Abstract:
A method for performing an electrosurgical procedure is presented including providing an electrosurgical system having an electrosurgical generator, a first electrosurgical device including a first electrically conductive element, a second electrosurgical device including a second electrically conductive element configured to be coupled to a first location of a target tissue and a third electrosurgical device including a third electrically conductive element configured to be coupled to a second location of the target tissue. The method also includes the steps of positioning the second and third electrically conductive elements relative to one another, orienting and defining a direction and a length of a single resection line between the second and third electrically conductive elements, and moving the first electrically conductive element along the single resection line to desiccate or divide the target tissue.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application is a continuation of U.S. application Ser. No. 11/418,879, filed on May 5, 2006, the disclosure of which is incorporated herein by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure is directed to electrosurgical systems and methods and, more particularly, to soft tissue RF transection and resection devices and methods of using the same. 
         [0004]    2. Background 
         [0005]    Electrosurgical methods are widely used in the operative field since they generally reduce patient bleeding associated with tissue cutting, transecting and/or resecting procedures and improve the surgeons&#39; ability to view the surgical site. Two widely accepted methods of electrosurgery are performed, namely, monopolar electrosurgery and bipolar electrosurgery. 
         [0006]    Monopolar electrosurgery methods generally direct electric current along a defined path from an exposed or active electrode through the patient&#39;s body to a return pad or electrode, which is externally attached to a suitable location on the patient&#39;s skin. 
         [0007]    Alternatively, bipolar electrosurgery methods generally direct electric current along a defined path from a first exposed or active electrode through the patient&#39;s body to a second exposed or return electrode. Both the first and the second electrodes are typically disposed within the body of the patient. 
         [0008]    Transection and/or resection of soft tissues, such as the liver or spleen, pose particular difficulties during electrosurgical operation as compared to electrosurgical operation of other tissues and thus require unique electrosurgical instruments, systems, techniques and the like for operating thereon. 
       SUMMARY 
       [0009]    The present disclosure is directed to electrosurgical systems and methods and, more particularly, to soft tissue RF transection and resection devices and methods of using the same. 
         [0010]    According to an aspect of the present disclosure, an electrosurgical system for transecting or resecting a target tissue is provided. The electrosurgical system includes an electrosurgical generator including an active terminal and a return terminal; a first electrically conductive element electrically connectable to the active terminal of the electrosurgical generator, the first electrically conductive element being selectively movable between a first location of a target tissue and a second location of the target tissue; a second electrically conductive element electrically connectable to the active terminal of the electrosurgical generator, the second electrically conductive element configured to couple to the first location of the target tissue; and a third electrically conductive element electrically connectable to the return terminal of the electrosurgical generator, the third electrically conductive element configured to couple to the second location of the target tissue. 
         [0011]    According to a further aspect of the present disclosure, a method of performing an electrosurgical procedure on a target tissue is provided. The method includes the steps of providing an electrosurgical system having an electrosurgical generator having an active and a return terminal; a first electrosurgical device electrically connectable to the active terminal of the electro surgical generator, the first electrosurgical device being selectively movable along target tissue; a second electrosurgical device electrically connectable to the active terminal of the electrosurgical generator, the second electrosurgical device being selectively connectable to a first location of the target tissue; and a third electrosurgical device electrically connectable to the return terminal of the electrosurgical generator, the third electrosurgical device being selectively connectable to a second location of the target tissue. 
         [0012]    The method further includes the steps of coupling the second electrosurgical device to the first location of the target tissue; coupling the third electrosurgical device to the second location of the target tissue, wherein a resection line is defined between the first location and the second location; and moving the first electrosurgical device substantially along the resection line to desiccate or divide the target tissue. 
         [0013]    According to yet another aspect of the present disclosure, a further method of performing an electrosurgical procedure on a target tissue is provided. The present method includes the steps of coupling a second electrosurgical device to a first location of a target tissue; coupling a third electrosurgical device to a second location of the target tissue; causing RF energy to flow between the first location and the second location; coupling a first electrosurgical device at or substantially near the first location; and moving the first electrosurgical device from the first location to the second location. 
         [0014]    It is an advantage of the present disclosure to provide a system and method for performing a bipolar tissue transection and/or resection. 
         [0015]    It is a further advantage of the present disclosure to provide a system and method to more efficiently desiccate and/or divide tissue using bipolar electrosurgical concepts. 
         [0016]    For a better understanding of the present invention and to show how it may be carried into effect, reference will be made by way of example to the accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]    In the drawings, which constitute a part of the specification, exemplary embodiments exhibiting various objectives and features hereof are set forth, specifically: 
           [0018]      FIG. 1  is a perspective view of an electrosurgical system in accordance with one embodiment of the present disclosure; and 
           [0019]      FIG. 2  is a schematic illustration of the electrosurgical system of  FIG. 1  being used to perform an electrosurgical procedure on an exemplary body tissue. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0020]    Embodiments of electrosurgical systems, in accordance with the present disclosure, are described in detail with reference to the drawings figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, device or apparatus, the term “proximal” refers to the end of the instrument, apparatus or device that is closer to the user and the term “distal” refers to the end of the apparatus that is further away from the user. 
         [0021]      FIG. 1  sets forth a perspective view of an electrosurgical system  10  in accordance with an embodiment of the present disclosure. As seen in  FIG. 1 , electrosurgical system  10  includes a first electrosurgical device  100  and a second electrosurgical device  200  electrically connected in parallel to first electrosurgical device  100 . The first electrosurgical device  100  and second electrosurgical device  200  may be connected to or connectable to an electrosurgical generator “G”, via a common plug or connector “P” or two individual plugs (not shown) connected in a parallel circuit. While a single common plug “P” is shown for first and second electrosurgical devices  100 ,  200 , it is within the scope of the present disclosure for each of the first and second electrosurgical devices  100 ,  200  to have a respective plug or the like for electrical connection to the electrosurgical generator “G”. 
         [0022]    In the illustrated embodiment, the first electrosurgical device  100  includes a housing or handle assembly  102 , an electrode blade  104  supported within and extending from a distal end of housing  102 , a cable  106  extending from a proximal end of housing  102 , and optionally at least one activation switch  108  supported on housing  102 . Blade  104  is electrically connected to cable  106 . Blade  104  may be fabricated from a suitable electrically conductive material. Each activation switch  108  may function to control the transmission of RF electrical energy supplied from generator “G” to electrosurgical blade  104 . While electrode blade  104  is shown and described as a blade, it is within the scope of the present disclosure for electrode blade  104  to be any suitable electrode having any suitable geometry or configuration, such as, for example, a loop, a ball, etc. 
         [0023]    Reference may be made to U.S. application Ser. No. 11/337,990, filed on Jan. 24, 2006, the entire contents of which are incorporated herein by reference, for a more detailed discussion of the first electrosurgical device  100 . Other suitable electrosurgical devices are contemplated by the present disclosure. 
         [0024]    In the illustrated embodiment, the second electrosurgical device  200  includes a housing or handle assembly  202 , a needle electrode  204  supported within and extending from a distal end of housing  202 , and a cable  206  extending from a proximal end or side of housing  202 . Electrode  204  is electrically connected to cable  206 . Electrode  204  may terminate in a sharpened distal tip  204   a , which is constructed so as to penetrate tissue with a minimum risk of hemorrhage from the puncture tract. Needle electrode  204  may be fabricated from a suitable electrically conductive material and may include an insulative layer covering at least a portion of the length thereof. In an embodiment, a distal end portion of needle electrode  204  may be exposed. Accordingly, since the distal end portion of needle electrode  204  is exposed or non-insulated, the distal end portion is capable of DC or AC delivery, preferably RF delivery. 
         [0025]    While the second electrosurgical device  200  is shown as including a needle electrode  204 , it is within the scope of the present disclosure for the second electrosurgical device  200  to include any suitable electrically conductive element that is configured to couple to a target tissue. For example, the second electrosurgical device  200  may include a contact pad, an array of needle electrodes, a clamp or clip, or any other electrically conductive element that may contact, be inserted into, may grab onto, the target tissue. 
         [0026]    As described above, cable  106  and cable  206  may join together and/or combine into a single cable that is connected to plug “P”. Accordingly, the first electrosurgical device  100  and the second electrosurgical device  200  are electrically joined in parallel to one another when connected to generator “G” and when in operative engagement with target tissue. 
         [0027]    It one embodiment, a potentiometer  20  may be placed along a cable of any of or each electrosurgical device. Potentiometer  20  may be configured to vary the current and/or voltage being transmitted to needle electrode of the electrosurgical device or devices. 
         [0028]    With continued reference to  FIG. 1 , electrosurgical system  10  further includes a third electrosurgical device  300 . In the illustrated embodiment, the third electrosurgical device  300  includes a housing or handle assembly  302 , at least one needle electrode assembly  310  supported within and extending from a distal end of handle  302 , and a cable  306  extending from a proximal end or a side of housing  302 . A plug “P” is provided at the end of cable  306  and functions to electrically connect the third electrosurgical device  300  to electrosurgical generator “G”. 
         [0029]    Needle electrode assembly  310  may be fabricated from a suitable electrically conductive material and may include an insulative layer covering at least a portion of the length thereof. 
         [0030]    In the illustrated embodiment, needle electrode assembly  310  includes an outer tube  312  having at least an exposed distal end portion terminating in a sharpened distal tip  312   a , which is constructed so as to penetrate tissue with a minimum risk of hemorrhage from the puncture tract. Outer tube  312  includes a proximal end portion supported in housing  302 . Outer tube  312  is hollow and defines a cavity therein that is in fluid communication with a distal end of an outflow conduit  320 . Since the distal end portion of outer tube  312  is exposed or non-insulated, the distal end portion is capable of DC or AC delivery, preferably RF delivery. 
         [0031]    Needle electrode assembly  312  further includes an inner tube (not explicitly shown) disposed substantially co-axially within the cavity of outer tube  312 . The inner tube includes a distal end portion located near the distal end portion of outer tube  312  and a proximal end portion that extends from the proximal end portion of outer tube  312  and that is in fluid communication with a distal end of an inflow conduit  322 . 
         [0032]    As mentioned above, an inflow conduit  322  includes a distal end that is in fluid communication with the inner tube and a proximal end that extends from housing  302  and is fluidly connected to or connectable to a fluid source “FS”. An outflow conduit  320  includes a distal end that is in fluid communication with the cavity of outflow conduit  320  and a proximal end that extends from housing  302  and is fluidly connected to or connectable to fluid source “FS”. 
         [0033]    In use, a cooling fluid is delivered to distal tip  312   a  of outer tube  312  from the inner tube and inflow conduit  322  and away from distal tip  312   a  of outer tube  312  through the cavity of outflow conduit  320 . Circulation of the cooling fluid may be established with the use of a suitable pump (not explicitly shown). 
         [0034]    While the third electrosurgical device  300  is shown as including a needle electrode assembly  312 , it is within the scope of the present disclosure for the third electrosurgical device  300  to include any suitable electrically conductive element that is configured to couple to a target tissue. For example, the third electrosurgical device  300  may include a contact pad, an array of needle electrodes, a clamp or clip, or any other electrically conductive element that may contact, be inserted into, may grab onto, the target tissue. 
         [0035]    Reference may be made to U.S. application Ser. No. 11/495,033, filed on Jul. 28, 2006, now U.S. Pat. No. 7,763,018, the entire contents of which are incorporated herein by reference, for a more detailed discussion of the third electrosurgical device  300 . 
         [0036]    In operation, the first and second electrosurgical devices  100  and  200  may be electrically connected to an active terminal of generator “G”, while the third electrosurgical device  300  may be electrically connected to the return electrode of generator “G”. 
         [0037]    Turning now to  FIG. 2 , a method of using electrosurgical system  10  for transecting and/or resecting tissue is described according to one embodiment of the disclosure. With the patient opened, e.g., the skin of the patient has been cut open to expose the inner tissue “T” of an operating cavity, needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300  are percutaneously inserted into the tissue “T”. The line defined between needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300  is denoted as a resection line “R”. Accordingly, needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300  may be suitably positioned relative to one another so as to orient and define the direction and length of the resection line “R”. 
         [0038]    In operation, when generator “G” is activated, RF energy flows between needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300 . With needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300  operatively positioned in tissue “T” and activated, blade electrode  104  of the first electrosurgical  100  may be brought into contact with tissue “T” at or substantially near the resection line “R” in order to desiccate and/or divide ablate tissue “T”. As described above, the first electrosurgical device  100  and the second electrosurgical device  200  are connected in parallel with one another. 
         [0039]    In order to aid the surgeon in making the cut along the resection line “R”, a visible line may be drawn or superimposed on a computer screen (not shown) between needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300  in order to approximate the resection line “R”. 
         [0040]    In operation, contact of blade electrode  104  of first electrosurgical device  100  with tissue “T” creates a short circuit to needle electrode assembly  310  of the third electrosurgical device  300 . Accordingly, a majority of the RF energy flows between blade electrode  104  of the first electrosurgical device  100  and needle electrode assembly  310  of the third electrosurgical device  300 , which results in relatively faster cutting and/or ablating of tissue “T”. According to one method of the present disclosure, blade electrode  104  of first electrosurgical device  100  is initially brought into contact with the resection line “R” in close proximity to needle electrode assembly  310  of the third electrosurgical device  300  and then moved along the resection line “R” toward needle electrode  204  of the second electrosurgical device  200 . 
         [0041]    As blade electrode  104  of the first electrosurgical device  100  is moved along the resection line “R”, toward needle electrode  204  of the second electrosurgical device  200 , the RF energy ablates the tissue “T” disposed between the blade electrode  104  of the first electrosurgical device  100  and the needle electrode assembly  310  of the third electrosurgical device  300 . 
         [0042]    As blade electrode  104  of the first electrosurgical device  100  is progressed or moved through tissue “T”, the tissue surrounding blade electrode  104  becomes cooked, thus increasing the impedance of the tissue. As a result, since blade electrode  204  of the second electrosurgical device  200  is connected in parallel with needle electrode  104  of the first electrosurgical device  100 , more RF energy is caused to flow between blade electrode  104  of the first electrosurgical device  100  and needle electrode assembly  310  of the third electrosurgical device  300 . In this manner, RF energy delivery to the tissue “T” is maximized with lower impedance loads on generator “G” and no relatively high impedance shut-offs are experienced. 
         [0043]    When blade electrode  104  is removed or lifted from tissue “T”, RF energy once again flows between needle electrode  204  of the second electrosurgical device  200  and needle electrode assembly  310  of the third electrosurgical device  300 , thereby preventing impedance cut-out and/or deactivation of generator “G”. 
         [0044]    It one embodiment, a cooling fluid may be circulated through needle electrode assembly  310  of third electrosurgical device  300 , in the manner described above. The cooling fluid prevents charring of tissue “T” around needle electrode assembly  310  and also function to maintain the impedance low. 
         [0045]    Any suitable number of needle electrodes connected to the active terminal of electrosurgical generator “G” and inserted in the tissue “T” may be used in the electrosurgical procedure. In addition, any suitable number of needle electrode assemblies connected to the return terminal of electrosurgical generator “G” and inserted in the tissue “T” may be used in the electrosurgical procedure. 
         [0046]    The foregoing description is merely a disclosure of particular embodiments and is no way intended to limit the scope of the invention. Other possible modifications are apparent to those skilled in the art and all modifications are to be defined by the following claims.