|Número de publicación||US20040073203 A1|
|Tipo de publicación||Solicitud|
|Número de solicitud||US 10/653,854|
|Fecha de publicación||15 Abr 2004|
|Fecha de presentación||2 Sep 2003|
|Fecha de prioridad||20 Sep 2001|
|También publicado como||CA2460739A1, CA2460739C, EP1435825A2, EP1435825A4, EP1435825B1, US6936045, US20030055415, WO2003024313A2, WO2003024313A3|
|Número de publicación||10653854, 653854, US 2004/0073203 A1, US 2004/073203 A1, US 20040073203 A1, US 20040073203A1, US 2004073203 A1, US 2004073203A1, US-A1-20040073203, US-A1-2004073203, US2004/0073203A1, US2004/073203A1, US20040073203 A1, US20040073203A1, US2004073203 A1, US2004073203A1|
|Inventores||Xiaoyu Yu, Sanford Damasco, Jay Eum|
|Cesionario original||Xiaoyu Yu, Damasco Sanford D., Eum Jay J.|
|Exportar cita||BiBTeX, EndNote, RefMan|
|Citas de patentes (18), Citada por (20), Clasificaciones (13), Eventos legales (1)|
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet|
 This application is a continuation-in-part of U.S. Ser. No. 09/957,337 filed Sep. 20, 2001.
 1. Field of the Invention
 The present invention relates to cryosurgical probes and more particularly to a cryosurgical probe that provides an adjustable freeze zone.
 2. Description of the Related Art
 Conventional cryosurgical probes generally have the probe tip permanently affixed to a probe instrument body, including a handle member, for example. Other probes were invented long ago which involved the use of removable and interchangeable probe tips, for example, U.S. Pat. No. 4,211,231, entitled “Cryosurgical Instrument”, issued to R. P. Rzasa. In the surgical destruction of tumors by freezing, different size probe tips may be required to treat different sizes and shapes of tumors. However, it is not generally practical or feasible to design or have available probe tips which have the ideal or optimum freezing area/length for every conceivable type of tumor. Therefore, there have been some proposals in the prior art to provide cryosurgical probe devices with means for adjusting the freezing zone by manipulating the length or penetration of the coolant delivery and/or coolant line with respect to the expansion chamber of the probe tip.
 U.S. Pat. No. 3,398,738, entitled “Refrigerated Surgical Probe,” issued to B. L. Lamb et al, discloses a cryosurgical probe in which the opening of its liquid refrigerant delivery tube may be longitudinally or axially adjustable. This manipulates the rate of flow of refrigerant. It does not change the freeze zone.
 U.S. Pat. No. 4,015,606 to Mitchiner, et al. discloses a cryosurgical probe having a cooling chamber that is permanently separated from the insulating chamber in which a supply conduit extends into the cooling chamber of the probe tip, wherein the freeze zone in the cooling chamber is controlled by adjusting the position of the refrigerant exhaust conduit in the tip relative to the position of the supply conduit. However, only minor, if any, adjustment is available with this device. Furthermore, the problems inherent in permanent vacuum seals still exist.
 U.S. Pat. No. 6,551,274, entitled “Cryoablation Catheter With An Expandable Cooling Chamber” discloses a cryoablation catheter having an expandable cooling chamber in which the cooling fluid, preferably a gas, serves to expand the expandable cooling chamber while simultaneously cooling the chamber. The cryoablation catheter includes an outer tubular member capable of insertion into the vessels of the body. An expandable cooling chamber, which preferably takes the form of a distendable balloon, is disposed at the distal end of the outer tubular member. An inner tubular member is disposed within the outer tubular member and extends through a passageway in the wall of the outer tubular member. The inner tubular member serves to carry a cooling fluid to the interior of the expandable cooling chamber. A fluid expansion nozzle is disposed on the distal end of the inner tubular member. Preferably the fluid expansion nozzle takes the form of a Joule-Thomson nozzle. By applying a cooling fluid to the inner tubular member it is possible to expand the expandable cooling chamber while simultaneously cooling the chamber.
 U.S. Pat. Nos. 6,547,785 and 6,497,703, each entitled “Cryoablation Catheter For Long Lesion Ablations,” each disclose a cryoablation catheter, comprising an outer tubular body with a closed distal end to form a fluid cooling chamber and an inner tubular member having a proximal end adapted to receive fluid suitable for cryoablation and a distal end coupled to a fluid expansion nozzle wherein the inner tubular member is movable in an axial direction to thereby change the position of the nozzle within the fluid cooling chamber.
 The '703 patent discloses the concept of “dragging” the ablation tip, or the cooling tip, of a cryoablation catheter along a line in order to create a long lesion. In order to accomplish this function, the cryogenic cooling nozzle is moved longitudinally along the inside of a cooling chamber to thereby cause the outer surface of the cooling chamber to be cooled along a linear path which in turn creates a linear lesion along the path.
 The '785 patent emphasizes that the catheter system includes a nozzle control system which is comprised of an inner ring member formed of a magnetic material which is mounted on the proximal end of the inner tubular member, and an outer ring member formed of magnetic material which is slidably mounted on the outer tubular member. Because of the magnetic attraction between these two magnetic members, when an outer ring member is moved along the outer tubular member it “pulls” or draws an inner magnetic ring member along with the outer magnetic ring member to thereby cause the inner tubular member to be moved longitudinally which in turn causes the fluid expansion nozzle to be moved longitudinally within the cooling chamber.
 Both of these patents involve changing the location of the freeze zone but do not increase or increase the length of the freeze zone.
 In one broad aspect, the present invention is embodied as a cryosurgical probe for providing an adjustable freeze zone. The cryosurgical probe includes an actuator housing assembly and an actuator assembly. The actuator housing assembly includes an actuator housing having an elongated central opening therethrough. The actuator housing has a proximal end portion and a distal end portion. A delivery system for a cryogenic fluid, includes a first end secured to the proximal end portion of the actuator housing. An insulation layer has a proximal portion securely attached to the proximal end portion of the actuator housing.
 An actuator assembly includes a rotatable actuator having a portion thereof contained within the actuator housing. The rotatable actuator is rotatable relative to the actuator housing. A cryosurgical shaft assembly is securely attached to the rotatable actuator. The insulation layer extends along an inner surface of the cryosurgical shaft to define insulated portions of the cryosurgical shaft and uninsulated portions. The relative disposition of insulated and uninsulated portions of the cryosurgical shaft assembly defines at least one freeze zone which is adjustable by relative rotation between the rotatable actuator and the actuator housing.
 In one preferred embodiment the rotatable actuator is operatively engaged with the actuator housing to provide axial movement therebetween during rotation of the rotatable actuator thereby changing the length of the freeze zone.
 In another preferred embodiment, instead of changing the length of the freeze zone, rotation of the actuator housing relative to the rotatable actuator changes the position of insulation located on a selected portion of the cryosurgical shaft assembly and effects an adjustment in the freeze zone.
FIG. 1 is a cross sectional view, partially in cross section, of a first embodiment of the cryosurgical probe of the present invention in which the freezing zone can adjusted to be longer or shorter.
FIG. 2 is another cross sectional view of the FIG. 1 embodiment, showing the shaft assembly detracted relative to the insulation, illustrating how the freeze zone length is decreased.
FIG. 3 is a cross sectional view, partially in cross section, of the cryosurgical probe, including its fluid supply line.
FIG. 4 is a cross sectional view of another embodiment in which the cryosurgical probe is angled.
FIG. 5 is a cross sectional view, partially in cross section of another embodiment in which there is no longitudinal relative movement of the cryosurgical shaft assembly relative to the actuator housing, and instead, insulation is located on a selected portion of the cryosurgical shaft assembly so that rotation effects a change in the freeze zone.
FIG. 6 is a view taken along line 6-6 of FIG. 5.
FIG. 7 is a cross sectional view, partially in cross section, of another embodiment of the cryosurgical probe of the present invention in which the actuator housing and the actuator are reversed.
FIG. 8 is another cross sectional view of the FIG. 8 embodiment, showing the shaft assembly detracted relative to the insulation, illustrating how the freeze zone length is decreased.
 Referring now to the drawings and the characters of reference marked thereon, FIGS. 1 and 2 illustrate a preferred embodiment of the cryosurgical probe of the present invention, designated generally as 10. The cryosurgical probe 10 includes an actuator housing assembly (i.e. stationary assembly), designated generally as 12, and an actuator assembly (i.e. positionable assembly), designated generally as 13. The stationary assembly 12 includes an actuator housing 14 having an elongated central opening therethrough. The actuator housing 14 has a proximal end portion 16 and a distal end portion 18. The actuator housing is preferably formed of a hard metal such as stainless steel.
 A cryostat assembly 20 includes a cryostat housing 22. The cryostat housing 22 includes a cryostat housing attachment end 24 secured to the proximal end portion 16 of the actuator housing 14. The cryostat assembly 20 also includes a cryostat 26 that comprises a coiled heat exchanger. A cryostat inlet receives gas entering the cryostat while a cryostat outlet provides the gas to the Joule-Thomson nozzle, as will be explained below. The coiled heat exchanger is coiled around a mandrel. In between each winding of the heat exchanger, gaps are formed between the coil and the main body portion, and gaps are formed between the coil and the mandrel. This construction is known as a Giaque-Hampson heat exchanger. The heat exchanger, which is an integral part of the high pressure gas pathway, is made with finned tubing, with numerous fins throughout its length.
 A stationary cylindrical insulation layer 28 has a proximal portion 30 securely attached to a proximal end portion 16 of the actuator housing 14 through a spacer 32. The insulation layer 28 may be, for example, a vacuum, a space or it may formed of an insulation material such as Teflon® or glass fiber.
 A Joule-Thomson tube assembly 34 is securely positioned within the actuator housing 14. The Joule-Thomson tube assembly 34 may be formed of, for example, stainless steel.
 The positionable assembly 13 of the cryosurgical probe 10 includes a rotatable cylindrical actuator 36 having a portion thereof contained within the actuator housing 14. The cylindrical actuator 36 is rotatable relative to the actuator housing 14, preferably through the use of threads 38. A cryosurgical shaft assembly 40 is securely attached to the rotatable cylindrical actuator 36 so that that there is no relative rotation therebetween. The cryosurgical shaft assembly 40 includes an outer sheath that is preferably formed of stainless steel.
 In the embodiment shown in FIGS. 1 and 2 the threads 38 are utilized to provide the required rotation of the cylindrical actuator 36 relative to the actuator housing 14. Therefore, as can be seen in FIG. 2, during operation, as the cylindrical actuator 36 is rotated relative to the actuator housing 14 so that it moves longitudinally inwardly, the Joule-Thomson tube assembly remains stationary but the cryosurgical probe tip 41 moves longitudinally inwardly. Thus, the boiling chamber length deceases from L1 to L2, where L2=L1−DX, where DX is the distance that positionable assembly 13 is detracted. This provides a commensurate decrease in the freeze zone length. The boiling chamber length, L, is shown as the distance from the end of the insulation layer 28 to the end of the expansion chamber 42 that contains the discharging gas.
 Referring now to FIG. 3, the remainder of the cryosurgical probe is shown including a fluid supply line assembly including a the high pressure fluid supply line 44 surrounded by a flexible hose 46 which terminates with a high pressure connector 47. A temperature measurement device, i.e. a thermocouple 48, is positioned within the elongated shaft assembly, extends through the fluid supply line assembly and is connectable to a data acquisition system. The thermocouple 48 is used to measure and monitor the temperature inside the cryosurgical probe.
 Fluid flow through the cryosurgical probe is as follows. High pressure fluid, preferably gaseous argon, and preferably at a pressure of about 3000 psi, is supplied to the assembly through high pressure fitting 47, flows through gas supply line 44, through the cryostat, i.e. heat exchanger 26, through the Joule-Thomson tube assembly 34 and out the Joule-Thomson nozzle 50. The high pressure gas expands within the expansion chamber 42 and cools to cryogenic temperatures. Condensation of the gas is preferably avoided but can be tolerated. After expanding, the gas is at lower pressure and exhausts over the exhaust gas pathway that includes flow over the outside of the coils of the heat exchanger 26. Because it is now cold, it cools the gas flowing inside the coils. This makes cooling more efficient and achieves colder temperatures. After passing through the heat exchanger, the exhaust gas flows through the remainder of the exhaust gas pathway. The exhaust gas is, typically, eventually vented to the atmosphere.
 Prior art warming methods such as exhaust blocking, reverse flow heat transfer, and electrical heating can be employed. The preferred method of warming is to supply high pressure helium gas through the supply line, heat exchanger and Joule-Thomson nozzle. Helium gas heats up when expanded through the gas outlet. Thus, the supply of gas to the probe can be switched from high pressure nitrogen or argon to high pressure helium to effect rapid re-warming of the nozzle. Helium gas heats up when expanded through the gas outlet. Thus, the supply of gas to the probe can be switched from high pressure nitrogen or argon to high pressure helium to effect rapid re-warming of the cryosurgical probe.
 Although the cryosurgical probe of the present invention has been shown as being straight it may be shaped to accommodate varying uses. For example, referring now to FIG. 4, an embodiment is illustrated, generally designated 52, in which a housing extension 53 is curved to make the invention particularly useful, for example, where space limitations exist. This may be useful, for example, if the cryosurgical probe is utilized in a CT device. In addition to its utilization relative to CT guidance, the cryosurgical probe 52 may be used with a variety of guidance tools, such as MRI and ultrasound.
 Referring now to FIG. 5, another embodiment is illustrated, designated generally as 54. In this embodiment, threads are not used. Instead, there is a radial extension 56 on the cylindrical actuator 58 that engages a complimentary groove 60 on the actuator housing 62 so when the positionable assembly is rotated relative to the stationary assembly there is no longitudinal movement. As can be seen in FIG. 6, insulation 64 is located on a selected portion of the cryosurgical shaft assembly 66 so that rotation effects a change in the freeze zone. In this figure the insulation 64 is shown to be about 180 degrees. Obviously, it can be configured as desired for the particular application.
 Although the present invention has been discussed relative to the use of a Joule-Thomson tube assembly in conjunction with a cryostat assembly to provide a delivery system for a cryogenic fluid, it is understood that various other types of cryogenic delivery systems may alternatively be used such as liquid nitrogen.
 Referring now to FIGS. 7 and 8, an embodiment of the present invention is illustrated, designated generally as 70, in which the actuator housing and the cylindrical actuator are reversed. The cryosurgical probe 70 includes an actuator housing assembly (i.e. stationary assembly), designated generally as 72, and an actuator assembly (i.e. positionable assembly), designated generally as 73. The stationary assembly 72 includes an actuator housing 74 having an elongated central opening therethrough and a cryosurgical shaft assembly 76 securely attached to the distal end portion of the actuator housing.
 The actuator assembly 73 includes a rotatable cylindrical actuator 78 having a portion thereof contained within the actuator housing 74. The cylindrical actuator 78 is rotatable relative to the actuator housing 74.
 As in the previous embodiment, a cryostat assembly 80 comprises a cryostat housing 82. The cryostat housing 82 includes a cryostat housing attachment end 84 secured to the rotatable cylindrical actuator 78. A cylindrical insulation layer 86 has a proximal portion securely attached to the rotatable cylindrical actuator 78. A Joule-Thomson tube assembly 88 is securely positioned within the cylindrical actuator. Thus, rotation of the rotatable cylindrical actuator 78 provides desired freezing.
 This embodiment may be modified, as was the previous embodiment, to provide for longitudinal relative movement or only radial motion (i.e. by a groove) so that rotation effects a change in the freeze zone.
 Although the present invention has been discussed above with respect to a cryosurgical probe having with a rigid outer sheath, the cryosurgical probe may be made to be malleable by including at least one malleable segment thereon. Malleable segments are formed of material that permit reshaping and bending to reposition the ablating surface for greater ablation precision. An example of a cryosurgical probe having malleable characteristics is disclosed and claimed in patent application Ser. No. 09/957,337, Pub. No. U.S. 2003/0055415 A1, filed on Sep. 20, 2001 entitled Malleable Cryosurgical Probe, incorporated in its entirety herein by reference.
 One method for providing malleable characteristics includes providing a malleable shaft with a bellows portion. Patent application Ser. No. 10/057,033, Pub. No. U.S. 2003/0055416 A1, filed on Jan. 23, 2002 entitled Cryosurgical Probe With Bellows Shaft, incorporated in its entirety herein by reference, discloses use of a bellows portion for providing the necessary reshaping and bending.
 If the cryosurgical probe is utilized in combination with ultrasound the outer sheath may have an echogenic coating with, for example, a porous microstructure having the ability to trap microscopic air bubbles. This creates thousands of highly efficient ultrasound reflectors on the surface of the sheath.
 Other embodiments and configurations may be devised without departing from the spirit of the invention and the scope of the appended claims.
|Patente citada||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US3398738 *||24 Sep 1964||27 Ago 1968||Aerojet General Co||Refrigerated surgical probe|
|US3800552 *||29 Mar 1972||2 Abr 1974||Bendix Corp||Cryogenic surgical instrument|
|US3913581 *||1 Jun 1973||21 Oct 1975||Spembly Ltd||Cryogenic apparatus|
|US4015606 *||9 Sep 1975||5 Abr 1977||Dynatech Corporation||Method and means for controlling the freeze zone of a cryosurgical probe|
|US4211231 *||15 May 1978||8 Jul 1980||Cryomedics, Inc.||Cryosurgical instrument|
|US5108390 *||14 Nov 1988||28 Abr 1992||Frigitronics, Inc.||Flexible cryoprobe|
|US5388415 *||5 Ene 1994||14 Feb 1995||State Of Israel - Ministry Of Defence Armament Development Authority, Rafael||System for a cooler and gas purity tester|
|US5452582 *||6 Jul 1994||26 Sep 1995||Apd Cryogenics, Inc.||Cryo-probe|
|US5520682 *||6 Mar 1995||28 May 1996||Cryomedical Sciences, Inc.||Cryosurgical instrument with vent means and method using same|
|US5522870 *||7 Ene 1994||4 Jun 1996||State Of Israel, Ministry Of Defense, Rafael-Armaments Development Authority||Fast changing heating-cooling device and method|
|US5800487 *||23 Jul 1996||1 Sep 1998||Endocare, Inc.||Cryoprobe|
|US6074412 *||29 Ago 1998||13 Jun 2000||Endocare, Inc.||Cryoprobe|
|US6161543 *||15 Oct 1997||19 Dic 2000||Epicor, Inc.||Methods of epicardial ablation for creating a lesion around the pulmonary veins|
|US6497785 *||16 Ene 2001||24 Dic 2002||Taiwan Semiconductor Manufacturing Co., Ltd.||Wet chemical process tank with improved fluid circulation|
|US6547785 *||23 Oct 2001||15 Abr 2003||Biosense Webster, Inc.||Cryoablation catheter for long lesion ablations|
|US6551274 *||3 Ene 2001||22 Abr 2003||Biosense Webster, Inc.||Cryoablation catheter with an expandable cooling chamber|
|US20030055414 *||21 Oct 2002||20 Mar 2003||Altshuler Gregory B.||Heads for dermatology treatment|
|US20030055416 *||23 Ene 2002||20 Mar 2003||Damasco Sanford D.||Cryosurgical probe with bellows shaft|
|Patente citante||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US7160290||5 Abr 2006||9 Ene 2007||Boston Scientific Scimed, Inc.||Low temperature lesion formation apparatus, systems and methods|
|US7288088||10 May 2004||30 Oct 2007||Boston Scientific Scimed, Inc.||Clamp based low temperature lesion formation apparatus, systems and methods|
|US7291142||10 May 2004||6 Nov 2007||Boston Scientific Scimed, Inc.||Low temperature lesion formation apparatus, systems and methods|
|US7291143||5 Abr 2006||6 Nov 2007||Boston Scientific Scimed, Inc.||Clamp based low temperature lesion formation apparatus, systems and methods|
|US7582083||10 May 2004||1 Sep 2009||Boston Scientific Scimed, Inc.||Probe based low temperature lesion formation apparatus, systems and methods|
|US7662177||12 Abr 2006||16 Feb 2010||Bacoustics, Llc||Apparatus and methods for pain relief using ultrasound waves in combination with cryogenic energy|
|US7727191||13 May 2005||1 Jun 2010||Medtronic Cryocath Lp||Compliant balloon catheter|
|US7794455||29 Abr 2005||14 Sep 2010||Medtronic Cryocath Lp||Wide area ablation of myocardial tissue|
|US7861725||31 Oct 2007||4 Ene 2011||Boston Scientific Scimed, Inc.||Method for monitoring formation of a lesion in a tissue structure using a cryogenic system|
|US7972327||31 Oct 2007||5 Jul 2011||Boston Scientific Scimed, Inc.||Low temperature lesion formation apparatus, systems and methods|
|US8142424||14 May 2007||27 Mar 2012||Boston Scientific Scimed, Inc.||Probe based low temperature lesion formation apparatus, systems and methods|
|US8425456||27 Abr 2010||23 Abr 2013||Medtronic Cryocath Lp||Compliant balloon catheter|
|US8475440||10 Dic 2007||2 Jul 2013||Medtronic Cryocath Lp||Wide area ablation of myocardial tissue|
|US8512324||4 Ene 2008||20 Ago 2013||Medtronic Cryocath Lp||Wide area ablation of myocardial tissue|
|US8679104||14 May 2008||25 Mar 2014||Medtronic Cryocath Lp||Wide area ablation of myocardial tissue|
|US20050251122 *||10 May 2004||10 Nov 2005||Scimed Life Systems, Inc.||Clamp based low temperature lesion formation apparatus, system and methods|
|US20100137853 *||27 May 2008||3 Jun 2010||Aumaitre Olivier||Cryogenic device for surgical use|
|US20120245574 *||27 Sep 2012||Medtronic Cryocath Lp||Spray nozzle design for a catheter|
|WO2014093465A1 *||11 Dic 2013||19 Jun 2014||Volcano Corporation||Rotational sensing catheter with self-supporting drive shaft section|
|WO2014093472A1 *||11 Dic 2013||19 Jun 2014||Volcano Corporation||Rotational catheter with extended catheter body drive shaft support|
|Clasificación de EE.UU.||606/21, 606/23|
|Clasificación internacional||A61B18/00, A61B18/02, A61B17/00|
|Clasificación cooperativa||A61B2017/00092, A61B2017/00084, A61B2018/00041, A61B2017/00243, A61B18/02, A61B2018/0262, A61B2018/00101|
|2 Sep 2003||AS||Assignment|
Owner name: ENDOCARE, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:YU, XIAOYU;DAMASCO, SANFORD D.;EUM, JAY J.;REEL/FRAME:014483/0018
Effective date: 20030902