisting of:   The method of claim 1, wherein control of fluid flow further comprises control of a peristaltic pump.   7. The method of claim 6, wherein controlling the peristaltic pump further comprises controlling a speed of a rotor of the peristaltic pump.   8. The method of claim 7, wherein control of the peristaltic pump rotor speed further comprises reversing the direction of the peristaltic pump rotor. An implementation of at least two ablation modes in an electrosurgical procedure, the implementation comprising a first active electrode of an electrosurgical wand coupled to an electrosurgical controller, the implementation comprising:
Control of the impedance of the electrode circuit in a first mode of operation of the electrosurgical procedure;
Controlling the impedance of the electrode circuit in a second mode of operation of the electrosurgical procedure, wherein the impedance of the electrode circuit in the second mode is different from the impedance in the first mode. The control of the impedance of the electrode circuit in the first mode is further:
Controlling the flow rate of fluid entering an opening proximate the first active electrode at a distal end of the electrosurgical wand;
10. Control of energy provided by the electrosurgical controller to the first active electrode. The control of the impedance of the electrode circuit in the second mode is further:
Controlling the flow rate of the fluid entering the opening, wherein the flow rate of the fluid in the second mode is different from the flow rate of the fluid in the first mode;
Control of energy provided to the first active electrode by the electrosurgical controller, wherein energy provided to the first active electrode in the second mode is the first mode. 11. A method according to claim 10, comprising controlling the energy different from the energy supplied to the one active electrode.   11. The method of claim 10, wherein controlling the fluid flow further comprises controlling a peristaltic pump.   13. The method of claim 12, wherein control of the peristaltic pump further comprises control of a speed of a rotor of the peristaltic pump.   14. The method of claim 13, wherein controlling the speed of the peristaltic pump rotor further comprises reversing the direction of the peristaltic pump rotor.   The implementation of the at least two ablation modes further comprises control of the impedance of the electrode circuit in a third mode of operation of the electrosurgical procedure, wherein the impedance of the plasma in the third mode is the first and second The method according to claim 9, which is different from the impedance in the mode. The control of the impedance of the electrode circuit in the first mode is further:
Controlling the flow rate of fluid entering an opening proximate the first active electrode at a distal end of the electrosurgical wand;
Controlling the energy supplied to the first active electrode by the electrosurgical controller.
The control of the impedance of the electrode circuit in the second mode is further:
Controlling the flow rate into the opening, wherein the flow rate of the fluid in the second mode is different from the flow rate of the fluid in the first mode;
Control of energy provided to the first active electrode by the electrosurgical controller, wherein energy provided to the first active electrode in the second mode is the first mode. Control of energy different from the energy supplied to one active electrode,
The control of the impedance of the electrode circuit in the third mode is further:
Controlling the flow rate of the fluid at the opening, wherein the flow rate of the fluid in the third mode is different from the flow rate of the fluid in the first and second modes;
Control of energy supplied to the first active electrode by the controller for electrosurgery, wherein energy supplied to the first active electrode in the third mode is in the first and second modes 16. The method of claim 15, wherein the energy is different from the energy supplied to the first active electrode.   The implementation of the at least two ablation modes may further include a low power mode for using cartilage ablation, an intermediate power mode for using fibrocartilage ablation, a high power mode for soft tissue ablation, and 10. The method of claim 9, comprising an implementation of at least two ablation modes selected from the group consisting of: a vacuum mode for removal of tissue.   10. The method of claim 9, wherein the implementation further comprises an implementation of at least four ablation modes in the electrosurgical procedure, the at least four ablation modes being implemented with the first active electrode.   The at least four ablation modes further include a low power mode for use in cartilage ablation, an intermediate power mode for use in meniscus ablation, a high power mode for soft tissue ablation, and free tissue. The method of claim 18, comprising: vacuum mode for removal. An implementation of at least two ablation modes in an electrosurgical procedure comprising: implementing with a first active electrode of an electrosurgical wand coupled to an electrosurgical controller, the implementation comprising:
Adjusting the average power supplied to the electrode circuitry in a first mode of operation of the electrosurgical procedure;
An adjustment of the average power supplied to the electrode circuit in a second mode of operation of the electrosurgical procedure, the average power supplied to the electrode circuit in the second mode being an average in the first mode Different from the output, with the adjustment of the average output, the method. The adjustment of the average power supplied to the electrode circuit in the first mode is further:
Controlling the flow rate of fluid entering an opening proximate the first active electrode at a distal end of the electrosurgical wand;
21. A method according to claim 20, comprising: controlling energy supplied by the electrosurgical controller to the first active electrode. An adjustment of the average power supplied to the electrode circuit in the second mode is further:
Controlling the flow rate of the fluid entering the opening, wherein the flow rate of the fluid in the second mode is different from the flow rate of the fluid in the first mode;
Control of energy provided to the first active electrode by the electrosurgical controller, wherein energy provided to the first active electrode in the second mode is the first mode. 22. A method according to claim 21, comprising controlling the energy different from the energy supplied to the one active electrode. A processor,
A memory coupled to the processor;
A voltage generator operably coupled to the processor and including an active terminal;
A wand connector configured to couple to a connector of an electrosurgical wand, the wand connector comprising a plurality of electrical pins, at least one electrical pin being coupled to the active terminal of the voltage generator , Wand connectors,
A peristaltic pump including a rotor coupled to an electric motor, wherein the electric motor is operably coupled to the processor;
When the memory is executed by the processor,
Implementing a first ablation mode by setting a first predetermined speed of the rotor of the peristaltic pump and setting a first predetermined energy supplied by the voltage generator;
Implementing a second ablation mode by setting a second predetermined speed of the rotor of the peristaltic pump and setting a second predetermined energy supplied by the voltage generator, Storing, wherein the second predetermined speed is different from the first predetermined speed and the second predetermined energy is different from the first predetermined energy. Surgical controller.   24. The electrosurgical controller according to claim 23, further comprising an outer housing, wherein the processor, memory, voltage generator, wand connector and motorized pump are at least partially disposed within the outer housing. A first external housing, wherein the processor, memory, voltage generator and wand connector are at least partially disposed within the external housing;
A second external housing distinguished from said first external housing, wherein said peristaltic pump is at least partially disposed within said second external housing; 24. The electrosurgical controller according to claim 23, further comprising. The program further comprises, in each ablation mode, the processor
Adjusting the speed of the peristaltic pump rotor in response to changes in a parameter indicative of the impedance of the electrode circuit;
Adjusting the energy supplied by the generator in response to a change in a parameter indicative of the impedance of the electrode circuit.   When the processor adjusts the speed of the rotor, the program further causes the processor to at least one selected from the group consisting of: momentary stopping of the rotor, and momentary reversal of the direction of the rotor. 27. The electrosurgical controller according to claim 26, wherein the controller is configured to   The first and second ablation modes are respectively a low power mode for use in cartilage ablation, an intermediate power mode for use in fibrocartilage ablation, and a high power mode for soft tissue ablation 24. The electrosurgical controller according to claim 23, wherein the at least one ablation mode is selected mutually exclusively from the group consisting of: and a vacuum mode for removal of free tissue.   The program further causes the processor to set a third predetermined speed of the rotor of the peristaltic pump and a third predetermined energy supplied by the voltage generator for third ablation. Mode implementation, the third predetermined velocity is different from the first and second predetermined velocities, and the third predetermined energy is different from the first and second predetermined energies. An electrosurgical controller according to claim 23.   The first, second and third ablation modes are respectively a low power mode for use in ablation of cartilage, an intermediate power mode for use in ablation of fibrocartilage, and high power for ablation of soft tissue 30. The electrosurgical controller according to claim 29, wherein the controller is at least one ablation mode exclusively selected from one another from the group consisting of: a mode and a vacuum mode for removal of free tissue. A processor,
A memory coupled to the processor;
A voltage generator operably coupled to the processor and including an active terminal;
A wand connector configured to be coupled to a connector of an electrosurgical wand, the wand connector comprising a plurality of electrical pins, the at least one electrical pin being coupled to the active terminal of the voltage generator And the wand connector,
A peristaltic pump, comprising a rotor coupled to an electric motor operably coupled to the processor;
A controller for electrosurgery, including
An elongated shaft defining a proximal end and a distal end;
A first active electrode disposed at the distal end of the elongated shaft;
A connector including at least one pin electrically coupled to the first active electrode;
And an electrosurgical wand,
A system that includes
The memory stores a program that, when executed by the processor, causes the processor to implement at least two ablation modes in an electrosurgical procedure, the implementation being implemented with the active electrode of the electrosurgical wand ,system. The program implements at least two modes, and the program causes the processor to:
Control of the impedance of the plasma in the first mode of operation of the electrosurgical procedure;
Controlling the impedance of the plasma in a second mode of operation of the electrosurgical procedure, wherein controlling the impedance of the plasma in the second mode is different from the impedance in the first mode 32. The system of claim 31. When the processor controls the impedance of the electrode circuit in the first operation mode, the program causes the processor to
Controlling the flow rate of fluid entering the opening proximate the first active electrode of the distal end of the electrosurgical wand;
33. The system of claim 32, performing control of energy provided to the first active electrode by the electrosurgical controller. When the processor controls the impedance of the electrode circuit in the second operation mode, the program causes the processor to
Controlling the flow rate of the fluid entering the opening, wherein the flow rate of the fluid in the second mode is different from the flow rate of the fluid in the first mode;
Control of energy supplied to the first active electrode, wherein energy supplied to the first active electrode in the second mode is supplied to the first active electrode in the first mode 34. The system according to claim 33, wherein the control of energy is performed different from the energy being delivered.   34. The system of claim 33, wherein the program causes the processor to control the speed of the rotor of the peristaltic pump as the processor controls the flow rate of fluid entering the opening.   36. The system of claim 35, wherein the program further causes the processor to perform a momentary reversal of the direction of the peristaltic pump rotor as the processor controls the speed of the peristaltic pump rotor. A first external housing, wherein the processor, memory, voltage generator and wand connector are at least partially disposed within the external housing;
A second external housing distinguished from said first external housing, wherein said peristaltic pump is at least partially disposed within said second external housing; 32. The system of claim 31, further comprising: The program further causes the processor to, in each ablation mode,
Adjusting the speed of the rotor of the peristaltic pump in response to changes in parameters indicative of the impedance of the electrode circuit;
32. The system according to claim 31, comprising: adjusting the energy supplied by the generator in response to changes in a parameter indicative of the impedance of the electrode circuit.   When the processor adjusts the speed of the rotor, the program further causes the processor to at least one selected from the group consisting of: momentary stopping of the rotor, and momentary reversal of the direction of the rotor. 39. The system of claim 38, wherein said system performs.   The at least two ablation modes are a low power mode for use in ablation of cartilage, an intermediate power mode for use in ablation of fibrocartilage, a high power mode for ablation of soft tissue, and removal of free tissue 32. The system of claim 31, wherein the systems are mutually selected exclusively from the group consisting of:

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