WO2003077779A1 - Apparatus for converting a clamp into an electrophysiology device - Google Patents

Apparatus for converting a clamp into an electrophysiology device Download PDF

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Publication number
WO2003077779A1
WO2003077779A1 PCT/US2002/038092 US0238092W WO03077779A1 WO 2003077779 A1 WO2003077779 A1 WO 2003077779A1 US 0238092 W US0238092 W US 0238092W WO 03077779 A1 WO03077779 A1 WO 03077779A1
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WO
WIPO (PCT)
Prior art keywords
energy transmission
transmission device
clamp
base member
clamp members
Prior art date
Application number
PCT/US2002/038092
Other languages
French (fr)
Inventor
Huy D. Phan
Original Assignee
Boston Scientific Limted
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 Boston Scientific Limted filed Critical Boston Scientific Limted
Priority to JP2003575836A priority Critical patent/JP2005519690A/en
Priority to CA002468635A priority patent/CA2468635A1/en
Priority to AU2002367769A priority patent/AU2002367769A1/en
Priority to EP02807088A priority patent/EP1476090A1/en
Publication of WO2003077779A1 publication Critical patent/WO2003077779A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00023Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00059Material properties
    • A61B2018/00065Material properties porous
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00107Coatings on the energy applicator
    • A61B2018/00125Coatings on the energy applicator with nanostructure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1472Probes or electrodes therefor for use with liquid electrolyte, e.g. virtual electrodes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1495Electrodes being detachable from a support structure

Definitions

  • the present inventions relate generally to structures for positioning diagnostic and therapeutic elements within the body and, more particularly, to devices which are particularly well suited for the treatment of cardiac conditions.
  • arrhythmia There are many instances where diagnostic and therapeutic elements must be inserted into the body.
  • One instance involves the treatment of cardiac conditions such as atrial fibrillation and atrial flutter which lead to an unpleasant, irregular heart beat, called arrhythmia.
  • SA node sinoatrial node
  • AV node atrioventricular node
  • This propagation causes the atria to contract in an organized way to transport blood from the atria to the ventricles, and to provide timed stimulation of the ventricles.
  • the AV node regulates the propagation delay to the atrioventricular bundle (or "HIS" bundle).
  • HIS atrioventricular bundle
  • Atrial fibrillation occurs when anatomical obstacles in the heart disrupt the normally uniform propagation of electrical impulses in the atria. These anatomical obstacles (called “conduction blocks”) can cause the electrical impulse to degenerate into several circular wavelets that circulate about the obstacles. These wavelets, called “reentry circuits,” disrupt the normally uniform activation of the left and right atria. Because of a loss of atrioventricular synchrony, the people who suffer from atrial fibrillation and flutter also suffer the consequences of impaired hemodynamics and loss of cardiac efficiency. They are also at greater risk of stroke and other thromboembolic complications because of loss of effective contraction and atrial stasis.
  • maze procedure One surgical method of treating atrial fibrillation by interrupting pathways for reentry circuits is the so-called "maze procedure" which relies on a prescribed pattern of incisions to anatomically create a convoluted path, or maze, for electrical propagation within the left and right atria.
  • the incisions direct the electrical impulse from the SA node along a specified route through all regions of both atria, causing uniform contraction required for normal atrial transport function.
  • the incisions finally direct the impulse to the AV node to activate the ventricles, restoring normal atrioventricular synchrony.
  • the incisions are also carefully placed to interrupt the conduction routes of the most common reentry circuits.
  • the maze procedure has been found very effective in curing atrial fibrillation. However, the maze procedure is technically difficult to do. It also requires open heart surgery and is very expensive. Thus, despite its considerable clinical success, only a few maze procedures are done each year.
  • Treatments have also been developed utilizing catheters and/or surgical probes (collectively “probes”) that form lesions to create a maze for electrical conduction in a predetermined path.
  • the lesions are formed by ablating tissue with one or more electrodes.
  • Electromagnetic radio frequency (“RF") energy applied by the electrode heats, and eventually kills (i.e. "ablates"), the tissue to form a lesion.
  • RF radio frequency
  • tissue coagulation occurs and it is the coagulation that kills the tissue.
  • references to the ablation of soft tissue are necessarily references to soft tissue coagulation.
  • tissue coagulation is the process of cross-linking proteins in tissue to cause the tissue to jell. In soft tissue, it is the fluid within the tissue cell membranes that jells to kill the cells, thereby killing the tissue.
  • Catheters used to create lesions typically include a relatively long and relatively flexible body that has one or more electrodes on its distal portion.
  • the portion of the catheter body that is inserted into the patient is typically from 58.4 to 139.7 cm in length and there may be another 20.3 to 38.1 cm, including a handle, outside the patient.
  • the proximal end of the catheter body is connected to the handle which includes steering controls.
  • the length and flexibility of the catheter body allow the catheter to be inserted into a main vein or artery (typically the femoral artery), directed into the interior of the heart, and then manipulated such that the electrode contacts the tissue that is to be ablated. Fluoroscopic imaging is used to provide the physician with a visual indication of the location of the catheter.
  • Surgical probes used to create lesions often include a handle, a relatively short shaft that is from about 10.2 to 45.7 cm in length and either rigid or relatively stiff, and a distal section that is from 2.54 to 25.4 cm in length and either malleable or somewhat flexible.
  • One or more electrodes are carried by the distal section.
  • Surgical probes are used in epicardial and endocardial procedures, including open heart procedures and minimally invasive procedures where access to the heart is obtained via a thoracotomy, thoracostomy or median sternotomy.
  • Exemplary surgical probes are disclosed in U.S. Patent No. 6,142,994.
  • Clamps which have a pair of opposable rigid clamp members that may be used to hold a bodily structure or a portion thereof, are used in many types surgical procedures. Lesion creating electrodes have also been permanently secured to certain types of clamps. Examples of clamps which carry lesion creating electrodes are disclosed in U.S. Patent No. 6,142,994. Such clamps are particularly useful when the physician intends to position electrodes on opposite sides of a body structure.
  • clamp includes, but is not limited to, clamps, clips, forceps, hemostats, and any other surgical device that includes a pair of opposable clamp members that hold tissue, at least one of which is movable relative to the other.
  • the rigid clamp members are connected to a scissors-like arrangement including a pair of handle supporting arms that are pivotably connected to one another.
  • the clamp members are secured to one end of the arms and the handles are secured to the other end.
  • the clamp members come together as the handles move toward one another.
  • Certain clamps that are particularly useful in minimally invasive procedures also include a pair of handles and a pair of clamp members.
  • the clamp members and handles are not mounted on the opposite ends of the same arm. Instead, the handles are carried by one end of an elongate housing and the clamp members are carried by the other.
  • a suitable mechanical linkage located within the housing causes the clamp members to move relative to one another in response to movement of the handles.
  • the rigid clamp members in conventional clamps may be linear or have a predefined curvature that is optimized for a particular surgical procedure or portion thereof. It is, therefore, necessary to have a wide variety of clamps on hand. In the field of electrophysiology, a wide variety of clamps that have electrodes permanently secured thereto must be kept on hand.
  • the inventor herein has determined that it would be advantageous to provide physicians with a wide variety of devices, including clamps (both with and without energy transmission devices) and surgical probes that carry energy transmission devices, in a wide variety of shapes, and to do so in a manner that is more cost effective than conventional apparatus.
  • An apparatus for use with a clamp in accordance with one embodiment of a present invention includes a base member configured to be secured to the clamp and at least one energy transmission device carried by the base member.
  • Such an apparatus provides a number of advantages. For example, such an apparatus may be used to quickly convert a conventional clamp into an electrophysiology device. In those instances where a procedure requires a number of different clamps, the apparatus can be moved from clamp to clamp, thereby eliminating the costs associated with providing a variety of different clamps with energy transmission devices permanently secured thereto.
  • An apparatus for use with a clamp and a probe that carries at least one energy transmission device in accordance with one embodiment of a present invention includes a base member configured to be secured to the clamp and an engagement device associated with the base member and configured to engage the probe.
  • Such an apparatus provides a number of advantages. For example, such an apparatus may be used to quickly convert a conventional clamp into an electrophysiology device and to achieve better (or merely different) tissue/energy transmission device contact than could be achieved with the probe itself. Additionally, in those instances where a procedure requires a number of different clamps, the apparatus can be moved from clamp to clamp, thereby eliminating the costs associated with providing a variety of different clamps with energy transmission devices permanently secured thereto.
  • a clamp in accordance with one embodiment of a present invention includes first and second clamp members, at least one of which is malleable, and a movement apparatus that moves at least one of the first and second clamp members relative to the other.
  • first and second clamp members at least one of which is malleable
  • a movement apparatus that moves at least one of the first and second clamp members relative to the other.
  • a surgical system in accordance with one embodiment of a present invention includes a clamp with first and second clamp members and a device that removably mounts at least one electrode on at least one of the first and second clamp members.
  • a clamp provides a number of advantages.
  • the system may be used both as a conventional clamp and an electrophysiology device.
  • Figure 1 is a plan view of a conventional clamp.
  • Figure 2 is a side view of the clamp illustrated in Figure 1.
  • Figure 3 is an enlarged view of a portion of the clamp illustrated in Figure 1 holding a vein.
  • Figure 4 is plan of a pair of energy transmission assemblies in accordance with a preferred embodiment of a present invention.
  • Figure 5 is plan showing the energy transmission assemblies illustrated in Figure 4 mounted on a clamp.
  • Figure 6 is a front view of an electrosurgical unit.
  • Figure 7a is a section view taken along line 7a-7a in Figure 4.
  • Figure 7b is a section view taken along line 7b-7b in Figure 4.
  • Figure 8 is a section view taken along line 8-8 in Figure 7a.
  • Figure 9a is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 9b is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 10 is a plan view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 11 is a section view taken along line 11-11 in Figure 10.
  • Figure 12 is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 13 is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 14 is a section view taken along line 14-14 in Figure 13.
  • Figure 15 is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 16a is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 16b is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
  • Figure 17 is a section view of a probe support device in accordance with a preferred embodiment of a present invention.
  • Figure 18 is a section view taken along line 18-18 in Figure 17.
  • Figure 19 is a partial plan view showing a pair of the probe support devices illustrated in Figure 17 supporting a pair of probes on a clamp.
  • Figure 20 is a plan view showing a pair of the probe support devices illustrated in Figure 17 supporting a pair of probes on a clamp.
  • Figure 21 is a section view of a probe support device in accordance with a preferred embodiment of a present invention.
  • Figure 22 is a section view taken along line 21-21 in Figure 20.
  • Figure 23 is a section view of a probe support device in accordance with a preferred embodiment of a present invention.
  • Figure 24 is an end view of a probe support device in accordance with a preferred embodiment of a present invention.
  • Figure 25 is a plan view of a probe support device illustrated in Figure 24.
  • Figure 26 is an end view of a probe support device in accordance with a preferred embodiment of a present invention.
  • Figure 27 is a plan view of a clamp in accordance with a preferred embodiment of a present invention.
  • Figure 28 is a plan view of a mandrel in accordance with a preferred embodiment of a present invention.
  • Figure 29 is a side view of the mandrel illustrated in Figure 28.
  • Figures 30 and 31 are plan views of the clamp illustrated in Figure 27 being bent with the mandrel illustrated in Figure 28.
  • Figure 32 is a plan view showing one example of how the clamp illustrated in Figure 27 may be bent.
  • Figure 33 is a plan view showing another example of how the clamp illustrated in Figure 27 may be bent.
  • Figure 34 is a plan view of a clamp in accordance with a preferred embodiment of a present invention.
  • Energy transmission assemblies in accordance with a present invention may be used to covert a conventional clamp into a tissue coagulation device.
  • the energy transmission assemblies may also be used to covert a clamp in accordance with the inventions described in Section V below into a tissue coagulation device.
  • the clamp 10 includes a pair of rigid arms 12 and 14 that are pivotably connected to one another by a pin 16. The proximal ends of the arms 12 and 14 are respectively connected to a pair handle members 18 and 20, while the distal ends are respectively connected to a pair of rigid clamp members 22 and 24.
  • a locking device 26 locks the clamp in the closed orientation, and prevents the clamp members 22 and 24 from coming any closer to one another than is illustrated in Figure 1 , thereby defining a predetermined spacing between the clamp members.
  • the clamp 10 also includes a pair of soft, deformable inserts 28 and 30 that are removably carried by the clamp members 22 and 24.
  • an apparatus 100 for converting the clamp 10 (which has had the inserts 28 and 30 removed) into a bi-polar tissue coagulation device includes a pair of energy transmission assemblies 102 and 104.
  • Each of the energy transmission assemblies includes a base member 106 that may be removably secured to one of the clamp members 22 and 24 and an energy transmission device 108.
  • the energy transmission assemblies 102 and 104 are discussed in greater detail in Section II below.
  • the configuration of the energy transmission assemblies 102 and 104 may vary from application to application to suit particular situations, the energy transmission assemblies in the exemplary embodiment are configured such that they will abut one another in the same manner as the inserts 28 and 30 ( Figures 1-3) when the clamp 10 is in the closed orientation illustrated in Figure 5. Such an arrangement will allow the energy transmission assemblies 102 and 104 to grip a bodily structure in the same manner as the inserts 28 and 30.
  • the exemplary base members 106 are preferably formed from a soft, resilient, low durometer material that is electrically insulating.
  • each of the exemplary base members 106 includes a longitudinally extending aperture 110 into which one of the clamp members 22 and 24 may be inserted.
  • the apertures 110 should be sized and shaped such that the base members 106 will be forced to stretch when the clamp members 22 and 24 are inserted. If, for example, the apertures 110 have the same cross- sectional shape as the clamp members 22 and 24 (e.g. both are elliptical), then the apertures should be slightly smaller in their cross-sectional dimensions than the corresponding clamp members.
  • the stretching of the apertures 110 creates a tight interference fit between the base members 106 and clamp members 22 and 24.
  • the apertures 110 have a semi-circular cross- section in the exemplary embodiment, the apertures may have a round, rectangular, square or elliptical cross-section, or define any other cross-sectional shape, depending on the particular application.
  • the exemplary base members 106 also include slots 112 ( Figure 8) that secure the energy transmission devices 108 in place.
  • the configuration of a slot 112 will, of course, depend on the configuration of the energy transmission device 108 that it is holding.
  • the illustrated energy transmission device 108 is generally cylindrical in shape and the slot 112 has a corresponding arcuate cross-sectional shape.
  • the arc is preferably greater than 180 degrees so that the base member 106 will deflect when the energy transmission device 108 is inserted into the slot 112 and then snap back to hold the energy transmission device in place.
  • Adhesive may also be used to secure the energy transmission devices 108, especially in those instances where the arc is less than 180 degrees.
  • FIG. 9a and 9b Another exemplary apparatus for converting the clamp 10 (which has had the inserts 28 and 30 removed) into a bi-polar tissue coagulation device is illustrated in Figures 9a and 9b.
  • the apparatus includes a pair of energy transmission assemblies 114 and 116 which are substantially similar to the energy transmission assemblies 102 and 104 and similar elements are represented by similar reference numerals.
  • Each of the energy transmission assemblies 114 and 116 includes a base member 106' that may be removably secured to one of the clamp members 22 and 24 and an energy transmission device 108.
  • the base members 106' are secured to the clamp members 22 and 24 with mating structures 118 that mechanically engage the clamp members.
  • the exemplary mating structures 118 which are preferably integral with the base members 106' and formed from the same resilient material, include a relatively narrow portion 120 and a relatively wide portion 122.
  • the relatively narrow portions are approximately the same size as the clamp member apertures 36 and the relatively wide portions 122 are slightly larger than the clamp member apertures.
  • a removable connection is made by urging the mating structures 118 into one end of the apertures 36, thereby deforming the relatively wide portions 122, and then urging the base members 106' against the clamp members 22 and 24 until the relatively wide portions exit through the other end of the apertures and reassume their original shape.
  • the exemplary mating structures 118 may also be reconfigured by eliminating the relatively wide portions 122 and enlarging the relatively narrow portions 120 such that the relatively narrow portions will create an interference fit within the clamp member apertures 36.
  • longitudinally extending mating structures which also create an interference fit, may be employed when longitudinally extending slots are formed in the clamp members.
  • Another alternative is to provide the clamp members with one or more small mating structures that extend outwardly therefrom. The clamp member mating structures will be received within apertures or slots formed in the base member.
  • an energy transmission assembly 124 may be used to convert the clamp 10 (which has had the inserts 28 and 30 removed) into a uni-polar tissue coagulation device.
  • the energy transmission assembly may be used to convert the clamp 10 (which has had the inserts 28 and 30 removed) into a uni-polar tissue coagulation device.
  • the energy transmission assembly 124 includes a base member 126, which may be removably secured to both of the clamp members 22 and 24, and a plurality of spaced energy transmission devices 108.
  • the configuration of the energy transmission assembly 124 may vary from application to application to suit particular situations, the energy transmission assembly in the exemplary embodiment is configured such that it will abut each of the clamp members when the clamp 10 is in the closed orientation illustrated in Figure 10.
  • the exemplary base member 126 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D.
  • a slot 128 secures the energy transmission devices 108 in place. Although the configuration of the slot 128 will depend on the configuration of the energy transmission devices 108, the exemplary slot has an arcuate cross-sectional shape that conforms to the shape of the exemplary cylindrical energy transmission devices. The arc is preferably greater than 180 degrees so that the base member 126 will deflect when the energy transmission devices 108 are inserted into the slot 128 and then snap back to hold the energy transmission devices in place. Adhesive may also be used to secure the energy transmission devices 108 in place, especially in those instances where the arc is less than
  • the base member 126 is removably secured to the clamp members 22 and 24 with two sets of the mating structures 118 that are described above with reference to Figures 9a and 9b (with or without the relatively wide portions 122).
  • the energy transmission assembly 124 may be provided with longitudinally extending mating structures 130 that extend outwardly from the base member 126'.
  • the longitudinally extending mating structures 130 which are preferably integral with the base member 126' and formed from the same resilient material, are sized and shaped to create an interference fit with the slots 38.
  • Still another alternative is to provide the clamp members with one or more small mating structures that are received within apertures or slots formed in the base member.
  • the energy transmission assembly 132 includes a base member 134 that is preferably formed from a soft, resilient, low durometer material and a plurality of energy transmission devices 108.
  • the material which forms the base member 134 should also be electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D.
  • a slot 128, which secures the energy transmission devices 108 in place in the manner described above with reference to Figures 10 and 11 is also provided.
  • the exemplary base member 134 includes a longitudinally extending aperture 136 into which both of the clamp members 22 and 24 may be inserted.
  • the aperture 136 should be sized and shaped such that the base member 134 will be forced to stretch when the clamp members 22 and 24 are inserted with the clamp 10 in a closed orientation. The stretching creates a tight interference fit between the base member 134 and the clamp members 22 and 24.
  • the apertures 110 have an elliptical cross-section in the exemplary embodiment, the apertures may have a round, rectangular, square or semi-circular cross-section, or define any other cross-sectional shape, depending on the particular application.
  • the length of the base members in the exemplary energy transmission assemblies will vary according to the intended application.
  • exemplary energy transmission assemblies described above may also be modified in a variety of ways.
  • the energy transmission assembly illustrated in Figures 10 and 11 may be converted into a bi-polar device by simply adding a second slot 128 that is preferably spaced apart from and parallel to the existing slot.
  • the second slot 128 could, for example, include a single return energy transmission device 108 or a plurality of spaced return energy transmission devices.
  • the base members and energy transmission devices in the illustrated embodiments are configured such that the energy transmission devices are generally linear and parallel to the longitudinal axis of the base members (when the assemblies are in a relaxed state and not being urged against a body structure).
  • the base members and/or energy transmission devices may be reconfigured such that the energy transmission devices, or a portion thereof, are curved and/or non-parallel to the longitudinal axis of the base members when in the relaxed state.
  • the energy transmission devices are electrodes. More specifically, the energy transmission devices are preferably in the form of wound, spiral coil electrodes that are relatively flexible.
  • the coils are made of electrically conducting material, like copper alloy, platinum, or stainless steel, or compositions such as drawn-filled tubing (e.g. a copper core with a platinum jacket).
  • the electrically conducting material of the coils can be further coated with platinum-iridium or gold to improve its conduction properties and biocompatibility.
  • a preferred coil electrode configuration is disclosed in U.S. Patent No. 5,797,905. Although the diameter of the electrodes will very from application to application, the diameter preferably ranges from about 1 mm to about 3 mm for cardiovascular applications.
  • the electrodes may be in the form of solid rings of conductive material, like platinum, or can comprise a conductive material, like platinum-iridium or gold, coated upon the base member using conventional coating techniques or an ion beam assisted deposition (I BAD) process. For better adherence, an undercoating of nickel or titanium can be applied.
  • the electrodes can also be in the form of helical ribbons.
  • the electrodes can also be formed with a conductive ink compound that is pad printed onto a non- conductive tubular body.
  • a preferred conductive ink compound is a silver-based flexible adhesive conductive ink (polyurethane binder), however other metal- based adhesive conductive inks such as platinum-based, gold-based, copper- based, etc., may also be used to form electrodes. Such inks are more flexible than epoxy-based inks.
  • the length of the base member will depend on the length of the base member and the intended application.
  • the electrodes will preferably be about 10 mm to about 40 mm in length.
  • the electrodes will be 25 mm in length with 1 mm to 2 mm spacing, which will result in the creation of continuous lesion patterns in tissue when coagulation energy is applied simultaneously to adjacent electrodes.
  • the length of the each electrode can vary from about 3 mm to about 10 mm.
  • Electrodes having lengths of less than about 2 mm do not consistently form the desired continuous lesion patterns.
  • other energy transmission devices such as laser arrays, ultrasonic transducers, microwave electrodes, and ohmically heated hot wires, may be substituted for the electrodes.
  • Another type of energy transmission device that may be substituted for the electrodes is cryotemperature elements. Here, the energy transmission is the removal of heat from the tissue.
  • Still another type of energy transmission device that may be substituted for the electrodes is needle projections for chemical ablation (which are preferably about 1 to 2 mm in length). Here, the energy transmission is the transmission of chemical energy.
  • each energy transmission device 108 is individually coupled to a wire 137 ( Figure 8) that conducts coagulating energy.
  • the wires 137 pass in conventional fashion through cables 138 to an associated connector (140 or 142).
  • the connectors 140 and 142 are configured to plug into an electrosurgical unit (“ESU") 144 that supplies and controls power, such RF power.
  • ESU electrosurgical unit
  • a suitable ESU is the Model 4810 ESU sold by EP Technologies, Inc. of San Jose, California.
  • the exemplary ESU 144 illustrated in Figure 6 includes a plurality of displays and buttons that are used to control the level of power supplied to the energy transmission device(s) 108 and the temperature at the energy transmission device(s).
  • the ESU 144 may also be used to selectively control which of the energy transmission devices receive power.
  • the amount of power required to coagulate tissue ranges from 5 to 150 w.
  • the exemplary ESU 144 illustrated in Figure 6 is operable in a bi-polar mode, where tissue coagulation energy emitted by the energy transmission device(s) 108 on one energy transmission assembly is returned through the energy transmission device(s) on another energy transmission assembly, and a uni-polar mode, where the tissue coagulation energy emitted by the energy transmission device(s) on an energy transmission assembly is returned through one or more indifferent electrodes (not shown) that are externally attached to the skin of the patient with a patch or one or more electrodes (not shown) that are positioned in the blood pool.
  • the exemplary ESU 144 is provided with a power output connector 141 and a pair of return connectors 143.
  • the ESU output and return connectors 141 and 143 have different shapes to avoid confusion and the connectors 140 and 142 have corresponding shapes.
  • the connector 140 associated with energy transmission assembly 102 has a shape corresponding to the ESU output connector 141 and the connector 142 associated with energy transmission assembly 104 has a shape corresponding to the ESU return connector 143.
  • the connector (not shown) associated with the energy transmission assembly 124 illustrated in Figure 10, which is intended to be operated in the uni-polar mode, would have a shape corresponding to the ESU output connector 141.
  • a second energy transmission assembly may be provided with a connector having a shape corresponding to the ESU return connector 143. Additionally, in those instances where the energy transmission assembly
  • one or more temperature sensors 146 may be located on, under, abutting the longitudinal end edges of, or in between, the energy transmission devices 108.
  • a reference thermocouple (not shown) may also be provided.
  • signals from the temperature sensors 146 are transmitted to the ESU 144 by way of wires 148 ( Figure 8) that are connected to the connector 140 and, in some instances, the connector 142.
  • the wires 137 and 148 (which are not shown in all of the Figures for clarity purposes) run through wire apertures 150 and small holes 152, which are formed in the base members 106, 126, 126', 134 and 134'.
  • Suitable temperature sensors and power control schemes that are based on a sensed temperature are disclosed in U.S. Patent Nos. 5,456,682, 5,582,609 and 5,755,715.
  • both of the energy transmission assemblies 102 and 104 include a single energy transmission device 108 and the energy transmission assembly 102 includes a plurality of spaced temperature sensors 146.
  • the level of power supplied to the energy transmission device 108 on the energy transmission assembly 102 would be controlled based on the highest temperature measured by the temperature sensors 146.
  • the energy transmission assembly 104 (which is being used as the return) may also provided with a plurality of spaced temperature sensors 146.
  • the level of power supplied to the energy transmission device 108 on the energy transmission assembly 102 would be controlled based on the highest temperature measured by any of the temperature sensors 146, whether on the transmitting assembly 102 or the return assembly 104.
  • a temperature sensor 146 may be associated with each of the energy transmission devices.
  • power to the energy transmission devices 108 may be individually controlled based on the temperature measured by the associated temperature sensor 146.
  • Another exemplary bi-polar arrangement which is illustrated in Figures
  • the energy transmission assembly 102' includes a plurality of spaced energy transmission device 108, each having a temperature sensor 146 associated therewith, and the energy transmission assembly 104' includes a single energy transmission device 108 and a plurality of temperature sensors 146.
  • the temperature sensors 146 are preferably positioned such that, when in use, the temperature sensors on the energy transmission assembly 102' will be aligned with the temperature sensors on the energy transmission assembly 104'. Such an arrangement allows power to the energy transmission devices
  • the assembly 102' to be individually controlled based on the highest of two temperatures, i.e. the temperature measured by the temperature sensor 146 associated with the particular energy transmission device and the temperature measured by the temperature sensor directly across from the particular energy transmission device.
  • Energy transmission devices in accordance with the present inventions may also include apparatus that cools the tissue during tissue coagulation procedures.
  • suitable cooling apparatus are illustrated in Figures 13- 15.
  • tissue cooling apparatus may also be used in conjunction with the exemplary devices illustrated in Figures 4, 5, 7a-12, 16a and 16b.
  • the tissue cooling apparatus disclosed herein employ conductive fluid to cool tissue during coagulation procedures. More specifically, and as described below and in U.S. application Serial No. 09/761 ,981 , heat from the tissue being coagulated is transferred to ionic fluid to cool the tissue while energy is transferred from an electrode or other energy transmission device to the tissue through the fluid by way of ionic transport.
  • an exemplary tissue cooling apparatus 154 includes a nanoporous outer casing 156 through which ionic fluid (represented by arrows F) is transferred.
  • the ionic fluid preferably flows from one longitudinal end of the tissue cooling apparatus 154 to the other.
  • the outer casing 156 is secured to the base member 134 over the energy transmission devices 108 such that a fluid transmission space 158 is defined therebetween.
  • the proximal and distal ends of the outer casing 156 are secured to the base member 134 with anchoring devices (not shown) such as lengths of heat shrink tubing, Nitinol tubing or other mechanical devices that form an interference fit between the casing and the base member.
  • anchoring devices such as lengths of heat shrink tubing, Nitinol tubing or other mechanical devices that form an interference fit between the casing and the base member.
  • Adhesive bonding is another method of securing the outer casing 156 to the base member
  • the fluid transmission space will typically be about 0.5 mm to about 2.0 mm high and slightly wider than the associated energy transmission device(s) 108.
  • the ionic fluid is supplied under pressure from a fluid source (not shown) by way of a supply line 160 and is returned to the source by way of a return line
  • the supply line 160 is connected to a fluid lumen 164 that runs from the proximal end of the base member 134 to the distal region of the outer casing 156.
  • the fluid lumen 164 is connected to the fluid transmission space 158 by an aperture 166.
  • the electrically conductive ionic fluid preferably possesses a low resistivity to decrease ohmic loses, and thus ohmic heating effects, within the outer casing 156.
  • the composition of the electrically conductive fluid can vary.
  • the fluid is a hypertonic saline solution, having a sodium chloride concentration at or near saturation, which is about 5% to about 25% weight by volume.
  • Hypertonic saline solution has a relatively low resistivity of only about 5 ohm-cm, as compared to blood resistivity of about 150 ohm-cm and myocardial tissue resistivity of about 500 ohm-cm.
  • the ionic fluid can be a hypertonic potassium chloride solution.
  • a suitable inlet temperature for epicardial applications (the temperature will, of course, rise as heat is transferred to the fluid) is about 0 to 25°C with a constant flow rate of about 2 to 20 ml/min.
  • the flow rate required for endocardial applications where blood is present would be about three-fold higher (i.e. 6 to 60 ml/min.). Should applications so require, a flow rate of up to 100 ml/min. may be employed.
  • the flexible bag In a closed system where the fluid is stored in a flexible bag, such as the Viaflex® bag manufactured by Baxter Corporation, and heated fluid is returned to the bag, it has been found that a volume of fluid between about 200 and 500 ml within the bag will remain at room temperature (about 22°C) when the flow rate is between about 2 ml/min. and 20 ml/min.
  • the flexible bag should include enough fluid to complete the procedure. 160 ml would, for example, be required for a 20 minute procedure where the flow rate was 8 ml/min.
  • the fluid pressure within the outer casing 156 should be about 30 mm Hg in order to provide a structure that will resiliently conform to the tissue surface in response to a relatively small force normal to the tissue. Pressures above about 100 mm Hg will cause the outer casing 156 to become too stiff to properly conform to the tissue surface. For that reason, the flow resistance to and from the outer casing 156 should be relatively low.
  • the pores in the nanoporous outer casing 156 allow the transport of ions contained in the fluid through the casing and into contact with tissue.
  • an energy transmission device 108 transmit RF energy into the ionic fluid
  • the ionic fluid establishes an electrically conductive path through the outer casing 156 to the tissue being coagulated.
  • Regenerated cellulose membrane materials typically used for blood oxygenation, dialysis or ultrafiltration, are a suitable nanoporous material for the outer casing 156.
  • the thickness of the material should be about 0.05 mm to 0.13 mm.
  • regenerated cellulose is electrically non-conductive, the relatively small pores of this material allow effective ionic transport in response to the applied RF field. At the same time, the relatively small pores prevent transfer of macromolecules through the material, so that pressure driven liquid perfusion is less likely to accompany the ionic transport, unless relatively high pressure conditions develop within the outer casing 156.
  • Hydro-FluoroTM material which is disclosed in U.S. Patent No. 6,395,325, is another material that may be used.
  • Materials such as nylons (with a softening temperature above 100°C), PTFE, PEI and PEEK that have nanopores created through the use of lasers, electrostatic discharge, ion beam bombardment or other processes may also be used. Such materials would preferably include a hydrophilic coating.
  • Nanoporous materials may also be fabricated by weaving a material (such as nylon, polyester, polyethylene, polypropylene, fluorocarbon, fine diameter stainless steel, or other fiber) into a mesh having the desired pore size and porosity. These materials permit effective passage of ions in response to the applied RF field. However, as many of these materials possess larger pore diameters, pressure driven liquid perfusion, and the attendant transport of macromolecules through the pores, are also more likely to occur.
  • the electrical resistivity of the outer casing 156 will have a significant influence on lesion geometry and controllability.
  • Low-resistivity (below about 500 ohm-cm) requires more RF power and results in deeper lesions, while high-resistivity (at or above about 500 ohm-cm) generates more uniform heating and improves controllability. Because of the additional heat generated by the increased body resistivity, less RF power is required to reach similar tissue temperatures after the same interval of time. Consequently, lesions generated with high-resistivity structures usually have smaller depth.
  • the electrical resistivity of the outer casing can be controlled by specifying the pore size of the material, the porosity of the material, and the water adsorption characteristics (hydrophilic versus hydrophobic) of the material. A detailed discussion of these characteristics is found in U.S. Patent No. 5,961 ,513.
  • a suitable electrical resistivity for epicardial and endocardial lesion formation is about 1 to 3000 ohm- cm measured wet.
  • low or essentially no liquid perfusion through the nanoporous outer casing 156 is preferred.
  • ionic transport creates a continuous virtual electrode at the tissue interface. The virtual electrode efficiently transfers RF energy without need for an electrically conductive metal surface.
  • Pore diameters smaller than about 0.1 ⁇ m retain macromolecules, but allow ionic transfer through the pores in response to the applied RF field. With smaller pore diameters, pressure driven liquid perfusion through the pores is less likely to accompany the ionic transport, unless relatively high pressure conditions develop within the outer casing 156. Larger pore diameters (up to 8 ⁇ m) can also be used to permit ionic current flow across the membrane in response to the applied RF field. With larger pore diameters, pressure driven fluid transport across the membrane is much higher and macromolecules (such as protein) and even small blood cells (such as platelets) could cross the membrane and contaminate the inside of the probe. Red blood cells would normally not cross the membrane barrier, even if fluid perfusion across the membrane stops.
  • a pore diameter of 1 to 5 ⁇ m is suitable for epicardial and endocardial lesion formation. Where a larger pore diameter is employed, thereby resulting in significant fluid transfer through the porous region, a saline solution having a sodium chloride concentration of about 0.9% weight by volume would be preferred.
  • porosity which represents the volumetric percentage of the outer casing 156 that is composed of pores and not occupied by the casing material
  • the magnitude of the porosity affects electrical resistance.
  • Low-porosity materials have high electrical resistivity, whereas high-porosity materials have low electrical resistivity.
  • the porosity of the outer casing 156 should be at least 1 % for epicardial and endocardial applications employing a 1 to 5 ⁇ m pore diameter.
  • hydrophilic materials are generally preferable because they possess a greater capacity to provide ionic transfer of RF energy without significant liquid flow through the material.
  • the exemplary tissue cooling apparatus 168 illustrated in Figure 15 consists of a wettable fluid retention element 170 that is simply saturated with ionic fluid (such as saline) prior to use, as opposed to having the fluid pumped through the apparatus in the manner described above with reference to Figures 13 and 14.
  • the energy transmission device(s) 108 are carried within the fluid retention element 170.
  • Suitable materials for the fluid retention element 170 include biocompatible fabrics commonly used for vascular patches (such as woven Dacron®), open cell foam materials, hydrogels, nanoporous balloon materials (with very slow fluid delivery to the surface), and hydrophilic nanoporous materials.
  • the effective electrical resistivity of the fluid retention element 170 when wetted with 0.9% saline (normal saline) should range from about 1 ⁇ -cm to about 2000 ⁇ -cm.
  • a preferred resistivity for epicardial and endocardial procedures is about 1000 ⁇ -cm.
  • Probe support devices in accordance with a present invention may be used to covert a conventional clamp, or a clamp in accordance with the inventions described in Section V below, into a tissue coagulation device by securing one or more conventional catheters, surgical probes, or other apparatus that support energy transmission devices, to the clamp.
  • the configuration of the probe support devices may vary from application to application to suit particular situations, the exemplary probe support devices are configured such that the probes being supported will abut one another in the same manner as the inserts 28 and 30 ( Figures 1-3) when the associated clamp is in the closed orientation. Such an arrangement will allow the energy transmission devices on the probes to face one another in the manner similar to that described in Section I above.
  • a base member 174 in accordance with one embodiment of a present invention includes a base member 174, a slot 176 configured to receive an electrode supporting device such as a catheter or surgical probe, and a plurality of mating structures 178 that mechanically engage a clamp member.
  • the exemplary base member 174 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D.
  • the size and shape of the slot 176 will, of course, depend on the size and shape of the probe that it is holding. Many probes are generally cylindrical in shape and, according, the exemplary slot 176 has a corresponding arcuate cross-sectional shape. The arc is preferably greater than 180 degrees so that the base member 174 will deflect when a probe is inserted into the slot 176 and then snap back to hold the probe in place.
  • the exemplary mating structures 178 which are preferably integral with the base member 174 and formed from the same resilient material, include a relatively narrow portion 180 and a relatively wide portion 182.
  • the relatively narrow portions 180 are approximately the same size as the clamp member apertures 36 ( Figure 3) and the relatively wide portions 182 are slightly larger than the clamp member apertures.
  • a removable connection is made by urging the mating structures 178 into one end of the apertures 36, thereby deforming the relatively wide portions 182, and then urging the base members 174 against the clamp member until the relatively wide portions exit through the other end of the apertures and reassume their original shape.
  • each probe 184 in the exemplary implementation includes a shaft 186, a plurality of spaced electrodes 188, and a plurality of temperature sensors (not shown) respectively associated with the electrodes.
  • One of the probes 184 may be connected to the output connector of an ESU, while the other probe may be connected to the return connector to complete the bi-polar arrangement.
  • Another exemplary probe support device 190 is illustrated in Figures 21 and 22.
  • the probe support device 190 is similar to the probe support device 172 illustrated in Figures 17 and 18 and similar structural element are represented by similar reference numerals.
  • the exemplary probe support device 190 may also be used in the manner described above with reference to Figures 19 and 20. Here, however, the mating structures 178 have been eliminated and the base member 172 is provided with a longitudinally extending aperture 192 into which one of the clamp members 22 and 24 may be inserted.
  • the aperture 192 should be sized and shaped such that the base member 174' will be forced to stretch when one of the clamp members 22 and 24 is inserted. If, for example, the apertures 192 have the same cross-sectional shape as the clamp members 22 and 24 (e.g. both are elliptical), then the apertures should be slightly smaller in their cross-sectional dimensions than the corresponding clamp members. The stretching of base member 174' creates a tight interference fit between the base member and the clamp member. Additionally, although the aperture 192 has a semi-circular cross-section in the exemplary embodiment, the apertures may have a round, rectangular, square or elliptical cross-section, or define any other cross-sectional shape, depending on the particular application.
  • the probe support device 172 may be provided with a longitudinally extending mating structure 194 that extends outwardly from the base member
  • the longitudinally extending mating structure 194 which is preferably integral with the base member 174 and formed from the same resilient material, is sized to create an interference fit with a slot. Still another alternative is to provide the clamp members with one or more small mating structures that are received within apertures or slots formed in the base member 174.
  • An exemplary probe support device 196 that may be used in conjunction with a probe 184 to convert the clamp 10 (which has had the inserts 28 and 30 removed) into a uni-polar tissue coagulation device is illustrated in Figures 24 and 25.
  • the configuration of the probe support device 196 may vary from application to application to suit particular situations, the probe support device in the exemplary embodiment is configured such that it will abut each of the clamp members 22 and 24 when the clamp is in the closed orientation illustrated in Figure 25.
  • the exemplary probe support device 196 includes a base member 198, a slot 200 configured to receive a probe 184 or other electrode supporting device, and a plurality of mating structures 178 that mechanically engage a clamp members 22 and 24 in the manner described above.
  • the exemplary base member 198 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D.
  • the size and shape of the slot 200 will depend on the size and shape of the probe that it is intended to hold.
  • the exemplary probe 184 is generally cylindrical in shape and, according, the exemplary slot 200 has a corresponding arcuate cross-sectional shape. The arc is preferably greater than 180 degrees so that the base member 198 will deflect when the probe 184 is inserted into the slot 200 and then snap back to hold the probe in place.
  • the probe support device 202 includes a base member 204, a slot 206 configured to receive a probe 184 or other electrode supporting device, and a longitudinally extending aperture 208 into which both of the clamp members 22 and 24 may be inserted.
  • the exemplary base member 204 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D.
  • the size and shape of the slot 206 will depend on the size and shape of the probe that it is intended to hold, as is described above with reference to slot 200.
  • the aperture 206 will depend on the size and shape of the probe that it is intended to hold, as is described above with reference to slot 200.
  • the aperture 208 should be sized and shaped such that the base member 204 will be forced to stretch when the clamp members 22 and 24 are inserted with the clamp 10 in a closed orientation. The stretching creates a tight interference fit between the base member 204 and the clamp members 22 and 24. Additionally, although the aperture 208 has an elliptical cross-section in the exemplary embodiment, the aperture may have a round, rectangular, square or semi-circular cross-section, or define any other cross-sectional shape, depending on the particular application.
  • the length of the base members in the exemplary probe support devices will vary according to the intended application. In the area of cardiovascular treatments, it is anticipated that suitable lengths will range from, but are not limited to, about 3 cm to about 10 cm. V. Clamp With Malleable Clamp Members
  • a rigid structure is a structure than cannot be readily bent by a physician.
  • a malleable structure can be readily bent by the physician to a desired shape, without springing back when released, so that it will remain in that shape during the surgical procedure.
  • the stiffness of a malleable structure must be low enough to allow the structure to be bent, but high enough to resist bending when the forces associated with a surgical procedure are applied to the structure.
  • Rigid structures are preferably formed from stainless steel, while malleable structure are preferably formed from annealed stainless steel or titanium. Additional information concerning malleable structures may be found in U.S.
  • a clamp 210 in accordance with a preferred embodiment of a present invention includes a pair of malleable clamp members 212 and 214.
  • the malleable clamp members 212 and 214 are carried at the distal ends of a pair of arms 216 and 218.
  • the arms 216 and 218 are pivotably secured to one another by a pin 220 to allow the clamp members 212 and 214 to be moved towards and away from one another between opened and closed positions.
  • the arms 216 and 218 are preferably formed from rigid material, but may also be malleable if desired. When rigid, the arms 216 and 218 may be linear or have a preformed curvature.
  • a pair of handles 222 and 224 are mounted on the proximal ends of the arms 216 and 218.
  • a locking device 226 locks the clamp 210 in the closed orientation illustrated in Figure 27.
  • the locking device 226 also prevents the clamp members 212 and 214 from coming any closer to one another than is illustrated in Figure 27, thereby defining a predetermined spacing between the clamp members.
  • the malleability of the clamp members 212 and 214 allows them to be re-shaped by the physician as needed for particular procedures and body structures. As such, a single clamp 210 is capable of taking the place of a number of conventional clamps with rigid clamp members. In some implementations, the clamp members 212 and 214 will be more malleable (i.e. easier to bend) at their distal end than at their proximal end. This may be accomplished by gradually decreasing the cross-sectional area of each clamp member 212 and 214 from the proximal end to the distal end.
  • the clamp members 212 and 214 may also be provided with holes 228 ( Figure 31) that allow soft deformable inserts, such as the conventional inserts 28 and 30 described above with reference to Figures 1-3.
  • the exemplary clamp 210 may also be used in conjunction with the energy transmission assemblies, probe support devices, and probes described in Sections l-IV above.
  • the exemplary clamp 210 is provided with a malleable insert 230 that is sized and shaped (rectangular in the exemplary implementation) to be held between the malleable clamp members 212 and 214 when the clamp is closed and locked.
  • the friction between the clamp members 212 and 214 and insert 230 will hold the insert in place during bending.
  • the insert 230 may be provided with small protrusions that will be received by the holes 228.
  • the malleable insert 230 which is preferably formed from the same material as the malleable clamp members 212 and 214, will bend with the clamp members during the bending process, thereby maintaining the predetermined spacing.
  • the exemplary mandrel 232 illustrated in Figures 28 and 29 may be used to bend the malleable clamp members 212 and 214.
  • the exemplary mandrel 232 includes a base 234 and a pair of cylindrical posts 236 and 238. Posts of other shapes, such as elliptical posts, may also be employed to achieve particular bends.
  • the mandrel 232 should also be formed from material that is harder than the malleable clamp members 212 and 214, such as stainless steel or titanium.
  • the exemplary mandrel 232 may be used to bend the malleable clamp members 212 and 214 in the manners illustrated in Figures 30 and 31.
  • the clamp 210 may be rotated in the direction of the arrow (or in the opposite direction) until the clamp members 212 and 214 are bent the desired amount.
  • the clamp 210 may then moved longitudinally and the bending process repeated until the desired bend, such as the exemplary bend illustrated in Figure 32, has been achieved.
  • the clamp 210 can be rotated about its longitudinal axis and bent in other planes, as is illustrated for example in Figures 31 and 33.
  • the malleable clamp members 212 and 214 may be bent independently of one another and/or into different shapes.
  • the physician will simply place the mandrel 232 on a suitable surface and press down the base 234 during a bending procedure.
  • structure may be provided to secure the mandrel 232 to the surface.
  • FIG. 240 Another example of a clamp in accordance with a preferred embodiment of a present invention is generally represented by reference numeral 240 in Figure 34.
  • Clamp 240 is similar to clamp 210 and similar elements are represented by similar reference numerals.
  • the exemplary clamp 240 includes malleable clamp members 212 and 214, pivotable arms 216 and 218, handles 222 and 224, and a locking device 226.
  • the arms 216 and 218 are pivotably carried by one end of an elongate housing 242 and the malleable clamp members 212 and 214 are carried by a pair of supports 244 and 246 that are pivotably carried the other end of the housing.
  • a suitable mechanical linkage located within the housing 242 causes the supports 244 and 246 (and clamp members 212 and 214) to move relative to one another in response to movement of the arms 216 and 218.
  • the housing 242 may be rigid or malleable
  • the present clamps with malleable clamp members have a wide variety of applications.
  • One example is the formation of transmural epicardial lesions to isolate the sources of focal (or ectopic) atrial fibrillation and, more specifically, the creation of transmural lesions around the pulmonary veins.
  • Energy transmission devices may be permanently affixed to the malleable clamp members. Energy transmission devices may also be added using the structures described in Sections l-IV above and the clamp may be used a clamp or as a surgical probe, depending on the structure being used in combination with the clamp. Access to the heart may be obtained via a thoracotomy, thoracostomy or median stemotomy. Ports may also be provided for cameras and other instruments.
  • Lesions may be created around the pulmonary veins individually or, alternatively, lesions may be created around pairs of pulmonary veins. For example, a first transmural epicardial lesion may be created around the right pulmonary vein pair and a second transmural epicardial lesion may be created around the left pulmonary vein pair. Thereafter, if needed, a linear transmural epicardial lesion may be created between the right and left pulmonary vein pairs. A linear transmural lesion that extends from the lesion between the right and left pulmonary vein pairs to the left atrial appendage may also be formed. Alternatively, a single lesion may be formed around all four of the pulmonary veins.

Abstract

An apparatus for use with a clamp including a base member configured to be secured to the clamp and at least one energy transmission device carried by the base member.

Description

APPARATUS FOR CONVERTING A CLAMP INTO AN ELECTROPHYSIOLOGY DEVICE
BACKGROUND OF THE INVENTIONS
1. Field of Inventions
The present inventions relate generally to structures for positioning diagnostic and therapeutic elements within the body and, more particularly, to devices which are particularly well suited for the treatment of cardiac conditions.
2. Description of the Related Art
There are many instances where diagnostic and therapeutic elements must be inserted into the body. One instance involves the treatment of cardiac conditions such as atrial fibrillation and atrial flutter which lead to an unpleasant, irregular heart beat, called arrhythmia.
Normal sinus rhythm of the heart begins with the sinoatrial node (or "SA node") generating an electrical impulse. The impulse usually propagates uniformly across the right and left atria and the atrial septum to the atrioventricular node (or "AV node"). This propagation causes the atria to contract in an organized way to transport blood from the atria to the ventricles, and to provide timed stimulation of the ventricles. The AV node regulates the propagation delay to the atrioventricular bundle (or "HIS" bundle). This coordination of the electrical activity of the heart causes atrial systole during ventricular diastole. This, in turn, improves the mechanical function of the heart. Atrial fibrillation occurs when anatomical obstacles in the heart disrupt the normally uniform propagation of electrical impulses in the atria. These anatomical obstacles (called "conduction blocks") can cause the electrical impulse to degenerate into several circular wavelets that circulate about the obstacles. These wavelets, called "reentry circuits," disrupt the normally uniform activation of the left and right atria. Because of a loss of atrioventricular synchrony, the people who suffer from atrial fibrillation and flutter also suffer the consequences of impaired hemodynamics and loss of cardiac efficiency. They are also at greater risk of stroke and other thromboembolic complications because of loss of effective contraction and atrial stasis. One surgical method of treating atrial fibrillation by interrupting pathways for reentry circuits is the so-called "maze procedure" which relies on a prescribed pattern of incisions to anatomically create a convoluted path, or maze, for electrical propagation within the left and right atria. The incisions direct the electrical impulse from the SA node along a specified route through all regions of both atria, causing uniform contraction required for normal atrial transport function. The incisions finally direct the impulse to the AV node to activate the ventricles, restoring normal atrioventricular synchrony. The incisions are also carefully placed to interrupt the conduction routes of the most common reentry circuits. The maze procedure has been found very effective in curing atrial fibrillation. However, the maze procedure is technically difficult to do. It also requires open heart surgery and is very expensive. Thus, despite its considerable clinical success, only a few maze procedures are done each year.
Maze-like procedures have also been developed utilizing catheters and/or surgical probes (collectively "probes") that form lesions to create a maze for electrical conduction in a predetermined path. Typically, the lesions are formed by ablating tissue with one or more electrodes. Electromagnetic radio frequency ("RF") energy applied by the electrode heats, and eventually kills (i.e. "ablates"), the tissue to form a lesion. During the ablation of soft tissue (i.e. tissue other than blood, bone and connective tissue), tissue coagulation occurs and it is the coagulation that kills the tissue. Thus, references to the ablation of soft tissue are necessarily references to soft tissue coagulation. "Tissue coagulation" is the process of cross-linking proteins in tissue to cause the tissue to jell. In soft tissue, it is the fluid within the tissue cell membranes that jells to kill the cells, thereby killing the tissue.
Catheters used to create lesions typically include a relatively long and relatively flexible body that has one or more electrodes on its distal portion. The portion of the catheter body that is inserted into the patient is typically from 58.4 to 139.7 cm in length and there may be another 20.3 to 38.1 cm, including a handle, outside the patient. The proximal end of the catheter body is connected to the handle which includes steering controls. The length and flexibility of the catheter body allow the catheter to be inserted into a main vein or artery (typically the femoral artery), directed into the interior of the heart, and then manipulated such that the electrode contacts the tissue that is to be ablated. Fluoroscopic imaging is used to provide the physician with a visual indication of the location of the catheter. Exemplary catheters are disclosed in U.S. Patent No. 5,582,609. Surgical probes used to create lesions often include a handle, a relatively short shaft that is from about 10.2 to 45.7 cm in length and either rigid or relatively stiff, and a distal section that is from 2.54 to 25.4 cm in length and either malleable or somewhat flexible. One or more electrodes are carried by the distal section. Surgical probes are used in epicardial and endocardial procedures, including open heart procedures and minimally invasive procedures where access to the heart is obtained via a thoracotomy, thoracostomy or median sternotomy. Exemplary surgical probes are disclosed in U.S. Patent No. 6,142,994.
Clamps, which have a pair of opposable rigid clamp members that may be used to hold a bodily structure or a portion thereof, are used in many types surgical procedures. Lesion creating electrodes have also been permanently secured to certain types of clamps. Examples of clamps which carry lesion creating electrodes are disclosed in U.S. Patent No. 6,142,994. Such clamps are particularly useful when the physician intends to position electrodes on opposite sides of a body structure.
As used herein, the term "clamp" includes, but is not limited to, clamps, clips, forceps, hemostats, and any other surgical device that includes a pair of opposable clamp members that hold tissue, at least one of which is movable relative to the other. In some instances, the rigid clamp members are connected to a scissors-like arrangement including a pair of handle supporting arms that are pivotably connected to one another. The clamp members are secured to one end of the arms and the handles are secured to the other end. The clamp members come together as the handles move toward one another. Certain clamps that are particularly useful in minimally invasive procedures also include a pair of handles and a pair of clamp members. Here, however, the clamp members and handles are not mounted on the opposite ends of the same arm. Instead, the handles are carried by one end of an elongate housing and the clamp members are carried by the other. A suitable mechanical linkage located within the housing causes the clamp members to move relative to one another in response to movement of the handles.
The rigid clamp members in conventional clamps may be linear or have a predefined curvature that is optimized for a particular surgical procedure or portion thereof. It is, therefore, necessary to have a wide variety of clamps on hand. In the field of electrophysiology, a wide variety of clamps that have electrodes permanently secured thereto must be kept on hand.
The inventor herein has determined that it would be advantageous to provide physicians with a wide variety of devices, including clamps (both with and without energy transmission devices) and surgical probes that carry energy transmission devices, in a wide variety of shapes, and to do so in a manner that is more cost effective than conventional apparatus.
SUMMARY OF THE INVENTIONS An apparatus for use with a clamp in accordance with one embodiment of a present invention includes a base member configured to be secured to the clamp and at least one energy transmission device carried by the base member. Such an apparatus provides a number of advantages. For example, such an apparatus may be used to quickly convert a conventional clamp into an electrophysiology device. In those instances where a procedure requires a number of different clamps, the apparatus can be moved from clamp to clamp, thereby eliminating the costs associated with providing a variety of different clamps with energy transmission devices permanently secured thereto. An apparatus for use with a clamp and a probe that carries at least one energy transmission device in accordance with one embodiment of a present invention includes a base member configured to be secured to the clamp and an engagement device associated with the base member and configured to engage the probe. Such an apparatus provides a number of advantages. For example, such an apparatus may be used to quickly convert a conventional clamp into an electrophysiology device and to achieve better (or merely different) tissue/energy transmission device contact than could be achieved with the probe itself. Additionally, in those instances where a procedure requires a number of different clamps, the apparatus can be moved from clamp to clamp, thereby eliminating the costs associated with providing a variety of different clamps with energy transmission devices permanently secured thereto. A clamp in accordance with one embodiment of a present invention includes first and second clamp members, at least one of which is malleable, and a movement apparatus that moves at least one of the first and second clamp members relative to the other. Such a clamp provides a number of advantages. For example, the malleable clamp member allows physicians to readily reconfigure the clamp, thereby reducing the number of clamps that must be provide for a particular surgical procedure.
A surgical system in accordance with one embodiment of a present invention includes a clamp with first and second clamp members and a device that removably mounts at least one electrode on at least one of the first and second clamp members. Such a clamp provides a number of advantages. For example, the system may be used both as a conventional clamp and an electrophysiology device.
The above described and many other features and attendant advantages of the present inventions will become apparent as the inventions become better understood by reference to the following detailed description when considered in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
Detailed description of preferred embodiments of the inventions will be made with reference to the accompanying drawings.
Figure 1 is a plan view of a conventional clamp.
Figure 2 is a side view of the clamp illustrated in Figure 1.
Figure 3 is an enlarged view of a portion of the clamp illustrated in Figure 1 holding a vein. Figure 4 is plan of a pair of energy transmission assemblies in accordance with a preferred embodiment of a present invention.
Figure 5 is plan showing the energy transmission assemblies illustrated in Figure 4 mounted on a clamp. Figure 6 is a front view of an electrosurgical unit.
Figure 7a is a section view taken along line 7a-7a in Figure 4.
Figure 7b is a section view taken along line 7b-7b in Figure 4.
Figure 8 is a section view taken along line 8-8 in Figure 7a. Figure 9a is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 9b is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 10 is a plan view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 11 is a section view taken along line 11-11 in Figure 10.
Figure 12 is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 13 is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 14 is a section view taken along line 14-14 in Figure 13.
Figure 15 is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 16a is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 16b is a section view of an energy transmission assembly in accordance with a preferred embodiment of a present invention.
Figure 17 is a section view of a probe support device in accordance with a preferred embodiment of a present invention. Figure 18 is a section view taken along line 18-18 in Figure 17.
Figure 19 is a partial plan view showing a pair of the probe support devices illustrated in Figure 17 supporting a pair of probes on a clamp.
Figure 20 is a plan view showing a pair of the probe support devices illustrated in Figure 17 supporting a pair of probes on a clamp. Figure 21 is a section view of a probe support device in accordance with a preferred embodiment of a present invention.
Figure 22 is a section view taken along line 21-21 in Figure 20. Figure 23 is a section view of a probe support device in accordance with a preferred embodiment of a present invention.
Figure 24 is an end view of a probe support device in accordance with a preferred embodiment of a present invention. Figure 25 is a plan view of a probe support device illustrated in Figure 24.
Figure 26 is an end view of a probe support device in accordance with a preferred embodiment of a present invention.
Figure 27 is a plan view of a clamp in accordance with a preferred embodiment of a present invention. Figure 28 is a plan view of a mandrel in accordance with a preferred embodiment of a present invention.
Figure 29 is a side view of the mandrel illustrated in Figure 28.
Figures 30 and 31 are plan views of the clamp illustrated in Figure 27 being bent with the mandrel illustrated in Figure 28. Figure 32 is a plan view showing one example of how the clamp illustrated in Figure 27 may be bent.
Figure 33 is a plan view showing another example of how the clamp illustrated in Figure 27 may be bent.
Figure 34 is a plan view of a clamp in accordance with a preferred embodiment of a present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The following is a detailed description of the best presently known modes of carrying out the inventions. This description is not to be taken in a limiting sense, but is made merely for the purpose of illustrating the general principles of the inventions.
The detailed description of the preferred embodiments is organized as follows:
I. Energy Transmission Assemblies II. Energy Transmission Devices, Temperature Sensing and Power
Control
III. Tissue Cooling Apparatus
IV. Probe Support Devices V. Clamp With Malleable Clamp Members The section titles and overall organization of the present detailed description are for the purpose of convenience only and are not intended to limit the present inventions. This specification discloses a number of structures, mainly in the context of cardiac ablation, because the structures are well suited for use with myocardial tissue. Nevertheless, it should be appreciated that the structures are applicable for use in therapies involving other types of soft tissue. For example, various aspects of the present inventions have applications in procedures concerning other regions of the body such as the prostate, liver, brain, gall bladder, uterus and- other solid organs. I. Energy Transmission Assemblies
Energy transmission assemblies in accordance with a present invention may be used to covert a conventional clamp into a tissue coagulation device. The energy transmission assemblies may also be used to covert a clamp in accordance with the inventions described in Section V below into a tissue coagulation device.
One example of a conventional clamp that may be used in conjunction with the present inventions is generally represented by reference numeral 10 in Figures 1-3. The clamp 10 includes a pair of rigid arms 12 and 14 that are pivotably connected to one another by a pin 16. The proximal ends of the arms 12 and 14 are respectively connected to a pair handle members 18 and 20, while the distal ends are respectively connected to a pair of rigid clamp members 22 and 24. A locking device 26 locks the clamp in the closed orientation, and prevents the clamp members 22 and 24 from coming any closer to one another than is illustrated in Figure 1 , thereby defining a predetermined spacing between the clamp members. The clamp 10 also includes a pair of soft, deformable inserts 28 and 30 that are removably carried by the clamp members 22 and 24. The inserts 28 and 30 allow clamp 10 to firmly grip a bodily structure 32 without damaging the bodily structure. The inserts 28 and 30 include mating structures 34 that extend through corresponding apertures 36 in the clamp members 22 and 24 to hold the inserts in place. As illustrated for example in Figures 4 and 5, an apparatus 100 for converting the clamp 10 (which has had the inserts 28 and 30 removed) into a bi-polar tissue coagulation device includes a pair of energy transmission assemblies 102 and 104. Each of the energy transmission assemblies includes a base member 106 that may be removably secured to one of the clamp members 22 and 24 and an energy transmission device 108. fThe energy transmission devices 108 are discussed in greater detail in Section II below.] Although the configuration of the energy transmission assemblies 102 and 104 may vary from application to application to suit particular situations, the energy transmission assemblies in the exemplary embodiment are configured such that they will abut one another in the same manner as the inserts 28 and 30 (Figures 1-3) when the clamp 10 is in the closed orientation illustrated in Figure 5. Such an arrangement will allow the energy transmission assemblies 102 and 104 to grip a bodily structure in the same manner as the inserts 28 and 30. The exemplary base members 106 are preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D. Referring to Figures 7a, 7b and 8, each of the exemplary base members 106 includes a longitudinally extending aperture 110 into which one of the clamp members 22 and 24 may be inserted. The apertures 110 should be sized and shaped such that the base members 106 will be forced to stretch when the clamp members 22 and 24 are inserted. If, for example, the apertures 110 have the same cross- sectional shape as the clamp members 22 and 24 (e.g. both are elliptical), then the apertures should be slightly smaller in their cross-sectional dimensions than the corresponding clamp members. The stretching of the apertures 110 creates a tight interference fit between the base members 106 and clamp members 22 and 24. Additionally, although the apertures 110 have a semi-circular cross- section in the exemplary embodiment, the apertures may have a round, rectangular, square or elliptical cross-section, or define any other cross-sectional shape, depending on the particular application.
The exemplary base members 106 also include slots 112 (Figure 8) that secure the energy transmission devices 108 in place. The configuration of a slot 112 will, of course, depend on the configuration of the energy transmission device 108 that it is holding. The illustrated energy transmission device 108 is generally cylindrical in shape and the slot 112 has a corresponding arcuate cross-sectional shape. The arc is preferably greater than 180 degrees so that the base member 106 will deflect when the energy transmission device 108 is inserted into the slot 112 and then snap back to hold the energy transmission device in place. Adhesive may also be used to secure the energy transmission devices 108, especially in those instances where the arc is less than 180 degrees. Another exemplary apparatus for converting the clamp 10 (which has had the inserts 28 and 30 removed) into a bi-polar tissue coagulation device is illustrated in Figures 9a and 9b. The apparatus includes a pair of energy transmission assemblies 114 and 116 which are substantially similar to the energy transmission assemblies 102 and 104 and similar elements are represented by similar reference numerals. Each of the energy transmission assemblies 114 and 116 includes a base member 106' that may be removably secured to one of the clamp members 22 and 24 and an energy transmission device 108. Here, however, the base members 106' are secured to the clamp members 22 and 24 with mating structures 118 that mechanically engage the clamp members.
The exemplary mating structures 118, which are preferably integral with the base members 106' and formed from the same resilient material, include a relatively narrow portion 120 and a relatively wide portion 122. The relatively narrow portions are approximately the same size as the clamp member apertures 36 and the relatively wide portions 122 are slightly larger than the clamp member apertures. A removable connection is made by urging the mating structures 118 into one end of the apertures 36, thereby deforming the relatively wide portions 122, and then urging the base members 106' against the clamp members 22 and 24 until the relatively wide portions exit through the other end of the apertures and reassume their original shape.
The exemplary mating structures 118 may also be reconfigured by eliminating the relatively wide portions 122 and enlarging the relatively narrow portions 120 such that the relatively narrow portions will create an interference fit within the clamp member apertures 36. Alternatively, as discussed below with reference to Figure 12, longitudinally extending mating structures, which also create an interference fit, may be employed when longitudinally extending slots are formed in the clamp members. Another alternative is to provide the clamp members with one or more small mating structures that extend outwardly therefrom. The clamp member mating structures will be received within apertures or slots formed in the base member.
Turning to Figures 10 and 11 , an energy transmission assembly 124 may be used to convert the clamp 10 (which has had the inserts 28 and 30 removed) into a uni-polar tissue coagulation device. The energy transmission assembly
124 includes a base member 126, which may be removably secured to both of the clamp members 22 and 24, and a plurality of spaced energy transmission devices 108. Although the configuration of the energy transmission assembly 124 may vary from application to application to suit particular situations, the energy transmission assembly in the exemplary embodiment is configured such that it will abut each of the clamp members when the clamp 10 is in the closed orientation illustrated in Figure 10.
The exemplary base member 126 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D. A slot 128 secures the energy transmission devices 108 in place. Although the configuration of the slot 128 will depend on the configuration of the energy transmission devices 108, the exemplary slot has an arcuate cross-sectional shape that conforms to the shape of the exemplary cylindrical energy transmission devices. The arc is preferably greater than 180 degrees so that the base member 126 will deflect when the energy transmission devices 108 are inserted into the slot 128 and then snap back to hold the energy transmission devices in place. Adhesive may also be used to secure the energy transmission devices 108 in place, especially in those instances where the arc is less than
180 degrees.
The base member 126 is removably secured to the clamp members 22 and 24 with two sets of the mating structures 118 that are described above with reference to Figures 9a and 9b (with or without the relatively wide portions 122). Alternatively, and as illustrated for example in Figure 12, in those instances where the clamp members 22' and 24' include longitudinally extending slots 38 instead of the apertures 36, the energy transmission assembly 124 may be provided with longitudinally extending mating structures 130 that extend outwardly from the base member 126'. The longitudinally extending mating structures 130, which are preferably integral with the base member 126' and formed from the same resilient material, are sized and shaped to create an interference fit with the slots 38. Still another alternative is to provide the clamp members with one or more small mating structures that are received within apertures or slots formed in the base member.
Another energy transmission assembly that may be used to convert the clamp 10 into a uni-polar tissue coagulation device is generally represented by reference numeral 132 in Figures 13 and 14. The energy transmission assembly 132 includes a base member 134 that is preferably formed from a soft, resilient, low durometer material and a plurality of energy transmission devices 108. The material which forms the base member 134 should also be electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D. A slot 128, which secures the energy transmission devices 108 in place in the manner described above with reference to Figures 10 and 11 , is also provided.
The exemplary base member 134 includes a longitudinally extending aperture 136 into which both of the clamp members 22 and 24 may be inserted. The aperture 136 should be sized and shaped such that the base member 134 will be forced to stretch when the clamp members 22 and 24 are inserted with the clamp 10 in a closed orientation. The stretching creates a tight interference fit between the base member 134 and the clamp members 22 and 24. Additionally, although the apertures 110 have an elliptical cross-section in the exemplary embodiment, the apertures may have a round, rectangular, square or semi-circular cross-section, or define any other cross-sectional shape, depending on the particular application. The length of the base members in the exemplary energy transmission assemblies will vary according to the intended application. In the area of cardiovascular treatments, it is anticipated that suitable lengths will range from, but are not limited to, about 2 cm to about 10 cm. The exemplary energy transmission assemblies described above may also be modified in a variety of ways. For example, the energy transmission assembly illustrated in Figures 10 and 11 may be converted into a bi-polar device by simply adding a second slot 128 that is preferably spaced apart from and parallel to the existing slot. The second slot 128 could, for example, include a single return energy transmission device 108 or a plurality of spaced return energy transmission devices. Additionally, as illustrated for example in Figures 7a and 13, the base members and energy transmission devices in the illustrated embodiments are configured such that the energy transmission devices are generally linear and parallel to the longitudinal axis of the base members (when the assemblies are in a relaxed state and not being urged against a body structure). The base members and/or energy transmission devices may be reconfigured such that the energy transmission devices, or a portion thereof, are curved and/or non-parallel to the longitudinal axis of the base members when in the relaxed state. II. Energy Transmission Devices, Temperature Sensing and Power
Control
In the exemplary embodiments illustrated in Figures 4-16b, the energy transmission devices are electrodes. More specifically, the energy transmission devices are preferably in the form of wound, spiral coil electrodes that are relatively flexible. The coils are made of electrically conducting material, like copper alloy, platinum, or stainless steel, or compositions such as drawn-filled tubing (e.g. a copper core with a platinum jacket). The electrically conducting material of the coils can be further coated with platinum-iridium or gold to improve its conduction properties and biocompatibility. A preferred coil electrode configuration is disclosed in U.S. Patent No. 5,797,905. Although the diameter of the electrodes will very from application to application, the diameter preferably ranges from about 1 mm to about 3 mm for cardiovascular applications. As an alternative, the electrodes may be in the form of solid rings of conductive material, like platinum, or can comprise a conductive material, like platinum-iridium or gold, coated upon the base member using conventional coating techniques or an ion beam assisted deposition (I BAD) process. For better adherence, an undercoating of nickel or titanium can be applied. The electrodes can also be in the form of helical ribbons. The electrodes can also be formed with a conductive ink compound that is pad printed onto a non- conductive tubular body. A preferred conductive ink compound is a silver-based flexible adhesive conductive ink (polyurethane binder), however other metal- based adhesive conductive inks such as platinum-based, gold-based, copper- based, etc., may also be used to form electrodes. Such inks are more flexible than epoxy-based inks.
When a single flexible coil electrode is carried by a base member (see, for example, Figure 7a), the length will depend on the length of the base member and the intended application. When a plurality of spaced flexible coil electrodes are carried by a base member (see, for example, Figure 10), the electrodes will preferably be about 10 mm to about 40 mm in length. Preferably, the electrodes will be 25 mm in length with 1 mm to 2 mm spacing, which will result in the creation of continuous lesion patterns in tissue when coagulation energy is applied simultaneously to adjacent electrodes. For rigid electrodes, the length of the each electrode can vary from about 3 mm to about 10 mm. Using multiple rigid electrodes longer than about 10 mm each adversely effects the overall flexibility of the device, while electrodes having lengths of less than about 2 mm do not consistently form the desired continuous lesion patterns. It should also be noted that other energy transmission devices, such as laser arrays, ultrasonic transducers, microwave electrodes, and ohmically heated hot wires, may be substituted for the electrodes. Another type of energy transmission device that may be substituted for the electrodes is cryotemperature elements. Here, the energy transmission is the removal of heat from the tissue. Still another type of energy transmission device that may be substituted for the electrodes is needle projections for chemical ablation (which are preferably about 1 to 2 mm in length). Here, the energy transmission is the transmission of chemical energy. Referring for example to Figures 5-8, each energy transmission device 108 is individually coupled to a wire 137 (Figure 8) that conducts coagulating energy. The wires 137 pass in conventional fashion through cables 138 to an associated connector (140 or 142). The connectors 140 and 142 are configured to plug into an electrosurgical unit ("ESU") 144 that supplies and controls power, such RF power. A suitable ESU is the Model 4810 ESU sold by EP Technologies, Inc. of San Jose, California. The exemplary ESU 144 illustrated in Figure 6 includes a plurality of displays and buttons that are used to control the level of power supplied to the energy transmission device(s) 108 and the temperature at the energy transmission device(s). When a plurality of spaced energy transmission devices 108 are employed, the ESU 144 may also be used to selectively control which of the energy transmission devices receive power. The amount of power required to coagulate tissue ranges from 5 to 150 w.
The exemplary ESU 144 illustrated in Figure 6 is operable in a bi-polar mode, where tissue coagulation energy emitted by the energy transmission device(s) 108 on one energy transmission assembly is returned through the energy transmission device(s) on another energy transmission assembly, and a uni-polar mode, where the tissue coagulation energy emitted by the energy transmission device(s) on an energy transmission assembly is returned through one or more indifferent electrodes (not shown) that are externally attached to the skin of the patient with a patch or one or more electrodes (not shown) that are positioned in the blood pool. To that end, the exemplary ESU 144 is provided with a power output connector 141 and a pair of return connectors 143. In a preferred implementation, the ESU output and return connectors 141 and 143 have different shapes to avoid confusion and the connectors 140 and 142 have corresponding shapes. As such, in the exemplary bi-polar arrangement illustrated in Figure 5, the connector 140 associated with energy transmission assembly 102 has a shape corresponding to the ESU output connector 141 and the connector 142 associated with energy transmission assembly 104 has a shape corresponding to the ESU return connector 143.
The connector (not shown) associated with the energy transmission assembly 124 illustrated in Figure 10, which is intended to be operated in the uni-polar mode, would have a shape corresponding to the ESU output connector 141. In those instances where it is desirable to clamp the indifferent electrode within the patient, as opposed to positioning the indifferent electrode on the patient's skin, a second energy transmission assembly may be provided with a connector having a shape corresponding to the ESU return connector 143. Additionally, in those instances where the energy transmission assembly
124 has been modified to includes space electrodes (or spaced groups of longitudinally spaced electrodes) that operated in bi-polar fashion, the assembly would be provided with a pair of connectors. One would have a shape corresponding to the ESU output connector 141 and the other would have a shape corresponding to the ESU return connector 143.
With respect to power and temperature control, one or more temperature sensors 146, such as thermocouples or thermistors, may be located on, under, abutting the longitudinal end edges of, or in between, the energy transmission devices 108. A reference thermocouple (not shown) may also be provided. For temperature control purposes, signals from the temperature sensors 146 are transmitted to the ESU 144 by way of wires 148 (Figure 8) that are connected to the connector 140 and, in some instances, the connector 142. The wires 137 and 148 (which are not shown in all of the Figures for clarity purposes) run through wire apertures 150 and small holes 152, which are formed in the base members 106, 126, 126', 134 and 134'. Suitable temperature sensors and power control schemes that are based on a sensed temperature are disclosed in U.S. Patent Nos. 5,456,682, 5,582,609 and 5,755,715.
The actual number of temperature sensors 146 may be varied in order to suit particular applications. In the bi-polar arrangement illustrated in Figures 7a and 7b, for example, both of the energy transmission assemblies 102 and 104 include a single energy transmission device 108 and the energy transmission assembly 102 includes a plurality of spaced temperature sensors 146. Here, the level of power supplied to the energy transmission device 108 on the energy transmission assembly 102 would be controlled based on the highest temperature measured by the temperature sensors 146. Alternatively, the energy transmission assembly 104 (which is being used as the return) may also provided with a plurality of spaced temperature sensors 146. Here, the level of power supplied to the energy transmission device 108 on the energy transmission assembly 102 would be controlled based on the highest temperature measured by any of the temperature sensors 146, whether on the transmitting assembly 102 or the return assembly 104.
In those instances where a plurality of spaced energy transmission devices 108 are provided, such as in the uni-polar arrangement illustrated in
Figure 13, a temperature sensor 146 may be associated with each of the energy transmission devices. Here, power to the energy transmission devices 108 may be individually controlled based on the temperature measured by the associated temperature sensor 146. Another exemplary bi-polar arrangement, which is illustrated in Figures
16a and 16b, is substantially similar to the arrangement illustrated in Figures 7a and 7b and similar reference numerals are used to represent similar elements. Here, however, the energy transmission assembly 102' includes a plurality of spaced energy transmission device 108, each having a temperature sensor 146 associated therewith, and the energy transmission assembly 104' includes a single energy transmission device 108 and a plurality of temperature sensors 146. The temperature sensors 146 are preferably positioned such that, when in use, the temperature sensors on the energy transmission assembly 102' will be aligned with the temperature sensors on the energy transmission assembly 104'. Such an arrangement allows power to the energy transmission devices
108 on the assembly 102' to be individually controlled based on the highest of two temperatures, i.e. the temperature measured by the temperature sensor 146 associated with the particular energy transmission device and the temperature measured by the temperature sensor directly across from the particular energy transmission device.
III. Tissue Cooling Apparatus
Energy transmission devices in accordance with the present inventions may also include apparatus that cools the tissue during tissue coagulation procedures. Examples of suitable cooling apparatus are illustrated in Figures 13- 15. Such tissue cooling apparatus may also be used in conjunction with the exemplary devices illustrated in Figures 4, 5, 7a-12, 16a and 16b. The tissue cooling apparatus disclosed herein employ conductive fluid to cool tissue during coagulation procedures. More specifically, and as described below and in U.S. application Serial No. 09/761 ,981 , heat from the tissue being coagulated is transferred to ionic fluid to cool the tissue while energy is transferred from an electrode or other energy transmission device to the tissue through the fluid by way of ionic transport. The conductive fluid may be pumped through the tissue cooling apparatus (Figures 13 and 14) or the tissue cooling apparatus may be saturated with the fluid prior to use (Figure 15). In either case, cooling tissue during a coagulation procedure facilitates the formation of lesions that are wider and deeper than those that could be realized with an otherwise identical device which lacks tissue cooling apparatus. Referring first to Figures 13 and 14, an exemplary tissue cooling apparatus 154 includes a nanoporous outer casing 156 through which ionic fluid (represented by arrows F) is transferred. The ionic fluid preferably flows from one longitudinal end of the tissue cooling apparatus 154 to the other. The outer casing 156 is secured to the base member 134 over the energy transmission devices 108 such that a fluid transmission space 158 is defined therebetween.
More specifically, the proximal and distal ends of the outer casing 156 are secured to the base member 134 with anchoring devices (not shown) such as lengths of heat shrink tubing, Nitinol tubing or other mechanical devices that form an interference fit between the casing and the base member. Adhesive bonding is another method of securing the outer casing 156 to the base member
134. The fluid transmission space will typically be about 0.5 mm to about 2.0 mm high and slightly wider than the associated energy transmission device(s) 108.
The ionic fluid is supplied under pressure from a fluid source (not shown) by way of a supply line 160 and is returned to the source by way of a return line
162. The supply line 160 is connected to a fluid lumen 164 that runs from the proximal end of the base member 134 to the distal region of the outer casing 156. The fluid lumen 164 is connected to the fluid transmission space 158 by an aperture 166. The electrically conductive ionic fluid preferably possesses a low resistivity to decrease ohmic loses, and thus ohmic heating effects, within the outer casing 156. The composition of the electrically conductive fluid can vary. In the illustrated embodiment, the fluid is a hypertonic saline solution, having a sodium chloride concentration at or near saturation, which is about 5% to about 25% weight by volume. Hypertonic saline solution has a relatively low resistivity of only about 5 ohm-cm, as compared to blood resistivity of about 150 ohm-cm and myocardial tissue resistivity of about 500 ohm-cm. Alternatively, the ionic fluid can be a hypertonic potassium chloride solution.
With respect to temperature and flow rate, a suitable inlet temperature for epicardial applications (the temperature will, of course, rise as heat is transferred to the fluid) is about 0 to 25°C with a constant flow rate of about 2 to 20 ml/min. The flow rate required for endocardial applications where blood is present would be about three-fold higher (i.e. 6 to 60 ml/min.). Should applications so require, a flow rate of up to 100 ml/min. may be employed. In a closed system where the fluid is stored in a flexible bag, such as the Viaflex® bag manufactured by Baxter Corporation, and heated fluid is returned to the bag, it has been found that a volume of fluid between about 200 and 500 ml within the bag will remain at room temperature (about 22°C) when the flow rate is between about 2 ml/min. and 20 ml/min. Alternatively, in an open system, the flexible bag should include enough fluid to complete the procedure. 160 ml would, for example, be required for a 20 minute procedure where the flow rate was 8 ml/min. The fluid pressure within the outer casing 156 should be about 30 mm Hg in order to provide a structure that will resiliently conform to the tissue surface in response to a relatively small force normal to the tissue. Pressures above about 100 mm Hg will cause the outer casing 156 to become too stiff to properly conform to the tissue surface. For that reason, the flow resistance to and from the outer casing 156 should be relatively low.
The pores in the nanoporous outer casing 156 allow the transport of ions contained in the fluid through the casing and into contact with tissue. Thus, when an energy transmission device 108 transmit RF energy into the ionic fluid, the ionic fluid establishes an electrically conductive path through the outer casing 156 to the tissue being coagulated. Regenerated cellulose membrane materials, typically used for blood oxygenation, dialysis or ultrafiltration, are a suitable nanoporous material for the outer casing 156. The thickness of the material should be about 0.05 mm to 0.13 mm. Although regenerated cellulose is electrically non-conductive, the relatively small pores of this material allow effective ionic transport in response to the applied RF field. At the same time, the relatively small pores prevent transfer of macromolecules through the material, so that pressure driven liquid perfusion is less likely to accompany the ionic transport, unless relatively high pressure conditions develop within the outer casing 156.
Hydro-Fluoro™ material, which is disclosed in U.S. Patent No. 6,395,325, is another material that may be used. Materials such as nylons (with a softening temperature above 100°C), PTFE, PEI and PEEK that have nanopores created through the use of lasers, electrostatic discharge, ion beam bombardment or other processes may also be used. Such materials would preferably include a hydrophilic coating. Nanoporous materials may also be fabricated by weaving a material (such as nylon, polyester, polyethylene, polypropylene, fluorocarbon, fine diameter stainless steel, or other fiber) into a mesh having the desired pore size and porosity. These materials permit effective passage of ions in response to the applied RF field. However, as many of these materials possess larger pore diameters, pressure driven liquid perfusion, and the attendant transport of macromolecules through the pores, are also more likely to occur.
The electrical resistivity of the outer casing 156 will have a significant influence on lesion geometry and controllability. Low-resistivity (below about 500 ohm-cm) requires more RF power and results in deeper lesions, while high-resistivity (at or above about 500 ohm-cm) generates more uniform heating and improves controllability. Because of the additional heat generated by the increased body resistivity, less RF power is required to reach similar tissue temperatures after the same interval of time. Consequently, lesions generated with high-resistivity structures usually have smaller depth. The electrical resistivity of the outer casing can be controlled by specifying the pore size of the material, the porosity of the material, and the water adsorption characteristics (hydrophilic versus hydrophobic) of the material. A detailed discussion of these characteristics is found in U.S. Patent No. 5,961 ,513. A suitable electrical resistivity for epicardial and endocardial lesion formation is about 1 to 3000 ohm- cm measured wet. Generally speaking, low or essentially no liquid perfusion through the nanoporous outer casing 156 is preferred. When undisturbed by attendant liquid perfusion, ionic transport creates a continuous virtual electrode at the tissue interface. The virtual electrode efficiently transfers RF energy without need for an electrically conductive metal surface.
Pore diameters smaller than about 0.1 μm retain macromolecules, but allow ionic transfer through the pores in response to the applied RF field. With smaller pore diameters, pressure driven liquid perfusion through the pores is less likely to accompany the ionic transport, unless relatively high pressure conditions develop within the outer casing 156. Larger pore diameters (up to 8 μm) can also be used to permit ionic current flow across the membrane in response to the applied RF field. With larger pore diameters, pressure driven fluid transport across the membrane is much higher and macromolecules (such as protein) and even small blood cells (such as platelets) could cross the membrane and contaminate the inside of the probe. Red blood cells would normally not cross the membrane barrier, even if fluid perfusion across the membrane stops. On balance, a pore diameter of 1 to 5 μm is suitable for epicardial and endocardial lesion formation. Where a larger pore diameter is employed, thereby resulting in significant fluid transfer through the porous region, a saline solution having a sodium chloride concentration of about 0.9% weight by volume would be preferred.
With respect to porosity, which represents the volumetric percentage of the outer casing 156 that is composed of pores and not occupied by the casing material, the magnitude of the porosity affects electrical resistance. Low-porosity materials have high electrical resistivity, whereas high-porosity materials have low electrical resistivity. The porosity of the outer casing 156 should be at least 1 % for epicardial and endocardial applications employing a 1 to 5 μm pore diameter.
Turning to water absorption characteristics, hydrophilic materials are generally preferable because they possess a greater capacity to provide ionic transfer of RF energy without significant liquid flow through the material.
The exemplary tissue cooling apparatus 168 illustrated in Figure 15 consists of a wettable fluid retention element 170 that is simply saturated with ionic fluid (such as saline) prior to use, as opposed to having the fluid pumped through the apparatus in the manner described above with reference to Figures 13 and 14. The energy transmission device(s) 108 are carried within the fluid retention element 170. Suitable materials for the fluid retention element 170 include biocompatible fabrics commonly used for vascular patches (such as woven Dacron®), open cell foam materials, hydrogels, nanoporous balloon materials (with very slow fluid delivery to the surface), and hydrophilic nanoporous materials. The effective electrical resistivity of the fluid retention element 170 when wetted with 0.9% saline (normal saline) should range from about 1 Ω-cm to about 2000 Ω-cm. A preferred resistivity for epicardial and endocardial procedures is about 1000 Ω-cm. IV. Probe Support Devices
Probe support devices in accordance with a present invention may be used to covert a conventional clamp, or a clamp in accordance with the inventions described in Section V below, into a tissue coagulation device by securing one or more conventional catheters, surgical probes, or other apparatus that support energy transmission devices, to the clamp. Although the configuration of the probe support devices may vary from application to application to suit particular situations, the exemplary probe support devices are configured such that the probes being supported will abut one another in the same manner as the inserts 28 and 30 (Figures 1-3) when the associated clamp is in the closed orientation. Such an arrangement will allow the energy transmission devices on the probes to face one another in the manner similar to that described in Section I above. As illustrated for example in Figures 17 and 18, a probe support device
172 in accordance with one embodiment of a present invention includes a base member 174, a slot 176 configured to receive an electrode supporting device such as a catheter or surgical probe, and a plurality of mating structures 178 that mechanically engage a clamp member. The exemplary base member 174 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D. The size and shape of the slot 176 will, of course, depend on the size and shape of the probe that it is holding. Many probes are generally cylindrical in shape and, according, the exemplary slot 176 has a corresponding arcuate cross-sectional shape. The arc is preferably greater than 180 degrees so that the base member 174 will deflect when a probe is inserted into the slot 176 and then snap back to hold the probe in place.
The exemplary mating structures 178, which are preferably integral with the base member 174 and formed from the same resilient material, include a relatively narrow portion 180 and a relatively wide portion 182. The relatively narrow portions 180 are approximately the same size as the clamp member apertures 36 (Figure 3) and the relatively wide portions 182 are slightly larger than the clamp member apertures. A removable connection is made by urging the mating structures 178 into one end of the apertures 36, thereby deforming the relatively wide portions 182, and then urging the base members 174 against the clamp member until the relatively wide portions exit through the other end of the apertures and reassume their original shape.
Turning to Figures 19 and 20, a pair of the exemplary probe support devices 172 may be used in conjunction with a pair of probes 184 to convert the clamp 10 (which has had the inserts 28 and 30 removed) into a bi-polar tissue coagulation device. Although the present inventions are not limited to use with an particular type of probe, each probe 184 in the exemplary implementation includes a shaft 186, a plurality of spaced electrodes 188, and a plurality of temperature sensors (not shown) respectively associated with the electrodes. Once the probe support devices 172 have been secured to the clamp members 22 and 24, the probes 184 may be snapped into the slots 176 by moving the probes from the dash line positions illustrated in Figure 19 to the solid line positions. One of the probes 184 may be connected to the output connector of an ESU, while the other probe may be connected to the return connector to complete the bi-polar arrangement. Another exemplary probe support device 190 is illustrated in Figures 21 and 22. The probe support device 190 is similar to the probe support device 172 illustrated in Figures 17 and 18 and similar structural element are represented by similar reference numerals. The exemplary probe support device 190 may also be used in the manner described above with reference to Figures 19 and 20. Here, however, the mating structures 178 have been eliminated and the base member 172 is provided with a longitudinally extending aperture 192 into which one of the clamp members 22 and 24 may be inserted. The aperture 192 should be sized and shaped such that the base member 174' will be forced to stretch when one of the clamp members 22 and 24 is inserted. If, for example, the apertures 192 have the same cross-sectional shape as the clamp members 22 and 24 (e.g. both are elliptical), then the apertures should be slightly smaller in their cross-sectional dimensions than the corresponding clamp members. The stretching of base member 174' creates a tight interference fit between the base member and the clamp member. Additionally, although the aperture 192 has a semi-circular cross-section in the exemplary embodiment, the apertures may have a round, rectangular, square or elliptical cross-section, or define any other cross-sectional shape, depending on the particular application.
Alternatively, and as illustrated for example in Figure 23, in those instances where the clamp members include longitudinally extending slots instead of apertures (such as the slots 38 described above with reference to Figure 12), the probe support device 172 may be provided with a longitudinally extending mating structure 194 that extends outwardly from the base member
174. The longitudinally extending mating structure 194, which is preferably integral with the base member 174 and formed from the same resilient material, is sized to create an interference fit with a slot. Still another alternative is to provide the clamp members with one or more small mating structures that are received within apertures or slots formed in the base member 174.
An exemplary probe support device 196 that may be used in conjunction with a probe 184 to convert the clamp 10 (which has had the inserts 28 and 30 removed) into a uni-polar tissue coagulation device is illustrated in Figures 24 and 25. Although the configuration of the probe support device 196 may vary from application to application to suit particular situations, the probe support device in the exemplary embodiment is configured such that it will abut each of the clamp members 22 and 24 when the clamp is in the closed orientation illustrated in Figure 25. The exemplary probe support device 196 includes a base member 198, a slot 200 configured to receive a probe 184 or other electrode supporting device, and a plurality of mating structures 178 that mechanically engage a clamp members 22 and 24 in the manner described above. The exemplary base member 198 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D. The size and shape of the slot 200 will depend on the size and shape of the probe that it is intended to hold. The exemplary probe 184 is generally cylindrical in shape and, according, the exemplary slot 200 has a corresponding arcuate cross-sectional shape. The arc is preferably greater than 180 degrees so that the base member 198 will deflect when the probe 184 is inserted into the slot 200 and then snap back to hold the probe in place.
Another exemplary probe support device that may be used in conjunction with a probe 184 to convert the clamp 10 into a uni-polar tissue coagulation device is generally represented by reference numeral 202 in Figure 26. The probe support device 202 includes a base member 204, a slot 206 configured to receive a probe 184 or other electrode supporting device, and a longitudinally extending aperture 208 into which both of the clamp members 22 and 24 may be inserted. The exemplary base member 204 is preferably formed from a soft, resilient, low durometer material that is electrically insulating. Suitable materials include polyurethane, silicone and polyurethane/silicone blends having a hardness of between about 20 Shore D and about 72 Shore D. The size and shape of the slot 206 will depend on the size and shape of the probe that it is intended to hold, as is described above with reference to slot 200. The aperture
208 should be sized and shaped such that the base member 204 will be forced to stretch when the clamp members 22 and 24 are inserted with the clamp 10 in a closed orientation. The stretching creates a tight interference fit between the base member 204 and the clamp members 22 and 24. Additionally, although the aperture 208 has an elliptical cross-section in the exemplary embodiment, the aperture may have a round, rectangular, square or semi-circular cross-section, or define any other cross-sectional shape, depending on the particular application. The length of the base members in the exemplary probe support devices will vary according to the intended application. In the area of cardiovascular treatments, it is anticipated that suitable lengths will range from, but are not limited to, about 3 cm to about 10 cm. V. Clamp With Malleable Clamp Members
This portion of the specification refers to rigid and malleable structures. A rigid structure is a structure than cannot be readily bent by a physician. A malleable structure can be readily bent by the physician to a desired shape, without springing back when released, so that it will remain in that shape during the surgical procedure. Thus, the stiffness of a malleable structure must be low enough to allow the structure to be bent, but high enough to resist bending when the forces associated with a surgical procedure are applied to the structure. Rigid structures are preferably formed from stainless steel, while malleable structure are preferably formed from annealed stainless steel or titanium. Additional information concerning malleable structures may be found in U.S.
Patent No. 6,142,994.
As illustrated for example in Figure 27, a clamp 210 in accordance with a preferred embodiment of a present invention includes a pair of malleable clamp members 212 and 214. The malleable clamp members 212 and 214 are carried at the distal ends of a pair of arms 216 and 218. The arms 216 and 218 are pivotably secured to one another by a pin 220 to allow the clamp members 212 and 214 to be moved towards and away from one another between opened and closed positions. The arms 216 and 218 are preferably formed from rigid material, but may also be malleable if desired. When rigid, the arms 216 and 218 may be linear or have a preformed curvature.
A pair of handles 222 and 224 are mounted on the proximal ends of the arms 216 and 218. A locking device 226 locks the clamp 210 in the closed orientation illustrated in Figure 27. The locking device 226 also prevents the clamp members 212 and 214 from coming any closer to one another than is illustrated in Figure 27, thereby defining a predetermined spacing between the clamp members.
The malleability of the clamp members 212 and 214 allows them to be re-shaped by the physician as needed for particular procedures and body structures. As such, a single clamp 210 is capable of taking the place of a number of conventional clamps with rigid clamp members. In some implementations, the clamp members 212 and 214 will be more malleable (i.e. easier to bend) at their distal end than at their proximal end. This may be accomplished by gradually decreasing the cross-sectional area of each clamp member 212 and 214 from the proximal end to the distal end.
The clamp members 212 and 214 may also be provided with holes 228 (Figure 31) that allow soft deformable inserts, such as the conventional inserts 28 and 30 described above with reference to Figures 1-3. The exemplary clamp 210 may also be used in conjunction with the energy transmission assemblies, probe support devices, and probes described in Sections l-IV above.
There will be many instances where it will be important to maintain the predefined spacing between the malleable clamp members 212 and 214 during the bending process in order to insure that the predefined spacing will remain when the bending process is complete. To that end, the exemplary clamp 210 is provided with a malleable insert 230 that is sized and shaped (rectangular in the exemplary implementation) to be held between the malleable clamp members 212 and 214 when the clamp is closed and locked. The friction between the clamp members 212 and 214 and insert 230 will hold the insert in place during bending. Nevertheless, if desired, the insert 230 may be provided with small protrusions that will be received by the holes 228. The malleable insert 230, which is preferably formed from the same material as the malleable clamp members 212 and 214, will bend with the clamp members during the bending process, thereby maintaining the predetermined spacing. [Note Figure 32.] The exemplary mandrel 232 illustrated in Figures 28 and 29 may be used to bend the malleable clamp members 212 and 214. The exemplary mandrel 232 includes a base 234 and a pair of cylindrical posts 236 and 238. Posts of other shapes, such as elliptical posts, may also be employed to achieve particular bends. The mandrel 232 should also be formed from material that is harder than the malleable clamp members 212 and 214, such as stainless steel or titanium.
The exemplary mandrel 232 may be used to bend the malleable clamp members 212 and 214 in the manners illustrated in Figures 30 and 31. Referring first to Figure 30, once the malleable clamp members 212 and 214 and malleable insert 230 have been placed between the posts 236 and 238, the clamp 210 may be rotated in the direction of the arrow (or in the opposite direction) until the clamp members 212 and 214 are bent the desired amount. The clamp 210 may then moved longitudinally and the bending process repeated until the desired bend, such as the exemplary bend illustrated in Figure 32, has been achieved. Alternatively, or in addition, the clamp 210 can be rotated about its longitudinal axis and bent in other planes, as is illustrated for example in Figures 31 and 33. It should also be noted that, if desired, the malleable clamp members 212 and 214 may be bent independently of one another and/or into different shapes. Preferably, the physician will simply place the mandrel 232 on a suitable surface and press down the base 234 during a bending procedure. Alternatively, structure may be provided to secure the mandrel 232 to the surface. Another example of a clamp in accordance with a preferred embodiment of a present invention is generally represented by reference numeral 240 in Figure 34. Clamp 240 is similar to clamp 210 and similar elements are represented by similar reference numerals. The exemplary clamp 240 includes malleable clamp members 212 and 214, pivotable arms 216 and 218, handles 222 and 224, and a locking device 226. Here, however, the arms 216 and 218 are pivotably carried by one end of an elongate housing 242 and the malleable clamp members 212 and 214 are carried by a pair of supports 244 and 246 that are pivotably carried the other end of the housing. A suitable mechanical linkage (not shown) located within the housing 242 causes the supports 244 and 246 (and clamp members 212 and 214) to move relative to one another in response to movement of the arms 216 and 218. The housing 242 may be rigid or malleable
The present clamps with malleable clamp members (such as exemplary clamps 210 and 240) have a wide variety of applications. One example is the formation of transmural epicardial lesions to isolate the sources of focal (or ectopic) atrial fibrillation and, more specifically, the creation of transmural lesions around the pulmonary veins. Energy transmission devices may be permanently affixed to the malleable clamp members. Energy transmission devices may also be added using the structures described in Sections l-IV above and the clamp may be used a clamp or as a surgical probe, depending on the structure being used in combination with the clamp. Access to the heart may be obtained via a thoracotomy, thoracostomy or median stemotomy. Ports may also be provided for cameras and other instruments.
Lesions may be created around the pulmonary veins individually or, alternatively, lesions may be created around pairs of pulmonary veins. For example, a first transmural epicardial lesion may be created around the right pulmonary vein pair and a second transmural epicardial lesion may be created around the left pulmonary vein pair. Thereafter, if needed, a linear transmural epicardial lesion may be created between the right and left pulmonary vein pairs. A linear transmural lesion that extends from the lesion between the right and left pulmonary vein pairs to the left atrial appendage may also be formed. Alternatively, a single lesion may be formed around all four of the pulmonary veins.
Although the present inventions have been described in terms of the preferred embodiments above, numerous modifications and/or additions to the above-described preferred embodiments would be readily apparent to one skilled in the art. It is intended that the scope of the present inventions extend to all such modifications and/or additions and that the scope of the present inventions is limited solely by the claims set forth below.

Claims

I claim:
1. An apparatus for use with a clamp including first and second clamp members, the apparatus comprising: a base member configured to be removably secured to at least one of the first and second clamp members; and at least one energy transmission device carried by the base member.
2. An apparatus as claimed in claim 1 , wherein the base member includes a longitudinally extending aperture configured to receive the first clamp member.
3. An apparatus as claimed in claim 2, wherein the first clamp member and the longitudinally extending aperture are respectively sized and shaped such that the base member will stretch when the first clamp member is inserted into the longitudinally extending aperture.
4. An apparatus as claimed in claim 1 , wherein the base member includes a longitudinally extending aperture configured to receive both of the first and second clamp members.
5. An apparatus as claimed in claim 4, wherein the first and second clamp members and the longitudinally extending aperture are respectively sized and shaped such that the base member will stretch when the first and second clamp members are inserted into the longitudinally extending aperture.
6. An apparatus as claimed in claim 1 , wherein the base member includes a base member mating structure configured to mate with the first clamp member.
7. An apparatus as claimed in claim 6, wherein the base member mating structure comprises a relatively narrow portion and a relatively wide portion.
8. An apparatus as claimed in claim 1 , wherein the base member includes first and second base member mating structures respectively configured to mate with the first and second clamp members.
9. An apparatus as claimed in claim 8, wherein the first and second base member mating structures each comprise a relatively narrow portion and a relatively wide portion.
10. An apparatus as claimed in claim 1 , wherein the at least one energy transmission device comprises an electrode.
11. An apparatus as claimed in claim 1 , further comprising: a temperature sensor.
12. An apparatus as claimed in claim 1 , wherein the at least one energy transmission device comprises a plurality of longitudinally spaced energy transmission devices.
13. An apparatus as claimed in claim 12, further comprising: a plurality of temperature sensors respectively associated with the plurality of longitudinally spaced energy transmission devices.
14. An apparatus as claimed in claim 1 , further comprising: a tissue cooling apparatus carried by the base member and covering at least a portion of the at least one energy transmission device.
15. An apparatus as claimed in claim 1 , wherein the base member comprises a substantially electrically insulating base member.
16. An apparatus as claimed in claim 1 , wherein the base member comprises a resilient base member.
17. An apparatus as claimed in claim 1 , wherein the base member defines a first base member configured to be removably secured to the first clamp member and the at one energy transmission device defines a first energy transmission device, the apparatus further comprising: a second base member configured to be removably secured to the second clamp member; and a second energy transmission device carried by the second base member.
18. An apparatus as claimed in claim 17, wherein the first energy transmission device comprises a plurality of longitudinally spaced first energy transmission devices.
19. An apparatus as claimed in claim 18, further comprising: a plurality of first temperature sensors respectively associated with the plurality of longitudinally spaced first energy transmission devices and defining a predetermined spacing therebetween; and a plurality of second temperature sensors associated with the second energy transmission device and defining a predetermined spacing therebetween that substantially corresponds to the predetermined spacing of the first temperature sensors.
20. An apparatus as claimed in claim 17, further comprising: a first electrical connector operably connected to the first energy transmission device and defining a first connector configuration; and a second electrical connector operably connected to the second energy transmission device and defining a second connector configuration, the second connector configuration being different than the first connector configuration.
21. An apparatus for use with a clamp including first and second clamp members, the apparatus comprising: at least one energy transmission device; and support means for removably securing the at least one energy transmission device to at least one of the first and second clamp members.
22. An apparatus as claimed in claim 21 , wherein the at least one energy transmission device comprises an electrode.
23. An apparatus as claimed in claim 21 , further comprising: a temperature sensor.
24. An apparatus as claimed in claim 21 , wherein the at least one energy transmission device comprises a plurality of longitudinally spaced energy transmission devices.
25. An apparatus as claimed in claim 24, further comprising: a plurality of temperature sensors respectively associated with the plurality of longitudinally spaced energy transmission devices.
26. An apparatus as claimed in claim 21 , further comprising: a tissue cooling apparatus carried by the support means and covering at least a portion of the at least one energy transmission device.
27. An apparatus as claimed in claim 21 , wherein the at one energy transmission device defines a first energy transmission device and the support means comprises first support means for removably securing the first energy transmission device to the first clamp member, the apparatus further comprising: a second energy transmission device; and second support means for removably securing the second energy transmission device to the second clamp member.
28. An apparatus as claimed in claim 27, wherein the first energy transmission device comprises a plurality of longitudinally spaced first energy transmission devices.
29. An apparatus as claimed in claim 28, further comprising: a plurality of first temperature sensors respectively associated with the plurality of longitudinally spaced first energy transmission devices and defining a predetermined spacing therebetween; and a plurality of second temperature sensors associated with the second energy transmission device and defining a predetermined spacing therebetween that substantially corresponds to the predetermined spacing of the first temperature sensors.
30. An apparatus as claimed in claim 27, further comprising: a first electrical connector operably connected to the first energy transmission device and defining a first connector configuration; and a second electrical connector operably connected to the second energy transmission device and defining a second connector configuration, the second connector configuration being different than the first connector configuration.
PCT/US2002/038092 2002-02-19 2002-11-25 Apparatus for converting a clamp into an electrophysiology device WO2003077779A1 (en)

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JP2003575836A JP2005519690A (en) 2002-02-19 2002-11-25 Apparatus for converting a clamp into an electrophysiology device
CA002468635A CA2468635A1 (en) 2002-02-19 2002-11-25 Apparatus for converting a clamp into an electrophysiology device
AU2002367769A AU2002367769A1 (en) 2002-02-19 2002-11-25 Apparatus for converting a clamp into an electrophysiology device
EP02807088A EP1476090A1 (en) 2002-02-19 2002-11-25 Apparatus for converting a clamp into an electrophysiology device

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US10/079,944 2002-02-19

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AU (1) AU2002367769A1 (en)
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Families Citing this family (228)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7435249B2 (en) 1997-11-12 2008-10-14 Covidien Ag Electrosurgical instruments which reduces collateral damage to adjacent tissue
US6726686B2 (en) 1997-11-12 2004-04-27 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US6228083B1 (en) 1997-11-14 2001-05-08 Sherwood Services Ag Laparoscopic bipolar electrosurgical instrument
US7118570B2 (en) 2001-04-06 2006-10-10 Sherwood Services Ag Vessel sealing forceps with disposable electrodes
US7267677B2 (en) 1998-10-23 2007-09-11 Sherwood Services Ag Vessel sealing instrument
US7364577B2 (en) 2002-02-11 2008-04-29 Sherwood Services Ag Vessel sealing system
US7582087B2 (en) 1998-10-23 2009-09-01 Covidien Ag Vessel sealing instrument
US7887535B2 (en) 1999-10-18 2011-02-15 Covidien Ag Vessel sealing wave jaw
US20030109875A1 (en) 1999-10-22 2003-06-12 Tetzlaff Philip M. Open vessel sealing forceps with disposable electrodes
US10849681B2 (en) 2001-04-06 2020-12-01 Covidien Ag Vessel sealer and divider
AU2001249933B2 (en) 2001-04-06 2006-06-08 Covidien Ag Vessel sealer and divider with non-conductive stop members
US7101371B2 (en) 2001-04-06 2006-09-05 Dycus Sean T Vessel sealer and divider
JP4394881B2 (en) 2001-04-06 2010-01-06 コヴィディエン アクチェンゲゼルシャフト An electrosurgical instrument that reduces incidental damage to adjacent tissue
US7674258B2 (en) * 2002-09-24 2010-03-09 Endoscopic Technologies, Inc. (ESTECH, Inc.) Electrophysiology electrode having multiple power connections and electrophysiology devices including the same
US7753908B2 (en) * 2002-02-19 2010-07-13 Endoscopic Technologies, Inc. (Estech) Apparatus for securing an electrophysiology probe to a clamp
US7785324B2 (en) 2005-02-25 2010-08-31 Endoscopic Technologies, Inc. (Estech) Clamp based lesion formation apparatus and methods configured to protect non-target tissue
US20030158548A1 (en) * 2002-02-19 2003-08-21 Phan Huy D. Surgical system including clamp and apparatus for securing an energy transmission device to the clamp and method of converting a clamp into an electrophysiology device
US6932816B2 (en) * 2002-02-19 2005-08-23 Boston Scientific Scimed, Inc. Apparatus for converting a clamp into an electrophysiology device
US7931649B2 (en) 2002-10-04 2011-04-26 Tyco Healthcare Group Lp Vessel sealing instrument with electrical cutting mechanism
US7270664B2 (en) 2002-10-04 2007-09-18 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7276068B2 (en) 2002-10-04 2007-10-02 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7799026B2 (en) * 2002-11-14 2010-09-21 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
AU2003223284C1 (en) 2003-03-13 2010-09-16 Covidien Ag Bipolar concentric electrode assembly for soft tissue fusion
US7160299B2 (en) 2003-05-01 2007-01-09 Sherwood Services Ag Method of fusing biomaterials with radiofrequency energy
WO2004098383A2 (en) 2003-05-01 2004-11-18 Sherwood Services Ag Electrosurgical instrument which reduces thermal damage to adjacent tissue
US8128624B2 (en) 2003-05-01 2012-03-06 Covidien Ag Electrosurgical instrument that directs energy delivery and protects adjacent tissue
EP1628586B1 (en) 2003-05-15 2011-07-06 Covidien AG Tissue sealer with non-conductive variable stop members
US7150749B2 (en) 2003-06-13 2006-12-19 Sherwood Services Ag Vessel sealer and divider having elongated knife stroke and safety cutting mechanism
USD956973S1 (en) 2003-06-13 2022-07-05 Covidien Ag Movable handle for endoscopic vessel sealer and divider
US7156846B2 (en) 2003-06-13 2007-01-02 Sherwood Services Ag Vessel sealer and divider for use with small trocars and cannulas
US7857812B2 (en) 2003-06-13 2010-12-28 Covidien Ag Vessel sealer and divider having elongated knife stroke and safety for cutting mechanism
US20050010202A1 (en) * 2003-06-30 2005-01-13 Ethicon, Inc. Applicator for creating linear lesions for the treatment of atrial fibrillation
JP4323517B2 (en) * 2003-07-24 2009-09-02 オリンパス株式会社 Treatment instrument protective cover sheath, surgical treatment instrument, and surgical treatment instrument system
US9848938B2 (en) 2003-11-13 2017-12-26 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US7367976B2 (en) 2003-11-17 2008-05-06 Sherwood Services Ag Bipolar forceps having monopolar extension
US7811283B2 (en) 2003-11-19 2010-10-12 Covidien Ag Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety
US7500975B2 (en) 2003-11-19 2009-03-10 Covidien Ag Spring loaded reciprocating tissue cutting mechanism in a forceps-style electrosurgical instrument
US7131970B2 (en) 2003-11-19 2006-11-07 Sherwood Services Ag Open vessel sealing instrument with cutting mechanism
US7442193B2 (en) 2003-11-20 2008-10-28 Covidien Ag Electrically conductive/insulative over-shoe for tissue fusion
US20050119653A1 (en) * 2003-12-02 2005-06-02 Swanson David K. Surgical methods and apparatus for forming lesions in tissue and confirming whether a therapeutic lesion has been formed
US8002770B2 (en) 2003-12-02 2011-08-23 Endoscopic Technologies, Inc. (Estech) Clamp based methods and apparatus for forming lesions in tissue and confirming whether a therapeutic lesion has been formed
US7780662B2 (en) 2004-03-02 2010-08-24 Covidien Ag Vessel sealing system using capacitive RF dielectric heating
JP4133873B2 (en) * 2004-03-04 2008-08-13 株式会社デンソー Thermoelectric generator
US7291142B2 (en) * 2004-05-10 2007-11-06 Boston Scientific Scimed, Inc. Low temperature lesion formation apparatus, systems and methods
US7288088B2 (en) * 2004-05-10 2007-10-30 Boston Scientific Scimed, Inc. Clamp based low temperature lesion formation apparatus, systems and methods
US7582083B2 (en) * 2004-05-10 2009-09-01 Boston Scientific Scimed, Inc. Probe based low temperature lesion formation apparatus, systems and methods
US7549988B2 (en) * 2004-08-30 2009-06-23 Boston Scientific Scimed, Inc. Hybrid lesion formation apparatus, systems and methods
US7195631B2 (en) 2004-09-09 2007-03-27 Sherwood Services Ag Forceps with spring loaded end effector assembly
US7540872B2 (en) * 2004-09-21 2009-06-02 Covidien Ag Articulating bipolar electrosurgical instrument
US7955332B2 (en) 2004-10-08 2011-06-07 Covidien Ag Mechanism for dividing tissue in a hemostat-style instrument
US7686827B2 (en) 2004-10-21 2010-03-30 Covidien Ag Magnetic closure mechanism for hemostat
US7727231B2 (en) 2005-01-08 2010-06-01 Boston Scientific Scimed, Inc. Apparatus and methods for forming lesions in tissue and applying stimulation energy to tissue in which lesions are formed
US7862561B2 (en) * 2005-01-08 2011-01-04 Boston Scientific Scimed, Inc. Clamp based lesion formation apparatus with variable spacing structures
US7776033B2 (en) * 2005-01-08 2010-08-17 Boston Scientific Scimed, Inc. Wettable structures including conductive fibers and apparatus including the same
WO2006074557A1 (en) * 2005-01-12 2006-07-20 Maquet Critical Care Ab Electrode for physiological signal measurements and method for making same
US7585310B2 (en) * 2005-01-14 2009-09-08 Boston Scientific Scimed, Inc. Minimally invasive clamp
US7686804B2 (en) 2005-01-14 2010-03-30 Covidien Ag Vessel sealer and divider with rotating sealer and cutter
US7909823B2 (en) 2005-01-14 2011-03-22 Covidien Ag Open vessel sealing instrument
US7892228B2 (en) * 2005-02-25 2011-02-22 Boston Scientific Scimed, Inc. Dual mode lesion formation apparatus, systems and methods
US7862562B2 (en) * 2005-02-25 2011-01-04 Boston Scientific Scimed, Inc. Wrap based lesion formation apparatus and methods configured to protect non-target tissue
US7455669B2 (en) * 2005-03-08 2008-11-25 Boston Scientific Scimed, Inc. Finger mountable lesion formation devices and methods
US7491202B2 (en) 2005-03-31 2009-02-17 Covidien Ag Electrosurgical forceps with slow closure sealing plates and method of sealing tissue
US9339323B2 (en) 2005-05-12 2016-05-17 Aesculap Ag Electrocautery method and apparatus
US7803156B2 (en) 2006-03-08 2010-09-28 Aragon Surgical, Inc. Method and apparatus for surgical electrocautery
US8696662B2 (en) 2005-05-12 2014-04-15 Aesculap Ag Electrocautery method and apparatus
US7942874B2 (en) * 2005-05-12 2011-05-17 Aragon Surgical, Inc. Apparatus for tissue cauterization
US8728072B2 (en) 2005-05-12 2014-05-20 Aesculap Ag Electrocautery method and apparatus
US20060271035A1 (en) * 2005-05-27 2006-11-30 Cardima, Inc. Bipolar tissue dessication system and method
US8016822B2 (en) 2005-05-28 2011-09-13 Boston Scientific Scimed, Inc. Fluid injecting devices and methods and apparatus for maintaining contact between fluid injecting devices and tissue
US8945151B2 (en) 2005-07-13 2015-02-03 Atricure, Inc. Surgical clip applicator and apparatus including the same
US7837685B2 (en) 2005-07-13 2010-11-23 Covidien Ag Switch mechanisms for safe activation of energy on an electrosurgical instrument
US20070032547A1 (en) * 2005-08-04 2007-02-08 Mark Friedman Method and device for treating migraine, tension-type and post-traumatic headache, atypical facial pain, and cervical muscle hyperactivity
US7628791B2 (en) 2005-08-19 2009-12-08 Covidien Ag Single action tissue sealer
US7722607B2 (en) 2005-09-30 2010-05-25 Covidien Ag In-line vessel sealer and divider
CA2561638C (en) 2005-09-30 2015-06-30 Sherwood Services Ag Insulating boot for electrosurgical forceps
US7789878B2 (en) 2005-09-30 2010-09-07 Covidien Ag In-line vessel sealer and divider
US7922953B2 (en) 2005-09-30 2011-04-12 Covidien Ag Method for manufacturing an end effector assembly
CA2561034C (en) 2005-09-30 2014-12-09 Sherwood Services Ag Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue
US7879035B2 (en) 2005-09-30 2011-02-01 Covidien Ag Insulating boot for electrosurgical forceps
US8241282B2 (en) 2006-01-24 2012-08-14 Tyco Healthcare Group Lp Vessel sealing cutting assemblies
US7766910B2 (en) 2006-01-24 2010-08-03 Tyco Healthcare Group Lp Vessel sealer and divider for large tissue structures
US8298232B2 (en) 2006-01-24 2012-10-30 Tyco Healthcare Group Lp Endoscopic vessel sealer and divider for large tissue structures
US8734443B2 (en) 2006-01-24 2014-05-27 Covidien Lp Vessel sealer and divider for large tissue structures
US8882766B2 (en) 2006-01-24 2014-11-11 Covidien Ag Method and system for controlling delivery of energy to divide tissue
US7645278B2 (en) * 2006-02-22 2010-01-12 Olympus Corporation Coagulating cutter
US8574229B2 (en) 2006-05-02 2013-11-05 Aesculap Ag Surgical tool
US7846158B2 (en) 2006-05-05 2010-12-07 Covidien Ag Apparatus and method for electrode thermosurgery
US7776037B2 (en) 2006-07-07 2010-08-17 Covidien Ag System and method for controlling electrode gap during tissue sealing
US7744615B2 (en) 2006-07-18 2010-06-29 Covidien Ag Apparatus and method for transecting tissue on a bipolar vessel sealing instrument
US20080033428A1 (en) * 2006-08-04 2008-02-07 Sherwood Services Ag System and method for disabling handswitching on an electrosurgical instrument
US8597297B2 (en) 2006-08-29 2013-12-03 Covidien Ag Vessel sealing instrument with multiple electrode configurations
US8070746B2 (en) 2006-10-03 2011-12-06 Tyco Healthcare Group Lp Radiofrequency fusion of cardiac tissue
US7951149B2 (en) 2006-10-17 2011-05-31 Tyco Healthcare Group Lp Ablative material for use with tissue treatment device
USD649249S1 (en) 2007-02-15 2011-11-22 Tyco Healthcare Group Lp End effectors of an elongated dissecting and dividing instrument
DE102007011568A1 (en) * 2007-03-08 2008-09-11 Cas Innovations Ag Medical clamp, in particular spinal clamp
US8267935B2 (en) 2007-04-04 2012-09-18 Tyco Healthcare Group Lp Electrosurgical instrument reducing current densities at an insulator conductor junction
US7877853B2 (en) 2007-09-20 2011-02-01 Tyco Healthcare Group Lp Method of manufacturing end effector assembly for sealing tissue
US7877852B2 (en) 2007-09-20 2011-02-01 Tyco Healthcare Group Lp Method of manufacturing an end effector assembly for sealing tissue
US8235993B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with exohinged structure
US8251996B2 (en) 2007-09-28 2012-08-28 Tyco Healthcare Group Lp Insulating sheath for electrosurgical forceps
US8235992B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot with mechanical reinforcement for electrosurgical forceps
US8241283B2 (en) 2007-09-28 2012-08-14 Tyco Healthcare Group Lp Dual durometer insulating boot for electrosurgical forceps
US8236025B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Silicone insulated electrosurgical forceps
US8267936B2 (en) 2007-09-28 2012-09-18 Tyco Healthcare Group Lp Insulating mechanically-interfaced adhesive for electrosurgical forceps
US8221416B2 (en) 2007-09-28 2012-07-17 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with thermoplastic clevis
US9023043B2 (en) 2007-09-28 2015-05-05 Covidien Lp Insulating mechanically-interfaced boot and jaws for electrosurgical forceps
US20090182322A1 (en) * 2008-01-11 2009-07-16 Live Tissue Connect, Inc. Bipolar modular forceps modular arms
US20090182328A1 (en) * 2008-01-11 2009-07-16 Live Tissue Connect, Inc. Bipolar modular forceps assembly
US8870867B2 (en) 2008-02-06 2014-10-28 Aesculap Ag Articulable electrosurgical instrument with a stabilizable articulation actuator
US8764748B2 (en) 2008-02-06 2014-07-01 Covidien Lp End effector assembly for electrosurgical device and method for making the same
US8623276B2 (en) 2008-02-15 2014-01-07 Covidien Lp Method and system for sterilizing an electrosurgical instrument
US8469956B2 (en) 2008-07-21 2013-06-25 Covidien Lp Variable resistor jaw
US8162973B2 (en) 2008-08-15 2012-04-24 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US8257387B2 (en) 2008-08-15 2012-09-04 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US9603652B2 (en) 2008-08-21 2017-03-28 Covidien Lp Electrosurgical instrument including a sensor
US8317787B2 (en) 2008-08-28 2012-11-27 Covidien Lp Tissue fusion jaw angle improvement
US8795274B2 (en) 2008-08-28 2014-08-05 Covidien Lp Tissue fusion jaw angle improvement
US8784417B2 (en) 2008-08-28 2014-07-22 Covidien Lp Tissue fusion jaw angle improvement
US8303582B2 (en) 2008-09-15 2012-11-06 Tyco Healthcare Group Lp Electrosurgical instrument having a coated electrode utilizing an atomic layer deposition technique
WO2010035953A2 (en) * 2008-09-23 2010-04-01 (주)트리플씨메디칼 Anastomotic device for a tubular organ
US9375254B2 (en) 2008-09-25 2016-06-28 Covidien Lp Seal and separate algorithm
US8968314B2 (en) 2008-09-25 2015-03-03 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8535312B2 (en) 2008-09-25 2013-09-17 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8142473B2 (en) 2008-10-03 2012-03-27 Tyco Healthcare Group Lp Method of transferring rotational motion in an articulating surgical instrument
US10695126B2 (en) 2008-10-06 2020-06-30 Santa Anna Tech Llc Catheter with a double balloon structure to generate and apply a heated ablative zone to tissue
US8469957B2 (en) 2008-10-07 2013-06-25 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US8636761B2 (en) 2008-10-09 2014-01-28 Covidien Lp Apparatus, system, and method for performing an endoscopic electrosurgical procedure
US8016827B2 (en) 2008-10-09 2011-09-13 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US8486107B2 (en) 2008-10-20 2013-07-16 Covidien Lp Method of sealing tissue using radiofrequency energy
US8197479B2 (en) 2008-12-10 2012-06-12 Tyco Healthcare Group Lp Vessel sealer and divider
US8114122B2 (en) 2009-01-13 2012-02-14 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US8945117B2 (en) 2009-02-11 2015-02-03 Boston Scientific Scimed, Inc. Insulated ablation catheter devices and methods of use
US20100249769A1 (en) * 2009-03-24 2010-09-30 Tyco Healthcare Group Lp Apparatus for Tissue Sealing
US8187273B2 (en) 2009-05-07 2012-05-29 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
EP3106116B1 (en) 2009-06-30 2018-08-01 Boston Scientific Scimed, Inc. Map and ablate open irrigated hybrid catheter
US8246618B2 (en) 2009-07-08 2012-08-21 Tyco Healthcare Group Lp Electrosurgical jaws with offset knife
US8672938B2 (en) 2009-07-23 2014-03-18 Covidien Lp Active cooling system and apparatus for controlling temperature of a fluid used during treatment of biological tissue
US8133254B2 (en) 2009-09-18 2012-03-13 Tyco Healthcare Group Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US8112871B2 (en) 2009-09-28 2012-02-14 Tyco Healthcare Group Lp Method for manufacturing electrosurgical seal plates
KR20120139661A (en) 2010-02-04 2012-12-27 아에스쿨랍 아게 Laparoscopic radiofrequency surgical device
US8827992B2 (en) 2010-03-26 2014-09-09 Aesculap Ag Impedance mediated control of power delivery for electrosurgery
US8419727B2 (en) 2010-03-26 2013-04-16 Aesculap Ag Impedance mediated power delivery for electrosurgery
US8568397B2 (en) 2010-04-28 2013-10-29 Covidien Lp Induction sealing
US9173698B2 (en) 2010-09-17 2015-11-03 Aesculap Ag Electrosurgical tissue sealing augmented with a seal-enhancing composition
US9089340B2 (en) 2010-12-30 2015-07-28 Boston Scientific Scimed, Inc. Ultrasound guided tissue ablation
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
JP2014516723A (en) 2011-06-01 2014-07-17 ボストン サイエンティフィック サイムド,インコーポレイテッド Ablation probe with ultrasound imaging capability
US9339327B2 (en) 2011-06-28 2016-05-17 Aesculap Ag Electrosurgical tissue dissecting device
US8968317B2 (en) 2011-08-18 2015-03-03 Covidien Lp Surgical forceps
US8685056B2 (en) 2011-08-18 2014-04-01 Covidien Lp Surgical forceps
US8968307B2 (en) 2011-08-18 2015-03-03 Covidien Lp Surgical forceps
AU2012308464B2 (en) 2011-09-14 2016-10-20 Boston Scientific Scimed, Inc. Ablation device with ionically conductive balloon
WO2013040201A2 (en) 2011-09-14 2013-03-21 Boston Scientific Scimed, Inc. Ablation device with multiple ablation modes
WO2013102072A1 (en) 2011-12-28 2013-07-04 Boston Scientific Scimed, Inc. Ablation probe with ultrasonic imaging capability
CN104039257A (en) 2012-01-10 2014-09-10 波士顿科学医学有限公司 Electrophysiology system
US8962062B2 (en) 2012-01-10 2015-02-24 Covidien Lp Methods of manufacturing end effectors for energy-based surgical instruments
USD680220S1 (en) 2012-01-12 2013-04-16 Coviden IP Slider handle for laparoscopic device
EP2809253B8 (en) 2012-01-31 2016-09-21 Boston Scientific Scimed, Inc. Ablation probe with fluid-based acoustic coupling for ultrasonic tissue imaging
US9375282B2 (en) 2012-03-26 2016-06-28 Covidien Lp Light energy sealing, cutting and sensing surgical device
US9271783B2 (en) 2012-07-17 2016-03-01 Covidien Lp End-effector assembly including a pressure-sensitive layer disposed on an electrode
US9833285B2 (en) 2012-07-17 2017-12-05 Covidien Lp Optical sealing device with cutting ability
US9861802B2 (en) 2012-08-09 2018-01-09 University Of Iowa Research Foundation Catheters, catheter systems, and methods for puncturing through a tissue structure
KR102174907B1 (en) 2012-09-26 2020-11-05 아에스쿨랍 아게 Apparatus for tissue cutting and sealing
US9173707B2 (en) 2012-09-27 2015-11-03 City Of Hope Coaptive surgical sealing tool
US9186214B2 (en) 2012-09-27 2015-11-17 City Of Hope Coaptive surgical sealing tool
US9186215B2 (en) 2012-09-27 2015-11-17 City Of Hope Microwave coaptive surgical sealing tool
US10098585B2 (en) 2013-03-15 2018-10-16 Cadwell Laboratories, Inc. Neuromonitoring systems and methods
WO2014209440A1 (en) 2013-06-26 2014-12-31 City Of Hope Surgical sealing tool
WO2015017992A1 (en) 2013-08-07 2015-02-12 Covidien Lp Surgical forceps
JP6529971B2 (en) * 2013-11-19 2019-06-12 エシコン・インコーポレイテッドEthicon, Inc. Thoracoscopic method for the treatment of bronchial disease
EP2907463B1 (en) * 2014-02-12 2016-04-20 Erbe Elektromedizin GmbH Surgical instrument with electrode holder
DE102014004290A1 (en) * 2014-03-26 2015-10-01 Olympus Winter & Ibe Gmbh Urological instrument
EP3495018B1 (en) 2014-05-07 2023-09-06 Farapulse, Inc. Apparatus for selective tissue ablation
WO2015192018A1 (en) 2014-06-12 2015-12-17 Iowa Approach Inc. Method and apparatus for rapid and selective tissue ablation with cooling
EP3154463B1 (en) 2014-06-12 2019-03-27 Farapulse, Inc. Apparatus for rapid and selective transurethral tissue ablation
US10398369B2 (en) 2014-08-08 2019-09-03 Medtronic Xomed, Inc. Wireless stimulation probe device for wireless nerve integrity monitoring systems
US11172935B2 (en) 2014-08-20 2021-11-16 City Of Hope Hand-held grasping device
US10231777B2 (en) 2014-08-26 2019-03-19 Covidien Lp Methods of manufacturing jaw members of an end-effector assembly for a surgical instrument
JP2017529169A (en) 2014-10-13 2017-10-05 ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. Tissue diagnosis and treatment using mini-electrodes
WO2016060983A1 (en) 2014-10-14 2016-04-21 Iowa Approach Inc. Method and apparatus for rapid and safe pulmonary vein cardiac ablation
WO2016065337A1 (en) 2014-10-24 2016-04-28 Boston Scientific Scimed Inc. Medical devices with a flexible electrode assembly coupled to an ablation tip
CN106999080B (en) 2014-12-18 2020-08-18 波士顿科学医学有限公司 Real-time morphological analysis for lesion assessment
US10039915B2 (en) 2015-04-03 2018-08-07 Medtronic Xomed, Inc. System and method for omni-directional bipolar stimulation of nerve tissue of a patient via a surgical tool
US9987078B2 (en) 2015-07-22 2018-06-05 Covidien Lp Surgical forceps
US10631918B2 (en) 2015-08-14 2020-04-28 Covidien Lp Energizable surgical attachment for a mechanical clamp
US10987159B2 (en) 2015-08-26 2021-04-27 Covidien Lp Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread
US10441349B2 (en) 2015-10-29 2019-10-15 Covidien Lp Non-stick coated electrosurgical instruments and method for manufacturing the same
US10368939B2 (en) 2015-10-29 2019-08-06 Covidien Lp Non-stick coated electrosurgical instruments and method for manufacturing the same
US10213250B2 (en) 2015-11-05 2019-02-26 Covidien Lp Deployment and safety mechanisms for surgical instruments
US10339273B2 (en) 2015-11-18 2019-07-02 Warsaw Orthopedic, Inc. Systems and methods for pre-operative procedure determination and outcome predicting
US10445466B2 (en) 2015-11-18 2019-10-15 Warsaw Orthopedic, Inc. Systems and methods for post-operative outcome monitoring
US20170189097A1 (en) 2016-01-05 2017-07-06 Iowa Approach Inc. Systems, apparatuses and methods for delivery of ablative energy to tissue
US10130423B1 (en) 2017-07-06 2018-11-20 Farapulse, Inc. Systems, devices, and methods for focal ablation
US10660702B2 (en) 2016-01-05 2020-05-26 Farapulse, Inc. Systems, devices, and methods for focal ablation
US10172673B2 (en) 2016-01-05 2019-01-08 Farapulse, Inc. Systems devices, and methods for delivery of pulsed electric field ablative energy to endocardial tissue
US11331140B2 (en) 2016-05-19 2022-05-17 Aqua Heart, Inc. Heated vapor ablation systems and methods for treating cardiac conditions
WO2017218734A1 (en) 2016-06-16 2017-12-21 Iowa Approach, Inc. Systems, apparatuses, and methods for guide wire delivery
US10856933B2 (en) 2016-08-02 2020-12-08 Covidien Lp Surgical instrument housing incorporating a channel and methods of manufacturing the same
US10849517B2 (en) 2016-09-19 2020-12-01 Medtronic Xomed, Inc. Remote control module for instruments
WO2018144090A2 (en) * 2016-11-08 2018-08-09 Innoblative Designs, Inc. Electrosurgical tissue and vessel sealing device
US10918407B2 (en) 2016-11-08 2021-02-16 Covidien Lp Surgical instrument for grasping, treating, and/or dividing tissue
US9935395B1 (en) 2017-01-23 2018-04-03 Cadwell Laboratories, Inc. Mass connection plate for electrical connectors
US10813695B2 (en) 2017-01-27 2020-10-27 Covidien Lp Reflectors for optical-based vessel sealing
JP6876821B2 (en) 2017-03-21 2021-05-26 テレフレックス メディカル インコーポレイテッド Clip applier with replaceable tip
CN116784923A (en) 2017-03-21 2023-09-22 泰利福医疗公司 Clip applier with stabilizing member
US11160559B2 (en) 2017-03-21 2021-11-02 Teleflex Medical Incorporated Clip applier with stabilizing member
EP3600083A4 (en) 2017-03-21 2021-03-31 Teleflex Medical Incorporated Flexible stabilizing member for a clip applier
WO2018175610A1 (en) 2017-03-21 2018-09-27 Teleflex Medical Incorporated Surgical clip and clip applier
US10617867B2 (en) 2017-04-28 2020-04-14 Farapulse, Inc. Systems, devices, and methods for delivery of pulsed electric field ablative energy to esophageal tissue
US11166759B2 (en) 2017-05-16 2021-11-09 Covidien Lp Surgical forceps
JP2020533050A (en) 2017-09-12 2020-11-19 ファラパルス,インコーポレイテッド Systems, devices, and methods for ventricular focal ablation
US10709497B2 (en) 2017-09-22 2020-07-14 Covidien Lp Electrosurgical tissue sealing device with non-stick coating
US10973569B2 (en) 2017-09-22 2021-04-13 Covidien Lp Electrosurgical tissue sealing device with non-stick coating
EP3459469A1 (en) 2017-09-23 2019-03-27 Universität Zürich Medical occluder device
US11357565B2 (en) 2017-11-03 2022-06-14 City Of Hope Energy-enhanced, hand-held vascular sealer
US11253182B2 (en) 2018-05-04 2022-02-22 Cadwell Laboratories, Inc. Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation
WO2019217300A1 (en) 2018-05-07 2019-11-14 Farapulse, Inc. Epicardial ablation catheter
JP7379377B2 (en) 2018-05-07 2023-11-14 ファラパルス,インコーポレイテッド Systems, devices, and methods for filtering high voltage noise induced by pulsed electric field ablation
CN112087980B (en) 2018-05-07 2023-01-10 波士顿科学医学有限公司 Systems, devices, and methods for delivering ablation energy to tissue
US11443649B2 (en) 2018-06-29 2022-09-13 Cadwell Laboratories, Inc. Neurophysiological monitoring training simulator
US10687892B2 (en) 2018-09-20 2020-06-23 Farapulse, Inc. Systems, apparatuses, and methods for delivery of pulsed electric field ablative energy to endocardial tissue
US11207124B2 (en) 2019-07-08 2021-12-28 Covidien Lp Electrosurgical system for use with non-stick coated electrodes
US10625080B1 (en) 2019-09-17 2020-04-21 Farapulse, Inc. Systems, apparatuses, and methods for detecting ectopic electrocardiogram signals during pulsed electric field ablation
US11497541B2 (en) 2019-11-20 2022-11-15 Boston Scientific Scimed, Inc. Systems, apparatuses, and methods for protecting electronic components from high power noise induced by high voltage pulses
US11065047B2 (en) 2019-11-20 2021-07-20 Farapulse, Inc. Systems, apparatuses, and methods for protecting electronic components from high power noise induced by high voltage pulses
US10842572B1 (en) 2019-11-25 2020-11-24 Farapulse, Inc. Methods, systems, and apparatuses for tracking ablation devices and generating lesion lines
US11369427B2 (en) 2019-12-17 2022-06-28 Covidien Lp System and method of manufacturing non-stick coated electrodes
US10825560B1 (en) 2020-01-03 2020-11-03 Berenson Consulting Group Inc. Infusion monitoring device and patient compliance system

Citations (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5456682A (en) 1991-11-08 1995-10-10 Ep Technologies, Inc. Electrode and associated systems using thermally insulated temperature sensing elements
US5582609A (en) 1993-10-14 1996-12-10 Ep Technologies, Inc. Systems and methods for forming large lesions in body tissue using curvilinear electrode elements
US5755715A (en) 1991-11-08 1998-05-26 Ep Technologies, Inc. Tissue heating and ablation systems and methods using time-variable set point temperature curves for monitoring and control
EP0853922A1 (en) * 1996-12-20 1998-07-22 Enable Medical Corporation Bipolar electrosurgical scissors
US5797905A (en) 1994-08-08 1998-08-25 E. P. Technologies Inc. Flexible tissue ablation elements for making long lesions
US5961513A (en) 1996-01-19 1999-10-05 Ep Technologies, Inc. Tissue heating and ablation systems and methods using porous electrode structures
US6004320A (en) * 1997-09-19 1999-12-21 Oratec Interventions, Inc. Clip on electrocauterizing sheath for orthopedic shave devices
WO2000024330A1 (en) * 1998-10-23 2000-05-04 Sherwood Services Ag Open vessel sealing forceps with disposable electrodes
US6071279A (en) * 1996-12-19 2000-06-06 Ep Technologies, Inc. Branched structures for supporting multiple electrode elements
US6142994A (en) 1994-10-07 2000-11-07 Ep Technologies, Inc. Surgical method and apparatus for positioning a diagnostic a therapeutic element within the body
US6312426B1 (en) * 1997-05-30 2001-11-06 Sherwood Services Ag Method and system for performing plate type radiofrequency ablation
US20020026187A1 (en) 2000-08-30 2002-02-28 Scimed Life Systems, Inc. Fluid cooled apparatus for supporting diagnostic and therapeutic elements in contact with tissue
US6395325B1 (en) 2000-05-16 2002-05-28 Scimed Life Systems, Inc. Porous membranes

Family Cites Families (153)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US463785A (en) 1891-11-24 Said har
US1743726A (en) * 1924-09-23 1930-01-14 Pier Process Corp Process for manufacture of producer gas
US1586654A (en) 1924-12-30 1926-06-01 Conway Elisha Asbury Combined chalk line and plumb bob
US2743726A (en) * 1953-05-28 1956-05-01 Herman R Grieshaber Surgical instrument
US3174309A (en) * 1960-08-26 1965-03-23 Maruman Company Ltd Liquid gas fueled lighter
US3316913A (en) 1964-02-28 1967-05-02 Rudolph E Swenson Catheter guiding forceps
US3503398A (en) 1965-09-10 1970-03-31 American Hospital Supply Corp Atraumatic clamp for vascular surgery
US3802437A (en) 1971-08-02 1974-04-09 G Kees Clip for blood vessel
DE7305040U (en) 1973-02-10 1973-06-20 Lindemann H ELECTROCOAGULATION FORCEPS FOR TUBE STERILIZATION USING BIPOLAR HIGH-FREQUENCY HEAT RADIATION
DE2324658B2 (en) 1973-05-16 1977-06-30 Richard Wolf Gmbh, 7134 Knittlingen PROBE FOR COAGULATING BODY TISSUE
US3999555A (en) 1975-10-28 1976-12-28 Medtronic, Inc. Atrial pinch on lead and insertion tool
US4120302A (en) 1976-10-08 1978-10-17 American Hospital Supply Corporation Disposable pads for surgical instruments
US4306561A (en) 1979-11-05 1981-12-22 Ocean Trading Co., Ltd. Holding apparatus for repairing severed nerves and method of using the same
SU1253633A1 (en) 1980-12-18 1986-08-30 Romanko Aleksandr M Apparatus for bipolar diathermocoagulation
JPS6036041A (en) 1983-08-09 1985-02-25 太田 富雄 Dual electrode electric coagulating tweezers used in operation
DE3511107A1 (en) 1985-03-27 1986-10-02 Fischer MET GmbH, 7800 Freiburg DEVICE FOR BIPOLAR HIGH-FREQUENCY COAGULATION OF BIOLOGICAL TISSUE
US4924864A (en) 1985-11-15 1990-05-15 Danzig Fred G Apparatus and article for ligating blood vessels, nerves and other anatomical structures
DE3629809A1 (en) 1986-09-02 1988-03-10 Wolf Gmbh Richard COAGULATION PLIERS
US4834090A (en) * 1987-03-02 1989-05-30 Moore J Paul Suture boot
DE4017626A1 (en) * 1989-05-31 1990-12-06 Kyocera Corp BLUTGEFAESSKOAGULATIONS - / - hemostatic DEVICE
US5002561A (en) 1989-08-17 1991-03-26 Fisher Frank E Protective hand forceps
US6632622B2 (en) * 1989-10-25 2003-10-14 Russell Jaffe Assay for evaluation of cellular response to allergens
CA2050868C (en) 1990-10-05 2002-01-01 Ernie Aranyi Endoscopic surgical instrument
US5250072A (en) * 1990-12-10 1993-10-05 Jain Krishna M Surgical clamp jaw cover
US5131379A (en) 1991-01-29 1992-07-21 Sewell Jr Frank K Device and method for inserting a cannula into a duct
US5147357A (en) 1991-03-18 1992-09-15 Rose Anthony T Medical instrument
US5300087A (en) 1991-03-22 1994-04-05 Knoepfler Dennis J Multiple purpose forceps
US5324288A (en) 1991-04-30 1994-06-28 Utah Medical Products, Inc. Electrosurgical loop with a depth gauge
CA2109793A1 (en) 1991-05-24 1992-12-10 Stuart D. Edwards Combination monophasic action potential/ablation catheter and high-performance filter system
US5282812A (en) 1991-07-10 1994-02-01 Suarez Jr Luis Clamp for use in vascular surgery
US5476479A (en) 1991-09-26 1995-12-19 United States Surgical Corporation Handle for endoscopic surgical instruments and jaw structure
US5697909A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation Methods and apparatus for surgical cutting
US5197964A (en) 1991-11-12 1993-03-30 Everest Medical Corporation Bipolar instrument utilizing one stationary electrode and one movable electrode
US7429262B2 (en) * 1992-01-07 2008-09-30 Arthrocare Corporation Apparatus and methods for electrosurgical ablation and resection of target tissue
US6974453B2 (en) * 1993-05-10 2005-12-13 Arthrocare Corporation Dual mode electrosurgical clamping probe and related methods
US5484435A (en) * 1992-01-15 1996-01-16 Conmed Corporation Bipolar electrosurgical instrument for use in minimally invasive internal surgical procedures
US5383880A (en) 1992-01-17 1995-01-24 Ethicon, Inc. Endoscopic surgical system with sensing means
CA2090000A1 (en) 1992-02-24 1993-08-25 H. Jonathan Tovey Articulating mesh deployment apparatus
US5443463A (en) * 1992-05-01 1995-08-22 Vesta Medical, Inc. Coagulating forceps
US5318564A (en) 1992-05-01 1994-06-07 Hemostatic Surgery Corporation Bipolar surgical snare and methods of use
US5324284A (en) * 1992-06-05 1994-06-28 Cardiac Pathways, Inc. Endocardial mapping and ablation system utilizing a separately controlled ablation catheter and method
CA2104423A1 (en) 1992-08-24 1994-02-25 Boris Zvenyatsky Handle for endoscopic instruments and jaw structure
US5300065A (en) 1992-11-06 1994-04-05 Proclosure Inc. Method and apparatus for simultaneously holding and sealing tissue
US5441483A (en) * 1992-11-16 1995-08-15 Avitall; Boaz Catheter deflection control
US5403312A (en) 1993-07-22 1995-04-04 Ethicon, Inc. Electrosurgical hemostatic device
US5385146A (en) * 1993-01-08 1995-01-31 Goldreyer; Bruce N. Orthogonal sensing for use in clinical electrophysiology
US6161543A (en) * 1993-02-22 2000-12-19 Epicor, Inc. Methods of epicardial ablation for creating a lesion around the pulmonary veins
US5445638B1 (en) 1993-03-08 1998-05-05 Everest Medical Corp Bipolar coagulation and cutting forceps
US5766153A (en) * 1993-05-10 1998-06-16 Arthrocare Corporation Methods and apparatus for surgical cutting
US5398689A (en) * 1993-06-16 1995-03-21 Hewlett-Packard Company Ultrasonic probe assembly and cable therefor
DE69432148T2 (en) 1993-07-01 2003-10-16 Boston Scient Ltd CATHETER FOR IMAGE DISPLAY, DISPLAY OF ELECTRICAL SIGNALS AND ABLATION
US5693051A (en) 1993-07-22 1997-12-02 Ethicon Endo-Surgery, Inc. Electrosurgical hemostatic device with adaptive electrodes
US5496312A (en) 1993-10-07 1996-03-05 Valleylab Inc. Impedance and temperature generator control
EP0754075B1 (en) * 1993-10-14 2006-03-15 Boston Scientific Limited Electrode elements for forming lesion patterns
US5545193A (en) * 1993-10-15 1996-08-13 Ep Technologies, Inc. Helically wound radio-frequency emitting electrodes for creating lesions in body tissue
WO1995010225A1 (en) * 1993-10-15 1995-04-20 Ep Technologies, Inc. Multiple electrode element for mapping and ablating
US5575810A (en) * 1993-10-15 1996-11-19 Ep Technologies, Inc. Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the like
EP0861676B1 (en) * 1993-11-10 2003-10-01 Medtronic Cardiorhythm Electrode array catheter
US5540684A (en) 1994-07-28 1996-07-30 Hassler, Jr.; William L. Method and apparatus for electrosurgically treating tissue
IL110517A (en) 1994-07-31 1998-08-16 Technion Res & Dev Foundation Padded vascular clamp
US6245068B1 (en) * 1994-08-08 2001-06-12 Scimed Life Systems, Inc. Resilient radiopaque electrophysiology electrodes and probes including the same
US6152920A (en) 1997-10-10 2000-11-28 Ep Technologies, Inc. Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body
US5885278A (en) * 1994-10-07 1999-03-23 E.P. Technologies, Inc. Structures for deploying movable electrode elements
US6464700B1 (en) 1994-10-07 2002-10-15 Scimed Life Systems, Inc. Loop structures for positioning a diagnostic or therapeutic element on the epicardium or other organ surface
US5897553A (en) * 1995-11-02 1999-04-27 Medtronic, Inc. Ball point fluid-assisted electrocautery device
US6179837B1 (en) 1995-03-07 2001-01-30 Enable Medical Corporation Bipolar electrosurgical scissors
US5766166A (en) 1995-03-07 1998-06-16 Enable Medical Corporation Bipolar Electrosurgical scissors
US5571121A (en) 1995-03-28 1996-11-05 Heifetz; Milton D. Atraumatic clamp for temporary occlusion of blood vessels
US5626607A (en) 1995-04-03 1997-05-06 Heartport, Inc. Clamp assembly and method of use
US6203542B1 (en) * 1995-06-07 2001-03-20 Arthrocare Corporation Method for electrosurgical treatment of submucosal tissue
US5707369A (en) 1995-04-24 1998-01-13 Ethicon Endo-Surgery, Inc. Temperature feedback monitor for hemostatic surgical instrument
US6837887B2 (en) * 1995-06-07 2005-01-04 Arthrocare Corporation Articulated electrosurgical probe and methods
US6023638A (en) * 1995-07-28 2000-02-08 Scimed Life Systems, Inc. System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissue
US5824005A (en) * 1995-08-22 1998-10-20 Board Of Regents, The University Of Texas System Maneuverable electrophysiology catheter for percutaneous or intraoperative ablation of cardiac arrhythmias
US5776130A (en) * 1995-09-19 1998-07-07 Valleylab, Inc. Vascular tissue sealing pressure control
US5837001A (en) * 1995-12-08 1998-11-17 C. R. Bard Radio frequency energy delivery system for multipolar electrode catheters
US5686368A (en) * 1995-12-13 1997-11-11 Quantum Group, Inc. Fibrous metal oxide textiles for spectral emitters
US5746748A (en) 1995-12-27 1998-05-05 Frederic Steinberg Circumcision instrument
US5846239A (en) 1996-04-12 1998-12-08 Ep Technologies, Inc. Tissue heating and ablation systems and methods using segmented porous electrode structures
US5925038A (en) * 1996-01-19 1999-07-20 Ep Technologies, Inc. Expandable-collapsible electrode structures for capacitive coupling to tissue
US5913876A (en) 1996-02-20 1999-06-22 Cardiothoracic Systems, Inc. Method and apparatus for using vagus nerve stimulation in surgery
US5817013A (en) 1996-03-19 1998-10-06 Enable Medical Corporation Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like
US6237605B1 (en) 1996-10-22 2001-05-29 Epicor, Inc. Methods of epicardial ablation
US6311692B1 (en) 1996-10-22 2001-11-06 Epicor, Inc. Apparatus and method for diagnosis and therapy of electrophysiological disease
US6076012A (en) 1996-12-19 2000-06-13 Ep Technologies, Inc. Structures for supporting porous electrode elements
US5891140A (en) 1996-12-23 1999-04-06 Cardiothoracic Systems, Inc. Electrosurgical device for harvesting a vessel especially the internal mammary artery for coronary artery bypass grafting
US6113596A (en) 1996-12-30 2000-09-05 Enable Medical Corporation Combination monopolar-bipolar electrosurgical instrument system, instrument and cable
US5843101A (en) 1997-05-02 1998-12-01 Fry; William R. Disposable clip for temporary vessel occulsion
US5971983A (en) * 1997-05-09 1999-10-26 The Regents Of The University Of California Tissue ablation device and method of use
US6012457A (en) 1997-07-08 2000-01-11 The Regents Of The University Of California Device and method for forming a circumferential conduction block in a pulmonary vein
US6855143B2 (en) * 1997-06-13 2005-02-15 Arthrocare Corporation Electrosurgical systems and methods for recanalization of occluded body lumens
US6997925B2 (en) * 1997-07-08 2006-02-14 Atrionx, Inc. Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wall
US6164283A (en) 1997-07-08 2000-12-26 The Regents Of The University Of California Device and method for forming a circumferential conduction block in a pulmonary vein
US6096037A (en) 1997-07-29 2000-08-01 Medtronic, Inc. Tissue sealing electrosurgery device and methods of sealing tissue
US6010500A (en) * 1997-07-21 2000-01-04 Cardiac Pathways Corporation Telescoping apparatus and method for linear lesion ablation
US6056747A (en) * 1997-08-04 2000-05-02 Gynecare, Inc. Apparatus and method for treatment of body tissues
EP1011493B1 (en) 1997-09-10 2005-03-23 Sherwood Services AG Bipolar instrument for vessel fusion
US6139563A (en) 1997-09-25 2000-10-31 Allegiance Corporation Surgical device with malleable shaft
US5908420A (en) 1997-10-03 1999-06-01 Everest Medical Corporation Surgical scissors with bipolar distal electrodes
US6464699B1 (en) 1997-10-10 2002-10-15 Scimed Life Systems, Inc. Method and apparatus for positioning a diagnostic or therapeutic element on body tissue and mask element for use with same
US6352536B1 (en) 2000-02-11 2002-03-05 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US6050996A (en) 1997-11-12 2000-04-18 Sherwood Services Ag Bipolar electrosurgical instrument with replaceable electrodes
US6273887B1 (en) 1998-01-23 2001-08-14 Olympus Optical Co., Ltd. High-frequency treatment tool
US6010516A (en) 1998-03-20 2000-01-04 Hulka; Jaroslav F. Bipolar coaptation clamps
US6115626A (en) * 1998-03-26 2000-09-05 Scimed Life Systems, Inc. Systems and methods using annotated images for controlling the use of diagnostic or therapeutic instruments in instruments in interior body regions
US6527767B2 (en) 1998-05-20 2003-03-04 New England Medical Center Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization
US6086586A (en) 1998-09-14 2000-07-11 Enable Medical Corporation Bipolar tissue grasping apparatus and tissue welding method
WO2000019926A1 (en) * 1998-10-05 2000-04-13 Scimed Life Systems, Inc. Large area thermal ablation
US6277117B1 (en) * 1998-10-23 2001-08-21 Sherwood Services Ag Open vessel sealing forceps with disposable electrodes
US6511480B1 (en) * 1998-10-23 2003-01-28 Sherwood Services Ag Open vessel sealing forceps with disposable electrodes
DE60042150D1 (en) 1999-01-25 2009-06-18 Applied Med Resources MODULAR LIGGER DEVICE AND METHOD
US6174309B1 (en) 1999-02-11 2001-01-16 Medical Scientific, Inc. Seal & cut electrosurgical instrument
US6228104B1 (en) * 1999-06-18 2001-05-08 Novare Surgical Systems, Inc. Surgical clamp having replaceable pad
US6273902B1 (en) 1999-06-18 2001-08-14 Novare Surgical Systems, Inc. Surgical clamp having replaceable pad
US6387112B1 (en) 1999-06-18 2002-05-14 Novare Surgical Systems, Inc. Surgical clamp having replaceable pad
US6290699B1 (en) 1999-07-07 2001-09-18 Uab Research Foundation Ablation tool for forming lesions in body tissue
CA2377583A1 (en) * 1999-07-19 2001-01-25 Epicor, Inc. Apparatus and method for ablating tissue
US6210330B1 (en) 1999-08-04 2001-04-03 Rontech Medical Ltd. Apparatus, system and method for real-time endovaginal sonography guidance of intra-uterine, cervical and tubal procedures
US6529756B1 (en) * 1999-11-22 2003-03-04 Scimed Life Systems, Inc. Apparatus for mapping and coagulating soft tissue in or around body orifices
US6542781B1 (en) * 1999-11-22 2003-04-01 Scimed Life Systems, Inc. Loop structures for supporting diagnostic and therapeutic elements in contact with body tissue
US6589235B2 (en) 2000-01-21 2003-07-08 The Regents Of The University Of California Method and apparatus for cartilage reshaping by radiofrequency heating
DE10008918A1 (en) * 2000-02-25 2001-08-30 Biotronik Mess & Therapieg Ablation catheter to generate linear lesions in heart muscle; has catheter body with linear, cylindrical ablation electrode and at least one insulated sensing electrode
US6692491B1 (en) 2000-03-24 2004-02-17 Scimed Life Systems, Inc. Surgical methods and apparatus for positioning a diagnostic or therapeutic element around one or more pulmonary veins or other body structures
US6926712B2 (en) * 2000-03-24 2005-08-09 Boston Scientific Scimed, Inc. Clamp having at least one malleable clamp member and surgical method employing the same
US6546935B2 (en) 2000-04-27 2003-04-15 Atricure, Inc. Method for transmural ablation
US20020107514A1 (en) 2000-04-27 2002-08-08 Hooven Michael D. Transmural ablation device with parallel jaws
WO2001082811A1 (en) * 2000-04-27 2001-11-08 Medtronic, Inc. System and method for assessing transmurality of ablation lesions
US6558382B2 (en) * 2000-04-27 2003-05-06 Medtronic, Inc. Suction stabilized epicardial ablation devices
US6454766B1 (en) * 2000-05-05 2002-09-24 Scimed Life Systems, Inc. Microporous electrode structure and method of making the same
US6312125B1 (en) * 2000-08-03 2001-11-06 Kevin D. Potts Relaxation sunglasses having absorbent element for retaining aromatic fluids
US20020099428A1 (en) * 2001-01-25 2002-07-25 Leon Kaufman Position-controlled heat delivery catheter
US6533784B2 (en) 2001-02-24 2003-03-18 Csaba Truckai Electrosurgical working end for transecting and sealing tissue
US6807968B2 (en) 2001-04-26 2004-10-26 Medtronic, Inc. Method and system for treatment of atrial tachyarrhythmias
US6771996B2 (en) * 2001-05-24 2004-08-03 Cardiac Pacemakers, Inc. Ablation and high-resolution mapping catheter system for pulmonary vein foci elimination
US6582429B2 (en) * 2001-07-10 2003-06-24 Cardiac Pacemakers, Inc. Ablation catheter with covered electrodes allowing electrical conduction therethrough
SE0102917D0 (en) * 2001-08-30 2001-08-30 St Jude Medical A battery and a battery encapsulation
US6939350B2 (en) * 2001-10-22 2005-09-06 Boston Scientific Scimed, Inc. Apparatus for supporting diagnostic and therapeutic elements in contact with tissue including electrode cooling device
US7011657B2 (en) * 2001-10-22 2006-03-14 Surgrx, Inc. Jaw structure for electrosurgical instrument and method of use
US7753908B2 (en) * 2002-02-19 2010-07-13 Endoscopic Technologies, Inc. (Estech) Apparatus for securing an electrophysiology probe to a clamp
US7674258B2 (en) * 2002-09-24 2010-03-09 Endoscopic Technologies, Inc. (ESTECH, Inc.) Electrophysiology electrode having multiple power connections and electrophysiology devices including the same
US7785324B2 (en) * 2005-02-25 2010-08-31 Endoscopic Technologies, Inc. (Estech) Clamp based lesion formation apparatus and methods configured to protect non-target tissue
US7967816B2 (en) * 2002-01-25 2011-06-28 Medtronic, Inc. Fluid-assisted electrosurgical instrument with shapeable electrode
US20030158548A1 (en) * 2002-02-19 2003-08-21 Phan Huy D. Surgical system including clamp and apparatus for securing an energy transmission device to the clamp and method of converting a clamp into an electrophysiology device
US6932816B2 (en) * 2002-02-19 2005-08-23 Boston Scientific Scimed, Inc. Apparatus for converting a clamp into an electrophysiology device
US20040186467A1 (en) * 2003-03-21 2004-09-23 Swanson David K. Apparatus for maintaining contact between diagnostic and therapeutic elements and tissue and systems including the same
JP2007517078A (en) * 2003-06-13 2007-06-28 アグリ−ポリメリックス・エルエルシー Biopolymer structures and components
US8002770B2 (en) * 2003-12-02 2011-08-23 Endoscopic Technologies, Inc. (Estech) Clamp based methods and apparatus for forming lesions in tissue and confirming whether a therapeutic lesion has been formed
US8055357B2 (en) * 2003-12-02 2011-11-08 Boston Scientific Scimed, Inc. Self-anchoring surgical methods and apparatus for stimulating tissue
US8052676B2 (en) * 2003-12-02 2011-11-08 Boston Scientific Scimed, Inc. Surgical methods and apparatus for stimulating tissue
US20050119653A1 (en) * 2003-12-02 2005-06-02 Swanson David K. Surgical methods and apparatus for forming lesions in tissue and confirming whether a therapeutic lesion has been formed
US7179254B2 (en) * 2004-03-09 2007-02-20 Ethicon, Inc. High intensity ablation device
US7549988B2 (en) * 2004-08-30 2009-06-23 Boston Scientific Scimed, Inc. Hybrid lesion formation apparatus, systems and methods
US7727231B2 (en) * 2005-01-08 2010-06-01 Boston Scientific Scimed, Inc. Apparatus and methods for forming lesions in tissue and applying stimulation energy to tissue in which lesions are formed

Patent Citations (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5755715A (en) 1991-11-08 1998-05-26 Ep Technologies, Inc. Tissue heating and ablation systems and methods using time-variable set point temperature curves for monitoring and control
US5456682A (en) 1991-11-08 1995-10-10 Ep Technologies, Inc. Electrode and associated systems using thermally insulated temperature sensing elements
US5582609A (en) 1993-10-14 1996-12-10 Ep Technologies, Inc. Systems and methods for forming large lesions in body tissue using curvilinear electrode elements
US5797905A (en) 1994-08-08 1998-08-25 E. P. Technologies Inc. Flexible tissue ablation elements for making long lesions
US6142994A (en) 1994-10-07 2000-11-07 Ep Technologies, Inc. Surgical method and apparatus for positioning a diagnostic a therapeutic element within the body
US5961513A (en) 1996-01-19 1999-10-05 Ep Technologies, Inc. Tissue heating and ablation systems and methods using porous electrode structures
US6071279A (en) * 1996-12-19 2000-06-06 Ep Technologies, Inc. Branched structures for supporting multiple electrode elements
EP0853922A1 (en) * 1996-12-20 1998-07-22 Enable Medical Corporation Bipolar electrosurgical scissors
US6312426B1 (en) * 1997-05-30 2001-11-06 Sherwood Services Ag Method and system for performing plate type radiofrequency ablation
US6004320A (en) * 1997-09-19 1999-12-21 Oratec Interventions, Inc. Clip on electrocauterizing sheath for orthopedic shave devices
WO2000024330A1 (en) * 1998-10-23 2000-05-04 Sherwood Services Ag Open vessel sealing forceps with disposable electrodes
US6395325B1 (en) 2000-05-16 2002-05-28 Scimed Life Systems, Inc. Porous membranes
US20020026187A1 (en) 2000-08-30 2002-02-28 Scimed Life Systems, Inc. Fluid cooled apparatus for supporting diagnostic and therapeutic elements in contact with tissue

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