The subject invention relates to bipolar RF needle electrode treatment devices and systems.
Bipolar RF needle electrodes have been used for various skin treatments. See U.S. Pat. Nos. 9,095,357 and 9,744,371 both incorporated herein by this reference. In some cases, an array of closely spaced needles are inserted into the skin and energized causing current to flow between the needles creating thermal damage to the tissue. Skin tightening, reduction of wrinkles, and cellulite reduction are common treatments. See also U.S. Pat. No. 8,845,630 and published U.S. Patent Application No. 2012/0143178 both incorporated herein in by this reference.
For some treatments, however, it would be beneficial to increase the volume of the thermal injuries. Examples include cellulite reduction, tumor ablation, abnormal tissue growth treatment, for example treatment of uterine fibroid tissue, and/or other treatments. For cellulite reductions, the subcutaneous fat to be treated includes two layers separated by superficial fascia. For women with cellulite, the inner layer thickness was found to be about five fold thicker than for women without cellulite (23 mm v. 4 mm). The total subcutis thickness for cellulite patients was between 2.7 and 50 cm. A higher percentage of fibrous septae perpendicular to skin surface was also noted in cellulite patients. See Rawlings A. V., Cellulite and its Treatment, International Journal of Cosmetic Science, 2006, 28. 175-190 incorporated herein by this reference.
Featured is a tissue treatment device which increases the total current density in the interior of a larger volume treatment zone thereby improving the uniformity of the temperature profile. In one particular example, the tissue treatment device, when used in conjunction with cellulite treatment, or fat removal procedure, creates thermal injuries in the entire or a significant portion of the subcutis space by increasing the volume of thermal injury.
One preferred device comprises two or more pairs of needle electrodes spaced about a zone wherein each pair of needle electrodes includes a first needle electrode on one side of the zone and a second needle electrode on an opposite side of the zone. There is an energy source for each pair of needle electrodes configured to induce current from the first needle electrode of the pair to only the second needle electrode of the pair in a cross firing manner through the interior of the zone to increase the total current density and temperature in the interior of the zone.
Each pair of needle electrodes preferably defines a plane intersecting the center of the zone and the planes defined by each pair of needle electrodes preferably intersect each other at the center of the zone. In another embodiment, the planes defined by each pair of needle electrodes intersect away from the center of the zone.
In one version, the energy source for each pair of needle electrodes is an RF generator connected to the first and second needle electrodes of each pair. The RF generators of each pair of needle electrodes are preferably electrically isolated from the RF generators of all other pairs of needle electrodes.
In some embodiments, the needle electrodes are all equidistantly spaced from the center of the zone. The device may further include a cartridge carrying the pairs of needle electrodes and an applicator for receiving the cartridge. Preferably, the cartridge is removeable from and insertable into the applicator.
In some embodiments, each needle electrode has an active length of between 0.5 and 40 mm, the needle electrodes of each pair of needle electrodes are spaced apart from each other by a distance of between 1.0 and 10 mm, and each needle electrode is spaced apart from each adjacent needle electrode by a distance of between 0.71 and 7.1 mm.
One or more needle electrodes may further include a temperature sensor. The device controller for the energy sources may be responsive to the one or more temperature sensors. In one example, the controller is configured to control the energy sources based on an output signal of the one or more temperature sensors. The device controller may be configured to automatically adjust the temperature in the zone to between 40° C. and 48° C. from between 30 seconds and 30 minutes.
Also featured is a method of treating tissue wherein two or more pairs of needle electrodes are inserted into a zone of tissue. Each pair of needle electrodes includes a first needle on one side of the zone and a second needle on an opposite side of the zone. The method includes electrically isolating each pair of needle electrodes from all other pairs of needle electrodes and inducing current from the first needle of each pair to only the second needle electrode of the pair through the interior of the zone increasing the total current density and temperature at the interior of the zone.
Also featured is a device for treating tissue including pairs of needle electrodes electrically isolated from each other and spaced about a tissue zone having a central volume. Each pair of needle electrodes define a plane intersecting the central volume of the tissue zone. The planes defined by each pair of needle electrodes intersecting each other at the central volume of the tissue zone. The device further includes means for inducing a current from the first needle electrode of each pair to only the second needle electrode of each pair across the central volume of the tissue zone.
Also featured is a method of treating tissue including inserting a plurality of needles into a tissue treatment zone, spacing the needles from a central volume of the tissue treatment zone, inducing current from each needle on one side of the central volume of the treatment zone through the central volume of the treatment zone to only another needle on an opposite side of the central volume of the treatment zone, and controlling the induced currents to intersect in the central volume of the treatment zone increasing the energy deposition in the central volume of the treatment zone.
The subject invention, however, in other embodiments, need not achieve all these objectives and the claims hereof should not be limited to structures or methods capable of achieving these objectives.
Other objects, features and advantages will occur to those skilled in the art from the following description of a preferred embodiment and the accompanying drawings, in which:
Aside from the preferred embodiment or embodiments disclosed below, this invention is capable of other embodiments and of being practiced or being carried out in various ways. Thus, it is to be understood that the invention is not limited in its application to the details of construction and the arrangements of components set forth in the following description or illustrated in the drawings. If only one embodiment is described herein, the claims hereof are not to be limited to that embodiment. Moreover, the claims hereof are not to be read restrictively unless there is clear and convincing evidence manifesting a certain exclusion, restriction, or disclaimer.
This result shows the difficulty of creating uniform thermal profiles in subcutis (fat) where the two needles of a pair are spaced apart to a distance of about 5 mm or more in a larger volume of tissue to be treated. This is partly explained by considering the low thermal conductivity of subcutis which is a good thermal isolator. Thermal energy does not propagate well and can produce steep thermal gradients within the tissue.
The issue of creating fairly uniform thermal profiles in biological tissue (subcutis and others) with needle-type electrodes spaced about 5 mm apart can be further explained by considering the divergence of the current lines. When the two energy delivering needle electrodes of a pair are too far away from each other, the current density in the tissue to be treated located at the midpoint between the two energy delivering needle electrodes is very low compared to the current density in the vicinity of the electrodes creating a zone of weak energy deposition in the tissue. As a consequence, the power deposited at the midpoint between the electrodes is lower than in the immediate vicinity of the electrode and the temperature elevation is consequently much lower.
To increase the RF energy deposition in the middle section between the energy delivering needle electrodes 104 and 108, a second pair of RF energy delivering needle electrodes 304 and 308,
This concept could be further expanded by using more than two pairs of RF needle electrode pairs where their zones of weak energy deposition coincide so they can work together to create a uniform thermal profile within the volume defined by the active portions of the needles.
Two RF electrode needle pairs defining perpendicular planes was simulated and the thermal profile result is shown in
Energy delivering needle electrodes 104, 108, 304 and 308,
A supply of RF energy to needle electrodes 304 and 308 induces a current between electrodes 304 and 308 schematically shown by current streamlines 312. As noted above the angle between the first plane and the second plane is 90 degrees and current 312 flows in the direction perpendicular to current streamline 112 flowing between the first pair of energy delivering needle electrodes 104 and 108. The RF energy at intersection line 316, or within central volume 320, shown by streamlines 112 between energy delivering needle electrodes 104, 108 of the first pair, intersect the RF induced current shown by streamlines 312 between energy delivering needle electrodes 304, 308 of the second pair, to become a sum of the RF energies.
Accordingly, two or more pairs of needle electrodes are spaced about a larger area treatment zone and there is an energy subsystem for the needle electrodes such as RF generator 32a for needle pair 104, 108 and RF generator 32b for needle pair 304, 308. This ensures current flows only between needles 104 and 108 (generated by RF generator 32a) and only between needles 304 and 308 (generated by RF generator 32b). These RF generators may be electrically isolated via a transformer or they may be independently battery powered generators. There are, however, other means known in the art for electrically isolating the pairs of needles from each other and for inducing current from the first needle electrode of each pair to only the second needle electrode of the pair across the central volume of the zone.
The RF generators are configured for supplying energy to each of the pairs of RF electrodes 104, 108, 304 and 308 in a controlled manner. Each pair of RF energy delivering needle electrodes is electrically insulated and separated from the other pair of RF energy delivering needle electrodes and each RF electrode pair could be independently and selectively activated, for example, by electrically isolating RF generators 32a, 32b feeding the pairs of electrodes from each other. See published U. S. Patent Application No. 2012/0143178 FIG. 12 and [0208]-[0210] incorporated herein by this reference. It would be also possible to only use one RF generator which would supply RF energy to one pair of electrodes at a time and then sequentially switching to other pairs during the treatment procedure. Typically, the switching time between the electrode pairs would be shorter than thermal relaxation time of the treated tissue. Thus, the energy source for each needle pair need not be a separate energy source for each needle pair.
Controller 34 may include a Personal Computer (PC). The PC may include a processor, one or more memories, a keyboard, a pointing device (mouse), and a display. The PC supports monitoring of the treatment process, changing the input parameters, and provides a graphical representation of an image of a target skin treatment volume. One or more programs stored in memory are executed by the processor to carry out the functionality described herein.
In this way, current is induced only between the needle electrode pairs 104, 108 and 304, 308 through the interior of the treatment volume 30 to increase the current density and temperature in the interior of the zone. In the specific embodiment of
The uniformity of the thermal profile can be further improved by increasing the RF application time in order to allow more time for the heat front to propagate toward the central volume of the needle assembly.
To quantify the temperature uniformity within the volume defined by the active parts of the needles of the array, a temperature smoothness ratio (SR) can be defined as:
SR=(Tmax−Tinit)/(Tmin−Tinit)=ΔTmax/ΔTmin, (1)
where:
From the results discussed above, a calculated smoothness ratio of 1.12 indicated a very smooth thermal profile as shown in
Increasing the inter electrode distance to 7.5 mm seemed to be a maximal limit in order to maintain a smooth thermal profile. Indeed, the simulation results shown in
The embodiments presented so far include of applying a fix voltage between the two needles of a common pair for a fixed amount of time. Instead of applying a fix electrical parameter such as a voltage, a current, or a power, a better way would be to use a temperature-control algorithm to precisely control the temperature within the treated area. To do so, a temperature sensor (such as a thermocouple) can be positioned within at least one needle of the arrangement shown in
Along with the temperature sensor and as described above, a controller is used to receive the in situ tissue temperature information and control the electrical power delivered to the needle pair to reach and maintain a pre-determined tissue temperature. Examples of commonly used controllers to reach and maintain a target, a temperature in this case, are PID (Proportional-Integral-Derivative) or PI (Proportional-Integral) controllers. Other types of controllers can also be used to reach and maintain a target temperature. In the case of electrically isolated electrode pairs described in
When a temperature-control algorithm is employed, a target tissue temperature is selected by the user, usually from a GUI (Graphical User Interface). The target temperature could also have a fixed value which is pre-programmed within the software or hardware controlling the RF generator(s). For example, a temperature input 301 is selected by the user, which is used as a target temperature value by the controller(s).
Controller 34,
As stated earlier, tissue temperature control methods may include a temperature sensor, like a thermocouple or a thermistor for example, within at least one needle of a pair, and a controller, such as or including a PID (Proportional-Integral-Derivative) or a PI (Proportional-Integral) controller, for example, in order to reach and maintain a pre-determined tissue temperature. The optimal location of the temperature sensor within the needle is anywhere along the active portion and preferably where the hottest temperature spot is located. The controller monitors the tissue temperature by reading the temperature of the temperature sensor located within at least a needle at a pre-determined sampling frequency, such as 10 Hz for example, and adjust the difference of potential between two needles of a pair to reach and maintain a predefined tissue temperature target. In similar embodiments, the controller could control the power applied in tissue by the needle pair or the current between the needles of a pair.
Using such a technique, along with the capability of the disclosed needle configurations, creates a fairly uniform thermal pattern within the treated volume allowing a user to deliver RF energy to create precise target tissue temperature and/or a precise thermal dose which has been clinically proven to achieve the therapeutic goals. For example, the time-temperature profile can be characterized to create irreversible damage to fat cells, or adipocytes, to bring them out of their viable range. See Weaver, J. A., and Stoll, A. M., Mathematical Model of Skin Exposed to Thermal Radiation, Aerospace Medicine, January 1969, pp 24-30, and Weaver, J. A., and Stoll, A. M. Mathematical Model of Skin Exposed to Thermal Radiation, Aerospace Medical Research Department, Department of the Navy, AirTask R01 101 01 (Task Problem No. RB-6-01) (Aug. 22, 1967), both incorporated herein by this reference. More specifically, irreversible damages were created when adipocyte temperature of 45° C. was maintained for 40 minutes. Since biological tissues are sensitive thermal dose, similar biological effects can be obtained at higher temperature and lower time, or lower temperature and higher time. Equivalent thermal effect can be determined using the Arrhenius equation, which is known by those skilled in the art. According to the data from the above cited papers, similar irreversible damages to adipocytes could be induced at temperatures of 46, 47, and 48° C., for durations of 16, 6, and 3 minutes, respectively. These settings could be useful when fat reduction is the objective of a medical or esthetic procedures, and when temperature feedback algorithm is used to reach and maintain a target temperature.
The example above is one treatment example only and many other treatment examples associated with subcutis and/or other biological tissues are possible.
There may be a limit to the inter electrode distance where a uniform thermal profile can be expected. With an inter electrode distance of 1 cm, the middle section temperature did not rise substantially and the smoothness factor was 3.33. Longer needles (2 cm active length) were then simulated with satisfactory results and
The RF energy delivering needle electrodes can be spaced apart from each other and from the central volume intersection axis by 1.0 mm to 10 mm. Simulations have shown that the most optimal inter-electrode distance to minimize the SR value defined above for the same pair is 7 to 8 mm. Usually, the RF energy delivering needle electrodes are made of the same length although different length electrode pairs could be used in some applications.
Subcutis (fat) was selected for the simulations because it arguably has the lowest electrical (σ) and thermal (k) conductivities of all biological tissues and presents a situation where it is very difficult to obtain large and uniform thermal profiles. Nonetheless, treatments of other biological tissues are possible using the new techniques described herein.
The pairs of needle electrodes may be mounted on a detachable and replaceable cartridge 602,
The RF energy delivering needle electrodes 104, 108, 304, and 308 could be made of regular hypodermic needles with gauge 12 (2.769 mm) to 34 (0.16 mm). A hypodermic needle has sharp ends to easily penetrate the skin and can be advanced into the skin/tissue the whole lengths (about 40 mm) of the needle. The hypodermic needle is also a hollow tube that could allow for a supply of fluids to the treatment volume. The preferred needles are made of medical grade steel although needles made of stainless steel, platinum, gold or silver could be used. The hypodermic needles are preferably sufficiently rigid to maintain the distance between them constant when inserted in the tissue. The hypodermic needles and non-conductive insulation layer are also sufficiently robust to sustain multiple penetrations into and retraction from biological tissue during typical treatment procedures.
The multiple non-coplanar needle pairs configurations described so far are arranged in a spatial configuration to work together in order to create a large and uniform thermal profile in biological tissue. This needle array arrangement could be considered as a unit cell. It is also possible to use a plurality of unit cells to increase the treatment volume by simultaneously inserting these unit cells in tissue. If the unit cells are spaced apart closely enough, the corresponding thermal patterns would be uniform from one unit cell to another. Conversely, the thermal patterns would show a zone of untreated tissue where the temperature levels are below a therapeutic threshold between the unit cells. Depending on the treatment requirements, the distance between unit cells could be varied to produce large and uniform thermal injuries or to leave zones of untreated tissue between the unit cells.
The frequency was 460 kHz which is normally used for cardiac and cancer RF ablation. It is worthwhile noting that higher frequencies, up to 5 MHz for example, could also be used.
Although a square RF electrode cell configuration has been shown, other RF energy delivering needle electrode configurations are possible such as hexagonal, octagonal, and the like.
The device disclosed is suitable to treat cellulite, circumference reduction of the abdomen, and body shaping, including fat reduction in the submental and neck area. The device can be used to deliver thermal energy to a large tissue mass such as cancer, uterine fibroid, and the like. Because of the small footprint of the needles, the large thermal profile, and the controllability of the thermal profile which is limited along the active length of the needles and within the cells defined by the needle configuration, the device would be beneficial for brain tumors and other uses where the protection of surrounding healthy tissue is of primary importance.
Although specific features of the invention are shown in some drawings and not in others, this is for convenience only as each feature may be combined with any or all of the other features in accordance with the invention. The words “including”, “comprising”, “having”, and “with” as used herein are to be interpreted broadly and comprehensively and are not limited to any physical interconnection. Moreover, any embodiments disclosed in the subject application are not to be taken as the only possible embodiments.
In addition, any amendment presented during the prosecution of the patent application for this patent is not a disclaimer of any claim element presented in the application as filed: those skilled in the art cannot reasonably be expected to draft a claim is that would literally encompass all possible equivalents, many equivalents will be unforeseeable at the time of the amendment and are beyond a fair interpretation of what is to be surrendered (if anything), the rationale underlying the amendment may bear no more than a tangential relation to many equivalents, and/or there are many other reasons the applicant cannot be expected to describe certain insubstantial substitutes for any claim element amended.
Other embodiments will occur to those skilled in the art and are within the following claims.