RF AND/OR MICROWAVE ENERGY CONVEYING STRUCTURE, AND AN INVASIVE ELECTROSURGICAL SCOPING DEVICE INCORPORATING THE SAME
20170215955 · 2017-08-03
Inventors
- Christopher Paul Hancock (Bath, GB)
- Malcolm White (Chepstow, GB)
- George Christian Ullrich (Bangor, GB)
- David Edward Webb (Bangor, GB)
- Shaun Preston (Chepstow, GB)
- Steven Morris (Chepstow, GB)
Cpc classification
A61B2017/0034
HUMAN NECESSITIES
A61B2018/1892
HUMAN NECESSITIES
A61B18/1492
HUMAN NECESSITIES
A61B2018/1861
HUMAN NECESSITIES
International classification
A61B18/12
HUMAN NECESSITIES
Abstract
Embodiments of the invention provide an energy conveying structure for delivering RF and/or microwave energy to an electrosurgical instrument, where the energy conveying structure is incorporated into an insertion tube of a surgical scoping device (e.g. endoscope, laparoscope or the like). The insertion tube is a flexible conduit that is introduced into a patient's body during an invasive procedure, and can include an instrument channel and an optical channel. The energy conveying structure may be a layered coaxial structure that formed a liner that fits within the scoping device, e.g. within an instrument channel. Alternatively, the energy conveying structure may be a coaxial structure integrally formed as part of the flexible conduit.
Claims
1-22. (canceled)
23. An energy conveying structure for invasive electrosurgery, the energy conveying structure comprising a coaxial layered structure having: an innermost insulating layer; an inner conductive layer formed on the innermost insulating layer; an outer conductive layer formed coaxially with the inner conductive layer; and a dielectric layer separating the inner conductive layer and the outer conductive layer, wherein the inner conductive layer, the outer conductive layer and the dielectric layer form a transmission line for conveying radiofrequency (RF) and/or microwave energy, characterised in that: the coaxial layered structure is insertable in a flexible insertion tube of an invasive surgical scoping device, wherein the innermost insulating layer is hollow to form an instrument channel for the invasive surgical scoping device, and wherein the energy conveying structure includes: a first terminal that is electrically connected to the inner conductive layer and which extends through the innermost insulating layer into the instrument channel; and a second terminal that is electrically connected to the outer conductive layer and which extends through the dielectric layer and innermost insulating layer into the instrument channel.
24. An energy conveying structure according to claim 23, wherein the instrument channel has a diameter between 1 mm and 5 mm.
25. An energy conveying structure according to claim 23, wherein the first terminal is located proximally from the second terminal.
26. An electrosurgical device comprising: an energy conveying structure according to claim 23; and an electrosurgical instrument mounted in the instrument channel of the energy conveying structure, wherein the electrosurgical instrument comprises: a first contact that is electrically connectable to the first terminal; a second contact that is electrically connected to the second terminal; a distal bipolar transmission structure electrically connected to the first contact and the second contact for delivering the RF and/or microwave energy into biological tissue.
27. An electrosurgical device according to claim 26, wherein the distal bipolar transmission structure comprises a first conductive element that is electrically connected to the first contact and a second conductive element that is electrically connected to the first contact.
28. An electrosurgical device according to claim 27, wherein the first contact and the second contact are formed on a connection collar located proximally to the bipolar transmission structure.
29. An electrosurgical device according to claim 26 including a catheter for conveying a control wire or a fluid feed to the electrosurgical instrument, the catheter being slidably mounted in the instrument channel.
30. An electrosurgical device according to claim 28 including a catheter for conveying a control wire or a fluid feed to the electrosurgical instrument, the catheter being slidably mounted in the instrument channel, and wherein the connection collar is mounted on an outer surface of the catheter.
31. An electrosurgical device according to claim 28, wherein the connection collar includes a shoulder for abutting a projection at the distal end of the instrument channel.
32. An electrosurgical device according to claim 28 including an extension sleeve that extends axially away from the connection collar towards the bipolar transmission structure at the distal end of the electrosurgical instrument.
33. An electrosurgical device according to claim 32, wherein the extension sleeve comprises a tube of dielectric material, and carries a conductive structure which provides electrical connection between the first contact and first conductive element and between the second contact and second conductive element respectively.
34. An electrosurgical device according to claim 26, wherein a geometry of an interconnection between the electrosurgical instrument and the energy conveying structure is configured to create an impedance match between the electrosurgical instrument and the energy conveying structure at the frequency of microwave energy conveyed by the energy conveying structure.
35. An electrosurgical device according to claim 26, wherein the energy conveying structure is arranged to convey RF energy only, and wherein the dielectric material is formed from polyimide.
36. An electrosurgical device according to claim 26, wherein the energy conveying structure comprises an additional conductor which forms a first pole of an RF-carrying bipolar transmission line, and wherein the inner conductive layer and the outer conductive layer form a second pole of the RF-carrying bipolar transmission line.
37. An electrosurgical device according to claim 36, wherein the additional conductor is a conductive wire carried within the instrument channel.
38. An invasive electrosurgical scoping device comprising: a flexible insertion tube having a longitudinal bore formed therethrough; an electrosurgical device according to claim 26 inserted in the longitudinal bore.
39. An invasive electrosurgical scoping device according to claim 38, wherein the flexible insertion tube includes a stop flange at its distal end, the stop flange having a projection that overhangs an entrance to the instrument channel.
40. An invasive electrosurgical scoping device according to claim 38, wherein the flexible insertion tube includes a resilient seal mounted over an entrance to the instrument channel.
41. An invasive surgical scoping device comprising a body having a flexible insertion tube extending therefrom, wherein the flexible insertion tube comprises: a longitudinal bore formed therethrough, and an energy conveying structure in the wall of the longitudinal bore, the energy conveying structure comprising a coaxial layered structure having: an innermost insulating layer; an inner conductive layer formed on the innermost insulating layer; an outer conductive layer formed coaxially with the inner conductive layer; and a dielectric layer separating the inner conductive layer and the outer conductive layer, wherein the inner conductive layer, the outer conductive layer and the dielectric layer form a transmission line for conveying radiofrequency (RF) or microwave energy, and wherein the innermost insulating layer is hollow to form an instrument channel for the invasive surgical scoping device.
42. An invasive surgical scoping device according to claim 41, wherein the energy conveying structure is integrally formed in the wall of the longitudinal bore.
43. An invasive surgical scoping device according to claim 41, wherein the outer conductive layer and a first portion of the dielectric layer are integrally formed in the wall of the longitudinal bore, and wherein the innermost insulating layer, the inner conductive layer and a second portion of the dielectric layer form a liner that can be detachably mounted in the longitudinal bore.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0034] Examples of the invention as discussed in detail below with reference to the accompanying drawings, in which:
[0035]
[0036]
[0037]
[0038]
[0039]
[0040]
[0041]
[0042]
[0043]
[0044]
[0045]
DETAILED DESCRIPTION; FURTHER OPTIONS AND PREFERENCES
[0046]
[0047] The main body 102 includes an instrument port 108 for receiving an electrosurgical instrument into the instrument channel. The electrosurgical instrument comprises a flexible catheter 110 which has at its distal end an instrument tip 112 that is arranged to receive the RF and/or microwave energy from the energy conveying means in the flexible insertion tube 104. The instrument tip 112 includes an energy delivery portion for delivering the receiving RF and/or microwave energy into biological tissue, e.g. to assist in treatment, e.g. cutting or coagulation.
[0048] The catheter 110 is connected at its proximal end to a rotator 114, which acts to rotate the catheter (and therefore the instrument tip 112) relative to the instrument channel. The catheter 110 may contain one of more control wires, e.g. pull/push rods or the like. The control wires may pass out of the proximal end of the catheter to engage a slider 116, which operates to extend and retract the control wires to effect action at the instrument tip.
[0049] In this embodiment, the catheter 110 is further arranged to receive a flexible fluid feed pipe 122 that is connected to a fluid delivery mechanism 124 (e.g. a syringe or pump, which can be manually or automatically operated). The flexible fluid feed pipe 122 may extend, e.g. within or alongside the catheter 110, through the instrument channel of the flexible insertion tube 104. The instrument tip 112 may include a fluid delivery port (not shown), e.g. a retractable needle, in fluid communication with the flexible fluid feed pipe 122. The fluid delivery port may be operable to deliver fluid (e.g. saline) to the treatment site, e.g. to flush or clean the area, or to be injected into tissue, e.g. to plump up a sessile polyp as a preliminary step in a polypectomy procedure.
[0050] The fluid feed pipe 122 may terminate at a sealed junction at a proximal end of the catheter 110. In this arrangement the catheter 110 itself may provide a fluid flow path for the fluid between the proximal end and the instrument tip 112. In this arrangement, the instrument tip may provide a sealed junction at a distal end of the catheter 110, and the fluid delivery port may include a proximal inlet (which may be opened and closed by an operator) in fluid communication with the inside of the catheter 110 in order to create the fluid flow path to the treatment site.
[0051] According to the invention, there is an energy conveying structure in the flexible insertion tube 104, e.g. in the walls of the instrument channel, for carrying the RF and/or microwave energy to the instrument tip 112. This arrangement has two advantages. Firstly, it means that the catheter 110 does not need to carry a cable or other energy conveying means. As a result there is more space for carrying control wires, fluid, etc. to the instrument tip 112, and moreover the presence of the control wires, fluid has no effect on the RF and/or microwave energy. Secondly, this arrangement enables the energy conveying structure to have a larger size that would be necessary if it were to fit within the catheter. As a result the energy conveying structure can have a lower loss than in conventional electrosurgical systems, which in turn enables more power to be safely delivered to the instrument tip 112.
[0052]
[0053] In conventional scoping devices, the inner surface of the instrument channel was formed by the resiliently deformable cylindrical member 126. However, according to the invention, the flexible insertion tube 104 includes a wall 134 around the instrument channel 130 that is formed from a plurality of layers which act as an energy conveying structure, which in this example is an coaxial energy conveying structure.
[0054] The wall 134 comprises an outer conductive layer 136, e.g. formed from silver or silver-plated copper, a dielectric layer 138 (e.g. formed from PTFE or other suitable flexible low loss material) in contact with the inner surface of the outer conductive layer 136, an inner conductive layer 140, e.g. formed from silver or silver-plated copper, in contact with the inner surface of the dielectric layer 138, and an insulating innermost layer 142, e.g. formed from polyimide or PEEK, in contact with the inner surface of the inner conductive layer 140.
[0055] The outer conductive layer 136 and the inner conductive layer 140 have a thickness greater than the skin depth of the microwave energy that they are to convey, but still thin enough to allow the insertion tube 104 to flex. For example the outer conductive layer 136 and the inner conductive layer 140 may be formed from foil or braided material.
[0056] The outer conductive layer 136, the inner conductive layer 140 and the dielectric layer 138 that separates them together form a coaxial structure suitable for conveying RF and/or microwave energy. In some embodiments, the energy conveying structure may be used only to convey RF energy. In such arrangements, it is desirable to prevent voltage breakdown between the outer conductive layer 136 and the inner conductive layer 140. In such RF-only examples, the dielectric layer 138 may preferably be formed from a dielectric with a high breakdown strength. For example, Kapton® polyimide film may be used, which as a breakdown strength of 118 kVmm.sup.−1 in the sub-mm thickness range.
[0057] Where microwave energy is to be delivered, it is desirable for the dielectric layer 138 to exhibit low loss at the frequency of the microwave energy. For example, at 5.8 GHz PTFE is a suitable low loss dielectric.
[0058]
[0059] The instrument tip 112, which is shown alone in
[0060] The connection collar 152 comprises a short rigid cylindrical portion having a diameter selected to snugly fit in the instrument channel so that its outer surface is in physical contact with the surface that defines the instrument channel 130 (i.e. the inner surface of wall 134). The connection collar 152 may have a larger diameter than the catheter 110.
[0061] A pair of contacts 156, 158 are formed on the outer surface of the connection collar 152. The contacts 156, 158 may extend around all or part of the outer surface. In this embodiment, a back (i.e. proximal) contact 156 is arranged to electrically connect to the inner conductive layer 140 of the energy conveying structure in the wall 134 of the instrument channel 130, and a forward (i.e. distal) annular contact 158 is arranged to electrically connect to the outer conductive layer 136 of the energy conveying structure in the wall 134 of the instrument channel 130.
[0062] To achieve these electrical connections, the wall 134 has a pair of longitudinally spaced terminals 160, 162 that protrude through the innermost layer 142 at the distal end of the instrument channel 130, as shown in
[0063] The outer conductive layer 136 extends longitudinally beyond a distal end of the inner conductive layer 140. The inner conductive layer 140 thus terminates at the back terminal 160, i.e. there is a gap 164 (e.g. an air gap or other insulating material) located beyond of the distal end of the inner conductive layer 140 before the forward terminal 162.
[0064] A conductive rod 166 extends from the back contact 156 through the extension sleeve 154 to provide an electrical connection for the conductive coating on the upper surface 146 of the piece of rigid dielectric 144. The upper surface 146 is therefore electrically connected to the inner conductive layer 140 of the energy conveying structure in the wall 134 of the instrument channel 130. Similarly, a conductive rod 168 extends from the forward contact 158 through the extension sleeve 154 to provide an electrical connection for the conductive coating on the lower surface 148 of the piece of rigid dielectric 144. The lower surface 148 is therefore electrically connected to the outer conductive layer 136 of the energy conveying structure in the wall 134 of the instrument channel 130.
[0065] The extension sleeve 154 may be a rigid tube of dielectric material for both protecting and electrically insulating the conductive rods 166, 168. The length of the extension sleeve 154 may be chosen to enable the instrument to protrude a useful distance from the distal end of the instrument channel 130. The extension sleeve 154 may have an electric length that corresponds to half a wavelength of the microwave energy that is conveyed by the extension sleeve 154. The conductive rods 166, 168 may be separately enclosed (e.g. coated of otherwise covered) by dielectric, e.g. glue, plastic or some other insulator, to prevent breakdown, especially where they are close together.
[0066] A distal end of the connection collar 152 may abut against a stop flange 170 formed at the distal end of the instrument channel 130. The instrument tip 112 can therefore be secured in place with an electrical connection between the contacts 156, 158 and terminals 160, 162, e.g. by maintaining a pushing force on the catheter 110. Although in this embodiment the connection collar 152 performs a dual function of electrical connection and physical stop, it is possible for these functions to be performed by separate features, in which case the connection collar 152 may be located further back in the instrument channel 130 and the extension sleeve 154 may be longer.
[0067] To prevent material from the treatment site escaping backwards into the instrument channel, a seal 172 may be formed over the entrance to the instrument channel 130. The seal 172 may comprise a resilient flap through which the instrument can be pushed but which closes to form a fluid tight cover when the instrument is removed (as shown in
[0068] The catheter 110 may be a hollow tube for conveying control lines or a fluid feed 178 to the instrument. In this embodiment, the fluid line extends right through to the distal end of the instrument, e.g. for delivering saline to the treatment site.
[0069] In practice, it may be desirable to form the wall 134 separately from the flexible insertion tube 104, e.g. as an insertable single-or multiple-use liner that can be introduced into the flexible insertion tube 104 in a separate assembly step.
[0070]
[0071]
[0072]
[0073] The outer diameter of the coaxial transmission line in this embodiment can thus correspond to the typical outer diameter of the insertion tube. Different types of scoping device can have different outer diameters. Depending on the type of scoping device, the outer diameter of the coaxial transmission line may be in a range of 5 mm to 20 mm. As discussed below, the thickness of the dielectric material may be determined based on the outer diameter to achieve an optimal (i.e. minimal) loss. The insertion tube may have a length up to 2.35 m.
[0074]
[0075] The tool can then be affixed into the instrument channel 204 and energy provided through the first pad 222 and second pad 224. The instrument channel can still be used as in a normal endoscope if the tool does not need electrical power. In order to avoid shorting the conductors, the first pad and second pad may be at different axial positions along the instrument channel, as discussed above. Preferably they are electrically insulated from each other, e.g. by providing an insulating material on the inner surface of the instrument channel between the first and second pads. Depending on the geometry, the insulating material may be the same as the dielectric material 214. If a higher strength material is required, then a Kapton® material could be used.
[0076]
[0077] In general the total loss can be determined based on the geometry of the transmission line. As the conductors get larger, the insertion loss should decrease due to the resistance. Similarly as more dielectric material is used the losses decrease. The larger the distance between conductors the higher the impedance. As dielectric thickness increases, there is less loss, higher impedance due to the conductor geometry and greater dielectric strength (i.e. the structure can withstand a higher voltage before breakdown).
[0078]
[0079] Similar principles regarding loss apply to the liner-type structure that can be mounted in the instrument channel of a scoping device.
[0080]
[0081]
[0082] The table below describes the geometry of the structures shown in
TABLE-US-00001 TABLE 1 Properties of liner-type coaxial transmission line structures FIG. 8A FIG. 8B FIG. 8C Thick- Diam- Thick- Diam- Thick- Diam- ness eter ness eter ness eter Layer (mm) (mm) (mm) (mm) (mm) (mm) 302 — 4 — 6 — 7.8 304 1 6 1 8 1 9.8 306 0.5 1 0.5 9 0.5 10.8 308 2 11 4 17 0.6 12 310 0.5 12 0.5 18 0.5 13 312 1 14 1 20 1 15 Impedance 18.714 26.332 4.362 (Ω) Loss per 0.436 0.280 1.156 metre (dB/m) Loss* 1.025 0.658 2.717 (dB) Power 47.390 51.565 32.099 (W)