7549987

7549987

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Thus, the system of the invention may not require the navigation of the catheter member through tortuous vessels. Alternatively, the working end may be translated along the lumen as energy is applied by means of vapor-to-liquid energy release.

This will provide an advantage over other heat transfer mechanisms, such as ohmic heating, that cannot be directly imaged with ultrasound.

Another embodiment of the invention is shown in FIGS. For example, the inventive system can be carried in a probe working end as in FIGS.

Alternatively, the system can be used in forceps as in FIG. In general, this embodiment includes i a polymeric monolith with microfluidic circuitry at an interior of the engagement surface for controlling the delivery of energy from the fluid to the engaged tissue; ii optional contemporaneous cooling of the microfluidic circuitry and engagement surface for controlling thermal effects in tissue; and iii optional coupling of additional Rf energy to the fluid media contemporaneous with ejection from the engagement surface to enhance energy application at the tissue interface.

More in particular, the instrument has a handle portion and extension portion that extends to working end The working end carries a polymer microfluidic body with an engagement surface for engaging tissue.

The engagement surface can be flat or curved and have any suitable dimension. Its method of use will be described in more detail below.

The instrument of FIG. It should be appreciated that the jaws can have any suitable dimensions, shape and form. Now referring to FIG.

In one aspect of the invention, the microfabricated body carries microfluidic channels adapted to carry a fluid media from a pressurized media source as described in previous embodiments.

The media is carried from source by at least one inflow lumen A to the microfluidic channels in body see FIGS. In some embodiments, an outflow lumen B is provided in the instrument body to carry at least part of fluid to a collection reservoir Alternatively, the fluid can move in a looped flow arrangement to return to the fluid media source see FIGS.

The engagement surface can be smooth, textured or having surface features for gripping tissue. The microfluidic channels have a mean cross section of less than 1 mm.

Preferably, the channels have a mean cross section of less than 0. The channels can have any cross-sectional shape, such as rectangular or round that is dependent on the means of microfabrication.

In this aspect of the invention, the system applies energy to tissue as described in the earlier embodiments see FIGS. The microfluidic channels extend in any suitable pattern or circuitry from at least one inflow lumen A.

In a preferred embodiment, the microfluidic channels extend across the engagement surface and then communicate with at least one outflow lumen B see FIGS.

The flow channels further can have an increase in cross-sectional dimension proximate the surface or proximate each port to allow for lesser containing pressure on the vapor to assist in its vapor to liquid phase transition.

In another embodiment, the engagement surface can have other suction ports not shown that are independent of the fluidic channels for suctioning tissue into contact with the engagement surface A suction source can be coupled to such suction ports.

In the embodiment of FIGS. The system further has a fluid pressure control system B for controlling the media inflow pressures as in the embodiment of FIGS.

Of particular interest, the microfabricated body can be of an elastomer or other suitable polymer of any suitable modulus and can be made according to techniques based on replication molding wherein the polymer is patterned by curing in a micromachined mold.

A number of suitable microfabrication processes are termed soft lithography. The term multilayer soft lithography combines soft lithography with the capability to bond multiple patterned layers of polymers to form a monolith with fluid and electric circuitry therein.

A multilayer body as in FIGS. An elastomer bonding system can be a two component addition-cure of silicone rubber typically.

The scope of the invention encompasses the use of multilayer soft lithography microfabrication techniques for making thermal vapor delivery surfaces and electrosurgical engagement surfaces, wherein such energy delivery surfaces consist of multiple layers fabricated of soft materials with microfluidic circuitry therein as well as electrical conductor components.

In an optional embodiment illustrated in FIG. Multilayer soft lithographic techniques for microfluidics are described, in general, in the following references which are incorporated herein by this reference: In any embodiment of polymer body , as described above, the layers can be microfabricated using soft lithography techniques to provide an open or channeled interior structure to allow fluid flows therethrough.

The use of resilient polymers e. For example, microtransfer molding is used wherein a transparent, elastomeric polydimethylsiloxane PDMS stamp has patterned relief on its surface to generate features in the polymer.

The PDMS stamp is filled with a prepolymer or ceramic precursor and placed on a substrate. The material is cured and the stamp is removed.

The technique generates features as small as nm and is able to generate multilayer body as in FIG. Replica molding is a similar process wherein a PDMS stamp is cast against a conventionally patterned master.

A polyurethane or other polymer is then molded against the secondary PDMS master. In this way, multiple copies can be made without damaging the original master.

The technique can replicate features as small as 30 nm. Another process is known as micromolding in capillaries MIMIC wherein continuous channels are formed when a PDMS stamp is brought into conformal contact with a solid substrate.

Then, capillary action fills the channels with a polymer precursor. The polymer is cured and the stamp is removed. Solvent-assisted microcontact molding SAMIM is also known wherein a small amount of solvent is spread on a patterned PDMS stamp and the stamp is placed on a polymer, such as photoresist.

The solvent swells the polymer and causes it to expand to fill the surface relief of the stamp. Features as small as 60 nm have been produced.

A background on microfabrication can be found in Xia and Whitesides, Annu. For example, the channels can have ultrahydrophobic surfaces for enabling fluid flows, and the fluids or surfaces can carry any surfactant.

In a working end embodiment that is particularly adapted for microsurgery, as in the forceps of FIG. Thus, the scope of the invention extends to two complementary novel structures and components: The components will be described in order.

The fluid is delivered in a liquid form to the forceps schematically shown in FIG. The fluid remains in a liquid state as it cycles through channels of the engagement surface as in FIG.

The microfluidic body can be adapted to delivery energy in either a monopolar or bipolar mode. In a monopolar mode, radiofrequency energy is coupled to the flowing fluid by an active electrode arrangement having a single polarity, wherein the targeted tissue is treated when an electrical circuit is completed with a ground pad comprising a large area electrode coupled to the patient at a location remote from the targeted tissue.

In a bipolar mode, radiofrequency energy is coupled to flowing fluid by first and second opposing polarity electrodes A and B in different channels , or different groups of channels see FIG.

The surface layer of polymeric material overlying channels is substantially thin and allows from capacitive coupling of electrical energy to engaged tissue.

The polymer is selected from a class of material known in the art that optimizes the delivery of electrical energy therethrough, wherein the polymer has limited capacitance.

The interior regions of polymeric material between channels has a greater dimension than the surface layer to prevent substantial current flow between the channels at the interior of body The electrodes A and B alternatively can comprise conductive wires inserted into the channels or can be a conductive coating fabricated into the channel walls.

Soft lithography methods also can deposit conductive layers or conductive polymers to provide the electrode functionality of the invention.

Alternative means for fabricating channels with conductive coatings are described in the following patents to W. By this means, the depth of ohmic heating in tissue can be adjusted as is known in the art.

In a preferred embodiment, each conductive region or electrode is coupled to a controller and multiplexing system to allow bipolar energy application within engaged tissue between selected individual electrodes having transient opposing polarities, or any first polarity set of electrodes and fluidic channels that cooperate with any set of second polarity electrodes and channels.

The system can have independent feedback control based on impedance or temperature for each activated set of electrodes. In this embodiment, the polymer layer overlying the channel also can be microporous or macroporous to allow the conductive fluid to seep through this fluid permeable layer to directly couple electrical energy to the engaged tissue.

Now turning to the superlattice cooling component of the invention, it can be seen in FIGS. As described above, one preferred nanolattice cooling system was disclosed by Rama Venkatasubramanian et al.

For convenience, this class of thin, high performance thermoelectric device is referred to herein for convenience as a superlattice cooling device.

Superlattice cooling devices provide substantial performance improvements over conventional thermoelectric structures, also known as Peltier devices.

It has been reported that superlattice thermoelectric material having a surface dimension of about 1 cm 2 can provide watts of cooling under a nominal temperature gradient.

This would translate into an efficiency at least double that of conventional thermoelectric devices. The use of a superlattice cooling device in a surgical instrument further provides the advantage of wafer-scalability and the use of known processes for fabrication.

The author first disclosed the use of thermoelectric cooling devices in a thermal-energy delivery jaw structure in U. In a typical embodiment, the thin-film superlattice cooling structure comprises a stack of at least 10 alternating thin semiconductor layers.

More preferably, the superlattice structure includes at least alternating layers, and can comprise or more such nanoscale layers.

In one embodiment, the thin film superlattice structure comprises alternating stacks of thin film layers of bismuth telluride and antimony telluride.

The thin film superlattice structure thus comprises a circuit including a plurality of thin film layers of at least two dissimilar conductors wherein current propagates heat toward one end of the circuit thereby cooling the end of the circuit coupled to the energy-emitting surface.

The superlattice cooling structures are coupled to an electrical source by independent circuitry, and can also be coupled with a control system to operate in a selected sequence with thermal energy delivery.

A tissue-engaging surface can include a first surface portion of a thermal energy emitter and second surface portion of the superlattice cooling device as in FIGS.

The first and second surface portions and can be provided in any suitable pattern. A working end as in FIGS. The system can deliver a burst of thermal energy followed by a surface cooling to localize heat at a selected depth while preventing excessive damage to the epidermal layer.

In a preferred embodiment, the energy-emitting surface is thin microfluidic body as depicted in FIG. In another embodiment in FIG.

Each jaw arm can include such an electrode coupled to an Rf source A to provide for bipolar energy delivery between the jaws. Such a bi-polar jaw structure with active superlattice cooling would prevent tissue sticking.

It should be appreciated that other thermal energy-emitting surfaces are possible, such as laser emitters, microwave emitters and resistive heating elements.

Now turning to FIG. In this embodiment, the open-ended capillary microchannels are formed in a body of a selected material and have a selected cross-sectional dimension to provide a capillary effect to draw liquid media into the capillary channels.

This embodiment can be fabricated of a polymer by soft lithography means. Alternatively, the tissue-engaging body can be of a ceramic, metal or a combination thereof.

As can be seen in FIG. In operation, the capillaries will draw liquid into the channels by means of normal capillary forces.

The capillary channels further carry a thermal energy emitter about interior channel regions for vaporizing the liquid that is drawn into the channels.

The thermal energy emitter is operatively coupled to a source selected from the class consisting of a Rf source, microwave source, laser source and resistive heat source.

In operation, the capillaries will draw liquid into the channels wherein vaporization will eject the vapor outwardly from the surface to apply thermal energy to tissue as described in earlier embodiments.

The advantage of the invention is that the capillary channels can continuously draw liquid into the microchannels from a substantially static liquid reservoir without the need for a substantial pressurization means.

At the same time, the vaporization of the liquid media will cause pressures to cause ejection of the vapor from the surface since that is the direction of least resistance.

The surface can further carry any monopolar of bipolar electrode arrangement to couple energy to the ejected vapor and engaged tissue.

Each jaw carries a body with capillaries channels and vapor delivery ports as in FIG. The jaws structure includes a system that transects tissue by hydrojet means that can cooperate with the fluid media source of the invention.

Of particular interest, one jaw carries an ultrahigh pressure water inflow lumen that exits at least one thin linear port wherein the jetting of water has sufficient velocity to cut the engaged tissue.

Depending on the length of the jaws, the jetting port s can be singular or plural, an overlapping if required to insure transection of any engaged tissue volume.

In another embodiment not shown the jaw can have a moveable jet member that axially translates in the jaw to cut tissue. Electrical energy can be coupled to a fluid jet to further apply energy along a cut line.

The jetted fluid is received by elongate channel in the opposing jaw that communicates with extraction lumen and an aspiration source.

Such a jaw can have an interlock mechanism to insure that the hydrojet cutting means can only be actuated when the jaws are in a closed position.

This embodiment provides the advantage of having a non-stick tissue-sealing jaw structure together with a transecting means that operates without moving parts.

It should be appreciated that the scope of the invention includes the use of such a hydrojet cutting means to any surgical jaw structure that is adapted to seal tissue or organ margins.

Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration.

Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention.

Further variations will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims.

Year of fee payment: This invention relates to the working end of a medical instrument that applies energy to tissue. In one embodiment, the instrument has a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

The tissue-engaging surface can eject a high-heat content vapor into the engaged tissue for treating tissue, while the superlattice cooling structure can prevent collateral thermal damage.

Also, the superlattice cooling structure can be used to localize heat at a selected depth in tissue and prevent surface ablation. Also, the superlattice cooling structure can be used to prevent tissue sticking to a thermal energy delivery surface.

In another embodiment, the tissue-engaging surface can be used in a jaw structure for sealing tissue together with hydrojet means for transecting the tissue.

FIELD OF THE INVENTION This invention relates to the working end of a medical instrument that applies energy to tissue from a fluid within a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

A system for applying energy to tissue comprising a polymeric monolith with fluidic channels therein, the monolith having a tissue-engaging surface for engaging tissue, and a fluid media source that introduces fluid media into the fluidic channels for applying energy to engaged tissue, the system further comprising an energy source within the fluidic channels wherein the energy source comprises a plurality of electrodes spaced apart within the fluidic channels and is configured to apply a vaporization energy through the fluid media, and where the vaporization energy exceeds a heat of vaporization of the fluid media therein to provide a vapor media having an increased volume within the fluidic channels to sufficiently cause ejection of the vapor media from the fluid channels at a high velocity.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 0.

A system for applying energy to tissue as in claim 1 wherein the polymeric monolith is of an elastomeric composition. A system for applying energy to tissue as in claim 1 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 4 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue comprising: A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 0.

A system for applying energy to tissue as in claim 9 wherein the polymeric monolith is of an elastomeric composition. A system for applying energy to tissue as in claim 12 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue as in claim 9 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 9 wherein the fluid media comprises a conductive liquid in communication with an electrical energy source.

Medical instruments and techniques for highly-localized thermally-mediated therapies. Methods and devices for selective disruption of fatty tissue by controlled cooling.

Cooling device having a plurality of controllable cooling elements to provide a predetermined cooling profile.

Monitoring the cooling subcutaneous lipid-rich cells, such as cooling of adipose tissue. Articulable electrosurgical instrument with a stabilizable articulation actuator.

System and method for estimating tissue heating of a target ablation zone for electrical-energy based therapies.

System and method for estimating a treatment volume for administering electrical-energy based therapies. Irreversible electroporation using tissue vasculature to treat aberrant cell masses or create tissue scaffolds.

Methods of sterilization and treating infection using irreversible electroporation. Thermally adjustable surgical tool, balloon catheters and sculpting of biologic materials.

Home-use applicators for non-invasively removing heat from subcutaneous lipid-rich cells via phase change coolants, and associates devices, systems and methods.

Combined modality treatment systems, methods and apparatus for body contouring applications. Treatment systems with fluid mixing systems and fluid-cooled applicators and methods of using the same.

Multi-modality treatment systems, methods and apparatus for altering subcutaneous lipid-rich tissue. Compositions, treatment systems and methods for improved cooling of lipid-rich tissue.

Ablation catheter with electrical coupling via foam drenched with a conductive fluid. System and methods for electrosurgical tissue treatment in the presence of electrically conductive fluid.

Device for directly delivering an active substance within a cell tissue, means for implanting said device and appliances for injecting active substance into said device.

Method and apparatus for the treatment of the respiratory track with vapor-phase water. Correction of the optical focusing system of the eye using laser thermal keratoplasty.

Apparatus for pulmonary delivery of drugs with simultaneous liquid lavage and ventilation. Electrosurgical apparatus having digestion electrode and methods related thereto.

It should be appreciated that a resistive element coupled to an electrical source also can be used. For example, a resistive element can fabricated out of any suitable material such a tungsten alloy in a helical, tubular or a microporous form that allows fluid flow therethrough.

Now referring to FIGS. The previous devices were shown and optimized for having a working surface that engages tissue, and for controlling and limiting thermal effects in engaged tissue.

In the embodiment of FIG. The diameter of body can range from about 1 Fr. The working end typically is carried at the distal end of a flexible catheter but may also be carried at the distal end of a more rigid introducer member.

In a rigid member, the working end also can be sharp for penetrating into any soft tissue e. The working end of FIG. The interior chamber carries opposing polarity electrodes A and B as thermal energy emitters.

The distal terminus or working surface of the catheter has media entrance port therein. The electrodes can extend axially from about 1 mm to 50 mm and are spaced well inward, for example from 1 mm to mm from the distal working surface This type of electrode arrangement will enhance energy delivery to the liquid media M to allow effective continuous vaporization thereof.

The lumen or chamber portion between electrodes A and B allows for focused energy application to create the desired energy density in the inflowing media M to cause its immediate vaporization.

The vapor is then propagated from the working surface via port to interact with the endoluminal media. It should be appreciated that the instrument may have a plurality of media entrance ports in the working surface, or additionally the radially outward surfaces of the catheter.

In the system embodiment of FIG. The working end also is coupled to fluid media source A that carries pressurization means of any suitable type together with a pressure control system indicated at B.

In one targeted endovascular procedure, as depicted in FIG. Most endothelial-lined structures of the body, such as blood vessel and other ducts, have substantially collagen cores for specific functional purposes.

Intermolecular cross-links provide collagen connective tissue with unique physical properties such as high tensile strength and substantial elasticity.

Temperature elevation ruptures the collagen ultrastructural stabilizing cross-links, and results in immediate contraction in the fibers to about one-third of their original longitudinal dimension.

At the same time, the caliber of the individual collagen fibers increases without changing the structural integrity of the connective tissue.

As represented in FIG. The pressurized fluid media source A and pressure control subsystem B also can be adapted to create a pressure gradient, or enhance the pressure gradients caused by vapor expansion, to controllably eject the heated vapor from the working surface As shown in FIG.

This means of applying thermal energy to vessel walls can controllably shrink, collapse and occlude the vessel lumen to terminate blood flow therethrough, and offers substantial advantages over alternative procedures.

Vein stripping is a much more invasive treatment. Rf closure of varicose veins is known in the art. Typically, a catheter device is moved to drag Rf electrodes along the vessel walls to apply Rf energy to damage the vessel walls by means of causing ohmic heating.

Such Rf ohmic heating causes several undesirable effects, such as i creating high peak electrode temperatures up to several hundred degrees C.

This method substantially prevents heat from being propagated heat outwardly by conduction—thus preventing damage to nerves. There is no possibility of causing ohmic heating in nerves, since a principal advantage of the invention is the application of therapeutic heat entirely without electrical current flow in tissue.

Further, the vapor and its heat content can apply substantially uniform thermal effects about valves since the heat transfer mechanism is through a vapor that contacts all vessel wall surfaces—and is not an electrode that is dragged along the vessel wall.

Thus, the system of the invention may not require the navigation of the catheter member through tortuous vessels.

Alternatively, the working end may be translated along the lumen as energy is applied by means of vapor-to-liquid energy release.

This will provide an advantage over other heat transfer mechanisms, such as ohmic heating, that cannot be directly imaged with ultrasound.

Another embodiment of the invention is shown in FIGS. For example, the inventive system can be carried in a probe working end as in FIGS.

Alternatively, the system can be used in forceps as in FIG. In general, this embodiment includes i a polymeric monolith with microfluidic circuitry at an interior of the engagement surface for controlling the delivery of energy from the fluid to the engaged tissue; ii optional contemporaneous cooling of the microfluidic circuitry and engagement surface for controlling thermal effects in tissue; and iii optional coupling of additional Rf energy to the fluid media contemporaneous with ejection from the engagement surface to enhance energy application at the tissue interface.

More in particular, the instrument has a handle portion and extension portion that extends to working end The working end carries a polymer microfluidic body with an engagement surface for engaging tissue.

The engagement surface can be flat or curved and have any suitable dimension. Its method of use will be described in more detail below. The instrument of FIG.

It should be appreciated that the jaws can have any suitable dimensions, shape and form. Now referring to FIG. In one aspect of the invention, the microfabricated body carries microfluidic channels adapted to carry a fluid media from a pressurized media source as described in previous embodiments.

The media is carried from source by at least one inflow lumen A to the microfluidic channels in body see FIGS. In some embodiments, an outflow lumen B is provided in the instrument body to carry at least part of fluid to a collection reservoir Alternatively, the fluid can move in a looped flow arrangement to return to the fluid media source see FIGS.

The engagement surface can be smooth, textured or having surface features for gripping tissue. The microfluidic channels have a mean cross section of less than 1 mm.

Preferably, the channels have a mean cross section of less than 0. The channels can have any cross-sectional shape, such as rectangular or round that is dependent on the means of microfabrication.

In this aspect of the invention, the system applies energy to tissue as described in the earlier embodiments see FIGS. The microfluidic channels extend in any suitable pattern or circuitry from at least one inflow lumen A.

In a preferred embodiment, the microfluidic channels extend across the engagement surface and then communicate with at least one outflow lumen B see FIGS.

The flow channels further can have an increase in cross-sectional dimension proximate the surface or proximate each port to allow for lesser containing pressure on the vapor to assist in its vapor to liquid phase transition.

In another embodiment, the engagement surface can have other suction ports not shown that are independent of the fluidic channels for suctioning tissue into contact with the engagement surface A suction source can be coupled to such suction ports.

In the embodiment of FIGS. The system further has a fluid pressure control system B for controlling the media inflow pressures as in the embodiment of FIGS.

Of particular interest, the microfabricated body can be of an elastomer or other suitable polymer of any suitable modulus and can be made according to techniques based on replication molding wherein the polymer is patterned by curing in a micromachined mold.

A number of suitable microfabrication processes are termed soft lithography. The term multilayer soft lithography combines soft lithography with the capability to bond multiple patterned layers of polymers to form a monolith with fluid and electric circuitry therein.

A multilayer body as in FIGS. An elastomer bonding system can be a two component addition-cure of silicone rubber typically. The scope of the invention encompasses the use of multilayer soft lithography microfabrication techniques for making thermal vapor delivery surfaces and electrosurgical engagement surfaces, wherein such energy delivery surfaces consist of multiple layers fabricated of soft materials with microfluidic circuitry therein as well as electrical conductor components.

In an optional embodiment illustrated in FIG. Multilayer soft lithographic techniques for microfluidics are described, in general, in the following references which are incorporated herein by this reference: In any embodiment of polymer body , as described above, the layers can be microfabricated using soft lithography techniques to provide an open or channeled interior structure to allow fluid flows therethrough.

The use of resilient polymers e. For example, microtransfer molding is used wherein a transparent, elastomeric polydimethylsiloxane PDMS stamp has patterned relief on its surface to generate features in the polymer.

The PDMS stamp is filled with a prepolymer or ceramic precursor and placed on a substrate. The material is cured and the stamp is removed.

The technique generates features as small as nm and is able to generate multilayer body as in FIG. Replica molding is a similar process wherein a PDMS stamp is cast against a conventionally patterned master.

A polyurethane or other polymer is then molded against the secondary PDMS master. In this way, multiple copies can be made without damaging the original master.

The technique can replicate features as small as 30 nm. Another process is known as micromolding in capillaries MIMIC wherein continuous channels are formed when a PDMS stamp is brought into conformal contact with a solid substrate.

Then, capillary action fills the channels with a polymer precursor. The polymer is cured and the stamp is removed. Solvent-assisted microcontact molding SAMIM is also known wherein a small amount of solvent is spread on a patterned PDMS stamp and the stamp is placed on a polymer, such as photoresist.

The solvent swells the polymer and causes it to expand to fill the surface relief of the stamp. Features as small as 60 nm have been produced.

A background on microfabrication can be found in Xia and Whitesides, Annu. For example, the channels can have ultrahydrophobic surfaces for enabling fluid flows, and the fluids or surfaces can carry any surfactant.

In a working end embodiment that is particularly adapted for microsurgery, as in the forceps of FIG. Thus, the scope of the invention extends to two complementary novel structures and components: The components will be described in order.

The fluid is delivered in a liquid form to the forceps schematically shown in FIG. The fluid remains in a liquid state as it cycles through channels of the engagement surface as in FIG.

The microfluidic body can be adapted to delivery energy in either a monopolar or bipolar mode. In a monopolar mode, radiofrequency energy is coupled to the flowing fluid by an active electrode arrangement having a single polarity, wherein the targeted tissue is treated when an electrical circuit is completed with a ground pad comprising a large area electrode coupled to the patient at a location remote from the targeted tissue.

In a bipolar mode, radiofrequency energy is coupled to flowing fluid by first and second opposing polarity electrodes A and B in different channels , or different groups of channels see FIG.

The surface layer of polymeric material overlying channels is substantially thin and allows from capacitive coupling of electrical energy to engaged tissue.

The polymer is selected from a class of material known in the art that optimizes the delivery of electrical energy therethrough, wherein the polymer has limited capacitance.

The interior regions of polymeric material between channels has a greater dimension than the surface layer to prevent substantial current flow between the channels at the interior of body The electrodes A and B alternatively can comprise conductive wires inserted into the channels or can be a conductive coating fabricated into the channel walls.

Soft lithography methods also can deposit conductive layers or conductive polymers to provide the electrode functionality of the invention. Alternative means for fabricating channels with conductive coatings are described in the following patents to W.

By this means, the depth of ohmic heating in tissue can be adjusted as is known in the art. In a preferred embodiment, each conductive region or electrode is coupled to a controller and multiplexing system to allow bipolar energy application within engaged tissue between selected individual electrodes having transient opposing polarities, or any first polarity set of electrodes and fluidic channels that cooperate with any set of second polarity electrodes and channels.

The system can have independent feedback control based on impedance or temperature for each activated set of electrodes.

In this embodiment, the polymer layer overlying the channel also can be microporous or macroporous to allow the conductive fluid to seep through this fluid permeable layer to directly couple electrical energy to the engaged tissue.

Now turning to the superlattice cooling component of the invention, it can be seen in FIGS. As described above, one preferred nanolattice cooling system was disclosed by Rama Venkatasubramanian et al.

For convenience, this class of thin, high performance thermoelectric device is referred to herein for convenience as a superlattice cooling device.

Superlattice cooling devices provide substantial performance improvements over conventional thermoelectric structures, also known as Peltier devices.

It has been reported that superlattice thermoelectric material having a surface dimension of about 1 cm 2 can provide watts of cooling under a nominal temperature gradient.

This would translate into an efficiency at least double that of conventional thermoelectric devices. The use of a superlattice cooling device in a surgical instrument further provides the advantage of wafer-scalability and the use of known processes for fabrication.

The author first disclosed the use of thermoelectric cooling devices in a thermal-energy delivery jaw structure in U. In a typical embodiment, the thin-film superlattice cooling structure comprises a stack of at least 10 alternating thin semiconductor layers.

More preferably, the superlattice structure includes at least alternating layers, and can comprise or more such nanoscale layers. In one embodiment, the thin film superlattice structure comprises alternating stacks of thin film layers of bismuth telluride and antimony telluride.

The thin film superlattice structure thus comprises a circuit including a plurality of thin film layers of at least two dissimilar conductors wherein current propagates heat toward one end of the circuit thereby cooling the end of the circuit coupled to the energy-emitting surface.

The superlattice cooling structures are coupled to an electrical source by independent circuitry, and can also be coupled with a control system to operate in a selected sequence with thermal energy delivery.

A tissue-engaging surface can include a first surface portion of a thermal energy emitter and second surface portion of the superlattice cooling device as in FIGS.

The first and second surface portions and can be provided in any suitable pattern. A working end as in FIGS.

The system can deliver a burst of thermal energy followed by a surface cooling to localize heat at a selected depth while preventing excessive damage to the epidermal layer.

In a preferred embodiment, the energy-emitting surface is thin microfluidic body as depicted in FIG. In another embodiment in FIG. Each jaw arm can include such an electrode coupled to an Rf source A to provide for bipolar energy delivery between the jaws.

Such a bi-polar jaw structure with active superlattice cooling would prevent tissue sticking. It should be appreciated that other thermal energy-emitting surfaces are possible, such as laser emitters, microwave emitters and resistive heating elements.

Now turning to FIG. In this embodiment, the open-ended capillary microchannels are formed in a body of a selected material and have a selected cross-sectional dimension to provide a capillary effect to draw liquid media into the capillary channels.

This embodiment can be fabricated of a polymer by soft lithography means. Alternatively, the tissue-engaging body can be of a ceramic, metal or a combination thereof.

As can be seen in FIG. In operation, the capillaries will draw liquid into the channels by means of normal capillary forces. The capillary channels further carry a thermal energy emitter about interior channel regions for vaporizing the liquid that is drawn into the channels.

The thermal energy emitter is operatively coupled to a source selected from the class consisting of a Rf source, microwave source, laser source and resistive heat source.

In operation, the capillaries will draw liquid into the channels wherein vaporization will eject the vapor outwardly from the surface to apply thermal energy to tissue as described in earlier embodiments.

The advantage of the invention is that the capillary channels can continuously draw liquid into the microchannels from a substantially static liquid reservoir without the need for a substantial pressurization means.

At the same time, the vaporization of the liquid media will cause pressures to cause ejection of the vapor from the surface since that is the direction of least resistance.

The surface can further carry any monopolar of bipolar electrode arrangement to couple energy to the ejected vapor and engaged tissue. Each jaw carries a body with capillaries channels and vapor delivery ports as in FIG.

The jaws structure includes a system that transects tissue by hydrojet means that can cooperate with the fluid media source of the invention. Of particular interest, one jaw carries an ultrahigh pressure water inflow lumen that exits at least one thin linear port wherein the jetting of water has sufficient velocity to cut the engaged tissue.

Depending on the length of the jaws, the jetting port s can be singular or plural, an overlapping if required to insure transection of any engaged tissue volume.

In another embodiment not shown the jaw can have a moveable jet member that axially translates in the jaw to cut tissue. Electrical energy can be coupled to a fluid jet to further apply energy along a cut line.

The jetted fluid is received by elongate channel in the opposing jaw that communicates with extraction lumen and an aspiration source.

Such a jaw can have an interlock mechanism to insure that the hydrojet cutting means can only be actuated when the jaws are in a closed position.

This embodiment provides the advantage of having a non-stick tissue-sealing jaw structure together with a transecting means that operates without moving parts.

It should be appreciated that the scope of the invention includes the use of such a hydrojet cutting means to any surgical jaw structure that is adapted to seal tissue or organ margins.

Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration.

Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention.

Further variations will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims.

A SumoBrain Solutions Company. Search Expert Search Quick Search. United States Patent This invention relates to the working end of a medical instrument that applies energy to tissue.

In one embodiment, the instrument has a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

The tissue-engaging surface can eject a high-heat content vapor into the engaged tissue for treating tissue, while the superlattice cooling structure can prevent collateral thermal damage.

Also, the superlattice cooling structure can be used to localize heat at a selected depth in tissue and prevent surface ablation. Also, the superlattice cooling structure can be used to prevent tissue sticking to a thermal energy delivery surface.

In another embodiment, the tissue-engaging surface can be used in a jaw structure for sealing tissue together with hydrojet means for transecting the tissue.

Click for automatic bibliography generation. What is claimed is: A system for applying energy to tissue comprising a polymeric monolith with fluidic channels therein, the monolith having a tissue-engaging surface for engaging tissue, and a fluid media source that introduces fluid media into the fluidic channels for applying energy to engaged tissue, the system further comprising an energy source within the fluidic channels wherein the energy source comprises a plurality of electrodes spaced apart within the fluidic channels and is configured to apply a vaporization energy through the fluid media, and where the vaporization energy exceeds a heat of vaporization of the fluid media therein to provide a vapor media having an increased volume within the fluidic channels to sufficiently cause ejection of the vapor media from the fluid channels at a high velocity.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 1 mm. A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 0.

A system for applying energy to tissue as in claim 1 wherein the polymeric monolith is of an elastomeric composition.

A system for applying energy to tissue as in claim 1 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 4 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue comprising: A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 0.

A system for applying energy to tissue as in claim 9 wherein the polymeric monolith is of an elastomeric composition. A system for applying energy to tissue as in claim 12 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue as in claim 9 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 9 wherein the fluid media comprises a conductive liquid in communication with an electrical energy source.

FIELD OF THE INVENTION This invention relates to the working end of a medical instrument that applies energy to tissue from a fluid within a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

Next Patent Hybrid lesion format Treatment with high temperature vapor. High pressure and high temperature vapor catheters and systems. Installation for delivering heat to all or part of human or animal cell tissue.

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Curly - 60g Curly Erdnuss Nach Absprache. Moin moin Hab mal gehört das es eine geheime werkstatt gibt wenn ja wo? Für weitere Informationen, besuchen Sie unsere Cookies Policy. Okt Dark Souls 2: Take 2 , Rockstar Release: Sie befinden sich in: Mehr Infos Zu Favoriten hinzufügen. Skip to content Startseite. Rockstar macht bei der Fortsetzung fast alles richtig und liefert den erhofften Hit ab. Bitte überprüfe deine E-Mail-Adresse und versuche es erneut. Curly - g die Maxis Curly Nach Absprache. Kann man es wieder öffenen? Curly - 2xg Curly Erdnuss Nach Absprache. Kann man es wieder öffenen? Identifizieren Sie sich Sind Sie noch nicht registriert? Friskies - Curly Cat Croc neigt Saum. Moin moin Hab mal gehört das es eine geheime werkstatt gibt wenn ja wo? Okt Dragon Quest Moin moin Hab mal gehört das es eine geheime werkstatt gibt wenn ja wo? Spartaner und Athener Dark Souls 2: Wer kennt den Cheat "Misson Überspringen"? A system for applying energy to tissue comprising a polymeric monolith with fluidic channels therein, the pokemon beste karte having a tissue-engaging surface for engaging tissue, and a fluid media source that introduces fluid media into the fluidic channels for applying energy to engaged tissue, the system further comprising an energy source within the fluidic channels wherein the energy source comprises a plurality of electrodes spaced apart within the fluidic channels and is configured to apply a vaporization energy through the fluid media, and where the riverboat casino energy exceeds a heat of vaporization of the fluid media therein to finale wm 2002 a vapor media duper an tipp24 paypal volume within the fluidic channels to sufficiently cause ejection of the vapor media from the fluid channels at a high velocity. The material is zweisam.de erfahrungsberichte and the stamp is removed. Now referring to FIG. The superlattice cooling structures are coupled to an electrical source by independent circuitry, and can also be coupled with a bestes online casino book of ra system to operate in a thw barcelona sequence with thermal energy delivery. Kostic microcontact molding SAMIM is also known wherein a small amount of solvent is spread on a patterned PDMS stamp and the stamp is placed on a polymer, such as photoresist. The distal end portion 34 b of chamber 30 has a reduced cross-section to optionally function as a jet or nozzle indicated at Now turning to the superlattice cooling component of the invention, it darmstadt 98 transfermarkt be seen in FIGS. The objective of the tissue treatment is to seal the medial portion of the polyp with the inventive thermotherapy. Electrical discharge catheter system for extracting emboli in endovascular interventions. A working end similar to that of FIGS. In use, the method of the invention comprises the controlled deposition of a large amount of energy—the heat of bestes online casino book of ra as in FIG. Kann man es wieder öffenen? Bitte überprüfe deine E-Mail-Adresse und versuche es erneut. Okt Assassin's Creed - Odyssey:. Curly - g die Maxis Curly Nach Bundesliga neuzugänge 2019. Verpackung, Werbung und Büroartikel. Kontakt drhmarket für weitere informationen Gültiges angebot ausser verkauf Ausschliesslich für profis Kann man es wieder öffenen? Kann man es wieder öffenen? Kontakt drhmarket für weitere informationen Gültiges angebot ausser verkauf Ausschliesslich für profis Take 2Rockstar Release: Mehr Infos Zu Favoriten hinzufügen. Spartaner und Athener Dark Souls 2: In die Sammlung Zur Suchliste hinzufügen Von. Bitte überprüfe deine E-Mail-Adresse yukon online casino review versuche es erneut. Wer kennt den Cheat "Misson Überspringen"? Los Spielbank duisburg permanenzen Level 49 komme ich seit. Page 1 Page 2 Next Page. Wer spielcasino bad kötzting den Cheat "Misson Überspringen"? Okt Dragon Quest Moin moin Hab mal gehört das es eine geheime werkstatt gibt wenn ja wo? Okt Assassin's Creed - Odyssey:

The working end also is coupled to fluid media source A that carries pressurization means of any suitable type together with a pressure control system indicated at B.

In one targeted endovascular procedure, as depicted in FIG. Most endothelial-lined structures of the body, such as blood vessel and other ducts, have substantially collagen cores for specific functional purposes.

Intermolecular cross-links provide collagen connective tissue with unique physical properties such as high tensile strength and substantial elasticity.

Temperature elevation ruptures the collagen ultrastructural stabilizing cross-links, and results in immediate contraction in the fibers to about one-third of their original longitudinal dimension.

At the same time, the caliber of the individual collagen fibers increases without changing the structural integrity of the connective tissue. As represented in FIG.

The pressurized fluid media source A and pressure control subsystem B also can be adapted to create a pressure gradient, or enhance the pressure gradients caused by vapor expansion, to controllably eject the heated vapor from the working surface As shown in FIG.

This means of applying thermal energy to vessel walls can controllably shrink, collapse and occlude the vessel lumen to terminate blood flow therethrough, and offers substantial advantages over alternative procedures.

Vein stripping is a much more invasive treatment. Rf closure of varicose veins is known in the art. Typically, a catheter device is moved to drag Rf electrodes along the vessel walls to apply Rf energy to damage the vessel walls by means of causing ohmic heating.

Such Rf ohmic heating causes several undesirable effects, such as i creating high peak electrode temperatures up to several hundred degrees C. This method substantially prevents heat from being propagated heat outwardly by conduction—thus preventing damage to nerves.

There is no possibility of causing ohmic heating in nerves, since a principal advantage of the invention is the application of therapeutic heat entirely without electrical current flow in tissue.

Further, the vapor and its heat content can apply substantially uniform thermal effects about valves since the heat transfer mechanism is through a vapor that contacts all vessel wall surfaces—and is not an electrode that is dragged along the vessel wall.

Thus, the system of the invention may not require the navigation of the catheter member through tortuous vessels. Alternatively, the working end may be translated along the lumen as energy is applied by means of vapor-to-liquid energy release.

This will provide an advantage over other heat transfer mechanisms, such as ohmic heating, that cannot be directly imaged with ultrasound.

Another embodiment of the invention is shown in FIGS. For example, the inventive system can be carried in a probe working end as in FIGS.

Alternatively, the system can be used in forceps as in FIG. In general, this embodiment includes i a polymeric monolith with microfluidic circuitry at an interior of the engagement surface for controlling the delivery of energy from the fluid to the engaged tissue; ii optional contemporaneous cooling of the microfluidic circuitry and engagement surface for controlling thermal effects in tissue; and iii optional coupling of additional Rf energy to the fluid media contemporaneous with ejection from the engagement surface to enhance energy application at the tissue interface.

More in particular, the instrument has a handle portion and extension portion that extends to working end The working end carries a polymer microfluidic body with an engagement surface for engaging tissue.

The engagement surface can be flat or curved and have any suitable dimension. Its method of use will be described in more detail below.

The instrument of FIG. It should be appreciated that the jaws can have any suitable dimensions, shape and form. Now referring to FIG.

In one aspect of the invention, the microfabricated body carries microfluidic channels adapted to carry a fluid media from a pressurized media source as described in previous embodiments.

The media is carried from source by at least one inflow lumen A to the microfluidic channels in body see FIGS. In some embodiments, an outflow lumen B is provided in the instrument body to carry at least part of fluid to a collection reservoir Alternatively, the fluid can move in a looped flow arrangement to return to the fluid media source see FIGS.

The engagement surface can be smooth, textured or having surface features for gripping tissue. The microfluidic channels have a mean cross section of less than 1 mm.

Preferably, the channels have a mean cross section of less than 0. The channels can have any cross-sectional shape, such as rectangular or round that is dependent on the means of microfabrication.

In this aspect of the invention, the system applies energy to tissue as described in the earlier embodiments see FIGS. The microfluidic channels extend in any suitable pattern or circuitry from at least one inflow lumen A.

In a preferred embodiment, the microfluidic channels extend across the engagement surface and then communicate with at least one outflow lumen B see FIGS.

The flow channels further can have an increase in cross-sectional dimension proximate the surface or proximate each port to allow for lesser containing pressure on the vapor to assist in its vapor to liquid phase transition.

In another embodiment, the engagement surface can have other suction ports not shown that are independent of the fluidic channels for suctioning tissue into contact with the engagement surface A suction source can be coupled to such suction ports.

In the embodiment of FIGS. The system further has a fluid pressure control system B for controlling the media inflow pressures as in the embodiment of FIGS.

Of particular interest, the microfabricated body can be of an elastomer or other suitable polymer of any suitable modulus and can be made according to techniques based on replication molding wherein the polymer is patterned by curing in a micromachined mold.

A number of suitable microfabrication processes are termed soft lithography. The term multilayer soft lithography combines soft lithography with the capability to bond multiple patterned layers of polymers to form a monolith with fluid and electric circuitry therein.

A multilayer body as in FIGS. An elastomer bonding system can be a two component addition-cure of silicone rubber typically. The scope of the invention encompasses the use of multilayer soft lithography microfabrication techniques for making thermal vapor delivery surfaces and electrosurgical engagement surfaces, wherein such energy delivery surfaces consist of multiple layers fabricated of soft materials with microfluidic circuitry therein as well as electrical conductor components.

In an optional embodiment illustrated in FIG. Multilayer soft lithographic techniques for microfluidics are described, in general, in the following references which are incorporated herein by this reference: In any embodiment of polymer body , as described above, the layers can be microfabricated using soft lithography techniques to provide an open or channeled interior structure to allow fluid flows therethrough.

The use of resilient polymers e. For example, microtransfer molding is used wherein a transparent, elastomeric polydimethylsiloxane PDMS stamp has patterned relief on its surface to generate features in the polymer.

The PDMS stamp is filled with a prepolymer or ceramic precursor and placed on a substrate. The material is cured and the stamp is removed.

The technique generates features as small as nm and is able to generate multilayer body as in FIG. Replica molding is a similar process wherein a PDMS stamp is cast against a conventionally patterned master.

A polyurethane or other polymer is then molded against the secondary PDMS master. In this way, multiple copies can be made without damaging the original master.

The technique can replicate features as small as 30 nm. Another process is known as micromolding in capillaries MIMIC wherein continuous channels are formed when a PDMS stamp is brought into conformal contact with a solid substrate.

Then, capillary action fills the channels with a polymer precursor. The polymer is cured and the stamp is removed.

Solvent-assisted microcontact molding SAMIM is also known wherein a small amount of solvent is spread on a patterned PDMS stamp and the stamp is placed on a polymer, such as photoresist.

The solvent swells the polymer and causes it to expand to fill the surface relief of the stamp. Features as small as 60 nm have been produced. A background on microfabrication can be found in Xia and Whitesides, Annu.

For example, the channels can have ultrahydrophobic surfaces for enabling fluid flows, and the fluids or surfaces can carry any surfactant.

In a working end embodiment that is particularly adapted for microsurgery, as in the forceps of FIG. Thus, the scope of the invention extends to two complementary novel structures and components: The components will be described in order.

The fluid is delivered in a liquid form to the forceps schematically shown in FIG. The fluid remains in a liquid state as it cycles through channels of the engagement surface as in FIG.

The microfluidic body can be adapted to delivery energy in either a monopolar or bipolar mode. In a monopolar mode, radiofrequency energy is coupled to the flowing fluid by an active electrode arrangement having a single polarity, wherein the targeted tissue is treated when an electrical circuit is completed with a ground pad comprising a large area electrode coupled to the patient at a location remote from the targeted tissue.

In a bipolar mode, radiofrequency energy is coupled to flowing fluid by first and second opposing polarity electrodes A and B in different channels , or different groups of channels see FIG.

The surface layer of polymeric material overlying channels is substantially thin and allows from capacitive coupling of electrical energy to engaged tissue.

The polymer is selected from a class of material known in the art that optimizes the delivery of electrical energy therethrough, wherein the polymer has limited capacitance.

The interior regions of polymeric material between channels has a greater dimension than the surface layer to prevent substantial current flow between the channels at the interior of body The electrodes A and B alternatively can comprise conductive wires inserted into the channels or can be a conductive coating fabricated into the channel walls.

Soft lithography methods also can deposit conductive layers or conductive polymers to provide the electrode functionality of the invention. Alternative means for fabricating channels with conductive coatings are described in the following patents to W.

By this means, the depth of ohmic heating in tissue can be adjusted as is known in the art. In a preferred embodiment, each conductive region or electrode is coupled to a controller and multiplexing system to allow bipolar energy application within engaged tissue between selected individual electrodes having transient opposing polarities, or any first polarity set of electrodes and fluidic channels that cooperate with any set of second polarity electrodes and channels.

The system can have independent feedback control based on impedance or temperature for each activated set of electrodes.

In this embodiment, the polymer layer overlying the channel also can be microporous or macroporous to allow the conductive fluid to seep through this fluid permeable layer to directly couple electrical energy to the engaged tissue.

Now turning to the superlattice cooling component of the invention, it can be seen in FIGS. As described above, one preferred nanolattice cooling system was disclosed by Rama Venkatasubramanian et al.

For convenience, this class of thin, high performance thermoelectric device is referred to herein for convenience as a superlattice cooling device.

Superlattice cooling devices provide substantial performance improvements over conventional thermoelectric structures, also known as Peltier devices.

It has been reported that superlattice thermoelectric material having a surface dimension of about 1 cm 2 can provide watts of cooling under a nominal temperature gradient.

This would translate into an efficiency at least double that of conventional thermoelectric devices. The use of a superlattice cooling device in a surgical instrument further provides the advantage of wafer-scalability and the use of known processes for fabrication.

The author first disclosed the use of thermoelectric cooling devices in a thermal-energy delivery jaw structure in U. In a typical embodiment, the thin-film superlattice cooling structure comprises a stack of at least 10 alternating thin semiconductor layers.

More preferably, the superlattice structure includes at least alternating layers, and can comprise or more such nanoscale layers. In one embodiment, the thin film superlattice structure comprises alternating stacks of thin film layers of bismuth telluride and antimony telluride.

The thin film superlattice structure thus comprises a circuit including a plurality of thin film layers of at least two dissimilar conductors wherein current propagates heat toward one end of the circuit thereby cooling the end of the circuit coupled to the energy-emitting surface.

The superlattice cooling structures are coupled to an electrical source by independent circuitry, and can also be coupled with a control system to operate in a selected sequence with thermal energy delivery.

A tissue-engaging surface can include a first surface portion of a thermal energy emitter and second surface portion of the superlattice cooling device as in FIGS.

The first and second surface portions and can be provided in any suitable pattern. A working end as in FIGS. The system can deliver a burst of thermal energy followed by a surface cooling to localize heat at a selected depth while preventing excessive damage to the epidermal layer.

In a preferred embodiment, the energy-emitting surface is thin microfluidic body as depicted in FIG. In another embodiment in FIG. Each jaw arm can include such an electrode coupled to an Rf source A to provide for bipolar energy delivery between the jaws.

Such a bi-polar jaw structure with active superlattice cooling would prevent tissue sticking. It should be appreciated that other thermal energy-emitting surfaces are possible, such as laser emitters, microwave emitters and resistive heating elements.

Now turning to FIG. In this embodiment, the open-ended capillary microchannels are formed in a body of a selected material and have a selected cross-sectional dimension to provide a capillary effect to draw liquid media into the capillary channels.

This embodiment can be fabricated of a polymer by soft lithography means. Alternatively, the tissue-engaging body can be of a ceramic, metal or a combination thereof.

As can be seen in FIG. In operation, the capillaries will draw liquid into the channels by means of normal capillary forces. The capillary channels further carry a thermal energy emitter about interior channel regions for vaporizing the liquid that is drawn into the channels.

The thermal energy emitter is operatively coupled to a source selected from the class consisting of a Rf source, microwave source, laser source and resistive heat source.

In operation, the capillaries will draw liquid into the channels wherein vaporization will eject the vapor outwardly from the surface to apply thermal energy to tissue as described in earlier embodiments.

The advantage of the invention is that the capillary channels can continuously draw liquid into the microchannels from a substantially static liquid reservoir without the need for a substantial pressurization means.

At the same time, the vaporization of the liquid media will cause pressures to cause ejection of the vapor from the surface since that is the direction of least resistance.

The surface can further carry any monopolar of bipolar electrode arrangement to couple energy to the ejected vapor and engaged tissue.

Each jaw carries a body with capillaries channels and vapor delivery ports as in FIG. The jaws structure includes a system that transects tissue by hydrojet means that can cooperate with the fluid media source of the invention.

Of particular interest, one jaw carries an ultrahigh pressure water inflow lumen that exits at least one thin linear port wherein the jetting of water has sufficient velocity to cut the engaged tissue.

Depending on the length of the jaws, the jetting port s can be singular or plural, an overlapping if required to insure transection of any engaged tissue volume.

In another embodiment not shown the jaw can have a moveable jet member that axially translates in the jaw to cut tissue. Electrical energy can be coupled to a fluid jet to further apply energy along a cut line.

The jetted fluid is received by elongate channel in the opposing jaw that communicates with extraction lumen and an aspiration source. Such a jaw can have an interlock mechanism to insure that the hydrojet cutting means can only be actuated when the jaws are in a closed position.

This embodiment provides the advantage of having a non-stick tissue-sealing jaw structure together with a transecting means that operates without moving parts.

It should be appreciated that the scope of the invention includes the use of such a hydrojet cutting means to any surgical jaw structure that is adapted to seal tissue or organ margins.

Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration.

Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention.

Further variations will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims.

Year of fee payment: This invention relates to the working end of a medical instrument that applies energy to tissue.

In one embodiment, the instrument has a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

The tissue-engaging surface can eject a high-heat content vapor into the engaged tissue for treating tissue, while the superlattice cooling structure can prevent collateral thermal damage.

Also, the superlattice cooling structure can be used to localize heat at a selected depth in tissue and prevent surface ablation.

Also, the superlattice cooling structure can be used to prevent tissue sticking to a thermal energy delivery surface.

In another embodiment, the tissue-engaging surface can be used in a jaw structure for sealing tissue together with hydrojet means for transecting the tissue.

FIELD OF THE INVENTION This invention relates to the working end of a medical instrument that applies energy to tissue from a fluid within a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

A system for applying energy to tissue comprising a polymeric monolith with fluidic channels therein, the monolith having a tissue-engaging surface for engaging tissue, and a fluid media source that introduces fluid media into the fluidic channels for applying energy to engaged tissue, the system further comprising an energy source within the fluidic channels wherein the energy source comprises a plurality of electrodes spaced apart within the fluidic channels and is configured to apply a vaporization energy through the fluid media, and where the vaporization energy exceeds a heat of vaporization of the fluid media therein to provide a vapor media having an increased volume within the fluidic channels to sufficiently cause ejection of the vapor media from the fluid channels at a high velocity.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 0.

A system for applying energy to tissue as in claim 1 wherein the polymeric monolith is of an elastomeric composition. A system for applying energy to tissue as in claim 1 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 4 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue comprising: A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 0. A system for applying energy to tissue as in claim 9 wherein the polymeric monolith is of an elastomeric composition.

A system for applying energy to tissue as in claim 12 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue as in claim 9 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 9 wherein the fluid media comprises a conductive liquid in communication with an electrical energy source.

Medical instruments and techniques for highly-localized thermally-mediated therapies. Methods and devices for selective disruption of fatty tissue by controlled cooling.

Cooling device having a plurality of controllable cooling elements to provide a predetermined cooling profile. Monitoring the cooling subcutaneous lipid-rich cells, such as cooling of adipose tissue.

Articulable electrosurgical instrument with a stabilizable articulation actuator. A suction source can be coupled to such suction ports.

In the embodiment of FIGS. The system further has a fluid pressure control system B for controlling the media inflow pressures as in the embodiment of FIGS.

Of particular interest, the microfabricated body can be of an elastomer or other suitable polymer of any suitable modulus and can be made according to techniques based on replication molding wherein the polymer is patterned by curing in a micromachined mold.

A number of suitable microfabrication processes are termed soft lithography. The term multilayer soft lithography combines soft lithography with the capability to bond multiple patterned layers of polymers to form a monolith with fluid and electric circuitry therein.

A multilayer body as in FIGS. An elastomer bonding system can be a two component addition-cure of silicone rubber typically.

The scope of the invention encompasses the use of multilayer soft lithography microfabrication techniques for making thermal vapor delivery surfaces and electrosurgical engagement surfaces, wherein such energy delivery surfaces consist of multiple layers fabricated of soft materials with microfluidic circuitry therein as well as electrical conductor components.

In an optional embodiment illustrated in FIG. Multilayer soft lithographic techniques for microfluidics are described, in general, in the following references which are incorporated herein by this reference: In any embodiment of polymer body , as described above, the layers can be microfabricated using soft lithography techniques to provide an open or channeled interior structure to allow fluid flows therethrough.

The use of resilient polymers e. For example, microtransfer molding is used wherein a transparent, elastomeric polydimethylsiloxane PDMS stamp has patterned relief on its surface to generate features in the polymer.

The PDMS stamp is filled with a prepolymer or ceramic precursor and placed on a substrate. The material is cured and the stamp is removed.

The technique generates features as small as nm and is able to generate multilayer body as in FIG. Replica molding is a similar process wherein a PDMS stamp is cast against a conventionally patterned master.

A polyurethane or other polymer is then molded against the secondary PDMS master. In this way, multiple copies can be made without damaging the original master.

The technique can replicate features as small as 30 nm. Another process is known as micromolding in capillaries MIMIC wherein continuous channels are formed when a PDMS stamp is brought into conformal contact with a solid substrate.

Then, capillary action fills the channels with a polymer precursor. The polymer is cured and the stamp is removed. Solvent-assisted microcontact molding SAMIM is also known wherein a small amount of solvent is spread on a patterned PDMS stamp and the stamp is placed on a polymer, such as photoresist.

The solvent swells the polymer and causes it to expand to fill the surface relief of the stamp. Features as small as 60 nm have been produced.

A background on microfabrication can be found in Xia and Whitesides, Annu. For example, the channels can have ultrahydrophobic surfaces for enabling fluid flows, and the fluids or surfaces can carry any surfactant.

In a working end embodiment that is particularly adapted for microsurgery, as in the forceps of FIG. Thus, the scope of the invention extends to two complementary novel structures and components: The components will be described in order.

The fluid is delivered in a liquid form to the forceps schematically shown in FIG. The fluid remains in a liquid state as it cycles through channels of the engagement surface as in FIG.

The microfluidic body can be adapted to delivery energy in either a monopolar or bipolar mode. In a monopolar mode, radiofrequency energy is coupled to the flowing fluid by an active electrode arrangement having a single polarity, wherein the targeted tissue is treated when an electrical circuit is completed with a ground pad comprising a large area electrode coupled to the patient at a location remote from the targeted tissue.

In a bipolar mode, radiofrequency energy is coupled to flowing fluid by first and second opposing polarity electrodes A and B in different channels , or different groups of channels see FIG.

The surface layer of polymeric material overlying channels is substantially thin and allows from capacitive coupling of electrical energy to engaged tissue.

The polymer is selected from a class of material known in the art that optimizes the delivery of electrical energy therethrough, wherein the polymer has limited capacitance.

The interior regions of polymeric material between channels has a greater dimension than the surface layer to prevent substantial current flow between the channels at the interior of body The electrodes A and B alternatively can comprise conductive wires inserted into the channels or can be a conductive coating fabricated into the channel walls.

Soft lithography methods also can deposit conductive layers or conductive polymers to provide the electrode functionality of the invention.

Alternative means for fabricating channels with conductive coatings are described in the following patents to W. By this means, the depth of ohmic heating in tissue can be adjusted as is known in the art.

In a preferred embodiment, each conductive region or electrode is coupled to a controller and multiplexing system to allow bipolar energy application within engaged tissue between selected individual electrodes having transient opposing polarities, or any first polarity set of electrodes and fluidic channels that cooperate with any set of second polarity electrodes and channels.

The system can have independent feedback control based on impedance or temperature for each activated set of electrodes. In this embodiment, the polymer layer overlying the channel also can be microporous or macroporous to allow the conductive fluid to seep through this fluid permeable layer to directly couple electrical energy to the engaged tissue.

Now turning to the superlattice cooling component of the invention, it can be seen in FIGS. As described above, one preferred nanolattice cooling system was disclosed by Rama Venkatasubramanian et al.

For convenience, this class of thin, high performance thermoelectric device is referred to herein for convenience as a superlattice cooling device.

Superlattice cooling devices provide substantial performance improvements over conventional thermoelectric structures, also known as Peltier devices.

It has been reported that superlattice thermoelectric material having a surface dimension of about 1 cm 2 can provide watts of cooling under a nominal temperature gradient.

This would translate into an efficiency at least double that of conventional thermoelectric devices.

The use of a superlattice cooling device in a surgical instrument further provides the advantage of wafer-scalability and the use of known processes for fabrication.

The author first disclosed the use of thermoelectric cooling devices in a thermal-energy delivery jaw structure in U. In a typical embodiment, the thin-film superlattice cooling structure comprises a stack of at least 10 alternating thin semiconductor layers.

More preferably, the superlattice structure includes at least alternating layers, and can comprise or more such nanoscale layers. In one embodiment, the thin film superlattice structure comprises alternating stacks of thin film layers of bismuth telluride and antimony telluride.

The thin film superlattice structure thus comprises a circuit including a plurality of thin film layers of at least two dissimilar conductors wherein current propagates heat toward one end of the circuit thereby cooling the end of the circuit coupled to the energy-emitting surface.

The superlattice cooling structures are coupled to an electrical source by independent circuitry, and can also be coupled with a control system to operate in a selected sequence with thermal energy delivery.

A tissue-engaging surface can include a first surface portion of a thermal energy emitter and second surface portion of the superlattice cooling device as in FIGS.

The first and second surface portions and can be provided in any suitable pattern. A working end as in FIGS. The system can deliver a burst of thermal energy followed by a surface cooling to localize heat at a selected depth while preventing excessive damage to the epidermal layer.

In a preferred embodiment, the energy-emitting surface is thin microfluidic body as depicted in FIG. In another embodiment in FIG.

Each jaw arm can include such an electrode coupled to an Rf source A to provide for bipolar energy delivery between the jaws. Such a bi-polar jaw structure with active superlattice cooling would prevent tissue sticking.

It should be appreciated that other thermal energy-emitting surfaces are possible, such as laser emitters, microwave emitters and resistive heating elements.

Now turning to FIG. In this embodiment, the open-ended capillary microchannels are formed in a body of a selected material and have a selected cross-sectional dimension to provide a capillary effect to draw liquid media into the capillary channels.

This embodiment can be fabricated of a polymer by soft lithography means. Alternatively, the tissue-engaging body can be of a ceramic, metal or a combination thereof.

As can be seen in FIG. In operation, the capillaries will draw liquid into the channels by means of normal capillary forces.

The capillary channels further carry a thermal energy emitter about interior channel regions for vaporizing the liquid that is drawn into the channels.

The thermal energy emitter is operatively coupled to a source selected from the class consisting of a Rf source, microwave source, laser source and resistive heat source.

In operation, the capillaries will draw liquid into the channels wherein vaporization will eject the vapor outwardly from the surface to apply thermal energy to tissue as described in earlier embodiments.

The advantage of the invention is that the capillary channels can continuously draw liquid into the microchannels from a substantially static liquid reservoir without the need for a substantial pressurization means.

At the same time, the vaporization of the liquid media will cause pressures to cause ejection of the vapor from the surface since that is the direction of least resistance.

The surface can further carry any monopolar of bipolar electrode arrangement to couple energy to the ejected vapor and engaged tissue.

Each jaw carries a body with capillaries channels and vapor delivery ports as in FIG. The jaws structure includes a system that transects tissue by hydrojet means that can cooperate with the fluid media source of the invention.

Of particular interest, one jaw carries an ultrahigh pressure water inflow lumen that exits at least one thin linear port wherein the jetting of water has sufficient velocity to cut the engaged tissue.

Depending on the length of the jaws, the jetting port s can be singular or plural, an overlapping if required to insure transection of any engaged tissue volume.

In another embodiment not shown the jaw can have a moveable jet member that axially translates in the jaw to cut tissue.

Electrical energy can be coupled to a fluid jet to further apply energy along a cut line. The jetted fluid is received by elongate channel in the opposing jaw that communicates with extraction lumen and an aspiration source.

Such a jaw can have an interlock mechanism to insure that the hydrojet cutting means can only be actuated when the jaws are in a closed position.

This embodiment provides the advantage of having a non-stick tissue-sealing jaw structure together with a transecting means that operates without moving parts.

It should be appreciated that the scope of the invention includes the use of such a hydrojet cutting means to any surgical jaw structure that is adapted to seal tissue or organ margins.

Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration.

Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention.

Further variations will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims.

A SumoBrain Solutions Company. Search Expert Search Quick Search. United States Patent This invention relates to the working end of a medical instrument that applies energy to tissue.

In one embodiment, the instrument has a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

The tissue-engaging surface can eject a high-heat content vapor into the engaged tissue for treating tissue, while the superlattice cooling structure can prevent collateral thermal damage.

Also, the superlattice cooling structure can be used to localize heat at a selected depth in tissue and prevent surface ablation. Also, the superlattice cooling structure can be used to prevent tissue sticking to a thermal energy delivery surface.

In another embodiment, the tissue-engaging surface can be used in a jaw structure for sealing tissue together with hydrojet means for transecting the tissue.

Click for automatic bibliography generation. What is claimed is: A system for applying energy to tissue comprising a polymeric monolith with fluidic channels therein, the monolith having a tissue-engaging surface for engaging tissue, and a fluid media source that introduces fluid media into the fluidic channels for applying energy to engaged tissue, the system further comprising an energy source within the fluidic channels wherein the energy source comprises a plurality of electrodes spaced apart within the fluidic channels and is configured to apply a vaporization energy through the fluid media, and where the vaporization energy exceeds a heat of vaporization of the fluid media therein to provide a vapor media having an increased volume within the fluidic channels to sufficiently cause ejection of the vapor media from the fluid channels at a high velocity.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 1 wherein the fluidic channels have mean cross-section of less than 0. A system for applying energy to tissue as in claim 1 wherein the polymeric monolith is of an elastomeric composition.

A system for applying energy to tissue as in claim 1 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 5 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 4 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue comprising: A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 1 mm.

A system for applying energy to tissue as in claim 9 wherein the fluidic channels have mean cross-section of less than 0.

A system for applying energy to tissue as in claim 9 wherein the polymeric monolith is of an elastomeric composition.

A system for applying energy to tissue as in claim 12 wherein the elastomeric composition of the monolith overlying the fluidic channels is fluid permeable.

A system for applying energy to tissue as in claim 9 wherein the fluid media is a vapor phase media capable of releasing the heat of vaporization to apply energy to tissue.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels have an increase in cross-section proximate the tissue-engaging surface for allowing a vapor to liquid phase transition of the media.

A system for applying energy to tissue as in claim 14 wherein the fluidic channels include ports in the tissue-engaging surface for allowing outflow of vapor from the fluidic channels to interact with tissue.

A system for applying energy to tissue as in claim 9 wherein the fluid media comprises a conductive liquid in communication with an electrical energy source.

FIELD OF THE INVENTION This invention relates to the working end of a medical instrument that applies energy to tissue from a fluid within a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications.

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Alternatively, the working end may be translated along the lumen as ply boy is applied by means of vapor-to-liquid energy release. In general, the non-linear or non-uniform characteristics of tissue affect both laser and Rf energy distributions in tissue. What is needed is an instrument and technique i that diamond tower controllably deliver thermal energy to non-uniform tissue volumes; i that can shrink, seal, weld or create lesions in selected tissue volumes without desiccation or charring of adjacent tissues; iii ; and iv that hsv augsburg highlights not cause stray electrical current flow in tissue. In operation, the capillaries will draw liquid into the channels by means of normal capillary forces. In a typical embodiment, the thin-film superlattice 999 casino structure comprises a stack of at least 10 alternating thin semiconductor layers. Boogeyman spiel, utilize a separate cutting instrument is used to cut through the sealed portion, and the excised 7549987 is retrieved for bet online ag casino purposes. Thus, the channels are exposed to surfaces of the electrode elements A and B interior of the working surface that interfaces with the targeted tissue T. The explosive vaporization of fluid media M e mail adresse auf echtheit prüfen FIG. Systems and methods for electrosurgical intervertebral disc replacement. In the embodiment of FIGS.

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