BACKGROUND
1. Field of the Invention
This invention relates to an interstitial microwave system and method employing a minimally-invasive probe for thermally treating diseased tissue of a patient and, more particularly, to a probe comprising a fluid-coolable insertion-sleeve assembly into which any one of a plurality of separate functional structures may be inserted.
2. Description of the Prior Art
Incorporated by reference herein is U.S. Pat. No. 6,312,428 B1, issued Nov. 6, 2001, which discloses an interstitial system employing a minimally-invasive probe or thermally treating diseased tissue of a patient, but the system is not a microwave system and its probe comprises an integral structure that is not fluid cooled. Further, incorporated by reference herein is U.S. Pat. No. 6,847,848, issued January 2005 and assigned to the same assignee as the present application, which discloses an interstitial microwave system employing a minimally-invasive catheter operating as a probe for thermally treating diseased tissue of a patient, but its probe comprises an integral structure that is fluid cooled, rather than comprising fluid-coolable insertion-sleeve assembly into which any one of a plurality of separate functional structures may be inserted. Further, this co-pending U.S. patent application Ser. No. 10/337,159 teaches the use of radiometer means for both monitoring the temperature of tissue being heated by microwave radiation and then using the monitored temperature to control such radiation to prevent overheating of this tissue.
SUMMARY OF THE INVENTION
The invention is directed to a minimally-invasive, fluid-coolable insertion-sleeve assembly into which any one of a group of separate individual insertable components, that includes an insertable microwave-radiator assembly component may be inserted, for use as a probe in an interstitial microwave system for thermally treating sub-cutaneous diseased tissue of a patient. Because the insertion-sleeve assembly may lack stiffness (if comprised of thin plastic tubing attached to a distally-located plastic penetrating point), the assembly may require that a rigid rod be inserted in the sleeve assembly to permit it to pierce the patient's skin and push through the underlying sub-cutaneous tissue to reach the diseased tissue. The rigid rod is then replaced by the microwave-radiator assembly, which is used to thermally treat the diseased tissue with microwave radiation. The microwave-radiator assembly may then be replaced by an inserted ultrasonic-imaging transducer assembly used to provide image display data of the treated tissue. The ultrasonic-imaging transducer assembly may also be used prior to treatment to provide a baseline display or during the treatment procedure.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is a functional block diagram of a microwave system that constitutes an illustrative embodiment of the present invention;
FIG. 2A shows the physical-structure embodiment of the minimally-invasive, water-cooled insertion-sleeve assembly with attached balloon of FIG. 1;
FIG. 2B shows a cross-section view of 2A, FIG. 2C shows the distal portion of the minimally-invasive, water-cooled insertion-sleeve assembly with an inflated balloon;
FIG. 2D shows an alternative embodiment of the distal portion of the minimally-invasive, water-cooled insertion-sleeve assembly without a balloon;
FIGS. 3A and 3B, respectively, show the physical-structure of first and second embodiments of the insertable microwave-radiator assembly of FIG. 1 prior to insertion in the insertion-sleeve assembly;
FIG. 4 shows the first embodiment of the insertable microwave-radiator assembly of FIGS. 3A subsequent to insertion in the insertion-sleeve assembly;
FIG. 5 shows the physical-structure of an embodiment of the distal portion of the insertable ultrasonic-imaging transducer assembly of FIG. 1 subsequent to insertion in the insertion-sleeve assembly; and
FIG. 6A schematically shows an inflatable balloon probe that has been inserted through the skin of a patient and sub-cutaneous tissue with its balloon in its deflated state situated in a tumor within deep-seated tissue and FIG. 6B shows this inserted probe with its balloon fully inflated and pressing against the tumor.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to the FIG. 1 functional block diagram, there is shown a group of separate individual insertable components 100, which comprises insertable rigid rod 102, insertable microwave-radiator assembly 104 and insertable ultrasonic-imaging transducer assembly 106. Microwave energy from microwave generation and control means 108 is supplied to insertable microwave-radiator assembly 104 through connection 110. In practice, connection 110 normally comprises a standard 50 ohm impedance coaxial cable. Ultrasonic energy from ultrasonic generation and processing means 112 is supplied to insertable ultrasonic-imaging transducer assembly 106 through connection 114.
As indicated by arrows 116, 118, 120 and 122, at any one time, any selected one of insertable rigid rod 102, insertable microwave-radiator assembly 104 or insertable ultrasonic-imaging transducer assembly 106 may be inserted in minimally-invasive water-cooled insertion-sleeve assembly with attached balloon 124. In a preferred embodiment, the outer diameter is equal to or less than 0.1 inch. Water-flow means 126, which is connected to insertion-sleeve assembly with attached balloon 124, controls the water-cooling of insertion-sleeve assembly with attached balloon 124.
Referring now to FIG. 2A, for the purpose of clarity, there is shown an enlarged sectional view of the physical structure of insertion-sleeve assembly with attached balloon 124. For the purposes of this invention, proximal refers to the portion of the device nearest to the user during use. Distal refers to the portion of the device closest to the patient during use. As indicated in FIG. 2A, insertion-sleeve assembly 124 comprises inner tube 200 situated inside of outer tube 202, which forms a sheath surrounding inner tube 200. In the illustrative embodiment of the invention, outer tube 202 has an inner diameter of 0.088 inch, inner tube 200 has an inner diameter of 0.072 inch and the thickness of each of these tubes is very small. Therefore, there is a coaxial lumen 212 having an overall width of slightly less than 0.016 inch (i.e., 0.088-0.072 inch) between the inner diameter of outer tube 202 and the outer diameter of inner tube 200. The proximal end of each of tubes 200 and 202 is attached to insertion-sleeve assembly fitting 216.
Insertion sleeve assembly fitting 216 is comprised of a water-coolant input connector 208 (indicated by a downward-pointing arrow), water-coolant output connector 210 (indicated by an upward-pointing arrow) and proximal end opening 206. Proximal end opening 206 allows for insertion of any of the group of separate insertable components 100 into the inner tube 200. Water-coolant input connector 208 and water-coolant output connector 210 provide separate pathways into coaxial lumen 212. As shown in FIG. 2A, water-coolant input connector 208, includes two separate fluid channels 228a and 228b (situated directly behind first fluid channel 228a and, therefore, only partially visible in FIG. 2A). In the illustrative embodiment, each of first and second fluid channels 228a and 228b are comprised of tubes having an inner diameter of only 0.012 inch. Both first and second fluid channels 228a and 228b enter the coaxial lumen 212 space and proceed toward the distal end of insertion-sleeve assembly 124. Alternative embodiments may include a single or multiple fluid channels.
Further, as shown in FIG. 2A, water coolant seal 230, which is situated within the interior of water-coolant input connector 208 and surrounds both of first and second fluid channels 228a and 228b, limits the input water-coolant to just the interior of first and second fluid channels 228a and 228b. Thus, as shown in the cross-sectional FIG. 2B, the input water-coolant flows toward the distal end of insertion-sleeve assembly 124 through the interior of fluid channels 228a and 228b which are situated within the coaxial lumen 212. The output water-coolant flows back through the portion of the coaxial lumen 212 which is outside of first and second fluid channels 228a and 228b toward the proximal end of insertion-sleeve assembly 124 and then exits through water-coolant output connector 210.
Referring now to FIG. 2C, for the purpose of clarity, there is shown a greatly enlarged view of the most distal section of the physical structure of minimally-invasive, water-cooled insertion-sleeve assembly with attached balloon 124. As indicated in FIG. 2C, the distal end of inner tube 200 is attached to solid, pointed-tip element 232. As shown, element 232 has an optional centrally-located bore hole 234 therethrough. The proximal end of balloon 236 is attached to the outer surface of outer tube 202 and the distal end of balloon 236 is attached to the outer surface of inner tube 200. As indicated in FIG. 2C, the distal end of outer tube 202 is located inside balloon 236 at a position situated only a short distance from the point of attachment of the more proximal end of balloon 236. The distal end of first fluid channel 228a and the distal end of second fluid channel 228b (situated directly behind first fluid channel 228a and, therefore, not visible in FIG. 2C) are also located inside balloon 236, but at respective positions situated near to the distal end of the balloon 236.
Reference is now made to FIG. 2D which shows the most distal section of the physical-structure of an alternative embodiment of a minimally-invasive, water-cooled insertion-sleeve assembly 124 without a balloon. In the case of FIG. 2D, distal ends of both inner tube 200 and the outer tube 202 are attached to solid, pointed-tip element 232. Further, in FIG. 2D, the distal end of first fluid channel 228a and the distal end of second fluid channel 228b (situated directly behind fluid channel 228a and, therefore, not visible in FIG. 2D) are spaced a relatively short distance from the attached distal ends of the inner tube 200 and the outer tube 202, thereby allowing input coolant water to flow out from the distal ends of first and second fluid channels 228a and 228b into the coaxial lumen 212. In all other respects, the distal portion of the physical-structure of the alternative embodiment of the minimally-invasive, water-cooled insertion-sleeve assembly shown in FIG. 2D is identical to the physical-structure of minimally-invasive, water-cooled insertion-sleeve assembly with attached balloon 124 shown in FIG. 2C. Further, the physical structure of the proximal section of the alternative embodiment of the minimally-invasive, water-cooled insertion-sleeve assembly without a balloon (which is identical to the physical structure of the proximal section of minimally-invasive, water-cooled insertion-sleeve assembly with attached balloon 124) is shown in FIGS. 2A.
Referring to FIGS. 3A and 3B, there are shown, respectively, first and second embodiments of insertable microwave-radiator assembly 104. Each of the first and second embodiments comprises a physical coaxial structure 300 that incorporates a gap antenna 310 for radiating microwave energy supplied as an input to that coaxial structure. The only significant difference between the first embodiment shown in FIG. 3A and the second embodiment shown in FIG. 3B is that the first-embodiment coaxial structure of FIG. 3A uses an externally-situated impedance-matching means, while the second-embodiment coaxial structure of FIG. 3B incorporates internally-situated impedance-matching means.
More specifically, coaxial structure 300 of FIG. 3A comprises a first given length of a commercially-available ceramic tubing 302 (shown in section) that has given inner and outer diameters. Commercially-available ceramic tubing 302 constitutes the dielectric of coaxial structure 300 and exhibits a relatively high given dielectric constant. Shown entirely in section is metal (preferably copper) cladding the inner surface of ceramic tubing 302 which constitutes the inner conductor 304 of coaxial structure 300. Shown partially in section is first metal (preferably copper) cladding the more proximal portion of the outer surface of ceramic tubing 302 which constitute first portion 306 of the outer conductor of coaxial structure 300. Show entirely in section is second metal (preferably copper) cladding the more distal portion of the outer surface of ceramic tubing which constitutes second portion 308 of the outer conductor of coaxial structure 300.
The first and second portions 306 and 308 of the outer conductor of coaxial structure 300 are longitudinally spaced a certain distance apart from one another thereby to create gap antenna 310 for radiating microwave energy therefrom in response to microwave energization of coaxial structure 300. Shown entirely in section is a metallic (preferably copper) disk 312 cladding the distal end of ceramic tubing 302, which (1) mechanically supports second portion 308 of the outer conductor and (2) electrically shorts the distal ends of the inner and outer conductors of coaxial structure 300. Coaxial structure 300 further comprises coaxial connector 314 for connecting the proximate end of coaxial structure 300 to the distal end of standard 50 ohm impedance coaxial cable connection.
The advantage of the first embodiment of coaxial structure 300 shown in FIG. 3A is that because dielectric comprises commercially-available ceramic tubing 302, it does not have to be machined to proper shape. However, the impedance of coaxial structure 300, which is determined by (1) the dielectric constant of ceramic tubing 302 and (2) the respective outer diameter of inner conductor 304 and the inner diameters of first and second portions 306 and 308 of the outer conductor of coaxial structure 300 (which are substantially equal to the inner and outer diameters of ceramic tubing), is only 18 ohms. Thus, the first embodiment of coaxial structure 300 requires relatively complex external impedance-matching means to match the 18 ohm impedance of coaxial structure 300 with the 50 ohm impedance of standard 50 ohm impedance coaxial cable connection 110, which is a disadvantage.
This disadvantage is avoided in the second embodiment of coaxial structure 300 having a physical structure shown in FIG. 3B which employs a relatively simple internal impedance matching means, rather than the relatively complex external impedance-matching means required with the coaxial structure 300 shown in FIG. 3A. More specifically, coaxial structure 300 comprises a second given length of commercially-available ceramic tubing 302 (which is shorter than the first given length of commercially-available ceramic tubing 302 illustrated in FIG. 3A) in series with impedance-matching ceramic tubing 316 having a length and dielectric constant which is electrically equal to one-quarter wavelength at the operating microwave frequency from microwave generator and control means 108. In all other respects the physical structures of the first and second embodiments of coaxial structures 300 are the same as one another. Impedance-matching ceramic tubing 316 comprises a ceramic having a given dielectric constant which is sufficiently lower than the dielectric constant of commercially-available ceramic tubing 302 to provide an impedance of substantially 30 ohms (i.e., 30 is equal to the square-root of the product of 18×50=900). Although ceramic having the desired given dielectric constant is available, it is not commercially available as tubing having the desired inner and outer diameters. Therefore, to provide impedance-matching ceramic tubing 316, it is necessary to custom machine the tubing to the proper shape and size, which is a disadvantage.
FIG. 4 shows the insertable coaxial structure 300 (described above in connection with FIG. 3A) inserted within the distal section of insertion sleeve assembly with attached balloon 124 (described above in connection with FIG. 2A). In FIG. 4, the distal section of insertion sleeve assembly with attached balloon 124 is shown as comprising inner tube 200, outer tube 202, visible fluid channel 228a and fluid channel 228b (not shown). Further, in FIG. 4, the distal section of insertion sleeve assembly with attached balloon 124 comprises attached balloon 236 and solid, pointed-tip element 232 attached to the distal end of inner and outer tubes 200 and 202. As shown, element 232 has centrally-located bore hole 234 therethrough. Situated within bore hole 234, close to the distal end of pointed-tip element 232, is optional thermistor 426. Optional wire 428, extending through the copper tube comprising inner conductor 304, interconnects thermistor 426 to the exterior of the insertable coaxial structures 300, where the output signal from thermistor 426 may be employed to monitor the temperature of tissue being heated by microwave radiation from gap antenna 310 or even to control the microwave power delivered to insertable coaxial structures 300 from microwave generation and control means 108.
If optional thermistor 426 is not employed, pointed-tip element 232 need not incorporate bore hole 234 and inner conductor 304 may comprise a solid copper rod instead of a copper tube.
Referring now to FIG. 5, there is shown the physical structure of an embodiment if insertable ultrasonic-imaging transducer assembly 106 is inserted within the distal section of insertion sleeve assembly with attached balloon 124. As shown in FIG. 5, solid, pointed-tip element 232 does not show an optional central bore hole therethrough. However, in practice, solid, pointed-tip element 232 may either (1) incorporate or (2) not incorporate such an optional central bore hole therethrough, since it is not needed for use with inserted ultrasonic-imaging transducer assembly 106.
As shown in FIG. 5, inserted ultrasonic-imaging transducer assembly 106 comprises the combination of ultrasonic lens 526 coupled to ultrasonic transducer means for use in (1) transmitting to targeted tissue of a patient with illuminating ultrasonic wave energy in response to being energized by ultrasonic generation and processing means 112 and (2) focusing received ultrasonic echoes from the targeted tissue and forwarding the focused received ultrasonic echoes to ultrasonic generation and processing means 112 for image processing and display.
Referring now to FIGS. 6A and 6B, which schematically illustrate the basic operation of a probe with an attached balloon used in an interstitial microwave system for thermally treating diseased tissue of a patient, such as a deep-seated tumor. In FIG. 6A, pointed-tip element 232 is used to puncture skin 604 and the underlying sub-cutaneous tissue 606 and then position the probe so that its deflated balloon 236 is situated within or in proximity to tumor 610 of the patient being treated. As shown in FIG. 6B, balloon 236 is then inflated to press against tumor 610, prior to tumor 610 being irradiated by microwave energy emitted from an antenna within the probe. The following irradiation of tumor 610 preferably heats the tissue of tumor 610 in proximity to inflated balloon 236 to a temperature sufficient to cause ablation and necrosis of proximate tumor cells. Balloon 236 may then be deflated and the probe removed from the body of the patient.
It is apparent that minimally-invasive water-cooled sleeve assembly with attached balloon 124, comprising the probe of the present invention, may be insufficiently stiff by itself, with its balloon in a deflated state, to first puncture skin 604 and then push through underlying sub-cutaneous tissue 606 and position itself so that its deflated balloon 236 is situated within or in proximity to tumor 610 of the patient being treated. Therefore, prior to any attempt to puncture skin 604, insertable rigid rod 102, which is preferably a stainless-steel rod, is inserted within sleeve assembly 124 to provide the necessary stiffness. Then with rigid rod 102 inserted, sleeve assembly 124, with its balloon in a deflated state, is used to first puncture skin 604 and then push through underlying sub-cutaneous tissue 606 and position itself so that its deflated balloon 236 is situated in proximity to tumor 610 of the patient being treated.
Once deflated balloon 236 has been situated within or in proximity to tumor 610 of the patient being treated inserted rigid rod 102 is removed from sleeve assembly 124 and insertable microwave-radiator assembly 104 is inserted within sleeve assembly 124 as a replacement for rigid rod 102. Then, water-flow means is operated to effect a continuous flow of water coolant through of first and second fluid channels 228a and 228b, balloon 236 of sleeve assembly 124, with the water coolant flowing through the space of coaxial lumen 212 to exit through output connector 210. This continuous flow of water coolant is effective in first inflating balloon 236 and then maintaining balloon 236 inflated. While balloon 236 is inflated, microwave energy from microwave generation and control means 108 is supplied to inserted microwave-radiator assembly 104. This results in gap antenna 310 radiating microwave energy to the targeted tissue of tumor 610 to effect the heating of the targeted tissue of tumor 610 to a temperature sufficient to cause ablation and necrosis thereof.
The continuous flow of water coolant makes it possible to supply gap antenna 310 relatively-high microwave power (50 to 100 watts) from microwave generation and control means 108 for heating the targeted tissue of tumor 610 to a temperature sufficient to cause ablation and necrosis thereof without, at the same time, causing non-targeted tissue in the immediate vicinity of the inserted probe being overheated to an unsafe temperature. Further, temperature data supplied from thermistor 426 may be used to lower the microwave power generated by microwave generation and control means 108 or, alternatively, turn off the generation of all microwave power by microwave generation and control means 108 to prevent non-targeted tissue in the immediate vicinity of the inserted probe from being overheated to an unsafe temperature. An additional benefit of employing a relatively-high microwave power of 50 to 100 watts is that this microwave power may be supplied for only a relatively short period of time (about 5 minutes) and still result in ablation and necrosis of the targeted tissue of tumor 610. This relatively short period of time limits the amount of unwanted heating by conduction of non-targeted tissue surrounding tumor 610. The use of relatively high microwave power and relatively short period of time radiation of tumor tissue is particularly suitable for use with a large-sized (up to a 4 centimeter-sized dimension) tumor (such as a liver tumor).
Ultrasonic-imaging transducer assembly 106 may be employed (1) prior to the commencement of tumor 610 being irradiated, (2) subsequent to the commencement, but prior to the completion, of tumor 610 being irradiated or (3) subsequent to the completion of tumor 610 being irradiated. In the first case, after sleeve assembly 124 has been installed and rigid rod 102 has been removed from sleeve assembly 124, insertable ultrasonic-imaging assembly 106 may be inserted within sleeve assembly 124 as a replacement for rigid rod 102. Water or other acoustical enhancing medium may be introduced into the insertion sleeve assembly 124 as previously described to increase echogenicity of the targeted tissue and provide the operator of ultrasonic generation and processing means 112 with an image display of tumor 610 prior to any irradiation thereof. The image display may be used by the operator in deciding the microwave-power and period-of-time settings to be employed by microwave generation and control means 108. Only then is ultrasonic-imaging assembly 106 replaced by the insertion of microwave-radiator assembly 104 inserted within sleeve assembly 124. The second case is applicable where a problem occurs during the irradiation of tumor 106. In the second case, microwave-radiator assembly 104 is replaced by the insertion of ultrasonic-imaging assembly 106 inserted within sleeve assembly 124 followed by the image display of the current condition of tumor 610. In the third case, microwave-radiator assembly 104 is replaced by the insertion of ultrasonic-imaging assembly 106 inserted within sleeve assembly 124 followed by the image display after ablation of the tissue of tumor 610 has occurred.
While the illustrative embodiment of the present invention employs a thermistor to determine tissue temperature, there are other known devices for determining tissue temperature that may be substituted for a thermistor. In this regard, incorporated by reference herein is the radiometer means disclosed in the aforementioned U.S. Pat. No. 6,847,848.
In all the above-described embodiments of the present invention, water has been employed as the fluid coolant because water has a high heat capacity. However, in general, the fluid coolant may be any desired liquid coolant or any desired pumped-gas coolant. Further, while insertable microwave-radiator assembly 104 is essential in the group of separate individual insertable components 100. This group could comprise one or more other components from those shown in FIG. 1. For instance, a miniature camera and light source that could view and image diseased tissue through clear tubing and clear fluid coolant might be employed as an additional one of the group of separate individual insertable components 100. Also, the physical structure of insertion-sleeve assembly 124 and the insertable elements of the group of separate individual insertable components 100 could be modified to have a slight curvature. (similar to the curvature of a scimitar) which would permit insertion-sleeve assembly 124 to go around obstacles such as bone during the process of its insertion through the sub-cutaneous tissue of the patient. In this regard, rigid rod 102 would have the appropriate curvature and the ceramic dielectric of the coaxial structure comprising microwave-radiator assembly 104 could be made from powdered ceramic, rather than solid ceramic.
Patent Application
20070185554
