The present application claims priority to, and the benefit of, U.S. Provisional Application Ser. No. 61/653,804, filed on May 31, 2012, and U.S. Provisional Application Ser. No. 61/658,577, filed on Jun. 12, 2012, the disclosures of which are herein incorporated by reference in their entireties.
1. Technical Field
The present disclosure relates to electrosurgical systems and devices for performing medical procedures. The present disclosure relates to the administration of beneficial agents in general, which include any physiologically, pharmacologically active and/or psychotropic substance(s). More particularly, the present disclosure relates to drug-delivery devices for use with ablation devices and electrosurgical systems including the same.
2. Discussion of Related Art
Electrosurgical instruments have become widely used by surgeons. Electrosurgery involves the application of thermal and/or electrical energy to cut, dissect, ablate, coagulate, cauterize, seal or otherwise treat biological tissue during a surgical procedure. Electrosurgery is typically performed using a handpiece including a surgical instrument (e.g., end effector, ablation probe, or electrode) adapted to transmit energy to a tissue site during electrosurgical procedures, an electrosurgical generator operable to output energy, and a cable assembly operatively connecting the surgical instrument to the generator.
Treatment of certain diseases requires the destruction of malignant tissue growths, e.g., tumors. Electromagnetic radiation can be used to heat and destroy tumor cells. Treatment may involve inserting ablation probes into tissues where cancerous tumors have been identified. Once the probes are positioned, electromagnetic energy is passed through the probes into surrounding tissue.
In the treatment of diseases such as cancer, certain types of tumor cells have been found to denature at elevated temperatures that are slightly lower than temperatures normally injurious to healthy cells. Known treatment methods, such as hyperthermia therapy, heat diseased cells to temperatures above 41° C. while maintaining adjacent healthy cells below the temperature at which irreversible cell destruction occurs. These methods involve applying various forms of energy (e.g., electromagnetic, ultrasonic, etc.) to heat, ablate and/or coagulate tissue. Microwave or radio-frequency energy is sometimes utilized to perform these methods. Radio-frequency (RF) and microwave (MW) energy are electromagnetic radiation in the frequency ranges of 3 kilohertz (kHz) to 300 Megahertz (MHz), and 300 MHz to 300 gigahertz (GHz), respectively. Other procedures utilizing electromagnetic radiation to heat tissue also include coagulation, cutting and/or ablation of tissue.
Electrosurgical devices utilizing electromagnetic radiation have been developed for a variety of uses and applications. A number of devices are available that can be used to provide high bursts of energy for short periods of time to achieve cutting and coagulative effects on various tissues. There are a number of different types of apparatus that can be used to perform ablation procedures. Typically, microwave apparatus for use in ablation procedures include a microwave generator that functions as an energy source, and a microwave surgical instrument (e.g., microwave ablation probe) having an antenna assembly for directing the energy to the target tissue. The microwave generator and surgical instrument are typically operatively coupled by a cable assembly having a plurality of conductors for transmitting microwave energy from the generator to the instrument, and for communicating control, feedback and identification signals between the instrument and the generator.
The basic purpose of both monopolar and bipolar electrosurgery is to produce heat to achieve the desired tissue/clinical effect. In monopolar electrosurgery, devices use an instrument with a single, active electrode to deliver energy from an electrosurgical generator to tissue, and a patient return electrode (usually a plate positioned on the patient's thigh or back) as the means to complete the electrical circuit between the electrosurgical generator and the patient. In bipolar electrosurgery, the electrosurgical device includes two electrodes that are located in proximity to one another for the application of current between their surfaces. Bipolar electrosurgical current travels from one electrode, through the intervening tissue to the other electrode to complete the electrical circuit.
The benefits provided by controlled delivery of active agents for the treatment of injury or disease are well recognized in the art and various approaches have been taken to realize the goal of delivering active agents at desired rates over predetermined periods of time. Various different implantable controlled delivery formulations are known in the art, and various different mechanisms have been employed for delivering active agent from implantable formulations at a controlled rate over time.
Medical imaging has become a significant component in the clinical setting and in basic physiology and biology research, e.g., due to enhanced spatial resolution, accuracy and contrast mechanisms that have been made widely available. Medical imaging now incorporates a wide variety of modalities, e.g., computed tomography (CT) and magnetic resonance imaging (MRI), that noninvasively capture the structure and/or function of the human body. Such images are acquired and used in many different ways including medical images for diagnosis, staging and therapeutic management of malignant disease.
Medical image processing, analysis and visualization play an increasingly useful role in disease diagnosis and monitoring as well as, among other things, surgical planning and monitoring of therapeutic procedures. A contrast agent may be used for enhancement of the contrast of structures or fluids within the body (or region of interest) in medical imaging to allow visualization and evaluation of lesions seen minimally, if at all, with imaging alone. There is a continuing need for devices capable of dispensing a contrast agent to enhance the visualization of the lesion during the procedure.
Despite advancements in the use of electrosurgical devices for treating biological tissue, there are still concerns for tumor reoccurrence. A continuing need exists for devices capable of dispensing a controlled delivery formulation of a desired active agent, which may help to reduce or eliminate tumor reoccurrence.
There is a need for drug-delivery devices configured for attachment to ablation devices to provide the capability of dispensing a controlled delivery formulation of a desired active agent (and/or contrast agent). There is a need for drug-delivery devices configured for attachment to energy-delivery devices to provide the capability of dispensing therapeutic agents, e.g., visualization agents, radioactive agents, and/or radiation-protective agents. The combination of ablation (e.g., RF ablation and/or microwave ablation) and drug delivery may help to reduce or eliminate tumor reoccurrence. The combination of ablation and contrast agent introduction may help to enhance the visualization of the lesion during the treatment procedure. There is a need for drug-delivery devices configured for attachment to ablation devices to provide the capability of dispensing a therapeutic agent and/or an active agent in a controlled delivery formulation and/or non-active agent (e.g., contrast agent) before, during and/or after ablation, e.g., without the need for further manipulation of the device.
Electromagnetic energy is generally classified by increasing energy or decreasing wavelength into radio waves, microwaves, infrared, visible light, ultraviolet, X-rays and gamma-rays. As it is used in this description, “ablation procedure” generally refers to any ablation procedure, such as, for example, microwave ablation, radio frequency (RF) ablation or microwave ablation-assisted resection.
As it is used in this description, “energy-delivery device” generally refers to any device that can be used to transfer energy from a power generating source, such as a microwave or RF electrosurgical generator, to tissue. For the purposes herein, the term “ablation device” is interchangeable with the term “energy-delivery device.” As it is used in this description, “transmission line” generally refers to any transmission medium that can be used for the propagation of signals from one point to another.
For the purposes of this description, the terms “drug,” “drug agent,” “implantable drug agent,” “active agent,” “beneficial agent,” “therapeutic agent,” “therapeutic molecule,” and the like are used interchangeably herein, and may include, for example, small molecules, proteins, enzymes, hormones, polynucleotides, nucleoproteins, polysaccharides, glycoproteins, lipoproteins, polypeptides, steroids, analgesics, local anesthetics, antibiotic agents, anti-inflammatory corticosteroids, ocular drugs and synthetic analogs of these species. Some examples of drug agents that may be delivered by devices according to embodiments of the present disclosure are provided later in this description.
According to an aspect of the present disclosure, a drug-delivery device is provided. The drug-delivery device includes a body configured for attachment to a handle of an ablation device, a shaft portion defining a passageway therein, and a delivery lumen to provide for drug delivery to tissue. The body includes a proximal portion, a distal portion, and a contoured portion disposed therebetween. The contoured portion is configured for engagement with a contoured portion of the handle of the ablation device. The shaft portion includes a proximal end and a distal end. The proximal end of the shaft engages with an opening defined in the distal end of the body. The passageway of the shaft portion is configured to receive the delivery lumen slideably moveably therein. The delivery lumen includes a proximal portion and a distal portion. The drug-delivery device also includes a knob member coupled to the proximal portion of the delivery lumen.
According to an aspect of the present disclosure, an electrosurgical system is provided. The electrosurgical system includes an ablation device and a drug-delivery device. The ablation device includes a handle portion and a plurality of ablation electrodes operatively connected to the handle portion. The handle portion includes a contoured portion. The drug-delivery device includes a body, a delivery lumen to provide for drug delivery to tissue, and a knob member. The body is configured for attachment to the handle portion of the ablation device. The body includes a proximal portion, a distal portion, and a contoured portion disposed therebetween. The contoured portion of the body is configured for engagement with the contoured portion of the handle portion of the ablation device. The shaft portion defines a passageway therein. The shaft portion includes a proximal end and a distal end. The proximal end of the shaft engages with an opening defined in the distal end of the body. The delivery lumen includes a proximal portion and a distal portion. The knob member is coupled to the proximal portion of the delivery lumen. The passageway of the shaft portion is configured to receive the delivery lumen slideably moveably therein.
Objects and features of the presently-disclosed drug-delivery devices for use with ablation devices and electrosurgical systems including the same will become apparent to those of ordinary skill in the art when descriptions of various embodiments thereof are read with reference to the accompanying drawings, of which:
Hereinafter, embodiments of the presently-disclosed drug-delivery devices for use with ablation devices, and electrosurgical systems including the same of the present disclosure are described with reference to the accompanying drawings. Like reference numerals may refer to similar or identical elements throughout the description of the figures. As shown in the drawings and as used in this description, and as is traditional when referring to relative positioning on an object, the term “proximal” refers to that portion of the device, or component thereof, closer to the user and the term “distal” refers to that portion of the device, or component thereof, farther from the user.
This description may use the phrases “in an embodiment,” “in embodiments,” “in some embodiments,” or “in other embodiments,” which may each refer to one or more of the same or different embodiments in accordance with the present disclosure.
Various embodiments of the present disclosure provide drug-delivery devices configured to be attachable to energy-delivery devices. Embodiments may be suitable for use with Cool-tip™ RF ablation devices. Embodiments may be suitable for use with microwave ablation devices. Embodiments may be suitable for utilization with endoscopic and laparoscopic surgical procedures. Embodiments may be implemented using electromagnetic radiation at microwave frequencies, RF frequencies or at other frequencies.
Various embodiments of the present disclosure provide electrosurgical system including a drug-delivery device configured to be attachable to an energy-delivery. Various embodiments of the presently-disclosed drug-delivery device include an elongated shaft portion configured to facilitate delivery of one or more drug agents and/or therapeutic agents, which may be temperature sensitive, into tissue. Any suitable number of the same or different drugs may be utilized, e.g., depending upon a particular purpose and/or to achieve a desired surgical outcome. The presently-disclosed drug-delivery device embodiments may be configured for visualization, e.g., configured to allow for delivery of a miniaturized camera system at the distal end of the delivery lumen. The presently-disclosed drug-delivery device embodiments may be configured to allow for delivery of pill-sized cameras.
Drug agents which may be delivered by devices according to embodiments of the present disclosure include drugs which act on the peripheral nerves, adrenergic receptors, cholinergic receptors, the skeletal muscles, the cardiovascular system, smooth muscles, the blood circulatory system, synoptic sites, neuroeffector junctional sites, endocrine and hormone systems, the immunological system, the reproductive system, the skeletal system, autacoid systems, the alimentary and excretory systems, the histamine system and the central nervous system. Some examples of implantable drug agents which may be delivered by devices according to embodiments of the present disclosure are provided later in this description. Therapeutic agents which may be delivered by devices according to embodiments of the present disclosure include visualization agents, radio-active agents, and radiation-protective agents. Therapeutic agents need not necessarily be in molecular form (e.g., ethanol may be preferred over molecular therapeutics to induce cytotoxicity for the tumorous tissue). The therapeutic agent and/or formulation may or may not have controlled-release or sustained-release, and may instead be delivered as a bolus.
Various embodiments of the present disclosure provide a “clip-on” component for drug-delivery suitable for use with an ablation device, wherein the device architecture, configuration, and manufacturing process for the ablation device does not need to be modified. Various embodiments of the presently-disclosed “clip-on” component for drug-delivery provide the capability to deliver localized drugs or other payload for therapeutic and/or visualization purposes.
Ablation device 101 includes an electrode array “E” and a handle assembly 130. Electrode array “E” may include one or more ablation electrodes 110. In some embodiments, as shown in
Ablation device 101 is operatively connected via a transmission line 150 to an electrosurgical power generating source 28, e.g., a microwave or radio frequency (RF) electrosurgical generator. Power generating source 28 may be any generator suitable for use with electrosurgical devices and may be configured to provide various frequencies of energy. In some embodiments, ablation device 101 is disposed in fluid communication with a coolant source (not shown). Ablation device 101 may include first and second conduits 151 and 152, respectively, to provide a first fluid-flow path, e.g., leading to the ablation electrodes 110, and a second fluid-flow path, e.g., leading away from the ablation electrodes 110, configured to provide fluid flow of a coolant fluid e.g., deionized water, or other suitable cooling medium, for cooling at least the distal end portion 113 of the ablation electrodes 110. Ablation device 101 may include additional, fewer, or different components than shown in
In some embodiments, electrosurgical system 100 (also referred to herein as ablation system 100) may include a controller 26 for controlling and/or monitoring the operating parameters of the ablation system 100. In some embodiments, as shown in
In some embodiments, a drug and/or contrast agent supply line (not shown) may be provided to fluidly-couple the drug-delivery device 10 to a source of the drug and/or contrast agent delivery supply for supplying drugs and/or contrast agent to the delivery lumen 70. A fluid-movement device may be fluidly coupled between the source of the drug (and/or contrast agent) and the delivery lumen 70, and the controller 26 may be communicatively-coupled to the fluid-movement device. In some embodiments, the controller 26 may be configured to control operation(s) of the fluid-movement device, e.g., during an ablation procedure based on one or more operating parameters of the electrosurgical power generating source 28. Electrosurgical system 100 may additionally, or alternatively, include an imaging system (not shown) capable of generating image data, and the controller 26 may be communicatively-coupled to the imaging system. In some embodiments, the controller 26 may be configured to control operation(s) of the fluid-movement device based, at least in part, on data captured by the imaging system.
Drug-delivery device 10 includes an elongated, substantially cylindrically-shaped shaft portion 12 defining a passageway 11 of generally tubular shape configured to receive the delivery lumen 70 slideably moveably therein. Shaft portion 12 generally includes a distal end portion 14 and a proximal end portion 16. A port 15 is located at the distal-most tip of the distal end portion 14. The proximal end portion 16 of the shaft portion 12 engages with an opening 35 defined in the distal portion 34 of the body 30. Although the passageway 11 is generally tubular-shaped, other shapes can be used depending on the configuration of the shaft portion 12. Shaft portion 12 may be formed of any suitable rigid material, and may be either disposable or reusable.
Drug-delivery device 10 includes an actuator 40 operatively coupled to the delivery lumen 70. In some embodiments, the actuator 40 includes a knob member 42. In some embodiments, as seen in
Drug-delivery device 10 is configured to allow the user to selectively position the delivery lumen 70, or portion thereof, from within the shaft portion 12 of the drug-delivery device 10 to outside the shaft portion 12. For ease of explanation and understanding, the delivery lumen 70 is described below as selectively positionable with respect to fixed structures, or portions thereof, of the ablation device 101, e.g., in relation to the distal end portion 113 of the ablation electrodes 110, and/or in relation to the distal end 14 of the shaft portion 12 of the drug-delivery device 10.
Delivery lumen 70 may be formed of any suitable material, and may include one or more portions formed of a flexible material. In some embodiments, as shown in
In some embodiments, where the delivery lumen 70 is disposable, replaceable and/or interchangeable, different configurations of the delivery lumen 70 (e.g., varied dimensions and angles for the distal end) may be used depending upon the needs of the procedure and/or the preference of the surgeon.
In some embodiments, as shown in
As shown in
Drug-delivery device 10 includes a body 30 configured to be attachable to an energy-delivery device (e.g., ablation device 101 shown in
Body 30 defines a body chamber 37 therein (
Body 30 may be formed of any suitable material or combination of materials by any suitable process. In some embodiments, the drug-delivery device 10 may be adapted to be a reusable device. Autoclavable materials may be used to form the body 30, and/or other components of the drug-delivery device 10, to provide for a sterilizable device. Body 30, or portions thereof, may be formed from two housing halves (not shown). Each half of the housing may include a series of mechanical interfacing components (not shown) configured to matingly engage with a corresponding series of mechanical interfaces (not shown) to align the two housing halves to define therein the body chamber 37. It is contemplated that the housing halves (as well as other components described herein) may be assembled together with the aid of alignment pins, snap-like interfaces, tongue and groove interfaces, locking tabs, adhesive ports, etc., utilized either alone or in combination for assembly purposes.
In some embodiments, as shown in
Drug-delivery device 10 includes a body 30 configured to be attachable to an energy-delivery device (e.g., ablation device 900 shown in
A variety of drug agents may be delivered by devices according to embodiments of the present disclosure. Some examples of drug agents which may be delivered by devices according to embodiments of the present disclosure include chemotherapeutic agents such as without limitation cisplatin, paclitaxel, doxorubicin, fluorouracil, as well as other compounds such as without limitation prochlorperzine edisylate, ferrous sulfate, aminocaproic acid, mecamylamine hydrochloride, procainamide hydrochloride, amphetamine sulfate, methamphetamine hydrochloride, benzamphetamine hydrochloride, isoproterenol sulfate, phenmetrazine hydrochloride, bethanechol chloride, methacholine chloride, pilocarpine hydrochloride, atropine sulfate, scopolamine bromide, isopropaniide iodide, tridihexethyl chloride, phenformin hydrochloride, methylphenidate hydrochloride, theophylline cholinate, cephalexin hydrochloride, diphenidol, meclizine hydrochloride, prochlorperazine maleate, phenoxybenzamine, thiethylperzine maleate, anisindone, diphenadione erythrityl tetranitrate, digoxin, isofluorophate, acetazolamide, methazolamide, bendroflumethiazide, chloropromaide, tolazamide, chlormadinone acetate, phenaglycodol, allopurinol, aluminum aspirin, methotrexate, acetyl sulfisoxazole, erythromycin, hydrocortisone, hydrocorticosterone acetate, cortisone acetate, dexamethasone and its derivatives such as betamethasone, triamcinolone, methyltestosterone, 17-S-estradiol, ethinyl estradiol, ethinyl estradiol 3-methyl ether, prednisolone, 17-oc-hydroxyprogesterone acetate, 19-nor-progesterone, norgestrel, norethindrone, norethisterone, norethiederone, progesterone, norgesterone, norethynodrel, aspirin, indornethacin, naproxen, fenoprofen, sulindac, indoprofen, nitroglycerin, isosorbide dinitrate, propranolol, timolol, atenolol, aiprenolol, cimetidine, clonidine, imipramine, levodopa, chlorpromazine, methyldopa, dihydroxyphenylalanine, theophylline, calcium gluconate, ketoprofen, ibuprofen, cephalexin, erythromycin, haloperidol, zomepirac, ferrous lactate, vincamine, diazepam, phenoxybenzamine, diltiazem, mitrinone, capropril, mandol, quanbenz, hydrochlorothiazide, ranitidine, flurbiprofen, fenufen, fluprofen, tolmetin, alciofenac, mefenamic, flufenamic, difiuinal, nimodipine, nitrendipine, nisoldipine, nicardipine, felodipine, lidoflazine, tiapamil, gallopamul, amlodipine, mioflazine, lisinoipril, enalapril, enalaprilat, captopril, ramipril, famotidine, nizatidine, sucralfate, etintidine, tetratolol, minoxidil, chlordazepoxide, diazepam, amitriptyline, and imipramine; opioids such as meperidine, hydrocodone, oxycodone, and semi-synthetic opioids such as oxymorphone, hydromorphone, opiates such as morphine and codeine, opioid antagonists such as without limitation naltrexone, nalbuphine, naloxone as well as opioid agonist/antagonist compounds such as buprenorphine, and synthetic analgesics such as methadone, tramadol, fentanyl and sufentanil.
Some other examples of drug agents which may be delivered by devices according to embodiments of the present disclosure include vitamin and supplements such as vitamins B-12 (cyanocobalamin) and D2, anti-virals such as without limitation acyclorvir and zidovudine; proteins and peptides such as without limitation insulin, colchicine, glucagon, thyroid stimulating hormone, parathyroid and pituitary hormones, calcitonin, renin, prolactin, corticotrdphin, thyrotropic hormone, follicle stimulating hormone, chorionic gonadotropin, gonadotropin releasing hormone, bovine somatotropin, porcine somatotropin, oxytocin, vasopressin, GRE, prolactin, somatostatin, lypressin, pancreozymin, luteinizing hormone, LHRH, LHRH agonists and antagonists, leuprolide, interferons, interleukins, growth hormones such as human growth hormone, bovine growth hormone and porcine growth hormone, fertility inhibitors such as the prostaglandins, fertility promoters, growth factors, coagulation factors, human pancreas hormone releasing factor, analogs and derivatives of these compounds, and pharmaceutically acceptable salts of these compounds, or their analogs or derivatives. On the molecular level, the various forms of the beneficial agent may include uncharged molecules, molecular complexes, and pharmaceutically acceptable acid addition and base addition salts such as hydrochlorides, hydrobromides, acetate, sulfate, laurylate, oleate, and salicylate. Examples of acidic compounds which may be delivered by devices according to embodiments of the present disclosure include salts of metals, amines or organic cations. Derivatives such as esters, ethers and amides may also be used.
A drug agent for delivery by devices according to embodiments of the present disclosure may be used alone or mixed with other agents. A drug agent for delivery by the presently-disclosed devices may include pharmaceutically acceptable excipients, polymeric carriers and/or additional ingredients, such as antioxidants, stabilizing agents, permeation enhancers, polysaccharides, proteins, nucleotides like aptamers, and fatty acids, etc., and fabricated into different forms, such as solution, suspension, gel, colloidal dispersion like liposome, or micro- and nano-particles for controlled delivery of the drug agent. A drug agent for delivery by the presently-disclosed devices may include a thermo-sensitive metal depositor or any such compound that increases the sensitivity of the target tissue, e.g., tumor, to ablation.
A drug agent for delivery by the presently-disclosed devices may include a cryoablation agent, e.g., liquid nitrogen, and may prove complementary to thermal ablation that uses electrosurgical energy at RF or microwave frequencies.
The above-described devices provide to the capability to operate with two or more different modalities (e.g., ablation and drug delivery), without any fundamental change to the device architecture, manufacturing process etc. for the ablation device.
The above-described systems and drug-delivery devices coupled to ablation devices may offer improved anti-cancer efficacy with RF ablation (or microwave ablation) and localized drug delivery capabilities integrated into a dual medical device. In accordance with the above-described systems and ablation devices, an approach is taken to deliver drug formulation(s) locally when the anatomical access has already been obtained for the purpose of RF or microwave ablation, which, in turn, presents the prospect of reduced side-effects associated with systemic administration of the same drug molecule(s).
In accordance with the above-described systems and ablation devices, heat activated drugs may be delivered to the periphery of the tumor, which may not get as hot as the center of the tumor, to ensure adequate margins. The above-described systems and ablation devices may be used to kill tumors from the inside out, wherein the temperature at the periphery may not be high enough to destroy the tumor through ablation (e.g., in some cases, requiring temperatures of at least 55° C.), but at high enough temperature (e.g., in some cases, temperatures of about 45° C.) to activate one or more drugs delivered by the above-described ablation devices, which may take care of killing the tumor edges.
Although embodiments have been described in detail with reference to the accompanying drawings for the purpose of illustration and description, it is to be understood that the inventive processes and apparatus are not to be construed as limited thereby. It will be apparent to those of ordinary skill in the art that various modifications to the foregoing embodiments may be made without departing from the scope of the disclosure.
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0108573 | Feb 2001 | WO |
0174252 | Oct 2001 | WO |
2006105121 | Oct 2006 | WO |
2006138719 | Dec 2006 | WO |
2008144341 | Nov 2008 | WO |
WO2009065058 | May 2009 | WO |
WO2010035831 | Apr 2010 | WO |
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Number | Date | Country | |
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20150065944 A1 | Mar 2015 | US |