Probe with distally orientated concave curve for arthroscopic surgery

Abstract
An arthroscopic probe with a distally orientated concave curve which constrains tissue is disclosed. It is particularly adapted to cutting ligaments and tendons. Also disclosed is a thermal energy delivery apparatus that includes (a) a probe with a distal end and a proximal end, (b) a first electrode positioned at the distal end of the probe and (c) a cabling coupled to the proximal end of the probe.
Description




BACKGROUND OF THE INVENTION




1. Field of Use




The present invention is in the field of medical devices which deliver radio-frequency energy to cut tissue. More specifically, the invention is in the field of cutting probes for arthroscopic surgery.




2. Background




Arthroscopic surgery is becoming increasingly popular, because it generally does less damage than open procedures, produces less scarring in and around joints, and results in faster healing and return of the patient to full productivity.




Nevertheless, arthroscopic surgery has its limitations. The surgeon must operate through a narrow tube, which is awkward. Only one probe can be used at a time. Often the viewing camera is positioned at an angle different from the surgeon's normal gaze. This contrasts with “open surgery” where the surgeon has relative ease of viewing the surgical site and can freely move both hands, even utilizing the hands of colleagues.




In view of such difficulties of arthroscopic surgery, it is understandable that laser, microwave and radio-frequency (RF) probes which simultaneously cut and coagulate are preferred. However, current probes are poorly adapted to certain activities, such as cutting narrow tendons or ligaments. Current probes have convex, pointed and/or flat tips. U.S. Pat. No. 5,308,311, issued May 3, 1994 to Eggers and Shaw, is exemplary in that it discloses a laser probe with a pointed tip and convex, side. With current probes, the surgeon has little control when pressing against a tough ligament. Now as the surgeon cuts through one portion of the ligament, the probe slips out of position. The surgeon must reapproximate the probe and cut again, an inefficient process. And, unless the surgeon is able to stop pressure at exactly the right time, the probe may slip and cut an adjacent structure. Because the surgeon must repeatedly reapproximate and cut the ligament, the surgeon has difficulty in cleanly ablating the ligament or tendon. Thus, there are certain procedures that surgeons still prefer to perform in the “open.” Unfortunately, this often results in bigger scars, longer convalescence, and more irritation of an already irritated joint.




What is needed is a probe that can simultaneously direct the tendon to the energy source (e.g., RF) and apply RF to cleanly and smoothly ablate the tendon or ligament. The advantage is that some procedures that have been considered too awkward or difficult to perform by arthroscopy can now be performed more effectively by arthroscopy.




SUMMARY OF THE INVENTION




A thermal energy delivery apparatus is disclosed which has a probe means including a distal end and a proximal end, wherein the distal end has a concave tip. A first electrode means is also positioned at the distal end of the probe means, so that the first electrode means is configured to deliver sufficient thermal energy to cut ligaments or tendons. The thermal energy delivery apparatus also includes a cabling means coupled to the proximal end of the probe means. The cabling means can be either permanently or impermanently coupled to the probe means.




In another embodiment, there is an RF probe comprising a distal tip, wherein the distal tip has a concave curve and an electrode, whereby the concave curve on the distal tip helps constrain tissue for cutting. In another embodiment, the RF probe has a concave curve with a sharp edge. In yet another embodiment, the RF probe has a concave curve separated from the lateral edges of the RF probe.




Another embodiment of this invention is a method of cutting a ligament or tendon by (a) providing an RF probe with a distal tip with a concave curve; (b) approximating the RF probe to the ligament or tendon to be cut; and (c) applying RF energy through the curve, thereby cutting the ligament, tendon, or other tissue.




In another embodiment of the invention a controller for controlling the delivery of energy and liquid to a surgical instrument with a temperature sensor is disclosed. The energy is supplied by an energy source and the liquid is supplied by a pump. The controller includes a temperature and a flow regulator. The temperature regulator is coupled to the energy source and coupled to the pump. The temperature regulator is responsive to a first temperature indication from the temperature sensor to determine that the first temperature indication exceeds a setpoint and to reduce an energy level from the energy source. The flow regulator is coupled to the pump and coupled to the temperature regulator. The flow regulator includes responsiveness to the first temperature indication to increase a flow of the liquid from the pump.











BRIEF DESCRIPTION OF THE DRAWINGS





FIG. 1

is a lateral view of the internal structures of the glenohumeral joint.





FIG. 2

is a medial side view of the knee joint.





FIG. 3

is a perspective view of the concave cutting tip of the RF probe.





FIGS. 4-11

show different monopolar and bipolar arrangements of the electrodes on the concave cutting tip.





FIG. 12

shows an overview of an RF probe.





FIG. 13

is a block diagram illustrating a feedback system useful to control the temperature of electrodes of the present invention.





FIG. 14

illustrates a circuit useful to implement the feedback system of FIG.


13


.





FIG. 15

illustrates an alternate embodiment of a probe with cutting tip.











DESCRIPTION OF SPECIFIC EMBODIMENTS




The present invention arose out of an observation that, during an arthroscopy procedure, the surgeon could not access and cut cleanly the coracoacromial (CA) ligament shown in FIG.


1


. This procedure is done in conjunction with a subacromial decompression, which makes a painful shoulder easier to move. If the cutting probe slips, the joint capsule could be damaged and even punctured, which would exacerbate an already painful joint. Thus, a concave rounded tip was designed which would center and position ligaments and could even be used to lift the ligament away from adjacent structures and avoid harm thereto.




This new style of tip has the advantage of being able to mechanically “gather” or constrain ligaments, tendons and other tissue into its center. This reduces the natural tendency of current cutting probes to slide off ligaments and tendons. This helps save time in that the surgeon is not repeatedly trying to center or approximate the probe tip on the target tissue.





FIG. 1

shows a lateral (side) view of a glenhumeral joint


100


and in particular the Coracoacromial ligament


102


, the Superior glenohumeral ligament


104


, the middle glenohumeral ligament


106


, the Subscapularis Tendon


108


(joined to capsule), the Inferior Glenoheumeral ligament


110


, the Glenoid “cup” with cartilage


112


, the Joint Capsule


114


, and the Bursa


116


. The Joint Capsule


114


is comprised of 3GH ligaments and surrounding capsule. The Bursa


116


lubricates and acts like a shock absorber, and is usually removed when an SA decompression is performed. The area


118


is the area at which impingement usually occurs.





FIG. 2

shows a medial (side) view of a glenohumeral joint


200


, and in particular the Medial Collateral Ligament


202


, the patella


204


, the Medial Lateral Retinaculum


206


, an incision line


208


for lateral release and the Patellar Ligament


210


.




While CA surgery was the inspiration for this invention, use of this concave probe is not limited to a particular ligament or tendon, or even to those tissues. The concave cutting probe is adapted to cut all types of tendons and ligaments more effectively than blunt or rounded tip probes. As another example whose anatomy is shown in

FIG. 2

, the lateral retinaculum sometimes must be severed in some types of patellar dislocation or malignment, when the patella is not properly tracking in the trochlear notch. Severing the lateral retinaculum is called lateral retinacular release. With this concave-tip probe, the surgeon is able to position the ligament and sever it cleanly.




Turning now to the probe itself,

FIG. 3

shows a concave edge


308


on a distal tip


304


of an RF probe head


300


. This concave edge is designed to constrain tissue, tendons and ligaments. The concave curve has lateral edges


306


which are rounded, so that the probe does not “snag” on unwanted tissue as the surgeon maneuvers the probe into position. The cylindrical portion


302


of the distal tip


304


fits inside probe sheath


410


, as shown in FIG.


4


. The distal tip may have a variety of configurations, as shown in

FIGS. 3-10

.

FIG. 4

shows probe


400


having a concave edge with less prominently rounded lateral edges.

FIGS. 4-6

show a distal tip which is angled with respect to the sheath


410


. This embodiment offers the advantage of helping the surgeon get around comers.





FIG. 5A

shows an angled probe


500


consisting of a cylindrical portion


502


with a distal tip


504


having a concave edge


508


and lateral edges


506


.

FIG. 5B

shows a side view of angled probe


500


.





FIG. 6

shows an angled probe


600


with a specialized surface (not heated) which imparts a third function to the probe, namely scraping tissue. Probe


600


is comprised of a cylindrical portion


602


, and a distal tip


604


which has a concave edge


608


and lateral edges


606


. The surface of the flat portion of distal tip


604


contains rasps


616


which can be used for scraping tissue.




For cutting tissue, the distal tip has a first electrode and a second electrode located on lateral edges


606


. The first and second electrodes can be operated in bipolar or monopolar mode. Bipolar is preferred and examples of “Taser” type electrodes are shown in

FIGS. 7 and 8

.





FIG. 7

shows a distal tip


700


having a three-pole, bipolar arrangement where, in addition to two side positive electrodes


702


and


706


, there is a central negative electrode


704


.

FIG. 8

shows a distal tip


800


wherein two electrodes


802


and


806


are positioned in two small sites on the lateral edges of the concave curve. In this particular embodiment, electrode


802


is positive and electrode


806


is negative





FIGS. 9-11

show exemplary monopolar arrangements. In

FIG. 9

, a single monopolar positive electrode


902


occupies a wide portion of the concave curve of distal tip


900


. A return path


904


is provided and is attached to the patient's body to complete the circuit. In

FIG. 10

, there is one small active electrode


1006


located centrally on distal tip


1000


. In

FIG. 11

there are two active electrodes


1102


and


1106


in lateral positions on distal tip


1100


. Suffice it to say that quite a variation in electrode design is contemplated for this concave curve.




To maintain the appropriate temperature for cutting tissue, the distal tip of the probe may also be equipped with a thermocouple, but such a thermocouple is optional in the concave-tipped probe.





FIG. 12

illustrates the RF probe of a larger RF apparatus shown schematically in

FIG. 13

, which is a block diagram of a temperature/impedance feedback system useful with apparatus


1200


.





FIG. 12A

is an illustration of a cannula utilized in one embodiment of the invention. Cannula


1202


consists of a guide


1224


with an opening


1226


at its distal end. Cannula


1202


is attached at its proximal end to introducer


1222


. As illustrated in

FIG. 12B

, surgical instrument


1200


consists of a handle


1212


to which is attached a power cord


1210


, a probe


1214


and a probe tip


1216


. Cannula


1202


is inserted into the surgical site on the patient. Surgical instrument


1200


is then inserted into cannula


1202


so that the tip


1216


protrudes from the opening


1226


in cannula


1202


.





FIG. 13

is an electrical block diagram of an embodiment of the current invention in which both RF power and saline solution are applied to a surgical site, under unified control of controller


1300


. The RF power is applied to the site for cutting, cauterizing, ablating and sculpting of tissue. The saline solution is applied to the site for irrigation and in order to create a cavity in the area in which surgery is to be performed. In this embodiment it is advantageous to regulate RF delivery through both temperature and impedance monitoring. It is advantageous to monitor saline solution flow to maintain clarity at the site. There is also the opportunity for synergy between RF and saline delivery to the surgical site to provide, for example, a greater level of control of temperatures at the site.




The controller


1300


shown in

FIG. 13

includes RF generator


1310


, temperature profile


1320


, temperature regulator


1322


, temperature monitor


1324


, surgical instrument


1326


, impedance monitor


1328


, impedance regulator


1330


, pump


1340


, flow regulator


1350


and flow monitor


1352


.




The RF generator is capable of delivering monopolar or bipolar power to surgical instrument


1326


. The surgical instrument contains a probe and tip which are positioned at the surgical site


1342


. The impedance monitor


1328


obtains impedance measurements by, for example, measuring current and voltage and performing a RMS calculation. The measurements of the impedance monitor are delivered to impedance regulator


1330


. The impedance regulator performs several functions. Generally the impedance regulator keeps the impedance levels within acceptable limits by controlling the power supplied by the RF generator


1310


. In an embodiment of the current invention the impedance regulator can control the flow regulator


1350


to deliver more or less saline solution to the surgical site.




The temperature monitor


1324


can include one or more types of temperature sensors, e.g. thermocouples, thermistors, resistive temperature device (RTD), infrared detectors, etc. . The temperature sensor is positioned at the tip of the surgical instrument to provide temperature monitoring of the tip. The output of the temperature monitor is delivered to the temperature regulator


1322


. The temperature regulator


1322


also accepts input from a temperature profile table


1320


. The temperature profiles contained in this table may include time and temperature points which need to be achieved during surgery. The temperature regulator may control both the RF generator


1310


and the flow regulator


1350


. When, for example, temperatures have increased beyond an acceptable limit, power supplied by the RF generator to the surgical instrument may be reduced. Alternately, the temperature regulator may cause the flow regulator


1350


to increase saline solution flow, thereby decreasing temperature at the surgical site. Conversely, the temperature regulator can interface with either the RF generator or the flow regulator when measured temperatures do not match the required temperatures called for in the temperature profile


1320


. When this condition occurs, the temperature regulator can cause the RF generator to increase power supply to the surgical instrument. Alternately, the temperature regulator can cause the flow regulator to decrease saline solution flow to the surgical site, thereby allowing a fixed amount of RF energy to cause an increase in temperature at the surgical site. In another embodiment of the invention a flow monitor


1352


can be positioned at the surgical site. The flow monitor can monitor the volume of saline solution flow, the actual dimension of the cavity, the pressure created by the saline solution within the cavity or the optical clarity of the saline solution within the cavity. Any one of these and other monitored parameters can be utilized independently to regulate the flow of saline solution to the site by providing these measurements to the flow regulator. The flow regulator may be programmed to accommodate regulatory signals from both the temperature and impedance regulators, as well as from the flow monitor and can be programmed to perform in whatever manner is desired by the user. The flow regulator interfaces with the pump


1340


to control the volume of saline solution delivered to the surgical site


1342


.




An exemplary interaction of these various components is shown by way of the following example. Initially the temperature regulator and/or impedance regulator and the flow regulator deliver pre-programmed amounts of power and saline solution to the surgical site


1342


. Each system operates independently. The flow regulator, for example, operates the pump to maintain saline solution flow within the desired parameters, i.e. clarity, pressure, flow rate, etc. The temperature regulator delivers pre-programmed time-based temperature profile to the surgical instrument


1326


from the RF generator


1310


. When impedance levels fall below a lower threshold indicating that the instrument has been removed from the site, the RF generator is caused to terminate power supply to the surgical instrument. Alternately, when impedance levels exceed an upper threshold indicating that tissue is accumulating on the tip of the surgical instrument, thereby increasing resistance to current flow, pulses of RF power are delivered to the surgical instrument to cause the tissue to ablate from the tip, thereby decreasing the impedance of the tip. Alternately, the impedance regulator can at the upper threshold of impedance signal the surgeon audibly, visibly or in any other manner that the instrument itself needs to be cleaned before proceeding further with the surgery. If during the operation the flow regulator receives from either the temperature or impedance regulator a signal indicating that temperatures and/or impedance are exceeding acceptable levels, then flow can be increased to reduce temperature and/or clean the tip. Alternately, if the flow regulator receives signals indicating that temperature and/or impedance are too low, then the flow regulator can reduce saline solution flow to allow greater heating at the surgical site


1342


. When the control signals from the temperature regulator


1322


and/or the impedance regulator


1330


cease, the flow regulator


1350


returns to normal operation.





FIG. 14

shows an alternate embodiment of the invention to that discussed above in connection with FIG.


13


. In this embodiment fluid flow and RF generation are regulated either by temperature regulator or impedance. There is no independent flow monitor such as the one shown and discussed above in connection with the embodiment in FIG.


13


. RF generator


1434


is coupled to first and second electrodes


1422


and


1424


to apply a biologically safe voltage to surgical site


1480


. In the embodiment shown in

FIG. 14

the surgical instrument


1410


is represented as a bipolar ablation device. The circuitry shown herein is equally applicable to monopolar surgical instruments as well. First and second electrodes


1422


and


1424


of the bipolar device are connected to a primary side of transformer windings


1458


A and


1460


A. The common primary windings


1458


A and


1460


A are magnetically coupled with a transformer core to secondary windings


1458


B and


1460


B. The transformer windings


1458


A-B are part of transformer t


1


. The transformer windings


1460


A-B are part of transformer t


2


. The primary windings of the first transformer t


1


couple the output voltage of surgical instrument


1410


to the secondary windings


1458


B. The primary windings


1460


A of the second transformer t


2


couple the output current of surgical instrument


1410


to the secondary windings


1460


B. Measuring circuits connected to the secondary windings


1458


B and


1460


B determine the root mean square (RMS) values or magnitudes of the current end voltage. These values, represented as voltages, are inputted to dividing circuit


1408


to mathematically calculate, by dividing the RMS voltage value by the RMS current value the impedance of the surgical site


1480


.




The output voltage


1462


of the divider circuit


1408


is coupled to a pole of single pole double throw (SPDT) switch


1470


. The other pole


1464


of the switch is connected to the output of thermal coupler amplifier


1424


. The inputs of thermal couple amplifier


1424


are connected to the temperature sensor


1446


which measures temperatures at the surgical site


1480


. Switch


1470


serves therefore to couple either the impedance circuitry or the temperature monitoring circuitry to the positive (+) input of comparator


1412


. Voltage reference


1414


supplies a voltage across a variable resistor Rv, thus allowing one to manually adjust the voltage presented to the negative input of comparator


1412


. This voltage represents a maximum impedance value beyond which power will not be applied to electrode


1422


. In an embodiment in which the switch


1470


is connected to the divider circuit


1408


, impedance values greater than the maximum cutoff impedance determined by resistor


1414


result in comparator


1412


reducing the power supplied by RF generator


1434


to the surgical site. Alternately, the comparator can deliver a signal to pump


1422


causing it to increase the fluid flow from coolant source


1420


through nozzle


1426


positioned at the surgical site


1480


. This will reduce temperatures at the site. Alternately, when switch


1470


connects pole


1464


to the positive input of comparator


1412


temperature rather than impedance can be utilized to control either the RF generator


1434


or the pump


1422


. Comparator


1412


can be of any commercially available type that is able to control the amplitude and pulse width modulation of RF generator


1434


. The temperature as discussed above within the surgical site


1480


can be controlled based on tissue impedance when switch


1470


connects pole


1462


to the comparator


1412


. Alternately, control can be based on tissue temperature as represented when the switch


1470


connects pole


1464


to the comparator


1412


. In an embodiment switch


1470


is activated to allow impedance node


1462


to enter the positive (+) input terminal of comparator


1412


. This signal along with the reference voltage applied to the negative (−) input terminal actuates comparator


1412


to produce an output signal. If the selected tissue ablation site is heated to a biologically damaging temperature, the tissue impedance will exceed a selected impedance value seen at the negative (−) input terminal, thereby reducing power to the RF generator


1434


and/or increasing flow from pump


1422


. The output signal of comparator


1412


may be utilized to sound an alarm or give a visual indication of an over temperature condition or, as discussed above, to reduce power and/or disable the RF generator.




Energy source


1434


is shown as providing RF energy, but is not limited to RF and can include microwave, ultrasonic, coherent and incoherent light thermal transfer and resistance heating.





FIGS. 15A-B

show an enlarged view of one embodiment of the tip


1510


of an electrosurgical instrument wherein two opposing arcuate segments


1504


A and


1504


B are compressed to form a probe tip


1216


A at the distal end of probe


1214


A. In such an embodiment, swagging is used to compress the tip of the probe. Swagging forms a chisel


1514


that can be used in the surgical instrument of

FIGS. 12 and 13

for RF ablation of tissue. Grinding applications can be added to the tip to provide for mechanical tissue ablation in addition to energy ablation. The core


1502


of probe


1214


A can be either hollow or solid. This particular embodiment is illustrated as having an annular probe. Probe


1214


A is coated in an insulating material which terminates prior to the tip


1510


, leaving chisel


1514


exposed.




The surgical chisel illustrated in

FIGS. 15A-B

provides various improvements over the prior art in allowing for precise hemostatic cutting and ablation of soft tissue in one convenient instrument. The malleable probe tips can be configured as straight, angled or curved, for example, which provides for optimal access to specific anatomy and pathology. Unique tip designs improve tactile feedback for optimal control and access, and provide for improved tissue visualization with greatly reduced bubbling or charring.




EXAMPLES




Example 1




Lateral retinacular release as mentioned above can be accomplished with the use of the concave-tipped RF probe as shown in FIG.


3


. First, the knee joint is distended with a clear fluid, usually saline. Initial distention can be done using a large syringe full of saline which is injected into the joint space. Distention forces the bones of the joint apart creating room to introduce instrumentation without damaging the cartilage.




Once the instrumentation has been inserted into the joint space, the irrigation tubing and cannulas are positioned and hooked up to provide continual fluid exchange during the procedure. The most common systems are gravity flow or the use of an arthroscopic irrigation pump. Just hanging bags of irrigation fluid on an IV pole raises them 3-4 feet above the operative site. This elevation difference is enough to create pressure to distend and irrigate the joint. The fluid enters the joint through the scope sheath and exits through a cannula placed in the superior lateral portal, or the reverse, through the cannula and out through the scope sheath. The setup is a matter of physician preference. The key to the proper function of either system is that the inflow volume must be larger than the outflow volume. This restriction in the outflow is what creates the back flow that distends the joint.




With an arthroscopic irrigation pump, the bags do not need to be raised on an IV pole. The factors controlling distention of the joint are controlled automatically by the pump. The pump monitors the fluid pressure in the joint space using a pressure sensing cannula and automatically increases or decreases fluid flow as needed to provide optimum viewing. As with the gravity flow system, fluid enters the joint cavity through the scope sheath or the cannula in the superior lateral portal.




Such an arthroscopic procedure requires the creation of two to five portals (entry ways) into the joint capsule. To create a portal, the surgeon usually begins by making a small stab wound with a scalpel (e.g., No. 11 blade) at the site of the portal. Next, the wound is enlarged and extended with a trocar encased in a sleeve (cannula) through muscle tissue to the synovial membrane. The trocar is removed, leaving the cannula in place. Then, the surgeon uses a blunt obturator (to avoid damage to menisci and articular cartilage) to puncture through the synovium into the joint cavity. The obturator is removed and the cannula left in place. The cannula can be used to insert an arthroscope or for the inflow and outflow of water. If the surgeon elects to insert instruments percutaneously, the sleeve is removed.




For lateral retinacular release, the surgeon frequently uses three portals, one for the arthroscope, one for the instrument and one for the drain. Additional portals may be created for the surgeon to access other areas of the knee (i.e., to tighten the medial retinaculum) during the procedure. Frequently, a superolateral (above and to the side of the patella) approach is used for the irrigation cannula. For the arthroscope and concave probe, anteromedial and anterolateral approaches often are chosen, because they are relatively safe (minimal potential tissue damage) and most surgeons have more experience with them. Once the arthroscope is viewed, the surgeon may use the concave-tipped probe (without power) to advance to the site of the lateral retinaculum. Having located the lateral retinaculum, the surgeon actuates the RF probe and cuts entirely through the ligament.




The foregoing description of a preferred embodiment of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obviously, many modifications and variations will be apparent to practitioners skilled in this art. It is intended that the scope of the invention be defined by the following claims and their equivalents.




All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.



Claims
  • 1. A thermal energy delivery apparatus, comprising:a probe including a distal end and a proximal end, the distal end including a distally orientated concave curve that is located between a pair of lateral edges and configured to constrain tissue; and a first electrode positioned at the distal end of the probe, the first electrode configured to deliver sufficient thermal energy to cut ligaments or tendons.
  • 2. The thermal energy delivery apparatus of claim 1, further comprising cabling coupled to the proximal end of the probe.
  • 3. The thermal energy delivery apparatus of claim 1, wherein the concave curve has a sharp edge.
  • 4. The thermal energy delivery apparatus of claim 1, wherein the concave curve is separated from the lateral edges of the probe.
  • 5. An RF probe, comprising:a proximal end and a distal end, the distal end including a distally orientated concave curve located between a pair of lateral edges and an electrode, wherein the concave curve helps constrain tissue for cutting.
  • 6. The RF probe of claim 5, further comprising cabling coupled to the proximal end of the probe.
  • 7. The RF probe of claim 5, wherein the concave curve has a sharp edge.
  • 8. The RF probe of claim 5, wherein the concave curve is separated from the lateral edges.
Parent Case Info

This application is a continuation of Application Ser. No. 09/022,612, filed Feb. 12, 1998, now U.S. Pat. No. 6,135,999, which application claims priority to Provisional Application Serial No. 60/037,782, filed Feb. 12, 1997, which is incorporated herein by reference in its entirety.

US Referenced Citations (164)
Number Name Date Kind
164184 Kidder Aug 1875 A
300155 Starr Jun 1884 A
371664 Brannan et al. Oct 1887 A
452220 Gunning May 1891 A
1314855 Carpenter Sep 1919 A
1366756 Wappler Jan 1921 A
1731627 Johnson et al. Oct 1929 A
1735271 Groff Dec 1929 A
1814791 Ende Jul 1931 A
1908583 Wappler May 1933 A
1916722 Ende Jul 1933 A
1932258 Wappler Oct 1933 A
1943543 McFadden Jan 1934 A
1983669 Kimble Nov 1934 A
2002594 Wappler et al. May 1935 A
2004559 Wappler et al. Jun 1935 A
2050904 Trice Aug 1936 A
2056377 Wappler Oct 1936 A
2090923 Wappler Aug 1937 A
2224464 Wolf Dec 1940 A
2275167 Bierman Mar 1942 A
2888928 Seiger Jun 1959 A
3152590 Zurdo et al. Oct 1964 A
3163165 Isakawa Dec 1964 A
3178728 Christensen Apr 1965 A
3460539 Anhalt, Sr. Aug 1969 A
3579653 Morgan May 1971 A
3595239 Petersen Jul 1971 A
3768482 Shaw Oct 1973 A
3776230 Neefe Dec 1973 A
3828780 Morrison, Jr. Aug 1974 A
3856015 Iglesias Dec 1974 A
3867728 Substad et al. Feb 1975 A
3870047 Gonser Mar 1975 A
3879767 Substad Apr 1975 A
3886600 Kahn et al. Jun 1975 A
3901242 Storz Aug 1975 A
3902494 McFadden Sep 1975 A
3920021 Hilterbrandt Nov 1975 A
3920022 Pastor Nov 1975 A
3938198 Kahn et al. Feb 1976 A
3938527 Rioux et al. Feb 1976 A
3945375 Banko Mar 1976 A
3987449 Scharbach et al. Oct 1976 A
3987795 Morrison Oct 1976 A
3992725 Homsy Nov 1976 A
4043342 Morrison, Jr. Aug 1977 A
4074718 Morrison, Jr. Feb 1978 A
4085466 Goodfellow et al. Apr 1978 A
4129470 Homsy Dec 1978 A
4134406 Iglesias Jan 1979 A
4224696 Murray et al. Sep 1980 A
4224697 Murray et al. Sep 1980 A
4326529 Doss et al. Apr 1982 A
4344193 Kenny Aug 1982 A
4362180 Hiltebrandt Dec 1982 A
4375220 Mitvias Mar 1983 A
4381007 Doss Apr 1983 A
4397314 Vaguine Aug 1983 A
4476862 Pao Oct 1984 A
4483338 Bloom et al. Nov 1984 A
4517965 Ellison May 1985 A
4517975 Garito et al. May 1985 A
4590934 Malis et al. May 1986 A
4593691 Lindstrom et al. Jun 1986 A
4597379 Kihn et al. Jul 1986 A
4601705 McCoy Jul 1986 A
4651734 Doss et al. Mar 1987 A
4811733 Borsanyi et al. Mar 1989 A
4815462 Clark Mar 1989 A
4838859 Strassmann Jun 1989 A
4846175 Frimberger Jul 1989 A
4873976 Schreiber Oct 1989 A
4894063 Nashef Jan 1990 A
4895148 Bays et al. Jan 1990 A
4907585 Schachar Mar 1990 A
4907589 Cosman Mar 1990 A
4924865 Bays et al. May 1990 A
4924882 Donovan May 1990 A
4927420 Newkirk et al. May 1990 A
4944727 McCoy Jul 1990 A
4950234 Fujioka et al. Aug 1990 A
4955882 Hakky Sep 1990 A
4966597 Cosman Oct 1990 A
4976709 Sand Dec 1990 A
4976715 Bays et al. Dec 1990 A
4998933 Eggers et al. Mar 1991 A
5007908 Rydell Apr 1991 A
5009656 Reimels Apr 1991 A
5085657 Ben-Simhon Feb 1992 A
5085659 Rydell Feb 1992 A
5098430 Fleenor Mar 1992 A
5100402 Fan Mar 1992 A
5103804 Abele et al. Apr 1992 A
5114402 McCoy May 1992 A
5152748 Chastagner Oct 1992 A
5178620 Eggers et al. Jan 1993 A
5186181 Franconi et al. Feb 1993 A
5191883 Lennox et al. Mar 1993 A
5192267 Shapira et al. Mar 1993 A
5201729 Hertzmann et al. Apr 1993 A
5201730 Easley et al. Apr 1993 A
5201731 Hakky Apr 1993 A
5213097 Zeindler May 1993 A
5230334 Klopotek Jul 1993 A
5242439 Larsen et al. Sep 1993 A
5242441 Avitall Sep 1993 A
5261906 Pennino et al. Nov 1993 A
5267994 Gentelia et al. Dec 1993 A
5275151 Shockey et al. Jan 1994 A
5277696 Hagan Jan 1994 A
5279559 Barr Jan 1994 A
5281218 Imran Jan 1994 A
5284479 de Jong Feb 1994 A
5304169 Sand Apr 1994 A
5308311 Eggers et al. May 1994 A
5311858 Adair May 1994 A
5320115 Kenna Jun 1994 A
5323778 Kandarpa et al. Jun 1994 A
5334193 Nardella Aug 1994 A
5342357 Nardella Aug 1994 A
5348554 Imran et al. Sep 1994 A
5352868 Denen et al. Oct 1994 A
5354331 Schachar Oct 1994 A
5364395 West, Jr. Nov 1994 A
5366443 Eggers et al. Nov 1994 A
5366490 Edwards et al. Nov 1994 A
5382247 Cimino et al. Jan 1995 A
5397304 Truckai Mar 1995 A
5401272 Perkins Mar 1995 A
5415633 Lazarus et al. May 1995 A
5423806 Dale et al. Jun 1995 A
5433739 Sluijter et al. Jul 1995 A
5437661 Rieser Aug 1995 A
5437662 Nardella Aug 1995 A
5451223 Ben-Simhon Sep 1995 A
5458596 Lax et al. Oct 1995 A
5464023 Viera Nov 1995 A
5465737 Schachar Nov 1995 A
5484403 Yoakum et al. Jan 1996 A
5484432 Sand Jan 1996 A
5484435 Fleenor et al. Jan 1996 A
5487757 Truckai et al. Jan 1996 A
5498258 Hakky et al. Mar 1996 A
5500012 Brucker et al. Mar 1996 A
5507812 Moore Apr 1996 A
5514130 Baker May 1996 A
5524338 Martiyniuk et al. Jun 1996 A
5527331 Kresch et al. Jun 1996 A
5542920 Cheikh Aug 1996 A
5542945 Fritzsch Aug 1996 A
5569242 Lax et al. Oct 1996 A
5599346 Edwards et al. Feb 1997 A
5630839 Corbett, III et al. May 1997 A
5643255 Organ Jul 1997 A
5681282 Eggers et al. Oct 1997 A
5683366 Eggers et al. Nov 1997 A
5688270 Yates et al. Nov 1997 A
5697909 Eggers et al. Dec 1997 A
5718702 Edwards Feb 1998 A
5782795 Bays Jul 1998 A
5785705 Baker Jul 1998 A
5810809 Rydell Sep 1998 A
6135999 Fanton et al. Oct 2000 A
Foreign Referenced Citations (51)
Number Date Country
3511107 Oct 1986 DE
3632197 Mar 1988 DE
39 18316 Mar 1990 DE
0 257 116 Mar 1988 EP
0 274 705 Jul 1988 EP
0 479 482 Apr 1992 EP
0 521 595 Jan 1993 EP
0 542 412 May 1993 EP
0 558 297 Sep 1993 EP
0 566 450 Oct 1993 EP
0 572 131 Dec 1993 EP
0 682 910 Nov 1995 EP
0 479 482 May 1996 EP
0 729 730 Sep 1996 EP
0 737 487 Oct 1996 EP
0 783 903 Jul 1997 EP
1122634 Sep 1956 FR
2 645 008 Mar 1989 FR
2 645 008 Oct 1990 FR
1 340 451 Dec 1973 GB
2160102 Dec 1985 GB
2160102 Dec 1985 GB
2 164 473 Mar 1986 GB
5-42166 May 1993 JP
637118 Dec 1978 RU
WO 8202488 Aug 1982 WO
WO 8502762 Jul 1985 WO
WO 9205828 Apr 1992 WO
WO 9210142 Jun 1992 WO
WO 9301774 Feb 1993 WO
WO 9316648 Sep 1993 WO
WO 9320984 Oct 1993 WO
WO 9501814 Jan 1995 WO
WO 9510981 Apr 1995 WO
WO 9513113 May 1995 WO
WO 9518575 Jul 1995 WO
WO 9520360 Aug 1995 WO
WO 9525471 Sep 1995 WO
WO 9530373 Nov 1995 WO
WO 9530377 Nov 1995 WO
WO 9534259 Dec 1995 WO
WO 9611638 Apr 1996 WO
WO 9632051 Oct 1996 WO
WO 9632885 Oct 1996 WO
WO 9634571 Oct 1996 WO
WO 9634559 Nov 1996 WO
WO 9634568 Nov 1996 WO
WO 9639914 Dec 1996 WO
WO 9706855 Feb 1997 WO
WO 9807468 Feb 1998 WO
WO 9817190 Apr 1998 WO
Non-Patent Literature Citations (46)
Entry
Christian, C. et al., “Allograft Anterior Cruciate Ligament Reconstruction with Patellar Tendon: An Endoscopic Technique”, Operative Techniques in Sports Medicine, vol. 1, No. 1, Jan. 1993, pp. 50-57.
Houpt, J. et al., “Experimental Study of Temperature Distributions and Thermal Transport During Radiofrequency Current Therapy of the Intervertebral Disc”, SPINE, vol. 21, No. 15 (1996), pp. 1808-1813.
Troussier, B. et al., “Percutaneous Intradiscal Radio-Frequency Thermocoagulation: A Cadaveric Study”, SPINE, vol. 20, No. 15 (Aug. 1995), pp. 1713-1718.
Beadling, L., “Bi-Polar electrosurgical devices: Sculpting the future of arthroscopy”, Orthopedics today, vol. 17, No. 1, Jan. 1997, 4 pages.
Ellman International Mfg., Inc., 1989, Catalog, pp. 1-15, 20.
Cosset, J.M., Resistive Radiofrequency (Low Frequency) Interstitial Heating (RF Techique), Interstitial Hypothermia, Dec. 6, 1993, pp. 3-5, 37.
Attachment I: Competitive Literature on Generators with Bipolar Capabilities, IME Co., Ltd., pp. 60-86.
Attachment II: Competitive Literature on Bipolar Forceps and Footswitch Controls, IME Co., Ltd., pp. 87-104.
Auhll, Richard A., “The Use of the Resectoscope in Gynecology”, Biomedical Business International, Oct. 11, 1990, pp. 91-93.
Trimedyne, The Less Invasive Laser Advantage, Omni Spinal Introduction System.
PRNewswire (Dec. 12, 1994), Two Physicians Perform First Outpatient Cervical Disc Procedure Using Laser Technology.
Introduction to the LDD Disc Kit, Oct. 16, 1996.
Mayer et al., Lasers in Percutaneous Disc Surgery: Beneficial Technology or Gimmick?, vol. 25, No. 251 (1993), pp. 38-44.
Schatz et al., Preliminary Experience with Percutaneous Laser Disc Decompression in the Treatment of Sciatica, vol. 38, No. 5, Oct. 1995, pp. 432-436.
Savitz, M. A., Same-day Microsurgical Arthroscopic lateral-approach Laser-assisted (SMALL) Fluoroscopic Discectomy, vol. 38, No. 5, Oct. 1995, pp. 432-436.
Bosacco et al., Functional Results of Percutaneous Laser Discectomy, Dec. 1996, pp. 825-828.
Sluijter, M.E., The Use of Radiofrequency lesions for Pain Relief in Failed Back Patients, vol. 10, No. 1 (1988).
Cosman et al., Theoretical Aspects of Radiofrequency lesions in the Dorsal Root Entry Zone, vol. 15, No. 6 (1984), pp. 945-950.
Wilkins et al., Neurosurgery: Method of Making Nervous System Lesions, ch. 377, pp. 2490-2499.
Yonezawa et al., The System and Procedure of percutaneous Intradiscal Laser Nucleotomy, vol. 15, No. 5 (1990), pp. 1175-1185.
Kolarik et al., Photonucleolysis of Intervertebral Disc and its Herniation (1990).
Gottlob et al., Laser in Surgery and Medicine: Holmium: YAG Laser Ablation of Hunan Intervertebral Disc: Preliminary Evaluation, vol. 12 (1991), pp. 86-91.
Buchelt et al., Lasers in Surgery and Medicine: Fluorescence Guided Excimer Laser Ablation of Intervertebral Discs In Vitro, vol. 11 (1991), pp. 280-286.
Choy et al., Percutaneous Laser Disc Decompression: A New Therapeutic Modality, vol. 17, No. 8 (1992), pp. 949-956.
Sluijter et al., Persistent Pain, Modern Methods of Treatment: Treatment of Chronic Back and Neck Pain, vol. 3 (1998), pp. 141-179.
Sluijter, Int Disabil Studies: The use of Radio Frequency Lesions For Pain Relief in Failed Back, vol. 10, Sep. 4, 1996, pp. 37-43.
Shatz et al., CJS JCC Preliminary Experience With Percutaneous Laser Disc Decompression in the Treatment of Sciatica, vol. 38, No. 5, Oct. 1995, pp. 432-436.
Gerber et al., Der Orthopade: Offene Laserchirurgie am Bewegungsapparat, vol. 25 (1996), pp. 56-63.
Gehring, W. J., Exploring the Homeobox (1993), pp. 215-221.
Kelly, L. E., Purification and Properties of a 23kDa Ca2+ binding Protein (1990), 171, pp. 661-666.
Sluyter, Radiofrequency Lesions in the Treatment of Cervical Pain Syndromes, Radionics, Inc. (1989).
Buchelt et al., Lasers In Surgery And Medicine: Erb:YAG and Hol:Yag Laser Ablation of Meniscus and Intervertebral Discs, No1. 12, No. 4 (1992), pp. 375-381.
Leu et al., Der Orthopade: Endoskopie der Wirbelsaule: Minimal-invasive Therapie, vol. 21 (1992), pp. 267-272.
Phillips et al., JMRI: MR Imaging of Ho: Yag Laser Diskectomy with Histologic Correlation, vol. 3, No. 3, May/Jun. 1993.
Bromm et al., Human Neurobiology: Nerve Fibre Discharges, Cerebral Potentials and Sensations Induced by CO2 laser Stimulation, vol. 3 (1984), pp. 33-40.
Kolarik et al., Photonucleolysis of Intervertebral Disc and its Herniation, vol. 51 (1990) pp. 69-71.
Vorwerck et al., Laserablation des Nucleus Pulposus: Optische Eigenshaften von Degeneriertem Bandscheibengewebe im Wellenlangenberich von 200 bis 2200nm, vol. 151, No. 6 (1989), pp. 725-728.
Wolgin et al., Excimer Ablation of Human Intervertebral Disc at 308 Nanometers, vol. 9 (1989), pp. 124-131.
Davis, Early experience with Laser Disc Decompression, J. Florida M.A. ., vol. 79, No. 1 (1992).
Quigley et al., Laser Disectomy: Comparison of Systems, vol. 19, No. 3 (1994), pp. 319-322.
Mehta et al., The Treatment of Chronic back Pain: A Preliminary survey of the Effect of Radiofrequency Denervation at the Posterior Vertebral Joints, vol. 34 (1979), pp. 768-776.
Patil et al., Percutaneous Discectomy Using the Electromagnetic Field Focusing Probe: A Feasibility Study.
McCulloch et al., CMA Journal: Percutaneous Radiofrequency Lumbar Rhizolysis (rhizotomy), vol. 116, Jan. 8, 1977.
Yonezawa et al., The System and Procedure of Percutaneous Intradiscal Laser Nucleotomy, vol. 15, No. 11 (1990).
Sminia et al., Effects of 434 MHz Microwave Hyperthermia applied to the rat in the region of the cervical Spinal Cord, vol. 3, No. 5 (1987), pp. 441-452.
Sluijter et al., Treatment of Chronic Back and Neck Pain by Percutaneous Thermal Lesions, vol. 3 (1981).
Provisional Applications (1)
Number Date Country
60/037782 Feb 1997 US
Continuations (1)
Number Date Country
Parent 09/022612 Feb 1998 US
Child 09/572709 US