WO1999059484A1 - Sonde de thermoablation - Google Patents

Sonde de thermoablation Download PDF

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Publication number
WO1999059484A1
WO1999059484A1 PCT/IL1999/000264 IL9900264W WO9959484A1 WO 1999059484 A1 WO1999059484 A1 WO 1999059484A1 IL 9900264 W IL9900264 W IL 9900264W WO 9959484 A1 WO9959484 A1 WO 9959484A1
Authority
WO
WIPO (PCT)
Prior art keywords
filaments
cannula
probe
thermal
generally
Prior art date
Application number
PCT/IL1999/000264
Other languages
English (en)
Inventor
Benny Gaber
Original Assignee
Benny Gaber
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 Benny Gaber filed Critical Benny Gaber
Priority to AU38458/99A priority Critical patent/AU3845899A/en
Publication of WO1999059484A1 publication Critical patent/WO1999059484A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor

Definitions

  • thermoablation probes and particularly to an expandable thermoablation probe which selectively cools/heats only those tissues which need to be necrotized while insulating neighboring, healthy tissues.
  • Thermoablation is a well known method for necrosis of a uterine endometrium or other related tissue by the application of extreme cold or heat. Ideally, the extreme cold/heat should be carefully applied only to those tissues which must be destroyed and not to neighboring, healthy tissues. Various problems pose a challenge to achieving this ideal goal.
  • thermoprobe For example, matching a thermoprobe to the geometry and topography of the inner structure of the cervix (or other body cavity), the complex mechanisms of heat transfer by phase changes, conduction through body tissues and convection by body fluids as well as mass transfer, the incidence of tissue preservation by freezing rather than necrosis by freezing (in the case of cryoablation), and the difficulties in safely reaching inner tissues with the cryoprobe are just some of the problems facing the surgeon performing cryoablation.
  • US Patent 5,147,355 describes a method for cryoablation comprising the steps of inserting a catheter having a tip portion into the lumen of a blood vessel, guiding the catheter to a predetermined portion of the patient's body and positioning the tip portion adjacent tissue in the lumen of the blood vessel to be ablated, and then directing a flow of cryogenic fluid to the tip portion so as to cryoablate the tissue.
  • thermoelectric cryosurgery tool for treating neoplasms.
  • the tool has cascade or thermoelectric modules coupled to a distal treatment tip which generates a steep temperature gradient.
  • a heat pipe is coupled to the thermoelectric cooling modules.
  • US Patent 5,501,681 to Neuwirth et al. describes an intrauterine cryoablation cauterizing apparatus including an applicator comprising a distendable bladder connected to a catheter which is introduced into the uterus.
  • the bladder is distended by introducing therein a non-toxic fluid under pressure and cooling the fluid to below 0°C for about 4-12 minutes.
  • Russian Patent 475,998 describes a cryosurgery probe tip.
  • the tip has a working chamber bag filled with a granular material that takes up the shape of the contacted tissue.
  • Russian Patent 1,178,423 describes an abdominal cavity organ cryosurgical instrument.
  • the instrument has tips which have removable resilient membranes and which are joined so that they can rotate around an organ.
  • the cryoinstrument attempts to reduce the volume of necrotized tissue so pathological formations can be destroyed with minimal damage to the surrounding healthy tissues.
  • Russian Patent 1,683,704 describes a multi-purpose ultrasound tissue cryo- destructor.
  • the working end of the cryoprobe includes a corrugated steel pipe with a changing angle of slant and a mobile pusher.
  • the purpose of the cryo-destructor is supposedly to enable maneuvering in closed cavities, to reduce trauma to the surrounding tissues in inaccessible zones and canals of complex profile, and to reduce the time taken by the operation.
  • Russian Patent 2,014,803 describes a cryosurgery instrument tip which includes an applicator in the form of a metallic chamber open at its distal end, filled by a capillary- porous material forming a branching cavity with communicating pores.
  • the contact part of the capillary-porous material is shaped in the form of a concave base jutting slightly into the chamber of the applicator, and is fitted with a gas evacuation pipe.
  • Russian Patents 2,018,273 and 2,018,274 both describe a deep localized tissue cooler comprising an applicator made with corrugated surfaces which has a radial recess to relieve pressure.
  • the cooler includes a cylindrical housing with coolant feed and return channels and an expansion chamber, and an applicator surface with concentric corrugations.
  • European Patent Document EP 624347 describes a cryoprobe that includes one or more non-linear elements adapted to receive a refrigerant medium and to conform to a body surface. Each refrigerant-receiving element is curved, kinked or bent whereby the probe may be Y-shaped, L-shaped or T-shaped in use.
  • the present invention seeks to provide an improved thermoablation probe which is expandable to fit the shape of any body cavity such as the cervix or uterus, and which selectively cools/heats only those tissues which need to be necrotized while insulating neighboring, healthy tissues.
  • filament encompasses any thread-like structure such as a filament, hair, thread, wire, strand, cilium, or the like.
  • thermoablation probe including a cannula having a bore formed therein with an open proximal end which is adapted for inserting therein a thermal element, a plurality of filaments extending outwards from a portion of the cannula and in thermal contact therewith, this portion being called a thermal conduction portion, wherein a portion of the cannula, called an insulating portion, has no filaments extending therefrom, and at least one guide element attached to the filaments for manipulating portions of the filaments.
  • the filaments can be flexed in a direction towards a distal and/or proximal end of the cannula by the at least one guide element.
  • the filaments are attached to the probe by being braided about the cannula.
  • the cannula itself is constructed of the filaments, preferably braided.
  • the filaments have a higher thermal conductivity than the insulating portion.
  • the insulating portion includes an auxiliary thermal insulator attached to the cannula.
  • the auxiliary thermal insulator also generally thermally insulates initial portions of the filaments which protrude from the cannula.
  • the filaments extend from generally diametrically opposite sides of the cannula.
  • the filaments extend from the cannula generally in the shape of a human body cavity, such as a human uterus.
  • a removable sheath is provided over the cannula for smoothing entry of the thermoablation probe into a body cavity.
  • the sheath may or may not be lubricated.
  • Fig. 1 is a simplified pictorial illustration of a thermoablation probe constructed and operative in accordance with a preferred embodiment of the present invention
  • Fig. 2 is a simplified sectional illustration of the thermoablation probe of Fig. 1, taken along lines II-II in Fig. 1 ;
  • Fig. 3 is a simplified pictorial illustration of the thermoablation probe of Fig. 1 wherein filaments are pulled proximally by guide elements;
  • Fig. 4 is a simplified pictorial illustration of the thermoablation probe of Fig. 1 wherein the filaments are pushed distally by the guide elements;
  • Fig. 5 is a simplified pictorial illustration of a removable sheath useful with the thermoablation probe of Fig. 1 in accordance with a preferred embodiment of the present invention.
  • Fig. 1 illustrates a thermoablation probe 10 constructed and operative in accordance with a preferred embodiment of the present invention.
  • Probe 10 preferably includes a hollow cannula 12 having an open proximal end
  • Thermal element 18 may typically be a hot or cryogenic probe used in prior art systems, depending on whether probe 10 necrotizes tissue by the application of heat or cold, respectively.
  • Bore 16 and thermal element 18 are preferably sized such that there is good thermal contact between thermal element 18 and the inner surface of bore 16.
  • Probe 10 is preferably closed at a distal end 20.
  • a plurality of filaments 22 extend outwards from a portion of cannula 12 and in thermal contact therewith, this portion being called a thermal conduction portion 24.
  • Another portion of cannula 12, called an insulating portion 26, has no filaments 22 extending therefrom.
  • thermal transfer path comprising thermal contact heat transfer between thermal element 16 and an inner wall of bore 16 of cannula 12, conduction through the thickness of the wall of cannula 12, conduction through thermal conduction portion 24 to filaments 22, conduction through filaments 22 and heat transfer by a combination of conduction and convection from filaments 22 to tissue and fluids in the region of body tissues to be necrotized.
  • Filaments 22 preferably extend from generally diametrically opposite sides of cannula 12.
  • filaments 22 preferably extend from cannula 12 generally in the shape of a body cavity in which it is desired to insert probe 10, such as a human uterus.
  • cannula 12 is constructed separately from filaments 22, and filaments 22 are wound around cannula 12, cannula 12 serving as a mandrel.
  • cannula 12 itself is constructed from braided filaments 22.
  • Filaments 22 are constructed of a material which has a higher thermal conductivity than insulating portion 26.
  • a preferred material for filaments 22 is copper, silver or gold because of their excellent thermal conductivity on the one hand and ductility on the other hand for being able to take on the shape of the particular body cavity into which probe
  • Insulating portion 26 may be constructed as part of cannula 12, in which case insulating portion 26 is constructed of a thermal insulating material, such as a plastic or a poorly conducting metal such as stainless steel.
  • insulating portion 26 may include an auxiliary thermal insulator 28 attached to cannula 12, such as a plastic covering.
  • the auxiliary thermal insulator 28 also extends over and thermally insulates initial portions of filaments 22 which protrude from cannula 12.
  • Auxiliary thermal insulator 28 may cover each filament 22 by itself, or instead, may collectively cover all filaments 22 together.
  • the thickness of auxiliary thermal insulator 28 gradually thins with increasing distance from cannula 12.
  • Heat transfer is generally constrained to flow along the length of each filament 22 and is generally minimal in a direction up and down (in the sense of Fig. 2) in the area of insulating portion 26 and in the initial protruding area of filaments 22. There is however heat transfer in the up and down direction (in the sense of Fig. 2) between the rest of the length of filaments 22 (which is not covered by insulator 28) and the particular body cavity into which probe 10 is inserted. Unlike the prior art, heat transfer is linear along the length of filaments 22 instead of cylindrically around cannula 12.
  • One or more guide elements 30 are preferably attached to filaments 22 for manipulating portions of filaments 22.
  • Guide elements 30 are illustrated as having a shape similar to a cylinder split longitudinally down its middle, but it is of course appreciated that any other arbitrary shape may also be employed.
  • Guide elements 30 may interface with filaments 22 in any suitable manner.
  • filaments 22 may pass through holes formed in guide elements 30.
  • guide elements 30 may be attached to filaments 22, such as by soldering or bonding. Filaments 22 extend from thermal conduction portion 24 at bending points 32.
  • filaments 22 are preferably attached to probe 10 by being braided about cannula 12 (auxiliary thermal insulator 28 not being illustrated in this area in order to illustrate the braided portion).
  • the braided attachment is a preferred method of attachment to easily permit flexing of filaments 22 and still ensure good thermal contact between cannula 12 and filaments 22.
  • cannula 12 itself may be formed of the braided filaments 22.
  • Figs. 3 and 4 illustrate manipulation of filaments 22.
  • filaments 22 are flexed to generally lie over cannula 12 pointing towards proximal end 14. This configuration would generally be used for inserting probe 10 into a body cavity.
  • filaments 22 are flexed to generally lie over cannula 12 pointing towards distal end 20.
  • This configuration could be used for removing probe 10 from a body cavity, for example. It is appreciated that guide elements 30 can be used to manipulate filaments 22 in any configuration.
  • Fig. 5 illustrates a removable sheath 40 useful with thermoablation probe 10 in accordance with a preferred embodiment of the present invention.
  • Sheath 40 is preferably constructed with a generally cylindrical shape, although other shapes may be employed as well. Sheath 40 may or may not be lubricated. Sheath 40 is preferably initially slipped over probe 10 prior to insertion into a body cavity and is adapted for covering at least a distal portion of cannula 12. After insertion into the body cavity, sheath 40 may be pulled distally off probe 10, such as by grasping and pulling strings 42 attached to sheath 40.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (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 une sonde de thermoablation (10) équipée d'une canule (12) comportant un trou (16), avec une extrémité proximale (14) conçue pour l'insertion d'un élément thermique (18), une pluralité de filaments (22) s'étendant vers l'extérieur depuis une partie de la canule (12) et en contact thermique avec elle, cette partie étant appelée partie de conduction thermique (24). Une partie de la canule (12), appelée partie isolante (26), est dépourvue de filaments (22) étendus vers l'extérieur, et il existe au moins un élément de guidage fixé aux filaments (22) pour la manipulation de parties de ces filaments (22).
PCT/IL1999/000264 1998-05-19 1999-05-18 Sonde de thermoablation WO1999059484A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU38458/99A AU3845899A (en) 1998-05-19 1999-05-18 Thermoablation probe

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IL124549 1998-05-19
IL12454998A IL124549A0 (en) 1998-05-19 1998-05-19 Thermoablation probe

Publications (1)

Publication Number Publication Date
WO1999059484A1 true WO1999059484A1 (fr) 1999-11-25

Family

ID=11071523

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IL1999/000264 WO1999059484A1 (fr) 1998-05-19 1999-05-18 Sonde de thermoablation

Country Status (3)

Country Link
AU (1) AU3845899A (fr)
IL (1) IL124549A0 (fr)
WO (1) WO1999059484A1 (fr)

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3630192A (en) * 1969-07-14 1971-12-28 Khosrow Jamshidi Instrument for internal organ biopsy
US5281215A (en) * 1992-04-16 1994-01-25 Implemed, Inc. Cryogenic catheter
EP0624347A1 (fr) * 1993-05-10 1994-11-17 Browning Healthcare Limited Sonde cryogénique

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3630192A (en) * 1969-07-14 1971-12-28 Khosrow Jamshidi Instrument for internal organ biopsy
US5281215A (en) * 1992-04-16 1994-01-25 Implemed, Inc. Cryogenic catheter
EP0624347A1 (fr) * 1993-05-10 1994-11-17 Browning Healthcare Limited Sonde cryogénique

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
DATABASE WPI Derwent World Patents Index; *

Also Published As

Publication number Publication date
IL124549A0 (en) 1998-12-06
AU3845899A (en) 1999-12-06

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