1. Technical Field
The present invention relates to systems and methods for performing a medical procedure, wherein the medical procedure includes transferring energy from an energy source to a patient via a transmission line and, more particularly, dynamically matching energy source impedance to tissue impedance.
2. Background of Related Art
Historically, surgery was performed using only mechanical tools, such as mechanical cutting instruments, scalpels, bladed forceps, saws, rongeurs, and the like. However, in recent years, technology has improved such that surgeons now frequently use electromagnetic waves to render a wider variety of surgical effects, e.g., by selectively modifying tissue using electromagnetic energy to produce a specific effect. The characteristics of the electromagnetic energy applied to tissue strongly correlates to the effect that the energy has on the tissue. These characteristics are therefore changed in accordance with the desired tissue effect. Two types of electromagnetic energy that are commonly applied during surgery include radiofrequency (RF) electrosurgical energy and microwave electrosurgical energy. During most medical procedures in which an energy source is employed, the energy generated for the medical procedure is transferred to a patient via a transmission line. One example of a medical procedure employing an energy source is an RF or microwave ablation surgical procedure. In an ablation surgical procedure the energy generated may be an RF or microwave surgical signal having a frequency and a wavelength associated therewith.
During the ablation surgical procedure, the surgical signal may be transmitted to the patient via a transmission line. Generally, the transmission line employed may have losses associated therewith that may be attributable to many factors. Factors that can cause transmission line losses include at least the following: the type of material used for the transmission line, the length of the transmission line, the thickness of the transmission line, and impedance mismatch between the transmission line and tissue load.
Generally, electrosurgery utilizes an electrosurgical generator, an active electrode and a return electrode. The electrosurgical generator generates electrosurgical energy typically above 100 kilohertz to avoid muscle and/or nerve stimulation between the active and return electrodes when applied to tissue. During electrosurgery, current generated by the electrosurgical generator is conducted through the patient's tissue disposed between the two electrodes. The electrosurgical energy is returned to the electrosurgical source via a return electrode pad positioned under a patient (i.e., a monopolar system configuration) or a smaller return electrode positionable in bodily contact with or immediately adjacent to the surgical site (i.e., a bipolar system configuration). The current causes the tissue to heat up as the electromagnetic wave overcomes the tissue's impedance. Although many other variables affect the total heating of the tissue, usually more current density directly correlates to increased heating.
Microwave surgical procedures invoke the application of microwave energy to tissue. Unlike low frequency RF therapy that heats tissue with current, microwave therapy heats tissue within the electromagnetic field delivered by an energy delivery device (e.g., a microwave antenna). Microwave surgical procedures typically utilize a microwave generator and an energy delivery device that delivers the microwave energy to the target tissue. One type of energy delivery device is a coaxial microwave antenna that forms an approximate dipole antenna. Microwave surgical systems involve applying microwave radiation to heat, ablate and/or coagulate tissue. For example, treatment of certain diseases requires destruction of malignant tissue growths (e.g., tumors) or surrounding tissue. It is known that tumor cells denature at elevated temperatures that are slightly lower than temperatures injurious to surrounding healthy cells. Therefore, by applying microwave energy to heat tumor cells to temperatures above 41° C. kills the tumor cells while adjacent healthy cells are maintained at lower temperatures avoiding irreversible cell damage. Another method used to treat diseased tissue is to resect a portion of the diseased organ, tissue or anatomical structure. For example, a liver may contain diseased tissue and healthy tissue. One treatment option is to pre-coagulate and ablate some of the liver tissue to facilitate resection of a portion of the liver including the diseased tissue. Microwave energy can be used during these types of procedures to pre-coagulate tissue prior to resection, to reduce bleeding during resection and to facilitate the actual resection of the tissue.
The microwave energy may be applied via an antenna that can penetrate tissue. There are several types of microwave antennas, such as monopole and dipole antennas. In monopole and dipole antennas, most of the microwave energy radiates perpendicularly away from the axis of the conductor. A monopole antenna includes a single, elongated conductor that transmits the microwave energy. A typical dipole antenna has two elongated conductors parallel to each other and positioned end-to-end relative to one another with an insulator placed therebetween. Each of the conductors is typically about ¼ of the length of the wavelength of the microwave energy making the aggregate length of both conductors about ½ of the wavelength of the microwave energy. Additionally, a microwave antenna may be adapted for use in a specific manner, for example, for endoscopic or laparoscopic (minimally invasive) procedures, for open procedures, and for percutaneous procedures.
It is known in the art that in order to maximize the amount of energy transferred from the source (microwave or RF generator) to the load (surgical implement or tissue), the line and load impedances should match. If the line and load impedances do not match (i.e. impedance mismatch) a reflected wave may be created. The ratio of the forward (primary) wave amplitude to the reflected wave amplitude is expressed as a reflection coefficient Γ. Standing waves within the transmission line may result from constructive and destructive interference between forward and reflected waves. The ratio between the wave maxima resulting from constructive interference and minima resulting from destructive interference is referred to as the voltage standing wave ratio, or VSWR. As an example, an unbalanced transmission line may exhibit an undesirably large VSWR up to around 4:1.
Standing waves created within the transmission line can contribute to the power loss associated with impedance mismatch, cause inaccurate energy dose (i.e., power) measurements, and impair monitoring of parameters associated with the surgical procedure. Moreover, standing waves may cause localized heating and failure of an interconnect (i.e., cable or coaxial cable), and cause premature wear and/or failure of the microwave or RF generator.
Further, during a typical ablation surgical procedure, the impedance at the surgical site changes over the course of the ablation procedure. This is because of tissue necrosis associated with the ablation surgical procedure. Generally, the energy source may include an impedance matching circuit and/or tuner, which may be configured to compensate for impedance changes at the surgical site.
Conventional impedance matching circuits may include devices such as motor-driven variable reactive elements, i.e., vacuum variable capacitors, and as a result may be large in size. In addition, because the energy source may have a much smaller wavelength than the length of the transmission line, it is often difficult to achieve accurate impedance matching in a rugged, reliable, and relatively compact design.
A system and method for impedance matching during an electrosurgical medical procedure is disclosed. The disclosed system may employ an energy source, such as an electrosurgical generator, wherein the energy source may be connected to an energy delivering device via a transmission line. In one embodiment, the transmission line may be a coaxial cable. The disclosed system includes a dynamic impedance matching network having the capability to dynamically adjust to the varying load conditions. In embodiments, the dynamic impedance matching network is adapted to automatically adjust, or “self-tune”, the energy delivery system to maintain a VSWR of less than about 1.5:1. It is envisioned that disclosed dynamic impedance matching network may have a relatively compact size, for example, occupying a printed circuit board (PCB) of less than about 30 cm2. It is to be understood, however, that in embodiments, the disclosed dynamic impedance matching network may occupy a space less than, or greater than, about 30 cm2. In embodiments, the PCB may be formed from any suitable material, for example without limitation, aluminum oxide (Al2O3). In embodiments, the electrosurgical generator is configured to generate an electrosurgical signal at a frequency in a range of about 915 mHz to about 925 mHz.
In one aspect of the present disclosure, a dynamic impedance matching network includes switchable reactive elements arranged in a pi configuration having a first shunt reactive leg, a series reactive leg, and a second shunt reactive leg. In embodiments the first shunt reactive leg includes a reactive element having a fixed value. The series reactive leg and the second shunt reactive leg each include a plurality of reactive elements arranged in a switchable configuration, such that the individual reactive elements contained therein may be selectively activated, separately or in combination, to achieve a desired (i.e., selectively variable) leg reactance. In embodiments, the reactive elements may include discrete components, such as without limitation surface mount capacitors (i.e., “chip caps”), inductive coils, tuned stubs formed on the PCB, capacitors formed on the PCB, and/or inductors formed on the PCB. In embodiments, a PCB capacitor may be formed by at least two adjacently disposed PCB traces (i.e., foil traces). A PCB capacitor constructed in this manner may be formed from traces disposed on the same side of the PCB or on traces formed on opposite side of the PCB. In embodiments, a PCB capacitor may have a dielectric portion that includes air and/or the PCB substrate.
An electrosurgical ablation system may be characterized by a range of antenna-to-tissue impedance values (i.e., impedance mismatches). The values of reactive elements in a dynamic impedance matching network of the present disclosure are selected accordingly to facilitate impedance matching over the range of mismatched values. Advantageously, the inventors have discovered that the identified range of mismatched antenna-to-tissue impedances can be corrected, i.e., effectively impedance matched, by the selective activation of four discrete values of series leg reactance and two discrete values of second shunt leg reactance. By this arrangement, sixty-four overlapping reactance ranges are available to dynamically impedance match the antenna to tissue. That is, the sixty-four overlapping ranges define an aggregate range of impedance matching ability which corresponds to the identified range of antenna-to-tissue impedance mismatch.
Each unique combination of reactive elements may be characterized by a circular region on a Smith diagram representing the reflection coefficient Γ of the unique combination combination. The position of center point of the circular region on the Smith diagram is determined by the aggregate value of the series leg reactance and represents a zero reflection coefficient Γ for the unique combination (i.e., perfect impedance matching). The diameter of the circular region represents the set of nominal reflection coefficient Γ values which fall within an acceptable tolerance of reflection coefficient Γ, that is, the circle encloses those nominal reflection coefficient Γ values which exhibit acceptable impedance matching. In embodiments, an acceptable reflection coefficient Γ is less than about 0.15, which has been determined to correspond to a power transfer efficiency (i.e., match efficiency) of greater than about 96%.
In another aspect of the present disclosure, a PIN diode switch array is provided. The PIN diode array is configured to selectively activate at least one of the reactive elements. The PIN diode array is further configured dynamically activate/deactivate reactive elements (“hot switch”) during application of electrosurgical energy. The PIN diode switch array may additionally or alternatively include field-effect transistor (FET) switching elements and/or microelectromechanical (MEMS) switching elements.
In yet another aspect, an electrosurgical system in accordance with the present disclosure includes a controller. The controller may be configured to receive any of a user input, an input related to impedance, a phase input, and/or a temperature input. The controller may further be configured to output any of a generator control signal, a PIN diode switch array control signal, and/or a user interface signal (i.e., a visual, audible, or haptic indicator). In embodiments, the controller includes a processor. For example without limitation, the controller may include a Cypress programmable system on a chip (PSOC), a PIC processor, a gate array or any suitable processor or chipset now or in the future known. The controller may be configured to execute a set of programmable instructions embodying a method of dynamically matching impedance as disclosed herein.
In still another aspect, an electrosurgical system in accordance with the present disclosure includes an RF measurement module configured to sense impedance and phase angle (i.e., phase shift) within the electrosurgical circuit. The RF Measurement module may include an Analog Device RFZ chip set configured to measure impedance and phase. The RF measurement module may be operatively coupled to at least one of the electrosurgical generator, the dynamic impedance matching network, and/or the electrosurgical antenna or electrode. The RF measurement module may also be configured to be in communication with the controller module and/or to provide impedance signals to the controller.
Also disclosed is a method of performing an electrosurgical procedure that includes the steps of providing an electrosurgical system that includes an electrosurgical instrument operatively coupled by a transmission line to an electrosurgical generator, a controller, an impedance sensor, a dynamic impedance matching network having includes a switchable reactive elements arranged in a pi configuration that includes a first shunt reactive leg, a series reactive leg, and a second shunt reactive leg, and a PINS diode array configured to selectively activate the reactive elements; applying the electrosurgical instrument to tissue; measuring the impedance of tissue; applying electrosurgical energy to tissue; and selectively activating at least one reactive element to match transmission line impedance to tissue impedance.
The above and other aspects, features, and advantages of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings wherein:
Particular embodiments of the present disclosure will be described hereinbelow with reference to the accompanying drawings. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. Those skilled in the art will understand that the present disclosure may be adapted for use with either an endoscopic instrument, laparoscopic instrument, or an open instrument. It should also be appreciated that different electrical and mechanical connections and other considerations may apply to each particular type of instrument, however, the novel aspects with respect to electrosurgical impedance matching are generally consistent with respect to both the open or endoscopic designs.
In the drawings and in the description which follows, the term “proximal” refers to the end of the instrument which is closer to the user (i.e., further from the patient), while the term “distal” refers to the end of the forceps which is further from the user (i.e., closer to the patient).
With reference to
Turning to
A block diagram of an impedance-matching electrosurgical system 100 in accordance with the present disclosure will now be described with reference to
Impedance-matching electrosurgical system 100 includes a controller 130 that is in operable communication with RF measurement module 120, RF generator 110, PIN diode switching array 160, and user interface module 140. Impedance-matching electrosurgical system 100 may be embodied in any of hardware, software, software in execution, firmware, microcode, bytecode, in virtualization, in a hardware description language, logic gates, circuitry, digital circuitry, RAM, ROM, MEMS, and the like. User interface 140 receives user input and provides the user input to controller 130. Controller 130 interprets the user input and controls operation of electrosurgical generation 110 in accordance therewith.
More particularly, controller 130 is configured to control RF generator 110 and PIN diode switching array 160. In particular, RF generator 110 generates sinusoidal waveforms of electrosurgical energy. RF generator 110 can generate a plurality of waveforms having various duty cycles, peak voltages, crest factors and other suitable parameters. Certain types of waveforms are suitable for specific electrosurgical modes. For instance, RF generator 110 generates a 100% duty cycle sinusoidal waveform in cut mode, which is best suited for ablating, fusing and dissecting tissue, and a 1-25% duty cycle waveform in coagulation mode, which is best used for cauterizing tissue to stop bleeding.
Controller 130 may include a microprocessor (not explicitly shown) operably connected to a memory (not explicitly shown) which may be volatile type memory (e.g., RAM) and/or non-volatile type memory (e.g., flash media, disk media, etc.). Controller 130 includes an output port that is operably connected to RF generator 110 that allows controller 130 to control the output of RF generator 110 according to either open and/or closed control loop schemes, and/or user input. Controller 130 may include any suitable logic processor (e.g., control circuit), hardware, software, firmware, or any other logic control adapted to perform the features discussed herein.
Impedance-matching electrosurgical system 100 includes an RF measurement module 120, and also includes an interface to at least one sensor (not explicitly shown) that is configured to measure a variety of tissue and energy properties (e.g., tissue impedance, output current and/or voltage, etc.) and to provide feedback to controller 130 in accordance with the measured properties.
RF measurement module 120 is operative communication with controller 130. The communication may be continuous or intermittent. The data may be communicated in analog form, digital form, using a pulse width modulated signal, using a frequency or analog modulated signal, or any other communication technology. Controller 130 is programmed to at least process data to control the generation and impedance matching of the electrosurgical energy.
Electrosurgical instrument 15 has one or more active electrodes 16 for treating tissue T of patient P. As described herein, electrosurgical instrument 15 may be any type of electrosurgical instrument (e.g., monopolar or bipolar) and may include active electrodes designed for a wide variety of electrosurgical procedures (e.g., electrosurgical cutting, ablation, etc.). Electrosurgical energy is supplied to electrosurgical instrument 15 by impedance-matching electrosurgical system 100 via transmission line 12, which is connected to an active output terminal, allowing electrosurgical instrument 15 to coagulate, ablate, and/or otherwise treat tissue endogenically. When impedance-matching electrosurgical system 100 is operated in a bipolar mode, the electrosurgical energy is returned to impedance-matching electrosurgical system 100 through a return pad 22 via cable 13 after passing through patient P.
The user interface 140 may include input controls, such as without limitation, buttons, activators, switches, touch screen, and the like (not explicitly shown) for controlling impedance-matching electrosurgical system 100. Input controls may be include a handswitch disposed on the instrument 15, a footswitch (not explicitly shown), or a control provided on the impedance-matching electrosurgical generator 10 (i.e., a “front-panel” control). Additionally or alternatively, user interface 140 may include one or more visual indicators and/or display screens (not explicitly shown) for providing the user with variety of output information (e.g., intensity settings, treatment complete indicators, etc.). The user interface 140 allows the user (e.g., a surgeon, nurse, or technician) to adjust the electrosurgical energy parameters (e.g., power, waveform, duty cycle, voltage, current, frequency, and/or other parameters) to achieve the desired electrosurgical energy characteristics suitable for a particular task (e.g., coagulating, tissue sealing, intensity setting, etc.). Additionally or alternatively, user interface 140 may include a settable desired tissue effect (e.g., hemostasis, coagulation, ablation, dissection, cutting, and/or to sealing tissue). The electrosurgical instrument 15 may also include one or more input controls (not explicitly shown) that may be redundant with user interface 140 of electrosurgical generator 10.
Impedance-matching electrosurgical system 100 includes an impedance matching module 200 that includes a dynamic impedance matching network 150 and a PIN diode switching array 160. As shown in
In embodiments, fixed reactive shunt section 201 may include a fixed reactive element 230, which may be a capacitor, an inductor, or a combination thereof. Variable reactive series section 202 includes a plurality of reactive legs 231, 232, 233, 234 coupled in parallel, each reactive leg 231, 232, 233, 234 having a PIN diode coupled in series with a reactive element, i.e., PIN diodes 244, 245, 246, 247 are coupled in series with reactive elements 240, 241, 242, and 243, respectively. The common junction 235, 236, 237, 237 of each PIN diode 244, 245, 246, and reactive element 240, 241, 242, and 243 are operably coupled to PIN diode control module 220. PIN diode control module is configured to selectively bias any of PIN diodes 244, 245, 246, 247 in accordance with a control signal received at control input 212.
Variable reactive shunt section 203 includes a plurality of reactive legs 261, 262 coupled in parallel, each reactive leg 261, 262 having a PIN diode coupled in series with a reactive element, i.e., PIN diodes 252, 253 are coupled in series with reactive elements 250, 251, respectively. A common junction 263, 264 of each PIN diode 252, 253 and reactive element 250, 251 are operably coupled to PIN diode control module 220 that is configured to selectively bias any of PIN diodes 252, 253 in accordance with a control signal received at control input 212.
Under forward bias, a PIN diode (i.e., PIN diodes 244, 245, 246, 247, 252, 253) acts as a low resistance (short circuit) path that causes the corresponding reactive element 235, 236, 237, 237, 250, 251 to be switched in-circuit (i.e. activated). Conversely, under reverse bias, a PIN diode (i.e., PIN diodes 244, 245, 246, 247, 252, 253) acts as a high impedance (open circuit) path that causes the corresponding reactive element 235, 236, 237, 237, 250, 251 to be switched out of the circuit (i.e. deactivated).
DC bias source 221 provides bias current to PIN diode control module 220 that is configured to selectively apply bias to a PIN diode (i.e., PIN diodes 244, 245, 246, 247, 252, 253) as previously described. DC bias source 221 is isolated from the RF signal path by isolation inductors 222, 223. Isolation capacitors 205, 206 also provide DC isolation as previously described herein. PIN diode control module may include an integrated circuit, such as an Impellimax Decoded Five Channel −100V PIN Diode Driver or a Supertex HV3922 PIN Diode Driver −220V.
In embodiments, the values of the reactance elements 235, 236, 237, 237, 250, 251 are selected in accordance with binary encoding. For example without limitation, an embodiment in accordance with the present disclosure may include reactive legs 231, 232, 233, 234 having an impedance (Z) corresponding to 5Ω, 10Ω, 20Ω, and 40Ω, respectively. In this manner, the reactive series section 202 is configured to provide sixteen discrete values of reactance, i.e., from zero to 75Ω in 5Ω increments. Variable reactive shunt section 203 includes reactive legs 261, 262 that are configured to provide four discrete values. For example without limitation, reactive legs 261, 262 may have an impedance (Z) corresponding to 375Ω and 750Ω, respectively. In embodiments, controller 130 includes a look-up table for determining which reactive elements to activate to achieve the required impedance correction.
The inventors have discovered relationships between reflection coefficient and impedance load which is best illustrated with reference to the Smith diagram 400 of
With reference now to
In an aspect of the present disclosure, a method of matching impedance includes the steps of measuring the impedance, identifying a corrective region in which the measured impedance falls, determining a combination of reactive elements corresponding to the identified corrective region, and activating the combination of reactive elements to match the measured impedance.
While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
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Number | Date | Country | |
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20130023870 A1 | Jan 2013 | US |