Patent Publication Number: US-2020297983-A1

Title: Delivery of mixed phase media for the treatment of the anatomy

Description:
FIELD 
     These teachings relate to a medical device and method for treating the anatomy. 
     BACKGROUND 
     Menorrhagia is a medical condition that includes abnormally heavy and prolonged menstrual bleeding and pain. For decades, hormone pills and/or hysterectomy were used to treat menorrhagia. 
     Recently, medical devices have been introduced to treat menorrhagia by way of endometrium ablation, where the endometrium is exposed to various treatment modalities such as RF energy, thermal energy, microwave energy, and/or steam. Some example medical devices are disclosed in US2018/0125561 and US20170265924, which are incorporated by reference herein for all purposes. 
     It may be desirable to have a medical device and/or method that is configured to improve treatment time of the anatomy. For example, it may be desirable to have a medical device and/or method that is configured to prolong endometrium ablation beyond treatment time after completion of a medical procedure and/or after the medical device has been removed from the anatomy. 
     SUMMARY 
     These teachings provide a medical device. The medical device is configured to improve treatment time of the anatomy. The medical device and/or method according to these teachings is configured to prolong ablation beyond treatment time after completion of a medical procedure and/or after the medical device has been removed from the anatomy. 
     These teachings provide a medical device including an introducer; a first section; and a second section. The first section is configured to connect to a supply of therapeutic fluid. The second section is configured to connect to a supply of therapeutic elements. The therapeutic elements are drawn into the introducer by way of a venturi effect or suction created by a flow of the therapeutic fluid through the introducer. 
     These teachings provide a medical device that includes an introducer; a supply of therapeutic fluid configured to pass through the introducer; and a supply of therapeutic elements configured to pass through the introducer. The therapeutic elements are drawn into the introducer by way of suction. 
     These teachings provide a medical device that includes an introducer comprising a narrowed section; a first section configured to connect to a supply of therapeutic fluid, the therapeutic fluid is configured to flow through the introducer and the narrowed section; and a second section configured to connect to a supply of therapeutic elements. The therapeutic elements are drawn into the introducer by way of a venturi effect or suction created by the flow of the therapeutic fluid through the narrowed section. 
     These teachings provide a method that includes: inserting the introducer of the medical device according to the teachings herein into the anatomy; configuring the therapeutic fluid to flow through the introducer; and after the configuring step, the method includes a step of configuring the therapeutic elements to be drawn into the introducer by way of the venturi effect or suction; and supplying a mixture of the therapeutic elements and the therapeutic fluid into the anatomy. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a side view of a medical device. 
         FIG. 2  is a cross-sectional view of a portion of the medical device of  FIG. 1 . 
         FIG. 3  is a cross-sectional view of a portion of the medical device of  FIG. 1  located inside of a body cavity. 
     
    
    
     DETAILED DESCRIPTION 
     These teachings relate to a medical device. The medical device may be used to treat or effect an anatomical feature. The anatomical feature may be any anatomical feature, such as a body cavity or a body lumen. The body cavity may be a uterus. The medical device may be configured to treat menorrhagia. The medical device may be configured to effect or destroy the endometrium by way of cryogenics. 
     While the medical device disclosed herein may be used to treat menorrhagia, it is understood that the medical device can be used in other applications as well. For example, the device and system can be used to treat tissue in the bladder, vagina, esophagus, trachea, urethra, ureter, prostate gland, kidney, intestinal growths or abnormal tissues of the intestine, cancerous tissue, etc. 
     The medical device may be configured to supply or deliver a therapeutic fluid into the anatomy. The medical device may be configured to supply or deliver therapeutic elements into the anatomy. The medical device may be configured to supply or deliver both therapeutic fluid and therapeutic elements into the anatomy. Stated another way, the medical device may be configured to supply or deliver a mixed phase medical into the anatomy to treat the anatomy. 
     The medical device according to these teachings is configured to provide global treatment of a body cavity like the uterus. That is, by supplying a flow of the therapeutic fluid and therapeutic elements into the anatomy, a global or full surface of the tissue of the body cavity can be treated at substantially the same time, as opposed to locally or discretely treating the tissue as may be the case with other medical devices that utilize forceps or a wire electrode, for example. 
     The medical device comprises a hand piece. The hand piece may function to be held by a user or robot and/or support or contain one or more components of the medical device. For example, the hand piece may support or contain one or more elements or devices for treating the anatomy and/or for operating the medical device. 
     The medical device and/or the hand piece may comprise one or more user controls. Movement or manipulation of the one or more user controls may function to move or actuate the introducer, activate or de-activate one or more modalities for treating the anatomy. Movement or manipulation of the one or more user controls may function to start, stop, slow, or speed up a flow of therapeutic fluid in fluid communication in the medical device. Movement or manipulation of the one or more user controls may function to increase or decrease a temperature of the therapeutic fluid. 
     Movement or manipulation of the one or more user controls may function to supply or cease suppling or increase or decrease a supply of the one or more of the therapeutic elements into the flow of therapeutic fluid. For example, movement or manipulation of the one or more user controls may function to open or close an opening, port or door located between the introduction port and the contrasted section thus allowing or preventing the therapeutic elements to be or from being suctioned into the flow of the therapeutic fluid. Movement or manipulation of the one or more user controls may function to increase or decrease the amount or number of therapeutic elements released into the flow of the therapeutic fluid by increasing or decreasing a size of an opening of the introduction port or tube between the supply of therapeutic elements and the constricted section. 
     The one or more user controls may be one or more switches, levers, buttons, triggers, knobs, rotation wheels, or a combination thereof. The one or more user controls may also be a foot pedal in communication with the medical device. 
     The medical device comprises an introducer. The introducer may function to permit a portion of the medical device to be inserted into a patient or the anatomy, while a portion of the device remains outside of the patient or anatomy. 
     The introducer may be a tubular member. The introducer may be a braided or coiled tube. The introducer may be a tube that is generally smooth on the inside and outside surfaces. The introducer may be an elongated member that extends along a longitudinal axis. The proximal end or proximal portion of the introducer may be connected to the hand piece. The introducer may have a relatively small diameter, on the order of about 10 mm or less, 9 mm or less, 8 mm or less, 7 mm or less, or even 6 mm or less. Preferably, the diameter of the introducer may be less than 5 mm. Such relatively small sized introducer may be advantageous in minimizing patient trauma during insertion and/or removal of the introducer into and from a body lumen and/or body cavity. 
     The introducer may be substantially straight and/or may include sections that are substantially straight; may include one or more angles, bends or arcs and/or may include sections that have one or more angles, bends or arcs; or a combination thereof. The introducer may be substantially rigid, substantially flexible, substantially resilient, substantially kink-resistant, or a combination thereof. The introducer may be configured in such a way to allow angular movements and/or can be advanced along a tortuous path within a body lumen and/or body cavity. 
     The introducer may comprise an internal channel or lumen. The channel or lumen may be configured to direct, deliver, or transport the therapeutic fluid, the therapeutic elements, or a mixture of both of the therapeutic fluid and therapeutic elements into the anatomy. 
     The introducer may have a plurality of channels or lumen. Each channel or lumen may be configured to direct, deliver, or transport the same therapeutic fluid, the same therapeutic elements, or a mixture of both of the therapeutic fluid and therapeutic elements into the anatomy, or each channel or lumen may be configured to direct, deliver, or transport different therapeutic fluid, different therapeutic elements, or a different mixture of the therapeutic fluid and therapeutic elements into the anatomy. This means that during a medical procedure, various therapeutic fluid, elements, and mixtures thereof can be delivered into the anatomy at the same time or at different times during the procedure. 
     The medical device comprises one or more expanders. The expander may function to reduce a temperature of the therapeutic fluid. The expander may function to reduce a temperature of the therapeutic fluid to a cryogenic temperature. The expander may be an expansion valve. The cryogenic temperature of the therapeutic fluid may be at or below approximately −180° C. The cryogenic temperature may be in a range of approximately −150° C. (−238° F.) to absolute zero (−273° C. or −460° F.). A temperature of the therapeutic fluid may be on the order of about 0 degrees Celsius or less, −10 degrees Celsius or less, −20 degrees, −85 degrees Celsius or less, −90 Celsius or less, etc. 
     The expander may be located downstream or distal of the first section or the supply of the therapeutic fluid. The expander may be located in between the first section and the second section. The expander may be located downstream or distal of the second section and also downstream or distal of the first section. 
     The medical device comprises a constricted section. The constricted section may function to increase a velocity of the flow of therapeutic fluid, decrease a pressure of the therapeutic fluid, or both. The constricted section may function to create a vacuum or a localized vacuum as a result of a flow of the therapeutic fluid through the constricted section. 
     The constricted section may function to create and/or apply a venturi effect to the therapeutic fluid passing or flowing through the constricted section, which causes the therapeutic elements to be drawn into, or suctioned into, the flow of the therapeutic fluid to create a mixture of the therapeutic fluid and therapeutic elements. 
     The constricted section may be a narrowed, tapered, or reduced cross section of the introducer or tube or passageway defined between the supply of therapeutic fluid and a distal end of the medical device. The constricted section may be hourglass shaped, such that it is relatively wide at a proximal end portion, tapers radially inwardly to a constricted portion, and then tapers radially outward form the constricted portion to a distal end portion. 
     The constricted section may be a coke of a pipe. The constricted section may be created by inserting a member inside of the introducer to reduce the inner diameter thereof while the outer diameter at the constricted section remains generally the same as the rest of the introducer. The constricted section may be created by locally narrowing the outer and inner diameter of the introducer. 
     The medical device may comprise one or more introduction ports at each constricted section. Advantageously, this means that more than one type of therapeutic element may be mixed with the therapeutic fluid(s) at the constricted section for delivery into the anatomy. The introduction of the therapeutic elements (i.e., the location of the introduction) may be at the constricted section or at a location distal of the constricted section where a venturi effect can still be applied to draw or suction the therapeutic elements into the flow of the therapeutic fluid. 
     The medical device may comprise more than one constricted section. This may be desirable to add different therapeutic elements into the flow of the therapeutic fluid at various locations before being deposited into the anatomy. This may also be desirable to adjust a flow or pressure of the therapeutic fluid before entry into the anatomy. 
     The medical device comprises one or more effectors. The effector is configured to deliver the therapeutic fluid, the therapeutic elements, or a mixture of both of the therapeutic fluid and therapeutic elements into the anatomy. The effector may be located at a distal-most end of the introducer, at a distal end of the introducer, or anywhere along a length of the introducer, or a combination thereof. 
     The effector may comprise one or more: nozzles, valves, expanders, orifices, holes, fissures, slots, or other openings so that the therapeutic fluid, the therapeutic elements, or a mixture of both can be released from within the introducer to a site of interest. 
     The therapeutic fluid may function to effect the anatomy, tissue or features defining the anatomy, a body cavity, a body lumen, or a combination thereof. For example, the therapeutic fluid may function to heat or cool tissue inside of a body cavity and/or therapeutic elements. The therapeutic fluid may function to treat or destroy the endometrium inside of the uterus. The therapeutic fluid may function to freeze the endometrium inside of the uterus. 
     The therapeutic fluid may be any fluid, such as a liquid, gas, or both. The therapeutic fluid may be nitrous oxide, liquid nitrogen, carbon dioxide, argon, nitrogen, krypton, the like, or a combination thereof. The therapeutic fluid may be a cryogenic fluid. The therapeutic fluid may be air. 
     A temperature of the therapeutic fluid may be cooled or chilled to a cryogenic temperature, which may be at or below approximately −180° C. The cryogenic temperature may be in a range of approximately −150° C. (−238° F.) to absolute zero (−273° C. or −460° F.). A temperature of the therapeutic fluid may be on the order of about 0 degrees Celsius or less, −10 degrees Celsius or less, −20 degrees, −85 degrees Celsius or less, −90 Celsius or less, etc. The therapeutic fluid may be cooled or chilled with an expander. 
     Alternatively, the therapeutic fluid may be not cooled; instead, the therapeutic fluid may be heated, or at room temperature, or heated to a temperature above room temperature. Room temperature may be about 70° F. Room temperature may be less than 70° F. Room temperature may be greater than 70° F. 
     The therapeutic fluid may be supplied to the medical device from a supply of a therapeutic fluid. The supply of the therapeutic fluid may be a canister, cartridge, pouch, bag, drum, or other container that is directly connected to the medical device, the hand piece, and/or the introducer. 
     The supply of the therapeutic fluid may be received into or connected to a port, housing, channel or guide defined in or on the medical device, the hand piece, and/or the introducer. Additionally, or alternatively, the supply of the therapeutic fluid may be located at a remote location from the medical device, the hand piece, and/or the introducer and connected thereto via one or more tubes or hoses. Preferably, the supply of the therapeutic fluid is supplied or provided into the medical device, the hand piece, and/or the introducer at a location that is proximal to the supply of the therapeutic elements. 
     The medical device may comprise one supply of the therapeutic fluid. The device may comprise multiple supplies of therapeutic fluid, each of which may comprise the same or different therapeutic fluid. For example, the medical device may comprise a plurality of supplies of the therapeutic fluid that can be delivered individually or as a mixture through the introducer and into the anatomy. Each of the different therapeutic fluids may be provided into a common lumen in the introducer, or into individual lumen in the introducer. Each of the different therapeutic fluids may be provided into a common constricted section, or into individual constricted sections that are sized to accommodate a particular type of fluid and element. 
     The therapeutic elements may function to effect the anatomy, tissue or features defining the anatomy, a body cavity, a body lumen, or a combination thereof. For example, the therapeutic elements may function to heat or cool tissue inside of a body cavity. The therapeutic elements may function to treat or destroy the endometrium inside of the uterus. The therapeutic fluid may function to freeze or destroy the endometrium inside of the uterus. 
     The therapeutic elements may be provided into a flow or stream of the therapeutic fluid flowing through the medical device and/or effector, and then may be carried in the flow or stream of the therapeutic fluid into the anatomy or body cavity. The therapeutic elements may be aimed or directed at or towards an anatomical feature and configured to be embedded and/or impact into the anatomical feature at a high velocity of the therapeutic fluid. By impacting the anatomy or the tissue of the body cavity, the therapeutic elements may function to soften, treat, or destroy the tissue. 
     The therapeutic elements may be configured to absorb, hold, and/or transfer thermal energy from the therapeutic fluid or other temperature source after the therapeutic elements are mixed with the therapeutic fluid. For example, if the therapeutic fluid or temperature source is a cryo-energy, then the therapeutic fluid is configured to absorb, hold, and/or transfer the cryogenic energy from the therapeutic fluid to the anatomical feature. For example, if the therapeutic fluid is a heated fluid such as saline or heater such as a resistive heater, then the therapeutic elements may be configured to absorb, hold, and/or transfer the heated energy from the therapeutic fluid to the anatomical feature. 
     The therapeutic elements may be configured to hold thermal energy from the therapeutic fluid, and then after being embedded in the tissue or anatomy, the therapeutic elements are configured to transfer or dissipate the thermal energy into the anatomy or tissue in the body cavity even after the medical device or introducer is removed from the anatomy. Stated another way, ablation or treatment time of the anatomy can continue even after the medical procedure has been completed and/or the device has been removed from within the anatomy. Advantageously, this means that medical procedure times can be shortened while increasing treatment times. 
     The therapeutic elements may be or comprise one or more of the following: biodegradable elements, metal elements, balls, powder, solid particles, pellets, a biodegradable polymer matrix, a non-swellable polymer (e.g., PLGA or poly (ortho ester), a swellable polymer such as, with hydrogels, or a combination thereof. The therapeutic elements may comprise high specific heat (thermal mass). For example, the therapeutic elements may have a high specific heat or thermal mass that is greater than a specific heat of the tissue or the anatomy or therapeutic fluid. The therapeutic elements comprise a material having a specific heat that is greater than a specific heat of the therapeutic fluid. The therapeutic elements may be made from magnesium, iron. The therapeutic elements may be implanted within a biodegradable polymer matrix, and formulated for sustained release of a therapeutic agent. This means that the therapeutic agent may be released from the therapeutic elements for an extended period of time, even after the medical device has been removed from within the anatomy. Advantageously, this means that treatment time of the anatomy may continue even after the medical device has been removed from within the anatomy. The therapeutic elements may comprise, or the therapeutic agent released by the therapeutic elements may be, a pain killer, an antibiotic, a steroidal anti-inflammatory agent, or a combination thereof. The therapeutic elements may be configured to release a therapeutic agent after being implanted in the anatomical feature or anatomy. The therapeutic elements may be contained or mixed with a carrier fluid, so that when the therapeutic elements are drawn or suctioned up into the flow of the therapeutic fluid, the carrier fluid is also drawn or suctioned into the flow of the therapeutic fluid. Mixing the therapeutic elements with the carrier fluid may assist with drawing or suctioning up the therapeutic elements into the flow of the therapeutic fluid. The carrier fluid may be the same as the therapeutic fluid. The carrier fluid may be water or saline or a gas. 
     A temperature of the therapeutic elements may be cooled or chilled to a cryogenic temperature, which may be at or below approximately −180° C. The cryogenic temperature may be in a range of approximately −150° C. (−238° F.) to absolute zero (−273° C. or −460° F.). A temperature of the therapeutic fluid may be on the order of about 0 degrees Celsius or less, −10 degrees Celsius or less, −20 degrees Celsius or less, −40 degrees Celsius or less, −60 degrees Celsius or less, −80 degrees Celsius or less, −85 degrees Celsius or less, −90 Celsius or less, etc. The therapeutic elements may be cooled or chilled by way of thermal transfer from a temperature of the therapeutic fluid that is configured to move or pass the therapeutic fluid through the medical device and introducer into the anatomy. In other words, the therapeutic fluid may be cooled or cold, and the temperature of the therapeutic fluid may be transferred to the therapeutic elements to cool or lower a temperature of the therapeutic elements. 
     The therapeutic elements may be contained or stored in a supply or source of the therapeutic elements. The supply or source of the therapeutic elements may be a canister, cartridge, pouch, bag, drum, or other container that is directly connected to the medical device, the hand piece, and/or the introducer or connected thereto via a hose or tube. 
       FIG. 1  illustrates a medical device  10 . The medical device  10  comprises a hand piece  12  and an introducer  14 . The hand piece  12  is configured to be gripped or held by a user. The hand piece  12  comprises one or more user controls  16  for operating, manipulating, and/or using the medical device  10 . The introducer  14  extends along a longitudinal axis and has a proximal end  20  connected to the hand piece  12 . The introducer  14  comprises an effector  22  at its distal end  24 . 
     The medical device  10  comprises a first section  42  that is configured to connect to a supply or source of therapeutic fluid  26  comprising therapeutic fluid TF. The therapeutic fluid TF may be nitrous oxide. 
     The medical device  10  comprises a second section  44  configured to connect to a supply or source of therapeutic elements  28  comprising therapeutic elements TE. The therapeutic elements TE may be biodegradable elements, metal balls, a powder, or a combination thereof. 
     The second section  44 , or the supply or source of the therapeutic elements  28  is connected to the medical device  10  at a constricted section  30 . Preferably, the first section  42  where the supply or source of the therapeutic fluid  26  is connected to the medical device  10  is located proximal or upstream relative to the constricted section  30  and the second location  44  of the medical device  10  where the supply or source of the therapeutic elements  28  is connected. 
     The medical device  10  comprises an expander  18 . The expander  18  is configured to expand therapeutic fluid TF so that a temperature of the therapeutic fluid TF is lowered or reduced. The temperature of the therapeutic fluid TF may be lowered to a cryogenic temperature. The expander  18  may be an expansion valve. The expander  18  is located downstream or distal of the first section  42  or the supply  26  of the therapeutic fluid TF. The expander  18  is located between the first section  26  and the second section  28 . In some configurations, the expander  18  may be located downstream or distal of the second section  28 . 
     Referring to  FIG. 2 , the constricted section  30  of the medical device  10  ( FIG. 1 ) is a narrowed, tapered, or reduced cross section of the introducer  14 . The constricted section  30  is configured to increase a fluid velocity of the therapeutic fluid TF passing through the introducer  14 , while decreasing a fluid pressure of the therapeutic fluid TF passing through the introducer  14  and/or the constricted section  30  as the therapeutic fluid TF flows towards the effector  22  ( FIG. 1 ). 
     The medical device  10  comprises an introduction port  32 . The introduction port  32  is an opening, passageway, port, or tube through which therapeutic elements TE from the supply or source of the therapeutic elements  28  are configured to be introduced into the constricted section  30  and/or into the introducer  14  and/or into the flow of the therapeutic fluid TF passing through the medical device  10  and/or introducer  14 . 
     As will be discussed below, during use, the therapeutic fluid TF is configured to flow through the introducer  14  towards the effector  22  and/or the distal end  24  of the introducer  14  (i.e., in the left direction in  FIGS. 1-3 ). As the therapeutic fluid TF flows through the constricted section  30 , a fluid velocity of the therapeutic fluid TF increases while a fluid pressure of the therapeutic fluid TF decreases, which creates a localized vacuum in the constricted section  30  or generally in the location of the introduction port  32  relative to the supply  28  of the therapeutic elements TE. The localized vacuum or venturi effect created by the flow of the therapeutic fluid FT through the constricted section  30  causes the therapeutic elements TE to be drawn up, or brought up, or suctioned into the introducer  14  and/or into the flow of the therapeutic fluid TF flowing or passing through the introducer  14 . The therapeutic elements TE are then mixed with the therapeutic fluid TF inside of the introducer  14  as the therapeutic fluid TF continues to flow towards the effector  22  or distal end  24  of the introducer  14 . 
     Referring now to  FIG. 3 , the introducer  14  is illustrated inside of the anatomy. More specifically, the introducer  14  has been inserted into a body cavity  34 , which may be a uterus, through a body lumen  36 , which may be the internal os. 
     Referring to  FIGS. 1-3 , the medical device  10  can be used in a medical procedure. It is understood that the order of the method steps described herein can change or be rearranged. For example, one or more steps can be repeated, omitted, or combined with other steps. One or more of the method steps described herein can be separated into one or more sub-steps, and one or more of those sub-steps can be repeated, omitted, or combined with other steps or sub-steps. 
     Before, during or after insertion or placement or implantation of the effector  22  or distal end  24  of the introducer  14  into the anatomy, one or more of the user controls  16  may be manipulated so that the medical device  10  delivers or supplies the therapeutic fluid TF from the supply or source of the therapeutic fluid  26  ( FIG. 1 ), through the introducer  14 , and into the anatomy through the effector  22 . The flow of the therapeutic fluid TF may be directed to contact with the uterus or the interior uterine surface or wall. The flow of the therapeutic fluid TF may be directed into direct contact with the uterus or the interior uterine surface or wall. The therapeutic fluid TF may function to effect tissue in the anatomy, such as the endometrium in the uterus. 
     The therapeutic fluid TF may pass through the expander  18 , which may function to reduce or cool a temperature of the therapeutic fluid TF. The therapeutic fluid TF may be cooled to a cryogenic temperature. 
     As the therapeutic fluid TF flows or passes through the constricted section  30 , a fluid velocity of the therapeutic fluid TF increases, while a fluid pressure of the therapeutic fluid TF decreases, which is configured to draw or suction or introduce the therapeutic elements TE from the source  28  into the flow of the therapeutic fluid TF to create a mixture thereof. The therapeutic elements TE may be introduced into the flow of the therapeutic fluid TF by way of a venturi effect. A temperature of the therapeutic elements TE may be reduced, even reduced to a cryogenic temperature by being mixed with the cooled or cryogenic temperature of the therapeutic fluid TF which was cooled after the therapeutic fluid TF passed through the expander  18 . The mixture of the therapeutic fluid TF and the therapeutic elements TE is then configured to be expelled into the anatomy via the effector  22 . The therapeutic elements TE are configured to be discharged through the effector  22  and directed at the anatomy, tissue, walls, or anatomical features defining the body cavity  34 . The body cavity  34  may be a uterus. The therapeutic elements TE are configured to contact and/or impact the body cavity  34  and/or at least partially embed into the body cavity  34  or tissue, wall, or anatomical feature defining the body cavity  34 . The therapeutic elements TE may be configured to transfer temperature (heat or cold) from the therapeutic fluid TF into the anatomy to medically effect the anatomy or tissue defining the body cavity  34 . Stated another way, if the therapeutic fluid TF is cooled through the expander  18 , then the therapeutic elements TE may also be cooled by way of thermal transfer from the therapeutic fluid TF to the therapeutic elements TE, which may then be transferred to the anatomy or tissue defining the body cavity  34  after the therapeutic elements TE contact or are embedded in the anatomy. 
     The therapeutic elements TE may be configured to hold or maintain thermal energy from the therapeutic fluid TF, and then after being embedded in the tissue or the body cavity  34 , the therapeutic elements TE may be configured to continue to transfer or dissipate the thermal energy into the body cavity  34  or anatomy defining the cavity  34  even after the medical device  10  or introducer  14  has been removed from the body cavity  34 . Stated another way, ablation or treatment time of the body cavity  34  can continue even after the medical procedure has been completed and/or after the device  10  has been removed from within the body cavity  34 . Moreover, because the therapeutic elements TE have a specific heat, the therapeutic elements TE may be configured to continue to transfer or dissipate the thermal energy into the body cavity  34  even after the therapeutic TF has warmed up inside of the body cavity  34  and is no longer at the cryogenic temperature Advantageously, this means that the time required for the actual medical procedure can be shortened while the treatment time increases. 
     Before, during, or after the medical procedure, the supply or source of the therapeutic elements  28  can be controlled (via the one or more user controls  16 , for example) so that only the therapeutic fluid TF is supplied into the anatomy, or the amount of the therapeutic elements  28  supplied into the anatomy can be increased or decreased by manipulating the amount and speed of the flow of the therapeutic fluid TF. 
     The medical device  10  may include multiple supplies or sources of therapeutic fluid  26  and/or multiple supplies or sources of the therapeutic elements  28 . The supply of the various therapeutic fluids TF and therapeutic elements TE can be located anywhere on the medical device  10  and/or introducer  14 . 
     The supply of various therapeutic fluids TF and therapeutic elements TE can be controlled or fine-tuned, depending on the medical procedure. For example, a first therapeutic fluid may be supplied into the anatomy with first therapeutic elements followed by a second therapeutic fluid and/or second therapeutic elements. For example, a first therapeutic fluid may be supplied into the anatomy with first therapeutic elements in combination with a second therapeutic fluid and/or second therapeutic elements. The various therapeutic fluids and/or therapeutic elements may flow or may be mixed in a common introducer  14  and/or constricted section  30 . The various therapeutic fluids and/or therapeutic elements may flow in separate and discrete lumen defined in the introducer  14  and/or separate or discrete constricted sections  30  in the medical device  10 . 
     In another configuration of the medical device  10  and/or the method of using the medical device  10 , the medical device  10  may be free of an expander  18 , or the flow of the therapeutic fluid TF may bypass the expander  18 , so that the therapeutic fluid is not cooled or reduced to a cryogenic temperature. The flow of the therapeutic fluid TF can pass through one or more constricted sections  30  so that therapeutic elements TE are drawn into or suctioned into or provided into the flow of the therapeutic fluid TF. The mixture of the therapeutic fluid TF and the therapeutic elements TE can then be delivered directly into the body cavity or uterus and directed at the walls or tissue defining the uterus. 
     In another configuration of the medical device  10  and/or the method of using the medical device  10 , the therapeutic fluid TF may pass through the expander  18 , which may function to reduce or cool a temperature of the therapeutic fluid TF to a cryogenic temperature, for example. The flow of the therapeutic fluid TF can then be delivered directly into the body cavity or uterus and directed at the walls or tissue defining the uterus. That is, the medical device  10  may be free of a constricted section  30 , or the constricted section  30  may be bypassed so that therapeutic elements TE are not drawn into or suctioned into or provided into the flow of the therapeutic fluid TF and only the therapeutic fluid TF is delivered directly into the body cavity or uterus and directed at the walls or tissue defining the uterus. 
     A method comprising reducing a temperature of a therapeutic fluid to a cryogenic temperature; and directing a flow of the therapeutic fluid into a uterus. The method comprises introducing therapeutic elements into the flow of the therapeutic fluid. The therapeutic elements are introduced into the flow of the therapeutic fluid by way of a venturi effect. 
     A method comprising reducing a temperature of particles to a cryogenic temperature; and directing a flow of the particles into a uterus. The method comprises reducing a temperature of a therapeutic fluid to a cryogenic temperature. The method comprises introducing the particles into a flow of the therapeutic fluid by way of suction. 
     LISTING OF REFERENCE NUMERALS 
     
         
         
           
               10  medical device 
               12  hand piece 
               14  introducer 
               16  user controls 
               18  expander 
               20  proximal end 
               22  effector 
               24  distal end 
               26  source of therapeutic fluid 
               28  source of therapeutic elements 
               30  constricted section 
               32  introduction port 
               34  body cavity 
               36  body lumen 
               38  anatomical feature 
               42  first section 
               44  second section 
             TE therapeutic element 
             TF therapeutic fluid 
           
         
       
    
     The explanations and illustrations presented herein are intended to acquaint others skilled in the art with the invention, its principles, and its practical application. The above description is intended to be illustrative and not restrictive. Those skilled in the art may adapt and apply the invention in its numerous forms, as may be best suited to the requirements of a particular use. 
     Accordingly, the specific embodiments of the present invention as set forth are not intended as being exhaustive or limiting of the teachings. The scope of the teachings should, therefore, be determined not with reference to this description, but should instead be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. The omission in the following claims of any aspect of subject matter that is disclosed herein is not a disclaimer of such subject matter, nor should it be regarded that the inventors did not consider such subject matter to be part of the disclosed inventive subject matter. 
     Plural elements or steps can be provided by a single integrated element or step. Alternatively, a single element or step might be divided into separate plural elements or steps. 
     The disclosure of “a” or “one” to describe an element or step is not intended to foreclose additional elements or steps. 
     While the terms first, second, third, etc., may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms may be used to distinguish one element, component, region, layer or section from another region, layer or section. Terms such as “first,” “second,” and other numerical terms when used herein do not imply a sequence or order unless clearly indicated by the context. Thus, a first element, component, region, layer or section discussed below could be termed a second element, component, region, layer or section without departing from the teachings. 
     Spatially relative terms, such as “inner,” “outer,” “beneath,” “below,” “lower,” “above,” “upper,” and the like, may be used herein for ease of description to describe one element or feature&#39;s relationship to another element(s) or feature(s) as illustrated in the figures. Spatially relative terms may be intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be oriented “above” the other elements or features. Thus, the example term “below” can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. 
     The disclosures of all articles and references, including patent applications and publications, are incorporated by reference for all purposes. Other combinations are also possible as will be gleaned from the following claims, which are also hereby incorporated by reference into this written description.