|Número de publicación||US3913581 A|
|Tipo de publicación||Concesión|
|Fecha de publicación||21 Oct 1975|
|Fecha de presentación||1 Jun 1973|
|Fecha de prioridad||2 Jun 1972|
|Número de publicación||US 3913581 A, US 3913581A, US-A-3913581, US3913581 A, US3913581A|
|Inventores||Ritson Carl, Thomas Ernest Hilton|
|Cesionario original||Spembly Ltd|
|Exportar cita||BiBTeX, EndNote, RefMan|
|Citas de patentes (8), Citada por (188), Clasificaciones (13)|
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet|
United States Patent 1 1 Ritson et al.
[ 1 Oct. 21, 1975 1 1 CRYOGENIC APPARATUS  Inventors: Carl Ritson, Upavon; Ernest Hilton Thomas, Kingston, Near Marlborough, both of England  Foreign Application Priority Data June 2, 1972 United Kingdom 25910/72 [521 U.S. Cl s 128/3031; 62/293 [51} Int. C13... A61B 17/36; F25D 3/08; F25D 3/10  Field of Search 62/293, 514; 128/3031 [56} References Cited UNITED STATES PATENTS 3,067,589 12/1962 Dennis et a1 62/293 3,393,679 7/1968 Crump el al 128/3031 3,502,081 3/1970 Amoils t t ,1 128/3031 3,512,531 5/1970 Crump ct al 128/3031 U 1 1F 98 2B 4 3B 3,548,829 12/1970 Reynolds e1 128/3031 3,613,689 10/1971 Crump et al...... 128/3031 3,696,813 10/1972 Wallach 62/293 3,762,179 10/1973 Jespersen 62/514 Primary ExaminerChanning L. Pace Attorney, Agent, or Firm-Shapiro and Shapiro [57} ABSTRACT The invention relates to cryosurgical instruments in which gas cooling by Joule-Thomson expansion is employed in an applicator adapted to contact and thermally cool human tissue, the gas in the cooling mode being carried to an orifice, for expansion there through, by a first duct and led away to atmosphere after expansion by a second ductv The invention resides in apparatus and a method of obtaining rapid warming of the applicator by providing valve means for connecting the second duct directly to a source of high pressure refrigerant gas so that gas condenses within the applicator upon any cold surface thereof.
23 Claims, 12 Drawing Figures US. Patent Oct. 21, 1975 Sheet 1 of4 3,913,581
U.S. Patent 0a. 21, 1975 Sheet 2 of4 3,913,581
cavocamc APPARATUS This invention relates to cryogenic apparatus and in particular to cryosurgical instruments of the type in which pressurised refrigerant gas, such as nitrous oxide for example, is expanded through an orifice to thereby produce a cooling effect by Joule-Thomson expansion, the cooled gas impinging upon the internal surfaces of a hollow working tip, applicator or probe whereby animal tissue in contact therewith may be frozen. Such instruments are described in U.S. Pat. No. 3,502,081 which also shows electrical heaters associated with the probes for the purpose of rapidly heating a working tip so that it may be readily detached from frozen tissue when so desired.
Such instruments have an exhaust passage leading from the hollow working tip to atmosphere whereby the refrigerant after expansion is ducted away, and may use the bottled refrigerant in the liquid phase, drawingoff the refrigerant as a gas from above the liquid surface.
Non-electrical methods have been proposed for reheating the working tips of similar instruments, which methods do not suffer from the need to regulate the heating, or to monitor the tip temperature when so doing, as with electrical methods. Such a non-electrical method is disclosed in U.S. Pat. No. 3,696,8l3 and involves restricting or completely closing the exhaust passage so that refrigerant fluid, still flowing through the orifice, raises the pressure within the working tip to that, or nearly so, of the refrigerant source. In the case of a Joule-Thomson, gas-cooled instrument, as the pressure of gas rises within the working tip, gas begins to condense on the cold surfaces, the latent heat of condensation serving to warm the surfaces and bring about a rapid "defrost as it is generally known.
Although the method described may be satisfactory in small instruments, it is believed that the rate of warming can be accelerated in larger instruments by by-passing the orifice and pressurising the interior of a working tip directly from the source of refrigerant thus avoiding delays due to exponential rates of pressure rise arising from the restriction to flow of an orifice.
The rate of pressure rise in a working tip is also affected by the size of the isolated volume and the size of orifice (which however is normally fixed to produce the required cooling power). It is believed that U.S. Pat. No. 3,696,813 seeks to minimise the restricted or isolated volume by providing a manually operated valve within the normally hand-held instrument so that the surgeon may initiate cooling and reheating of the working tip by respectively depressing and releasing the valve with his finger/s. In view of the high refrigerant pressures employed, for example 700 p.s.i. in the case of nitrous oxide, such a valve requires either a large force, or an exaggerated finger movement if levers are employed to reduce the force for operation thereof, and which may make precise movements or manipulations of the instrument difficult during surgery. By removing the valve and placing it remote from the instrument, although permitting the surgeon greater sensitivity of operation, the isolated volume in the warming mode would be greatly increased resulting in slower defrost.
It is therefore an aim of the invention to provide a method for initiating a cooling mode and for causing the cooled working tip of a cryosurgical instrument to rapidly rewarm sufficiently for detachment from tissue frozen theret, i.e., a warming mode, in which the rate of warming is independent of any isolated volume; and it is also an aim to provide apparatus in which such cooling and rewarming is achieved by valve or other control means which may be either within or separate from the instrument.
Accordingly the invention provides a cryosurgical instrument for use with a remote source of pressurised gas and adapted to operate in a cooling mode and in a rapid warming mode, comprising:
a body enclosing a cavity having a wall of high thermal conductance, said wall being shaped externally for contacting human tissue and being of sufficient structural integrity to withstand the full source pressure and providing heat transfer with the tissue;
a first conduit extending through said body and connected to said cavity terminating therein in a restricted orifice through which pressurised gas may expand into said cavity, experiencing Joule-Thomson cooling in so doing, and thereby cool said wall when said first conduit is connected to said source of gas;
a second conduit connected to said cavity; cross-over valve means to which connects said first and second conduits, said source of pressurised gas and an exhaust passage leading to atmosphere, which valve means, in the cooling mode connect said source to said first conduit and connect said second conduit to said exhaust passage, and in the warming mode connect said source to said second conduit;
all such that, in the cooling mode, pressurised gas from said source expands through said orifice and into said cavity wherefrom it is ducted to atmosphere via said second conduit and said exhaust passage and, that in the warming mode, gas from said source is fed via said second conduit directly into said cavity wherein, if the wall is cold it condenses thereupon, thus liberating latent heat and warming said wall in consequence.
The valve means may conveniently comprise a two position valve, either within or remote from said body, which in a second position provides connection for the warming mode and in a first position provides connection for a cooling mode. Such a valve may be biased, by a spring for example, towards said second position, and may be adapted for foot, hand or pressure control.
When such a two-position valve is used it is preferable to include means, such as for example a non-return valve in series with said first conduit, in order to prevent continuous reversal of flow when in the warming mode. The valve itself, when in its second position, may be adapted to close said first conduit, or the conduit may be permitted to remain connected to said source since no flow will occur when the pressure in said first and second conduits is equal.
In order to isolate the source of gas and/or to vent said first and second conduits when the instrument is not in use, the valve means may comprise a threeposition valve having the same first and second positions as the aforementioned two-position valve but having a third position whereat the source is isolated and, if so desired, at least the first conduit of said first and second conduits may be connected to said exhaust passage.
lf the valve is adapted to pass through the second position when changing from the first to third positions, and vice versa and is biased normally towards said third position, the instrument may then be operated by a single movement, automatically passing through the warming mode in each direction of valve movement. Should the time of transit through the second position be insufficient for thorough warming to take place, the invention provides for delay means which temporarily maintain the valve in its second position when changing from first to third positions. Such delay means in its simplest form may comprise a dashpot operatively connected to the movable member of the valve, or may, in a preferred form, comprise a pressure operated detent which includes a bleed orifice through which any gas pressure in the detent may leak away when the detent is fluidly isolated. The detent may be operated by said three-position valve which may be adapted to connect the detent to said source of gas only when in said first position, and means may be provided to fluidly isolate the detent when the valve is in said second position, the valve, when changing from first to third positions, being maintained in its second position by said detent for a period determined by the rate of bleed of gas from the now fluidly isolated detent. The detent isolation means may comprise a non-return valve, or be part of said three-position valve. The three-position valve may be adapted for hand, foot or pressure operation.
When a three position valve is used, said first conduit when a warming mode is selected, may be either closed, open to atmosphere and shut off from the source, or remain connected to said source. If open to atmosphere, reverse flow through said restricted orifice being only for such time that the valve is maintained in its second position. It is therefore within the scope of the invention to connect said first conduit to atmosphere by said three-position valve when in its second position particularly when delay means are incorporated which ensure such connection holds for only a brief period. Such momentary reversal of gas flow is advantageous in that contaminants may be flushed out of said first conduit.
[t has been found in practice that when cryosurgical instruments according to the invention are used in the cooling mode for excessively long periods, such as for example when freezing a large volume of human tissue, the second conduit, and even the valve means when remote, are cooled by the effluent gas to such an extent that they fill or partially fill with condensed liquid when pressurised in the warming mode. With a three-position valve which when in the third position, vents the second conduit, such liquid is expelled. However, by including a pressure operated shuttle valve within said instrument body, cold effluent may be vented to atmosphere directly from said body thus minimising the regions which may be cooled by such gas flow.
Accordingly the invention provides a cryosurgical instrument for use with a remote source of pressurised gas and adapted to operate in a cooling mode and in a rapid warming mode, comprising:
a body defining a chamber and enclosing a cavity having a wall of high thermal conductance, said wall being shaped externally for contacting human tissue and providing heat transfer with the tissue and being of sufficient structural integrity to withstand the full source pressure, a wall of which chamber is provided with an exhaust passage leading to atmosphere adjacent a first end thereof;
a first conduit connecting with said remote source of pressurised gas, extending through said body and into said cavity terminating therein in a restricted orifice through which gas from said source may expand into said cavity and thereby cool said wall;
a second conduit leading from said cavity into said first end of said chamber;
a valve member slidably mounted in said chamber movable therein under the action of pressure and having an axially aligned fluid passage therethrough, said exhaust passage being closeable by said valve member;
a control valve connected to said source and a third conduit leading from said control valve to a second end of said chamber;
all such that; when the control valve is operated for the cooling mode, said third conduit is connected by said valve to atmosphere so that gas entering and expanding in said cavity is ducted to said first end of said chamber thrusting said valve member towards said chamber second end thus opening said exhaust passage and permitting said expanded gas to escape to atmosphere therethrough; when the control valve is released for the warming mode, said third conduit is connected to said source so that said valve member is thrust towards said chamber first end thus closing said exhaust passage and ducting high pressure gas from said third conduit through said fluid passage and into said cavity, via said second passage, wherein said gas will condense upon the wall, if this be cold, giving up latent heat in so doing.
The control valve may be adapted for hand, foot or pressure operation.
With the possible exception of the aspect of the invention in which reverse flow is permitted in the warming mode, it is also advantageous to provide a nonreturn valve in said restricted orifice being such that, in the cooling mode gas flow is restricted and that, in the reverse sense of flow, gas flow is relatively unrestricted. Such an arrangement permits said first conduit to be flushed if so desired and therefore constitutes a facility for unblocking a blocked restricted orifice.
The invention contemplates a method for controlling the cooling and subsequent reheating of the working tip of a cryosurgical instrument of the type described in which an exhaust passage leads normally to atmosphere from the interior of the working tip, which method involves connecting by valve means the exhaust passage to atmosphere during a cooling operation, and directly to a source of gaseous refrigerant during a reheating operation. The refrigerant leading to the orifice in operation, may be permanently connected to its source, since all flow through that orifice will cease as the pressure difference thereacross equalises. However, it is within the scope of the invention to interrupt the supply of refrigerant to the orifice during a warming mode, and even to connect the supply side of the thus isolated orifice briefly to atmosphere so that a modicum of reverse flow occurs therethrough, thus clearing the supply passages of liquid refrigerant which may condense therein, or of contaminants.
The invention will now be exemplified with reference to the accompanying drawings which are as follows:
FIG. 1 illustrates a simple cryosurgical probe or applicator having the general features referred to in the invention;
FIGS. 2 and 3 show, in sectional elevation and end view respectively, a restricted orifice fitted with a ball valve;
FIGS. 4 and 5 are schematic diagrams of cryosurgical instruments which incorporate remote, two-position control valves and such an applicator as illustrated in FIG. 1;
FIG. 6 is a schematic diagram of a cryosurgical instrument having a remote, three-position, control valve and an applicator such as illustrated in FIG. 1.
FIG. 7 shows schematically a cryosurgical instrument, of the type illustrated in FIG. 6, in which a pneumatic delay is provided;
FIGS. 8, 8A and 8B illustrate respectively the threecontrol positions of an instrument similar to the kind depicted in FIG. 6;
FIG. 9 shows in section a cryosurgical applicator, in the body of which is provided a two-position, pressure operated, shuttle valve; and
FIG. is a schematic diagram of an instrument which incorporates an applicator such as illustrated in FIG. 9.
Referring to FIG. 1, the cryosurgical applicator illustrated comprises a hollow, cylindrical body 1 of stainless steel, closed at one end and having a bore 1H recessed at 1A, into which recess is brazed end 28 of a thin-walled stainless steel tube 2. The other end 2A of tube 2 is closed to define a cavity and constitutes the working tip of the applicator, the external surface of end 2A being, in operation, applied to human tissue in order to extract heat therefrom. The wall of end 2A is thin so that the thermal conductance thereof is high but is sufficient structural integrity to withstand the full source pressure.
A first conduit 3 extends co-axially and sealedly through the wall of the closed end of body 1, extending through bore 1H and tube 2 wherein it terminates in an orifice 3A such that any gas issuing from orifice 3A is directed towards the internal surface of the end 2A. The orifice 3A is restricted in the sense that its crosssectional area is smaller than that of the bore of conduit 3 leading up to the orifice.
End 38 of conduit 3 is adapted to receive a flexible hose 4 through which a high pressure gaseous refrigerant is, in the cooling operation, ducted to .the applicator. Such a refrigerant may, for example, be a polyatomic gas such as carbon dioxide or nitrous oxide and which has an inversion temperature above normal room temperature, normally stored in bottles as a liquid at high pressure (around 700 p.s.i.).
A second conduit 7 also leads sealedly through the wall of the closed end of body 1, opening within a recess l] of bore ll-I. The outer end 7A of the second conduit 7 is adapted to receive a flexible hose 8 through which, in operation, gases expanded from orifice 3A into tube 2 are exhausted away to a region of low pressure, such as the atmosphere.
Body 1 is threaded externally to engagedly receive a thermally insulative handle 9, suitably threaded internally at 9B for this purpose.
The schematic diagram in FIG. 4 shows how such an applicator 16 may be connected to a control valve VI and thereby to a source of gaseous refrigerant 12, the combination of applicator, valve and source constituting a practical embodiment of the invention.
The control valve VI is a two-position, foot-operated, two-way, cross-over valve, shown in FIG. 4 in the defrost or warming mode position. When the valve VI is depressed, gaseous refrigerant from gas bottle 12 is ducted to the applicator 16 via isolation valve 14, duct 13, flexible hose 4 and non-return valve 4A, leaving the applicator via hose 8 and escaping to atmosphere via valve port 15.
High pressure gas expands through orifice 3A, cooling as it does so as a result of the Joule-Thomson effect, thus cooling application surface 2A, the expanded gas being led away by hose 8 as described above.
When the valve Vl is released, refrigerant gas from gas bottle 12 is ducted into hose 8 thus immediately pressurising the bore of tube 2 of the applicator so that gas condenses on the cold inner surfaces thereof, thus liberating latent heat and rapidly rewarming the surfaces including application surface 2A. The non-return valve 4A, in this particular embodiment, prevents a reversal of gas flow.
It is to be noted that in this last-described case, while there is reversal of the sense of direction of the pressurized gas supply, there is reversal of gas flow only to the extent required to charge the cavity and connected spaces with the pressurized gas. The valve provisions may be such that, as in the case where there is a valve 4A, there is no continuous reverse flow in the warming mode; or it may be such that the valve port 15 is so restricted that virtually the whole of the source pressure is applied within the cavity and connected spaces, there being only a very reduced continuous flow. The device of FIGS. 2 and 3 (described in full below) may be used in either case.
The system illustrated in FIG. 5 is similar to that of FIG. 4, but has a different control valve, now V2, which achieves the same result as follows:
In the warming mode position as illustrated, hoses 8, 4 and gas bottle 12 are all connected together so that, when the pressures in hoses 4 and 8 have equalised, no reverse flow can occur. When the valve V2 is depressed, the applicator 16 is connected as before.
A three-position valve V3 is used in the instrument of FIG. 6, and is shown in its intermediate position corresponding to the warming mode, but is naturally biased towards the OFF" position whereat gas bottle 12 is isolated. When valve V3 is fully depressed, and as illustrated it is foot operated, applicator 16 receives high pressure gas as described before, via duct 13, isolation valve 14 which may now comprise the gas bottle valve and be normally left open, and duct 4. Hose 8 is connected to atmosphere via valve port 15.
As valve V3 is released, it passes through the intermediate position illustrated, and if necessary may be momentarily checked in this position by the operator, whereat hose 4 is isolated and hose 8 connected to bottle 12. When valve V3 reaches its final, or "OFF" position, bottle 12 is isolated and applicator l6 vented of high pressure through valve-port 15.
In order to ensure that valve V3 dwells in the intermediate position long enough for adequate warming of the application surface 2A, means may be provided for detaining the valve in the intermediate position when it is released. Such an arrangement is shown in FIG. 7 in which the control valve V4, a foot-operated, threeposition valve, normally biased towards the OFF" position, is illustrated in the intermediate position. The plunger 19 by which the valve is operated, is provided with a collar 20 which acts as a stop in co-operation with a pneumatically operated detent 18, such that when bellows 17 are inflated by high pressure gas. detent 18 is thrust into the path of the collar 20.
Valve V4 has ports and associated passages such that: it behaves as valve V3 of FIG. 6 as regards controlling applicator 16; in the intermediate position, duct 22, which connects bellows 17 to the valve, is closed; in the first or operating position, bellows 17 is connected to the gas bottle 12. The bellow 17 is also provided with a bleed valve 21, through which gas is bled from the bellows at a rate determined by the valve 21 setting.
When valve V4 is fully depressed, applicator 16 is put into the cooling mode and bellows 17 are pressurised thus extending detent 18 into the path of collar 20 which is now below and spaced from the detent 18. Upon releasing the valve V4, it moves into the intermediate position whereat it is held by detent 18. In this position, the applicator 16 is put into the warming mode, and the pressure in the now isolated bellows 17 falls at a rate determined by the now setting of bleed valve 21, until the detent 18 moves clear of collar 20 and permits the valve to move to the OFF position whereat both applicator and bellows are vented to atmosphere. By adjusting bleed valve 21, the length of the warming mode period may be varied.
FIGS. 8, 8A and 8B depict schematically a variation of the instrument of FIG. 7 in which the control valve is so modified that the valve may be changed directly from the OFF" to the first, or operational position, without passing through the intermediate position, but does pass through temporarily and is held in the intermediate position when changing in the reverse sense.
Applicator 16 is connected to control valve assembly generally indicated as V5, hose 4 connecting with twoposition valve VA and hose 8 connecting with another two position valve V58 which has a ported body 31 moveable axially relative to the fixed body of valve VSA, the valve member 32 of VSB being connected by rod 33 to member 30 of VSA.
A lever 35, pivotally mounted at 37, extends through a slot 34 in rod 33 such that when button 35A on the lever is pressed, i.e., the lever is urged in a clockwise direction, valve members 30 and 32 are moved to the left against the action of the valve biasing spring 36. Valve body 31 may be moved axially against the action of compression springs 43 by means of a bellows 38 which, when pressurised, extends and thrusts upon end 318 of the valve body 31. The bellows fluidly connect with hose 4 via a spring loaded non-return valve, and a bleed valve 39 permits any pressurised gas within the bellows 38 to gradually bleed to atmosphere.
A gas-bottle 12 is connected to valve VSA via duct 13 and to valve-body 31 of valve VSB via a duct 13A which has sufficient flexibility to permit movement of body 31, likewise hose 8 is sufficiently flexible.
FIG. 8 illustrates the OFF" position and FIG. 8A the operational position. Referring then to FIG. 8A, when button 35A is depressed, VSA takes up the position shown in which duct 13 connects with hose 4, V5B remains unchanged, the valve body 31 not having moved relative to member 32 which engaged with end stops 31A, both member 32 and body 31 having moved to the left. Hose 8, in this position of valve V5B, is connected to atmosphere via port 15. As hose 4 received gas from bottle 12, the pressure therein was communicated via duct 41 of non-return valve 40 to bellows 38 which extended leftwards to engage with end 318 of body 31, thus preventing return of the body to its original position, whilst not impeding any subsequent rightwards movement of member 32. When button 35A is released, members 30 and 32 move to the right under the action of spring 36, body 31 remaining held to the left by bellows 38, and FIG. 88 illustrates this, the warming mode position. Hose 4 is now vented to atmo sphere via valve VSA and port 42, hose 8 is connected by valve VSB to gas bottle 12 via duct 13A, so that rapid warming of the applicator 16 occurs. Some reverse flow results through orifice 3A of the applicator, but as the warming period is short, this flow is unimportant. Because hose 4 is vented to atmosphere, nonreturn valve 40 isolates bellows 38 which, after a predetermined period of time (according to the adjustment of bleed valve 39) retract, permitting body 31 to move to its original OFF position (as in FIG. 8) under the action of springs 43.
It has been found that, in some particular surgical operations where prolonged cooling is required, cold effluent gas may cool hose 8 and the associated control valve (such as valve VI of FIG. 1 for example) sufficiently for condensation of refrigerant gas to occur within these members during a warming mode, thus tending to flood the instrument. FIG. 9 therefore shows an applicator in which a pneumatically operated shuttle valve is included which permits the effluent gas to escape to atmosphere at the applicator and not at some remote point. The total mass that can be cooled is therefore reduced. 1
Referring to FIG. 9, the cryosurgical instrument illustrated comprises a valve body 51 of stainless steel which is in the form of a hollow chamber having a cylindrical bore 51G in which is a shuttle valve member 55 in axially slidable sealed engagement therewith.
A passing 51D leads axially from the bore 51G, opening thereinto, terminating in a spigot 51B to which is soldered or welded end 52B of a stainless steel tube 52, the other end 52A of which is closed. Where passage 51D opens into bore 51G, a valve seat 51C, comprising a lip, is provided with which valve member 55 may sealedly engage. Holes 51E are provided in the valve body wall adjacent the valve seat, leading from the bore 51G into an annular space 59A existing between a handle 59 of insulating material which substantially encloses the instrument, except for a length of tube 52 and the enclosed end 52A thereof which extends from the handle 59 and which constitutes the working tip or application surface of the instrument, i.e., that portion which may be used to contact and cool human tissue.
The handle 59 is in threaded engagement with threaded portion 51F of valve body 51, and the annulus 59A opens to atmosphere.
A conduit extends co-axially and sealedly through the left hand end wall of the valve body 51, it extends through bore 51G and valve member 55 (which has a bore 55A extending therethrough), passage 51D and tube 52 where it terminates in an orifice of chosen diameter or area adjacent closed end 52A. A nylon hose 54 is shown connected to the external end of conduit 53, and leads to a gas-bottle 12 as will be explained in relation to FIG. 10. Another conduit 57 also extends sealedly through the left hand end wall of valve body 51, and opens into bore 516. Another nylon hose 58 connected to the external end of conduit 57 leads to a control valve V6 as shown in FIG. 10.
The valve member 55, which is provided with an an nular seal 56 in slideable contact with bore SIG, may be moved from one end of the bore 516 to the other by the use of pressurised gaseous refrigerant in the following manner: when conduit 57 is, via hose 58, open to atmosphere, and pressurised refrigerant is supplied to conduit 53, the refrigerant issues from orifice 53A, impinges upon the internal wall of tube end 52A which it cools, and exhausts along tube 52, passage 51D, and pushes valve-member 55 into the position illustrated. The exhaust gas may now pass through holes 51E and annulus 59A to atmosphere.
If, now, gaseous refrigerant, from the same gas-bottle 12 is connected via hose 58 to conduit 57, valve mem' ber 55 is thrust towards valve seat 51C which it sealedly contacts thus closing the exhaust passage but permitting the gaseous refrigerant to flow through the annulus bounded by conduit 53 and valve member 55A, thus to rapidly raise the pressure within the working tip to that of the source. 1
Although the annulus extending through the valve member must not be so large that it prevents operation of the valve member, its area can be very much greater than that of the orifice 53A without affecting such operation.
In the arrangement of FIG. 10, valve member is controlled directly from a foot operated valve V6. No reverse flow is contemplated therefore it is sufficient to move valve-member 55 onto seat 51C so that gas is supplied directly from bottle 12 to the interior of tube 52. Flow through orifice 53A ceases as the pressure difference thereacross disappears.
Instruments according to the invention may also be provided with means for clearing a blocked expansion orifice, such blocking occuring occasionally in practice due to the presence in the first conduit of particulate matter which has either escaped the gas filter, if such be provided, or is due to failure to adequately clean the conduit during manufacture.
Such means are illustrated in FIGS. 2 and 3 and comprise a ball 11 situated within tubular conduit 3 in the vicinity of end 3C thereof which has been reduced in diameter (by spinning for example) to form a seat for the ball. The ball 11 is retained within conduit 3 by a stop 3B welded or soldered into the wall thereof. A small nick 3D in the reduced end 3C constitutes the restricted orifice when the ball 11 is seated as shown in FIG. 2.
in operation, when high pressure gas is introduced into conduit 3, the ball is thrust thereby onto its seat, thus closing end 3C with the exception of orifice 31) through which the gas then expands.
When the pressure across ball 11 is equalised, or when a reverse flow occurs, the ball 11 either drops away from end 3C or is lifted by the reverse flow.
So that a blocked orifice may readily be cleared, a further valve may be provided (such as that shown in dotted line in FIG. 6 and annotated 60) which, when the applicator is in the warming mode, may be briefly opened to atmosphere thus flushing conduit 3 and lifting ball 11 clear of its seat permitting particulate matter trapped in orifice 3D to be blown away.
While particular embodiments of the invention have been described, various modifications may be made thereto by practitioners in the art without departing from the spirit of the invention and the scope of the appended claims.
I. A cryosurgical instrument for use with a remote source of pressurized gas and adapted to operate in a cooling mode and in a rapid warming mode, comprisa body enclosing a caviyty having a wall of high thermal conductance, said wall being shaped externally for contacting human tissue and providing heat transfer with the tissue and being of sufficient structural integrity to withstand the full source pressure;
a first conduit extending through said body and connected to said cavity terminating therein in a restricted orifice through which pressurized gas may expand into said cavity experiencing Joule- Thompson cooling in so doing and thereby cool said wall when said first conduit is connected to said source of gas;
a second conduit connected to said cavity;
an exhaust passage leading to atmosphere; and
valve means for providing a cooling mode gas-flow path from said source of pressurized gas, through said first conduit and said orifice, into said cavity, and then through said exhaust passage, whereby the expansion of as through said orifice cools said wall, and for selectively providing a heating mode gas-flow path from said source of pressurized gas, through said second conduit, and directly to said cavity for pressurizing said cavity sufficiently to condense said gas on the cooled wall and liberate latent heat to warm the wall.
2. A cryosurgical instrument according to claim 1 in which said valve means are remote from said body and comprise;
a two-position valve which in a second position provides connection for the warming mode and in a first position provides connection for the cooling mode;
means which prevent flow through sad first conduit in the warming mode.
3. A cryosurgical instrument according to claim 2 in which said means for preventing flow in said first conduit is said two-position valve.
4. A cryosurgical instrument according to claim 2 in which said means for preventing flow in said first conduit is a non-return valve.
5. A cryosurgical instrument according to claim 2 in which said valve is biased towards said second position.
6. A cryosurgical instrument according to claim 1 in which said valve means comprise a pressure operated two-position valve situated in said body.
7. A cryosurgical instrument according to claim 1 in which said valve means comprise a three-position valve which, in a first position, provides connection for the cooling mode, in a second position provides connection for the warming mode and in a third position isolates said source of pressurised gas.
8. A cryosurgical instrument according to claim 7 in which said three position valve, when in said third position, also connects at least the first conduit of said first and second conduits to said exhaust passage.
9. A cryosurgical instrument according to claim 8 in which said three-position valve when in said second position connects said first conduit to said exhaust passage.
10. A cryosurgical instrument according to claim 7 in which said three position valve passes through said second position at least when changing from the first to the third position.
11. A cryosurgical instrument according to claim 10 in which delay means are provided which temporarily maintain said three-position valve in said second position when it is urged from said first position towards said third position.
12. A cryosurgical instrument according to claim 11 in which said delay means comprise; a pressure operated detent including a bleed orifice through which any gas pressure in said detent may leak away when said detent is fluidly isolated; in which cryosurgical instrument said three-position valve is adapted to (a) operate said detent by connecting it to said source only when in said first position; and (b) to be maintained in said second position by said operated detent, when changing from said first to said third position, for a period determined by the rate of bleed of gas from said detent when fluidly isolated; means which fluidly isolate said detent from said source when said three-position valve is in said second position.
13. A cryosurgical instrument according to claim 12 in which said detent isolation means is a non-return valve connecting said detent to said first conduit and said three-position valve when in its second position connects said first conduit to said exhaust passage.
14. A cryosurgical instrument according to claim 1 in which said restricted orifice includes a non-return valve such that, in the cooling mode, gas flow is restricted but that gas flow is relatively unrestricted in the reverse sense of flow.
15. A cryosurgical instrument according to claim 14 in which said first conduit terminates in a portion of reduced diameter and in which said non-return valve comprises a free ball of smaller diameter than that of the first conduit bore but greater than that portion of reduced diameter and which seats on the reduced portion under the action of pressure within said first conduit, and is released upon reversal of pressure; in which said restricted orifice is formed in the wall of said reduced portion.
16. A method of cooling and then warming the highly thermally conductive wall of an expension chamber in a cryosurgical instrument, the external surface of the wall providing the applicator surface of the instrument, the method comprising:
introducing a pressurized gaseous refrigerant from a source thereof into said chamber through flowrestricting means while connecting said chamber to a region of pressure lower than the pressure of said source, thereby cooling said wall and said applicator surface by the Joule-Thomson effect; and then pressurizing said chamber from said source of pressurized gaseous refrigerant through a flow path separate from said flow-restricting means so that said refrigerant condenses on said wall and liberates latent heat thereto, thereby warming said wall and said applicator surface.
l7. A method as described in claim 16 wherein the gaseous refrigerant is carbon dioxide.
18. A method as described in claim 16 wherein the gaseous refrigerant gas is nitrous oxide.
19. A method as set forth in claim 16, wherein said introducing is effected through a conduit having said flow-restricting means therein.
20. A method as set forth in claim 19, wherein said conduit is blocked during said warming.
21. A method as set forth in claim 19, wherein said conduit is connected to said source during said warming.
22. A method as set forth in claim 19, wherein said conduit is connected to atmosphere during said warming.
23. A cryosurgical instrument according to claim 1, in which said body is a hollow cylindrical body having said first conduit extending therethrough from one end of the body and into said cavity at the opposite end, said second conduit and said exhaust passage being connected to said body at said one end, said valve means comprising a valve member slidably mounted in said body at said one end of said body and having means for connecting said second conduit and said exhaust passage to said cavity alternately in response to gas pressure in said second conduit, said valve means further comprising a control valve for selectively connecting said second conduit to said source or to atmosphere.
l II i II
|Patente citada||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US3067589 *||8 Nov 1960||11 Dic 1962||Specialties Dev Corp||Cooling apparatus|
|US3393679 *||27 Dic 1965||23 Jul 1968||Frigitronics Of Conn Inc||Cryosurgical instrument|
|US3502081 *||5 Abr 1966||24 Mar 1970||Amoils Selig Percy||Cryosurgical instrument|
|US3512531 *||11 Ene 1968||19 May 1970||Frigitronics Of Conn Inc||Method and apparatus for cryosurgery|
|US3548829 *||21 Oct 1968||22 Dic 1970||Frigitronics Of Conn Inc||Cryosurgical instrument|
|US3613689 *||13 Ene 1970||19 Oct 1971||Frigitronics Of Conn Inc||Cryosurgical apparatus|
|US3696813 *||6 Oct 1971||10 Oct 1972||Cryomedics||Cryosurgical instrument|
|US3762179 *||5 Oct 1971||2 Oct 1973||Danfoss As||Valve arrangement for a cooling system|
|Patente citante||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US4015606 *||9 Sep 1975||5 Abr 1977||Dynatech Corporation||Method and means for controlling the freeze zone of a cryosurgical probe|
|US4018227 *||9 Oct 1975||19 Abr 1977||Cryomedics, Inc.||Cryosurgical instrument|
|US4063560 *||5 Abr 1976||20 Dic 1977||Spembly Limited||Cryosurgical instrument|
|US4146030 *||27 Dic 1976||27 Mar 1979||Dynatech Corporation||Cryosurgical instrument|
|US4236518 *||14 Abr 1978||2 Dic 1980||Gyne-Tech Instrument Corporation||Cryogenic device selectively operable in a continuous freezing mode, a continuous thawing mode or a combination thereof|
|US4275734 *||12 Ago 1977||30 Jun 1981||Valleylab, Inc.||Cryosurgical apparatus and method|
|US4377168 *||27 Feb 1981||22 Mar 1983||Wallach Surgical Instruments, Inc.||Cryosurgical instrument|
|US4468935 *||4 Ene 1983||4 Sep 1984||Societe Anonyme De Telecommunications||Device for regulating a Joule-Thomson effect refrigerator|
|US4735063 *||13 Abr 1987||5 Abr 1988||Superior Marketing Research Corp.||Self-contained cooling device|
|US5078713 *||30 Nov 1989||7 Ene 1992||Spembly Medical Limited||Cryosurgical probe|
|US5139496 *||20 Dic 1990||18 Ago 1992||Hed Aharon Z||Ultrasonic freeze ablation catheters and probes|
|US5176686 *||19 Abr 1991||5 Ene 1993||Poley Brooks J||Apparatus for packaging, folding, rigidifying and inserting an intraocular lens|
|US5224943 *||14 Dic 1989||6 Jul 1993||Spembly Medical Ltd.||Cryosurgical apparatus|
|US5758505 *||7 Oct 1996||2 Jun 1998||Cryogen, Inc.||Precooling system for joule-thomson probe|
|US5787715 *||15 Ago 1996||4 Ago 1998||Cryogen, Inc.||Mixed gas refrigeration method|
|US5800487 *||23 Jul 1996||1 Sep 1998||Endocare, Inc.||Cryoprobe|
|US5800488 *||23 Jul 1996||1 Sep 1998||Endocare, Inc.||Cryoprobe with warming feature|
|US5860971 *||23 May 1997||19 Ene 1999||Spembly Cryosurgery Limited||Thawing of cryosurgical apparatus|
|US5901783 *||17 Jul 1997||11 May 1999||Croyogen, Inc.||Cryogenic heat exchanger|
|US5956958 *||9 Sep 1997||28 Sep 1999||Cryogen, Inc.||Gas mixture for cryogenic applications|
|US6074412 *||29 Ago 1998||13 Jun 2000||Endocare, Inc.||Cryoprobe|
|US6151901 *||12 Oct 1995||28 Nov 2000||Cryogen, Inc.||Miniature mixed gas refrigeration system|
|US6161543 *||15 Oct 1997||19 Dic 2000||Epicor, Inc.||Methods of epicardial ablation for creating a lesion around the pulmonary veins|
|US6165207 *||27 May 1999||26 Dic 2000||Alsius Corporation||Method of selectively shaping hollow fibers of heat exchange catheter|
|US6182666||28 Oct 1998||6 Feb 2001||Cryogen, Inc.||Cryosurgical probe and method for uterine ablation|
|US6193644||4 Mar 1999||27 Feb 2001||Cryogen, Inc.||Cryosurgical probe with sheath|
|US6251105||31 Mar 1998||26 Jun 2001||Endocare, Inc.||Cryoprobe system|
|US6270494||25 Ago 1999||7 Ago 2001||Cryogen, Inc.||Stretchable cryoprobe sheath|
|US6287326||2 Ago 1999||11 Sep 2001||Alsius Corporation||Catheter with coiled multi-lumen heat transfer extension|
|US6299599||27 Oct 1999||9 Oct 2001||Alsius Corporation||Dual balloon central venous line catheter temperature control system|
|US6306129||19 Ago 1999||23 Oct 2001||Femrx, Inc.||Cryosurgical system and method|
|US6378525||29 Ene 1998||30 Abr 2002||American Medical Systems, Inc.||Combined cryotherapy and hyperthermia method for the treatment of airway obstruction or prostrate enlargement|
|US6393320||24 Jul 2001||21 May 2002||Alsius Corporation||Method for treating cardiac arrest|
|US6409747||11 Feb 2000||25 Jun 2002||Alsius Corporation||Indwelling heat exchange catheter and method of using same|
|US6419643||18 Ago 1999||16 Jul 2002||Alsius Corporation||Central venous catheter with heat exchange properties|
|US6447474||15 Sep 1999||10 Sep 2002||Alsius Corporation||Automatic fever abatement system|
|US6450990||19 Abr 1999||17 Sep 2002||Alsius Corporation||Catheter with multiple heating/cooling fibers employing fiber spreading features|
|US6451012||5 Feb 2001||17 Sep 2002||Cryogen, Inc.||Cryosurgical method for endometrial ablation|
|US6458150||11 Mar 1999||1 Oct 2002||Alsius Corporation||Method and apparatus for patient temperature control|
|US6475212||22 Feb 2001||5 Nov 2002||Cryogen, Inc.||Cryosurgical probe with sheath|
|US6505629||15 Dic 1999||14 Ene 2003||Endocare, Inc.||Cryosurgical system with protective warming feature|
|US6516224||24 Jul 2001||4 Feb 2003||Alsius Corporation||Method for treating cardiac arrest|
|US6530234||7 May 1998||11 Mar 2003||Cryogen, Inc.||Precooling system for Joule-Thomson probe|
|US6530946||3 Oct 2000||11 Mar 2003||Alsius Corporation||Indwelling heat exchange heat pipe catheter and method of using same|
|US6572640||21 Nov 2001||3 Jun 2003||Alsius Corporation||Method and apparatus for cardiopulmonary bypass patient temperature control|
|US6582398||22 Sep 2000||24 Jun 2003||Alsius Corporation||Method of managing patient temperature with a heat exchange catheter|
|US6585729||25 Jun 2001||1 Jul 2003||Endocare, Inc.||Vented cryosurgical system with backpressure source|
|US6589271||13 Dic 2001||8 Jul 2003||Alsius Corporations||Indwelling heat exchange catheter|
|US6620131||10 Ago 2001||16 Sep 2003||Alsius Corporation||Dual balloon central venous line catheter temperature control system|
|US6652565||24 Ago 2001||25 Nov 2003||Alsius Corporation||Central venous catheter with heat exchange properties|
|US6716236||19 Oct 2001||6 Abr 2004||Alsius Corporation||Intravascular catheter with heat exchange element having inner inflation element and methods of use|
|US6755851||2 May 2002||29 Jun 2004||Alsius Corporation||Indwelling heat exchange catheter and method of using same|
|US6767346||23 Ene 2002||27 Jul 2004||Endocare, Inc.||Cryosurgical probe with bellows shaft|
|US6936045||20 Sep 2001||30 Ago 2005||Endocare, Inc.||Malleable cryosurgical probe|
|US6955673||16 Ago 2002||18 Oct 2005||Cryocor, Inc.||Heat transfer segment for a cryoablation catheter|
|US6981382||24 Jul 2003||3 Ene 2006||Cryocor, Inc.||Distal end for cryoablation catheters|
|US7004936||12 Sep 2002||28 Feb 2006||Cryocor, Inc.||Refrigeration source for a cryoablation catheter|
|US7070594||10 Feb 2004||4 Jul 2006||Cryocor, Inc.||System and method for assessing ice ball formation during a cryoablation procedure|
|US7083620||17 Jul 2003||1 Ago 2006||Medtronic, Inc.||Electrosurgical hemostat|
|US7094235||13 Ene 2004||22 Ago 2006||Medtronic, Inc.||Method and apparatus for tissue ablation|
|US7118566||3 Feb 2003||10 Oct 2006||Medtronic, Inc.||Device and method for needle-less interstitial injection of fluid for ablation of cardiac tissue|
|US7128740||2 Abr 2003||31 Oct 2006||Jacobs Clemens J||Method for interrupting conduction paths within the heart|
|US7156840||29 Jun 2004||2 Ene 2007||Cryocor, Inc.||Pressure monitor for cryoablation catheter|
|US7156845||16 Sep 2005||2 Ene 2007||Medtronic, Inc.||Method and apparatus for creating a bi-polar virtual electrode used for the ablation of tissue|
|US7163535||30 Jun 2004||16 Ene 2007||Cryocor, Inc.||System for detecting leaks and occlusions in a cryoablation catheter|
|US7166105||20 Sep 2005||23 Ene 2007||Medtronic, Inc.||Pen-type electrosurgical instrument|
|US7169144||31 Oct 2003||30 Ene 2007||Medtronic, Inc.||Apparatus and method for creating, maintaining, and controlling a virtual electrode used for the ablation of tissue|
|US7195625||18 Jun 2004||27 Mar 2007||Cryocor, Inc.||Catheter system for performing a single step cryoablation|
|US7207985 *||25 Jun 2003||24 Abr 2007||Endocare, Inc.||Detachable cryosurgical probe|
|US7247155||18 May 2004||24 Jul 2007||Medtronic, Inc.||Apparatus and method for creating, maintaining, and controlling a virtual electrode used for the ablation of tissue|
|US7250048||20 Ago 2004||31 Jul 2007||Medtronic, Inc.||Ablation system and method of use|
|US7250051||26 Abr 2006||31 Jul 2007||Medtronic, Inc.||Method and apparatus for tissue ablation|
|US7278984||31 Dic 2002||9 Oct 2007||Alsius Corporation||System and method for controlling rate of heat exchange with patient|
|US7294143||3 Feb 2003||13 Nov 2007||Medtronic, Inc.||Device and method for ablation of cardiac tissue|
|US7309325||28 Jun 2005||18 Dic 2007||Medtronic, Inc.||Helical needle apparatus for creating a virtual electrode used for the ablation of tissue|
|US7347858||14 Oct 2003||25 Mar 2008||Medtronic, Inc.||Method and system for treatment of atrial tachyarrhythmias|
|US7357797 *||30 Jun 2004||15 Abr 2008||Cryocor, Inc.||System and method for varying return pressure to control tip temperature of a cryoablation catheter|
|US7364578||3 Dic 2004||29 Abr 2008||Medtronic, Inc.||System and method of performing an electrosurgical procedure|
|US7367972||9 Sep 2003||6 May 2008||Medtronic, Inc.||Ablation system|
|US7422588||7 Dic 2006||9 Sep 2008||Medtronic, Inc.||Pen-type electrosurgical instrument|
|US7435250||18 Feb 2005||14 Oct 2008||Medtronic, Inc.||Method and apparatus for tissue ablation|
|US7470272||30 Jun 2004||30 Dic 2008||Medtronic, Inc.||Device and method for ablating tissue|
|US7497857||29 Abr 2003||3 Mar 2009||Medtronic, Inc.||Endocardial dispersive electrode for use with a monopolar RF ablation pen|
|US7507235||28 May 2002||24 Mar 2009||Medtronic, Inc.||Method and system for organ positioning and stabilization|
|US7566334||2 Jun 2005||28 Jul 2009||Medtronic, Inc.||Ablation device with jaws|
|US7615015||20 Jun 2003||10 Nov 2009||Medtronic, Inc.||Focused ultrasound ablation devices having selectively actuatable emitting elements and methods of using the same|
|US7628780||30 Nov 2004||8 Dic 2009||Medtronic, Inc.||Devices and methods for interstitial injection of biologic agents into tissue|
|US7641632||31 Ago 2007||5 Ene 2010||Zoll Circulation, Inc.||System and method for controlling rate of heat exchange with patient|
|US7678108||2 Jun 2005||16 Mar 2010||Medtronic, Inc.||Loop ablation apparatus and method|
|US7678111||29 Nov 2005||16 Mar 2010||Medtronic, Inc.||Device and method for ablating tissue|
|US7699805||30 Nov 2007||20 Abr 2010||Medtronic, Inc.||Helical coil apparatus for ablation of tissue|
|US7706882||13 May 2005||27 Abr 2010||Medtronic, Inc.||Methods of using high intensity focused ultrasound to form an ablated tissue area|
|US7706894||26 Abr 2005||27 Abr 2010||Medtronic, Inc.||Heart wall ablation/mapping catheter and method|
|US7740623||23 Jun 2005||22 Jun 2010||Medtronic, Inc.||Devices and methods for interstitial injection of biologic agents into tissue|
|US7744562||10 Oct 2006||29 Jun 2010||Medtronics, Inc.||Devices and methods for interstitial injection of biologic agents into tissue|
|US7758576||2 Jun 2005||20 Jul 2010||Medtronic, Inc.||Clamping ablation tool and method|
|US7758580||2 Jun 2005||20 Jul 2010||Medtronic, Inc.||Compound bipolar ablation device and method|
|US7794460||11 Ago 2008||14 Sep 2010||Medtronic, Inc.||Method of ablating tissue|
|US7818039||15 Jul 2005||19 Oct 2010||Medtronic, Inc.||Suction stabilized epicardial ablation devices|
|US7824399||16 Feb 2006||2 Nov 2010||Medtronic, Inc.||Ablation system and method of use|
|US7846154||6 Dic 2004||7 Dic 2010||Galil Medical Ltd.||Gas-heated gas-cooled cryoprobe utilizing electrical heating and a single gas source|
|US7871409||2 Feb 2009||18 Ene 2011||Medtronic, Inc.||Endocardial dispersive electrode for use with a monopolar RF ablation pen|
|US7875028||8 Jul 2009||25 Ene 2011||Medtronic, Inc.||Ablation device with jaws|
|US7959626||20 Jul 2007||14 Jun 2011||Medtronic, Inc.||Transmural ablation systems and methods|
|US7963940||22 Ago 2005||21 Jun 2011||Boston Scientific Scimed, Inc.||Local perfusion device|
|US7963963||21 Ene 2005||21 Jun 2011||Medtronic, Inc.||Electrosurgical hemostat|
|US7967816||25 Ene 2002||28 Jun 2011||Medtronic, Inc.||Fluid-assisted electrosurgical instrument with shapeable electrode|
|US7975703||31 Ago 2006||12 Jul 2011||Medtronic, Inc.||Device and method for needle-less interstitial injection of fluid for ablation of cardiac tissue|
|US8048066||16 Jun 2009||1 Nov 2011||Boston Scientific Scimed, Inc.||Cryotreatment device and method of forming conduction blocks|
|US8128595||24 Ago 2001||6 Mar 2012||Zoll Circulation, Inc.||Method for a central venous line catheter having a temperature control system|
|US8162933||3 Mar 2004||24 Abr 2012||Medtronic, Inc.||Vibration sensitive ablation device and method|
|US8162941||20 Dic 2010||24 Abr 2012||Medtronic, Inc.||Ablation device with jaws|
|US8172837||14 Jun 2010||8 May 2012||Medtronic, Inc.||Clamping ablation tool and method|
|US8221402||9 Dic 2005||17 Jul 2012||Medtronic, Inc.||Method for guiding a medical device|
|US8221415||27 Jul 2007||17 Jul 2012||Medtronic, Inc.||Method and apparatus for tissue ablation|
|US8262649||27 Jul 2007||11 Sep 2012||Medtronic, Inc.||Method and apparatus for tissue ablation|
|US8273072||18 Nov 2009||25 Sep 2012||Medtronic, Inc.||Devices and methods for interstitial injection of biologic agents into tissue|
|US8333764||12 May 2004||18 Dic 2012||Medtronic, Inc.||Device and method for determining tissue thickness and creating cardiac ablation lesions|
|US8409219||30 Sep 2009||2 Abr 2013||Medtronic, Inc.||Method and system for placement of electrical lead inside heart|
|US8414573||11 Oct 2006||9 Abr 2013||Medtronic, Inc.||Device and method for ablation of cardiac tissue|
|US8512337||20 Ago 2004||20 Ago 2013||Medtronic, Inc.||Method and system for treatment of atrial tachyarrhythmias|
|US8568409||31 Oct 2007||29 Oct 2013||Medtronic Advanced Energy Llc||Fluid-assisted medical devices, systems and methods|
|US8585689||4 Oct 2011||19 Nov 2013||Boston Scientific Scimed, Inc.||Cryotreatment devices and methods of forming conduction blocks|
|US8623010||9 Jun 2009||7 Ene 2014||Medtronic, Inc.||Cardiac mapping instrument with shapeable electrode|
|US8632533||23 Feb 2010||21 Ene 2014||Medtronic Advanced Energy Llc||Fluid-assisted electrosurgical device|
|US8663245||19 Abr 2007||4 Mar 2014||Medtronic, Inc.||Device for occlusion of a left atrial appendage|
|US8706260||27 Oct 2011||22 Abr 2014||Medtronic, Inc.||Heart wall ablation/mapping catheter and method|
|US8747396||18 Oct 2009||10 Jun 2014||Endocare, Inc.||Cryosurgical probe with adjustable sliding apparatus|
|US8801707||14 Ago 2012||12 Ago 2014||Medtronic, Inc.||Method and devices for treating atrial fibrillation by mass ablation|
|US8821488||13 May 2009||2 Sep 2014||Medtronic, Inc.||Tissue lesion evaluation|
|US8906012||30 Jun 2010||9 Dic 2014||Medtronic Advanced Energy Llc||Electrosurgical devices with wire electrode|
|US8926635||2 Oct 2009||6 Ene 2015||Medtronic, Inc.||Methods and devices for occlusion of an atrial appendage|
|US9033967||19 Nov 2013||19 May 2015||Boston Scientific Scimed, Inc.||Cryotreatment devices and methods of forming conduction blocks|
|US9113896||28 Dic 2007||25 Ago 2015||Medtronic, Inc.||Method and apparatus for creating a bi-polar virtual electrode used for the ablation of tissue|
|US9119608||30 Mar 2010||1 Sep 2015||Erbe Elektromedizin Gmbh||Adapter for overpressure protection, cryoprobe having such an adapter and cryosurgical device with overpressure protection|
|US9138289||28 Jun 2010||22 Sep 2015||Medtronic Advanced Energy Llc||Electrode sheath for electrosurgical device|
|US9227088||3 May 2010||5 Ene 2016||Medtronic, Inc.||Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesions|
|US9333027 *||3 Oct 2013||10 May 2016||Medtronic Advanced Energy Llc||Method of producing an electrosurgical device|
|US9339322||13 May 2015||17 May 2016||Boston Scientific Scimed Inc.||Cryotreatment devices and methods of forming conduction blocks|
|US9381061||23 Nov 2011||5 Jul 2016||Medtronic Advanced Energy Llc||Fluid-assisted medical devices, systems and methods|
|US9486283||20 Dic 2013||8 Nov 2016||Medtronic Advanced Energy Llc||Fluid-assisted electrosurgical device|
|US20030220634 *||12 Sep 2002||27 Nov 2003||Ryba Eric L.||Refrigeration source for a cryoablation catheter|
|US20040034344 *||16 Ago 2002||19 Feb 2004||Eric Ryba||Tip pressure monitoring for cryoablation catheters|
|US20040034345 *||16 Ago 2002||19 Feb 2004||Lentz David J.||Heat transfer segment for a cryoablation catheter|
|US20040073203 *||2 Sep 2003||15 Abr 2004||Xiaoyu Yu||Cryosurgical probe with adjustable freeze zone|
|US20040204705 *||10 Abr 2003||14 Oct 2004||Scimed Life Systems, Inc.||Cryotreatment devices and methods of forming conduction blocks|
|US20040243117 *||18 Jun 2004||2 Dic 2004||Lentz David J.||Catheter system for performing a single step cryoablation|
|US20040243118 *||25 Jun 2004||2 Dic 2004||Ayers Gregory M.||Device and method for positioning a catheter tip for creating a cryogenic lesion|
|US20040267248 *||25 Jun 2003||30 Dic 2004||Thach Duong||Detachable cryosurgical probe|
|US20040267338 *||25 Jun 2003||30 Dic 2004||Kent Harrison||Targeted tissue cooling within a body|
|US20050016188 *||24 Jul 2003||27 Ene 2005||Lentz David J.||Distal end for cryoablation catheters|
|US20050027289 *||31 Jul 2003||3 Feb 2005||Thomas Castellano||Cryoablation systems and methods|
|US20050081541 *||17 Oct 2003||21 Abr 2005||Gareth Copping||Method and apparatus for supplying refrigerant fluid|
|US20050177146 *||10 Feb 2004||11 Ago 2005||Marshall Sherman||System and method for assessing ice ball formation during a cryoablation procedure|
|US20050198972 *||10 Mar 2004||15 Sep 2005||Lentz David J.||Pressure-temperature control for a cryoablation catheter system|
|US20050283146 *||17 Jun 2004||22 Dic 2005||Lentz David J||Thermally extended spiral cryotip for a cryoablation catheter|
|US20050288657 *||29 Jun 2004||29 Dic 2005||Lentz David J||Pressure monitor for cryoablation catheter|
|US20060004349 *||30 Jun 2004||5 Ene 2006||Eric Ryba||System for detecting leaks and occlusions in a cryoablation catheter|
|US20060004350 *||30 Jun 2004||5 Ene 2006||Eric Ryba||System and method for varying return pressure to control tip temperature of a cryoablation catheter|
|US20060122590 *||6 Dic 2004||8 Jun 2006||Galil Medical Ltd.||Gas-heated gas-cooled cryoprobe utilizing electrical heating and a single gas source|
|US20070005048 *||29 Jun 2006||4 Ene 2007||Niedbala R S||Method and apparatus for cryogenically treating lesions on biological tissue|
|US20070060918 *||22 Ago 2005||15 Mar 2007||Holman Thomas J||Local perfusion device|
|US20080015562 *||20 Jul 2007||17 Ene 2008||Medtronic, Inc.||Transmural ablation systems and methods|
|US20080051776 *||20 Ago 2007||28 Feb 2008||Galil Medical Ltd.||Thin uninsulated cryoprobe and insulating probe introducer|
|US20080125764 *||19 Nov 2007||29 May 2008||Vancelette David W||Cryoprobe thermal control for a closed-loop cryosurgical system|
|US20090270857 *||8 Jul 2009||29 Oct 2009||Christian Steven C||Ablation Device with Jaws|
|US20090299358 *||16 Jun 2009||3 Dic 2009||Lafontaine Daniel M||Cryotreatment Device and Method of Forming Conduction Blocks|
|US20100100088 *||18 Oct 2009||22 Abr 2010||Endocare, Inc.||Cryosurgical probe with adjustable sliding apparatus|
|US20100145361 *||2 Oct 2009||10 Jun 2010||Francischelli David E||Methods and Devices for Occlusion of an Atrial Appendage|
|US20140026395 *||3 Oct 2013||30 Ene 2014||Medtronic Advanced Energy Llc||Fluid-assisted electrosurgical devices, and methods of manufacture thereof|
|USRE40868 *||1 Oct 2007||11 Ago 2009||Cryocor, Inc.||Refrigeration source for a cryoblation catheter|
|DE9303073U1 *||3 Mar 1993||19 Ago 1993||Lotsch Friedemann Dipl Designe||Vorrichtung zur partiellen Vereisung von Oberflächen|
|DE102009017370B3 *||14 Abr 2009||9 Dic 2010||Erbe Elektromedizin Gmbh||Adapter zur Überdrucksicherung, Kryosonde mit entsprechendem Adapter und kryochirurgisches Gerät mit Überdrucksicherung|
|EP0084308A2 *||3 Ene 1983||27 Jul 1983||Societe Anonyme De Telecommunications (S.A.T.)||Regulating device for a Joule-Thomson effect cooling apparatus|
|EP0084308A3 *||3 Ene 1983||3 Ago 1983||Societe Anonyme De Telecommunications||Regulating device for a joule-thomson effect cooling apparatus|
|EP0459019A2 *||3 Dic 1990||4 Dic 1991||Polycold Systems International||Fast cycle cryogenic flex probe|
|EP0952386A2 *||22 Abr 1999||27 Oct 1999||Zimmerli Messtechnik AG||Leak measuring apparatus|
|EP0952386A3 *||22 Abr 1999||8 May 2002||Zimmerli Messtechnik AG||Leak measuring apparatus|
|EP2311398A1||15 Ene 2004||20 Abr 2011||Cryodynamics, LLC.||Cryotherapy probe and system|
|EP2904986A1||15 Ene 2004||12 Ago 2015||Cryodynamics, LLC.||Cryotherapy probe and system|
|WO1993024065A1 *||4 Jun 1992||9 Dic 1993||Aharon Zeev Hed||Ultrasonic freeze ablation catheters and probes|
|WO1998004221A1||21 Jul 1997||5 Feb 1998||Endocare, Inc.||Cryoprobe|
|WO2001019447A1 *||15 Sep 2000||22 Mar 2001||Alsius Corporation||Automatic fever abatement system|
|WO2003024313A2||19 Sep 2002||27 Mar 2003||Endocare, Inc.||Malleable cryosurgical probe|
|WO2004064914A2||15 Ene 2004||5 Ago 2004||Cryodynamics, Llc.||Cryotherapy probe and system|
|WO2005038357A2 *||18 Oct 2004||28 Abr 2005||Cryomed Group Limited||Method and apparatus for supplying refrigerant fluid|
|WO2005038357A3 *||18 Oct 2004||23 Mar 2006||Cryomed Group Ltd||Method and apparatus for supplying refrigerant fluid|
|WO2006006989A3 *||15 Abr 2005||24 Ago 2006||Cryocor Inc||System and method for varying return pressure to control tip temperature of a cryoablation catheter|
|Clasificación de EE.UU.||606/23, 62/293|
|Clasificación internacional||A61B18/00, A61B18/02, F25B9/02, F25D3/10|
|Clasificación cooperativa||A61B18/02, F25B9/02, F25D3/10, A61B2018/00041|
|Clasificación europea||A61B18/02, F25B9/02, F25D3/10|