fabric treatment system

专利摘要:
TISSUE TREATMENT SYSTEM. Methods and apparatus for treating a body cavity or lumen are described, where a heated fluid and/or gas can be introduced through a catheter and into the treatment area within the body contained between one or more inflatable/expandable limbs. The catheter may also have optional pressure and temperature sensing elements that can allow pressure and temperature control within the treatment zone and also prevent the pressure from exceeding the pressure of the inflatable/expandable limbs to thereby contain the area of treatment between these inflatable/expandable limbs. Optionally, a cold, room temperature or warm fluid such as water can then be used to quickly end the treatment session.
公开号:BR112013019091B1
申请号:R112013019091-4
申请日:2012-01-30
公开日:2022-02-01
发明作者:Daniel Rogers Burnett；Brian Michael Neil；William Walter Malecki；Kathleen Marie Koch；Gregory Jin-Keng Lee
申请人:Channel Medsystems, Inc；
IPC主号:

专利说明:

CROSS REFERENCE TO RELATED ORDERS
This application claims priority benefit to US Provisional Application No. 61/462,328, filed 5 February 1, 2011, and US Provisional Application No. 61/571,123, filed June 22, 2011, each of which is incorporated herein by reference in its entirety. FIELD OF THE INVENTION
The present invention relates to medical devices. In particular, the present invention relates to methods and apparatus for therapeutic devices capable of exposing areas of the body to elevated or reduced temperatures in a highly controlled manner. HISTORY OF THE INVENTION
In the last few decades, therapeutic intervention within a body cavity or lumen has developed - rapidly in relation to energy delivery via radiofrequency ablation. Although successful in several spheres, radiofrequency ablation has several major downsides, including complete ablation, frequent lack of visualization during catheter insertion, potential for overlap during treatment (with some areas receiving twice as much energy as others). areas), 25 tissue scorching and frequent debridement needs, frequent need for additional energy doses after debridement, and possible perforation of the body cavity or lumen, due to the rigidity of the RF electrodes.
Current technique would benefit from minimally invasive devices and methods that deliver heat energy to a desired area or extract energy from a desired area, in a consistent and controlled manner that does not inadvertently scorch or cool certain tissues or create excessive risk of unwanted organ damage. or lumen. SUMMARY OF THE INVENTION
When body tissues are exposed to slightly higher temperatures (eg, 42 degrees C or higher), focal damage can occur. If tissues are exposed to temperatures greater than, for example, 50 degrees C, for an extended period of time, tissue death will occur. The energy released by RF may then be excessive, although more controlled treatment can be achieved with heated fluids and/or vapors.
Generally, devices for delivering controlled treatment may comprise a source of heated liquid and/or gas, for example hot water/steam, one or more pumps for delivering said hot water/steam, a catheter having one or more lumens defined therethrough. and also having one or more ports for releasing or circulating the heated liquid and/or gas. eg hot water and/or steam, to a controlled location in a controlled manner. The catheter may also have optional pressure and temperature sensitivity elements. Optional pressure and temperature sensitivity elements can allow the operator to monitor and/or control the pressure and temperature within the treatment zone and also prevent the pressure from becoming too high. The treatment site may be delineated by inflatable or expandable members that are pressurized or expanded to a target pressure to form a seal with the body cavity/lumen. The heated liquid and/or gas can then be released to the area contained by the inflatable/expandable members at a pressure that is less than that of the inflatable/expandable members, thereby effectively containing the treatment area between these inflatable/expandable members. expandable. Optionally, a cold, ambient or warm temperature fluid such as water can then be used to quickly end the treatment session.
The catheter having the inflatable/expandable limbs and optional pressure and temperature sensitivity elements can be fitted within the lumen of an endoscope or other viewing device that allows therapy to be delivered under direct visualization. In addition to direct visualization, this advancement allows the scope to function as an insulator for the treatment catheter, thereby preventing unwanted exposure of body cavities/lumens to elevated temperatures found in the heated liquid and/or gas flowing inside the treatment catheter.
Generally, the heated liquid and/or gas can be heated to a temperature of between, for example, 50 and 100 degrees Celsius. Exposure to these lower temperatures may allow for more controlled tissue damage and may prevent issues typically associated with forms of . higher energy treatment. It is understood and known in the art that the lower the temperature, the longer the interruption/treatment time required. One treatment modality may be to release the heated liquid and/or gas at a temperature, for example, about 70 degrees C for 5 minutes. Another embodiment can be to treat the tissue with the liquid and/or gas heated to a temperature, for example, 90 degrees C for 30 seconds.
Among other aspects, the system may also include 1) the ability to completely treat the treatment area due to the use of limiting balloon(s) and/or use of an umbrella-type seal and use of a liquid and/or pressurized heated gas as the energy delivery medium, 2) the ability to treat relatively large areas in a very controlled manner, due to the adjustable ratio between the two treatments being of defining inflatable/expandable components (e.g. balloon(s) and /or an umbrella-type seal), 3) the ability to form a liquid and/or gas-tight seal between the balloon(s) (and/or an umbrella-type seal), due to the catheter for the distal balloon to travel within the lumen of the proximal balloon catheter (avoidance of leakage around catheters over which the balloons can seal), 4) the optional ability to monitor and control pressure within the treatment area to ensure that the treatment area is not exposed to pressure es and that the pressure in the treatment area is prohibited from exceeding a pressure of the balloons defining the treatment area, 5) the ability to reliably ablate at a controlled depth, due to the lower energy and longer exposure times , which allows the submucosa to cool on its own with incoming blood flow, 6) the optional ability to fit within an endoscope's working channel, so the device does not need to be inserted blindly, 7 ) the ability to combine thermal or cooling therapy with the delivery of active agents (e.g., anesthesia for pre-treatment of the target area or a chemotherapeutic agent for the treatment of cancer or pre-neoplastic lesions, etc.), 8 ) the ability to fill the treatment definition area with fluid (e.g. cold, ambient or hot temperature fluid) capable of neutralizing the thermal or cooling energy in the treatment area in order to ev address the potential damage caused by balloon rupture or infiltration around the balloon and/or expandable limb, 9) the ability to pre-cool (or pre-warm) the treatment area so that the submucosal tissues can be protected in relation to the elevated (or cooling) temperature to which the lumen or body organ is being exposed, 10) the ability to adjust the temperature timing and/or treatment temperature, 11) the ability to have modular, automatic or semi-automatic components -automatic and controls the handling of cooling, heating, inflations, deflations, infusions and/or extractions, 12) the ability to treat through the working channel of an endoscope or alongside an endoscope, 13) the ability to treat by a variety of endoscopes, e.g. nasal, gastrointestinal, esophageal, etc., 14) the ability to use readily available and/or disposable components to manipulate fluid and pressure controls or to utilize an automatic or semi-automatic.
Additionally, the system may also incorporate features that may allow for effective therapy. For example, the system may utilize a sub-zero degree Celsius temperature fluid wash. This cold wash can provide much better control than scorching and heating the tissue and, conversely, can provide a consistent depth of ablation in a way that allows for rapid recovery and minimal post-operative pain (as opposed to heating methods) . Furthermore, by using a liquid wash rather than cryogenic sprays (e.g., sprays that rely on the judgment of the user to determine the timing of spray application or spray location, etc.), the potential for overablation can be avoided. . Also, relatively colder cryogenic sprays have been found, in many cases, to result in damage to the endoscope, while the highest temperatures possible with the system described here (e.g., any from -5 degrees Celsius to -90 degrees Celsius) are less likely to damage the release equipment.
Second, the apparatus may utilize an umbrella-like element in the gastric space to allow ablation of tissue regions, such as the lower esophageal sphincter at the gastroesophageal junction. This ablation is generally difficult to perform using balloon-based ablation technologies, due to the expansion of the sphincter into the stomach. By using an umbrella-like structure, it expands to form a tight seal at that location, while allowing the ablation liquid and/or gas (heated or cooled) to contact the entire gastroesophageal junction. In addition, a spring element or other external force mechanism may be incorporated to provide fixed pressure and a tight seal against the internal tissue of the stomach.
The apparatus may also be used with or without a balloon in the lumens or cavities of the body, which may otherwise be sealed. For example, a hypothermic fluid washout of the uterus can be performed by introducing subzero fluid (Celsius) into the uterus by cannulating the uterus with a tube or cannula. If the tube is of sufficient diameter, the backflow of the hypothermic lavage into the cervix. of the uterus and vagina can be avoided without the need for a balloon to contain the fluid. The use of balloons can be avoided 20 for this particular type of application. In using a hypothermic wash, a fluid can be used which remains fluid even at sub-zero temperatures. This fluid can then be circulated in the lumen (with or without a balloon) in order to achieve ablation.
In using a hypothermic liquid rather than a gas, a greater thermal load can be repeatedly extracted from the tissue under controlled physiological conditions using a liquid in addition to the thermal load, which can be extracted using a compressed gas. A liquid wash, on the other hand, can be controlled based on temperature and pressure to provide a repeatable effect on the target organ. Compressed gas or other rapid cooling mechanisms, however, can be used in combination with this therapy to cool a solution to sub-zero temperatures after introduction into the body. In this variation, biocompatible liquid capable of retaining liquid characteristics in a sub-zero state or "anti-cooling solution", can be infused into a lumen or cavity, after which the cooling probe can be introduced. Heat can be collected from the anti-refrigeration solution until the desired hypothermic ablation temperature is reached for the desired duration of time. The fluid may or may not be circulated during this process via a pump or agitation element within the catheter in order to improve delivery of the ablative fluid. In yet another variation, the treatment fluid may function to expand the uterus for consistent ablation, function to distribute cryoablative cooling more evenly throughout the uterus, and possibly function to delay or prevent surface ice formation. lumen or body cavity. The apparatus can be used, for example, with lipophilic, hydrophilic or amphipathic solutions, with the latter two having the ability to remove any aqueous fluid from the surface of the target cavity or lumen that may interfere with heat conduction from the target tissues to the cryoablative fluid. In addition and/or alternatively, the apparatus and methods described herein may be used as an adjunct to other treatments, such as Her Option® therapy (American Medical Systems, Minnetonka, MN), using a cavity or lumen wash. target, such as the uterus, with the aqueous anti-refrigeration solution, either before or during treatment, in order to provide superior transmission of cryoablation with other existing cryogenic probes, without creating the insulating ice layer on the surface. In addition, flushing the lumen or target cavity with a biocompatible, anti-refrigeration solution can be performed to enhance the transmission of the cryoablative effect as an adjunct to any cryotherapy treatment anywhere in the body, when applicable. As described herein, cryoablative fluid may also be introduced and/or flushed into the target lumen or body cavity within a balloon that can be expanded to contact the walls of the lumen or body cavity. The cryoablative treatment fluid can be actively flushed into or out of the flask and/or cooled deeply by a cryogenic probe inside the flask after introduction into the body cavity or lumen. Furthermore, the anti-cooling solution may also comprise various salts and/or other biocompatible molecules capable of driving the cooling temperature of the solution below, for example, -10 degrees Celsius. Additionally, the fluid may be able to resist refrigeration even at a temperature of, for example, -90 degrees Celsius. A combination of salts, alcohols, glycols and/or . other molecules can be used to provide this resistance to refrigeration in an aqueous solution.
In yet another variation, a cryogenic probe with, for example, a protective housing and/or a fluid recirculator/agitator, can be used to ensure that the hypothermic fluid is evenly distributed. The housing can be configured in a variety of ways, as long as it exposes fluid to the surface of the cryogenic probe, while avoiding direct contact of the cryogenic probe with the wall of the lumen or cavity undergoing ablation (such as a uterus). A recirculator may comprise, for example, an agitation element at the tip of the cryogenic probe, an intermittent or continuous flow system or other fluid movement mechanism.
In another variation, to facilitate the balloon to expand and conform readily to the tissue walls of the uterus, the balloon may be inflated with a gas or liquid. Alternatively, the balloon may be partially or completely filled with a conductive material. Once the elongated shaft has been introduced through the cervix and into the uterus, the distal opening of the shaft can be positioned distal to the internal and the balloon can be implanted from within the shaft or an outer sheath. The balloon can be implanted and allowed to unfurl or unroll within the uterus. The cooling probe can be introduced through the shaft and into the balloon (or introduced after insertion of the conducting elements).
Conductive elements may be introduced into the balloon through an annular opening within the distal end of the shaft, until the balloon is at least partially or completely filled with the elements. The conductive elements may generally comprise any number of thermally conductive elements, such as copper spheres or some other inert metal, such as gold. These conductive elements can be atraumatic in shape and are small enough to fill the interior of the balloon and conform the balloon walls to the uterine walls to ensure consistent tissue contact, e.g. about 20 ml by volume of the elements. . Conductive elements can also help fill any air pockets that may form particularly near the conical parts of the balloon and insulate tissue from the ablative effects of cryoablative fluid. For example, the conductive elements may be formed into spheres having a diameter of, for example, 0.8 mm to 4 mm or greater. To ensure that the conductive elements are completely and evenly dispersed throughout the interior of the balloon, the elements can be introduced through the shaft, by means of an ejector or push rod, drill, compressed air, etc. In particular, the conductive elements can fill the conical parts of the balloon to ensure that the balloon is positioned close to and in contact with the uterine horn to fully treat the interior of the uterus.
With the conductive elements placed inside the balloon, cryoablative fluid can be introduced into and through the balloon, such that the conductive elements facilitate heat transfer from the contacted uterine walls. Once the cryoablative treatment has been completed, the conductive elements can be removed through the shaft by means of a vacuum force or other mechanical or electromechanical mechanisms, and the balloon, once deflated, can also be withdrawn from the uterus.
The cooling probe introduced into the flask may comprise several different configurations that facilitate the introduction of cryoablative fluid into the flask. In one such variation, the shaft may have one or more cooling members that protrude from the distal end of the shaft at various angles. Another variation of the cooling probe may have a swivel base and spray member positioned 20° above the shaft. The spray member may have a surface that is mesh, mesh, perforated, etc., so that cryoablative fluid introduced through the shaft can enter the turntable and spray member, where it can be equally dispersed through the spray member. and into the balloon 25 for treatment.
The cooling probe positioned inside the flask can be variously configured and can include additional variations. The cooling probe assembly may comprise an escape catheter having an atraumatic tip 30 and an imaging instrument such as an internally positioned hysteroscope. One or more support members or inserts may be positioned along the entire length of the lumen to provide structural support to the catheter and to prevent its collapse, and a probe holder (e.g., uniform cable, tape, etc.) may extend through. inside the catheter.
The probe holder can be supported inside the 5 lumen via the inserts, so the probe holder separates the lumen into a first channel and a second channel where cooling lumens can be positioned along the probe holder inside of the second channel, while the first 1 channel can remain free for the optional insertion of a 10 hysteroscope. Due to the thickness of the probe holder relative to its amplitude, the probe holder can be flexed or curved in a single plane, while remaining relatively rigid in the plane transverse to the plane.
The probe may further include one or more cooling lumens which are positioned along the probe holder within the second channel. Because the cooling lumens are located along the second channel, as separated by the probe holder, one or more windows or openings can be defined along the length of the probe holder to allow any cryoablative fluid to pass through to proliferate. through the entire lumen defined by the catheter. The number of cooling lumens can also be varied to the number of more than three lumens ending at different positions along the active part.
As cryoablative fluid is introduced and delivered through the lumen of the catheter, the escape catheter may also define one or more openings to allow cryoablative fluid to vent or escape from the interior of the catheter and into the interior of the balloon.
An example for a treatment cycle using a two cycle process might include introducing cryoablative fluid for a two minute treatment time where the surrounding tissue is frozen. Fluid can be withdrawn from the balloon and the tissue allowed to melt for a period of minutes. The cryoablative fluid can then be reintroduced and the tissue refrozen for a period of two minutes and the fluid can then be withdrawn again to allow the tissue to melt over a period of five minutes. The tissue can be visually inspected, for example, using a hysteroscope, to verify ablation coverage. If the tissue has been ablated sufficiently, the set can be removed from the uterus, otherwise the treatment cycle can be repeated as needed. In other alternatives, a single cycle may be used or more than two cycles may be used, as needed, to sufficiently treat the tissue. Furthermore, during the treatment cycle, a minimum pressure of, for example, 40 to 80 mm Hg, may optionally be maintained by the cryogenic liquid or a gas (e.g., air, carbon dioxide, etc.) to . keep the balloon and uterus open.
The balloon can be expanded within the uterus and particularly the uterine horn by an initial burst of gas or liquid. Other mechanisms can also be used to facilitate balloon expansion. A variation may utilize one or more support arms which extend from a support which can be implanted within the balloon. The support arms 25 can be variously configured, although they are shown in this example in a Y-configuration. Yet another variation can include support arms incorporated into the elongated channels or pockets defined along the balloon itself.
Apart from the balloon itself and the use of balloons for obstruction of the inner and/or outer os, inflatable balloons or liners can also be used to isolate cryogenic fluid during delivery to the balloon to protect tissue structures while around that should not undergo ablation, such as the cervix.
In controlling the ablative treatments described above, the treatment set can be integrated into a single cooling system contained entirely within the handle set or can be separated into components as needed or desired. In either case, the cooling system may generally comprise a microcontroller to monitor and/or control parameters such as cavity temperature, cavity pressure, exhaust pressure, etc.
A coolant reservoir, for example nitrous oxide canister, can be fluidly coupled to the handle and/or elongate shaft by means of a coolant valve which can optionally be controlled by the microcontroller. The coolant reservoir may be in fluid communication with the coolant probe assembly and the interior of the flask. Additionally, an exhaust lumen 20 in communication with the elongate probe and having a back pressure valve may also include a pressure sensor where one or both, the back pressure sensor and/or valve, may also be in communication with the microcontroller. BRIEF DESCRIPTION OF THE DRAWINGS
For purposes of drawings and preferred embodiments, applications to the esophagus and uterus will be presented. However, the apparatus and methods can be applied to any cavity/lumen of the body that can be visualized with an endoscope or other visualization mechanism.
Figure 1 shows an example of a device advanced through an endoscope, for example, a nasal or orally inserted scope.
Figure 2 shows an example of an advanced device through the operating channel of the nasal endoscope.
Figure 3 shows an example of a device attached to a logic controller.
Figure 4 shows an example of a device placed through the operating channel of the nasal endoscope and implanted into an esophagus for treatment.
Figure 5 shows an example of an advanced device next to the endoscope.
Figures 6A to 6C show a device being introduced through an endoscope and implanted for treatment into the esophagus.
Figures 7A to 7C show examples of a device introduced through an endoscope for insertion into the bladder.
Figures 8A to 8C show examples of a device that • prepares the treatment area with a pre-treatment wash prior to treatment.
Figure 9 shows an example of a distal obstruction having an umbrella-like shape implanted in proximity to a gastroesophageal junction for treatment.
Figure 10 shows another example of a balloon sheath endoscopic having an expanded distal occluder distal to the gastroesophageal junction for treatment.
Figure 11 shows another example where treatment fluid is introduced between balloons implanted for treatment.
Figure 12 shows another example of a size-adjustable balloon device for treating the esophagus.
Figures 13A and 13B show another example of a single balloon device for treating ablation within the uterus and/or internal endometrial tissue.
Figures 14A and 14B show yet another example of a truss/conducting cage implanted for cryoablative treatment.
Figure 15 presents another example of an external cervical os obstruction device.
Figure 16 presents another example of an internal cervical os obstruction device.
Figures 17A and 17B show another example of a device having an deployable low pressure shaping balloon used for cryogenic treatment of the uterus.
Figures 18A to 18D show another example of a shaping balloon that can also be partially or completely filled with a conductive material for cryoablative treatment.
Figure 19 shows another example of a cooling probe having one or more cooling members that protrude • from the distal end of a shaft.
Figure 20 shows another example of a cooling probe having a swivel base and spray member.
Figure 21A shows a side view of an integrated treatment set.
Figure 21B shows an example of the assembly advanced through the cervix and into the uterus, where the sheath 25 can be retracted via the loop assembly to deploy the balloon.
Figure 22A shows a side view of a system that allows an adjustable extension of the balloon along the axis to be configured.
Figure 22B shows a side view of the everted balloon within the lumen axis for release.
Figures 23A and 23B show perspective and side views, respectively, of another example of a cooling probe assembly having a uniform cable integrated across the probe.
Figure 24 shows a perspective view of the cooling probe assembly with one or more openings 5 defined along the probe assembly.
Figures 25A and 25B show end views of a cross-section of the cooling probe and the distal end of the probe.
Figures 26A to 26L show perspective views of various tubular members that can be used for the cooling probe assembly.
Figures 27A and 27B show perspective views of a cooling probe assembly utilizing one or more linearly discrete ring members 15 coupled together.
Figures 28A and 28B show end cross-sectional views of another variation of a probe assembly. cooling system coupled via cover and/or insert members.
Figure 29 shows a perspective view of another variation of a cooling probe assembly having one or more insert members coupled along a coiled spring body.
Figures 30A and 30B show cross-sectional side views of another variation of insert members supported along a spring body.
Figure 31 shows a detailed side view of a variation of a pivoting cooling lumen body.
Figure 32 shows a side view of another variation of one or more insert members having an integral cover.
Figure 33 shows a side view of yet another variation of one or more insert members having a sliding joint attached.
Figure 34 shows a side view of another variation of a spring body having one or more cooling lumens affixed directly to the spring.
Figure 35 shows a side view of another variation of a spring body having the one or more insert members.
Figure 36 shows a side view of another variation of a spring body having the one or more cooling lumens and a secondary lumen.
Figure 37 shows end cross-sectional views of secondary lumen variations.
Figures 38A and 38B show perspective views of another variation of the cooling probe. using one main release line and at least two parallel release lines. ■
Figure 38C shows a detail view of the parallel release line having an adjustable mandrel slidably positioned therein.
Figure 39 shows a cross-sectional side view of another variation of the cooling probe assembly, where the main release line and parallel release lines are in fluid communication through a common chamber.
Figure 40A and 40B show end cross-sectional views of variations in the exhaust lumen and respective cooling lumens.
Figure 41 shows a cross-sectional side view of another variation of a cooling probe assembly having a single lead-in line and a single release line.
Figure 42 shows a cross-sectional side view of a cooling probe assembly inserted into a balloon within the uterus.
Figures 43A and 43B show side views of several examples of parallel release lines having the 5 openings aligned in different directions.
Figure 44 shows a side view of a variation of cooling probe having a beveled window for easy viewing.
Figure 45 shows a side view of an example of a balloon having one or more extendable support arms within the balloon.
Figure 46 shows a side view of another example of a flask having one or more support arms affixed to the cooling probe assembly.
Figure 47 shows a side view of another example of a balloon having one or more support arms that also define one or more openings for releasing fluid. cryoablative.
Figure 48 shows a side view of yet another example of a balloon having the one or more support arms positioned within elongated channels along the interior of the balloon.
Figure 49 shows a side view of an example of an inflatable liner or balloon located along the outer distal surface of the sheath.
Figure 50 shows a side view of another example of an inflatable liner or balloon located along the inner distal surface of the sheath.
Figure 51 shows a side view of another example, where expandable foam can be deployed through the outer sheath.
Figure 52 shows a side view of another example where a heating element may be located along the inner or outer surface of the elongate shaft.
Figure 53 shows a side view of another example where a ring balloon can be inflated along the sheath or shaft to isolate surrounding cervical tissue or to ensure secure placement of the shaft and/or balloon during treatment.
Figure 54 shows a cross-sectional side view of another variation, where the outer sheath can be formed as an inflatable structure.
Figures 55A and 55B show side views of variations of an outer sheath having a reconfigurable distal end.
Figure 56 shows a side view of another variation of a balloon positioned along an outer surface of the outer sheath.
Figure 57 shows a cross-sectional side view of a variation of a double-sheath design.
Figure 58A and 58B show cross-sectional detail views of the seal between the inner and outer sheaths.
Figure 59 shows a partial cross-sectional side view of another double-sheathed variation having an expandable balloon contained between the sheaths.
Figure 60 shows a side view of another variation of a sheath having a reinforced structure.
Figure 61 shows a cross-sectional side view of another variation of an outer sheath having an adjustable balloon member.
Figures 62A and 62B show cross-sectional side views of another variation of an outer sheath having a reconfigurable distal end.
Figure 63 shows a cross-sectional side view of the reconfigurable distal end having one or more lubricated surfaces.
Figure 64 shows a partial cross-sectional side view of another variation where the reconfigurable distal end can be affixed as a separate component.
Figure 65 shows a cross-sectional side view of another variation where a distal end of the cooling probe has a tapered distal end.
Figure 66 shows a side view of another variation of an outer sheath having a radially expandable portion.
Figures 67A and 67B show cross-sectional side views of variations of the locking mechanism for the expandable part.
Figures 68A and 68B show cross-sectional side views of an illustrative example of an upper center coupling mechanism.
Figure 69 shows a cross-sectional side view of another variation of an outer sheath having one or more distal shoulder members.
Figure 70 presents a cross-sectional side view of the one or more shoulder members implanted in their expanded configuration and fixed in relation to the cervical tissue.
Figure 71 shows a cross-sectional side view of another variation where the lugged distal end is positioned in a tapered outer sheath.
Figure 72 shows a side view of an example of how the outer sheath can be initially deployed and secured and the cooling probe assembly advanced separately.
Figure 73 shows a side view of another variation where the outer sheath is configured as a corrugated structure.
Figure 74 shows a partial cross-sectional side view of another variation of the outer sheath having an inflatable balloon along an inner surface.
Figure 75 shows a partial cross-sectional side view of another variation of the outer sheath having an inflatable balloon along an outer surface.
Figures 76A through 76D show end cross-sectional views of variations of the outer sheath having an integrated feature to provide additional insulation to the surrounding fabric.
Figure 77 presents an exemplary schematic illustration of the treatment set integrated into a single cooling system. DETAILED DESCRIPTION OF THE INVENTION
FIGURE 1 shows a perspective view of an example treatment assembly 10 positioned within an operating channel 14 of an endoscope 12 (e.g., nasal or orally inserted scope). In that example, the treatment device 16 itself may utilize a first catheter 18 having an inflatable or expandable balloon member 22 and a second catheter 20 which is freely slidable relative to the first catheter 18 and also having an inflatable balloon member 24 at its distal end. The first catheter 18 as well as the second catheter 20 may have a liquid and/or gas-tight seal 30 formed at the proximal end of the catheters. The inflatable and/or expandable limbs 22, 24 (shown in this example as inflated balloons) can be pressurized to occlude the lumen efficiently and safely. Balloons can be filled with fluid at cold or room temperature to avoid possible damage caused by balloon rupture or seepage around the balloon. Pressure within the inflatable or expandable balloon members can also be monitored to ensure that an airtight seal is formed within the lumen or body cavity.
Additionally, liquid may be introduced to the treatment area through a liquid and/or gas port 28 and into the lumen of the catheter which terminates with the proximal balloon 22 and leaves the catheter through perforations or holes 32 within the second catheter 20 which terminates at the distal balloon 24, although this flow path can be easily reversed if necessary. Alternatively, one or more ports may be projected into the lumen between the distal 24 and proximal 22 balloons so that heated or cooling fluid exits one or more ports 32 in the lumens near the distal balloon 24, i.e., then , evacuated into a designated port or ports within the lumen of the first catheter 18 closest to the proximal balloon 22. In this variation, the endoscope 12 can isolate the catheters, allowing the catheters to be - much smaller than would otherwise be possible , and allowing them to fit within the working channel 14 of a standard endoscope 12. One or more pressure sensors may be used to detect either balloon inflation pressures and/or the pressure seen by the body cavity/lumen that is exposed to the treatment liquid/vapour. In this way, the flow of liquid/vapor can be controlled by pressure sensing elements within the cavity/lumen of the body to ensure safe pressures are never exceeded. Manual controls can be used to create and/or maintain these pressures (e.g. syringes with regulating valves) or automatic and/or semi-automatic systems can be used as well (e.g. pumps with PID loops and pressure). While the tissue treatment liquid and/or gas may be heated or cooled prior to introduction to the tissue-contacting treatment area, the liquid and/or gas may alternatively be heated or cooled after introduction to the area. of treatment and already in contact with the tissue.
Figure 2 shows an example where the second catheter 20 and the distal balloon member 24 is slidable relative to the proximal balloon 22. These examples illustrate the endoscope inserted through the nasal cavity and advanced through the ES esophagus, wherein the catheters 18, 20 may comprise single or multiple lumen catheters having inflation lumens for the distal 24 and proximal 22 inflatable/expandable elements, infusion port and extraction port. At least one of the catheters can be fitted with a pressure transducer 42 or a lumen to carry the pressure signal from the treatment area back to the controller or quadrant indicator. Pressure sensitivity can be accomplished by means of a small air cap close to the distal balloon 24, but within the treatment area. Both balloons 22, 24 can be inflated along the ES esophagus in the vicinity of the GJ gastroesophageal junction, close to the ST stomach to create a treatment space 40 that encompasses the region of tissue to be treated.
In an alternative embodiment, an extraction lumen can be omitted as a pre-set dose of heated liquid and/or gas can be released, allowed to stop, and then extracted through the same lumen or harmlessly with cold fluid infusion. This treatment algorithm would provide an even simpler therapy and would rely on excluding a particular area and exposing that area to a liquid or vapor with the desired energy. The infusion of the liquid or vapor can be controlled to ensure that the treatment area is not exposed to excessive temperatures.
Figure 3 presents another example where the treatment set 10 may be in communication with a controller 50, such as a logic controller. The controller 50 can control certain parameters, such as infusion pressure 54 of the fluid, as well as the temperature of the fluid 56 and can be coupled to the assembly by one or more cables 52. The pressure in the treatment area, the elapsed time, the temperature of the fluid and extraction rate can also be monitored and controlled.
Figure 4 shows a detailed view of the treatment area 40 defined, in this case, by two balloons 22, 24. The first catheter 18 can open in the lumen, just after the proximal balloon 22 and this catheter 18 can be inserted together or before insertion of the second catheter 20. The inner diameter of the first catheter 18 is greater than the outer diameter of the second catheter, allowing liquid (and/or steam) to be infused or extracted around the outer diameter of the second catheter 20. second catheter 20, a first lumen - for balloon inflation, and a second lumen for evacuating the treatment region 40. With the balloons inflated, in contact with the ES esophagus, the treatment area 40 can encompass the tissue region to be treated, for example, a lesion 60 such as Barrett's esophagus or neoplastic lesion in the esophagus and the distal end of the endoscope 12 can be positioned in close proximity to the proximal balloon 22 and the treatment fluid and/or gas 66 can be infused through the lumen cancel air 70 defined by means of the first catheter 18 and between the second catheter 20, so that fluid 66 can enter through the opening 62 to the treatment region 40, while contained by the balloons. Once the treatment has been completed, fluid can be evacuated 68 through one or more openings 64 located along the second catheter 20, proximal to the distal balloon 24 and proximally through the second catheter 20 through the evacuation lumen 72. As mentioned above, a pressure sensor 42 (e.g., pressure measuring air cap) can be positioned along the first 18 and/or the second 20 catheter to sense the various parameters. Additionally, the treatment liquid and/or gas may include any number of liquids, vapors, or other chemical (e.g., chemotherapeutic) actives or inactive compounds for further tissue treatment.
In the case where treatment is provided by a simple timed interruption, the extraction 72 and infusion 70 lumens, both, may not be used. The pressure sensing element 42 (solid state, piezoelectric or other method) may be located on the first or second catheters and the second catheter and may comprise a single slide balloon. A pressure sensor for the treatment can be omitted as long as the pressure can be controlled by other mechanisms, for example a check valve or a simple gravity fluid column. An . Active pressure measurement, however, can ensure that safe pressures are not exceeded.
The second catheter 20 can easily fit inside the first catheter 18 and can slide inside the first catheter 18 until its distal balloon 24 is distal to the first balloon 22. The distal balloon 24 can then be inflated just beyond the distal part. from the treatment area 40 and the endoscope 12 can be pulled back. The most proximal extent of lesion 60 can then be identified and the proximal balloon 22 can be inflated close to this area. Once the treatment area 40 has been enveloped (which can be verified by infusing the liquid 66 and/or steam in visualization and observing the seal around the balloon, balloons and/or expandable member), the lumen or body cavity it can then be filled with the treatment liquid and/or steam at a safe pressure. The liquid and/or vapor may also contain active agents (e.g., chemotherapeutic and/or anesthetic agents) and comprise more than simply an inactive liquid and/or vapor. Options would be for active agents to be released before, during and/or after heating (or cooling) liquid and/or vapor treatment.
As the treatment set 16 does not contain the treatment liquid or vapor within the balloon(s) or expandable member and allows it to flow freely over the treatment area, therapy can be delivered consistently, leaving no areas untreated (as is often seen with balloon infusion or RF therapies) . Additionally, treatment can be performed with a heated liquid (instead of a high-energy electrode or excessively hot steam) or more controlled treatment can be achieved through the use of a relatively cooler liquid with a longer treatment time. . Furthermore, the ES esophagus is a fluid transport (lumen) type organ and may be more compatible with fluid-based therapies than RF-based therapies. It is also believed that the safety margin of these treatments may be better than with an RF-based therapy.
Figure 5 shows an alternative embodiment of the device, in which the first catheter 18 and the second catheter 20 of the treatment set 16 can be inserted alongside an endoscope 12 that can be used to provide visualization. Due to the small size of the catheters, this realization is feasible.
As Figures 6A to 6C illustrate, there is an example for a set placement procedure for treating a body lumen such as the ES esophagus. The catheters may be inserted simultaneously or separately through the operating channel of the endoscope 12. In one example, the first larger catheter 18 may be inserted first, followed by the insertion of the second catheter 20 into the lumen of the first catheter 18. single or multi-lumen balloons have been inserted and after the endoscope 12 is advanced through the ES esophagus and in proximity to the tissue treatment region, the distal balloon 24 can be advanced to define the distal end of the treatment area and inflated ( eg with cold, ambient or body temperature fluid) while viewing through the endoscope 12, as shown in Figure 6A. The endoscope 12 can then be pulled back until the proximal end of the desired treatment area is identified and the proximal balloon 22 can be slid over the shaft of the second catheter 20 and inflated (e.g., with fluid at cold, ambient or cold temperatures). body) in a location very close to the closest part of the lesion, as shown in Figure 6B.
With the treatment area 40 now encased in these balloons, an optional pressure capsule 42 (e.g., solid state, piezoelectric, or other pressure sensing method) can be inflated and treatment can proceed, as shown in Figure 6C. The treatment session then exposes the lumen or body cavity to pressurized fluid at a positive pressure in the range of, for example, 5-100 cmH2O (although this pressure can be maintained at a level below a balloon inflation pressure). inflation) at temperatures between, for example, 50 and 100 degrees Celsius, for a period of, for example, 1 second to 10 minutes. Additionally and/or alternatively, treatment area 40 may be flushed for a period of time with an anesthetic (e.g., lidocaine or bupivicaine) to reduce pain with the procedure prior to application of thermal energy or other active compounds. Likewise, ablation can be performed to a consistent depth of, for example, about 0.5 mm, along the entire ES esophagus.
Figures 7A to 7C illustrate another example for treating an enveloped body cavity (shown here as a BL bladder). In this example, a single balloon can be used to infuse and extract the treatment fluid. Pressure can be monitored to ensure therapy is safe and a relatively lower temperature fluid can be used (eg 42-100°C) so that the entire cavity can observe a controlled, uniform heat load. The order or insertion of the catheter may vary as may the sequence for balloon inflation or exposure to active or inactive liquids or vapors in this or any embodiment of the device. As shown in Figure 7A, an endoscope (or cystoscope) 12 can be inserted into the BL target organ, then the fluid catheter 20 can be advanced to the . lumen. With the endoscope 12 inserted and the occlusion balloon 24 inflated (e.g., with unheated fluid) to seal the organ, a pressure sensor 42 can also be optionally inflated to measure pressure, as shown in Figure 7B. Optionally, an anesthetic or pretreatment drug can be delivered to the BL bladder, if desired. Then, a high or low temperature fluid 80 can be circulated within the BL bladder at adequate pressure to safely distend the organ to ensure complete treatment, as shown in Figure 7C.
Figures 8A to 8C illustrate another example for treatment, where the use of a fluid wash to prepare the treatment area (here presented as the BL bladder) can be performed prior to the application of energy compounds and/or thermal actives (or of cooling). As described above, the endoscope 12 and catheter 20 can be introduced into the BL bladder and subsequently sealed with the occluding balloon 24, as shown in Figures 8A and 8B. Preparation of the treatment area may involve the use of an anesthetic to decrease pain during therapy or the use of an arterial constrictor to reduce blood flow to the organ or lumen. Alternatively, other pretreatment fluids 82 may include, for example, anesthetic, vascular constrictor, cooled fluid, active component antidote, etc. The pre-treatment fluid 82 can be evacuated (or left inside the bladder BL) and the wash with the treatment fluid 80 can be introduced into the bladder BL for treatment, as shown in Figure 8C.
Alternatively, the pretreatment fluid 82 may also be cooled (or heated) to cool (or heat) the lumen or organ prior to treatment so that thermal (or cooling) energy can be applied to the inner surface. from the lumen or body cavity with minimal transmission or conduction of the elevated (or cooling) temperatures to the submucosal tissues (or tissue lining of the organ or lumen of the body). The use of pre-treatment of the area can avoid damage to the base tissues, in order to avoid many of the complications of the therapy. For example, strangulation and/or tissue stenosis (or compression) can be avoided by controlling the depth of penetration which can be controlled by pre-treating the area with a cooled fluid so that the submucosa can absorb significant amounts of heat without reach harmful temperatures.
The depth of penetration can also be controlled by using a lower temperature fluid for thermal ablation so that the submucosa can cool on its own with its tough vascular circulation (which is less tough in the mucosa and epithelium). In the event that an active compound is used, as well, an antidote to that compound can be delivered to the patient (either systematically or as a local pretreatment) so that the underlying tissues and submucosa are not damaged. An example of this is the use of powerful antioxidants (systematically or locally) before washing the esophagus with, for example, methotrexate. Methotrexate can have a powerful effect on tissues that are directly exposed to it in the lumen or body cavity, but antioxidants can prevent methotrexate from penetrating deeper. The neutralizing compound can also be placed inside the balloon or in the lumen of surrounding body lumens or cavities to prevent exposure of these areas in the event of a balloon rupture.
Figure 9 presents another example in which the distal obstruction member can be configured into an umbrella-like element 90 that can be expanded in the ST stomach and placed over a region of tissue that is typically difficult to occlude by a balloon. For example, this form may allow ablation of the lower esophageal sphincter LES at the gastroesophageal junction (or other sphincter region if used elsewhere). The expandable, umbrella-like structure 90 can form a tight seal at this location while allowing ablation fluid (hot or cold) to contact the entire gastroesophageal junction. Once expanded, the umbrella-like member 90 can be held firmly to the ST stomach by traction on the endoscope 12 or by a tensioning member on the catheter and balloon itself.
In addition, that element 90 may optionally incorporate a polarized or spring element or other external force mechanism to provide fixed pressure and a tight seal to the internal tissue of the stomach. Alternative structures may also incorporate a more complex cage of nitinol (or other rigid material) connected by a thin, water-tight film. For example, nitinol can be used to decrease the overall profile of the blocking element and increase its potency and durability.
Figure 10 presents another example using a balloon sheath endoscopic used as a distal occluder that allows exposure and treatment of the distal gastroesophageal junction. In that embodiment, the second catheter 20 may have a distal occluding balloon 100 which may be passed through the operating channel of the endoscope 12 or through a channel incorporated into the balloon sheath itself (outside the actual endoscope). Once expanded into an enlarged form, the balloon 100 can be retracted to fully fit the lower esophageal junction LES to form the distal seal by traction on the endoscope 12 or by a tensioning member on the catheter and balloon itself. This gastric obstruction balloon may allow exposure of the junction. gastroesophageal reflux, while preventing fluid from flowing into the ST stomach. Balloon 22 may be configured to be saddle-shaped, circular, wedge-shaped, etc. It can also be self-expanding and non-inflating.
Additionally, the proximal balloon 22 can be configured to be part of the sheath that is placed over the endoscope tip 12 or can be formed directly onto the endoscope tip itself. An inflation lumen may run within the endoscope 12 or may run alongside the endoscope 12 in a sheath or catheter. The balloon sheath can also incorporate a temperature sensor, pressure sensor, etc. In addition, the proximal occluding balloon 22 may optionally incorporate a temperature or pressure sensing element for therapy and may be positioned through the operating channel(s) of the endoscope 12 or alongside the endoscope 12 within the endoscope. balloon sheath.
In yet another embodiment, in order to reduce the risks associated with fluid flow and lavage, a fluid or gel can be infused into the esophagus between the balloons, then heated or frozen in situ, in order to provide the desired ablative effect without the circulation of any fluid or gel. In an example of this configuration, a gel can be infused into the esophagus and pressurized to a safe level (e.g. 30100 mmHg), which can then be rapidly cooled using, for example, a compressed gas cooling element and/or Peltier junction type. The gel can cool to a temperature below that water and allow rapid transmission of the ablative temperature to the tissues being treated. Such a gel may also be a liquid with a cooling point below that of water, in which case the treatment zone may be flushed with such a fluid prior to treatment to remove free water and prevent crystal formation during therapy. Once the therapy was . completed, the gel or liquid can be removed or left in the esophagus to be passed to the stomach. In the event that a Peltier cooling or heating element is used, the polarity can be reversed once therapy is complete in order to reverse the temperature and end the ablation session.
The distance from the lower end of the most distal part of the catheter may, on the other hand, be about 150 mm. The distance between the proximal and distal balloons is operator adjustable, but can be adjusted, for example, from as small as 0 mm to as large as 25 cm. The treatment zone can have a variation of, for example, 3 to 15 cm.
Yet, in a further embodiment, a power generator (e.g., an RF electrode or direct lead or other power source) can be advanced to the treatment area in a protective sheath (to avoid direct contact with body tissues). and energy can be applied to the treatment fluid to heat it to the desired temperature. Once the fluid is adequately warmed and the time necessary to achieve controlled ablation has elapsed, the fluid can then be evacuated or neutralized with the inflow of cooler fluid. This realization would allow for a very low profile design and would not need any fluid heating elements outside the body.
In another variation, the cavity or lumen can be exposed to hot water at a temperature lower than, for example, 100 degrees Celsius, but higher than, for example, 42 degrees Celsius, to allow easier control of the treatment, due to a longer treatment period. Variations for optimal hyperthermic treatment include temperatures between, for example, 42 and 100°C and periods of . exposure ranging from, for example, 15 seconds to 15 minutes. In this embodiment, the treatment can be carried out with an active fluid (e.g. Methotrexate) or an inactive fluid, at a temperature, e.g. 90 degrees C, for a period of e.g. 5-60 seconds, depending on the depth of treatment. desired penetration.
Figure 11 shows another example of a balloon sheath endoscopic that can be used to provide proximal obstruction of the treatment area 40 and can house one or more temperature and pressure sensors. This variation may incorporate a recirculation or mixing/stirring mechanism 110 incorporated into the device which may be actuated within the treatment area 40 once the treatment fluid has been introduced to allow for further cooling/heating. The distal obstruction balloon 100 can be inflated into the ST stomach and pulled proximally with controlled traction to the gastric portion of the lower esophageal sphincter LES, as previously described.
In this example, a cooled liquid wash (or steam infusion) can then be initiated and the tissue ablated via refrigeration. A pre-treatment wash, for example, a hypertonic, hyperosmotic saline solution, can be introduced with the above refrigeration temperatures, followed by a sub-zero temperature wash to ablate the tissues within the treatment area 40. The hypertonic, hyperosmotic fluid can reach temperatures below, for example, -40 degrees C, without creating ice crystals in the treatment area 40 due to the pre-treatment wash which removes any free water. The treatment fluid after the pre-treatment wash may have temperatures of, for example, -2 degrees C to -40 degrees C, for ablation or, more particularly, a range of . temperature from, for example, -5 degrees C to -20 degrees C. This temperature range can allow refrigeration and crystal formation in exposed tissues without damaging the underlying submucosa (which is protected by the circulating body temperature blood that prevents refrigeration). This temperature range can also be easily achieved with hypersalination of aqueous fluid using sodium chloride and can inhibit any unwanted tissue damage with brief contact. Also, the use of heavily saline wash or other sub-zero solution wash can provide optimal sealing of the plug flasks, where any sub-zero temperatures outside the pre-washed treatment zone can form an impaction of ice crystals. and preventing any additional fluid flow out of the treatment zone. This hyper-physiological water solution is, however, a cooling solution, however, and any aqueous or non-aqueous liquid or vapor that can be infused or extracted at that temperature could be used. Alternatively, the cryoablative fluid may simply comprise nitrous oxide (N20) or be formed by cooling ethanol or other aqueous or lipophilic fluid to sub-zero cooling temperatures with compressed gas or dry ice. In another alternative, compressed CO 2 or dry ice can be introduced into the fluid (eg, ethanol, butylene glycols, propylene glycol, etc.) to cool it to, for example, -50 degrees C or below.
Despite the potential for toxicity, ethanol can be used for a liquid wash, as ethanol resists refrigeration below -118°C and is relatively biocompatible, although ethanol is dose-dependent for toxicity. A liquid wash with about 75% to 99.9% ethanol concentrations can be used to good effect and has been shown to show that a coolant layer develops very quickly, which also inhibits further ethanol absorption. For example, a concentration of 95% ethanol can be introduced at a temperature of about, for example, -80 to -50 degrees C, for a treatment time of about, for example, 5 minutes, using 0.25 to 0.5 liters of cryogenic fluid. A copper and ethanol composition can also be very useful as ethanol resists refrigeration, while aqueous fluids will cool and expand, thereby moving the metal particle out of direct contact with the tissue.
In the case where nitrous oxide is used as the cryogenic fluid, the nitrous can be introduced through a nozzle or spray at a pressure of, for example, 600-800 psi, at a temperature of about -88 degrees C. temperature and pressure can be used for a treatment time of about, for example, 3 minutes.
The use of a sub-zero solution within this range may also allow for precise control of treatment depth, as tissue damage would not begin to occur until a temperature differential of about 37 degrees C is reached (assuming a temperature body temperature of 37 °C), but once this threshold is reached, tissue damage occurs rapidly due to the formation of ice crystals. In contrast, tissue damage is on a continuum spectrum with hyperthermia and damage can begin to occur at a temperature differential of, say, 5 degrees C. Thus, the ability of the vasculature to protect the underlying tissues from damage is greatly enhanced. reduced due to the small difference between protective blood temperature versus ablation fluid temperature. With hypothermic lavage, the protective blood may differ by, for example, 37 degrees C, in temperature and thus may allow control of the ablation depth, based on the fluid lavage temperature and exposure time.
Figure 12 illustrates another variation in which a conformal balloon 111 having an adjustable diameter as well as length size can be positioned along or near the distal end of the catheter 18. The conformal balloon 111 can be advanced into the esophagus (shown here in the esophagus, but applicable to any cavity) in a deformed state. Once the balloon 111 has been positioned in a desired manner along the length of the ES esophagus to be treated, the catheter 18 can optionally utilize a vacuum that can be collected along the entire length of the balloon 111, through perforations or openings in the balloon 111 to serve as a shield to prevent migration of liquid, gas and/or ablation conductive material in the event of balloon rupture. Vacuum can also be used to remove air, fluid or particulate between the outer wall of the balloon 111 and the tissue to improve contact and heat transfer of the hyperthermic or cryogenic fluid and the tissue. Additionally and/or alternatively, a distal vacuum may be collected via a port 117 distal to the balloon 111 either alone or in conjunction with a vacuum port proximal 115 proximal to the balloon 115.
With catheter 18 and balloon 111 desirably positioned for treatment, an insulating sheath 113 can be advanced on catheter 18 and balloon extension 111 to vary an inflation extent of balloon 111 emerging from insulating sheath 113. The variable balloon extension 111 can be adjusted to allow treatment of any variant extensions of the ES esophagus during a single ablation treatment. This design can avoid dangerous ablation overlap zones of ablated tissue.
The balloon 111 itself can be comprised of a . compatible or non-compatible material, but, in both cases, being able to directly contact the tissues to be ablated. The flask 111 may likewise be filled with a hyperthermic or cryogenic material and/or may utilize liquid, gas and/or conductive solids, as described herein.
Although esophageal therapy is illustrated, this therapy could be used in any body cavity/lumen for therapeutic purposes including but not limited to gastrointestinal therapy, stomach tightening (e.g. post bariatric surgery), urogynecological uses (treatment of pre-neoplasms or neoplasms). cervical, endometrial treatment of internal tissue, stress incontinence therapy), prostate therapy, intravascular therapy (e.g. varicose veins) or treatment of any other body cavity/lumen. In the case where an entire body cavity is being treated (eg, the entire uterus), a single balloon system may be sufficient to exclude the entire cavity. Cycling or stopping of fluid can then be accomplished using pressure-controlled exposure of the cavity or lumen.
Figures 13A and 13B present another example of how the system can be introduced, for example, into a UT uterus, through the cervix for treatment by means of a lavage catheter 20. In that example, the catheter 20 may have a diameter of about, for example, 8 mm, or, in other examples, a diameter of about, for example, less than 6 mm. Infusion of lavage fluid can fully dilate or partially dilate the uterine walls. Optionally, catheter 20 may incorporate a tip 120 to perform one or more functions, including, for example, an expandable cage or support to prevent direct exposure of a cryogenic probe to the tissue walls of the UT uterus, an agitator, or . recirculator to ensure equal distribution of cryoablation effect etc. As previously described, the system can be used with lavage or infusion, then cooling the cryogenic fluid probe. In an alternative embodiment, infusion of an anti-refrigerant fluid and insertion of the cryogenic probe can be done separately with cooling of the anti-freeze done after insertion of the cryogenic probe.
In this and other examples, therapy may be guided by time/temperature tracking or visualization (eg, hysteroscope, endoscope, ultrasound, etc.). Pressure can be regulated by a pressure sensor aligned with the infusion or extraction lumen or a dedicated pressure lumen on a multi-lumen catheter. Additionally, the pressure can also be regulated by limiting the infusion pressure (eg, infusion bag height, maximum infusion pump pressure, etc.). Any organ, cavity or body lumen can be treated using the lavage and/or infusion/cryogenic probe technique described here for the uterus.
Figures 14A and 14B illustrate another variation of a treatment system that utilizes a thermally conductive fiber, cage or lattice arrangement 130 that can be implanted within the UT uterus. In this variation, the endoscope 12 can be advanced through the cervix and at least partially into the UT uterus, where the fiber array or lattice 130 can be implanted from the distal end of the endoscope 12, where the array 130 can be positioned in a state. tablet for release, as shown in Figure 14A. The array 130 can be advanced into the UT uterus, where it can then be expanded into an implanted configuration 130', as shown in Figure 14B. The individual cryogenic probes of the expanded array 130' may be in , distributed with respect to the distal end of the endoscope 12 in several directions to be in direct contact or close proximity to the tissue to be treated.
After implantation, the implanted array 130' may be rapidly cooled to transmit heat within the uterine walls to the array 130' to provide a consistent cryoablative effect throughout the body cavity or lumen. Array members 130' may be cooled by conductive cooling or by infusing a cooling fluid (as described herein) through array members 130'. Similar to conductive fluid, cooled array 130' can provide consistent ablation of the entire lumen with a single application of array 130'. The individual members of the 130' array
Additionally and/or alternatively, arrangement 130' may be used in conjunction with infusion and/or flushing of fluid in order to optimize therapy. One or more sizes and shapes of arrangement 130' may be available, depending on the size and shape of the cavity to be treated. Furthermore, the array 130' can be formed of any material as long as it has a thermal conductivity greater than, for example, 2 W/m-K, such as a metal with a relatively high thermal conductivity.
Figure 15 shows another variation of a device that can utilize cryogenic lavage treatment inside the UT uterus. In this example, the distal end of the endoscope 12 can be advanced through the CV cervix and into the UT uterus, where a cryogenic probe 140 can be implanted, as shown. One or more inflatable balloons 144 may be inflated, for example, within the outer os, or a balloon 142 along the outer surface of the endoscope 12 may be inflated within the extent of the os itself. Alternatively, a single balloon (eg, having an hourglass or dumbbell shape) can be inflated to block the external os and the extension of the os itself. With the UT uterus obstructed, cryogenic treatment or lavage can be performed inside the uterine lumen.
Another variation is illustrated in Figure 16 which shows the endoscope 12 advanced through the CV cervix with the distal end 156 positioned within the uterine lumen. An optional balloon 152 located near the distal end of the endoscope can be inflated into the UT uterus and then pulled proximal to the internals with a fixed amount of tension to occlude the opening. Additionally and/or alternatively, a proximal balloon 154 positioned along the endoscope 12 proximal to where the CV cervix is located may also be inflated to further provide obstruction of the entire uterus. Then, the outer cervical fitting portion, e.g., proximal balloon 154, may be secured in place with respect to the endoscope portion 12 spanning the cervical os to provide consistent tension. The proximal balloon 154 may also have a spring-like function to provide consistent tension, independent of tissue relaxation and accommodation.
With the UT uterus obstructed, the endoscope 12 can then be used to provide cryogenic treatment or lavage. Optionally, the endoscope 12 may also incorporate one or more vacuum ports along the length of the shaft to seal and provide a guarantee against the flow of fluid from the UT uterus.
Optionally, the uterine horn can be temporarily occluded to block the openings of one or both fallopian tubes prior to cryogenic treatment. The occluding member(s) 158A, 158B may comprise, for example, balloons, inserts, energy-based ablation to contract the opening, hydrophilic or hydrophobic gel-based solutions, or any other modality that is capable of reversing or irreversibly sealing the fallopian tube. Additional fallopian tube obstruction may be temporary or permanent (if sterility is desired).
Once the cryogenic procedure has been completed, the clogging elements 158A, 158B can be removed or allowed to passively corrode. Alternatively, they can be left occluded for those desiring sterility. Obstruction of the uterine horn prior to a lavage may allow increased fluid pressure and fluid flow within the UT uterus.
Figures 17A and 17B illustrate another variation of a low pressure forming balloon. In this variation, a conformal balloon 160 can be implanted from the distal end 156 of the endoscope 12 and then inflated with the cryogenic liquid/gas (as described herein) while in the UT uterus. Balloon 160 can be formed to resist tearing at low and high temperatures and can be further configured to conform well to the anatomy of the UT uterus. For example, balloon 160, when inflated, may be shaped to approximate the lumen into which it is inflated and/or be of varying sizes to accommodate different patient anatomies. In the present example, the expanded balloon 160' can be formed to taper and have two rounded parts to expand in close contact at the uterine horn UC, as shown, without painful deformation or distension of the uterus UT at a pressure, for example, less than 150 mmHg.
In addition, the expanded balloon 160' may have a wall that is relatively thin (eg, 0.040 in. or less) to facilitate thermal conduction through the balloon. Balloon 160 may also be thin enough so that folding balloon 160 alone does not create a significant thermal barrier, allowing uniform ablation in the event that a non-conforming balloon is used. For treatment, the 160' expanded balloon can be filled with cryogenic liquid, gas, or a thermally conductive compound (as described above) to subject the contacted tissue to cryogenic and/or hyperthermic injury (e.g., steam, plasma, micro- wave, RF, hot water etc.). Additionally and/or alternatively, the 160' balloon can also be used to transmit photodynamic therapy light to the UT uterus or ES esophagus. This modality can be used to achieve ablation of any body cavity or lumen.
Additionally, one or more vacuum ports can be used anywhere along the length of the shaft to seal and provide a guarantee against the flow of fluid from the UT uterus in the event of a balloon rupture.
Additionally, one or more inflatable balloons 160 may also be used to block the internal or external, also as described above.
In another variation, to facilitate the balloon to expand and conform readily against the tissue walls of the UT uterus, the balloon may be inflated with a gas or liquid. Alternatively, as shown in Figures 18A to 18D, the balloon may be partially or completely filled with a conductive material. As shown in Figure 18A, once the elongate shaft 170 has been introduced through the cervix CV and into the uterus UT, the distal opening 172 of the shaft 170 can be positioned distal to the interior and the balloon 174 can be implanted into the uterus. shaft 170 or an outer sheath (described below in further detail). The balloon can be implanted and allowed to unfurl or unroll within the UT uterus, as shown in Figure 18B. The cooling probe 178 can be introduced through the shaft 172 and inside the balloon (or introduced after the insertion of the conductive elements).
Because balloon 174 is used to contact tissue and thermally conduct heat through the balloon, the balloon material can be comprised of a variety of materials, such as polyurethane, fluorinated ethylene propylene (FEP), polyether-ether-ketone (PEEK), low density polyethylene, polyethylene terephthalate (PET), polyvinylidene fluoride (PVDF), or any number of other conformable polymers. Furthermore, the balloon material can be of a thickness that remains flexible and thermally conductive, yet strong enough, for example, about 0.0005 to 0.015 in. This thickness can allow the balloon to remain pliable enough to desirably conform to the underlying tissue anatomy and can also provide sufficient transparency to visualize through the material, for example, with a hysteroscope.
Conductive elements 182 may be introduced into the balloon through an annular opening 180 within the distal end 172 of the shaft, as shown in Figure 18C, until the balloon 174 is at least partially or completely filled with the elements 182. Conductors 182 may generally comprise any number of thermally conductive elements, such as copper spheres or some other inert metal, such as gold. These conductive elements 182 can be atraumatic in shape and are small enough to fill the interior of the balloon and conform the balloon walls to the UW uterine walls to ensure consistent tissue contact, e.g. about 20 ml in volume. of elements 182. Conductive elements 182 may also help to fill any air pockets that may form, particularly near the conical portions 176 of the balloon, and insulate tissue from the ablative effects of cryoablative fluid. For example, the conductive elements 182 may be in the form of spheres having a diameter of, for example, 0.8 mm to 4 mm or greater. To ensure that the conductive elements 182 are completely and evenly dispersed throughout the entire interior of the balloon, the elements 182 may be introduced through the shaft 170 by means of an ejector or push rod, drill, compressed air, etc. In particular, the conductive elements 182 can fill the conical portions 176 of the balloon 174 to ensure that the balloon is positioned in close proximity to and in contact with the uterine horn UC to fully treat the interior of the uterus UT, as shown in Figure 18D.
With the conductive elements 182 placed within the balloon 174, cryoablative fluid can be introduced into and through the balloon 174 such that the conductive elements 182 facilitate heat transfer from the UW-contacted uterine walls. Once the cryoablative treatment has been completed, the conductive elements 182 can be removed through the shaft 170 by means of a vacuum force or other mechanical or electromechanical mechanisms, and the balloon 174, once deflated, can also be withdrawn from the UT uterus. .
The cooling probe 178 introduced into the flask 174 may comprise several different configurations that facilitate the introduction of cryoablative fluid into the flask 174. A variation thereof, similar to the variation shown above in Figure 14B, is illustrated in the detail view of Figure 19. In this variation, shaft 178 may have one or more cooling members 190A, 190B, 190C, 190D that project from the distal end of shaft 178 at various angles. Although illustrated with four cooling members extending from shaft 178, any number of cooling members can be utilized in a variety of different angles and extents as desired. Furthermore, . the cooling members can be made of various materials, for example, polyimide, Nitinol, etc., which are sufficiently strong and temperature resistant as to the relatively low temperature of the fluid. Each of the cooling members 190A, 190B, 190C, 190D, in this example, may have an obstructed tip 192 and at least one opening 194 defined along the side of the cooling member. The cryoablative fluid can be fluidized through the shaft 178 and into each cooling member where the fluid can then be sprayed or ejected through the respective openings 194 for distribution throughout the interior of the balloon to cool the contracted uterine tissue.
Another variation of the cooling probe is illustrated in the detail view of Figure 20 which shows the elongate shaft 178 having a swivel base 200 and spray member 202 positioned on shaft 178. The spray member 202 may have a surface that is mesh, lattice, perforated, etc., so that cryoablative fluid introduced through shaft 178 can enter turntable 200 and spray member 202, where it can be equally dispersed through spray member 202 and into the interior of balloon 174 for treatment. Fluid pressure can rotate base 200 about its longitudinal axis, as shown, to further facilitate delivery of cryoablative fluid within balloon 174.
The cooling probe 178 as well as the balloon assembly can be variously configured, for example in an integrated treatment assembly 210, as shown in the side view of Figure 21A. In this variation, assembly 210 may be integral with elongate shaft 170 with balloon 174 extending therefrom with cooling probe 178 translatably positioned within shaft 170 and balloon 174. A separate translatable sheath 212 may be positioned over shaft. elongate 170 and both the elongate shaft 170 and the sheath 212 may be affixed to a handle assembly 214. The handle assembly 214 may further comprise an actuator 216 for controlling a translation of the sheath 212 for the release and deployment of the balloon 174. The sheath 212 may be configured to have a diameter of, for example, 5.5 mm or less, to avoid the need to dilate the cervix.
With the sheath 212 positioned over the elongate shaft 170 and the balloon 174, the assembly 210 can be advanced through the cervix and into the uterus UT, where the sheath 212 can be retracted via the loop assembly 214 to implant the balloon 174 , as shown in Figure 21B. As described above, once the balloon 174 is initially deployed from the sheath 212, it can be expanded by an initial burst of a gas, e.g., air, carbon dioxide, etc., or by cryogenic fluid. In particular, the conical portions of balloon 174 can be expanded to ensure contact with the uterine horn. The handle assembly 214 can also be used to drive and control a longitudinal position of the cooling probe 178 with respect to the elongate axis 170 and the balloon 174, as indicated by the arrows.
Figure 22A shows an example of a design variation of a system that can be used to implant the Balloon 174 into the UT uterus after properly adjusting the uterine cavity depth (or some other anatomical measurement). The elongate shaft 170 may have the balloon 174 affixed along or near the distal end of the shaft 170 by means of a clamp or O-ring 171 disposed along the outside of the shaft 170. One or more indicators 173 along the surface cannula may correspond to clinical measurements of uterine extension that can be measured by the physician prior to the cryoablative procedure. With the measured uterine cavity known, the balloon 174 may be squeezed snugly along the length of the axis 170 on any of the indicators 173 which may correspond to the length of the measured cavity. With the balloon 174 properly secured in place, it can be pushed into the shaft lumen, as shown in Figure 22B, using a puller or some other UT uterus delivery instrument. The elongate shaft 170 and balloon 174 may then be introduced into the UT uterus where the balloon 174 may be implanted from shaft 170 and having a suitable length that may correspond to the particular anatomy of the patient.
The cooling probe positioned within the flask 174 may be variously configured, as described above, and may include additional variations. As illustrated in the perspective and side views of Figures 23A and 23B, respectively, the cooling probe assembly 220, in this variation, may comprise an escape catheter 222 which may define a lumen 224 therethrough. While the diameter of the escape catheter 222 can be varied, its diameter can range anywhere from, for example, 4.5 to 4.75 mm. The escape catheter 222 can be formed from a variety of materials, such as extruded polyurethane, that are sufficiently flexible and capable of withstanding reduced treatment temperatures. The distal ends of the catheter 222 may have an atraumatic tip 226 which may be transparent and/or which may also define a viewing window or opening through which an imaging instrument, such as a hysteroscope 246, may be positioned. One or more support members or inserts 228, for example, made of a polymer such as polysulfone, can be positioned along the entire length of the lumen 224 to provide structural support to the catheter 222 and to prevent its collapse. Inserts 228 are relatively short in length and . define a channel therethrough through which a probe holder 230 (e.g., uniform cable, tape, etc.) can extend. The probe holder 230 shown in this variation may comprise a uniform cable defining one or more notches 232 along either side, which may interlock with one or more of the inserts 228 by means of insert holders 240 to stabilize the probe holder 230.
The probe holder 230 itself may be made of a material such as stainless steel and may have a thickness of, for example, 0.008 in. The probe holder 230 may be supported within the lumen 224 by means of the inserts 228, so that the probe holder 230 separates the lumen 224 into a first channel 242 and a second channel 244 where the cooling lumens 236 may be positioned alongside. along the probe holder 230 into the second channel 244, while the first channel 242 may remain clear for the optional insertion of a hysteroscope 246. In the event that a hysteroscope 246 is inserted into the first channel 242, the hysteroscope 246 may be selectively advanced along the lumen of catheter 224 to visualize surrounding tissue, or hysteroscope 246 may be advanced through catheter extension 222 until it is positioned within a scope receiving channel 238 defined within catheter tip 226.
Due to the thickness of the probe holder 230 relative to its amplitude, the probe holder 230 can be flexed or curved in a single plane, for example, in the plane defined by the bending direction 254 shown in Figure 23B, while remaining relatively rigid in the plane transverse to the plane defined by the direction of flexion 254. This may allow the probe 220 to be advanced into and through the CV cervix and into the patient's UT uterus, while conforming to any anatomical features by bending along the direction of flexure 254 (e.g., up to 90 degrees or more), but may still allow probe 220 to maintain some degree of rigidity and strength in the transverse plane. Additionally and/or alternatively, catheter 222 may be actively directed along the flexural direction 254, for example, by means of one or more pull wires, to allow positioning or repositioning of catheter 222 within balloon 174 to facilitate the distribution and/or visualization of fluid.
The probe 220 may further include one or more cooling lumens 236 which are positioned along the probe holder 230 within the second channel 244. In this example, at least two cooling lumens are utilized where a first cooling lumen may extend through. probe 220 and terminate at the end of the first cooling lumen 248 near the distal tip 226 and a second cooling lumen may extend through the probe 220 adjacent the first cooling lumen and terminate at an end of the second cooling lumen 250 at a location near first end 248. End points may be varied along the length of probe 220, depending on the desired length of active cooling portion 252 of probe 220, which may extend from distal tip 226 to an extent ranging from any measurement from, for example, 2 to 14 cm, along the length of the probe.
Cooling Lumens 236A, 236B may be manufactured from any number of materials suitable to resist low temperature fluids, e.g. Nitinol, Polyimide etc. Furthermore, the inside diameter of the cooling lumens can be made to range from any measurement from, for example, 0.010 to 0.018 in. In certain variations, the cooling lumens may have an outside diameter of, for example, 0.020 in., and an inside diameter ranging from, for example, 0.016 to 0.018 in., with a wall thickness ranging from, for example, 0.002 to 0.004 in. .
Because the cooling lumens 236 are located along the second channel 244, as separated by the probe holder 230, one or more windows or openings 234 can be defined along the length of the probe holder 230 to allow the passage of any cryoablative fluid. passing through openings 234 and to then exit directly from catheter 222 through openings 260 defined along the body of catheter 222 (as described below) and within the balloon. Alternatively, cryoablative fluid may instead proliferate through the entire lumen 224 defined by catheter 222 before exiting the catheter body 222. Such openings 234 may be cut through probe holder 230 and may contain no openings. to six or more, as shown, and can be configured in any number of sizes and shapes. Furthermore, these openings 234 may be distributed in any spacing arrangement or may be evenly spaced, for example 0.320 in., depending on the desired cooling arrangement.
The number of cooling lumens 236 can also be varied to a greater number of three lumens that terminate at different positions along the active portion 252. Additionally, activation of the cooling lumens to spray or introduce cryoablative fluid can be performed simultaneously or sequentially from each of the different cooling lumens, depending on the desired ablation characteristics. While the cooling lumens can simply define a distal opening for fluid to pass through, they can be configured to define multiple openings along their lengths to further distribute the cryoablative fluid introduction. Openings 260 along the body of catheter 222 for venting cryoablative fluid in balloon 174 are omitted from Figure 23A for clarity only, but are shown in additional detail in Figure 24 below.
As cryoablative fluid is initially introduced into the lumen of catheter 242, escape catheter 222 may also define one or more openings to allow cryoablative fluid to vent or escape from the interior of the catheter and into the interior of the balloon 174. From the perspective of Figure 24, one or more openings 260 are illustrated to provide an example of how the openings 260 may be defined on the body of the catheter 222. The openings 260 may be positioned along a single side of the catheter 222 or may be positioned in an alternating transverse pattern as shown to further distribute the coolant throughout the interior of the flask. In either case, the positioning of the openings 260 can be varied depending on the desired cryoablation characteristics.
A final cross-sectional view of the cooling probe assembly 220 is shown in Figure 25A illustrating the relative positioning of the holder insert 228 affixed to the probe holder 230 within the catheter 222. The two cooling lumens 236A, 236B are illustrated positioned in a similar position. adjacently along probe holder 230, although they may be positioned anywhere along catheter 222 and may also number one lumen or more than two lumens. In addition, an optional hysteroscope 246 is also illustrated positioned within the catheter 222 along the probe holder 230. An end view of the distal tip 226 is also illustrated in Figure 25B, which shows a variation in which a distal tip 226 can define a window. viewport 270 through which the hysteroscope 246 can be advanced to view inside the balloon 174 and uterus UT. In other variations, the viewing window 270 may be omitted and the distal tip 226 may be transparent to allow viewing directly through the tip 226 by the hysteroscope 246.
With such an arrangement of the cooling probe assembly 220 positioned within the balloon 174 (as illustrated above in Figure 21B), the assembly 210 can be used to treat the surrounding uterine system in strict compliance with the outer surface of the balloon 174. Introducing cryoablative fluid, eg nitrous oxide, through the cooling probe 220 may allow ablation of the surrounding tissue to a depth of eg 4 to 8 mm.
An example for a treatment cycle using a two cycle process might include introducing cryoablative fluid for a two minute treatment time where the surrounding tissue is cooled. Fluid may be withdrawn from balloon 174 and tissue may be allowed to thaw for a period of five minutes. The cryoablative fluid can then be reintroduced and the tissue refrozen for a period of two minutes and the fluid can then be withdrawn again to allow the tissue to thaw over a period of five minutes. Tissue can be visually inspected, for example using the 246 hysteroscope, to verify ablation coverage. If the tissue is sufficiently ablated, the assembly 210 can be removed from the UT uterus, otherwise the treatment cycle can be repeated as needed. In other alternatives, a single cycle may be used or more than two cycles may be used, as needed, to sufficiently treat the tissue. Furthermore, during the treatment cycle, a minimum pressure of, for example, 40 to 80 mm Hg, can optionally be maintained by the cryogenic liquid or by a gas (e.g., air, carbon dioxide, etc.) to keep the flask 174 and the uterus UT open.
In yet another alternative, in addition to having a catheter 222 made of an extruded lumen, the catheter may be formed in the tubing 201, as a hypotube made of a material such as, for example, stainless steel, nitinol, etc. A tubing 201 formed from a metal can provide additional resistance to the catheter and can remove the need for any inserts to maintain a clear lumen. To increase the flexibility of the pipe 201, one or more grooves 203 may be formed or cut along the body of the pipe 201, as shown in the example of Figure 26A, which illustrates a perspective view of the pipe 201 having one or more grooves 203 cut out. in a transverse manner with respect to the pipeline 201. In addition to increased flexibility, the grooves 203 may be aligned to provide preferential bending or bending along planes predetermined by the pipeline, while inhibiting bending or bending along other planes, e.g. transverse to the plane of bending, similar to the preferential bending or bending provided by the probe holder 230.
The ends of the grooves 203 may be formed to provide a separation 205 between the ends of the grooves 203. Figure 26B shows another variation in which each of the transverse grooves 203 may have a strain relief feature 207 formed at the distal ends of each groove. 203, so that bending of the tubing 201 over the notched region can occur with reduced stress imparted to the grooves 203 and tubing 201. An additional feature can include optional tabs 209 that can be formed along the tubing body 201 to extend internally to hold a cooling lumen within the lumen of tubing 201.
Another variation is shown in Figure 26C which features transverse grooves 203 formed along the tubing body 201, where the grooves 203 may be formed in an alternating pattern with respect to one another. Figure 26D shows yet another variation where angled grooves 211 may be formed with respect to tubing 201. Figure 26E shows another variation having one or more serpentine grooves 213 to prevent compression where a distal end of each groove 213 may have a transverse groove 215 formed. Figure 26F shows another variation where one or more grooves 217 having a transverse and longitudinal pattern can be formed along the pipeline 201.
Figure 26G shows another variation where a transverse groove 219 may have a longitudinal groove 221 formed at its distal end. Figure 26H shows yet another variation where one or more tapered grooves 223 may be formed along the pipe 201. Figure 261 shows another variation where a transverse groove 219 may have a longitudinal groove 221 formed where each of the longitudinal grooves 221 may be aligned longitudinally to the tubing body 201. Figure 26J shows another variation where transverse grooves 219 may have longitudinal grooves 223 aligned adjacent to each other and having rounded ends. Figure 26K shows another variation where a curved serpentine groove 225 or an angled groove 227 can be formed along the tubing 201. Alternatively, both the curved serpentine groove 225 and the angled groove 227 can both be formed. Another variation features the tubing 201 having a plurality of grooves 229 formed in a lattice structure over the tubing body 201.
In addition to using a continuous body of tubing 201 for the extension of the cooling probe, different tubing reinforcing ring 231 may instead be formed from tubing 201. Figure 27A shows an example where a plurality of reinforcing rings 231 can be separated into different ring elements and affixed to each other in a linear fashion with one or more longitudinal beam members 233 that can be affixed to each reinforcing ring 231 at an affixing point 235, e.g. solder, adhesive etc. One or more of the reinforcing rings 231 may be formed to have, for example, an inwardly bent flap 237 to support the beam 233 rather than using a solder, adhesive etc., as shown in the detail perspective view of Figure 27B. Reinforcement ring assembly 231 and bundles 233 may be covered with a membrane or other covering to form a uniform structure.
An example of a cover that can be used is shown in the end view of Figure 28A which shows a portion of the tubing 201 or reinforcement ring 231 and cooling lumens 236 positioned on either side of the tubing 201 or reinforcement ring 231. heat-shrink 241 may be placed over the probe assembly while maintaining the release openings 239 to allow release of cryoablative fluid.
Another variation is shown in the final cross-sectional view of Figure 28B, which shows tubing 201 and respective cooling lumens 236 positioned within an insert 243 that defines insert openings 245 for the introduction of cryoablative fluid. Yet another variation is shown in the perspective view of Figure 29 which may incorporate a coiled spring 247 that can be coiled or tightly packed to provide flexibility and to further provide a lumen 249 for escape. One or more inserts 243 may be positioned longitudinally along the length of spring 247 and cooling lumens 236 may be routed through spring 247 and coupled to each insert 243.
Another variation is shown in the partial cross-sectional side view of Figure 30A which illustrates how one or more inserts 243 can define a step 251 for attaching the spring 247. The entire assembly can then be covered by a cover 253, for example. , flexible extrusion. Each of the inserts 243 may remain uncovered by the spring 247 or cover 253 to ensure that the cryoablative fluid has an unobstructed path to the interior of the balloon. Figure 30B shows another variation where each of the inserts 243 may define a respective receiving channel 257 on either side of the insert 243 for attaching the spring 247. An example of a cooling lumen 236 is shown affixed to each of the inserts 243. by means of an affix 255, e.g. solder, adhesive, etc.
In addition to increasing the flexibility of the cooling tubing or probe, the cooling lumen can be configured to increase its flexibility as well. An example is shown in Figure 31, which shows a portion of a cooling lumen wall 261 having a plurality of pivoted affixations 263. Such an arrangement may allow each segment of the cooling lumen wall 261 to pivot, so that the cooling lumen The cooling probe cumulatively provides sufficient flexibility to bend and bend as the cooling probe assembly is advanced and positioned within the uterus. This cooling lumen can be incorporated into any of the probe variations described here.
Another example of a cooling probe assembly is illustrated in the perspective view of Figure 32 which features a different recessed insert 265 and one or more cooling lumens 236 affixed to each respective insert 265 covered with a cover 267. In this example, cover 267 can be implemented without any additional features or structures. Figure 33 shows yet another example where individual inserts 265 can be aligned and coupled to one or more beams 233 as described above. An additional slide joint 269 may be affixed or integrated along each insert 265 to support one or more cooling lumens 236 which can be translated translatably across each aligned slide joint 269.
Yet another variation is illustrated in the side view of Figure 34, which features a coiled spring element 271 having one or more cooling lumens 236 aligned longitudinally along spring element 271. The one or more cooling lumens 236 may be affixed to the spring element 271 by means of connectors 273 which may be aligned with one another to receive and hold the cooling lumens 236. A cover may optionally be secured over the spring assembly.
Figure 35 shows another variation where the spring element 271 may incorporate one or more respective inserts 243. In that variation, the spring element 271 has the one or more cooling lumens 236 coupled to the spring element 271 itself. Figure 36 shows yet another variation, where the spring element 271 and the one or more cooling lumens 236 (which may be directly coupled to the spring element 271) may have an optional secondary lumen 275 that passes through the spring element. 271 and optionally affixed to the spring itself. The second lumen 275 may be sized to receive an instrument, such as a hysteroscope 246. The second lumen 275 may provide a redundant liquid or gas path that must render the primary lumen partially or completely occluded. The redundant path may exist between the optional instrument, e.g. hysteroscope, and the primary lumen or within the entire 275 lumen.
The secondary lumen 275 may be shown in various cross-sections in the end views of Figure 37. A first variation is illustrated, the secondary lumen 275 shown having a circular cross-sectional area with a hysteroscope 246 passed through the center of the lumen 275. A second variation is illustrated, where the hysteroscope 246 can be passed along one side of the lumen 275 and a third variation is illustrated, featuring a secondary lumen 275A having an elliptical cross-sectional area.
Another variation for a cooling probe assembly is shown in the perspective views of Figures 38A through 38C. In this variation, the catheter body 222 is omitted for clarity only, but a main release line 280 is shown, extending through the catheter with at least two parallel release lines 282, 284 positioned near the surface of the catheter body. catheter, as shown in Figure 38A. The main delivery line 280 may be in fluid communication with the parallel delivery lines 282, 284 through a junction 288, shown in Figure 38B, near or within the distal tip 226. As cryoablative fluid is introduced into the delivery line 280, the fluid in the parallel delivery lines 282, 284 may be vented through one or more openings 286 defined in their length to vent through and into the catheter and interior of the balloon. An optional mandrel 290, as shown in Figure 38C, can be slidably fitted within each of the parallel release lines 282, 284 and driven automatically along with sheath retraction 212 or by the user to slide along the interior of one or more both parallel release lines 282, 284 to selectively occlude the openings 286 and thereby control the amount of cryoablative fluid released. As shown, one or more obstructed openings 292 can be blocked by mandrel 290 by selectively sliding mandrel 290 in the same manner. In other variations, instead of using mandrels inserted within the release lines 282, 284, a sheath or mandrel placed over the release lines 282, 284 can be used in place to achieve the same results.
As described above, retraction of mandrel 290 may optionally be driven to accompany retraction of sheath 212. Likewise, retraction of mandrel 290 may occur simultaneously with retraction of sheath 212, but retraction may optionally occur at different rates, how the amount of cryoablative fluid released can be related to the extent of the uterine cavity to be treated. For example, a hem retraction of e.g. 7 cm may result in 10 unobstructed openings 286, while a hem retraction of e.g. 4 cm may result in e.g. 6 unobstructed openings 286.
Another variation of the cooling probe assembly is illustrated in the detailed cross-sectional side view of Figure 39. In this variation, a single main release line 280 may pass through and in communication with the distal tip 226. Instead of having the lines parallel release lines 282, 284 coupled directly to the main release line 280, each respective line may be coupled to a common chamber 301 defined within the distal tip 226. This assembly may be used with alternate variations of the escape lumen 303 as shown in an example in the end cross-sectional view of Figure 40A. In this example, the exhaust lumen 303 may be shaped to have a cross-sectional area intended to accommodate the parallel release lines 282, 284. Alternatively, the exhaust lumen 303 may be shaped to have an elliptical cross-sectional area. in place, as shown in Figure 40B.
In yet another alternative, the cooling lumens may be formed to have a single introduction or infusion line 305 and a single delivery line 307 where the delivery line 307 may be in fluid communication directly with the introduction or infusion line 305. through the distal tip 226, as shown in the cross-sectional side view of Figure 41. The infusion line 305 and the release line 307 can be formed as separate lines or they can be formed as a single continuous line where the infusion line 305 enters distal tip 226 and is curved to redirect ablative fluid proximally through release line 307. In this variation, as in previous variations, a translatable mandrel 290 can be slidably positioned within release line 307 or optionally along the along an outer surface of release line 307 to selectively occlude openings 286 defined along line 307. In other vars In addition, one or more openings may also be optionally aligned along the infusion line 305 in addition to the openings 286 along the release line 307. In addition, the mandrel 290 may be driven to slide (at the same or a different rate) together. to sheath retraction. Figure 42 illustrates an example in which the cooling probe assembly may be introduced into the balloon 174 when implanted into the UT uterus. Alternatively, the balloon 174 may be affixed directly along an outer surface of the cooling probe assembly itself. The expanded extension of balloon 174 may be fixed along the outer surface of the cooling probe assembly near the distal tip or may be optionally adjustable by positioning the outer sheath. As shown, introduction line 305 can introduce cryoablative fluid along the cooling probe assembly, where it can then be fluid proximally along delivery line 307 for introduction into balloon 174. cryoablative fluid is introduced, a grooved tube 311 having one or more directional grooves 313 can be used to optionally direct the flow of cryoablative fluid within the flask.
Figures 43A and 43B illustrate additional variations to selectively control the configuration of orifice directions along parallel release lines to optionally control proper ablation depths and taper as needed or desired. In the variation of Figure 43A, adjacent, parallel release lines 282, 284 of distal tip 226 may be configured so that openings 300 are configured in an up/down configuration, openings 302 are configured in a down/down configuration. up, apertures 304 are configured in a left/right configuration, apertures 306 are configured in an up/down configuration, and apertures 308 are configured in a down/up configuration. The top/bottom/left/right hole directions are relative to the figures shown and are shown for illustrative purposes.
Likewise, the variation shown in Figure 43B illustrates how adjacent, parallel release lines 282, 284 can be configured such that apertures 310 are configured in an up/down configuration, apertures 312 are configured in an up/down configuration. left/right, apertures 314 are configured in a down/up configuration, apertures 316 are configured in a left/right configuration, and apertures 318 are configured in an up/down configuration. These variations are illustrated as exemplary variations and other hole direction variations can be performed as desired.
In addition to positioning the fluid openings, the catheter body 222 itself may optionally incorporate a polished viewing window 320, as shown in the side view of Figure 44, to facilitate visualization of the balloon 174 and surrounding tissue by the hysteroscope 246, which can be advanced in close proximity to the 320 window or entirely through it if desired.
As described above, balloon 174 can be expanded within the uterus UT and particularly the uterine horn UC by an initial burst of gas or liquid. Other mechanisms can also be used to facilitate balloon expansion. A variation is shown in Figure 45, which illustrates a balloon 174 having one or more support arms 330A, 330B that extend from a support 334 deployable within the balloon 174. Support arms 330A, 330B can be configured in a way that in a variety of ways, although they are shown in this example in a Y-configuration. Each of the distal ends of the arms may extend from a linear configuration to the expanded Y-configuration, for example, by means of a polarization mechanism 332, which can polarize the arms to extend once the sheath 212 is retracted. The distal ends of arms 330A, 330B may extend into the conical corners of balloon 174 to facilitate expansion of balloon 174 into the uterine horn UC and may also help center balloon 174 within the uterus UT.
Figure 46 shows a partial cross-sectional side view of another variation of an expansion mechanism contained within the balloon 174, where one or more support arms 342A, 342B can be mechanically actuated to extend, for example by means of a mechanism polarization wires, pull/push wires, etc. Furthermore, the 342A, 342B arms can be integrated into the 340 cooling probe design as an integrated assembly.
Figure 47 shows a partial cross-sectional side view of another variation, in which support arms 350A, 350B may also integrate one or more openings 352 for infusing cryoablative fluid. In this example, the arms 350A, 350B can be integrated with the cooling probe 340 or separate. In either case, the inclusion of openings 352 can facilitate distribution of fluid within the balloon 174.
Figure 48 shows yet another variation, in which support arms 360A, 360B may be incorporated into elongated channels or pockets 362A, 362B defined along the balloon 174 itself. In this and other variations shown, the support arm members may optionally integrate with one or more cryoablative fluid release openings and may also be integrated into elongated channels, as practicable.
In addition to the balloon itself and the use of balloons to occlude the inner and/or outer os as described above, inflatable balloons or liners can also be used to isolate cryogenic fluid during release into the balloon to protect structures from surrounding tissue that should not be ablated, such as the CV cervix. Figure 49 shows a partial cross-section of a variation in which an inflatable balloon 370 can be located along the outer distal surface of the sheath 212 to directly contact and isolate the CV cervix. The sheath or balloon 370 may be filled with a gas or liquid, such as air, water, carbon dioxide, etc., to act as an insulator to prevent contact between the released cryoablative fluid passing through the shaft 170 and the surrounding cervical tissue. . Balloon 370 can be inflated before or during an ablation treatment and then deflated once the treatment is complete. To facilitate device removal. The size of the balloon 370 may optionally be varied, for example, by the location of the sheath placement.
Figure 50 shows a cross-sectional side view of another variation of an inflatable liner or balloon 380 located along the inner distal surface of the sheath 212. In this variation, the balloon 380 may inflate to isolate cryoablative fluid from cervical tissue. Figure 51 shows another variation where expandable foam 390 can be implanted through outer sheath 212 to insulate against the CV cervix. Figure 52 shows yet another variation where a heating element 400 can be located along the inner or outer surface of the elongate shaft 170 to heat the surrounding cervical tissue as cryoablative fluid is released during treatment. Figure 53 shows yet another variation where a ring balloon 410 may be inflated along sheath 212 or shaft 170 to isolate surrounding cervical tissue or to ensure secure placement of shaft 170 and/or balloon 174 during treatment.
Figure 54 shows a cross-sectional side view of yet another variation of a sheath 411 that can be formed from, for example, urethane having a thin wall of about 0.001 in., which can be folded and sealed so that the sheath 411 contains a volume of liquid or gas 413 such as saline, air, etc. The cooling probe assembly having tubing 201 and balloon 174 in its collapsed state can also be seen. The distal end of the sheath 415 may optionally incorporate a deformable member, such as an elastic or expandable ring 417 circumferentially contained within the distal end 415, as shown in the side view of Figure 55A. Alternatively, a circular polarized member such as a ring 419 comprised of a non-circularly formed spring may be circumferentially contained within the distal end 415, as shown in Figure 55B. With the sheath 411 positioned with its distal end 415 distal to the tubing 201, the ring 417 can configure for a ring having a first diameter that at least partially covers the distal opening of the sheath 411. However, when the tubing 201 is advanced from the sheath 411 , ring 417 may stretch or deform to a second larger diameter as it conforms to the outer surface of tubing 201. Stretch ring 417 may likewise form a stop or detent to prevent excessive proximal withdrawal of sheath 411 relative to the CV cervix, as well as facilitating the positioning of the sheath 411 over the CV cervix to provide isolation during a procedure. As outer sheath 411 and stretched ring 417 are positioned proximally along tubing 201 to secure a position of ring 417 with respect to cervical tissue, sheath retraction can likewise adjust to an expanded extension of balloon 174 inside the UT uterus. Furthermore, since the positioning of the sheath 411 can also trigger to adjust a position of a mandrel 290 within one or more lines 307 to selectively occlude or open a selected number of openings 286 (as illustrated in Figure 41), the only withdrawal and positioning of the outer sheath 411 can not only provide an adjustable fixation of the device with respect to the cervical tissue, but can also adjust correspondingly to the expanded extent of the balloon and further control the active extension of the release line 307 through the positioning of the mandrel. 290. Sheath retraction and attachment may be used not only in this variation, but in any other variations presented and described herein, as practicable.
Figure 56 shows another variation of a cervical protection balloon 421 which may have a length of, for example, 4 to 8 cm, which may also be positioned along the outer surface of the sheath 212 (as shown) or along the surface inner tube for insertion into cervical tissue.
Figure 57 shows a cross-sectional side view of yet another variation of a double sheath assembly having an inner sheath 423 and an outer sheath 425 that are longitudinally translatable with respect to each other. An annular balloon 427 can be affixed to the distal ends of both the inner sheath 423 and the outer sheath 425, so that the configuration size of the balloon 427 can be changed by the relative movement and positioning of the sheaths 423,425. Figures 58A and 58B show detailed cross-sectional side views of an example of an arrangement of several seals 429 that may be positioned between each respective sheath 423, 425. Corresponding O-ring seal 431 may be incorporated into these seals. 429 to provide an airtight seal to the fluid. Also, a fluid line 433 may be passed through one or more seals 429, as shown, to provide inflation and deflation of balloon 174 or annular balloon 427.
Another variation is shown in the cross-sectional side view of Figure 59, which features another double-sheath design where the annular balloon may be comprised of a confined balloon 441 having an expandable balloon portion 443. The balloon, for example urethane, may be be contained between each respective sheath 423, 425, while a folded portion may be positioned to extend between the distal ends of the sheaths 423, 425. As inflation fluid is introduced into the balloon, the balloon portion is squeezed between the sheaths 423 , 425 may remain collapsing, but the expandable portion of the unrepressed balloon 443 may extend into an annular shape, as shown.
Figure 60 shows yet another variation in which the sheath 445 may be formed to have a reinforcing member 447, e.g., yarn, braid, mesh, etc., integrated along its body to provide added strength and space between the sheath 445. and adjacent tissue. Any of the balloon embodiments described herein may be incorporated with the sheath 445 as shown.
Figure 61 shows another variation of a sheath having an annular balloon 449 positioned along the distal end of the inner sheath 423, while constrained by the distal end of the outer sheath 425. The balloon 449 can be sized according to the relative positioning between the sheaths. internal and external.
Figures 62A and 62B show partial cross-sectional side views of yet another example of an outer sheath 451 slidably positioned over the tubing 201, where the distal end of the outer sheath 451 may incorporate an integrated expandable ring 453, e.g. elastomeric. , foam etc. As described above, in a similar embodiment, the expandable ring 453 may have a first diameter that closes at the distal end of the tubing 201 when the outer sheath 451 is advanced distal to the tubing 201. As the outer sheath 451 is retracted from the tubing 201, ring 453 can expand to a second larger diameter as it conforms to the outer surface of tubing 201. The enlarged profile of outer sheath 451 can therefore function as a stop to cervical tissue during a procedure.
Figure 63 shows a similar variation in which the expandable ring 453 may incorporate one or more lubricated surfaces 455 to facilitate retraction of the outer sheath 451, for example, by peeling the outer layer from the inner layer, and ring compliance 453 with respect to the tubing 201. Figure 64 shows a side view of yet another variation, where the outer sheath 451 may instead incorporate a different ring section 461 having the expandable ring 453 positioned with respect to the tubing 201. Figure 65 presents yet another variation, where the distal end of the tubing 201 may define a tapered distal end 463 to facilitate expansion of the expandable ring 453 when the outer sheath 451 is retracted.
In yet another variation of the outer sheath, Figure 66 presents an embodiment in which the outer sheath 465 may have a radially expandable portion 467 formed near or at a distal end of the outer sheath 465. Before or during a procedure for securing a position of the outer sheath 465 relative to the cervical tissue, the expandable portion 467 may be used in place of an inflatable balloon. Expandable portion 467 may generally comprise one or more extensions of outer sheath 465 being reconfigurable along a pivoting or collapsible portion such that, as the distal end of outer sheath 465 is retracted with respect to the remainder of sheath 465, at an or more extensions can articulate and reconfigure to their radial configuration.
A coupling 475 (such as wire, rod, rope, tape, etc.) may be coupled to the distal end of outer sheath 465 at a first stop 469, as shown in the partial cross-sectional side view of Figure 67A. A second stop 471 may be positioned proximal to the first stop 469, which limits proximal withdrawal of coupling 475 by a predetermined distance. When coupling 475 engages first stop 469 and retracts the distal end of sheath to radially extend expandable portion 467, further retraction of coupling 475 may be stopped by second stop 471. Outer sheath 465 may define the lumen through which the Cooling probe assembly can be advanced, without interference from the retraction assembly. Another variation is illustrated in Figure 67B which features a similar mechanism, but in which the second stop 471 may be replaced by a biasing element 473, e.g. spring, positioned proximally to the first stop 469.
Yet another variation is shown in the side views of Figures 68A and 68B which illustrate a representation of an exemplary upper center coupling mechanism 481 that may be incorporated into the retraction mechanism. A coupling 483 and corresponding biasing element 485, e.g. spring, may be coupled to coupling member 475 affixed to stop 469. As coupling 475 is retracted to reconfigure expandable portion 467, upper center mechanism 481 may also be retracted and actuated to snap into position of coupling 475 so that retraction of expandable part 467 can be selectively maintained, upper center mechanism 481 can be selectively disengaged to release and reset expandable part 467.
Figure 69 shows a side view of yet another variation, in which the outer sheath 491 may incorporate one or more distal shoulder members 493A, 493B. With outer sheath 491 positioned distally from tubing 201, shoulder members 493A, 493B may be configured in a first collapsed configuration. As the outer sheath 491 is retracted with respect to the tubing 201, the shoulder members 493A, 493B can pivot along the outer sheath 491 when urged by the outer surface of the tubing 201 and reconfigure to an expanded configuration as indicated. The reconfigured, expanded shoulder members 493A, 493B can then be used as a stop for the outer sheath 491 relative to the cervical tissue.
An example of the reconfigured shoulder members 493A, 493B used as a stop is illustrated in the exemplary cross-sectional side view of Figure 70. As indicated, as the outer sheath 491 is retracted and the shoulder members 493A, 493B reconfigure, the outer sheath 491 can be further retracted until it is fixed in relation to the CV cervix. Figure 71 shows another example where the outer sheath 501 having the distal end shoulder members 503A, 503B can be configured to have a tapered distal end 505 to allow further articulation of the shoulder members 503A, 503B during sheath retraction.
Figure 72 presents an exemplary illustration of how the outer sheath 465 can be implanted first and secured in position with, for example, the expandable portion 467 placed in contact with the CV cervix. The cooling probe assembly and collapsing balloon 174 can then be inserted through the outer sheath 465 at a later time and advanced into the UT uterus for treatment. In this and any other variations described herein, as practicable, the outer sheath may be deployed independently of the cooling probe, if desired.
Figure 73 shows yet another variation, in which the outer sheath may be configured as a corrugated outer sheath 511 to provide a structure that is strong yet flexible. Figures 74 and 75 show additional variations in which the outer sheath 513 may comprise an annular balloon 517 located along the inner surface of the sheath 513. The distal end sheath may define one or more longitudinal slots 515 for selective expansion of the balloon 517 Alternatively, the annular balloon 519 may be located along the outer surface of the sheath 513, as well, as described above.
Figures 76A through 76D show yet another variation, in which the sheath 521 may incorporate an integrated appearance to provide additional isolation between the cryoablative fluid and the surrounding cervical tissue by creating or forming insulating air pockets. The cross-sectional end of Figure 76A shows a hem 521 defining a plurality of raised, curved surfaces 523 along the inner surface of the hem 521. Figure 76B shows another variation, in which a plurality of raised, curved surfaces 525 may be formed along the along the outer surface of the sheath 521. Yet another example is shown in Figure 76C, which features a sheath 521 formed to have both inner and outer raised surfaces 527, while the variation of Figure 76D shows a variation in which the inner hem surface may having a plurality of projections or elevated indicators that extend internally.
In controlling the ablative treatments described above, the treatment set can be integrated into a single cooling system 420, as shown in the schematic illustration, exemplary Figure 77. The cooling system 420 can be contained entirely within the loop assembly 214, as described above, or may be separated into components as needed or desired. In either case, the cooling system 420 may generally comprise a microcontroller 422 to monitor and/or control parameters such as cavity temperature, cavity pressure, exhaust pressure, etc. A display 424, e.g. a digital display that may be located along the handle assembly 214, may be in communication with the microcontroller 422 to display parameters such as cavity pressure, cavity temperature, treatment time, etc. Any errors may also be displayed on the screen 424. A separate indicator 426, for example, visual or audible alarm, may also be in communication with the microcontroller 422 to alert the user of initiations, errors, etc.
A coolant reservoir 428, e.g., nitrous oxide canister, in that example, may be fluidly coupled to handle 214 and/or elongate shaft 170 by means of a coolant valve 430 which may optionally be controlled by the microcontroller 422. Coolant reservoir 428 may be in fluid communication with cooling probe assembly 220 and with the interior of balloon 174. One or more pressure sensors 432 may be in communication with a pressure lumen 434 contained within of the cooling probe assembly 220 or elongate shaft 170 and one or more temperature sensors 436 in communication with a thermocouple/thermistor wire 438 also contained within the cooling probe assembly 220 or elongate shaft 170 may be incorporated. The one or more pressure sensors 432 and/or temperature sensors 436 may be in communication with the microcontroller 422 as well. Furthermore, pressure sensors 432 may optionally comprise a sensor positioned within the balloon 174, where the sensor is designed for low temperature measurement. This pressure sensor may incorporate a closed or open column of liquid (eg, ethanol, etc.) or gas (eg, air, carbon dioxide, etc.) that extends through the cooling probe assembly.
Cryoablative fluid contained within the coolant reservoir 428, such as nitrous oxide, may be pumped (or allowed to flow if the reservoir 428 is under pressure) through, for example, an engine-operated valve such as the coolant valve. cooling 430, to control the incoming nitrous oxide flow rate. Valve 430 can also be used to maintain a desired amount of back pressure to separate the walls of the uterus. For example, a relatively low back pressure of, for example, 40 to 60 mm Hg, can be used. Alternatively, a simple but precise exhaust flow restriction could be all that is needed, for example as a fixed, non-adjustable valve. In yet another alternative, vacuum pressure may be used to control the rate at which the exhaust gas is drawn in, for example a nitrous oxide deactivation filter.
The rate at which cryoablative fluid, such as nitrous oxide, is released can be controlled by the temperature measured within the balloon 174 and/or uterine cavity. The target temperature range can range, for example, between -65 and -80 degrees C. By limiting the temperature measured inside the flask 174 to a value that is less than the boiling point of nitrous oxide, about -88.5 degrees C, the change in liquid nitrous oxide integrated into balloon 174 can be greatly reduced to avoid any excessive intrauterine pressures if the exhaust tube is blocked.
In the event that excessive pressure is measured within the balloon 174 or the differential pressure between two sensors is too high, the system can be programmed to automatically stop the flow of cryoablative fluid. A separate shut-off valve can be used in place of the coolant valve 430. In addition, if electrical power is interrupted to the system, the separate shut-off valve can be activated automatically. Additionally, the 426 indicator can signal the user that excessive pressures have been reached and the system shut down.
The inner diameter of the delivery line can also be sized to deliver cryoablative fluid up to, but not exceeding, for example, a maximum anticipated rate for a large, well-perfused uterus. By limiting the infusion rate of the cryoablative fluid and sizing the exhaust tube appropriately, the system can be allowed to evacuate the expanded gas even in the event of a catastrophic failure of the delivery line.
Additionally, an exhaust lumen 440 in communication with the elongate probe 170 and having a back pressure valve 444 may also include a pressure sensor 42 where one or both of the back pressure sensor 442 and/or the valve 444 also may be in communication with the microcontroller 422. While the microcontroller 422 may be used to control the pressure of the introduced cryoablative fluid, the pressure of the cryoablative fluid within the interior of the balloon 174 may also be automatically controlled by the microcontroller 422 which adjusts the pressure valve 444 or by manually adjusting the back pressure valve 444. In the event that the microcontroller 422 is used to control the back pressure via the valve 444, the microcontroller 422 can be configured or otherwise programmed to adjust the 444 valve based on feedback from other sensors, such as measured parameters from one or more 432 pressure sensors and/or temperature sensors ura 436 to create a closed feedback loop system.
Exhaust lumen 440 may be fluidly connected, for example, to a reservoir 446 to collect or deactivate depleted cryoablative fluid. Reservoir 446 may optionally incorporate a filter in handle 214 or become integrated into a reusable console. Alternatively, depleted cryoablative fluid can simply be collected in a reservoir 446 or escaped to the atmosphere.
Generally, redundant pressure lines and sensors such as pressure lumen 434 terminating in balloon 174 may match sensors located in handle 214 to make comparison measurements. Pressure lines can be filled with a fluid, such as ethanol, to prevent refrigeration during a procedure. Alternatively, a gas such as air can be used in the pressure lines, but they can use temperature compensation.
As at least one thermocouple may be located within the flask 174 and used to measure temperature during the procedure, additional thermocouples may optionally be included at other locations internal or external to the flask 174 to provide additional temperature measurements. For example, a thermocouple may optionally be located at the distal part of the sheath 212 to monitor the temperature within the CV cervix.
Upon completion of the procedure, any unused cryoablative fluid still contained in the reservoir 428 or within the system can be automatically or manually vented, for example, to the deactivation filter or collection reservoir 446.
The system 420 may optionally further incorporate an emergency shutdown system that can be activated in the event that electrical power is lost, if a user manually activates the shutdown system, or in the event that the microcontroller 422 detects high pressure within the system. 420. An example of the emergency shut-off system may incorporate an emergency shut-off valve which may include a valve 430 or which may alternatively incorporate another valve separate from the valve 430. Furthermore, in sensing the pressure within the system 420 , a redundant pressure sensor may also be used in conjunction with one or more pressure sensors 432 at the same location or at a different location throughout the 420 system.
In any of the examples described herein, the system may employ a thermally conductive fluid having a higher thermal conductivity than a physiological solution. This thermal conductivity can help ensure that the fluid within the body cavity or lumen is at the same temperature entirely, even without agitation or washing. This fluid can be used with flushing fluid and/or infusing fluid followed by application of a cryogenic probe. Improved thermal conductivity can be achieved through a variety of different options including but not limited to choosing a thermally conductive fluid or gel, adding thermally conductive compounds to the fluid or gel (e.g. metals or metal ions etc. .) and/or agitation of the fluid within the cavity to help achieve temperature equilibrium. Additionally, the fluid can be infused as a fluid or gel until a set pressure is reached. The cryogenic probe can then be introduced into the body cavity/lumen and heat can be removed from the fluid/gel. Before or in conjunction with reaching a cryotherapeutic temperature (ablative or non-ablative), the fluid can either form a gel or a solid. This can be used so that the fluid or gel within the cavity can be funneled into the target lumen or cavity of the body with its change in viscosity or state, thereby preventing leakage of the fluid or gel and undesired exposure of adjacent tissues. to the cryotherapeutic effect. Due to the higher thermal conductivity of either the chilled or chilled fluid or gel, the continuous removal of heat from the chilled or chilled mass can be rapidly and evenly distributed throughout the body cavity or lumen. The solution can also be partially refrigerated or chilled and then shaken or recirculated to ensure more even distribution of the cryotherapeutic effect.
Furthermore, the fluid or gel can be made thermally conductive by the addition of a biocompatible metal or metal ion. Any metal or conductive material can be used for this purpose, for example silver, gold, platinum, titanium, stainless steel, or other metals that are biocompatible. Alternatively, the thermally conductive fluid can be used to transmit thermal energy to tissues to provide thermal ablation, as opposed to cryoablation energy extraction. In both embodiments, with sufficient thermal conductivity, the fluid can act as an extension of the ablative energy source and provide a custom ablation tip for the application or removal of energy to any body tissues, body cavities, or body lumens. Another benefit is consistency of treatment, as cryoablation may require the use of ultrasound in the uterine ablation setup. Any of the devices here may allow the use of temperature tracking or simple timed treatment in order to automate ablation (with or without ultrasound monitoring). For example, application of -80°C for 3 minutes has been shown to provide the correct depth of ablation for many uterine cavities. Devices here can allow for temperature tracking so that once the desired temperature is reached (e.g. -60°C), a timer can be triggered which automatically discontinues therapy and warms the cavity based on time. in isolation. This can be used when setting up a fixed volume infusion (e.g. 10 to 15 cc of thermally conductive fluid/gel to all patients) or setting up a fluid/gel infusion at a set pressure (with varying volumes). This timed ablation can also be used in conjunction with any of the devices here to allow for the elimination of the painful need for ultrasound tracking of cryogenically treated regions.
Alternatively, this thermally conducting fluid (which may optionally include solid metal particles) can be infused into a balloon that conforms to the uterus, esophagus, or other body cavity or lumen at relatively low pressures (e.g., less than 150 mmHg). ), as also described above. The thermally conductive material may alternatively be comprised entirely of a solid (e.g. copper spheres or copper current) within the forming flask, whereby the thermally conductive solid and/or fluid may be reversibly released to the flask. conformation at low pressure, after which a cryogenic probe, cryogenic liquid and/or cryogenic gas can be delivered to the balloon and triggered to ablate the entire UT uterus once. The cryogenic source can also be positioned inside the balloon to achieve maximum cryoablation within the uterine body with less ablative effect proximally and in the horn. Vaseline, oils or other thermally resistant materials can also be used in conjunction with these or other modalities to protect certain areas of the uterus, cervix and vagina.
In creating the ideal thermally conductive fluid and/or gel, any conductive material may be added to the fluid or gel, including, for example, gold, silver, platinum, steel, iron, titanium, copper or any other conductive metal, ion, or molecule. If a metal is used as a dopant to increase thermal conductivity, the added metal can be of any shape or shape, including spheres, rods, powders, nanofibers, nanotubes, nanospheres, thin filaments, or any other form that can be suspended in a solution or gel. The fluid or gel may itself also be thermally conductive and may be infused and then removed or may be left in the cavity and allowed to flow naturally from the uterus, as with normal menstruation. The thermally conductive polymer may also be biocompatible, but this may not be necessary if the fluid/gel is extracted immediately after the procedure.
Despite the potential for toxicity, ethanol may be well suited for liquid washing, as it resists refrigeration below -110°C and is, unlike dose-dependent toxicity, biocompatible. Solutions of 75% to 99.9% concentrations of ethanol can be used to good effect and have been shown to show that a refrigerated layer develops very quickly, inhibiting further absorption of ethanol. A copper and ethanol composition can also be used, as ethanol resists refrigeration, while aqueous fluids freeze and expand, thereby moving the metal particle out of direct contact with the tissue.
Although illustrative examples are described above, it will be apparent to one skilled in the art that various changes and modifications can be made thereto. In addition, various devices or procedures described above are also intended to be used in combination with others, as practicable. The appended claims are intended to cover all such changes and modifications that exist within the actual spirit and scope of the invention.

权利要求:
Claims (55)
[0001]
1. TISSUE TREATMENT SYSTEM, comprising: an elongated lumen having a distal tip and a flexible extension, wherein the lumen further has a body defining one or more grooves in its extension; at least one infusion lumen positioned through or along the elongated lumen; at least one release lumen in fluid communication with the infusion lumen positioned through or along the elongated lumen, wherein a translation of the release lumen relative to one or more openings along the infusion lumen exposes to one or more openings correspondents; and, a shell in which the elongated lumen is positionable; a translatable sheath with respect to the elongated lumen, wherein distal or proximal translation of the sheath selectively controls a number of one or more openings that remain unobstructed and also correspondingly adjusts an expanded length of the balloon according to the number of one or more openings that are clear; and a reservoir having an ablative fluid in fluid communication with the at least one delivery lumen, wherein the introduction of the ablative fluid into the delivery lumen passes the ablative fluid through one or more unobstructed openings and in contact with an interior surface of the coating.
[0002]
2. SYSTEM according to claim 1, characterized in that the elongated lumen comprises an escape lumen for the ablative fluid.
[0003]
3. SYSTEM, according to claim 1, characterized in that the infusion lumen and the release lumen form a single continuous lumen.
[0004]
4. SYSTEM according to claim 1, characterized in that the infusion lumen and the release lumen form separate lines in fluid communication through the distal tip.
[0005]
A SYSTEM as claimed in claim 1, further comprising a hysteroscope slidably positioned within a secondary lumen defined through the elongated lumen.
[0006]
6. SYSTEM according to claim 1, characterized in that the distal tip comprises a viewing port.
[0007]
7. SYSTEM according to claim 1, characterized in that the elongated lumen is configured to bend within a single plane by means of one or more slots.
[0008]
8. SYSTEM according to claim 1, characterized in that the ablative fluid comprises a cryoablative or hyperthermic fluid.
[0009]
9. SYSTEM according to claim 8, characterized in that the cryoablative fluid comprises nitrous oxide.
[0010]
10. SYSTEM according to claim 1, characterized in that the elongated lumen defines an active treatment part near or at the distal tip.
[0011]
11. SYSTEM, according to claim 10, characterized in that the active treatment part varies from 2 to 14 cm in length.
[0012]
12. SYSTEM according to claim 1, characterized in that a part of the coating is affixed to the elongated lumen, close to the distal tip.
[0013]
A SYSTEM as claimed in claim 1, characterized in that a portion of the casing is affixed to a distal end of an axis defining a lumen through which the elongated lumen is slidably positioned.
[0014]
14. SYSTEM according to claim 1, characterized in that the coating comprises at least two conical parts that extend from the distal end of the shaft, so that the conical parts are configured to contact a corresponding uterine horn.
[0015]
A SYSTEM as claimed in claim 1, further comprising one or more support arms deployable within the sheath and adjacent to the elongated lumen.
[0016]
A SYSTEM as claimed in claim 15, characterized in that one or more support arms define one or more openings in fluid communication with the reservoir.
[0017]
17. SYSTEM according to claim 15, characterized in that the casing defines one or more elongate channels to receive one or more corresponding support arms.
[0018]
A SYSTEM as claimed in claim 1, further comprising a mandrel slidably positioned within or along at least one release lumen, wherein a distal or proximal translation of the mandrel relative to the release lumen selectively controls several clear openings along the release lumen.
[0019]
19. SYSTEM, according to claim 18, characterized in that the mandrel translation is driven by means of the sheath translation.
[0020]
20. SYSTEM, according to claim 19, characterized in that it further comprises a stop mechanism positioned along the sheath.
[0021]
21. SYSTEM as claimed in claim 20, characterized in that the stop mechanism comprises a ring positioned within a distal end of the sheath, wherein the ring has a first configuration when positioned distally from the elongated lumen and a second larger configuration when pulled. proximally over an external surface of the elongated lumen.
[0022]
22. SYSTEM according to claim 20, characterized in that the stop mechanism comprises a radially expandable part formed near or at the distal end of the sheath.
[0023]
23. SYSTEM according to claim 22, characterized in that the radially expandable part comprises one or more sheath extensions which are pivotable or collapsible when actuated by means of a coupling.
[0024]
A SYSTEM as claimed in claim 1, characterized in that the sheath has a radially expandable portion formed near or at a distal end of the sheath.
[0025]
A SYSTEM as claimed in claim 24, further comprising an isolating balloon affixed to a distal end of the sheath.
[0026]
26. SYSTEM according to claim 25, characterized in that the insulating balloon comprises an inflatable balloon, expandable foam or heat resistant element.
[0027]
A SYSTEM as claimed in claim 25, further comprising a plurality of conductive elements insertable within the balloon adjacent the elongated lumen.
[0028]
28. TISSUE TREATMENT SYSTEM, comprising: a thermal probe assembly having an elongated lumen, at least one infusion lumen positioned through or along the elongated lumen, and at least one release lumen in fluid communication with the lumen infusion, where the delivery lumen defines one or more openings therealong; a liner defining an interior volume into which the thermal probe assembly is insertable, where the liner is configured to conform to a tissue surface; and, a translatable sheath with respect to the elongated lumen, wherein distal or proximal translation of the sheath selectively controls a number of one or more openings that remain unobstructed and also correspondingly adjusts an expanded length of the sheath in accordance with the number of one or more openings that are unobstructed; and a reservoir having an ablative fluid in fluid communication with the thermal probe assembly and the interior volume of the sheath, wherein the introduction of the ablative fluid into the thermal probe passes the ablative fluid through one or more unobstructed openings and comes into contact with the inner volume.
[0029]
29. SYSTEM as claimed in claim 28, further comprising an axis on which the casing is affixed, the axis defining a lumen through which the cooling probe assembly is slidably positioned.
[0030]
30. SYSTEM according to claim 28, characterized in that the balloon is affixed along an external surface of the thermal probe assembly.
[0031]
The SYSTEM of claim 28, further comprising a hysteroscope slidably positioned within a secondary lumen defined through the elongated lumen.
[0032]
32. SYSTEM according to claim 28, characterized in that the thermal probe assembly is configured to fold within a single plane.
[0033]
33. SYSTEM according to claim 28, characterized in that the ablative fluid comprises a cryoablative or hyperthermic fluid.
[0034]
34. SYSTEM according to claim 33, characterized in that the cryoablative fluid comprises nitrous oxide.
[0035]
35. SYSTEM according to claim 28, characterized in that the thermal probe assembly defines an active treatment part near or at the distal end of the assembly.
[0036]
36. SYSTEM according to claim 35, characterized in that the active treatment part is adjustable from 2 to 14 cm, starting at the distal tip.
[0037]
37. SYSTEM according to claim 28, characterized in that the coating comprises at least two conical parts that extend from the distal end of the shaft, so that the conical parts are configured to contact a corresponding uterine horn.
[0038]
38. A SYSTEM as claimed in claim 28, further comprising one or more support arms deployable within the casing and adjacent to the cooling probe assembly.
[0039]
A SYSTEM as claimed in claim 38, characterized in that one or more support arms define one or more openings in fluid communication with the reservoir.
[0040]
A SYSTEM as claimed in claim 28, further comprising an isolating balloon affixed to a distal end of the sheath.
[0041]
41. SYSTEM according to claim 40, characterized in that the insulating balloon comprises an inflatable balloon, expandable foam or heat resistant element.
[0042]
A SYSTEM as claimed in claim 28, further comprising a plurality of conductive elements insertable within the casing adjacent to the cooling probe assembly.
[0043]
43. SYSTEM according to claim 28, characterized in that the cooling probe assembly comprises one or more cooling members that protrude from a distal end of the shaft.
[0044]
44. SYSTEM according to claim 28, characterized in that the cooling probe assembly comprises a swivel base and a spray member affixed to the base.
[0045]
45. SYSTEM, according to claim 28, characterized in that it further comprises a microcontroller in communication with the thermal probe assembly, where the microcontroller is configured to control a rate of release of the ablative fluid to the interior volume of the flask.
[0046]
46. SYSTEM, according to claim 45, characterized in that the microcontroller is configured to control the rate of release of the ablative fluid in response to a sensed temperature and/or pressure parameter.
[0047]
47. SYSTEM according to claim 28, characterized in that it further comprises one or more temperature sensors in communication with an interior of the casing.
[0048]
48. SYSTEM according to claim 28, characterized in that it further comprises one or more pressure sensors in communication with an interior of the casing.
[0049]
A SYSTEM as claimed in claim 28, further comprising a valve in communication with an exhaust lumen in communication with an interior of the casing.
[0050]
50. SYSTEM according to claim 49, characterized in that the valve is adjustable to create a back pressure within the interior of the casing.
[0051]
51. SYSTEM, according to claim 50, characterized in that the valve is adjustable by means of a microcontroller.
[0052]
52. SYSTEM, according to claim 50, characterized in that the valve is mechanically adjustable.
[0053]
53. SYSTEM, according to claim 49, characterized in that the valve is a fixed, non-adjustable valve.
[0054]
54. SYSTEM, according to claim 28, characterized in that it further comprises a microcontroller in communication with the thermal probe assembly, where the microcontroller is configured to control a temperature of the ablative fluid in the interior volume of the coating.
[0055]
55. SYSTEM, according to claim 28, characterized in that it further comprises an emergency shut-off valve in communication with the reservoir.

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法律状态:
2017-10-24| B15I| Others concerning applications: loss of priority|

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2017-12-19| B12F| Other appeals [chapter 12.6 patent gazette]|

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2019-12-17| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2021-08-17| B350| Update of information on the portal [chapter 15.35 patent gazette]|

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2021-12-14| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2022-02-01| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 30/01/2012, OBSERVADAS AS CONDICOES LEGAIS. PATENTE CONCEDIDA CONFORME ADI 5.529/DF, QUE DETERMINA A ALTERACAO DO PRAZO DE CONCESSAO. |

优先权:

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申请号 | 申请日 | 专利标题

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US201161462328P| true| 2011-02-01|2011-02-01|

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US61/462,328|2011-02-01|

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US201161571123P| true| 2011-06-22|2011-06-22|

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US61/571,123|2011-06-22|

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PCT/US2012/023176|WO2012106260A2|2011-02-01|2012-01-30|Methods and apparatus for cyrogenic treatment of a body cavity or lumen|

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