An electrosurgical apparatus and method for performing thermal treatment in the gastrointestinal tract, e.g. to ablate duodenal mucosal tissue. The apparatus comprises an instrument having a flexible cable and an applicator suitable for use with a gastroscope, which can be deployed within a patient to delivery energy in a targeted or otherwise controllable manner. The applicator can deliver microwave energy by radiation. The direct and depth-limited nature of microwave energy can be make it more effective than treatments that rely on thermal conduction. The applicator may include a radially extendable portion arranged to move an microwave energy delivery structure into contact with duodenal mucosal tissue at the treatment region. The applicator may comprise any of a balloon, bipolar radiator, movable paddle, and rotatable roller element.

An ablation apparatus for creating a lesion in target tissue, the ablation apparatus having an ablation shaft including a handle, a first portion, an ablation portion, distal tip, at least one ablation energy delivery lumen, at least one ablation energy return lumen, and a stylet lumen that extends substantially along a length of the ablation shaft from the handle to at least the ablation portion. The ablation apparatus also includes a stylet that is capable of being inserted into the stylet lumen where the stylet is made of a shape-memory material.

The disclosure relates to a computer-implemented method for monitoring diaphragmatic response to phrenic nerve stimulation. The method comprises receiving in real-time a diaphragmatic CMAP signal. The method comprises computing a baseline value of a characteristic of the CMAP signal. The characteristic represents a diaphragmatic response intensity to a phrenic nerve stimulation. The method comprises determining a threshold value of the characteristic, representing a boundary of values of the characteristic indicative of upcoming diaphragmatic palsy. The determining of the threshold value includes shifting the baseline value. The method comprises receiving in real-time a ECG signal. The method comprises repeating in real-time: detecting a QRS complex in the ECG signal, monitoring the CMAP signal, computing a real-time value of the characteristic, comparing the real-time value to the threshold value, and outputting an alert when the threshold is passed. The real-time value of the characteristic is asynchronous to the QRS complex.

A photoacoustic imaging approach identifies, concurrently with ablation therapy, an extent of the ablation by measuring and rendering a necrotic extent of treated tissue in a treatment region. Laser pulsed light directed at the treatment region induces an acoustic (ultrasound) signal for differentiating ablated tissue from its non-ablative counterpart based on a photoacoustic spectrum variation. The acoustic signal indicates a range of necrotic extent based on a quantified ablated tissue contrast and a total contrast of both necrotic and non-necrotic tissue, defined as a fraction for computing a degree of necrosis. Generation of an image indicating the degree of necrosis allows continuous or near continuous feedback for ablation therapy guidance to ensure complete and effective ablation of the proper tissue in the treatment region.

Systems and methods for visualizing ablated tissue are disclosed. In some embodiments, a system for imaging tissue comprising: a catheter having a distal end and a proximal end; an inflatable balloon disposed about the distal end of the catheter; and an optical housing extending from the distal end of the catheter into the balloon, the optical housing being configured to position inside the balloon a light source for illuminating a tissue outside the balloon and a camera for imaging the illuminated tissue.

A system and device for cryoablation of tissue that is suitable for use within an MRI environment. The device may include an elongate body, a treatment element at the distal portion of the elongate body, and one or more pull fibers. The pull fibers may be composed of a non-ferromagnetic material, such as a polymer. Likewise, none of the other device components may be composed of a ferromagnetic material. The device may also include at least one fiber optic sensor. The elongate body distal portion may include a distal tip to which the pull fibers are directly coupled. Additionally or alternatively, the elongate body may include one or more pull fiber lumens configured to allow the pull fibers to deflect the distal portion when a pull force is exerted on the pull fibers.

An ablation system comprises: an ablation catheter and a console. The ablation catheter comprises: a shaft including a proximal end, a distal portion and a distal end; an ablation element configured to deliver energy to tissue; and a force maintenance assembly comprising a force maintenance element and configured to control and/or assess contact force between the ablation element and cardiac tissue. The console is configured to operably attach to the ablation catheter and comprises: an energy delivery assembly configured to provide energy to the ablation element. Methods of ablating tissue are also provided.

A method and system for lesion formation assessment in tissue that has undergone an ablation procedure. In one embodiment, a method of assessing lesion formation comprises: recording a baseline impedance measurement from an area of tissue with a medical device; ablating the area of tissue with the medical device; recording a post-treatment impedance measurement from the area of tissue with the medical device; identifying at least one amplitude characteristic of the baseline impedance measurement and identifying at least one amplitude characteristic of the post-treatment impedance measurement; comparing the at least one amplitude characteristic of the baseline impedance measurement and the at least one amplitude characteristic of the post-treatment impedance measurement; generating an indication of efficacy based on the comparison, the indication of efficacy being one of sufficient lesion formation and insufficient lesion formation; and re-ablating the area of tissue if the indication of efficacy is insufficient lesion formation.

Embodiments include a cryogenic device for alleviating pain by cryogenically treating a nerve, the cryogenic device including a handpiece; a needle coupled to a distal end of the handpiece, the needle including a needle lumen, the needle being configured for insertion into a skin of a patient along an insertion axis at a site laterally displaced from a treatment zone proximate to the nerve. The needle is configured to resiliently bend after insertion away from the insertion axis, such that at least a portion of the needle is adapted to traverse a skin layer laterally toward the treatment zone. The device includes a cooling fluid supply tube extending distally into the needle lumen; and a cooling fluid source, wherein the cooling fluid source is coupled to the cooling fluid supply tube to direct cooling fluid into the needle lumen.

Devices and methods for treating rhinitis are provided. An integrated therapy and imaging device is provided for single handheld use. The device may have a hollow elongated cannula, a therapeutic element coupled to a distal portion of the cannula, an imaging assembly coupled to the cannula to provide visualization of the therapeutic element, and an articulating region operably coupled to the imaging assembly to articulate the imaging assembly. The imaging assembly may be articulated so as to translate vertically, laterally, axially, and/or rotationally.