Abstract:
An electrosurgical assembly is disclosed, the assembly having two, three or more electrodes configured to provide advantageous tissue removal and precision for conducting electrosurgical procedures, including improved ablation and coagulation of tissue. The electrodes are configured and arranged so that energy can be applied in a highly uniform and precise fashion, depending upon the application. In addition, the electrosurgical assembly allows flexibility in use by, in some embodiments, allowing selective switching of the active and return electrodes, and also selective switching between ablation and coagulation modes. In certain embodiments the invention includes one or more electrodes having the ability to undergo changes in shape.

Description:
[0001]    This application is being filed as a PCT International Patent application on Oct. 5, 2007, applicant and inventor, Scott T. Latterell, a U.S. Citizen, is an applicant for the purposes of the United States only, and claims priority to U.S. Patent Application Ser. No. 60/849,369, titled “Shapeable Vaporization Catheter”, filed Oct. 5, 2006; the contents of which are herein incorporated by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    The present technology relates to medical devices. Particularly, the present technology relates to electrosurgical devices. 
       BACKGROUND 
       [0003]    Electrosurgery is the application of electrical current to tissue for the purpose of surgically altering the tissue. It is a method commonly used for a variety of medical procedures including, but not limited to, resecting or vaporizing tissue (typically by ablation) associated with warts, benign tumors, and tissue growth such as that associated with Benign Prostatic Hyperplasia (BPH). During such procedures, electrosurgery can also be used for controlling bleeding through coagulation. Electrosurgical devices generally operate by providing electrical current traveling from an active electrode through target tissue to a return electrode. Depending on the characteristics of the energy (voltage, frequency, wattage, for example) being passed through the tissue, and the device electrodes (size, shape, distance, for example), the tissue can be transected, vaporized or coagulated. 
         [0004]    Traditionally there have been two primary types of electrosurgical equipment: bipolar and monopolar. Bipolar electrosurgery provides the active and return electrode on the surgical device itself in close proximity to the targeted site, while monopolar electrosurgery provides only the active electrode at the targeted site, and the return electrode is generally a conductive plate that is secured to the patient&#39;s outer skin surface. In monopolar electrosurgery higher voltages are required to overcome the associated resistance of the patient&#39;s body, which serves as a necessary part of the circuit. In bipolar electrosurgery, less input power is needed, but the effect on the targeted tissue is limited by a number of factors, including the proximity of the active to the return electrode, the size and shape of the electrodes, the shape and regularity of the electric field that is created, and the ratio of the surface area of the return electrode to the surface area of the active electrode. 
         [0005]    Although present electrosurgery equipment and techniques are suitable for many applications, a need remains for equipment and techniques that offer improved ablation and coagulation and greater control over the ablation and coagulation processes. 
       SUMMARY 
       [0006]    The technology disclosed herein provides for an electrosurgical apparatus that offers improved control and precision in removal of tissue. 
         [0007]    In some embodiments the invention includes an electrosurgical apparatus having one active electrode and two return electrodes, the return electrodes are typically positioned on opposite ends of the active electrode so as to provide balanced current flow (as appropriate, or controlled imbalanced current flow as desired) and improved performance with regard to tissue removal, as well as coagulation of tissue as desired. 
         [0008]    The present invention, by providing (in certain embodiments) a central active electrode intermediate two return electrodes, offers significant improvements over preexisting electrosurgical devices. One problem with prior electrosurgical devices is that they often have relatively small active electrodes, a problem that can be countered using the designs of the present invention. Size and shape of prior electrodes has been restricted due to issues with near field and far field distances, as well as issues associated with current density. For example, when the active and return electrodes are too close to one another, then near field issues become prominent and the electrodes can arc and be destroyed. When the electrodes are too far apart, or have a surface area that is too large, then far field issues arise causing problems with initiation and creation of a uniform plasma zone around the active electrode. Far field issues also often require higher power levels. 
         [0009]    Existing devices, such as many bipolar electrosurgical devices, often suffer from slow tissue removal rates (less than 1 g/min). This is due, in part, to the return surface area to active surface area ratio requiring that the active electrode be substantially smaller than the return electrode to provide the current density required if reliable initiation and maintaining of the plasma zone is to occur. Unfortunately, a small active surface area results in increased procedure time (costly and harder on patient); and reduced tissue removal. Simply increasing the active surface area does not solve this problem, because it inhibits initiation, reducing precision, and increasing the chance of patient injury due to unintended tissue damage. Also, increased active surface area requires more power to maintain high current density and counter increased far field distance. 
         [0010]    Furthermore, coagulation/hemostasis is inconsistent and unreliable with existing devices because of inefficient flow of current. This problem is due to electrode design, and can arise during both vaporization (also known as ablation) and spot coagulation. This can result in additional blood loss; poor visibility and associated decreases in safety; potential for “re-bleeds” after the operation requiring additional intervention; and increased procedure time 
         [0011]    Electrode configurations of the present invention provide reduce far field distances and allow larger plasma zones resulting in a method of energy delivery that improves tissue removal rates, up to for example 50 percent, over existing devices, and provides consistent initiation and vaporization without more power required. The active zones can, in some embodiments, also be changed in shape and size, further improving performance in many implementations. These improvements also lead, in certain embodiments, to better hemostasis during vaporization due to the current flow which is deeper and broader; improved spot coagulation of bleeders because the hemostasis energy is delivered faster and broader, resulting in more consistent and reliable effect; and an opportunity for blended vaporization and coagulation energy delivery to further enhance performance. 
         [0012]    The result, using the various embodiments of the present invention, allows for potentially reduced procedure time; greater tissue removal; improved visibility and safety; reduced blood loss; faster patient recovery and reduced patient complications. 
         [0013]    The technology of the present invention offers medical practitioners improved views of the area in which tissue is being removed, and customizable active areas that allow a single electrosurgical apparatus to have multiple operational modes, including two or more tissue removal configurations and two or more coagulation configurations. The technology allows for changes in the shape of the electrosurgical apparatus, specifically changes in shape and orientation of the electrode surfaces, as well as changes in current delivered to the electrode assembly, so as to allow adjustments in performance and function. 
         [0014]    In addition, in certain embodiments, the electrosurgical apparatus allows high tissue removal rates while still maintaining control and precision of the tissue removal. As noted earlier, in some embodiments the electrosurgical apparatus can be adjusted, during a surgical procedure, to modify the size and shape of the electrodes, as well as to adjust whether specific electrodes function as active or return electrodes. This allows, for example, a single electrosurgical apparatus to be switched between tissue removal at a tip surface of the apparatus or a side surface of the apparatus. For example, in some implementations the present invention uses three (or more) electrodes in a row. The active electrode is switched repeatedly between the distal (tip) electrode and a middle electrode. The other two (or more) electrodes are left as return electrodes, maintaining a high ratio of return surface area to active surface area. In the alternative, the active electrode can cycle through the three (or more) electrodes to generate an active surface at a larger area than would otherwise be possible from having a single fixed active electrode. 
         [0015]    In some implementations one or more of the electrodes is expandable and/or flexible for good maneuverability and effectiveness when performing electrosurgery. For example, the apparatus may be inserted into small cavities and expanded when it reaches a localized operation site. This expandability may manifest itself in regard to having one or more electrodes that have a normal state that is modified before or after a surgical procedure begins. For example, in one implementation an electrode assembly having a first diameter is inserted into a patient and subsequently the diameter of the assembly is expanded. However, in other implementations the electrode assembly is contracted before insertion into a patient, and thereafter the assembly is allowed to expand within the patient. 
         [0016]    The apparatus, through some embodiments, may be expanded in asymmetrical shapes to accommodate asymmetrical surgery locales, as well as to provide asymmetric tissue removal and coagulation. 
         [0017]    According to example embodiments, the apparatus produces an electric field that is substantially symmetric and consistent from a substantially balanced and symmetric electrode placement. Additionally, in various embodiments, the ratio of the return electrode surface area to the active electrode surface area may be maximized by disposing a return electrode at least partially within an active electrode, using more than one return electrode in proximity of the active electrode, or both. Such configurations allow for fast, safe, and efficient electrosurgical procedures. It is also possible to apply coagulation and ablation frequencies simultaneously in those embodiments having multiple electrodes. 
         [0018]    More specifically, the technology disclosed herein has, in certain embodiments, a first electrode that may contain a second electrode. The first electrode can partially surround the second electrode. The assembly may have an additional electrode on the proximal end of the first electrode and an additional electrode on the distal end of the first electrode, meaning that the electrode assembly includes (in some embodiments) a first electrode with additional electrodes on either ends of the first electrode. 
         [0019]    Furthermore, the first electrode may have a shape and/or size that can be altered via a manipulation means that is in mechanical communication with the electrode, such that the diameter or other aspect of the first electrode can be altered. The disclosed configurations allow for an increase in the ratio of the return electrode surface area to the active electrode surface area relative to the prior art, a consistent and predictable electric field, an alterability of the proximity between the return and active electrodes, and/or an alterability of the shape of at least one electrode. 
         [0020]    In one embodiment, the first electrode is a conductive woven material that has a circular cross-section that defines a central cavity. In another embodiment, the first electrode (typically the active electrode) is constructed of a woven conductive material and is substantially spherical in shape. In yet another embodiment, the first electrode comprises a conductive material in the shape of a helix. 
         [0021]    As noted above, the apparatus itself may be attached to an electrosurgical generator unit through leads or wires, as is known in the art. The first electrode is optionally constructed so as to be flexible, and to define at least a partial cavity within the electrode, and has a proximal end and a distal end. The first electrode is not limited to a circular cross section, and may have a cross section of virtually any shape. The first electrode may be constructed of coiled wire, braided electrically conductive material, welded lattice, laser cut or machined lattice, woven electrically conductive material, any combination thereof, or other suitable electrically conductive material, especially when such material is able to be configured to be repeatedly expanded and contracted. However, it will be appreciated that the first electrode may be constructed out of coiled wire, braided material, woven material, etc. even when the first electrode is not configured to be expanded and contracted. The first electrode could also be constructed of any other material where structural flexibility is allowed for shape manipulation. The first electrode may have a lattice configuration, for example. Additionally, a cavity defined by the first electrode is not limited to a circular cross section, and also may have a cross section of virtually any shape. 
         [0022]    Generally, the apparatus has at least a second electrode in addition to the first electrode, the second electrode at least partially disposed proximate to the first electrode, meaning that the second electrode may be disposed near the proximal end of the first electrode or near the distal end of the first electrode. The second electrode and the first electrode should not make direct conductive contact when the device is in operation, i.e. when a current is passing between them to remove or coagulate tissue, otherwise the apparatus will develop an electrical short. Generally a resistive material will be positioned between the electrodes to insulate them from each other. Additionally, at least a portion of the second electrode may be contained within the first electrode. There also can be a third electrode that is disposed proximate to the first electrode, meaning that the third electrode may be at least disposed on the proximal end of the first electrode or on the distal end of the first electrode. The third electrode and the first electrode may not generally make electrical contact. Additionally, at least a portion of the third electrode may be contained within the first electrode. 
         [0023]    In some implementations of the invention, a manipulation means is in mechanical communication with the first electrode. The manipulation means may be a means of changing the diameter of the first electrode, or other electrodes. The manipulation means also may be a means of changing the shape of the first electrode, or other electrodes. The manipulation means may be a rod, screw, solenoid, or similar device that, when engaged, changes the shape (such as the diameter) of the first electrode by applying a force either directly or indirectly to the first electrode. The manipulation means may be engaged through a foot pedal, lever, button, valve, dial, nut, or any other applicable user-apparatus interface. 
         [0024]    The above summary of the present invention is not intended to describe each discussed embodiment of the present invention. This is the purpose of the figures and the detailed description that follows. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0025]    The technology will now be described in greater detail, by way of example, with references to the drawings, in which: 
           [0026]      FIG. 1  is a perspective view of an overall system incorporating one embodiment of the apparatus disclosed herein. 
           [0027]      FIG. 2A  is a side view of one embodiment of an electrode assembly constructed and arranged consistent with the technology claimed herein. 
           [0028]      FIG. 2B  is a side sectional view of the electrode assembly of  FIG. 2A  in an alternative position. 
           [0029]      FIG. 2C  is a cross sectional view of the electrode assembly of  FIG. 2A . 
           [0030]      FIG. 3A  is a side sectional view of an alternative electrode assembly embodiment consistent with the technology claimed herein. 
           [0031]      FIG. 3B  is a side sectional view of the electrode assembly of  FIG. 3A  in an alternative position. 
           [0032]      FIG. 3C  is a cross sectional view of the electrode assembly of  FIG. 3A . 
           [0033]      FIG. 4A  is a side sectional view of an alternative embodiment electrode assembly consistent with the technology claimed herein. 
           [0034]      FIG. 4B  is a side sectional view of the apparatus of  FIG. 4A  in an alternative position. 
           [0035]      FIG. 4C  is a cross sectional view of the apparatus of  FIG. 4A . 
           [0036]      FIG. 5A  is a side sectional view of an alternative embodiment consistent with the technology claimed herein. 
           [0037]      FIG. 5B  is a side sectional view of the apparatus of  FIG. 5A  in an alternative position. 
           [0038]      FIG. 5C  is a cross sectional view of the apparatus of  FIG. 5A . 
           [0039]      FIG. 6A  is a side sectional view of an alternative embodiment consistent with the technology claimed herein. 
           [0040]      FIG. 6B  is a side sectional view of the apparatus of  FIG. 6A  in an alternative position. 
           [0041]      FIG. 6C  is a cross sectional view of the apparatus of  FIG. 6A . 
           [0042]      FIG. 7A  is a side view of an alternative embodiment consistent with the technology claimed herein. 
           [0043]      FIG. 7B  is a side sectional view of the apparatus of  FIG. 7A  in an alternative position. 
           [0044]      FIG. 7C  is a cross sectional view of the apparatus of  FIG. 7A . 
           [0045]      FIG. 8A  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus inserted into a representation of an expanded prostate, prior to removal of any prostate tissue. 
           [0046]      FIG. 8B  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus inserted into a representation of an expanded prostate after removal of some prostate tissue. 
           [0047]      FIG. 8C  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus inserted into a representation of an expanded prostate and showing the apparatus with an expanded active electrode to further remove prostate tissue. 
           [0048]      FIG. 8D  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus inserted into a representation of an expanded prostate and showing the apparatus with an expanded active electrode to further remove prostate tissue. 
           [0049]      FIG. 9  is a side sectional view of an alternative embodiment consistent with the technology claimed herein. 
           [0050]      FIG. 10A  is a cross sectional view of an example implementation of the apparatus of the invention. 
           [0051]      FIG. 10B  is a cross sectional view of an example implementation of the apparatus of the invention. 
           [0052]      FIG. 10C  is a cross sectional view of an example implementation of the apparatus of the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0053]    The technology disclosed herein provides for an electrosurgical apparatus that offers improved control and precision in removal of tissue. In some embodiments the electrosurgical apparatus can be adjusted, during a surgical procedure, to modify the size and shape of one or more of the electrodes. In addition, in certain embodiments, specific electrodes functioning as active or return electrodes can be changed during a surgical procedure, such as to change an active electrode into a passive electrode, or to change the frequency of electrical energy. In addition, in certain embodiments, the electrosurgical apparatus allows higher tissue removal rates while still maintaining control and precision. 
         [0054]    In some implementations one or more of the electrodes is expandable for good maneuverability and effectiveness when performing electrosurgery. For example, the apparatus may be inserted into small cavities and expanded when it reaches a localized operation site. The apparatus, through some embodiments, may be expanded in asymmetrical shapes to accommodate asymmetrical surgery locales, as well as to provide asymmetric tissue removal. In the alternative, such expansion can be symmetric or substantially symmetric around a central axis. 
         [0055]    Referring now to the figures, various embodiments of the invention will be described in greater detail.  FIG. 1  is a perspective view of an example system incorporating one embodiment of an electrosurgical apparatus made in accordance with the invention. In this example embodiment, an electrosurgical apparatus  100  is connected to an electrosurgical generator  130 . The connection can be made, for example, via a lead, cord, wire, or cable  110 . A user-apparatus interface  120  may be disposed between the electrosurgical apparatus  100  and the electrosurgical generator  130 . In the depicted embodiment, a foot pedal  150  is also connected to the electrosurgical generator  130  via a lead, cord, wire, or cable, for example, which may control output of the electrosurgical generator. 
         [0056]      FIG. 2A  shows a side view of one embodiment electrode assembly  200  constructed in accordance with the invention and consistent with the technology claimed herein. The assembly includes a first electrode  210 . Near the first electrode  210  is a second electrode  220  disposed on the distal end  212  of the first electrode  210 , at the tip of the electrode assembly  200 . A first insulator  240  separates the first electrode  210  and the second electrode  220 . Near the first electrode  210  is also a third electrode  230  positioned on the other end (the proximal end  214 , which is opposite the tip of the assembly  200 ) of the first electrode  210 . A second insulator  250  separates the first electrode  210  from the third electrode  230 . 
         [0057]    The first electrode  210  is constructed so as to be flexible, to define at least a partial cavity within the electrode, and has a distal end  212  and a proximal end  214 . The first electrode  210  is not limited to a circular cross section, and may have a cross section of virtually any shape, including a shape that does not completely surround the assembly  200 . The first electrode  210  may be at least partially constructed of coiled wire, braided electrically conductive material, woven electrically conductive material, or any combination thereof. 
         [0058]    The first electrode  210  can also be at least partially constructed of any other conductive material where structural flexibility is allowed for shape manipulation. In one embodiment, the first electrode  210  is a woven conductive material that has a circular cross-section that defines a central cavity. In one other embodiment, the first electrode  210  is constructed of a woven conductive material and is substantially spherical in shape, and defines a substantially spherical cavity within the electrode. In yet another embodiment, the first electrode  210  comprises a conductive material in the shape of a helix that defines an opening within the helix. The first electrode  210  may have a lattice configuration, and may be an active electrode. 
         [0059]    As discussed above, proximate (meaning near) to the first electrode  210  is the second electrode  220  located on the distal end  212  of the first electrode  210 . The second electrode  220  may be constructed of any electrically conductive material, typically a metal. Proximate to the first electrode  210  is the second electrode  220  disposed on the distal end  212  of the first electrode  210 , and partially contained within the first electrode  210 . A first insulator  240  separates the first electrode  210  from the second electrode  220 . A manipulation means  270  is anchored to the second electrode  220 . The first electrode  210  is typically an active electrode and the second electrode  220  may be a return electrode. 
         [0060]    Also proximate to the first electrode  210  is a third electrode  230 . As shown in  FIG. 2A , the second electrode  220  and the third electrode  230  are typically positioned on opposite ends of the first electrode  210 . The third electrode  230  may be constructed of any electrically conductive material and, like the second electrode  220 , can function as an active or return electrode, but is typically used as a return electrode. The third electrode  230  and the first electrode  210  are separated by the second insulator  250 . The second insulator  250  may be constructed of a high-temperature, electrically insulating material such as ceramic or silicone. 
         [0061]    Typically, in use the second electrode  220  functions as a return electrode, although in certain embodiments the second electrode  220  functions as either a return electrode or an active electrode by switching the polarity of the electrodes. For example, it is possible to switch between having the first electrode  210  and second electrode  220  be the active electrode. In such embodiments the third electrode  230  is typically kept as a return electrode, so as to maintain a ratio where the surface area of return electrodes is significantly greater than the surface area of the active electrodes. The second electrode  220  and the first electrode  210  are separated by the first insulator  240 . The first insulator  240  may be constructed of any high-temperature, electrically insulating material such as ceramic or silicone. However, it may be desirable to temporarily remove tissue at the tip of the apparatus  200 , in which case switching functionality to allow the second electrode  220  to be the active electrode is desirable, since tissue will be removed most at the tip of the assembly  200 . 
         [0062]      FIG. 2B  is a side sectional view of the apparatus of  FIG. 2A  in an alternative position. This view reveals that the second electrode  220 , which is partially disposed on the distal end of the first electrode  210 , is partially contained within the first electrode  210 . In this depicted embodiment, second electrode  220  includes a central shaft  222  that runs down the interior of the first electrode  210  and connects to a wider head  224 . This central shaft  222  can be integrally formed with the head  224  of the second electrode  220 , such that the second electrode  220  is a single piece. However, in other embodiments this central shaft  222  can be an independent piece, although typically in electrical communication with the head  224 . 
         [0063]    In the depicted embodiment, a third insulator  260  surrounds the partially contained portion of the second electrode  220  to prevent contact between the first electrode  210  and the second electrode  220 . The third insulator  260  may be constructed of a high-temperature, electrically insulating material such as ceramic or silicone, and may be disposed on the second electrode  220 . It will be appreciated that third insulator  260  can cover more or less of the second electrode than is shown in  FIG. 2B . Also revealed through this side sectional view of the apparatus of  FIG. 2A , is that the first insulator  240 , the second insulator  250 , and the third electrode  230  define respective openings through which the second electrode  220  may pass. 
         [0064]    It will be appreciated that the configuration of electrodes shown in  FIGS. 2A and 2B  is only representative, and that alterations in the configuration of the electrodes can be made without deviating from the spirit and scope of the design. For example, specifically in reference to  FIG. 2B , it will be appreciated that the portion of the central shaft  222  of the second electrode  220  surrounded by the first electrode  210  can be shortened significantly, or even eliminated so that none of the second electrode  220  is surrounded by the first electrode  210 . Similarly, it is possible to increase the size and/or surface area of any of the electrodes shown in  FIGS. 2A and 2B . 
         [0065]    Referring again to  FIG. 2B , attached to the second electrode  220  is a manipulation means  270 . The manipulation means is, in this example, a rod  270  that is in mechanical communication with the first electrode  210  and is anchored to the second electrode  220 . Thus, although the rod  270  does not actually touch the first electrode  210 , it is in mechanical communication with the first electrode  210  because movement of the rod mechanically changes the shape of the first electrode  210 . 
         [0066]    In the alternative, the manipulation means  270  may be a rod, screw, solenoid, or similar device that, when engaged, changes the shape, diameter, or surface area of the first electrode  210  by applying a force either directly or indirectly to the first electrode  210 . The manipulation means may be engaged through a foot pedal, button, lever, valve, dial, nut, or any other applicable user-apparatus interface. The manipulation means may be a means of changing the diameter of the first electrode  210 . The manipulation means also may be a means of changing the shape of the first electrode  210 . For example, the manipulation means may be used to create a protrusion in the first electrode along just one side of the electrosurgical apparatus, such as that shown and described later in  FIG. 6 . 
         [0067]      FIG. 2C  is a cross sectional view of the electrode assembly  200  of  FIG. 2A  in the alternative position demonstrated in  FIG. 2B . The first electrode  210 , being expanded, has a larger diameter than the outside diameter of the second insulator  250 . The second electrode  220 , a portion of which is partially contained within the first electrode  210 , has a smaller diameter than the first electrode, and a smaller diameter than the second insulator  250 . The cavity defined by the first electrode  210  is not limited to a circular cross section, and also may have a cross section of virtually any shape. Likewise, the cavity defined by the second insulator  250  need not be circular. 
         [0068]      FIG. 3A  is a side sectional view of an alternative embodiment of an electrode assembly  300  made in accordance with an implementation of the invention. This implementation shows the electrode assembly  300  having just first and second electrodes, in which a first electrode  310  partially surrounds a second electrode  320 . Proximate to a first electrode  310  is a second electrode  320  disposed on the distal end  312  of the first electrode  310 , and partially contained within the first electrode  310 . A first insulator  340  separates the first electrode  310  from the second electrode  320 . A manipulation means  370  is anchored to the second electrode  320 . The first electrode  310  is typically an active electrode and the second electrode  320  may be a return electrode. 
         [0069]    While the various apparatuses of the invention will frequently be used to remove tissue, it should be appreciated that the active electrodes can also be readily used to deliver energy at coagulation frequency. The large surface area of the first electrodes  210 ,  310 , etc. allow a broad delivery of coagulation energy, thereby allowing aggressive efforts to stop even relatively large areas of bleeding resulting from tissue removal. Thus, the present invention offers the opportunity to provide quick, wide-area coagulation energy by using the large surface area of the first electrodes  210 ,  310 , etc. 
         [0070]    In further review of  FIG. 3 , a manipulation means  370  is in mechanical communication with the first electrode  310 , and is anchored to the second electrode  320  at the end  326  of central shaft  322 . The first electrode  310 , first insulator  340 , second electrode  320 , manipulation means  370 , and leads or wires  380  are of a similar nature, construct, and materials to those discussed in  FIG. 2A ,  FIG. 2B , and  FIG. 2C , above. 
         [0071]      FIG. 3B  is a side sectional view of the apparatus of  FIG. 3A  in an alternative position. In  FIG. 3B  the distal end  312  and proximal end  314  of the first electrode  310  are drawn closer together, thus changing the diameter and shape of the first electrode  310 . The manipulation means  370  may be engaged so as to pull the second electrode  320  toward the proximal end  314  of the first electrode  310 , thereby compressing the first electrode  310  and causing the change in shape and/or diameter. 
         [0072]      FIG. 3C  is a cross sectional view of the apparatus of  FIG. 3A  in the alternative position demonstrated in  FIG. 3B . The first electrode  310  is in a shortened state whereby it becomes wider, and defines a cavity that at least partially contains the second electrode  320 . 
         [0073]      FIG. 4A  is a side sectional view of an alternative embodiment consistent with the technology of the present invention. Proximate to a first electrode  410  is a second electrode  430  disposed near (or proximate to) the proximal end of the first electrode  410 . Separating the first electrode  410  from the second electrode  430  is a first insulator  450 . In mechanical communication with the first electrode  410  is a manipulation means  470 , which extends from a lead or wire to the distal end of the first electrode  410 . The manipulation means  470  may be slidably disposed within the first electrode  410  and anchored to the tip  490  on the distal end of the first electrode  410 . The first electrode  410 , first insulator  450 , second electrode  430 , manipulation means  470 , and leads or wires are of a similar nature, construction, and materials to those discussed in  FIG. 2A ,  FIG. 2B , and  FIG. 2C , above. 
         [0074]    The tip  490  may be an extension of the manipulation means  470 , or may be a separate entity constructed out of any material that allows the manipulation means  470  to be anchored to the distal end of the first electrode  410 . The tip  490  may also be a portion of the first electrode  410 , and be constructed out of substantially similar material, or the tip  490  can be an extension of either the first electrode  410  or the manipulation means  470 . Thus, electrode assembly  400  contains two electrodes: An outer electrode (the first electrode  410 ) plus a substantially surrounded inner electrode (the second electrode  430 ). 
         [0075]      FIG. 4B  is a side sectional view of the apparatus of  FIG. 4A  in an alternative position. In  FIG. 4B  the distal end  412  of the first electrode has been drawn closer to the proximal end  414  than in  FIG. 4A , thus changing the diameter and shape of the first electrode  410 . The manipulation means  470  may be engaged so as to pull the tip  490  closer to the proximal end of the first electrode  410 , thereby compressing the first electrode  410  and causing a change in diameter. 
         [0076]      FIG. 4C  is a cross sectional view of the apparatus of  FIG. 4A  in the alternative position demonstrated in  FIG. 4B . The first electrode  410  is in an expanded state and defines a cavity that at least partially contains the second electrode  430 . The first insulator  450  separates the first electrode from the second electrode  430 . Thus, the second electrode  430  may define a passage through which the manipulation means  470  is disposed. The passage need not have a circular cross section as shown in  FIGS. 4B and 4C , but could be a variety of shapes that allow sliding or shifting in position of the manipulation means  470 . The passage also need not be in the center of the second electrode  430 , but could be positioned anywhere through the second electrode  430  so long as the passage allows sliding or shifting of the manipulation means  470 . 
         [0077]      FIG. 5A  is a side sectional view of an alternative embodiment consistent with the technology claimed herein. Separating a first electrode  510  and a second electrode  520  is a first insulator  550 . A manipulation means  570  extends through a passage within the first electrode  510  and the second electrode  520 . Proximate to the first electrode  510  is the second electrode  520  disposed proximate to the proximal end of the first electrode  510 . The second electrode  520  is also at least partially contained by the first electrode  510 . In this embodiment, the second electrode  520  is, like the first electrode  510 , constructed so as to be flexible, to define at least a partial cavity within the electrode, and has a proximal end and a distal end. The second electrode  520  is not limited to a circular cross section, and may have a cross section of virtually any shape. The second electrode  520  may be at least partially constructed of coiled wire, braided electrically conductive material, woven electrically conductive material, or any combination thereof. The second electrode  520  can also be at least partially constructed of any other conductive material where structural flexibility is allowed for shape manipulation. The second electrode  520  may have a lattice configuration, and may be return electrode. 
         [0078]    As shown, the second electrode  520  may have a distal end that shares a tip  590  with the distal end of the first electrode  510 . If so, then a second insulator would be used to prevent contact between the distal end of the first electrode  510  and the distal end of the second electrode  520 . The manipulation means  570  then extends through the passage of the first electrode  510  and the second electrode  520  to the tip of the apparatus. In an alternative embodiment, the second electrode does not share a tip  590  with the first electrode, and has a distal end that is separate from the distal end of the first electrode  510 . In such a situation the manipulation means  570  may extend into the passage though the first electrode  510  and the second electrode  520 , and then extend through the distal end of the second electrode  520  to the tip  590  of the first electrode  510 . 
         [0079]    The first electrode  510 , first insulator  550 , manipulation means  570 , and leads or wires are of a similar nature, construct, and materials to those discussed in  FIG. 2A ,  FIG. 2B , and  FIG. 2C , above. 
         [0080]      FIG. 5B  is a side sectional view of the electrode assembly  500  of  FIG. 5A  in an alternative position. In  FIG. 5B  the distal end is positioned closer to the proximal end of the first electrode  510  and the second electrode  520  than in  FIG. 5A , thus changing the diameter and shape of the first electrode  510 . The manipulation means  570  may be engaged so as to pull the tip  590  closer to the proximal end of the first electrode  510 , thereby compressing the first electrode  510  and the second electrode  520 , causing a change in shape or diameter. In this embodiment of an electrode assembly  500 , the diameter of the second electrode  520  changes in substantially the same proportion to the first electrode  510 . 
         [0081]      FIG. 5C  is a cross sectional view of the apparatus of  FIG. 5A  in the alternative position demonstrated in  FIG. 5B . The first electrode  510  is in an expanded state and defines a passage that at least partially contains the second electrode  520 . The second electrode  520  is also in an expanded state and defines a cavity that at least partially contains the manipulation means  570 . The first insulator  550  separates the first electrode  510  from the second electrode  520 , and defines a passage that at least partially contains the manipulation means  570 . 
         [0082]      FIG. 6A  is a side sectional view of an alternative embodiment for an electrode assembly  600 , the assembly constructed consistent with the technology claimed herein. Also proximate to the first electrode  610  is a second electrode  620  partially disposed on the distal end of the first electrode  610 , and also partially contained within the first electrode  610 . The first electrode  610  may be an active electrode and the second electrode  620  may be a return electrode. The second electrode  620  and the first electrode  610  are separated by a first insulator  640 . 
         [0083]    The manipulation means  670  is in mechanical communication with the first electrode  610 , and is anchored to the second electrode  620 . The manipulation means  670  may be at least partially disposed in leads or wires  680  connected to the apparatus  600 . The first electrode  610 , first insulator  640 , second electrode  620 , manipulation means  670 , and leads or wires  680  are of a similar nature, construct, and materials to those discussed in  FIG. 2A ,  FIG. 2B , and  FIG. 2C , above. 
         [0084]      FIG. 6B  is a side sectional view of the apparatus of  FIG. 6A  in an alternative position. In  FIG. 6B  the distal end is positioned closer to the proximal end of the first electrode  610  than in  FIG. 6A , thus changing the diameter and shape of the first electrode  610 . The manipulation means  670  may be engaged so as to pull the second electrode  620  closer to the proximal end of the first electrode  610 , thereby compressing the first electrode  610  and causing a change in shape. In this embodiment the apparatus  600  is asymmetrical and may be relevant for asymmetrical tissue requiring electrosurgery. 
         [0085]      FIG. 6C  is a cross sectional view of the apparatus of  FIG. 6A  in the alternative position demonstrated in  FIG. 6B . The first electrode  610  is in an expanded state and defines an opening that at least partially contains the second electrode  620 . 
         [0086]      FIG. 7A  is a side view of an alternative embodiment consistent with the technology claimed herein. Proximate to a first electrode  710  is a second electrode  720  at least partially disposed on the distal end of the first electrode  710 . The second electrode  720  and the first electrode  710  are separated by a first insulator  740 . Also proximate to the first electrode  710  is a third electrode  730 . The third electrode  730  and the first electrode  710  are separated by a second insulator  750 . A manipulation means  770  is in mechanical communication with the first electrode  710 , and is anchored to the second electrode  720 . The manipulation means  770  may be at least partially disposed in leads or wires connected to the apparatus  700 . In this illustrative embodiment, the first electrode  710 , and the manipulation means  770  are curved so as to form an asymmetrical electrode assembly  700 . 
         [0087]    It will be appreciated that the first electrode  710  may be flexible, but formed such that the electrode is curved in its natural or at rest state, or that the electrode is configured to be moved between curved and straight positions. Thus, the electrode can be deflectable, such as to be steerable, or the electrode can be permanently made to encompass a curve. One advantage of such deflected and deflectable electrode assemblies is that they can be used to aid navigation of partially obstructed passageways and non-linear passageways more easily than a straight assembly. In addition, the deflected shapes (i.e, the non-linear shapes), can be used advantageously for some tissue removal and coagulation processes, improving precision and effectiveness by allowing access to areas that might be off-axis form the apparatus, and would thus be more difficult to reach with a straight electrode assembly. 
         [0088]      FIG. 7B  is a side sectional view of the apparatus of  FIG. 7A  in an alternative position. In  FIG. 7B  the distal end is positioned closer to the proximal end of the first electrode  710  than in  FIG. 7A , thus changing the diameter and shape of the first electrode  710 . The manipulation means  770  may be engaged so as to pull the second electrode  720  closer to the proximal end of the first electrode  710 , thereby compressing the first electrode  710  and causing the change in diameter.  FIG. 7B  illustrates that there may be asymmetrical expansion of the apparatus  700 . 
         [0089]      FIG. 7C  is a cross sectional view of the apparatus of  FIG. 7A  in the alternative position demonstrated in  FIG. 7B . The first electrode  710  is in an expanded state and defines a passage that at least partially contains the manipulation means  770 . The second insulator  750  that separates the first electrode  710  from the third electrode  730  defines a cavity that at least partially contains the manipulation means  770 . 
         [0090]      FIG. 8  is a diagram of an example implementation consistent with the technology claimed herein and according to various embodiments. The example implementation demonstrates use of various embodiments of the technology disclosed herein to remove prostatic tissue associated with benign prostatic hyperplasia (BPH), for example. The example implementation discussed is merely for explicative purposes rather than limiting purposes. 
         [0091]    The apparatus may be inserted into a urethra in a relatively unexpanded state so as to extend into the urethra to the site where electrosurgery will take place. The illustrated urethra includes a narrowing or occlusion, which is desirably widened or removed. Insertion may be similar to urinary catheterization. 
         [0092]    When apparatus is extended to the site of the electrosurgery, the apparatus may be engaged for tissue removal. The apparatus may be engaged through a user-apparatus interface such as a foot pedal, button, valve, dial, nut, or any other applicable user-apparatus interface that is in communication with the electrosurgical generator. The frequency of the electricity may be selected for ablation or coagulation, or both. 
         [0093]    As the tissue is removed, the apparatus may be expanded to increase the working diameter of the apparatus. Expansion may occur through a user-apparatus interface such as a foot pedal, button, valve, dial, nut, or any other applicable user-apparatus interface that is in communication with the manipulation means, discussed through  FIGS. 2-7 , above. A greater working diameter of the apparatus improves tissue removal, including precision of removal, so as to create a greater internal passageway through the prostate. When the surgery session is ended, the apparatus may be contracted again to provide relative ease in the removal of the device. 
         [0094]    The method demonstrated in  FIG. 8  is merely one example implementation of the technology disclosed herein. The technology could also be used for other open, laproscopic, or endoluminal surgical procedures. Thus,  FIG. 8A  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus inserted into a urethra, prior to removal of any tissue at the narrowing caused by prostate tissue.  FIG. 8B  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus inserted into a urethra, after removal of any tissue at the narrowing has started.  FIG. 8C  is a side view of use of an example implementation of the apparatus of the invention, showing after removal of any tissue at the narrowing has started, with an expanded active electrode to further remove prostate tissue.  FIG. 8D  is a side view of use of an example implementation of the apparatus of the invention, showing the apparatus showing the apparatus with an expanded active electrode to further remove tissue (or to apply coagulation energy. 
         [0095]      FIG. 9  is a side sectional view of an alternative embodiment assembly  900  consistent with the technology claimed herein, wherein first electrode  910  has second electrode  920  and third electrode  930  positioned on alternative ends. In this embodiment, second electrode  920  has significantly more surface area than third electrode  930 . It will be appreciated, however, as discussed earlier in this application, that the size difference may be reversed, so that the second electrode has significantly less surface area than the third electrode. Also shown are first and second insulators,  940  and  950 . In the embodiment shown in  FIG. 9 , the energy delivered to each electrode can be adjusted to control the location and nature of delivered energy. In most embodiments the first electrode  910  is active, while the second electrode  920  and third electrode  930  are returns. However, the function of the first and second electrodes can be reversed, so that the second electrode  920  is active and the first electrode  910  is a return (along with the third electrode  920 , which would typically remain as a return electrode so as to maintain significantly greater surface area for the return electrodes). The alternation of function between the first and second electrodes can be automatic or manual. Also, it can be cycled rapidly to create a boring electrode that both cuts at the tip (second electrode  920 ) and at the sides (first electrode  910 ). Notably, it is also possible to switch the third electrode into this rotation, such that the third electrode  930  becomes active while the first and second electrodes  910 ,  920  are returns. Also, it will be appreciated that any and all of these electrodes can be used to deliver coagulation energy, not just ablation energy. In one desirable mode, coagulation energy is delivered between the second and third electrodes  920 ,  930 . 
         [0096]      FIGS. 10A to 10C  are cross sectional views of example implementations of the invention, showing different configurations for first electrodes. In  FIG. 10A , the first electrode extends about 270 degrees around the outside of the assembly; the first electrode extends about 90 degrees around the assembly of  FIG. 10B ; and the first electrode extends about 180 degrees around the outside of the assembly of  FIG. 10C . The approximate extent of the electrodes is shown by dashed lines. It will be appreciated, as shown in these examples, that various shapes of first electrodes can be used, and the first electrodes can be configured to cover relatively large or small parts of the circumference of the electrode assembly