US20050283148A1 - Ablation apparatus and system to limit nerve conduction - Google Patents

Ablation apparatus and system to limit nerve conduction Download PDF

Info

Publication number
US20050283148A1
US20050283148A1 US10/870,202 US87020204A US2005283148A1 US 20050283148 A1 US20050283148 A1 US 20050283148A1 US 87020204 A US87020204 A US 87020204A US 2005283148 A1 US2005283148 A1 US 2005283148A1
Authority
US
United States
Prior art keywords
probe
tip
ablation
nerve
energy
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US10/870,202
Inventor
William Janssen
James Newman
James Jones
Jeffrey Buske
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Serene Medical Inc
Original Assignee
JNJ Technology Holdings LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by JNJ Technology Holdings LLC filed Critical JNJ Technology Holdings LLC
Priority to US10/870,202 priority Critical patent/US20050283148A1/en
Priority to JP2007516656A priority patent/JP2008503255A/en
Priority to BRPI0512233-3A priority patent/BRPI0512233A/en
Priority to CNA2005800197502A priority patent/CN1981256A/en
Priority to ZA200610576A priority patent/ZA200610576B/en
Priority to KR1020077001231A priority patent/KR20070047762A/en
Priority to RU2006144073/14A priority patent/RU2006144073A/en
Priority to PCT/US2005/021023 priority patent/WO2006009705A2/en
Priority to CA002570911A priority patent/CA2570911A1/en
Priority to AU2005264967A priority patent/AU2005264967A1/en
Assigned to JNJ TECHNOLOGY HOLDINGS, L.L.C. reassignment JNJ TECHNOLOGY HOLDINGS, L.L.C. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: JONES, JAMES WHITNEY, BUSKE, JEFFERY MICHAEL, JANSSEN, WILLIAM MICHAEL, NEWMAN, JAMES PAUL
Priority to MXPA06014889A priority patent/MXPA06014889A/en
Priority to EP05790717A priority patent/EP1769320A2/en
Publication of US20050283148A1 publication Critical patent/US20050283148A1/en
Priority to US11/460,870 priority patent/US20070060921A1/en
Priority to US11/559,232 priority patent/US20070167943A1/en
Priority to IL179503A priority patent/IL179503A0/en
Priority to CR8817A priority patent/CR8817A/en
Priority to NO20070184A priority patent/NO20070184L/en
Assigned to BIOFORM MEDICAL, INC. reassignment BIOFORM MEDICAL, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: JNJ TECHNOLOGY HOLDINGS, LLC
Priority to US12/612,360 priority patent/US9283031B2/en
Assigned to SERENE MEDICAL, INC. reassignment SERENE MEDICAL, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: BIOFORM MEDICAL, INC.
Priority to US13/570,138 priority patent/US9168091B2/en
Priority to US14/852,983 priority patent/US10548660B2/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B18/1477Needle-like probes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206Generators therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B18/16Indifferent or passive electrodes for grounding
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06FELECTRIC DIGITAL DATA PROCESSING
    • G06F13/00Interconnection of, or transfer of information or other signals between, memories, input/output devices or central processing units
    • HELECTRICITY
    • H04ELECTRIC COMMUNICATION TECHNIQUE
    • H04NPICTORIAL COMMUNICATION, e.g. TELEVISION
    • H04N5/00Details of television systems
    • H04N5/44Receiver circuitry for the reception of television signals according to analogue transmission standards
    • H04N5/455Demodulation-circuits
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477Coupling
    • A61B2017/00482Coupling with a code
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00434Neural system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577Ablation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00696Controlled or regulated parameters
    • A61B2018/00702Power or energy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00696Controlled or regulated parameters
    • A61B2018/0072Current
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00696Controlled or regulated parameters
    • A61B2018/00732Frequency
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00696Controlled or regulated parameters
    • A61B2018/00761Duration
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00988Means for storing information, e.g. calibration constants, or for preventing excessive use, e.g. usage, service life counter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1467Probes or electrodes therefor using more than two electrodes on a single probe
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B18/16Indifferent or passive electrodes for grounding
    • A61B2018/162Indifferent or passive electrodes for grounding located on the probe body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0803Counting the number of times an instrument is used
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0814Preventing re-use
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937Visible markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis

Definitions

  • the present invention relates to a method and device used in the field of Minimally Invasive Surgery (or MIS) for interrupting the flow of signals through nerves.
  • MIS Minimally Invasive Surgery
  • nerves may be rendered incapable of transmitting signals either on a temporarily (hours, days or weeks) or a permanent (months or years) basis.
  • This new device itself consists of a single puncture system, which incorporates both an active and return electrode capable of creating areas of nerve destruction, inhibition and ablation; a generator for precisely delivering RF energy, and the method necessary for properly locating the active tip and generating energy to ablate target nerves.
  • the human nervous system is used to send and receive signals.
  • the pathway taken by the nerve signals convey sensory information such as pain, heat, cold and touch and command signals which cause movement (e.g. muscle contractions).
  • the normal conduction of nerve signals can cause undesirable effects.
  • the activation of the corrugator supercilli muscle causes frown lines which may result in permanent distortion of the brow (or forehead); giving the appearance of premature aging. By interruption of the corrugator supercilli activation nerves, this phenomenon may be terminated.
  • Other cosmetic applications include all neck and facial expression muscles, which are innervated by cranial nerves (including, but not limited to, the orbicularis oculi, orbicularis ori, frontalis, procerus, temporalis, masseter, zygomaticus major, depressor anguli oris, depressor labii inferioris, mentalis, platysma, and/or corrugator supercili muscles). Further, Platysma myoides, Procerus muscles, back muscles, back pain, and other pain/abnormal muscle or nerve activations would be treatable.
  • a unipolar electrode system includes a small surface area electrode, and a return electrode.
  • the return electrode is generally larger in size, and is either resistively or capacitively coupled to the body. Since the same amount of current must flow through each electrode to complete the circuit; the heat generated in the return electrode is dissipated over a larger surface area, and whenever possible, the return electrode is located in areas of high blood flow (such as the biceps, buttocks or other muscular or highly vascularized area) so that heat generated is rapidly carried away, thus preventing a heat rise and consequent burns of the tissue.
  • the advantage of these system is the ability to place the unipolar probe exactly where it is needed and optimally focus the energy where desired.
  • a resistive return electrode would typically be coated with a conductive paste or jelly. If the contact with the patient is reduced or if the jelly dries out, a high-current density area would result, increasing the probability for burns at the contact point.
  • Bipolar electrode systems use a two surface device (such as forceps, tweezers, pliers and other grasping type instruments) where two separate surfaces can be brought together mechanically under force. Each opposing surface is connected to one of the two source connections of the electrical generator. Then the desired object is held and compressed between the two surfaces. Then when the electrical energy is applied, it is concentrated (and focused) so that tissue can be cut, desiccated, burned, killed, stunned, closed, destroyed or sealed between the grasping surfaces. Assuming the instrument has been designed and used properly, the resulting current flow will be constrained within the target tissue between the two surfaces.
  • the disadvantage of the conventional bipolar system is that the target tissue must be properly located and isolated between these surfaces.
  • RF ablation delivers electrical energy in either a bipolar or unipolar configuration utilizing a long catheter, similar to an EP (electrophysiology) catheter.
  • That catheter (consisting of a long system of wires and supporting structures normally introduced via an artery or vein which leads into the heart) is manipulated using various guidance techniques, such as measurement of electrical activity, ultrasonic guidance, and/or X-ray visualization, into the target area. Electrical energy is then applied and the target tissue is destroyed.
  • U.S. Pat. No. 5,397,339 (issued Mar. 14, 1995) describes a multipolar electrode catheter, which can be used to stimulate, ablate, obtain intercardiac signals, and can expand and enlarge itself inside the heart.
  • Other applications include the ability to destroy plaque formations in the interior of lumens within the body; using RF energy applied near (or at the tip of) catheters such as described in U.S. Pat. No. 5,454,809 (issued Oct. 3, 1995) and U.S. Pat. No. 5,749,914 (issued May 12, 1998).
  • a more advanced catheter (though similar to the EP catheters (described above)) contains an array of electrodes that is able to selectively apply energy in a specific direction.
  • This device allows ablation and removal of asymmetric deposits/obstructions within lumens in the body.
  • guidance may also be applied in various forms.
  • U.S. Pat. No. 5,098,431 (issued Mar. 24, 1992), discloses another catheter based system for removing obstructions from within blood vessels.
  • Parins in U.S. Pat. No. 5,078,717 (issued Jan. 7, 1992) discloses yet another catheter to selectively remove stenotic lesions from the interior walls of blood vessels.
  • Auth in U.S. Pat. No. 5,364,393 (issued Nov.
  • a guide wire (a much smaller wire which goes through an angioplasty device and is typically 110 cm or longer) has an electrically energized tip, which creates a path to follow and thus guides itself through the obstructions.
  • catheters which carry larger busts of energy (for example from a defibrillator) into chambers of the heart have been disclosed. These catheters are used to destroy both tissues and structures as described in Cunningham (see U.S. Pat. No. 4,896,671 issued Jan. 30, 1990) that describes a catheter for delivery in electroshock ablative therapy.
  • Botulinum toxin botulinum toxin
  • Thestrength duration curve has been used for many years. This curve consists of a vertical axis (or Y-axis) typically voltage, current, charge or other measure of amplitude, and has a horizontal axis (or X-axis) of pulse duration (typically in milliseconds). Such a curve is a rapidly declining line, which decreases exponentially as the pulse width is increased.
  • the new method and device of this preferred embodiment also uses (among other potential methods of locating the tip of the electrode in proximity to the target nerve) stimulation, followed by ablation.
  • the energy is delivered via the single puncture MIS system (as later described).
  • This unique technology and resulting device is a single needle that contains both electrodes. It will access the site via a single puncture and will be used with MIS surgical techniques. It will also have features that provide for placement and have substantial added benefits, which are described later in this document.
  • the primary aspect, of the present invention is to provide a single-needle type puncture entry way for bi-polar electrodes for delivering RF energy near the nerve (to terminate signal flow), in a minimally invasive procedure.
  • a hollow lumen for delivery of medication often, but not limited to, anesthetic
  • Controlled metered energy delivery determines permanence
  • Integrated dielectric insulator as fiber optic for illumination, thus reducing diameter
  • Integrated hollow electrode for photo-medication delivery to tagged tumor with illumination activation source
  • Another aspect of the invention is a probe usage register to reduce or eliminate chance of patient cross contamination.
  • This invention is an improved device (and method for its use) that will allow the physician to terminate signal flow through nerves, in a minimally invasive manner, by requiring only a single-needle type puncture.
  • Said method and device would allow for a reduced patient recovery time; the patient would be awake during the procedure; using only a local (or very little) anesthetic; have a substantially reduced risk of infection; less of a risk of intensive care (or hospital stay), and subsequently, a reduced associated costs. Inasmuch, the patient would more rapidly return to a normal lifestyle as compared to many procedures requiring open surgery.
  • This single-puncture device presents an improvement over conventional uni-polar systems because it does not require a separate return electrode, which is attached to the patient at a remote site and subsequently must be maintained during the surgical procedure. Also, it represents an improvement over bi-polar electrodes and earlier two needle systems, because it concentrates the energy specifically at the desired location (by use of one active electrode) and when ablation areas need to be precisely focused this device may best accomplish that task.
  • the device (and the methods needed to operate it) can be used to terminate, stop or inhibit (on a temporary, semi-permanent or even permanent basis) the transmission of nerve signals to the muscles, organs and receivers of nerve signals, which convey activation, perception, pain signals or other nervous impulses.
  • the active electrode or the probe/needle tip
  • the complete system shall include an intelligent external energy generator, which can be used either by programmed or manual control.
  • the manual control may be mitigated (or limited for the protection of the patient) by means of various sensors including (but not limited to) impedance (and the change in impedance), temperature (and the change in temperature), normal voltage (or current) regulation, etc.
  • Said generator will generate RF energy in the frequency range of 50 Khz to 2.5 Mhz, in a controlled manner.
  • the generator will also be usable under program control. Said programming will deliver a predetermined “bolus” (or packet) of electrical energy, whereby the dose is adjustable (within limits) by the physician proportional to the desired effect.
  • This bolus will be predetermined in clinical studies and may have preset parameters such as minimal effect, average effect, maximum effect, corresponding to a low, normal and high-output level.
  • the output cycle will be activated by the physician via footswitch, a button on the probe itself, voice or other similar method of activation methods. When the bolus output is activated it may be terminated (at any time) by releasing activation means (i.e. the footswitch, button or the like).
  • the activation mechanism To deliver a second packet of energy, the activation mechanism must be released for (an internally set) time period before another packet of energy may be delivered. Also, because this technology may be used in various applications (e.g. plastic surgery, spinal nerves causing back pain, and other applications where terminating signal flows through nerves is desired) the delivery systems (i.e. single-pass needle or probe, and the generator required to power same) may be of differing sizes, surface areas or mechanical configurations. Some may even require a substantially different amount or type of energy packet. Program setting and preferences made be controlled for the different applications by providing a specific hand tool device that would then contain a coded circuit, connector or other means of providing identification to the generator so that it may deliver the required energy packets automatically for the different applications or methods.
  • the methods of ablation may include both a linear or circular zone.
  • the effective ablation area may be modified by “laying down” a series of individual ablation zones, thus creating a line of ablated tissues. This would be possible by withdrawing, inserting, and/or moving the active tip while ablating in the successive zones, which would expanding the liner component of any lesion produced.
  • the effective zone of ablation could be extended circumferentially by manipulating the tip during the ablation cycle in small circles, thereby mechanically moving the tip enlarging the effective zone of ablation.
  • FIG. 1 Bi-Polar Driver System
  • FIG. 2 Schematic diagram of the bi-polar needle
  • FIG. 2A Schematic diagram of the split bi-polar needle
  • FIG. 3A Magnified side view of conical bi-polar probe.
  • FIG. 3B Magnified side view of hollow chisel bi-polar probe.
  • FIG. 3C Magnified side view of tapered conical bi-polar probe.
  • FIG. 3D Magnified side view of split conical bi-polar probe.
  • FIG. 4 Schematic diagram of the bi-polar driver system
  • FIG. 5A Ablation Procedure without Auxiliary probe
  • FIG. 5B Ablation Procedure with Auxiliary probe
  • FIG. 6 Side view Hybrid bi-polar needle for nerve ablation.
  • FIG. 6A Side view Hybrid bi-polar needle for tumor ablation.
  • FIG. 7 Side view of auxiliary nerve probe.
  • FIG. 7A Side view of auxiliary dual-tipped nerve probe.
  • FIG. 8 Side view of guided ablation procedure with auxiliary nerve probe(s).
  • FIG. 9 Sample electro-surgery waveforms.
  • FIG. 10 Side view of visually guided ablation procedure.
  • FIGS. 11-11A Controller and probe data base structure
  • the I2C bus is used on and between system boards for internal system management and diagnostic functions.
  • FIG. 1 has two main components and one optional component, which are the energy generator 400 , the probe 371 (alternate probes are described in FIGS. 3 A-D) and optionally probes 771 or 772 that may be used.
  • the energy generator 400 the probe 371 (alternate probes are described in FIGS. 3 A-D) and optionally probes 771 or 772 that may be used.
  • the novel probe 371 would combine a unique bipolar configuration in a single MIS needle, is inserted into the patient using MIS techniques.
  • the probe which may contain and/or convey various functions described later, is initially guided anatomically to the region of the anticipated or desired location.
  • Various means of locating the tip 301 are utilized of placing the zone of ablation in the proper area to interrupt signal flows through the nerve 101 .
  • the ‘novel’ probe performs a variety of functions, such as stimulation, optical and electronic guidance, medication delivery, sample extraction, and controlled ablation.
  • This bi-polar electrode is designed as a small diameter needle inserted from a single point of entry thus minimizing scaring and simplifying precise electrode placement. This low cost, compact design provides a new tool to the art.
  • Probes may emit fiber optic illumination for deep applications using electronic guidance as taught in FIGS. 1 and 8 .
  • the invention offers a simple low cost ablation probe that is capable of performing precise ablation while minimizing damage to nearby tissue structures.
  • the metered ablation energy and precise probe targeting give the practitioner a tool is also not available in prior art.
  • the practitioner has unprecedented control of treatment permanence in a minimally invasive procedure. Such a procedure is typically performed in less than one hour with only local anesthetic and would require no stitches or chemicals common to prior medical art.
  • the user initiates the treatment via switch(s) 410 and 310 using the selected power setting 404 ( FIG. 4 ).
  • the controller configures the generators 411 ( FIG. 4 ) and 412 to the amplitude frequency and modulation envelope, delivering 50 KHz-2.5 MHz of 5 to 500 watts of available energy.
  • the summing junction 413 combines the RF outputs as the application requires and passes them to the pulse-width modulator 415 for output power control.
  • the output of modulation generator 420 is applied to the multiplier 415 with radio frequency RF signals 422 and 423 . This permits complex energy profiles to be delivered to a time variant non-linear biologic load. All of these settings are based on the information provide to the generator by the installed probe 371 the selected power 404 settings, and the modulation envelope 420 ( FIG. 4 ) settings, which are then loaded by the generator 421 .
  • both a high amplitude sine wave 910 ( FIG. 9 ), used for cutting, and a pulse-width modulated (or PWM) sine wave 920 , used for coagulation, are well known to electro-surgery art.
  • Precise power rates and limits of average total power are controlled via integrator 435 minimizing damage to nearby structures or burning close to the skin for shallow procedures.
  • nearby structures 111 ( FIG. 2A ) are too close to be avoided by electrodes such as 371 ( FIG. 3 ), 372 ( FIG. 3A ), and 372 ( FIG. 3B )
  • additional probe geometries as taught in FIGS. 3D, 6 and 6 A offer novel methods to direct energy and limit ablation to a smaller region, thereby avoiding other structures.
  • a hardwired switch 436 disables the power amplifier in the event of a system fault, the probe is unplugged or over power condition, thus protecting both the patient and practitioner.
  • the output of the modulator 415 is applied to the input of the power amplifier 416 section.
  • the power amplifier's 416 outputs are then feed into the impedance matching network 418 , which provides dynamic controlled output to the biologic loads that are highly variable and non-linear, and require dynamic control of both power levels and impedance matching.
  • the tuning of the matching network 418 is performed for optimal power transfer for the probe, power level, and treatment frequencies settled.
  • the system's peak power is 500 watts for this disclosed embodiment. Precise control is established by the proximity of the tip and the control loops included in the generator itself
  • the final energy envelope 420 is delivered to probe tip 301 and return electrodes 302 .
  • a low energy nerve stimulator 771 has been integrated into the system to assist in more precise identification of nearby structures and for highly accurate target location.
  • additional sensors such as temperature 311 , voltage, frequency, current and the like are read directly from the device and/or across the communications media 403 to the probe.
  • FIG. 3D switching or dividing ablation power to multiple electrodes ( FIG. 3D ) can generate a asymmetric ablation zone.
  • This high intensity source 608 with probe 610 FIGS. 6 and 6 A
  • FIGS. 2A and 3D identifies probe configurations for selective or asymmetric ablation.
  • the power amplifier output 430 and buffered the feedback signals 437 are connected to an Analog to Digital converter (or ADC) 431 for processor analysis and control. Said signals 437 control power modulation 420 settings and impact the impedance matching control signals 419 .
  • This integrated power signal 437 is recorded to the operating-condition database ( FIG. 11 ) for later procedure review. This power level is also compared to reading taken from the probe 1492 ( FIG. 11A ) as compared against procedure maximums, which if exceeded will in turn disable the amplifier output, thereby protecting the patient from error or equipment fault. Similarly, limits from the probe and generator sensors such as temperature 330 are also used to terminate or substantially reduce the modulated power levels and ultimately the procedure.
  • serial communications 403 (or bus).
  • Serial communications is used because it is commonly available to most single-chip microprocessors. This or similar methods (e.g. I2C, or SPI) may be used, but this disclosed embodiment will use serial for its simplicity.
  • Serial communications 403 permits the generator to address and control EEROM memory 331 , temperature sensors 330 , processors, ADC and DACs within the single-chip microprocessor embedded in the probe itself.
  • the user selects the desired power setting 404 and based on probe identification read from the EEROM or microprocessor 331 makes the appropriate configurations.
  • the probe 371 is connected via cable 1334 ( FIG.
  • the controller 401 ( FIG. 4 ) reads the stored time register from ID memory module 331 . If the probe's initialized time 1467 ( FIG. 14 ) is zero, the current real-time clock 482 value is written to probe's 331 's initial time register via serial bus 403 . If time read on module 331 is non-zero, the probe's initial time register is added to two(2) times the procedural time (based on the probe type) FIG. 14 1420 . If that value when compared to current real-time clock 482 , is less than current time, the controller will alert the practitioner via display 450 , speaker 451 and, flashing probe illumination 608 , that the procedure will be terminated and the probe rendered invalid.
  • the controller 401 also verifies selected procedure 1415 ( FIG. 11 ) for compatibility with installed probe. If incompatible, the user is also prompted to select a different power setting 404 , procedure, or probe 371 . If probe 371 matches power setting 404 , the system enables power amplifier 416 , guide light source 408 , and low-voltage nerve simulation 732 . Both of these procedures are enforced by a mandatory “hand shake” protocol and the serialized information, which must be present and properly verified by the electronic circuitry for a procedure to be instituted. During a clinical procedure, information is required to be conveyed by the embedded electronics contained within the probe, which provides another way of enforcing this protection and thus again preventing unauthorized re-use.
  • the ultimate goal is prevent cross-contamination between patients.
  • the probe will accomplish this by being unique, serialized, and given the above procedures. Once plugged in, the probe will enter the serial number into the data logging system via the serial bus 403 and circuit logic will thereafter prevent re-use of the probe and cross-contamination that would occur. Further, this scheme will prevent the use of unauthorized third party probes, for they will not be activated, preventing potential inferior or uncertified probes from being used and presenting potential danger to the patient.
  • auxiliary probe 771 Prior to treatment, the practitioner may use auxiliary probe 771 ( FIG. 4 ), to locate target 101 and nearby structures 111 as taught in FIGS. 4, 7 , 7 A, 8 , and 10 .
  • needle 771 When needle 771 is in place, the practitioner may locate and place a mark or marks on the surface of the skin 755 (see FIGS. 7 and 8 ) or leaves auxiliary probe 771 in place.
  • probe tip illumination 448 from source 408 is visible to practitioner aiding in probe placement to pre-marked location.
  • FIG. 6A In other procedures, whereby somewhat larger targets are sought, such as more diffuse nerve structures or small areas of abnormal growth (e.g. such as cancer) the injection of specially designed dyes that attach to target structures are used, as taught in FIG. 6A .
  • the probe 610 FIG. 6
  • the light source 608 illuminates quantum-dot/dye tagged antibody 670 .
  • the dye fluoresces 675 at a frequency/wavelength of a particular material and will typically emit light in the visible to infrared (or IR) or potentially other wavelength regions.
  • the return fiber(s) 680 deliver emissions 675 to the detector 478 for measurement and are the result is then displayed on bar graph 554 ( FIG.
  • Low energy nerve stimulation current 810 ( FIG. 8 ) assist in locating desired treatment region and avoiding nearby structures.
  • Probe 771 is selectable between nerve stimulator and current measurement to/from auxiliary probe tip 702 ( FIG. 8 ).
  • Return electrode 736 provides a return path for local ground 735 .
  • Ablation probe switch 367 selects low-energy stimulator/receiver and high-energy ablation to/from probe 372 .
  • Amplitude of measured guidance current 811 and light 478 are transmitted to display 554 , and audio feedback 452 through the speaker 451 .
  • Disclosed invention provides optical sources 408 that aid in probe placement ( FIG. 10 ) by supplementing stimulation source 732 and acting as preliminary guide.
  • Probe 771 is selectable between nerve stimulator or current 811 measurement and to or from the auxiliary probe tip 702 .
  • the ablation probe switch 367 selects low-energy stimulator/receiver or high-energy ablation to or from probe 371 , 372 , 373 , and 374 .
  • the physician operator will have previously placed marks 755 on the surface of the skin by various means described.
  • the physician operator 775 will then see the tip when the 448 if the optical illumination is turned on. It 448 will provide a bright spot under the skin indicating the location of the tip in relation to the marks 755 .
  • the physician 775 will then guide the probe tip 301 into precise alignment under these marks 755 so as to enable ablation of that target tissue 101 .
  • Real-time engineering parameters are measured such as average power 437 , luminous intensity 478 , probe current 811 , energy 438 and, temperature 330 to be recoded into USB memory 438 .
  • the internal parameters disclosed such as frequency 423 , modulation 420 and such are recoded into USB memory 438 as well.
  • probe, patient, and procedure parameters ( FIG. 11 ) are written to local storage 438 .
  • the practitioner dictates text and voice notes via microphone 455 , which are saved to memory 438 ( FIG. 1 ). All data and records are time stamped using the real-time clock 482 . This permits detailed post procedure graphing and analysis.
  • the system transfers the data 438 recorded to the USB removable memory 1338 and to a file server(s) 1309 and 1307 .
  • data transfer is performed over Ethernet connection 480 .
  • Probe usage records 1460 FIG. 11
  • Parallel records are mirrored to local storage 1309 and remote server 1306 storage 1307 via Ethernet connection 480 or similar means.
  • Sensitive records are encrypted and transferred via secure network connection and also written to removable module 1320 .
  • the database contained on the remote server tracks the following information: equipment by manufacture, probe accessory inventory, usage, billing, repair/warranty exchange information, and program recorders.
  • the relational databases are automatically updated to reflect new billing/procedure codes 1416 , potential power settings 1417 and the like. This insures that the equipment is current and alerts the practitioner to new probes/procedures as they are developed and certified.
  • FIG. 1 Bi-Polar Driver System
  • FIG. 1 identifies the two required components of the system, various modules and optional items.
  • the two components always utilized during a procedure will be the energy generator/controller/data storage device 400 and probe 371 .
  • 400 contains advanced electronic systems capable of recognizing a properly authorized probe, preventing re use of a previously used probe, generating appropriate energy as described, performing safety checks, storing data, and other functions as described.
  • Main functions of 400 may include, but not be limited to, generation of light, generation of location-stimulation currents, generation of ablation energies, data logging, storage, communication and retrieval, and other functions critical to a MIS procedure.
  • Probe 371 and its various forms are single puncture bipolar surgical tools that may be used in identifying proper location of its tip 301 , in relation to target tissue 101 which is desired to be ablated, modified or destroyed. Probe 771 and its various derivatives may optionally be used to assist in locating and properly positioning tip 301 of probe 371 .
  • FIG. 2 Isometric View of the Bi-Polar Probe
  • Bi-polar probe 310 represents probes 371 , 372 , 373 shown in FIGS. 3 A-C with exception to type of needlepoint on the probe.
  • FIG. 3D varies from the other because it has a split return probe.
  • Bi-polar probe 310 (not drawn to scale) consists of insulating dielectric body 309 made from a suitable biology inert material, such as Teflon, PTFE or other insulative material, covering electrode 302 except for where 302 is exposed as a return electrode.
  • Conductive return electrode 302 tube is fabricated from medical grade stainless steel, titanium or other conductive material.
  • Hollow or solid conductive tip electrode 301 protrudes from surrounding dielectric insulator 305 . Sizes of 309 , 302 , 305 , and 301 and its inner lumen (diameter, length, thickness, etc.) may be adjusted so as to allow for different surface areas resulting in specific current densities as required for specific therapeutic applications.
  • Hollow Electrode 301 often used as a syringe to deliver medication such as local anesthetic.
  • Tip electrode 301 is connected to power amplifier 416 via impedance matching network 418 ( FIG. 4 ).
  • Return electrode(s) 302 delivers return current to power amplifier 416 via impedance matching network 418 .
  • Dielectric insulator in the disclosed embodiment is a transparent medical grade polycarbonate acting as a light pipe or fiber optic cable.
  • Light source LED or laser 408 FIG. 4
  • dielectric insulator is replaced with a plurality of optical fibers for viewing and illumination as taught in FIG. 6 .
  • Ablation regions 306 and 140 extend radially about electrode 301 generally following electric field lines. For procedures very close to skin 330 a chance of burning exists in region 306 . To minimize the chance of burning, a split return electrode probe 374 in FIG. 3D is offered. Thereby concentrating the current away from region 306 to 140 or vice versa.
  • insulator 307 splits the return electrode into two sections 302 and 303 , dividing return current ratio from 0-50%, which may also be selectively activated. Active electrodes are also split into two sections 301 and 311 so energy may be directed in a desired direction. This electrode configuration is identified on the proximal portion of the probe so the operator may position the needle and electrodes accordingly.
  • FIG. 6 teaches a laser directed ablation for more precise energy delivery.
  • FIG. 2A Isometric View of Split Bi-Polar Probe.
  • the bi-polar probe 380 (not drawn to scale) consists of an insulating dielectric body 309 made from a suitable biologically inert material, such as Teflon PTFE or other electrical insulation, that covers split return electrodes 302 and 303 .
  • the disclosed conductive return electrodes 302 and 303 are fabricated from medical grade stainless steel, titanium or other electrically conductive material.
  • Hollow or solid split conductive tip electrodes 301 and 311 protrude from the surrounding dielectric insulator 305 .
  • the operation of the hollow/split conductive tip is very similar to probe tip 310 as taught in FIG. 3D .
  • Ablation regions 1203 ( FIG. 10 ) and 140 - 144 extend radially about electrode 301 generally following electric field lines.
  • the disclosed split electrode 380 permits dividing or splitting energy delivered to electrode pairs 301 / 302 and 311 / 303 .
  • the disclosed division or ratio between pairs is 0-100%.
  • Dual amplifiers or time multiplexing/switching main amplifier, 416 located between electrode pairs, directs energy to target 101 avoiding 111 . This simple switch network reliably ratios electrical energy while minimizing damage to nearby structures.
  • FIG. 3A Conical Bi-Polar Needle
  • Bi-polar probe 371 discloses conical shaped electrode 301 and tip 351 for minimally invasive single point entry.
  • Probe diameter 358 is similar to a 20-gage or other small gauge syringe needle, but may be larger or smaller depending on the application, surface area required and depth of penetration necessary.
  • electrode shaft 302 is 30 mm long with approximately 5 mm not insulated. Lengths and surface areas of both may be modified to meet various applications such as in cosmetic surgery or in elimination of back pain.
  • the conductive return electrode 302 is fabricated from medical grade stainless steel, titanium or other conductive material.
  • the dielectric insulator 305 in the disclosed embodiment is a transparent medical grade material such as polycarbonate, which may double as a light pipe or fiber optic cable.
  • the high intensity light source 408 LED/laser ( FIG. 4 ) provides guidance Illumination 448 at working end of probe.
  • the illumination source modulation/flash rate is proportional to the received stimulation current 810 as taught in FIG. 8 .
  • a small diameter electrode permits a minimally invasive procedure that is typically performed with local anesthetic. This configuration may contain lumens for delivery of agents as described elsewhere.
  • FIG. 3B Hollow Chisel
  • the hollow chisel electrode 352 is often used as a syringe to deliver medication such as local anesthetic, medications,/tracer dye.
  • the hollow electrode may also extract a sample.
  • Dielectric insulator 305 in the disclosed embodiment is a transparent medical grade polycarbonate and performs as a light pipe or fiber optic cable. The novel dual-purpose dielectric reduces probe diameter and manufacturing costs.
  • Light source 408 typically a LED or laser ( FIG. 4 not shown), provides Illumination 448 at the working end of probe. It provides an illumination source for guiding the probe under the skin.
  • a second embodiment, as taught in FIG. 6 dielectric insulator is replaced/combined with plurality of optical fibers for viewing/illumination.
  • FIG. 3C Tapered Conical
  • the bi-polar probe 373 discloses a tapered conical shaped probe for minimally invasive single point entry. It is constructed similarly to probe 371 as taught in FIG. 3A . Probe tip is not drawn to scale to teach the tip geometry. In disclosed embodiment, electrode 301 is approximately 5 mm long and fabricated from medical grade stainless steel but may be of various lengths to accommodate specific application and surface area requirements.
  • the solid tapered conductive tip electrode 353 protrudes from tapered dielectric insulator 305 .
  • Transparent dielectric insulator 305 also performs as light pipe or fiber optic cable terminated to high intensity light source 408 ( FIG. 4 ) providing illumination 448 .
  • the electrode assembly is mounted in an ergonomic handle 388 (which has not been drawn to scale). Handle 388 holds ablation on/off switch 310 , ablation/stimulation mode switch 367 , identification module 331 and terminations for cable 1334 ( FIG. 13 ).
  • Temperature sensor 330 located close to tip monitors tissue temperature.
  • FIG. 3D Split Conical Bi-Polar Probe
  • Bi-polar probe 374 (not drawn to scale) consists of insulating dielectric body 309 made from a suitable biologically inert material, such as Teflon, that covers split return electrodes 302 and 303 .
  • Conductive return electrodes 302 are fabricated from medical grade stainless steel, titanium or other suitable conductive material.
  • Hollow or solid split conductive tip electrodes 301 and 311 protrude from surrounding dielectric insulator 305 . Their operation is very similar to probe tip 380 as taught in FIG. 2A .
  • Solid tapered conductive tip electrodes 311 and 301 protrude from transparent dielectric insulator 305 .
  • Dielectric insulator 305 also performs as a light pipe or fiber optic cable terminated to high intensity light source 408 providing illumination 448 .
  • Probe handle (not drawn to scale) encloses memory module 331 , on/off switch 310 and mode switch 367 .
  • Temperature sensor 330 (located close to tip) monitors tissue temperature.
  • Split electrode 380 ( FIG. 2A ) permits dividing or splitting energy delivered to electrode pairs 301 / 302 and 311 / 303 .
  • Dual amplifiers or time multiplexing/switching main amplifier 416 are located between electrode pairs directing energy to target 101 avoiding 111 creating asymmetric ablation volume. A small diameter electrode needle is injected from a single point of entry minimizing scaring and simplifying precise electrode placement.
  • Connections consist of a tapered dielectric sleeve 309 covering the ridged stainless electrode tube 302 .
  • Insulating sleeve 309 is made from a suitable biologically inert material, which covers electrode 302 .
  • Dielectric 305 insulates conical tipped electrodes 351 and 301 .
  • FIG. 4A Schematic Diagram of the Bi-Polar Driver System.
  • Ablation probe 371 is inserted and directed anatomically into the area where the target nerve to be ablated (Box 531 ) is located.
  • Test current 811 is applied (Box 532 ). If probe is located in the immediate proximity of the target nerve a physiological reaction will be detected/observed (Example: During elimination of glabellar furrowing, muscle stimulation of the forehead will be observed). If reaction is observed, then a mark may optionally be applied on the surface of the skin to locate the area of the nerve. Power is applied (Box 535 ) in an attempt to ablate the nerve. If physiological reaction is not observed, (Box 534 ) the probe will be relocated closer to the target nerve and the stimulation test will be repeated (Box 536 & 537 ). If no physiological reaction is observed, the procedure may be terminated (Box 544 ). Also, the probe may be moved in any direction, up, down, near, far, circular, in a pattern, etc. to create a larger area of ablation for a more permanent result.
  • the ablation power may be set higher (Box 538 ), alternatively, as mentioned, the needle may be moved in various directions, or a larger dosage of energy may be reapplied, to form a larger area of ablation for more effective or permanent termination of signal conduction through the nerve.
  • stimulation energy may be applied again (Box 541 ). If there is no stimulation, the procedure is completed (Box 544 ). If there is still signal flow through the nerve (stimulation or physiological reaction) then the probe may be relocated (Box 542 ) and the procedure is started over again (Box 533 ).
  • FIG. 5B Flow Chart of Visually Guided Ablation Procedure Using Auxiliary Probes Such As 771 and 772 .
  • Auxiliary probes 771 and 772 provide a method to quickly and accurately locate target structure 101 and subsequently mark target location 755 .
  • Auxiliary probes may be much smaller (like acupuncture needles) than ablation probes. Structures are marked typically with an ink or similar pen allowing the illuminated ablation probe 371 or other ablation probe to be quickly guided to mark 755 .
  • non-illuminated probes may be used allowing the practitioner to simply feel for the probe tip.
  • probe 771 ( FIG. 8 ) us employed as an electronic beacon. Small current 811 , which is similar to the stimulation current but smaller, from probe tip 702 is used to guide ablation probe 372 ( FIG. 8 )
  • Operation 530 inserts auxiliary probe 771 or 772 ( FIGS. 7 and 7 A) thru skin 330 and muscle layer(s) 710 near nerve 101 .
  • Target 101 depth 766 is measured ( FIGS. 7 and 7 A) using auxiliary probe markings 765 .
  • Decision 533 checks if the probe is in position if not adjustments are performed in 534 .
  • Operation 532 enables nerve simulation current 811 . When muscle stimulation is obtained or physiological reaction is obtained, Auxiliary probe tip is in place. Depth may be noted by reading marks 765 and location marks 755 may be made in operation 535 . With the probe in position under mark in operations 536 and 537 , operation 538 sets power level 404 and closes ablation switch 410 .
  • stimulation may be applied directly from the ablation probe as taught elsewhere.
  • Operation 540 and controller 401 set generator 411 ( FIG. 4 ) frequencies, modulation 420 envelope and enables power amplifier 416 to deliver preset ablation energy.
  • Region 1203 FIG. 10 shows the general shape of the ablation region for conical tip 301 for example.
  • ablation regions 140 , 141 , 142 , 143 , and 144 are shown in FIG. 10 .
  • Ablation starts with area 144 , then the probe is moved to 143 and so on to 140 .
  • movement may be during insertion, moved laterally, in a circular manner or other manner to enlarge the area of targeted nerve destruction.
  • Nerve responses may be tested after each ablation allowing the practitioner to immediately check the level of nerve conduction. Probe position and power adjustments are made before applying additional ablations if required.
  • Accurate probe location tools and methods taught herein permit use of minimal ablation energy thereby minimizing damage to non-target structures. This translates to reduced healing time and minimal patient discomfort.
  • the instant invention gives the practitioner a new tool to perform a minimally invasive nerve conduction limiting procedure with the ability to select, temporary or permanent nerve conduction interruption with a new level of confidence.
  • This new tool offers a low cost procedure performed typically in office or outpatient setting often taking less than one hour with local anesthetic. In contrast to prior art where surgical procedures require stitches and longer healing intervals with limited control of permanence (nerve re-growth).
  • FIG. 6 Side View of the Bi-Polar Probe 610 With Enhanced Laser Targeting.
  • target nerve 101 or ablation region 640 is in close proximity to second nerve 111 or skin 330 bi-polar probes 371 or 372 ( FIG. 3 ) create an annular ablation region between electrodes 301 and/or 302 , potentially damaging nearby structures such as other nerves 111 .
  • laser 608 FIG. 4
  • target 670 FIG. 6A
  • fiber(s) 690 Fiber(s) transmitting high intensity laser light to ionized region 640 is illuminated by fiber(s) 690 .
  • RF energy 470 is delivered to electrodes 301 and 302 .
  • Probe 610 improves on the already very precise ablation taught in FIG. 3 with the addition of a low power laser (or other type light source) and fiber delivery system.
  • a diode pumped Nd:YAG (Neodymium Doped Yttrium Aluminum Garnet) laser is offered as an example and not a limitation.
  • FIG. 6A Side View is the Florescence Emission Guided Hybrid Bi-Polar Tumor Probe.
  • Probe construction is similar to FIGS. 3A and 6 with dielectric 305 embedded with a plurality of optical fibers 380 , 690 , and 680 for illumination detection/imaging. These enhanced systems and processed augments the selective nature of previously disclosed probes.
  • Fiber(s) 690 - 691 are illuminated by a high intensity light source(s) 608 which is typically a tunable laser or UV LED.
  • Source(s) 608 FIG. 4
  • Source(s) 608 FIG. 4
  • Excitation/illumination wavelength(s) are specific to the dye/nano-particle used with marker 670 that is very specific for the desired target 671 .
  • the marker/tag is typically a protein specific antigen combined with a florescent marker.
  • the novel probe illumination permits delivery of intense illumination to the target for maximum system sensitivity. Many dyes excited by short (Blue/UV) wavelength light are transmitted poorly in tissue but are easily delivered by fiber 690 .
  • a second application offered for hybrid bi-polar ablation probe 610 is for locating/destroying small cancer lesions. The probe addresses cases where surgery is not practical or it dangerous due to location or sub-operable size.
  • Quantum-dot or dye tagged antibody materials 670 are injected into the patients where it attaches to target structure 671 . Once tagged, cancer node(s) may be located, tested, and treated.
  • FIG. 7 Side View of Auxiliary Single Tipped Nerve Probe
  • FIG. 7A Side View of Auxiliary Dual-Tipped Nerve Probe.
  • Dual tipped probe 772 offers an additional embodiment that eliminates return electrode pad 736 .
  • Probe frame/handle 739 holds two fine needles, 702 and 701 , in the disclosed embodiment that are spaced a short distance (a few mm)-mm apart ( 730 ).
  • the shaft of conductive needle 701 is covered with dielectric insulator 706 , similar to the construction of probe 771 ( FIG. 7 ).
  • the shaft of the second conductive needle 702 is covered with dielectric insulator sleeve 703 .
  • Electric generator 732 provides current to the probes via conductors 734 and 735 . Current originates from 701 and returns via electrode 702 . Large probe handle 739 is drawn out to teach the dual probes.
  • markers 765 are printed on needle shafts.
  • Dielectric insulating sleeves 703 and 706 isolate the needle shaft current from muscle layer 710 .
  • Current applied via generator 732 stimulates the nerve directly while avoiding muscle 710 .
  • Smaller probe tips with smaller current permits accurately locating small structures.
  • FIG. 8 Side View of Guided Ablation Procedure With Auxiliary Nerve Probe(s).
  • Auxiliary probes 771 and 772 are used to accurately locate target structure 101 .
  • Probe 771 holds a fine conductive needle 702 that has a shaft covered with dielectric insulator 704 .
  • Electric generator 732 provides a small current to the auxiliary probe via conductor 734 and return conductor 735 via return electrode 736 .
  • the sharp auxiliary probe is inserted thru skin 330 and muscle layer(s) 710 near target nerve 101 .
  • Dielectric insulating sleeve 704 isolates needle shaft from muscle layer 710 . Current is applied via generator 732 thereby stimulating the nerve directly while avoiding muscles 710 .
  • Prior art probes without insulating sleeve 704 stimulate both the nerve and muscle simultaneously, masking nerve 101 and subsequently making nerve location difficult.
  • Auxiliary probe 771 and 772 provide a method to quickly locate shallow or deep target structures. Shallow structures are typically marked with ink pen allowing illuminated ablation probe 371 or its equivalents to be quickly guided to mark 755 . Optionally, non-illuminated probes may be used by the practitioner who simply feels for the probe tip. For deep structures, probe 771 may also be employed as an electronic beacon; small current 811 (which will be lower intensity and different from the stimulating current) from probe tip 702 is used to guide ablation probe 372 . Amplifier 430 ( FIG. 4 ) detects current from tip electrode 301 for reading and displays it by controller 401 .
  • probe 701 is used as a receiver detecting current 811 from electrode 301
  • Moving probe tip 301 horizontally 1202 and in depth 766 relative to auxiliary probe 702 changes current 810 inversely proportional to distance.
  • Detected signal current 811 isolated and buffered by amplifier 430 is measured and the current is displayed to simple bar graph 554 for rapid reading.
  • audio feedback in which the tone is modulated by proximity of probe tip 351 , 352 or equivalent in relation to auxiliary probe tip 702 is provided to minimize or eliminate the practitioner having to look away from the needle, thus assisting in accurate probe placement.
  • Variable frequency/pitch and volume audio signal are proportional to sensed current 811 that is generated by 452 .
  • the tone signal emitted by speaker 451 FIGS.
  • illumination source 408 is modulated by amplifier 456 to blink at a rate proportional to the sensed current.
  • This permits the practitioner to quickly and accuracy guide ablation probe 372 into position using a combination of audio and visual guides.
  • the audio and visual aides also reduce the practitioner's training/learning time.
  • the novel real-time probe placement feedback gives the practitioner confidence that the system is working correctly so he/she can concentrate on the delicate procedure. Accurate probe location permits use of minimal energy during ablation, minimizing damage to non-target structures and reducing healing time and patient discomfort.
  • FIG. 9 A High-Energy Electro-Surgery Sinusoid Cutting Waveform 910 .
  • Lower energy pulse width modulated (or PWM) sinusoid 920 for coagulation is also well known to electro-surgery art. Variations of cut followed by coagulation are also well known.
  • FIG. 10 Side View of Visually Guided Ablation Procedure.
  • Auxiliary probes 771 and 772 have accurately located target structure 101 and subsequently marked target locations 140 to 144 .
  • Shallow structures are marked typically with ink pen ( 755 ) allowing illuminated ablation probe 371 , 372 or equivalent to be quickly guided to that point.
  • probe 771 is employed as electronic beacon, small current 811 from probe tip 702 is used to guide ablation probe 372 as taught in FIG. 8 .
  • Ablation probe 372 is inserted thru skin 330 and muscle layer(s) 710 near nerve 101 .
  • Illumination source 408 permits practitioner to quickly and accuracy guide illuminated 448 ablation probe 372 into position.
  • Illumination 448 from ablation probe as seen by practitioner 775 is used as an additional aide in depth estimation.
  • Selectable nerve simulation current 811 aids nerve 101 location within region 1204 . This novel probe placement system gives practitioner confidence system is working correctly so s/he can concentrate on the delicate procedure. Accurate probe location permits use of minimal energy during ablation, minimizing damage to non-target structures and reducing healing time and patient discomfort.
  • Region 1203 shows the general shape of the ablation region for conical tip 301 .
  • Tip 301 is positioned in close proximity to target nerve 101 .
  • Ablation generally requires one or a series of localized ablations. Number and ablation intensity/energy are set by the particular procedure and the desired permanence.
  • ablation regions Five ablation regions are illustrated 140 , 141 , 142 , 143 , and 144 ; however, there could be more or less regions. Ablation starts with area 144 , then the probe is moved to 143 and so on to 140 , conversely, ablations could start at 140 and progress to 144 . Also, the practitioner could perform rotating motions, thus further increasing the areas of ablation and permanence of the procedure. Between each ablation procedure 540 ( FIG. 5C ), a small nerve stimulation test current 811 is emitted from electrode 301 . The approximate effective range of the nerve stimulation current 811 is shown by 1204 . Testing nerve response after each ablation allows the practitioner to immediately check level of nerve conduction. Without probe 372 removal, the practitioner receives immediate feedback as to the quality of the ablation. Then minor probe position adjustments are made before conducting additional ablations (if required).
  • FIG. 11-11A Controller and Probe Data Base Structure
  • Controller 101 maintains local probe 1460 , patient 1430 , and procedure 1410 databases. All work together to insure correct probes and settings are used for the desired procedure. Automatically verifying that the attached probe matches selected procedure and verifying probe authentication and usage to avoid patient cross contamination or use of unauthorized probes. Automatic probe inventory control quickly and accurately transfers procedure results to the billing system.
  • FIG. 11 Provide Parameters Code(s) Database 1410
  • the practitioner selects the desired procedure from list 1410 .
  • “TEMPORARY NERVE CONDUCTION” 1411 , “SMALL TUMOR 1CC” 1412 , and “SMALL NERVE ABLATE” 1413 are a few of the choices.
  • Each procedure has a unique procedure code 1416 to be used in the billing system.
  • Power range parameter 1417 is a recommended power setting via power level control 404 .
  • the recommended probe(s) Associated with procedure 1415 and power range parameter 1417 are listed in parameters 1419 . With the probe connected, the part number is read from memory 331 ( FIGS. 1, 3 and 4 ) and compared to list 1419 .
  • the total power parameter 1418 is the maximum energy that the system may deliver for this procedure and is determined by the procedure code, probe being used and software parameters. These parameters may be modified, updated and changed as required by addition of new probes and procedures allowed/approved. Power is delivered, measured and totaled with integrator 435 ( FIG. 4 ).
  • the power integration circuit is designed as a hardwired redundant safety circuit that turns off the power amplifier if maximum energy is exceeded. This novel feature protects patients from system fault or practitioner error. Standard procedure time 1420 is doubled and added to current RTC 482 then written to probe memory 331 (in FIG. 1 ).
  • FIG. 11 & 11 A Provide Usage Authorization Database 1460
  • Probe 371 and equivalents (FIGS. 3 A-D) type is selected from recommended list 1419 and is connected via cable 1334 ( FIG. 1 ) to control unit 101 .
  • controller 401 FIG. 4
  • controller 401 FIG. 4
  • start time 1487 read is zero (factory default)
  • current real time clock 482 FIG. 4
  • twice the standard procedure time 1420 parameter is added to RTC 482 and written to time register 1487 via serial bus 403 .
  • probe start time 1487 reads ( 331 ) non-zero, the value compared to real time clock 482 . If greater than current time plus twice the standard selected procedure duration 1420 , the controller alerts the practitioner via display 450 , speaker 451 and flashing probe illumination 608 of previously probe used condition. To correct the situation, the practitioner simply connects a new sterile probe and repeats the above process.
  • FIG. 13 teaches additional detail regarding probe verification usage and related database operations. Periodically controller 401 performs the above verification to alert practitioner that he/she has forgotten to change probe(s).
  • various parameters such as peak temperature 1473 , power 1472 , impedance, etc. . . . are read, scaled, stored and displayed. Parameters such as procedure start 1467 ; end time 1468 , serial number 1469 , and part number 1468 are recorded as well. Critical parameters are written to local high-speed memory 438 for display and analysis. On a time permitting or end of procedure, data is mirrored to removable USB 1320 memory stick 1338 . Probe specific parameters 1463 are copied and written to probe memory 1338 for use at probe refurbishment facility. Database checksum/CRC(s) 1449 , 1479 , and 1499 are check and updated as required. Faults such as shorts (dielectric 305 ( FIG.
  • USB memory stick permits continued operation in the event of a network 1326 failure Data is loaded to memory 1338 for simple transfer to office computer 1306 ( FIG. 1 ) for backup.
  • Commonly available USB memory sticks 1320 have large data capacities in the tens to hundreds of megabytes at a low cost with long retention times. USB memory sticks also can support data encryption for secure transfer of patient data. Sealed versions are available as well compatible with chemical sterilization procedures.
  • remote server 1307 If computer network 1326 such as Ethernet 802.11 or wireless 802.11x is available, files are mirrored to local storage 1309 , remote server 1307 .
  • the remote server (typically maintained by equipment manufacture) can be remotely update procedure(s).
  • a high availability database engine made by Birdstep of Americas Birdstep technology, Inc 2101 Fourth Ave. Suite 2000, Seattle Wash. is offered as an example.
  • the Birdstep database supports distributed backups, extensive fault and error recovery while requiring minimal system resources.
  • FIG. 11 Patient/Procedure Database 1430
  • the practitioner selects or enters patient name from previous procedure 1430 and creates a new record 1433 .
  • a procedure is selected from 1410 (for example “TEMPORARY NERVE CONDUCTION” 1411 , “SMALL TUMOR 1CC” 1412 , and “SMALL NERVE ABLATE” 1413 ).
  • Each procedure has a unique procedure code 1416 that is used for the billing system.
  • Other information such as practitioners name 1440 , date 1435 is entered to record 1433 . As taught above probe appropriate for the procedure is connected and verified, part 1470 and serial number 1469 recorded.
  • FIG. 11 Voice and Notes
  • the practitioner enters additional text notes to file 1442 or records them with microphone 455 ( FIG. 5 ) to wave file 1445 for later playback or transcription.
  • the instant invention permits temporary/permanent nerve conduction interruption. Thus, procedures are performed at intervals from months to years apart. A hands free integrated voice recorder is extremely useful. Detailed text and voice notes made while probing/ablating are also recording specific settings, and patient response. A feature that is very helpful when reviewing treatment progress and saves valuable time instead of writing notes. Practitioners play back voice/wave files 1445 with standard audio tools a his/or hers desk. Audio files 1445 can be sent via email or file transfer for transcription, updating note field 1442 .
  • USB 1320 memory stick 1338 ( FIG. 1 ). If computer network 1326 such as Ethernet 802.11 or wireless 802.11x is available, files are mirrored to local storage 1309 , remote server 1307 . Patient name 1436 , procedure date 1435 , and procedure codes 1416 are automatically transferred via network or USB device 1320 to billing system 1306 .
  • USB memory stick permits continued operation in the event of a network 1326 failure. Data is loaded to USB memory 1338 for simple transfer to office computer 1306 ( FIG. 1 ) for backup. USB memory sticks 1320 have large data capacities in the tens to hundreds of megabytes at a low cost with long retention times. USB memory stick also support data encryption for secure transfer of patient data. Insuring patient is accurately billed with minimal office paper work. Probe inventory is automatic maintained with replacement probes automatic shipped as needed.

Abstract

A surgical system and the associated methods for use in Minimally Invasive Surgical procedures for use in the short- and long-term termination of signals through nerves. Such a procedure is an improvement over the current state-of-the-art because of the use of a tightly coupled single-needle bi-polar probe. The proximity of both electrodes, to the nerve or tissue targeted for the treatment, is such that it reduces the losses experienced with external electrodes (e.g. plates or probes). Further, the probe has features associated with locating the probe and dispensing or sampling far above the probes currently available. The resulting improvements provide a quantum leap in technology for the associated medical industries and a base line for these procedures in the future.

Description

    FIELD OF INVENTION
  • The present invention relates to a method and device used in the field of Minimally Invasive Surgery (or MIS) for interrupting the flow of signals through nerves. These nerves may be rendered incapable of transmitting signals either on a temporarily (hours, days or weeks) or a permanent (months or years) basis. This new device itself consists of a single puncture system, which incorporates both an active and return electrode capable of creating areas of nerve destruction, inhibition and ablation; a generator for precisely delivering RF energy, and the method necessary for properly locating the active tip and generating energy to ablate target nerves.
  • BACKGROUND OF THE INVENTION
  • The human nervous system is used to send and receive signals. The pathway taken by the nerve signals convey sensory information such as pain, heat, cold and touch and command signals which cause movement (e.g. muscle contractions).
  • Often extraneous, undesired, or abnormal signals are generated (or are transmitted). Examples include (but are not limited to) the pinching of a minor nerve in the back, which causes extreme back pain, or the compression (or otherwise activation) of nerves causing referred pain. Also with certain diseases the lining of the nerves is compromised, or signals are spontaneously generated, which can cause a variety of maladies, from seizures to pain or (in extreme conditions) even death. Abnormal signal activations can cause many other problems including (but not limited to) twitching, tics, seizures, distortions, cramps, disabilities (in addition to pain), other undesirable conditions, or other painful, abnormal, undesirable, socially or physically detrimental afflictions. This device can be used to treat various types of nerve conditions. Such as functional applications to innervations of the posterior neck muscles that will relieve headaches, muscle strain, and pain. The device can be used to treat abnormal muscle activity a result of over stimulation of peripheral nerves, for relief of pain, spasticity, and dystonias. Further, conditions such as hyperhidrosis, rhinorrhea, drooling, and facial flushing, caused by the overactive signals from sympathetic and parasymapathetic nerve path ways, can be treated.
  • In other situations, the normal conduction of nerve signals can cause undesirable effects. For example in cosmetic applications the activation of the corrugator supercilli muscle causes frown lines which may result in permanent distortion of the brow (or forehead); giving the appearance of premature aging. By interruption of the corrugator supercilli activation nerves, this phenomenon may be terminated. Other cosmetic applications include all neck and facial expression muscles, which are innervated by cranial nerves (including, but not limited to, the orbicularis oculi, orbicularis ori, frontalis, procerus, temporalis, masseter, zygomaticus major, depressor anguli oris, depressor labii inferioris, mentalis, platysma, and/or corrugator supercili muscles). Further, Platysma myoides, Procerus muscles, back muscles, back pain, and other pain/abnormal muscle or nerve activations would be treatable.
  • This technology describes an improved method of interrupting signal flows through nerve fibers with a new single puncture technique; used in the emerging field of Minimally Invasive Surgery (or MIS). Interrupting such flows is done using electricity to form an electrical circuit with the nerve. The circuit created is formed with a source of energy connected to an active electrode with a return path again connected to the source.
  • Traditional electrosurgical procedures use either a unipolar or bipolar device connected to that energy source. A unipolar electrode system includes a small surface area electrode, and a return electrode. The return electrode is generally larger in size, and is either resistively or capacitively coupled to the body. Since the same amount of current must flow through each electrode to complete the circuit; the heat generated in the return electrode is dissipated over a larger surface area, and whenever possible, the return electrode is located in areas of high blood flow (such as the biceps, buttocks or other muscular or highly vascularized area) so that heat generated is rapidly carried away, thus preventing a heat rise and consequent burns of the tissue. The advantage of these system is the ability to place the unipolar probe exactly where it is needed and optimally focus the energy where desired. The disadvantage of the system is that the return electrode must be properly placed and in contact throughout the procedure. A resistive return electrode would typically be coated with a conductive paste or jelly. If the contact with the patient is reduced or if the jelly dries out, a high-current density area would result, increasing the probability for burns at the contact point.
  • Bipolar electrode systems use a two surface device (such as forceps, tweezers, pliers and other grasping type instruments) where two separate surfaces can be brought together mechanically under force. Each opposing surface is connected to one of the two source connections of the electrical generator. Then the desired object is held and compressed between the two surfaces. Then when the electrical energy is applied, it is concentrated (and focused) so that tissue can be cut, desiccated, burned, killed, stunned, closed, destroyed or sealed between the grasping surfaces. Assuming the instrument has been designed and used properly, the resulting current flow will be constrained within the target tissue between the two surfaces. The disadvantage of the conventional bipolar system is that the target tissue must be properly located and isolated between these surfaces. To reduce extraneous current flow the electrodes can not make contact with other tissue, which often requires visual guidance (such as direct visualization, use of a scope, ultrasound or other direct visualization methods) so that the target tissue is properly contained within the bipolar electrodes themselves, prior to application of electrical energy.
  • In recent years, considerable efforts have been made in refining sources of RF or electrical energy, as well as devices for applying electrical energy to specific targeted tissue. Various applications such as tachyarrhythmia ablation have been developed, whereby accessory (extra) pathways within the heart conduct electrical energy in an abnormal pattern. This abnormal signal flow results in excessive, and potentially lethal cardiac arrhythmias. RF ablation (as it is called) delivers electrical energy in either a bipolar or unipolar configuration utilizing a long catheter, similar to an EP (electrophysiology) catheter. That catheter (consisting of a long system of wires and supporting structures normally introduced via an artery or vein which leads into the heart) is manipulated using various guidance techniques, such as measurement of electrical activity, ultrasonic guidance, and/or X-ray visualization, into the target area. Electrical energy is then applied and the target tissue is destroyed.
  • A wide variety of technology in the development of related systems, devices and EP products has already been disclosed. For example, U.S. Pat. No. 5,397,339 (issued Mar. 14, 1995) describes a multipolar electrode catheter, which can be used to stimulate, ablate, obtain intercardiac signals, and can expand and enlarge itself inside the heart. Other applications include the ability to destroy plaque formations in the interior of lumens within the body; using RF energy applied near (or at the tip of) catheters such as described in U.S. Pat. No. 5,454,809 (issued Oct. 3, 1995) and U.S. Pat. No. 5,749,914 (issued May 12, 1998). In these applications a more advanced catheter (though similar to the EP catheters (described above)) contains an array of electrodes that is able to selectively apply energy in a specific direction. This device allows ablation and removal of asymmetric deposits/obstructions within lumens in the body. In that application, guidance may also be applied in various forms. U.S. Pat. No. 5,098,431 (issued Mar. 24, 1992), discloses another catheter based system for removing obstructions from within blood vessels. Parins in U.S. Pat. No. 5,078,717 (issued Jan. 7, 1992) discloses yet another catheter to selectively remove stenotic lesions from the interior walls of blood vessels. Auth in U.S. Pat. No. 5,364,393 (issued Nov. 15, 1994) describes a modification of the above technologies whereby a guide wire (a much smaller wire which goes through an angioplasty device and is typically 110 cm or longer) has an electrically energized tip, which creates a path to follow and thus guides itself through the obstructions.
  • In applications of a similar nature, catheters which carry larger busts of energy (for example from a defibrillator) into chambers of the heart have been disclosed. These catheters are used to destroy both tissues and structures as described in Cunningham (see U.S. Pat. No. 4,896,671 issued Jan. 30, 1990) that describes a catheter for delivery in electroshock ablative therapy.
  • One application of this technology would induce the elimination of glabellar furrowing by interrupting the conduction of nerve signals to muscles causing frown wrinkles. Traditional treatments have included surgical forehead lifts, resection of corrugator supercilli muscle, as described by Guyuron, Michelow and Thomas in Corrugator supercilli muscle resection through blepharoplasty incision., Plastic Reconstructive Surgery 95 691-696 (1995). Also, surgical division of the corrugator supercilli motor nerves is used and was described by Ellis and Bakala in Anatomy of the motor innervation of the corrugator supercilli muscle: clinical significance and development of a new surgical technique for frowning., J Otolaryngology 27; 222-227 (1998). These techniques described are highly invasive and sometimes temporary as nerves regenerate over time and repeat or alternative procedures are required.
  • More recently, a less invasive procedure to treat glabellar furrowing involves injection of botulinum toxin (Botox) directly into the muscle. This produces a flaccid paralysis and is best described in The New England Journal of Medicine, 324:1186-1194 (1991). While minimally invasive, this technique is predictably transient; so, it must be re-done every few months.
  • Specific efforts to use RF energy via a less sophisticated two needle bipolar system has been described in an articleby Hernandez-Zendejas and Guerrero-Santos called Percutaneous Selective Radio-Frequency Neuroablation in Plastic Surgery, Aesthetic Plastic Surgery, 18:41 pp 41-48 (1994) They described a bipolar system using two needle type electrodes. Utley and Goode described a similar system in Radio-frequency Ablation of the Nerve to the Corrugator Muscle for Elimination of Glabellar Furrowing, Archives of Facial Plastic Surgery, Jan-Mar, 99, VI P 46-48. Later they were granted U.S. Pat. No. 6,139,545 (issued Oct. 31, 2000), which fully described the two needle bipolar system. These systems were unable to produce permanent results (i.e. greater than a few months) because of limitations in the energy and their polar configurations and like with Botox, would have required periodic repeat procedures.
  • There are many ways of properly locating an active electrode near the target tissue and determining if it is in close proximity to the nerve. Traditional methods have included stimulation by using either unipolar and bipolar energy by means of a test pacemaker pulse prior to the implantation of a pacemaker or other stimulation device. A method of threshold analysis called the ‘strength duration curve’ has been used for many years. This curve consists of a vertical axis (or Y-axis) typically voltage, current, charge or other measure of amplitude, and has a horizontal axis (or X-axis) of pulse duration (typically in milliseconds). Such a curve is a rapidly declining line, which decreases exponentially as the pulse width is increased. This curve is described on pp31 ff in The Third Decade of Pacing, by Barold and Mugica (1982) and also on pp 245 in The Biomedical Engineering Handbook” CRC Press, IEEE Press, Ed by J. D. Bronzino, (1995).
  • Various stimulation devices have been made and patented. The process of stimulation/ablation using a two-needle system is disclosed in U.S. Pat. No. 6,139,545 (Oct. 31, 2000). This process is described in reverse, where the area not desired for detection of ancillary tissue is treated with stimulation then ablation. The process is best described in U.S. Pat. No. 5,782,826 (issued Jul. 21, 1998).
  • The new method and device of this preferred embodiment also uses (among other potential methods of locating the tip of the electrode in proximity to the target nerve) stimulation, followed by ablation. In this process the energy is delivered via the single puncture MIS system (as later described). This unique technology and resulting device is a single needle that contains both electrodes. It will access the site via a single puncture and will be used with MIS surgical techniques. It will also have features that provide for placement and have substantial added benefits, which are described later in this document.
  • SUMMARY OF THE INVENTION
  • The primary aspect, of the present invention, is to provide a single-needle type puncture entry way for bi-polar electrodes for delivering RF energy near the nerve (to terminate signal flow), in a minimally invasive procedure. Other aspects of this invention will be apparent from the appended claims, descriptions and drawings that follow.
  • Important aspects of this invention include:
  • A visible probe tip illumination to aide in positioning;
  • A hollow lumen for delivery of medication, often, but not limited to, anesthetic;
  • Delivery of ionizing radiation, via laser, to probe tip for direct energy delivery;
  • Coordination of ionizing radiation and RF energy delivery;
  • Unique probe identification;
  • Prior usage detection to eliminate potential contamination or unauthorized re use;
  • Procedure power settings matched to probe internal identification;
  • Direct reading of ablation probe temperature and impedance;
  • Pre-stored arbitrary amplitude modulation envelopes with multi-frequency for controlled energy delivery;
  • Controlled metered energy delivery determines permanence;
  • Multi-frequency operation for optimal power delivery;
  • Dynamic impedance matching for optimal power delivery;
  • Integrated dielectric insulator as fiber optic for illumination, thus reducing diameter;
  • Auxiliary nerve locator probe;
  • Depth markings on auxiliary probe;
  • Auxiliary probe needle shaft insulation;
  • Dual needle tipped auxiliary probe;
  • Electronic guidance of ablation probe to auxiliary probe;
  • Electronic guidance measures and displays current proportional probe distances;
  • Electronic guidance variable frequency audio tone proportional to distance/sense current;
  • Electronic guidance variable amplitude audio tone proportional to distance/sense current;
  • Electronic guidance variable frequency/flash rate of ablation tip illumination proportional to distance/sense current;
  • Illumination of florescent-tagged marker;
  • Detection of florescent emission of tagged marker;
  • Simultaneous illumination of florescent-tagged marker and emission detection;
  • Simultaneous illumination of florescent-tagged marker by means of a tunable laser;
  • Integrated hollow biopsy electrode for florescent-tagged tumor sampling;
  • Integrated hollow electrode for medication delivery to tagged tumor;
  • Integrated hollow electrode for photo-medication delivery to tagged tumor with illumination activation source; and
  • Another aspect of the invention is a probe usage register to reduce or eliminate chance of patient cross contamination.
  • This invention is an improved device (and method for its use) that will allow the physician to terminate signal flow through nerves, in a minimally invasive manner, by requiring only a single-needle type puncture. Said method and device would allow for a reduced patient recovery time; the patient would be awake during the procedure; using only a local (or very little) anesthetic; have a substantially reduced risk of infection; less of a risk of intensive care (or hospital stay), and subsequently, a reduced associated costs. Inasmuch, the patient would more rapidly return to a normal lifestyle as compared to many procedures requiring open surgery.
  • This single-puncture device (hereafter called ‘single-pass’) presents an improvement over conventional uni-polar systems because it does not require a separate return electrode, which is attached to the patient at a remote site and subsequently must be maintained during the surgical procedure. Also, it represents an improvement over bi-polar electrodes and earlier two needle systems, because it concentrates the energy specifically at the desired location (by use of one active electrode) and when ablation areas need to be precisely focused this device may best accomplish that task.
  • The device (and the methods needed to operate it) can be used to terminate, stop or inhibit (on a temporary, semi-permanent or even permanent basis) the transmission of nerve signals to the muscles, organs and receivers of nerve signals, which convey activation, perception, pain signals or other nervous impulses. In the preferred embodiment, the active electrode (or the probe/needle tip) may be positioned by various guidance and/or sensing means. This includes (but is not limited to) ultrasound, traditional pace/sense (apply stimulating signals and observe placement of the electrode in proximity to the target nerve), manual palpitation, proper anatomical positioning, X-ray, CT, MRI, PET or other radiation or emission type imaging means, fiber-optic video, external location (and marking) and subsequent location by illuminating the probe tip or by other similar means.
  • In addition to the ‘single-pass’ needle, the complete system shall include an intelligent external energy generator, which can be used either by programmed or manual control. The manual control may be mitigated (or limited for the protection of the patient) by means of various sensors including (but not limited to) impedance (and the change in impedance), temperature (and the change in temperature), normal voltage (or current) regulation, etc. Said generator will generate RF energy in the frequency range of 50 Khz to 2.5 Mhz, in a controlled manner.
  • The generator will also be usable under program control. Said programming will deliver a predetermined “bolus” (or packet) of electrical energy, whereby the dose is adjustable (within limits) by the physician proportional to the desired effect. This bolus will be predetermined in clinical studies and may have preset parameters such as minimal effect, average effect, maximum effect, corresponding to a low, normal and high-output level. The output cycle will be activated by the physician via footswitch, a button on the probe itself, voice or other similar method of activation methods. When the bolus output is activated it may be terminated (at any time) by releasing activation means (i.e. the footswitch, button or the like). However, it will provide output no greater or longer than the activation device is held down, and will also be limited to the length of time and dosage preset. To deliver a second packet of energy, the activation mechanism must be released for (an internally set) time period before another packet of energy may be delivered. Also, because this technology may be used in various applications (e.g. plastic surgery, spinal nerves causing back pain, and other applications where terminating signal flows through nerves is desired) the delivery systems (i.e. single-pass needle or probe, and the generator required to power same) may be of differing sizes, surface areas or mechanical configurations. Some may even require a substantially different amount or type of energy packet. Program setting and preferences made be controlled for the different applications by providing a specific hand tool device that would then contain a coded circuit, connector or other means of providing identification to the generator so that it may deliver the required energy packets automatically for the different applications or methods.
  • The methods of ablation may include both a linear or circular zone. The effective ablation area may be modified by “laying down” a series of individual ablation zones, thus creating a line of ablated tissues. This would be possible by withdrawing, inserting, and/or moving the active tip while ablating in the successive zones, which would expanding the liner component of any lesion produced. In the alternative, the effective zone of ablation could be extended circumferentially by manipulating the tip during the ablation cycle in small circles, thereby mechanically moving the tip enlarging the effective zone of ablation.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 Bi-Polar Driver System
  • FIG. 2 Schematic diagram of the bi-polar needle
  • FIG. 2A Schematic diagram of the split bi-polar needle
  • FIG. 3A Magnified side view of conical bi-polar probe.
  • FIG. 3B Magnified side view of hollow chisel bi-polar probe.
  • FIG. 3C Magnified side view of tapered conical bi-polar probe.
  • FIG. 3D Magnified side view of split conical bi-polar probe.
  • FIG. 4 Schematic diagram of the bi-polar driver system
  • FIG. 5A Ablation Procedure without Auxiliary probe
  • FIG. 5B Ablation Procedure with Auxiliary probe
  • FIG. 6. Side view Hybrid bi-polar needle for nerve ablation.
  • FIG. 6A Side view Hybrid bi-polar needle for tumor ablation.
  • FIG. 7 Side view of auxiliary nerve probe.
  • FIG. 7A Side view of auxiliary dual-tipped nerve probe.
  • FIG. 8 Side view of guided ablation procedure with auxiliary nerve probe(s).
  • FIG. 9 Sample electro-surgery waveforms.
  • FIG. 10 Side view of visually guided ablation procedure.
  • FIGS. 11-11A Controller and probe data base structure
  • Defined below are the terms used here within:
  • Medical Terms
    • Corrugator supercili muscles—skeletal muscles of the forehead that produce brow depression and frowning
    • Cepressor anguli oris—skeletal muscle of the corner of the mouth that produces depression of the corner of the mouth
    • Depressor labii inferioris—skeletal muscle of the lower lip that causes the lip to evert and depress downward
    • Dystonias—medical condition describing an aberrant contraction of a skeletal muscle which is involuntary
    • Frontalis—skeletal muscle of the forehead that produces brow elevation or raising of the eyebrows
    • Hyperhidrosis—condition of excessive sweat production
    • Masseter—skeletal muscle of the jaw that produces jaw closure and clenching
    • Mentalis—skeletal muscle of the lower lip and chin which stabilizes lower lip position a
    • Orbicularis oculio—skeletal muscle of the eyelid area responsible for eyelid closure
    • Orbicularis ori—skeletal muscle of the mouth area responsible for closure and competency of the lips and mouth
    • Parasymapathetic—refers to one division of the autonomic nervous system
    • Platysma myoides—skeletal muscle of the neck that protects deeper structures of the neck
    • Platysma—same as above
    • Procerus muscles—skeletal muscle of the central forehead responsible for frowning and producing horizontal creasing along the nasofrontal area
    • Procerus—same as above
    • Rhinorrhea—excessive nasal mucous secretions
    • Supercilli—a portion of the corrugator muscle that sits above the eyelids
    • Temporalis—skeletal muscle of the jaw that stabilized the temporamandibular joint
    • Zygomaticus major—skeletal muscle of the face that produces smiling or creasing of the midface
      Electrical Terms
    • ADC: Analog to digital converter
    • ASCII: American standard of computer information interchange.
    • BAUD: Serial communication data rate in bits per second.
    • BYTE: Digital data 8-bits in length
    • CHARACTER: Symbol from the ASCII set.
    • CHECKSUM: Numerical sum of the data in a list.
    • CPU: Central processing unit.
    • EEPROM: Electronically erasable programmable read only memory.
    • FLASH MEMORY: Electrically alterable read only memory. (See EEPROM)
    • GUI: Graphical user interface.
    • HEXADECIMAL: Base 16 representation of integer numbers.
    • 12C BUS: Inter Integrated Circuit bus. Simple two-wire bi-directional serial bus developed by Philips for an independent communications path between embedded ICs on printed circuit boards and subsystems.
  • The I2C bus is used on and between system boards for internal system management and diagnostic functions.
    • INTERRUPT: Signal the computer to perform another task
    • PC: Personal computer.
    • PWM: Pulse-width modulation
    • ROM: Read only memory.
    • WORD: Digital data 16-bits in length
    DETAILED DESCRIPTION OF OVERALL OPERATION
  • This section provides information on the overall operation of this system. FIG. 1 has two main components and one optional component, which are the energy generator 400, the probe 371 (alternate probes are described in FIGS. 3A-D) and optionally probes 771 or 772 that may be used.
  • In normal operation, the novel probe 371 would combine a unique bipolar configuration in a single MIS needle, is inserted into the patient using MIS techniques. The probe, which may contain and/or convey various functions described later, is initially guided anatomically to the region of the anticipated or desired location. Various means of locating the tip 301 are utilized of placing the zone of ablation in the proper area to interrupt signal flows through the nerve 101.
  • DETAILED DESCRIPTION OF DEVICE OPERATION
  • This section refers to the drawings to describe use of the probe. There are many combinations of electrode diameters and tip shapes are possible. The ‘novel’ probe performs a variety of functions, such as stimulation, optical and electronic guidance, medication delivery, sample extraction, and controlled ablation. This bi-polar electrode is designed as a small diameter needle inserted from a single point of entry thus minimizing scaring and simplifying precise electrode placement. This low cost, compact design provides a new tool to the art.
  • Probes may emit fiber optic illumination for deep applications using electronic guidance as taught in FIGS. 1 and 8. The invention offers a simple low cost ablation probe that is capable of performing precise ablation while minimizing damage to nearby tissue structures. The metered ablation energy and precise probe targeting give the practitioner a tool is also not available in prior art. The practitioner has unprecedented control of treatment permanence in a minimally invasive procedure. Such a procedure is typically performed in less than one hour with only local anesthetic and would require no stitches or chemicals common to prior medical art.
  • Stimulation/Ablation
  • First the probe electrode 301 must be in the desired location relative to the target nerve 101 (FIG. 4), then the user initiates the treatment via switch(s) 410 and 310 using the selected power setting 404 (FIG. 4). The controller configures the generators 411 (FIG. 4) and 412 to the amplitude frequency and modulation envelope, delivering 50 KHz-2.5 MHz of 5 to 500 watts of available energy. The summing junction 413 combines the RF outputs as the application requires and passes them to the pulse-width modulator 415 for output power control. The output of modulation generator 420 is applied to the multiplier 415 with radio frequency RF signals 422 and 423. This permits complex energy profiles to be delivered to a time variant non-linear biologic load. All of these settings are based on the information provide to the generator by the installed probe 371 the selected power 404 settings, and the modulation envelope 420 (FIG. 4) settings, which are then loaded by the generator 421.
  • For example, both a high amplitude sine wave 910 (FIG. 9), used for cutting, and a pulse-width modulated (or PWM) sine wave 920, used for coagulation, are well known to electro-surgery art. Precise power rates and limits of average total power are controlled via integrator 435 minimizing damage to nearby structures or burning close to the skin for shallow procedures. Where nearby structures 111(FIG. 2A) are too close to be avoided by electrodes such as 371 (FIG. 3), 372 (FIG. 3A), and 372 (FIG. 3B), additional probe geometries as taught in FIGS. 3D, 6 and 6A offer novel methods to direct energy and limit ablation to a smaller region, thereby avoiding other structures. For safety a hardwired switch 436 disables the power amplifier in the event of a system fault, the probe is unplugged or over power condition, thus protecting both the patient and practitioner.
  • The output of the modulator 415 is applied to the input of the power amplifier 416 section. The power amplifier's 416 outputs are then feed into the impedance matching network 418, which provides dynamic controlled output to the biologic loads that are highly variable and non-linear, and require dynamic control of both power levels and impedance matching. The tuning of the matching network 418 is performed for optimal power transfer for the probe, power level, and treatment frequencies settled. The system's peak power is 500 watts for this disclosed embodiment. Precise control is established by the proximity of the tip and the control loops included in the generator itself The final energy envelope 420 is delivered to probe tip 301 and return electrodes 302.
  • This precise control of energy permits extension of the ablation region(s), 140 and 1203 (FIG. 10), and the duration of treatment efficiency. Low or medium energy settings 404 permit temporary nerve-conduction interruption for 3-6 months. Higher energy settings at 404 may result in a longer nerve conduction interruption of 1 year to permanent. In the prior art, procedures had little control over duration of termination of such signal flow through the nerve. This invention gives the practitioner enhanced control of such duration. Patients can evaluate controlled temporary treatment before choosing longer or permanent treatment options.
  • A low energy nerve stimulator 771 has been integrated into the system to assist in more precise identification of nearby structures and for highly accurate target location. Lastly, additional sensors, such as temperature 311, voltage, frequency, current and the like are read directly from the device and/or across the communications media 403 to the probe.
  • Directed Ablation
  • In addition to the substantial radially-symmetric ablation patterns with probes as taught in 371 (FIG. 3) and 372, switching or dividing ablation power to multiple electrodes (FIG. 3D) can generate a asymmetric ablation zone. This high intensity source 608 with probe 610 (FIGS. 6 and 6A) minimizes damage to nearby structures 111 or the burning of skin 330 in shallow procedures. Also, FIGS. 2A and 3D identifies probe configurations for selective or asymmetric ablation.
  • Power Feedback
  • The power amplifier output430 and buffered the feedback signals 437 are connected to an Analog to Digital converter (or ADC) 431 for processor analysis and control. Said signals 437 control power modulation 420 settings and impact the impedance matching control signals 419. This integrated power signal 437 is recorded to the operating-condition database (FIG. 11) for later procedure review. This power level is also compared to reading taken from the probe 1492 (FIG. 11A) as compared against procedure maximums, which if exceeded will in turn disable the amplifier output, thereby protecting the patient from error or equipment fault. Similarly, limits from the probe and generator sensors such as temperature 330 are also used to terminate or substantially reduce the modulated power levels and ultimately the procedure.
  • Probe Identification
  • At power startup, the controller 401(FIG. 4) reads the probe status and internal identification kept within the probe itself 331 (and 371) via serial communications 403 (or bus). Serial communications is used because it is commonly available to most single-chip microprocessors. This or similar methods (e.g. I2C, or SPI) may be used, but this disclosed embodiment will use serial for its simplicity. Serial communications 403 permits the generator to address and control EEROM memory 331, temperature sensors 330, processors, ADC and DACs within the single-chip microprocessor embedded in the probe itself The user selects the desired power setting 404 and based on probe identification read from the EEROM or microprocessor 331 makes the appropriate configurations. The probe 371 is connected via cable 1334 (FIG. 1) to control unit 101 or generator. This probe is not intended for multiple procedural use. So to prevent such use of the probe, the controller 401 (FIG. 4) reads the stored time register from ID memory module 331. If the probe's initialized time 1467 (FIG. 14) is zero, the current real-time clock 482 value is written to probe's 331's initial time register via serial bus 403. If time read on module 331 is non-zero, the probe's initial time register is added to two(2) times the procedural time (based on the probe type) FIG. 14 1420. If that value when compared to current real-time clock 482, is less than current time, the controller will alert the practitioner via display 450, speaker 451 and, flashing probe illumination 608, that the procedure will be terminated and the probe rendered invalid.
  • The controller 401 also verifies selected procedure 1415 (FIG. 11) for compatibility with installed probe. If incompatible, the user is also prompted to select a different power setting 404, procedure, or probe 371. If probe 371 matches power setting 404, the system enables power amplifier 416, guide light source 408, and low-voltage nerve simulation 732. Both of these procedures are enforced by a mandatory “hand shake” protocol and the serialized information, which must be present and properly verified by the electronic circuitry for a procedure to be instituted. During a clinical procedure, information is required to be conveyed by the embedded electronics contained within the probe, which provides another way of enforcing this protection and thus again preventing unauthorized re-use. The ultimate goal is prevent cross-contamination between patients. The probe will accomplish this by being unique, serialized, and given the above procedures. Once plugged in, the probe will enter the serial number into the data logging system via the serial bus 403 and circuit logic will thereafter prevent re-use of the probe and cross-contamination that would occur. Further, this scheme will prevent the use of unauthorized third party probes, for they will not be activated, preventing potential inferior or uncertified probes from being used and presenting potential danger to the patient.
  • Nerve Target Location Tools
  • Prior to treatment, the practitioner may use auxiliary probe 771(FIG. 4), to locate target 101 and nearby structures 111 as taught in FIGS. 4, 7, 7A, 8, and 10. When needle 771 is in place, the practitioner may locate and place a mark or marks on the surface of the skin 755 (see FIGS. 7 and 8) or leaves auxiliary probe 771 in place. For shallow sub-cutaneous procedures, probe tip illumination 448 from source 408 is visible to practitioner aiding in probe placement to pre-marked location.
  • Location Via Florescence Marker Dye
  • In other procedures, whereby somewhat larger targets are sought, such as more diffuse nerve structures or small areas of abnormal growth (e.g. such as cancer) the injection of specially designed dyes that attach to target structures are used, as taught in FIG. 6A. The probe 610 (FIG. 6) is moved into the proximity of the target 671. The light source 608 illuminates quantum-dot/dye tagged antibody 670. The dye fluoresces 675 at a frequency/wavelength of a particular material and will typically emit light in the visible to infrared (or IR) or potentially other wavelength regions. The return fiber(s) 680 deliver emissions 675 to the detector 478 for measurement and are the result is then displayed on bar graph 554 (FIG. 1) and/or an audio tone sounded via speaker 451 based on proximity. Visible and IR light emissions propagate over limited distances permitting additional external detectors 678 to be used for shallow targets just under the skin 330. Location via this method is similar to the electronically guided probe method taught in FIG. 8 where probe 610 movement maximizes the signal output when in close proximity. IR emissions propagate and can permit deeper (typically several centimeters) detection with optional additional external sensors 678. Unfortunately, many dyes fluoresce in the visible region making external detection imposable for deep targets or when obscured by bone. However, probe 610 (FIG. 6A) solves this problem by integrating target illumination 674, emission 675 detector, ablation, biopsy, and medication delivery in single compact probe. Electronic probe guidance (FIG. 8) if required is used in combination with florescence detection to rapidly locate target. The instant invention offers a minimally invasive system for locating and treating small/deep tumors and other tissue that are to be ablated, destroyed or removed.
  • Electronic Probe Guidance
  • Low energy nerve stimulation current 810 (FIG. 8) assist in locating desired treatment region and avoiding nearby structures. Probe 771 is selectable between nerve stimulator and current measurement to/from auxiliary probe tip 702(FIG. 8). Return electrode 736 provides a return path for local ground 735. Ablation probe switch 367 selects low-energy stimulator/receiver and high-energy ablation to/from probe 372. Amplitude of measured guidance current 811 and light 478 are transmitted to display 554, and audio feedback 452 through the speaker 451.
  • Optical Probe Guidance
  • Disclosed invention provides optical sources 408 that aid in probe placement (FIG. 10) by supplementing stimulation source 732 and acting as preliminary guide. Probe 771 is selectable between nerve stimulator or current 811 measurement and to or from the auxiliary probe tip 702. The ablation probe switch 367 selects low-energy stimulator/receiver or high-energy ablation to or from probe 371, 372, 373, and 374. In this mode, the physician operator will have previously placed marks 755 on the surface of the skin by various means described. The physician operator 775 will then see the tip when the 448 if the optical illumination is turned on. It 448 will provide a bright spot under the skin indicating the location of the tip in relation to the marks 755. The physician 775 will then guide the probe tip 301 into precise alignment under these marks 755 so as to enable ablation of that target tissue 101.
  • Data and Voice
  • Real-time engineering parameters are measured such as average power 437, luminous intensity 478, probe current 811, energy 438 and, temperature 330 to be recoded into USB memory 438. Simultaneously, the internal parameters disclosed such as frequency 423, modulation 420 and such are recoded into USB memory 438 as well. Additionally probe, patient, and procedure parameters (FIG. 11) are written to local storage 438. The practitioner dictates text and voice notes via microphone 455, which are saved to memory 438 (FIG. 1). All data and records are time stamped using the real-time clock 482. This permits detailed post procedure graphing and analysis.
  • Data Transfer
  • At procedure conclusion, the system transfers the data 438 recorded to the USB removable memory 1338 and to a file server(s) 1309 and 1307. In the disclosed embodiment, data transfer is performed over Ethernet connection 480. Probe usage records 1460(FIG. 11) that are stored in local memory 438 are then written to removable memory module 1338. Parallel records are mirrored to local storage 1309 and remote server 1306 storage 1307 via Ethernet connection 480 or similar means. Sensitive records are encrypted and transferred via secure network connection and also written to removable module 1320. The database contained on the remote server tracks the following information: equipment by manufacture, probe accessory inventory, usage, billing, repair/warranty exchange information, and program recorders. As a system 400 is certified for new procedures 1410 (FIG. 11), the relational databases are automatically updated to reflect new billing/procedure codes 1416, potential power settings 1417 and the like. This insures that the equipment is current and alerts the practitioner to new probes/procedures as they are developed and certified.
  • DETAILED DESCRIPTION OF THE DRAWINGS
  • Before explaining the disclosed embodiment of the present invention in detail, it is to be understood that the invention is not limited in its application or to the details of the particular arrangement shown. The invention is capable of other embodiments. Further, the terminology used herein is for the purpose of describing the probe and its operation. Each apparatus embodiment described herein has numerous equivalents.
  • FIG. 1 Bi-Polar Driver System
  • FIG. 1 identifies the two required components of the system, various modules and optional items. The two components always utilized during a procedure will be the energy generator/controller/data storage device 400 and probe 371. 400 contains advanced electronic systems capable of recognizing a properly authorized probe, preventing re use of a previously used probe, generating appropriate energy as described, performing safety checks, storing data, and other functions as described. Main functions of 400 may include, but not be limited to, generation of light, generation of location-stimulation currents, generation of ablation energies, data logging, storage, communication and retrieval, and other functions critical to a MIS procedure. Probe 371 and its various forms are single puncture bipolar surgical tools that may be used in identifying proper location of its tip 301, in relation to target tissue 101 which is desired to be ablated, modified or destroyed. Probe 771 and its various derivatives may optionally be used to assist in locating and properly positioning tip 301 of probe 371.
  • FIG. 2 Isometric View of the Bi-Polar Probe
  • Bi-polar probe 310 represents probes 371, 372, 373 shown in FIGS. 3A-C with exception to type of needlepoint on the probe. FIG. 3D varies from the other because it has a split return probe. Bi-polar probe 310 (not drawn to scale) consists of insulating dielectric body 309 made from a suitable biology inert material, such as Teflon, PTFE or other insulative material, covering electrode 302 except for where 302 is exposed as a return electrode. Conductive return electrode 302 tube is fabricated from medical grade stainless steel, titanium or other conductive material. Hollow or solid conductive tip electrode 301 protrudes from surrounding dielectric insulator 305. Sizes of 309, 302, 305, and 301 and its inner lumen (diameter, length, thickness, etc.) may be adjusted so as to allow for different surface areas resulting in specific current densities as required for specific therapeutic applications.
  • Hollow Electrode 301 often used as a syringe to deliver medication such as local anesthetic. Tip electrode 301 is connected to power amplifier 416 via impedance matching network 418 (FIG. 4). Return electrode(s) 302 delivers return current to power amplifier 416 via impedance matching network 418. Dielectric insulator in the disclosed embodiment is a transparent medical grade polycarbonate acting as a light pipe or fiber optic cable. Light source LED or laser 408 (FIG. 4) provides illumination at the far end of the probe via fiber optic cable/transparent dielectric 305 for guiding the probe under the skin i.e. shallow procedures. In an alternate embodiment dielectric insulator is replaced with a plurality of optical fibers for viewing and illumination as taught in FIG. 6.
  • Ablation regions 306 and 140 extend radially about electrode 301 generally following electric field lines. For procedures very close to skin 330 a chance of burning exists in region 306. To minimize the chance of burning, a split return electrode probe 374 in FIG. 3D is offered. Thereby concentrating the current away from region 306 to 140 or vice versa. In FIG. 2A, insulator 307 splits the return electrode into two sections 302 and 303, dividing return current ratio from 0-50%, which may also be selectively activated. Active electrodes are also split into two sections 301 and 311 so energy may be directed in a desired direction. This electrode configuration is identified on the proximal portion of the probe so the operator may position the needle and electrodes accordingly. FIG. 6 teaches a laser directed ablation for more precise energy delivery.
  • FIG. 2A Isometric View of Split Bi-Polar Probe.
  • The bi-polar probe 380 (not drawn to scale) consists of an insulating dielectric body 309 made from a suitable biologically inert material, such as Teflon PTFE or other electrical insulation, that covers split return electrodes 302 and 303. The disclosed conductive return electrodes 302 and 303 are fabricated from medical grade stainless steel, titanium or other electrically conductive material. Hollow or solid split conductive tip electrodes 301 and 311 protrude from the surrounding dielectric insulator 305. The operation of the hollow/split conductive tip is very similar to probe tip 310 as taught in FIG. 3D. Ablation regions 1203 (FIG. 10) and 140-144 extend radially about electrode 301 generally following electric field lines. For procedures very close to skin 330 a chance of burning exists in region 306. To minimize chance of burning a split return electrode probe 311 is used, thereby concentrating the current away from region 306 to 140. For procedures where there is a risk to nearby structures 111, the ablation region 1203 must be a non-radial ablation zone. The disclosed split electrode 380 permits dividing or splitting energy delivered to electrode pairs 301/302 and 311/303. The disclosed division or ratio between pairs is 0-100%. Dual amplifiers or time multiplexing/switching main amplifier, 416 located between electrode pairs, directs energy to target 101 avoiding 111. This simple switch network reliably ratios electrical energy while minimizing damage to nearby structures.
  • FIG. 3A Conical Bi-Polar Needle
  • Bi-polar probe 371 discloses conical shaped electrode 301 and tip 351 for minimally invasive single point entry. Probe diameter 358 is similar to a 20-gage or other small gauge syringe needle, but may be larger or smaller depending on the application, surface area required and depth of penetration necessary. In disclosed embodiment, electrode shaft 302 is 30 mm long with approximately 5 mm not insulated. Lengths and surface areas of both may be modified to meet various applications such as in cosmetic surgery or in elimination of back pain. The conductive return electrode 302 is fabricated from medical grade stainless steel, titanium or other conductive material. The dielectric insulator 305 in the disclosed embodiment is a transparent medical grade material such as polycarbonate, which may double as a light pipe or fiber optic cable. The high intensity light source 408 LED/laser (FIG. 4) provides guidance Illumination 448 at working end of probe. The illumination source modulation/flash rate is proportional to the received stimulation current 810 as taught in FIG. 8. A small diameter electrode permits a minimally invasive procedure that is typically performed with local anesthetic. This configuration may contain lumens for delivery of agents as described elsewhere.
  • FIG. 3B Hollow Chisel
  • The hollow chisel electrode 352 is often used as a syringe to deliver medication such as local anesthetic, medications,/tracer dye. The hollow electrode may also extract a sample. Dielectric insulator 305 in the disclosed embodiment is a transparent medical grade polycarbonate and performs as a light pipe or fiber optic cable. The novel dual-purpose dielectric reduces probe diameter and manufacturing costs. Light source 408, typically a LED or laser (FIG. 4 not shown), provides Illumination 448 at the working end of probe. It provides an illumination source for guiding the probe under the skin. A second embodiment, as taught in FIG. 6, dielectric insulator is replaced/combined with plurality of optical fibers for viewing/illumination.
  • FIG. 3C Tapered Conical
  • The bi-polar probe 373 discloses a tapered conical shaped probe for minimally invasive single point entry. It is constructed similarly to probe 371 as taught in FIG. 3A. Probe tip is not drawn to scale to teach the tip geometry. In disclosed embodiment, electrode 301 is approximately 5 mm long and fabricated from medical grade stainless steel but may be of various lengths to accommodate specific application and surface area requirements. The solid tapered conductive tip electrode 353 protrudes from tapered dielectric insulator 305. Transparent dielectric insulator 305 also performs as light pipe or fiber optic cable terminated to high intensity light source 408 (FIG. 4) providing illumination 448. The electrode assembly is mounted in an ergonomic handle 388 (which has not been drawn to scale). Handle 388 holds ablation on/off switch 310, ablation/stimulation mode switch 367, identification module 331 and terminations for cable 1334 (FIG. 13). Temperature sensor 330 (located close to tip) monitors tissue temperature.
  • FIG. 3D Split Conical Bi-Polar Probe
  • Description of this probe is described in both drawings 2A and 3D. Bi-polar probe 374 (not drawn to scale) consists of insulating dielectric body 309 made from a suitable biologically inert material, such as Teflon, that covers split return electrodes 302 and 303. Conductive return electrodes 302 are fabricated from medical grade stainless steel, titanium or other suitable conductive material. Hollow or solid split conductive tip electrodes 301 and 311 protrude from surrounding dielectric insulator 305. Their operation is very similar to probe tip 380 as taught in FIG. 2A. Solid tapered conductive tip electrodes 311 and 301 protrude from transparent dielectric insulator 305. Dielectric insulator 305 also performs as a light pipe or fiber optic cable terminated to high intensity light source 408 providing illumination 448.
  • Probe handle (not drawn to scale) encloses memory module 331, on/off switch 310 and mode switch 367. Temperature sensor 330 (located close to tip) monitors tissue temperature. Split electrode 380 (FIG. 2A) permits dividing or splitting energy delivered to electrode pairs 301/302 and 311/303. Dual amplifiers or time multiplexing/switching main amplifier 416 are located between electrode pairs directing energy to target 101 avoiding 111 creating asymmetric ablation volume. A small diameter electrode needle is injected from a single point of entry minimizing scaring and simplifying precise electrode placement.
  • Connections consist of a tapered dielectric sleeve 309 covering the ridged stainless electrode tube 302. Insulating sleeve 309 is made from a suitable biologically inert material, which covers electrode 302. Dielectric 305 insulates conical tipped electrodes 351 and 301.
  • FIG. 4A Schematic Diagram of the Bi-Polar Driver System.
  • See section Detailed Description of Device Operation.
  • FIG. 5A Ablation Procedure (Without Auxiliary Probes)
  • Ablation probe 371 is inserted and directed anatomically into the area where the target nerve to be ablated (Box 531) is located. Test current 811 is applied (Box 532). If probe is located in the immediate proximity of the target nerve a physiological reaction will be detected/observed (Example: During elimination of glabellar furrowing, muscle stimulation of the forehead will be observed). If reaction is observed, then a mark may optionally be applied on the surface of the skin to locate the area of the nerve. Power is applied (Box 535) in an attempt to ablate the nerve. If physiological reaction is not observed, (Box 534) the probe will be relocated closer to the target nerve and the stimulation test will be repeated (Box 536 & 537). If no physiological reaction is observed, the procedure may be terminated (Box 544). Also, the probe may be moved in any direction, up, down, near, far, circular, in a pattern, etc. to create a larger area of ablation for a more permanent result.
  • In Box 537, if stimulation is observed again, then the ablation power may be set higher (Box 538), alternatively, as mentioned, the needle may be moved in various directions, or a larger dosage of energy may be reapplied, to form a larger area of ablation for more effective or permanent termination of signal conduction through the nerve. After delivery of power (Box 540), stimulation energy may be applied again (Box 541). If there is no stimulation, the procedure is completed (Box 544). If there is still signal flow through the nerve (stimulation or physiological reaction) then the probe may be relocated (Box 542) and the procedure is started over again (Box 533).
  • FIG. 5B Flow Chart of Visually Guided Ablation Procedure Using Auxiliary Probes Such As 771 and 772.
  • Auxiliary probes 771 and 772 (FIGS. 7 and 7A) provide a method to quickly and accurately locate target structure 101 and subsequently mark target location 755. Auxiliary probes may be much smaller (like acupuncture needles) than ablation probes. Structures are marked typically with an ink or similar pen allowing the illuminated ablation probe 371 or other ablation probe to be quickly guided to mark 755. Optionally, non-illuminated probes may be used allowing the practitioner to simply feel for the probe tip. For deep structures, probe 771(FIG. 8) us employed as an electronic beacon. Small current 811, which is similar to the stimulation current but smaller, from probe tip 702 is used to guide ablation probe 372 (FIG. 8)
  • Operation 530 (FIG.5B) inserts auxiliary probe 771 or 772 (FIGS. 7 and 7A) thru skin 330 and muscle layer(s) 710 near nerve 101. Target 101 depth 766 is measured (FIGS. 7 and 7A) using auxiliary probe markings 765. Decision 533 checks if the probe is in position if not adjustments are performed in 534. Operation 532 enables nerve simulation current 811. When muscle stimulation is obtained or physiological reaction is obtained, Auxiliary probe tip is in place. Depth may be noted by reading marks 765 and location marks 755 may be made in operation 535. With the probe in position under mark in operations 536 and 537, operation 538 sets power level 404 and closes ablation switch 410. Alternatively, stimulation may be applied directly from the ablation probe as taught elsewhere. Operation 540 and controller 401 set generator 411 (FIG. 4) frequencies, modulation 420 envelope and enables power amplifier 416 to deliver preset ablation energy. Region 1203 (FIG. 10) shows the general shape of the ablation region for conical tip 301 for example.
  • Between each ablation, procedure 540 (FIG. 5C) (nerve conduction) is tested in 541. Probe amplifier 416 delivers small nerve stimulation current 811 from electrode 301 or Auxiliary probe 771 or both. Based on the nerve conduction test 541 if the desired level of conduction is achieved the procedure is compete. Operation 542 moves the probe to the next position and repeats conduction test 541. If compete, the probe(s) is removed in operation 544. Number and ablation intensity/energy are set by the particular procedure and the desired permanence. The practitioner selects the procedure/power level 404 (FIG. 4) and controller 401 compares the installed probe via identification 331 (FIG. 4) for compatibility with selected procedure. The practitioner is alerted if the installed probe is incompatible with selected power range 404.
  • As an example and not a limitation, five ablation regions (140, 141, 142, 143, and 144) are shown in FIG. 10. Ablation starts with area 144, then the probe is moved to 143 and so on to 140. Alternatively, movement may be during insertion, moved laterally, in a circular manner or other manner to enlarge the area of targeted nerve destruction. Nerve responses may be tested after each ablation allowing the practitioner to immediately check the level of nerve conduction. Probe position and power adjustments are made before applying additional ablations if required. Accurate probe location tools and methods taught herein permit use of minimal ablation energy thereby minimizing damage to non-target structures. This translates to reduced healing time and minimal patient discomfort. The instant invention gives the practitioner a new tool to perform a minimally invasive nerve conduction limiting procedure with the ability to select, temporary or permanent nerve conduction interruption with a new level of confidence. This new tool offers a low cost procedure performed typically in office or outpatient setting often taking less than one hour with local anesthetic. In contrast to prior art where surgical procedures require stitches and longer healing intervals with limited control of permanence (nerve re-growth).
  • FIG. 6 Side View of the Bi-Polar Probe 610 With Enhanced Laser Targeting.
  • Probe insertion and placement is same as taught in FIG. 3. Probe construction is the same as FIG. 3 with the dielectric 305 having embedded optical fibers 690 and 680 providing imaging/illumination. Additional fiber(s) 690-691 are illuminated by a high intensity laser source.
  • In special cases were target nerve 101 or ablation region 640 is in close proximity to second nerve 111 or skin 330 bi-polar probes 371 or 372 (FIG. 3) create an annular ablation region between electrodes 301 and/or 302, potentially damaging nearby structures such as other nerves 111. With probe 610 in the desired position, laser 608 (FIG. 4) is turned on target 670 (FIG. 6A) with illuminating fiber(s) 690. Fiber(s) transmitting high intensity laser light to ionized region 640 is illuminated by fiber(s) 690. Simultaneous with laser illumination, RF energy 470 is delivered to electrodes 301 and 302. A relatively low impedance path is created by the high intensity laser illumination wherein RF energy will follow this newly created path. Thus very specific regions may be selected for ablation. By permitting operation at a lower power, energy is concentrated where it is needed and eliminates or reduces damage to nearby structures such as skin 330 or nerves 111. Probe 610 improves on the already very precise ablation taught in FIG. 3 with the addition of a low power laser (or other type light source) and fiber delivery system. In the disclosed embodiment a diode pumped Nd:YAG (Neodymium Doped Yttrium Aluminum Garnet) laser is offered as an example and not a limitation.
  • FIG. 6A Side View is the Florescence Emission Guided Hybrid Bi-Polar Tumor Probe.
  • Probe construction is similar to FIGS. 3A and 6 with dielectric 305 embedded with a plurality of optical fibers 380, 690, and 680 for illumination detection/imaging. These enhanced systems and processed augments the selective nature of previously disclosed probes. Fiber(s) 690-691 are illuminated by a high intensity light source(s) 608 which is typically a tunable laser or UV LED. Source(s) 608 (FIG. 4) provides illumination for tagged marker(s) 670 in the disclose embodiment where a tunable laser is employed. Excitation/illumination wavelength(s) are specific to the dye/nano-particle used with marker 670 that is very specific for the desired target 671. The marker/tag is typically a protein specific antigen combined with a florescent marker. The novel probe illumination permits delivery of intense illumination to the target for maximum system sensitivity. Many dyes excited by short (Blue/UV) wavelength light are transmitted poorly in tissue but are easily delivered by fiber 690. A second application offered for hybrid bi-polar ablation probe 610 is for locating/destroying small cancer lesions. The probe addresses cases where surgery is not practical or it dangerous due to location or sub-operable size. Quantum-dot or dye tagged antibody materials 670 are injected into the patients where it attaches to target structure 671. Once tagged, cancer node(s) may be located, tested, and treated.
  • FIG. 7 Side View of Auxiliary Single Tipped Nerve Probe
  • This probe may be used in conjunction with any of the therapeutic probes 371 and their derivatives. The needle itself will be very fine in nature, such as an acupuncture type needle. By its small size, numerous needle insertions may be accomplished with no scarring and minimal pain. The probe 771 will be inserted in the vicinity of the target tissue through skin 330. The exposed tip of 771, 702 will be exposed and electrically connected to generator 732 via wire 734. The surface of probe 771 is covered with dielectric 704 so the only exposed electrical contact is surface 702 and return electrode 736. Exposed tip 702 will be advanced to the vicinity of target 101 and test stimulation current will be applied. Appropriate physiological reaction will be observed and when the tip 702 is properly located, depth will be noted via observing marks 765. External mark 755 may be applied for reference. Ablation probe 371 may then be advanced to the proximity of the target tissue under the X mark 755 and ablation/nerve destruction as described elsewhere may be performed.
  • FIG. 7A Side View of Auxiliary Dual-Tipped Nerve Probe.
  • Dual tipped probe 772 offers an additional embodiment that eliminates return electrode pad 736. Probe frame/handle 739 holds two fine needles, 702 and 701, in the disclosed embodiment that are spaced a short distance (a few mm)-mm apart (730). The shaft of conductive needle 701 is covered with dielectric insulator 706, similar to the construction of probe 771 (FIG. 7). The shaft of the second conductive needle 702 is covered with dielectric insulator sleeve 703. Electric generator 732 provides current to the probes via conductors 734 and 735. Current originates from 701 and returns via electrode 702. Large probe handle 739 is drawn out to teach the dual probes. To aide in probe depth measurement, markers 765 are printed on needle shafts. Dielectric insulating sleeves 703 and 706 isolate the needle shaft current from muscle layer 710. Current applied via generator 732 stimulates the nerve directly while avoiding muscle 710. Smaller probe tips with smaller current permits accurately locating small structures.
  • Probes 702 and 701 are very small gage needles similar in size to common acupuncture needles, thus permitting repeated probing with minimal discomfort, bleeding, and insertion force. Sharp probes are inserted thru skin 330 and muscle layer(s) 710 near nerve 101. The practitioner locates target nerve 101, then the skin surface may be marked 755 as location aide for ablation step as shown in flow chart (FIG. 5B). Once the desired site of ablation is located, ablation probe(s) 610(FIG. 6), 371 and related probes (FIG. 3), may be inserted under skin 330, illuminated 448 by tip 305. They are visible through skin (via illumination 448 from tip 305) and are guided to mark 755 (FIG. 8). The observed intensity 765 from illumination source 305 is used as an estimator of measured depth 765. This simple probe system permits rapid, accurate locating of target structures with minimal pain and injury. Accurate target location permits use of lower ablation energy thereby minimizing damage to nearby structures.
  • FIG. 8 Side View of Guided Ablation Procedure With Auxiliary Nerve Probe(s).
  • Auxiliary probes 771 and 772 (FIGS. 7 and 7A) are used to accurately locate target structure 101. Probe 771 holds a fine conductive needle 702 that has a shaft covered with dielectric insulator 704. Electric generator 732 provides a small current to the auxiliary probe via conductor 734 and return conductor 735 via return electrode 736. The sharp auxiliary probe is inserted thru skin 330 and muscle layer(s) 710 near target nerve 101. Dielectric insulating sleeve 704 isolates needle shaft from muscle layer 710. Current is applied via generator 732 thereby stimulating the nerve directly while avoiding muscles 710. Prior art probes without insulating sleeve 704 stimulate both the nerve and muscle simultaneously, masking nerve 101 and subsequently making nerve location difficult.
  • Auxiliary probe 771 and 772 provide a method to quickly locate shallow or deep target structures. Shallow structures are typically marked with ink pen allowing illuminated ablation probe 371 or its equivalents to be quickly guided to mark 755. Optionally, non-illuminated probes may be used by the practitioner who simply feels for the probe tip. For deep structures, probe 771 may also be employed as an electronic beacon; small current 811 (which will be lower intensity and different from the stimulating current) from probe tip 702 is used to guide ablation probe 372. Amplifier 430 (FIG. 4) detects current from tip electrode 301 for reading and displays it by controller 401. Alternately probe 701 is used as a receiver detecting current 811 from electrode 301 Moving probe tip 301 horizontally 1202 and in depth 766 relative to auxiliary probe 702 changes current 810 inversely proportional to distance. Detected signal current 811 isolated and buffered by amplifier 430, is measured and the current is displayed to simple bar graph 554 for rapid reading. In addition, audio feedback, in which the tone is modulated by proximity of probe tip 351, 352 or equivalent in relation to auxiliary probe tip 702 is provided to minimize or eliminate the practitioner having to look away from the needle, thus assisting in accurate probe placement. Variable frequency/pitch and volume audio signal are proportional to sensed current 811 that is generated by 452. The tone signal emitted by speaker 451 (FIGS. 4 and 1) provides a pleasant and accurate method to aide in probe placement. Simultaneously, illumination source 408 is modulated by amplifier 456 to blink at a rate proportional to the sensed current. This permits the practitioner to quickly and accuracy guide ablation probe 372 into position using a combination of audio and visual guides. The audio and visual aides also reduce the practitioner's training/learning time. The novel real-time probe placement feedback gives the practitioner confidence that the system is working correctly so he/she can concentrate on the delicate procedure. Accurate probe location permits use of minimal energy during ablation, minimizing damage to non-target structures and reducing healing time and patient discomfort.
  • FIG. 9 A High-Energy Electro-Surgery Sinusoid Cutting Waveform 910.
  • Lower energy pulse width modulated (or PWM) sinusoid 920 for coagulation is also well known to electro-surgery art. Variations of cut followed by coagulation are also well known.
  • FIG. 10 Side View of Visually Guided Ablation Procedure.
  • Auxiliary probes 771 and 772 (FIGS. 7 and 7A) have accurately located target structure 101 and subsequently marked target locations 140 to 144. Shallow structures are marked typically with ink pen (755) allowing illuminated ablation probe 371, 372 or equivalent to be quickly guided to that point. For deep structures, probe 771 is employed as electronic beacon, small current 811 from probe tip 702 is used to guide ablation probe 372 as taught in FIG. 8.
  • Ablation probe 372 is inserted thru skin 330 and muscle layer(s) 710 near nerve 101. Illumination source 408 permits practitioner to quickly and accuracy guide illuminated 448 ablation probe 372 into position. Illumination 448 from ablation probe as seen by practitioner 775 is used as an additional aide in depth estimation. Selectable nerve simulation current 811 aids nerve 101 location within region 1204. This novel probe placement system gives practitioner confidence system is working correctly so s/he can concentrate on the delicate procedure. Accurate probe location permits use of minimal energy during ablation, minimizing damage to non-target structures and reducing healing time and patient discomfort.
  • Region 1203 shows the general shape of the ablation region for conical tip 301. Tip 301 is positioned in close proximity to target nerve 101. Ablation generally requires one or a series of localized ablations. Number and ablation intensity/energy are set by the particular procedure and the desired permanence.
  • Five ablation regions are illustrated 140, 141, 142, 143, and 144; however, there could be more or less regions. Ablation starts with area 144, then the probe is moved to 143 and so on to 140, conversely, ablations could start at 140 and progress to 144. Also, the practitioner could perform rotating motions, thus further increasing the areas of ablation and permanence of the procedure. Between each ablation procedure 540 (FIG. 5C), a small nerve stimulation test current 811 is emitted from electrode 301. The approximate effective range of the nerve stimulation current 811 is shown by 1204. Testing nerve response after each ablation allows the practitioner to immediately check level of nerve conduction. Without probe 372 removal, the practitioner receives immediate feedback as to the quality of the ablation. Then minor probe position adjustments are made before conducting additional ablations (if required).
  • FIG. 11-11A Controller and Probe Data Base Structure
  • Controller 101 maintains local probe 1460, patient 1430, and procedure 1410 databases. All work together to insure correct probes and settings are used for the desired procedure. Automatically verifying that the attached probe matches selected procedure and verifying probe authentication and usage to avoid patient cross contamination or use of unauthorized probes. Automatic probe inventory control quickly and accurately transfers procedure results to the billing system.
  • FIG. 11—Procedure Parameters Code(s) Database 1410
  • From a touch screen, the practitioner selects the desired procedure from list 1410. For example “TEMPORARY NERVE CONDUCTION” 1411, “SMALL TUMOR 1CC” 1412, and “SMALL NERVE ABLATE” 1413 are a few of the choices. Each procedure has a unique procedure code 1416 to be used in the billing system. Power range parameter 1417 is a recommended power setting via power level control 404. The recommended probe(s) Associated with procedure 1415 and power range parameter 1417 are listed in parameters 1419. With the probe connected, the part number is read from memory 331 (FIGS. 1, 3 and 4) and compared to list 1419. The total power parameter 1418 is the maximum energy that the system may deliver for this procedure and is determined by the procedure code, probe being used and software parameters. These parameters may be modified, updated and changed as required by addition of new probes and procedures allowed/approved. Power is delivered, measured and totaled with integrator 435 (FIG. 4). The power integration circuit is designed as a hardwired redundant safety circuit that turns off the power amplifier if maximum energy is exceeded. This novel feature protects patients from system fault or practitioner error. Standard procedure time 1420 is doubled and added to current RTC 482 then written to probe memory 331 (in FIG. 1).
  • FIG. 11 & 11A—Probe Usage Authorization Database 1460
  • From touch screen 450 (FIGS. 1 and 4) practitioner selects desired procedure from list 1410. Probe 371 and equivalents (FIGS. 3A-D) type is selected from recommended list 1419 and is connected via cable 1334 (FIG. 1) to control unit 101. Once connected, controller 401 (FIG. 4) reads the stored time register from ID memory module 331 (FIG. 1). If start time 1487 read is zero (factory default), current real time clock 482 (FIG. 4) is written to database 1460 in the start time field 1467, 1430 and 1435. Simultaneously, twice the standard procedure time 1420 parameter is added to RTC 482 and written to time register 1487 via serial bus 403. If probe start time 1487 reads (331) non-zero, the value compared to real time clock 482. If greater than current time plus twice the standard selected procedure duration 1420, the controller alerts the practitioner via display 450, speaker 451 and flashing probe illumination 608 of previously probe used condition. To correct the situation, the practitioner simply connects a new sterile probe and repeats the above process. FIG. 13 teaches additional detail regarding probe verification usage and related database operations. Periodically controller 401 performs the above verification to alert practitioner that he/she has forgotten to change probe(s).
  • During the procedure (FIG. 10), various parameters such as peak temperature 1473, power 1472, impedance, etc. . . . are read, scaled, stored and displayed. Parameters such as procedure start 1467; end time 1468, serial number 1469, and part number 1468 are recorded as well. Critical parameters are written to local high-speed memory 438 for display and analysis. On a time permitting or end of procedure, data is mirrored to removable USB 1320 memory stick 1338. Probe specific parameters 1463 are copied and written to probe memory 1338 for use at probe refurbishment facility. Database checksum/CRC(s) 1449, 1479, and 1499 are check and updated as required. Faults such as shorts (dielectric 305 (FIG. 3) breakdown) that are detected are saved to error field 1494 and 1474. If network connection 1305 is available, email request for replacement probe are automatically sent to repair/customer service center 1308. Defective probe 374 with saved failure information 1494 is returned for credit and repair.
  • Use of a USB memory stick permits continued operation in the event of a network 1326 failure Data is loaded to memory 1338 for simple transfer to office computer 1306 (FIG. 1) for backup. Commonly available USB memory sticks 1320 have large data capacities in the tens to hundreds of megabytes at a low cost with long retention times. USB memory sticks also can support data encryption for secure transfer of patient data. Sealed versions are available as well compatible with chemical sterilization procedures.
  • If computer network 1326 such as Ethernet 802.11 or wireless 802.11x is available, files are mirrored to local storage 1309, remote server 1307. The remote server (typically maintained by equipment manufacture) can be remotely update procedure(s). To insure data integrity and system reliability a high availability database engine made by Birdstep of Americas Birdstep technology, Inc 2101 Fourth Ave. Suite 2000, Seattle Wash. is offered as an example. The Birdstep database supports distributed backups, extensive fault and error recovery while requiring minimal system resources.
  • FIG. 11—Patient/Procedure Database 1430
  • From a touch screen, the practitioner selects or enters patient name from previous procedure 1430 and creates a new record 1433. Similarly, a procedure is selected from 1410 (for example “TEMPORARY NERVE CONDUCTION” 1411, “SMALL TUMOR 1CC” 1412, and “SMALL NERVE ABLATE” 1413). Each procedure has a unique procedure code 1416 that is used for the billing system. Other information such as practitioners name 1440, date 1435 is entered to record 1433. As taught above probe appropriate for the procedure is connected and verified, part 1470 and serial number 1469 recorded.
  • FIG. 11—Voice and Notes
  • The practitioner enters additional text notes to file 1442 or records them with microphone 455 (FIG. 5) to wave file 1445 for later playback or transcription. The instant invention permits temporary/permanent nerve conduction interruption. Thus, procedures are performed at intervals from months to years apart. A hands free integrated voice recorder is extremely useful. Detailed text and voice notes made while probing/ablating are also recording specific settings, and patient response. A feature that is very helpful when reviewing treatment progress and saves valuable time instead of writing notes. Practitioners play back voice/wave files 1445 with standard audio tools a his/or hers desk. Audio files 1445 can be sent via email or file transfer for transcription, updating note field 1442.
  • At the end of procedure, records are updated and stored to memory 438. Backup copies are written to USB 1320 memory stick 1338 (FIG. 1). If computer network 1326 such as Ethernet 802.11 or wireless 802.11x is available, files are mirrored to local storage 1309, remote server 1307. Patient name 1436, procedure date 1435, and procedure codes 1416 are automatically transferred via network or USB device 1320 to billing system 1306. USB memory stick permits continued operation in the event of a network 1326 failure. Data is loaded to USB memory 1338 for simple transfer to office computer 1306 (FIG. 1) for backup. USB memory sticks 1320 have large data capacities in the tens to hundreds of megabytes at a low cost with long retention times. USB memory stick also support data encryption for secure transfer of patient data. Insuring patient is accurately billed with minimal office paper work. Probe inventory is automatic maintained with replacement probes automatic shipped as needed.

Claims (14)

1) A System for Minimally Invasive Surgery comprising:
a. an electrically isolated RF Energy Generator, that delivers up to 500 watts of RF energy in amplitude or frequency modulated form with a frequency between 50 Khz and 2.5 Mhz;
b. a single-needle bi- or multi-polar probe that requires but a single puncture entranceway and has electrodes in close proximity to the extent necessary to promote precision within the procedure itself; and
c. a secondary means to locate and position said single-needle probe by illumination, the creation of electrical signal or signals, or by use of florescent dye.
2) A generator as described in claim #1 that delivers RF energy regulate-able intelligently by use of dynamic load detection measuring the effective load-by voltage, current, phase or varying frequency comprising:
a. connection to the probe;
b. connection to the probe's internal microcontroller for memory and sensor reading and writing if any, and to retrieve procedural, control sequence and limitations that are in turn used for that probe's specific procedure;
c. display and sound as required for surgical functionality;
d. memory storage for record keeping of procedural information related to the operating parameters, date, time, sensor measurements taken, and voice or data recording; and
e. connection to a communication channel such as RS-232, RS485, Ethernet, Bluetooth, or any other viable communication media.
3) A single needle two electrode probe used in a bi- or multi-polar configuration for Minimally Invasive Surgery comprising:
a. an inner diameter electrode made of surgical grade metal of a size and shape dictated by the application requirement;
b. a voltage insulator that covers and creates an electrical isolation between the two exposed electrodes; and
c. an Outer-sleeve return-electrode made of a surgical grade metal with surface area greater than that necessary to eliminate burning of the tissue in contact;
4) A single needle multiple electrode probe used in a multi-polar configuration for Minimally Invasive Surgery comprising:
a. an inner diameter electrode made of surgical grade metal of a size and shape dictated by the application requirement;
b. a voltage insulator that covers and creates an electrical isolation between the two exposed electrodes; and
c. an Outer-sleeve return-electrode made of a surgical grade metal with surface area greater than that necessary to eliminate burning of the tissue in contact;
5) A single needle probe as in claim #3 or #4 with a inner diameter electrode hollow such that injections of medications, florescent dyes and the like can be made and samples of the surrounding tissue can be taken.
6) A single needle probe as in claims #3, #4, or #5 that communicates, to the generator, information related to the procedure, measurements of sensors embedded within the probe and probe specific information.
7) A single needle probe as in claim #3, #4, #5 or #6 with an electrical isolator that is capable of illuminating the area so that placement of the probe can be facilitated;
8) A method for ablating tissues or terminating the flow of nerve impulses utilizing a single puncture probe introduced via a Minimally Invasive surgical techniques comprising:
a. locating probe tip in close proximity to said nerve or target tissue with a needle type probe having an exposed active area or areas on or near the distal tip, said probe and system to generate RF energy so as to ablate, destroy tissue or render nerve conduction through said nerves impossible on either semi permanent or permanent basis;
b. placing said probe tip in position so that ablative energy may be selectively delivered to target tissue thus avoiding destruction or areas and tissues that must remain intact and not be destroyed or traumatized; and
c. delivering RF energy from a tuned RF source so as to destroy target tissues in close proximity to electrode(s) at tip.
9) A method as in claim #7 wherein guidance between auxiliary probes and ablation probes is provided via current signals, illumination or other means.
10) A method as in claim #7 wherein positioning involves placing tip of the probe in desired general area using physiologic and anatomic landmarks with manual guidance.
11) A method as in claim #7 wherein precise positioning is done using illumination from tip region of probe so operator can see exact location of tip through the skin and other intervening structures.
12) A method as in claim #7 whereby the therapeutic probe is guided in to general area desired and then directed precisely under surface marking by observing the location of illumination point emanating from tip of probe.
13) A method as in claim #7 wherein auxiliary probes are inserted into vicinity of target tissues, stimulation energy is applied from the auxiliary probes, location is determined, and the target area is identified by marking the tissue or other means.
14) A method as in claim #7 wherein nerve, muscle, or physiologic reaction is observed by applying stimulation currents from ablative tip(s), thus confirming proper location of tip in relation to target tissue(s).
US10/870,202 2004-06-17 2004-06-17 Ablation apparatus and system to limit nerve conduction Abandoned US20050283148A1 (en)

Priority Applications (20)

Application Number Priority Date Filing Date Title
US10/870,202 US20050283148A1 (en) 2004-06-17 2004-06-17 Ablation apparatus and system to limit nerve conduction
MXPA06014889A MXPA06014889A (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction.
EP05790717A EP1769320A2 (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction
CNA2005800197502A CN1981256A (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction
ZA200610576A ZA200610576B (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve condition
KR1020077001231A KR20070047762A (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction
RU2006144073/14A RU2006144073A (en) 2004-06-17 2005-06-14 DEVICE FOR CARRYING OUT ABLATION AND NERVO CONDUCTIVITY RESTRICTION SYSTEM
PCT/US2005/021023 WO2006009705A2 (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction
CA002570911A CA2570911A1 (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction
AU2005264967A AU2005264967A1 (en) 2004-06-17 2005-06-14 Ablation apparatus and system to limit nerve conduction
BRPI0512233-3A BRPI0512233A (en) 2004-06-17 2005-06-14 ablation apparatus and system to limit nerve conduction
JP2007516656A JP2008503255A (en) 2004-06-17 2005-06-14 Ablation apparatus and system for limiting nerve conduction
US11/460,870 US20070060921A1 (en) 2004-06-17 2006-07-28 Ablation apparatus and system to limit nerve conduction
US11/559,232 US20070167943A1 (en) 2004-06-17 2006-11-13 Ablation apparatus and system to limit nerve conduction
IL179503A IL179503A0 (en) 2004-06-17 2006-11-22 Ablation apparatus and system to limit nerve conduction
CR8817A CR8817A (en) 2004-06-17 2006-12-15 ABLATION DEVICE AND SYSTEM TO LIMIT NERVOUS DRIVING
NO20070184A NO20070184L (en) 2004-06-17 2007-01-11 Ablation device and system for limiting nerve conduction
US12/612,360 US9283031B2 (en) 2004-06-17 2009-11-04 Ablation apparatus and system to limit nerve conduction
US13/570,138 US9168091B2 (en) 2004-06-17 2012-08-08 Ablation apparatus and system to limit nerve conduction
US14/852,983 US10548660B2 (en) 2004-06-17 2015-09-14 Ablation apparatus and system to limit nerve conduction

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US10/870,202 US20050283148A1 (en) 2004-06-17 2004-06-17 Ablation apparatus and system to limit nerve conduction

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US11/460,870 Continuation-In-Part US20070060921A1 (en) 2004-06-17 2006-07-28 Ablation apparatus and system to limit nerve conduction
US11/559,232 Continuation-In-Part US20070167943A1 (en) 2004-06-17 2006-11-13 Ablation apparatus and system to limit nerve conduction

Publications (1)

Publication Number Publication Date
US20050283148A1 true US20050283148A1 (en) 2005-12-22

Family

ID=35481620

Family Applications (6)

Application Number Title Priority Date Filing Date
US10/870,202 Abandoned US20050283148A1 (en) 2004-06-17 2004-06-17 Ablation apparatus and system to limit nerve conduction
US11/460,870 Abandoned US20070060921A1 (en) 2004-06-17 2006-07-28 Ablation apparatus and system to limit nerve conduction
US11/559,232 Abandoned US20070167943A1 (en) 2004-06-17 2006-11-13 Ablation apparatus and system to limit nerve conduction
US12/612,360 Active 2028-11-05 US9283031B2 (en) 2004-06-17 2009-11-04 Ablation apparatus and system to limit nerve conduction
US13/570,138 Expired - Fee Related US9168091B2 (en) 2004-06-17 2012-08-08 Ablation apparatus and system to limit nerve conduction
US14/852,983 Expired - Fee Related US10548660B2 (en) 2004-06-17 2015-09-14 Ablation apparatus and system to limit nerve conduction

Family Applications After (5)

Application Number Title Priority Date Filing Date
US11/460,870 Abandoned US20070060921A1 (en) 2004-06-17 2006-07-28 Ablation apparatus and system to limit nerve conduction
US11/559,232 Abandoned US20070167943A1 (en) 2004-06-17 2006-11-13 Ablation apparatus and system to limit nerve conduction
US12/612,360 Active 2028-11-05 US9283031B2 (en) 2004-06-17 2009-11-04 Ablation apparatus and system to limit nerve conduction
US13/570,138 Expired - Fee Related US9168091B2 (en) 2004-06-17 2012-08-08 Ablation apparatus and system to limit nerve conduction
US14/852,983 Expired - Fee Related US10548660B2 (en) 2004-06-17 2015-09-14 Ablation apparatus and system to limit nerve conduction

Country Status (14)

Country Link
US (6) US20050283148A1 (en)
EP (1) EP1769320A2 (en)
JP (1) JP2008503255A (en)
KR (1) KR20070047762A (en)
CN (1) CN1981256A (en)
BR (1) BRPI0512233A (en)
CA (1) CA2570911A1 (en)
CR (1) CR8817A (en)
IL (1) IL179503A0 (en)
MX (1) MXPA06014889A (en)
NO (1) NO20070184L (en)
RU (1) RU2006144073A (en)
WO (1) WO2006009705A2 (en)
ZA (1) ZA200610576B (en)

Cited By (186)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060030845A1 (en) * 2004-08-04 2006-02-09 Baylis Medical Company, Inc. Electrosurgical treatment in conjunction with monitoring
US20060041295A1 (en) * 2004-08-17 2006-02-23 Osypka Thomas P Positive fixation percutaneous epidural neurostimulation lead
US20070060921A1 (en) * 2004-06-17 2007-03-15 Jnj Technology Holdings Llc Ablation apparatus and system to limit nerve conduction
US20070129714A1 (en) * 2005-05-20 2007-06-07 Echo Healthcare Llc Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (FAT)
US20070191827A1 (en) * 2006-01-17 2007-08-16 Endymion Medical Ltd. Electrosurgical methods and devices employing phase-controlled radiofrequency energy
US20070219547A1 (en) * 2005-12-27 2007-09-20 Oscor Inc. Neuro-stimulation and ablation system
US20080200910A1 (en) * 2007-02-16 2008-08-21 Myoscience, Inc. Replaceable and/or Easily Removable Needle Systems for Dermal and Transdermal Cryogenic Remodeling
US20080200973A1 (en) * 2007-02-20 2008-08-21 General Electric Company Method and system using MRI compatibility defibrillation pads
US20080262490A1 (en) * 2005-03-04 2008-10-23 Williams Donald V Minimal Device and Method for Effecting Hyperthermia Derived Anesthesia
WO2009124726A1 (en) * 2008-04-10 2009-10-15 Erbe Elektromedizin Gmbh Surgical apparatus comprising a nerve testing device
US20090270859A1 (en) * 2008-03-20 2009-10-29 Ari Hirvi Fluid compositions and methods for the use thereof
US20090275940A1 (en) * 2008-05-05 2009-11-05 Malackowski Donald W Surgical tool system including a tool and a control console, the console capable of reading data from a memory internal to the tool over the conductors over which power is sourced to the tool
US20090318916A1 (en) * 2007-03-01 2009-12-24 Daniel Lischinsky Electrosurgical Methods and Devices Employing Semiconductor Chips
US7645277B2 (en) 2000-09-22 2010-01-12 Salient Surgical Technologies, Inc. Fluid-assisted medical device
US7727232B1 (en) 2004-02-04 2010-06-01 Salient Surgical Technologies, Inc. Fluid-assisted medical devices and methods
US7738968B2 (en) 2004-10-15 2010-06-15 Baxano, Inc. Devices and methods for selective surgical removal of tissue
US7738969B2 (en) 2004-10-15 2010-06-15 Baxano, Inc. Devices and methods for selective surgical removal of tissue
US20100152715A1 (en) * 2008-12-14 2010-06-17 Pattanam Srinivasan Method for Deep Tissue Laser Treatments Using Low Intensity Laser Therapy Causing Selective Destruction of Nociceptive Nerves
US20100185161A1 (en) * 2002-09-30 2010-07-22 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
US7811282B2 (en) 2000-03-06 2010-10-12 Salient Surgical Technologies, Inc. Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof
US7815634B2 (en) 2000-03-06 2010-10-19 Salient Surgical Technologies, Inc. Fluid delivery system and controller for electrosurgical devices
EP2246003A1 (en) * 2009-05-01 2010-11-03 Tyco Healthcare Group, LP Electrosurgical instrument with time limit circuit
US7850683B2 (en) 2005-05-20 2010-12-14 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US7857813B2 (en) 2006-08-29 2010-12-28 Baxano, Inc. Tissue access guidewire system and method
US7887538B2 (en) 2005-10-15 2011-02-15 Baxano, Inc. Methods and apparatus for tissue modification
US20110104632A1 (en) * 2009-05-11 2011-05-05 Colby Leigh E Therapeutic tooth ablation
US20110106076A1 (en) * 2009-11-04 2011-05-05 Gregorio Hernandez Zendejas Myoablation system
US7938830B2 (en) 2004-10-15 2011-05-10 Baxano, Inc. Powered tissue modification devices and methods
US7951148B2 (en) 2001-03-08 2011-05-31 Salient Surgical Technologies, Inc. Electrosurgical device having a tissue reduction sensor
US20110137305A1 (en) * 2009-12-06 2011-06-09 Gregorio Hernandez Zendejas Thermal neuroablator
US7959577B2 (en) 2007-09-06 2011-06-14 Baxano, Inc. Method, system, and apparatus for neural localization
US7987001B2 (en) 2007-01-25 2011-07-26 Warsaw Orthopedic, Inc. Surgical navigational and neuromonitoring instrument
US7998140B2 (en) 2002-02-12 2011-08-16 Salient Surgical Technologies, Inc. Fluid-assisted medical devices, systems and methods
US8048080B2 (en) 2004-10-15 2011-11-01 Baxano, Inc. Flexible tissue rasp
WO2011136962A1 (en) * 2010-04-30 2011-11-03 Medtronic Xomed, Inc. Interface module for use with nerve monitoring and electrosurgery
US8062300B2 (en) 2006-05-04 2011-11-22 Baxano, Inc. Tissue removal with at least partially flexible devices
US8062298B2 (en) 2005-10-15 2011-11-22 Baxano, Inc. Flexible tissue removal devices and methods
US8092456B2 (en) 2005-10-15 2012-01-10 Baxano, Inc. Multiple pathways for spinal nerve root decompression from a single access point
US8147489B2 (en) 2005-01-14 2012-04-03 Covidien Ag Open vessel sealing instrument
US8192435B2 (en) 2004-10-15 2012-06-05 Baxano, Inc. Devices and methods for tissue modification
US8192436B2 (en) 2007-12-07 2012-06-05 Baxano, Inc. Tissue modification devices
US8197633B2 (en) 2005-09-30 2012-06-12 Covidien Ag Method for manufacturing an end effector assembly
WO2012078278A1 (en) * 2010-12-10 2012-06-14 Salient Surgical Technologies, Inc. Bipolar electrosurgical device
US8221397B2 (en) 2004-10-15 2012-07-17 Baxano, Inc. Devices and methods for tissue modification
US8257352B2 (en) 2003-11-17 2012-09-04 Covidien Ag Bipolar forceps having monopolar extension
US8257356B2 (en) 2004-10-15 2012-09-04 Baxano, Inc. Guidewire exchange systems to treat spinal stenosis
US8298216B2 (en) 2007-11-14 2012-10-30 Myoscience, Inc. Pain management using cryogenic remodeling
US20120330300A1 (en) * 2002-09-30 2012-12-27 Relievant Medsystems, Inc. Intraosseous nerve denervation methods
US8348948B2 (en) 2004-03-02 2013-01-08 Covidien Ag Vessel sealing system using capacitive RF dielectric heating
US20130023871A1 (en) * 2011-07-19 2013-01-24 Tyco Healthcare Group Lp Microwave and rf ablation system and related method for dynamic impedance matching
US20130023870A1 (en) * 2011-07-19 2013-01-24 Tyco Healthcare Group Lp Microwave and rf ablation system and related method for dynamic impedance matching
US8361072B2 (en) 2005-09-30 2013-01-29 Covidien Ag Insulating boot for electrosurgical forceps
US8366712B2 (en) 2005-10-15 2013-02-05 Baxano, Inc. Multiple pathways for spinal nerve root decompression from a single access point
US8394102B2 (en) 2009-06-25 2013-03-12 Baxano, Inc. Surgical tools for treatment of spinal stenosis
US8394095B2 (en) 2005-09-30 2013-03-12 Covidien Ag Insulating boot for electrosurgical forceps
US8394096B2 (en) 2003-11-19 2013-03-12 Covidien Ag Open vessel sealing instrument with cutting mechanism
US8398641B2 (en) 2008-07-01 2013-03-19 Baxano, Inc. Tissue modification devices and methods
US8409206B2 (en) 2008-07-01 2013-04-02 Baxano, Inc. Tissue modification devices and methods
US8419653B2 (en) 2005-05-16 2013-04-16 Baxano, Inc. Spinal access and neural localization
US8419730B2 (en) 2008-09-26 2013-04-16 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
USD680220S1 (en) 2012-01-12 2013-04-16 Coviden IP Slider handle for laparoscopic device
US8419731B2 (en) 2002-09-30 2013-04-16 Relievant Medsystems, Inc. Methods of treating back pain
US8430881B2 (en) 2004-10-15 2013-04-30 Baxano, Inc. Mechanical tissue modification devices and methods
US8454602B2 (en) 2009-05-07 2013-06-04 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US8475455B2 (en) 2002-10-29 2013-07-02 Medtronic Advanced Energy Llc Fluid-assisted electrosurgical scissors and methods
US8523898B2 (en) 2009-07-08 2013-09-03 Covidien Lp Endoscopic electrosurgical jaws with offset knife
US20130229668A1 (en) * 2012-03-05 2013-09-05 Sick Ag Light source for a sensor and a distance-measuring optoelectronic sensor
US8551091B2 (en) 2002-10-04 2013-10-08 Covidien Ag Vessel sealing instrument with electrical cutting mechanism
US8568416B2 (en) 2004-10-15 2013-10-29 Baxano Surgical, Inc. Access and tissue modification systems and methods
US8568444B2 (en) 2008-10-03 2013-10-29 Covidien Lp Method of transferring rotational motion in an articulating surgical instrument
US8591506B2 (en) 1998-10-23 2013-11-26 Covidien Ag Vessel sealing system
US8613745B2 (en) 2004-10-15 2013-12-24 Baxano Surgical, Inc. Methods, systems and devices for carpal tunnel release
CN103479351A (en) * 2013-09-27 2014-01-01 中国科学院深圳先进技术研究院 Electrophysiological recording device
US20140025051A1 (en) * 2011-03-25 2014-01-23 Lutronic Corporation Apparatus for optical surgery and method for controlling same
US8641713B2 (en) 2005-09-30 2014-02-04 Covidien Ag Flexible endoscopic catheter with ligasure
US20140051999A1 (en) * 2005-09-27 2014-02-20 Nuvasive, Inc. System and Methods for Nerve Monitoring
WO2013163307A3 (en) * 2012-04-25 2014-07-10 Medtronic Xomed, Inc. Stimulation probe for robotic and laparoscopic surgery
US8801626B2 (en) 2004-10-15 2014-08-12 Baxano Surgical, Inc. Flexible neural localization devices and methods
WO2014150455A1 (en) * 2013-03-15 2014-09-25 St. Jude Medical, Cardiology Division, Inc. Multi-electrode ablation system with means for determining a common path impedance
US8845639B2 (en) 2008-07-14 2014-09-30 Baxano Surgical, Inc. Tissue modification devices
US8852228B2 (en) 2009-01-13 2014-10-07 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US8882764B2 (en) 2003-03-28 2014-11-11 Relievant Medsystems, Inc. Thermal denervation devices
US8898888B2 (en) 2009-09-28 2014-12-02 Covidien Lp System for manufacturing electrosurgical seal plates
US8945125B2 (en) 2002-11-14 2015-02-03 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
EP2068740A4 (en) * 2006-07-28 2015-02-25 Serene Medical Inc Ablation apparatus and system to limit nerve conduction
WO2015038167A1 (en) * 2013-09-16 2015-03-19 Empire Technology Development, Llc Nerve location detection
US9005100B2 (en) 2011-12-15 2015-04-14 The Board Of Trustees Of The Leland Stanford Jr. University Apparatus and methods for treating pulmonary hypertension
US9017318B2 (en) 2012-01-20 2015-04-28 Myoscience, Inc. Cryogenic probe system and method
US9028493B2 (en) 2009-09-18 2015-05-12 Covidien Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US20150148643A1 (en) * 2011-12-20 2015-05-28 Mled Limited Integrated medical device
US9066712B2 (en) 2008-12-22 2015-06-30 Myoscience, Inc. Integrated cryosurgical system with refrigerant and electrical power source
US9066720B2 (en) 2010-10-25 2015-06-30 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
US20150216442A1 (en) * 2012-07-24 2015-08-06 Lev Lavy Multilayer coaxial probe for impedance spatial contrast measurement
US9101386B2 (en) 2004-10-15 2015-08-11 Amendia, Inc. Devices and methods for treating tissue
US9113912B1 (en) 2015-01-21 2015-08-25 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
US9113898B2 (en) 2008-10-09 2015-08-25 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US9119628B1 (en) 2015-01-21 2015-09-01 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US9155584B2 (en) 2012-01-13 2015-10-13 Myoscience, Inc. Cryogenic probe filtration system
US9198717B2 (en) 2005-08-19 2015-12-01 Covidien Ag Single action tissue sealer
US20150374456A1 (en) * 2013-03-15 2015-12-31 Triagenics, Llc Therapeutic Tooth Bud Ablation
US20160015997A1 (en) * 2010-02-21 2016-01-21 C Laser, Inc. Treatment Using Low Intensity Laser Therapy
US9241753B2 (en) 2012-01-13 2016-01-26 Myoscience, Inc. Skin protection for subdermal cryogenic remodeling for cosmetic and other treatments
US9247952B2 (en) 2004-10-15 2016-02-02 Amendia, Inc. Devices and methods for tissue access
US9254162B2 (en) 2006-12-21 2016-02-09 Myoscience, Inc. Dermal and transdermal cryogenic microprobe systems
US20160074668A1 (en) * 2014-09-12 2016-03-17 Albert Nunez Apparatus and method for providing hyperthermia therapy
US9295512B2 (en) 2013-03-15 2016-03-29 Myoscience, Inc. Methods and devices for pain management
US9314253B2 (en) 2008-07-01 2016-04-19 Amendia, Inc. Tissue modification devices and methods
US9314290B2 (en) 2012-01-13 2016-04-19 Myoscience, Inc. Cryogenic needle with freeze zone regulation
US9314644B2 (en) 2006-06-28 2016-04-19 Medtronic Ardian Luxembourg S.A.R.L. Methods and systems for thermally-induced renal neuromodulation
US20160206372A1 (en) * 2015-01-15 2016-07-21 Daniel Rivlin Method of nerve ablation and uses thereof
US20160206362A1 (en) * 2015-01-21 2016-07-21 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US9456829B2 (en) 2004-10-15 2016-10-04 Amendia, Inc. Powered tissue modification devices and methods
US9566109B2 (en) 2013-07-18 2017-02-14 Covidien Lp Limited-use surgical devices
US9610112B2 (en) 2013-03-15 2017-04-04 Myoscience, Inc. Cryogenic enhancement of joint function, alleviation of joint stiffness and/or alleviation of pain associated with osteoarthritis
USRE46356E1 (en) 2002-09-30 2017-04-04 Relievant Medsystems, Inc. Method of treating an intraosseous nerve
US9668800B2 (en) 2013-03-15 2017-06-06 Myoscience, Inc. Methods and systems for treatment of spasticity
US9693825B2 (en) 2008-12-14 2017-07-04 C Laser, Inc. Fiber embedded hollow needle for percutaneous delivery of laser energy
US9693816B2 (en) 2012-01-30 2017-07-04 Covidien Lp Electrosurgical apparatus with integrated energy sensing at tissue site
US9724151B2 (en) 2013-08-08 2017-08-08 Relievant Medsystems, Inc. Modulating nerves within bone using bone fasteners
US9724107B2 (en) 2008-09-26 2017-08-08 Relievant Medsystems, Inc. Nerve modulation systems
US9730754B2 (en) * 2012-07-19 2017-08-15 Covidien Lp Ablation needle including fiber Bragg grating
US9775627B2 (en) 2012-11-05 2017-10-03 Relievant Medsystems, Inc. Systems and methods for creating curved paths through bone and modulating nerves within the bone
US9820800B2 (en) 2012-11-13 2017-11-21 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
EP3245973A1 (en) * 2016-05-19 2017-11-22 Covidien LP Modular microwave generators and methods for operating modular microwave generators
US9848938B2 (en) 2003-11-13 2017-12-26 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US9855112B2 (en) 2013-03-15 2018-01-02 Triagenics, Llc Therapeutic tooth bud ablation
US9943357B2 (en) 2013-09-16 2018-04-17 Covidien Lp Split electrode for use in a bipolar electrosurgical instrument
EP3229899A4 (en) * 2014-12-08 2018-07-04 Invuity, Inc. Methods and apparatus for electrosurgical illumination and sensing
WO2018144297A1 (en) * 2017-02-01 2018-08-09 Avent, Inc. Emg guidance for probe placement, nearby tissue preservation, and lesion confirmation
WO2018156160A1 (en) * 2017-02-27 2018-08-30 Avent, Inc. Method and system for improving location accuracy of a radiofrequency ablation procedure via fiducial marking
US10076383B2 (en) 2012-01-25 2018-09-18 Covidien Lp Electrosurgical device having a multiplexer
US10130409B2 (en) 2013-11-05 2018-11-20 Myoscience, Inc. Secure cryosurgical treatment system
US10206742B2 (en) 2010-02-21 2019-02-19 C Laser, Inc. Fiber embedded hollow spikes for percutaneous delivery of laser energy
US10213250B2 (en) 2015-11-05 2019-02-26 Covidien Lp Deployment and safety mechanisms for surgical instruments
US10251696B2 (en) 2001-04-06 2019-04-09 Covidien Ag Vessel sealer and divider with stop members
US10298255B2 (en) 2013-03-15 2019-05-21 TriAgenics, Inc. Therapeutic tooth bud ablation
US10327841B2 (en) * 2010-04-29 2019-06-25 Dfine, Inc. System for use in treatment of vertebral fractures
US10390877B2 (en) 2011-12-30 2019-08-27 Relievant Medsystems, Inc. Systems and methods for treating back pain
US10433902B2 (en) 2013-10-23 2019-10-08 Medtronic Ardian Luxembourg S.A.R.L. Current control methods and systems
US10463380B2 (en) 2016-12-09 2019-11-05 Dfine, Inc. Medical devices for treating hard tissues and related methods
US10478241B2 (en) 2016-10-27 2019-11-19 Merit Medical Systems, Inc. Articulating osteotome with cement delivery channel
US10588691B2 (en) 2012-09-12 2020-03-17 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US10610292B2 (en) 2014-04-25 2020-04-07 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems, and methods for monitoring and/or controlling deployment of a neuromodulation element within a body lumen and related technology
US10624652B2 (en) 2010-04-29 2020-04-21 Dfine, Inc. System for use in treatment of vertebral fractures
US10660656B2 (en) 2017-01-06 2020-05-26 Dfine, Inc. Osteotome with a distal portion for simultaneous advancement and articulation
US10799670B2 (en) 2015-06-18 2020-10-13 Avent, Inc. Expandable sleeve for a catheter assembly
US10874454B2 (en) 2012-11-13 2020-12-29 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US10888366B2 (en) 2013-03-15 2021-01-12 Pacira Cryotech, Inc. Cryogenic blunt dissection methods and devices
WO2020260950A3 (en) * 2019-06-28 2021-02-04 Neurent Medical Limited Systems and methods for targeted therapeutic nasal neuromodulation
US10918434B2 (en) 2013-03-15 2021-02-16 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US10987159B2 (en) 2015-08-26 2021-04-27 Covidien Lp Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread
US11007010B2 (en) 2019-09-12 2021-05-18 Relevant Medsysterns, Inc. Curved bone access systems
US11026744B2 (en) 2016-11-28 2021-06-08 Dfine, Inc. Tumor ablation devices and related methods
US20210298822A1 (en) * 2020-03-31 2021-09-30 Boston Scientific Scimed, Inc. Smart probe identification for ablation modalities
CN113456211A (en) * 2020-03-30 2021-10-01 奥林匹斯冬季和Ibe有限公司 Electrosurgical system, electrosurgical instrument and electrosurgical generator
US11134998B2 (en) 2017-11-15 2021-10-05 Pacira Cryotech, Inc. Integrated cold therapy and electrical stimulation systems for locating and treating nerves and associated methods
US11197681B2 (en) 2009-05-20 2021-12-14 Merit Medical Systems, Inc. Steerable curvable vertebroplasty drill
US20220022962A1 (en) * 2011-09-09 2022-01-27 Boston Scientific Scimed, Inc. Split surgical laser fiber
US11241267B2 (en) 2012-11-13 2022-02-08 Pulnovo Medical (Wuxi) Co., Ltd Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US11272909B2 (en) 2012-03-13 2022-03-15 Medtronic Xomed, Inc. Surgical system including powered rotary-type handpiece
US11311327B2 (en) 2016-05-13 2022-04-26 Pacira Cryotech, Inc. Methods and systems for locating and treating nerves with cold therapy
US11419671B2 (en) 2018-12-11 2022-08-23 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11446078B2 (en) 2015-07-20 2022-09-20 Megadyne Medical Products, Inc. Electrosurgical wave generator
US11452559B2 (en) 2019-06-25 2022-09-27 Covidien Lp Electrosurgical plug for energy activation of surgical instruments
US11504179B2 (en) 2019-06-25 2022-11-22 Covidien Lp Electrosurgical plug for energy activation of surgical instruments
US11510723B2 (en) 2018-11-08 2022-11-29 Dfine, Inc. Tumor ablation device and related systems and methods
US11529260B2 (en) 2019-04-19 2022-12-20 Elios Vision, Inc. Systems and methods for performing an intraocular procedure for treating an eye condition
US11534235B2 (en) 2019-04-04 2022-12-27 Acclarent, Inc. Needle instrument for posterior nasal neurectomy ablation
US11583337B2 (en) 2019-06-06 2023-02-21 TriAgenics, Inc. Ablation probe systems
US11607267B2 (en) 2019-06-10 2023-03-21 Covidien Lp Electrosurgical forceps
US11622805B2 (en) 2018-06-08 2023-04-11 Acclarent, Inc. Apparatus and method for performing vidian neurectomy procedure
US11633234B2 (en) 2019-04-19 2023-04-25 Elios Vision, Inc. Enhanced fiber probes for ELT
US11666482B2 (en) 2019-04-19 2023-06-06 Elios Vision, Inc. Personalization of excimer laser fibers
US11672475B2 (en) 2019-04-19 2023-06-13 Elios Vision, Inc. Combination treatment using ELT
US11690672B2 (en) 2015-05-12 2023-07-04 National University Of Ireland, Galway Devices for therapeutic nasal neuromodulation and associated methods and systems
US11717346B2 (en) 2021-06-24 2023-08-08 Gradient Denervation Technologies Sas Systems and methods for monitoring energy application to denervate a pulmonary artery
US11751942B2 (en) * 2009-09-08 2023-09-12 Medtronic Advanced Energy Llc Surgical device
US11759271B2 (en) 2017-04-28 2023-09-19 Stryker Corporation System and method for indicating mapping of console-based surgical systems
US11786296B2 (en) 2019-02-15 2023-10-17 Accularent, Inc. Instrument for endoscopic posterior nasal nerve ablation
US11877951B1 (en) 2022-08-30 2024-01-23 Elios Vision, Inc. Systems and methods for applying excimer laser energy with transverse placement in the eye
US11883091B2 (en) 2020-04-09 2024-01-30 Neurent Medical Limited Systems and methods for improving sleep with therapeutic nasal treatment
US11896818B2 (en) 2020-04-09 2024-02-13 Neurent Medical Limited Systems and methods for therapeutic nasal treatment
US11903876B1 (en) 2022-08-30 2024-02-20 Elios Vision, Inc. Systems and methods for prophylactic treatment of an eye using an excimer laser unit
US11918516B1 (en) 2022-08-30 2024-03-05 Elios Vision, Inc. Systems and methods for treating patients with closed-angle or narrow-angle glaucoma using an excimer laser unit
EP4303486A3 (en) * 2016-10-24 2024-03-13 Invuity, Inc. Lighting element

Families Citing this family (195)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1487346B1 (en) 2002-03-19 2005-08-31 Bard Dublin ITC Limited Vacuum biopsy device
CA2479349C (en) 2002-03-19 2012-07-03 Bard Dublin Itc Limited Biopsy device and biopsy needle module that can be inserted into the biopsy device
DE10314240A1 (en) 2003-03-29 2004-10-07 Bard Dublin Itc Ltd., Crawley Pressure generating unit
ES2398914T3 (en) 2004-07-09 2013-03-22 Bard Peripheral Vascular, Inc. Transport system for biopsy device
WO2010110823A1 (en) 2009-03-27 2010-09-30 Bing Innovations, Llc Apparatus and method for reducing pain during skin puncturing procedures
US9168340B2 (en) 2009-03-27 2015-10-27 Bing Innovations, Llc System and method for pain reduction during skin puncture and breakable tip therefor
US9463287B1 (en) * 2004-09-20 2016-10-11 Bing Innovations, Llc Controlling usage of replaceable tool ends
US7517321B2 (en) 2005-01-31 2009-04-14 C. R. Bard, Inc. Quick cycle biopsy system
CA3060814C (en) 2005-08-10 2022-04-19 C.R. Bard, Inc. Single-insertion, multiple sample biopsy device with integrated markers
WO2007021903A2 (en) 2005-08-10 2007-02-22 C.R. Bard Inc. Single-insertion, multiple sampling biopsy device with linear drive
ES2380208T3 (en) 2005-08-10 2012-05-09 C.R.Bard, Inc. Transport system for single insertion, biopsy devices for multiple samples
US7988688B2 (en) * 2006-09-21 2011-08-02 Lockheed Martin Corporation Miniature apparatus and method for optical stimulation of nerves and other animal tissue
US7887534B2 (en) * 2006-01-18 2011-02-15 Stryker Corporation Electrosurgical system
US20070213705A1 (en) * 2006-03-08 2007-09-13 Schmid Peter M Insulated needle and system
US8251917B2 (en) 2006-08-21 2012-08-28 C. R. Bard, Inc. Self-contained handheld biopsy needle
DE602006012675D1 (en) * 2006-09-08 2010-04-15 Ethicon Endo Surgery Inc Surgical instrument for the controlled performance of myotomies
DK2086418T3 (en) 2006-10-06 2011-03-14 Bard Peripheral Vascular Inc Tissue management system with reduced operator exposure
EP2086417B1 (en) 2006-10-24 2015-07-01 C.R.Bard, Inc. Large sample low aspect ratio biopsy needle
US9375246B2 (en) * 2007-01-19 2016-06-28 Covidien Lp System and method of using thermal and electrical conductivity of tissue
US20080183074A1 (en) * 2007-01-25 2008-07-31 Warsaw Orthopedic, Inc. Method and apparatus for coordinated display of anatomical and neuromonitoring information
US8216233B2 (en) * 2007-03-23 2012-07-10 Salient Surgical Technologies, Inc. Surgical devices and methods of use thereof
US8083685B2 (en) 2007-05-08 2011-12-27 Propep, Llc System and method for laparoscopic nerve detection
US9364287B2 (en) * 2007-06-05 2016-06-14 Reliant Technologies, Inc. Method for reducing pain of dermatological treatments
US7867273B2 (en) 2007-06-27 2011-01-11 Abbott Laboratories Endoprostheses for peripheral arteries and other body vessels
US8035685B2 (en) * 2007-07-30 2011-10-11 General Electric Company Systems and methods for communicating video data between a mobile imaging system and a fixed monitor system
US8506565B2 (en) 2007-08-23 2013-08-13 Covidien Lp Electrosurgical device with LED adapter
US8241225B2 (en) 2007-12-20 2012-08-14 C. R. Bard, Inc. Biopsy device
US9204925B2 (en) 2008-08-14 2015-12-08 The Cleveland Clinic Foundation Apparatus and method for treating a neuromuscular defect
US8512715B2 (en) 2008-08-14 2013-08-20 The Cleveland Clinic Foundation Apparatus and method for treating a neuromuscular defect
US9421359B2 (en) * 2008-10-15 2016-08-23 Medtronic Bakken Research Center B.V. Probe for implantable electro-stimulation device
EP2349479B1 (en) * 2008-10-29 2015-08-26 Nomir Medical Technologies, Inc Near-infrared electromagnetic modification of cellular steady-state membrane potentials
US8355799B2 (en) 2008-12-12 2013-01-15 Arthrocare Corporation Systems and methods for limiting joint temperature
US8882758B2 (en) 2009-01-09 2014-11-11 Solta Medical, Inc. Tissue treatment apparatus and systems with pain mitigation and methods for mitigating pain during tissue treatments
US8506506B2 (en) * 2009-01-12 2013-08-13 Solta Medical, Inc. Tissue treatment apparatus with functional mechanical stimulation and methods for reducing pain during tissue treatments
KR100943089B1 (en) * 2009-01-23 2010-02-18 강동환 Handpiece for treating skin
CA2751273A1 (en) 2009-03-16 2010-09-23 C.R. Bard, Inc. Biopsy device having rotational cutting
EP3034008B1 (en) 2009-04-15 2018-09-12 C.R. Bard Inc. Fluid management
US20100305596A1 (en) * 2009-05-26 2010-12-02 Erik William Peterson Non-linear cut-rate multiplier for vitreous cutter
US8788060B2 (en) 2009-07-16 2014-07-22 Solta Medical, Inc. Tissue treatment systems with high powered functional electrical stimulation and methods for reducing pain during tissue treatments
EP2464294B1 (en) 2009-08-12 2019-10-02 C.R. Bard Inc. Biopsy appaparatus having integrated thumbwheel mechanism for manual rotation of biopsy cannula
US8283890B2 (en) 2009-09-25 2012-10-09 Bard Peripheral Vascular, Inc. Charging station for battery powered biopsy apparatus
US8485989B2 (en) 2009-09-01 2013-07-16 Bard Peripheral Vascular, Inc. Biopsy apparatus having a tissue sample retrieval mechanism
US8430824B2 (en) 2009-10-29 2013-04-30 Bard Peripheral Vascular, Inc. Biopsy driver assembly having a control circuit for conserving battery power
US8597206B2 (en) 2009-10-12 2013-12-03 Bard Peripheral Vascular, Inc. Biopsy probe assembly having a mechanism to prevent misalignment of components prior to installation
US20110105946A1 (en) * 2009-10-31 2011-05-05 Sorensen Peter L Biopsy system with infrared communications
JP5836964B2 (en) 2009-11-05 2015-12-24 ニンバス・コンセプツ・エルエルシー Method and system for spinal radiofrequency nerve cutting
WO2011084957A1 (en) 2010-01-05 2011-07-14 Curo Medical, Inc. Medical heating device and method with self-limiting electrical heating element
US8600719B2 (en) * 2010-02-09 2013-12-03 Fraunhofer Gesellschaft zur Förderung der angewandten Forschung e.V. Ablated object region determining apparatuses and methods
US8864761B2 (en) 2010-03-10 2014-10-21 Covidien Lp System and method for determining proximity relative to a critical structure
EP2571439B1 (en) 2010-05-21 2020-06-24 Stratus Medical, LLC Systems for tissue ablation
CN101862219B (en) * 2010-06-01 2011-12-21 谭伟 Radio frequency ablation probe
US9498278B2 (en) 2010-09-08 2016-11-22 Covidien Lp Asymmetrical electrodes for bipolar vessel sealing
EP2624908B1 (en) * 2010-10-04 2015-04-08 Nervomatrix Ltd. Electrode for finding points of low impedance and applying electrical stimulation thereto
WO2012067879A1 (en) * 2010-11-19 2012-05-24 Neural Pathways, Llc Integrated nerve stimulation and skin marking device and methods of using same
AU2011329669B2 (en) * 2010-11-19 2016-07-28 Boston Scientific Scimed, Inc. Renal nerve detection and ablation apparatus and method
KR101246112B1 (en) * 2010-12-08 2013-03-20 주식회사 루트로닉 An apparatus for treat motor nerves and a method for controlling the apparatus
WO2012158864A1 (en) * 2011-05-18 2012-11-22 St. Jude Medical, Inc. Apparatus and method of assessing transvascular denervation
US8909316B2 (en) 2011-05-18 2014-12-09 St. Jude Medical, Cardiology Division, Inc. Apparatus and method of assessing transvascular denervation
US9231926B2 (en) * 2011-09-08 2016-01-05 Lexmark International, Inc. System and method for secured host-slave communication
US9579503B2 (en) * 2011-10-05 2017-02-28 Medtronic Xomed, Inc. Interface module allowing delivery of tissue stimulation and electrosurgery through a common surgical instrument
US9283334B2 (en) 2011-11-23 2016-03-15 Northgate Technologies Inc. System for identifying the presence and correctness of a medical device accessory
US20150058032A1 (en) 2011-12-30 2015-02-26 St. Jude Medical, Atrial Fibrillation Division, Inc. System for sharing data within an electrophysiology lab
RU2487686C1 (en) * 2012-03-11 2013-07-20 Федеральное государственное бюджетное учреждение "Научно-исследовательский институт кардиологии" Сибирского отделения Российской академии медицинских наук Method of treating resistant arterial hypertension
US20130253480A1 (en) 2012-03-22 2013-09-26 Cory G. Kimball Surgical instrument usage data management
US20130267874A1 (en) 2012-04-09 2013-10-10 Amy L. Marcotte Surgical instrument with nerve detection feature
US9204920B2 (en) * 2012-05-02 2015-12-08 Covidien Lp External reader for device management
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US9901395B2 (en) 2012-05-21 2018-02-27 II Erich W. Wolf Probe for directional surgical coagulation with integrated nerve detection and method of use
RU2633198C2 (en) * 2013-03-07 2017-10-11 Зе Кливленд Клиник Фаундейшн Device for neuromuscular defect treatment
US20140275993A1 (en) * 2013-03-15 2014-09-18 Medtronic Ardian Luxembourg S.a.r.I. Devices, Systems, and Methods for Specialization of Neuromodulation Treatment
CN105228532B (en) 2013-03-20 2018-04-27 巴德血管外围设备公司 Biopsy device
WO2015069223A1 (en) 2013-11-05 2015-05-14 C.R. Bard, Inc. Biopsy device having integrated vacuum
CA2931617C (en) * 2013-11-27 2021-10-19 Convergent Dental, Inc. Systems and methods for grounding or isolating a dental hand piece
US9999463B2 (en) 2014-04-14 2018-06-19 NeuroMedic, Inc. Monitoring nerve activity
CN111671517A (en) * 2014-04-29 2020-09-18 威廉·迪恩·华莱士 Electrosurgical device
US10342606B2 (en) * 2014-05-06 2019-07-09 Cosman Instruments, Llc Electrosurgical generator
US10643371B2 (en) * 2014-08-11 2020-05-05 Covidien Lp Treatment procedure planning system and method
MX364276B (en) 2014-08-26 2019-04-22 Avent Inc Method and system for identification of source of chronic pain and treatment.
US9936961B2 (en) 2014-09-26 2018-04-10 DePuy Synthes Products, Inc. Surgical tool with feedback
US10231783B2 (en) * 2014-10-03 2019-03-19 Covidien Lp Energy-based surgical instrument including integrated nerve detection system
US11504192B2 (en) 2014-10-30 2022-11-22 Cilag Gmbh International Method of hub communication with surgical instrument systems
WO2016118752A1 (en) 2015-01-21 2016-07-28 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
CN111281442B (en) 2015-05-01 2023-01-10 C·R·巴德公司 Biopsy device
US10695508B2 (en) 2015-05-01 2020-06-30 Bing Innovations, Llc Reducing pain of skin piercing using vibration
US10993765B2 (en) 2015-06-30 2021-05-04 Smith & Nephew, Inc. Temperature measurement of electrically conductive fluids
CN105287016A (en) * 2015-09-23 2016-02-03 苏州新区明基高分子医疗器械有限公司 Neuroendoscopic craniocerebral operation protective sheath apparatus
TWI626035B (en) 2016-01-28 2018-06-11 財團法人工業技術研究院 Radiofrequency ablation electrode needle
WO2018200254A2 (en) 2017-04-28 2018-11-01 Stryker Corporation Control console and accessories for rf nerve ablation and methods of operating the same
US10589089B2 (en) 2017-10-25 2020-03-17 Epineuron Technologies Inc. Systems and methods for delivering neuroregenerative therapy
AU2018354250A1 (en) 2017-10-25 2020-06-11 Epineuron Technologies Inc. Systems and methods for delivering neuroregenerative therapy
US11123070B2 (en) 2017-10-30 2021-09-21 Cilag Gmbh International Clip applier comprising a rotatable clip magazine
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
US11291510B2 (en) 2017-10-30 2022-04-05 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11510741B2 (en) 2017-10-30 2022-11-29 Cilag Gmbh International Method for producing a surgical instrument comprising a smart electrical system
US20190125320A1 (en) 2017-10-30 2019-05-02 Ethicon Llc Control system arrangements for a modular surgical instrument
US11317919B2 (en) 2017-10-30 2022-05-03 Cilag Gmbh International Clip applier comprising a clip crimping system
US11564756B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11311342B2 (en) 2017-10-30 2022-04-26 Cilag Gmbh International Method for communicating with surgical instrument systems
US10881376B2 (en) 2017-11-08 2021-01-05 Biosense Webster (Israel) Ltd. System and method for providing auditory guidance in medical systems
US11633237B2 (en) 2017-12-28 2023-04-25 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11234756B2 (en) 2017-12-28 2022-02-01 Cilag Gmbh International Powered surgical tool with predefined adjustable control algorithm for controlling end effector parameter
US11446052B2 (en) 2017-12-28 2022-09-20 Cilag Gmbh International Variation of radio frequency and ultrasonic power level in cooperation with varying clamp arm pressure to achieve predefined heat flux or power applied to tissue
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11589888B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Method for controlling smart energy devices
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11202570B2 (en) 2017-12-28 2021-12-21 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US11844579B2 (en) 2017-12-28 2023-12-19 Cilag Gmbh International Adjustments based on airborne particle properties
US20190201146A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Safety systems for smart powered surgical stapling
US11602393B2 (en) 2017-12-28 2023-03-14 Cilag Gmbh International Surgical evacuation sensing and generator control
US11832840B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical instrument having a flexible circuit
US11179175B2 (en) 2017-12-28 2021-11-23 Cilag Gmbh International Controlling an ultrasonic surgical instrument according to tissue location
US11559308B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method for smart energy device infrastructure
US11109866B2 (en) 2017-12-28 2021-09-07 Cilag Gmbh International Method for circular stapler control algorithm adjustment based on situational awareness
US11672605B2 (en) 2017-12-28 2023-06-13 Cilag Gmbh International Sterile field interactive control displays
US11266468B2 (en) 2017-12-28 2022-03-08 Cilag Gmbh International Cooperative utilization of data derived from secondary sources by intelligent surgical hubs
US11576677B2 (en) 2017-12-28 2023-02-14 Cilag Gmbh International Method of hub communication, processing, display, and cloud analytics
US11571234B2 (en) 2017-12-28 2023-02-07 Cilag Gmbh International Temperature control of ultrasonic end effector and control system therefor
US20190200981A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Method of compressing tissue within a stapling device and simultaneously displaying the location of the tissue within the jaws
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11432885B2 (en) 2017-12-28 2022-09-06 Cilag Gmbh International Sensing arrangements for robot-assisted surgical platforms
US11771487B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Mechanisms for controlling different electromechanical systems of an electrosurgical instrument
US11284936B2 (en) 2017-12-28 2022-03-29 Cilag Gmbh International Surgical instrument having a flexible electrode
US11304720B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Activation of energy devices
US11304745B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical evacuation sensing and display
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11317937B2 (en) 2018-03-08 2022-05-03 Cilag Gmbh International Determining the state of an ultrasonic end effector
US11419630B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Surgical system distributed processing
US11013563B2 (en) 2017-12-28 2021-05-25 Ethicon Llc Drive arrangements for robot-assisted surgical platforms
US11529187B2 (en) 2017-12-28 2022-12-20 Cilag Gmbh International Surgical evacuation sensor arrangements
US11540855B2 (en) 2017-12-28 2023-01-03 Cilag Gmbh International Controlling activation of an ultrasonic surgical instrument according to the presence of tissue
US11291495B2 (en) 2017-12-28 2022-04-05 Cilag Gmbh International Interruption of energy due to inadvertent capacitive coupling
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US11464559B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Estimating state of ultrasonic end effector and control system therefor
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US11364075B2 (en) 2017-12-28 2022-06-21 Cilag Gmbh International Radio frequency energy device for delivering combined electrical signals
US10892995B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11559307B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method of robotic hub communication, detection, and control
US11423007B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Adjustment of device control programs based on stratified contextual data in addition to the data
US11410259B2 (en) 2017-12-28 2022-08-09 Cilag Gmbh International Adaptive control program updates for surgical devices
US11278281B2 (en) 2017-12-28 2022-03-22 Cilag Gmbh International Interactive surgical system
US11304763B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Image capturing of the areas outside the abdomen to improve placement and control of a surgical device in use
US11424027B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Method for operating surgical instrument systems
US11389164B2 (en) 2017-12-28 2022-07-19 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11132462B2 (en) 2017-12-28 2021-09-28 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US11166772B2 (en) 2017-12-28 2021-11-09 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US10758310B2 (en) 2017-12-28 2020-09-01 Ethicon Llc Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US11311306B2 (en) 2017-12-28 2022-04-26 Cilag Gmbh International Surgical systems for detecting end effector tissue distribution irregularities
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11308075B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical network, instrument, and cloud responses based on validation of received dataset and authentication of its source and integrity
US11253315B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Increasing radio frequency to create pad-less monopolar loop
US11659023B2 (en) 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11419667B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11304699B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11464535B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Detection of end effector emersion in liquid
US11666331B2 (en) 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11324557B2 (en) 2017-12-28 2022-05-10 Cilag Gmbh International Surgical instrument with a sensing array
US11337746B2 (en) 2018-03-08 2022-05-24 Cilag Gmbh International Smart blade and power pulsing
US11534196B2 (en) 2018-03-08 2022-12-27 Cilag Gmbh International Using spectroscopy to determine device use state in combo instrument
US11259830B2 (en) 2018-03-08 2022-03-01 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
RU2687009C1 (en) * 2018-03-13 2019-05-06 Федеральное государственное бюджетное научное учреждение "Томский национальный исследовательский медицинский центр Российской академии наук" (Томский НИМЦ) Method of selecting patients with resistant hypertension younger than 60 years with disturbed cerebral blood flow reserve for safe and effective treatment by renal denervation
US11471156B2 (en) 2018-03-28 2022-10-18 Cilag Gmbh International Surgical stapling devices with improved rotary driven closure systems
US11166716B2 (en) 2018-03-28 2021-11-09 Cilag Gmbh International Stapling instrument comprising a deactivatable lockout
US11278280B2 (en) 2018-03-28 2022-03-22 Cilag Gmbh International Surgical instrument comprising a jaw closure lockout
US11589865B2 (en) 2018-03-28 2023-02-28 Cilag Gmbh International Methods for controlling a powered surgical stapler that has separate rotary closure and firing systems
US11804679B2 (en) 2018-09-07 2023-10-31 Cilag Gmbh International Flexible hand-switch circuit
US11923084B2 (en) 2018-09-07 2024-03-05 Cilag Gmbh International First and second communication protocol arrangement for driving primary and secondary devices through a single port
US11471206B2 (en) 2018-09-07 2022-10-18 Cilag Gmbh International Method for controlling a modular energy system user interface
US20200078071A1 (en) * 2018-09-07 2020-03-12 Ethicon Llc Instrument tracking arrangement based on real time clock information
US11369377B2 (en) 2019-02-19 2022-06-28 Cilag Gmbh International Surgical stapling assembly with cartridge based retainer configured to unlock a firing lockout
US11751872B2 (en) 2019-02-19 2023-09-12 Cilag Gmbh International Insertable deactivator element for surgical stapler lockouts
US11317915B2 (en) 2019-02-19 2022-05-03 Cilag Gmbh International Universal cartridge based key feature that unlocks multiple lockout arrangements in different surgical staplers
US11357503B2 (en) 2019-02-19 2022-06-14 Cilag Gmbh International Staple cartridge retainers with frangible retention features and methods of using same
US11259807B2 (en) 2019-02-19 2022-03-01 Cilag Gmbh International Staple cartridges with cam surfaces configured to engage primary and secondary portions of a lockout of a surgical stapling device
US11218822B2 (en) 2019-03-29 2022-01-04 Cilag Gmbh International Audio tone construction for an energy module of a modular energy system
US11076933B2 (en) * 2019-04-19 2021-08-03 Elt Sight, Inc. Authentication systems and methods for an excimer laser system
USD964564S1 (en) 2019-06-25 2022-09-20 Cilag Gmbh International Surgical staple cartridge retainer with a closure system authentication key
USD950728S1 (en) 2019-06-25 2022-05-03 Cilag Gmbh International Surgical staple cartridge
USD952144S1 (en) 2019-06-25 2022-05-17 Cilag Gmbh International Surgical staple cartridge retainer with firing system authentication key
USD924139S1 (en) 2019-09-05 2021-07-06 Ethicon Llc Energy module with a backplane connector
USD928726S1 (en) 2019-09-05 2021-08-24 Cilag Gmbh International Energy module monopolar port
USD928725S1 (en) 2019-09-05 2021-08-24 Cilag Gmbh International Energy module
USD939545S1 (en) 2019-09-05 2021-12-28 Cilag Gmbh International Display panel or portion thereof with graphical user interface for energy module
US11364381B2 (en) 2019-10-01 2022-06-21 Epineuron Technologies Inc. Methods for delivering neuroregenerative therapy and reducing post-operative and chronic pain
US11771488B2 (en) * 2019-10-21 2023-10-03 Biosense Webster (Israel) Ltd. Ablation of lesions of low-medium depths using ultrahigh radiofrequency (RF) power for ultrashort durations
EP4065003A4 (en) * 2019-11-25 2023-12-20 Cosman, Eric, R., Jr. Electrosurgical system
US11711596B2 (en) 2020-01-23 2023-07-25 Covidien Lp System and methods for determining proximity relative to an anatomical structure
DE102020103278A1 (en) * 2020-02-10 2021-08-12 Olympus Winter & Ibe Gmbh Electrosurgical system, electrosurgical instrument, method of writing operating modes, and electrosurgical supply device
DE102020103280A1 (en) 2020-02-10 2021-08-12 Olympus Winter & Ibe Gmbh Electrosurgical system, electrosurgical instrument, method for reading configuration data, and electrosurgical supply device
US11857252B2 (en) 2021-03-30 2024-01-02 Cilag Gmbh International Bezel with light blocking features for modular energy system
CN217908152U (en) * 2022-05-19 2022-11-29 苏州朗目医疗科技有限公司 Ablation electrode and ablation host for treating glaucoma

Citations (70)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3104879A (en) * 1963-09-24 Jetton
US4411266A (en) * 1980-09-24 1983-10-25 Cosman Eric R Thermocouple radio frequency lesion electrode
US4674499A (en) * 1980-12-08 1987-06-23 Pao David S C Coaxial bipolar probe
US4896671A (en) * 1988-08-01 1990-01-30 C. R. Bard, Inc. Catheter with contoured ablation electrode
US4936842A (en) * 1987-05-08 1990-06-26 Circon Corporation Electrosurgical probe apparatus
US5078717A (en) * 1989-04-13 1992-01-07 Everest Medical Corporation Ablation catheter with selectively deployable electrodes
US5098431A (en) * 1989-04-13 1992-03-24 Everest Medical Corporation RF ablation catheter
US5122137A (en) * 1990-04-27 1992-06-16 Boston Scientific Corporation Temperature controlled rf coagulation
US5364393A (en) * 1990-07-02 1994-11-15 Heart Technology, Inc. Tissue dissipative recanalization catheter
US5397339A (en) * 1986-11-14 1995-03-14 Desai; Jawahar M. Catheter for mapping and ablation and method therefor
US5439224A (en) * 1992-06-05 1995-08-08 Bertoncino; James Driving range with automated scoring system
US5450846A (en) * 1993-01-08 1995-09-19 Goldreyer; Bruce N. Method for spatially specific electrophysiological sensing for mapping, pacing and ablating human myocardium and a catheter for the same
US5454809A (en) * 1989-01-06 1995-10-03 Angioplasty Systems, Inc. Electrosurgical catheter and method for resolving atherosclerotic plaque by radio frequency sparking
US5458597A (en) * 1993-11-08 1995-10-17 Zomed International Device for treating cancer and non-malignant tumors and methods
US5540681A (en) * 1992-04-10 1996-07-30 Medtronic Cardiorhythm Method and system for radiofrequency ablation of tissue
US5674191A (en) * 1994-05-09 1997-10-07 Somnus Medical Technologies, Inc. Ablation apparatus and system for removal of soft palate tissue
US5697536A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US5697909A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation Methods and apparatus for surgical cutting
US5697882A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US5749914A (en) * 1989-01-06 1998-05-12 Advanced Coronary Intervention Catheter for obstructed stent
US5782826A (en) * 1996-11-01 1998-07-21 Ep Technologies, Inc. System and methods for detecting ancillary tissue near tissue targeted for ablation
US5843019A (en) * 1992-01-07 1998-12-01 Arthrocare Corporation Shaped electrodes and methods for electrosurgical cutting and ablation
US5895386A (en) * 1996-12-20 1999-04-20 Electroscope, Inc. Bipolar coagulation apparatus and method for arthroscopy
US5897552A (en) * 1991-11-08 1999-04-27 Ep Technologies, Inc. Electrode and associated systems using thermally insulated temperature sensing elements
US5906614A (en) * 1991-11-08 1999-05-25 Ep Technologies, Inc. Tissue heating and ablation systems and methods using predicted temperature for monitoring and control
US5971983A (en) * 1997-05-09 1999-10-26 The Regents Of The University Of California Tissue ablation device and method of use
US6004319A (en) * 1995-06-23 1999-12-21 Gyrus Medical Limited Electrosurgical instrument
US6016452A (en) * 1996-03-19 2000-01-18 Kasevich; Raymond S. Dynamic heating method and radio frequency thermal treatment
US6023638A (en) * 1995-07-28 2000-02-08 Scimed Life Systems, Inc. System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissue
US6096035A (en) * 1995-08-18 2000-08-01 Sodhi; Chris Multipolar transmural probe
US6102907A (en) * 1997-08-15 2000-08-15 Somnus Medical Technologies, Inc. Apparatus and device for use therein and method for ablation of tissue
US6122549A (en) * 1996-08-13 2000-09-19 Oratec Interventions, Inc. Apparatus for treating intervertebral discs with resistive energy
US6139545A (en) * 1998-09-09 2000-10-31 Vidaderm Systems and methods for ablating discrete motor nerve regions
US6146380A (en) * 1998-01-09 2000-11-14 Radionics, Inc. Bent tip electrical surgical probe
US6149620A (en) * 1995-11-22 2000-11-21 Arthrocare Corporation System and methods for electrosurgical tissue treatment in the presence of electrically conductive fluid
US6149647A (en) * 1999-04-19 2000-11-21 Tu; Lily Chen Apparatus and methods for tissue treatment
US6159194A (en) * 1992-01-07 2000-12-12 Arthrocare Corporation System and method for electrosurgical tissue contraction
US6161048A (en) * 1997-06-26 2000-12-12 Radionics, Inc. Method and system for neural tissue modification
US6165169A (en) * 1994-03-04 2000-12-26 Ep Technologies, Inc. Systems and methods for identifying the physical, mechanical, and functional attributes of multiple electrode arrays
US6197021B1 (en) * 1994-08-08 2001-03-06 Ep Technologies, Inc. Systems and methods for controlling tissue ablation using multiple temperature sensing elements
US6241753B1 (en) * 1995-05-05 2001-06-05 Thermage, Inc. Method for scar collagen formation and contraction
US6246912B1 (en) * 1996-06-27 2001-06-12 Sherwood Services Ag Modulated high frequency tissue modification
US6259952B1 (en) * 1996-06-27 2001-07-10 Radionics, Inc. Method and apparatus for altering neural tissue function
US6259945B1 (en) * 1999-04-30 2001-07-10 Uromed Corporation Method and device for locating a nerve
US6292695B1 (en) * 1998-06-19 2001-09-18 Wilton W. Webster, Jr. Method and apparatus for transvascular treatment of tachycardia and fibrillation
US6312428B1 (en) * 1995-03-03 2001-11-06 Neothermia Corporation Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue
US6337994B1 (en) * 1998-04-30 2002-01-08 Johns Hopkins University Surgical needle probe for electrical impedance measurements
US6379349B1 (en) * 1995-11-08 2002-04-30 Celon Ag Medical Instruments Arrangement for electrothermal treatment of the human or animal body
US6384384B1 (en) * 2000-07-28 2002-05-07 General Electric Company Boil dry detection in cooking appliances
US20020065481A1 (en) * 2000-11-24 2002-05-30 Ckm Diagnostics, Inc. Nerve stimulator output control needle with depth determination capability and method of use
US20020065567A1 (en) * 2000-11-27 2002-05-30 Kodera Electronics Co., Ltd. Game providing system in golf driving range
US6405732B1 (en) * 1994-06-24 2002-06-18 Curon Medical, Inc. Method to treat gastric reflux via the detection and ablation of gastro-esophageal nerves and receptors
US20020120260A1 (en) * 2001-02-28 2002-08-29 Morris David L. Tissue surface treatment apparatus and method
US6466817B1 (en) * 1999-11-24 2002-10-15 Nuvasive, Inc. Nerve proximity and status detection system and method
US6524308B1 (en) * 1997-09-04 2003-02-25 Celon Ag Medical Instruments Electrode arrangement for electrothermal treatment of human or animal bodies
US6569028B1 (en) * 1995-01-28 2003-05-27 Glowrange, L.L.C. Golf driving range
US6575969B1 (en) * 1995-05-04 2003-06-10 Sherwood Services Ag Cool-tip radiofrequency thermosurgery electrode system for tumor ablation
US6618626B2 (en) * 2001-01-16 2003-09-09 Hs West Investments, Llc Apparatus and methods for protecting the axillary nerve during thermal capsullorhaphy
US6663627B2 (en) * 2001-04-26 2003-12-16 Medtronic, Inc. Ablation system and method of use
US6719754B2 (en) * 1995-11-22 2004-04-13 Arthrocare Corporation Methods for electrosurgical-assisted lipectomy
US6740084B2 (en) * 2001-12-18 2004-05-25 Ethicon, Inc. Method and device to enhance RF electrode performance
US6749604B1 (en) * 1993-05-10 2004-06-15 Arthrocare Corporation Electrosurgical instrument with axially-spaced electrodes
US20050033137A1 (en) * 2002-10-25 2005-02-10 The Regents Of The University Of Michigan Ablation catheters and methods for their use
US20050177211A1 (en) * 2002-03-05 2005-08-11 Baylis Medical Company Inc. Electrosurgical device for treatment of tissue
US6989010B2 (en) * 2001-04-26 2006-01-24 Medtronic, Inc. Ablation system and method of use
US20060089688A1 (en) * 2004-10-25 2006-04-27 Dorin Panescu Method and apparatus to reduce wrinkles through application of radio frequency energy to nerves
US7115124B1 (en) * 2003-11-12 2006-10-03 Jia Hua Xiao Device and method for tissue ablation using bipolar radio-frequency current
US7282049B2 (en) * 2004-10-08 2007-10-16 Sherwood Services Ag Electrosurgical system employing multiple electrodes and method thereof
US7300435B2 (en) * 2003-11-21 2007-11-27 Sherwood Services Ag Automatic control system for an electrosurgical generator
US20080051859A1 (en) * 1996-08-13 2008-02-28 Oratec Interventions, Inc. Method for treating intervertebral discs

Family Cites Families (32)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US870202A (en) * 1907-11-05 Charles W Sponsel Reversing-gear.
US4306111A (en) 1979-05-31 1981-12-15 Communications Satellite Corporation Simple and effective public-key cryptosystem
US5403311A (en) 1993-03-29 1995-04-04 Boston Scientific Corporation Electro-coagulation and ablation and other electrotherapeutic treatments of body tissue
US6099524A (en) * 1994-01-28 2000-08-08 Cardiac Pacemakers, Inc. Electrophysiological mapping and ablation catheter and method
US5540734A (en) 1994-09-28 1996-07-30 Zabara; Jacob Cranial nerve stimulation treatments using neurocybernetic prosthesis
US6228082B1 (en) 1995-11-22 2001-05-08 Arthrocare Corporation Systems and methods for electrosurgical treatment of vascular disorders
US6805130B2 (en) * 1995-11-22 2004-10-19 Arthrocare Corporation Methods for electrosurgical tendon vascularization
DE29519651U1 (en) 1995-12-14 1996-02-01 Muntermann Axel Device for linear radio frequency catheter ablation of endomyocardial tissue
US6432986B2 (en) 1997-07-21 2002-08-13 Bruce H. Levin Compositions, kits, and methods for inhibiting cerebral neurovascular disorders and muscular headaches
US6139546A (en) * 1997-10-06 2000-10-31 Somnus Medical Technologies, Inc. Linear power control with digital phase lock
US5984918A (en) * 1997-12-22 1999-11-16 Garito; Jon C. Electrosurgical handpiece with multiple electrode collet
US6428537B1 (en) 1998-05-22 2002-08-06 Scimed Life Systems, Inc. Electrophysiological treatment methods and apparatus employing high voltage pulse to render tissue temporarily unresponsive
US6235027B1 (en) * 1999-01-21 2001-05-22 Garrett D. Herzon Thermal cautery surgical forceps
US6702811B2 (en) 1999-04-05 2004-03-09 Medtronic, Inc. Ablation catheter assembly with radially decreasing helix and method of use
US6526318B1 (en) 2000-06-16 2003-02-25 Mehdi M. Ansarinia Stimulation method for the sphenopalatine ganglia, sphenopalatine nerve, or vidian nerve for treatment of medical conditions
US6424890B1 (en) * 2000-11-30 2002-07-23 Nokia Mobile Phones, Ltd. Method and apparatus for satellite orbit interpolation using piecewise hermite interpolating polynomials
WO2002054941A2 (en) * 2001-01-11 2002-07-18 Rita Medical Systems Inc Bone-treatment instrument and method
US6735475B1 (en) 2001-01-30 2004-05-11 Advanced Bionics Corporation Fully implantable miniature neurostimulator for stimulation as a therapy for headache and/or facial pain
US6564096B2 (en) * 2001-02-28 2003-05-13 Robert A. Mest Method and system for treatment of tachycardia and fibrillation
AU2002357166A1 (en) 2001-12-12 2003-06-23 Tissuelink Medical, Inc. Fluid-assisted medical devices, systems and methods
EP1474057B1 (en) 2002-02-12 2007-03-28 Oratec Interventions, Inc Radiofrequency arthroscopic ablation device
US7004174B2 (en) 2002-05-31 2006-02-28 Neothermia Corporation Electrosurgery with infiltration anesthesia
US20090062886A1 (en) 2002-12-09 2009-03-05 Ferro Solutions, Inc. Systems and methods for delivering electrical energy in the body
US20060153876A1 (en) 2003-02-24 2006-07-13 Ira Sanders Cell membrane translocation of regulated snare inhibitors, compositions therefor, and methods for treatment of disease
US20050283148A1 (en) 2004-06-17 2005-12-22 Janssen William M Ablation apparatus and system to limit nerve conduction
US8521295B2 (en) 2004-09-23 2013-08-27 Michael D. Laufer Location and deactivation of muscles
CA2659261C (en) 2006-07-28 2017-03-07 Centre Hospitalier Universitaire De Quebec Probe, sleeve, system, method and kit for performing percutaneous thermotherapy
WO2008014465A2 (en) 2006-07-28 2008-01-31 Jnj Technology Holdings, Llc Ablation apparatus and system to limit nerve conduction
US8512715B2 (en) 2008-08-14 2013-08-20 The Cleveland Clinic Foundation Apparatus and method for treating a neuromuscular defect
US8666498B2 (en) 2008-10-27 2014-03-04 Serene Medical, Inc. Treatment of headache
US20140058372A1 (en) 2012-08-22 2014-02-27 Amir Belson Treatment for renal failure
US20140303617A1 (en) 2013-03-05 2014-10-09 Neuro Ablation, Inc. Intravascular nerve ablation devices & methods

Patent Citations (74)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3104879A (en) * 1963-09-24 Jetton
US4411266A (en) * 1980-09-24 1983-10-25 Cosman Eric R Thermocouple radio frequency lesion electrode
US4674499A (en) * 1980-12-08 1987-06-23 Pao David S C Coaxial bipolar probe
US5397339A (en) * 1986-11-14 1995-03-14 Desai; Jawahar M. Catheter for mapping and ablation and method therefor
US4936842A (en) * 1987-05-08 1990-06-26 Circon Corporation Electrosurgical probe apparatus
US4896671A (en) * 1988-08-01 1990-01-30 C. R. Bard, Inc. Catheter with contoured ablation electrode
US5454809A (en) * 1989-01-06 1995-10-03 Angioplasty Systems, Inc. Electrosurgical catheter and method for resolving atherosclerotic plaque by radio frequency sparking
US5749914A (en) * 1989-01-06 1998-05-12 Advanced Coronary Intervention Catheter for obstructed stent
US5098431A (en) * 1989-04-13 1992-03-24 Everest Medical Corporation RF ablation catheter
US5078717A (en) * 1989-04-13 1992-01-07 Everest Medical Corporation Ablation catheter with selectively deployable electrodes
US5122137A (en) * 1990-04-27 1992-06-16 Boston Scientific Corporation Temperature controlled rf coagulation
US5364393A (en) * 1990-07-02 1994-11-15 Heart Technology, Inc. Tissue dissipative recanalization catheter
US5906614A (en) * 1991-11-08 1999-05-25 Ep Technologies, Inc. Tissue heating and ablation systems and methods using predicted temperature for monitoring and control
US5897552A (en) * 1991-11-08 1999-04-27 Ep Technologies, Inc. Electrode and associated systems using thermally insulated temperature sensing elements
US5697882A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US5697536A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation System and method for electrosurgical cutting and ablation
US5697909A (en) * 1992-01-07 1997-12-16 Arthrocare Corporation Methods and apparatus for surgical cutting
US6159194A (en) * 1992-01-07 2000-12-12 Arthrocare Corporation System and method for electrosurgical tissue contraction
US5843019A (en) * 1992-01-07 1998-12-01 Arthrocare Corporation Shaped electrodes and methods for electrosurgical cutting and ablation
US5540681A (en) * 1992-04-10 1996-07-30 Medtronic Cardiorhythm Method and system for radiofrequency ablation of tissue
US5439224A (en) * 1992-06-05 1995-08-08 Bertoncino; James Driving range with automated scoring system
US5450846A (en) * 1993-01-08 1995-09-19 Goldreyer; Bruce N. Method for spatially specific electrophysiological sensing for mapping, pacing and ablating human myocardium and a catheter for the same
US6749604B1 (en) * 1993-05-10 2004-06-15 Arthrocare Corporation Electrosurgical instrument with axially-spaced electrodes
US5458597A (en) * 1993-11-08 1995-10-17 Zomed International Device for treating cancer and non-malignant tumors and methods
US6165169A (en) * 1994-03-04 2000-12-26 Ep Technologies, Inc. Systems and methods for identifying the physical, mechanical, and functional attributes of multiple electrode arrays
US5674191A (en) * 1994-05-09 1997-10-07 Somnus Medical Technologies, Inc. Ablation apparatus and system for removal of soft palate tissue
US6405732B1 (en) * 1994-06-24 2002-06-18 Curon Medical, Inc. Method to treat gastric reflux via the detection and ablation of gastro-esophageal nerves and receptors
US6197021B1 (en) * 1994-08-08 2001-03-06 Ep Technologies, Inc. Systems and methods for controlling tissue ablation using multiple temperature sensing elements
US6569028B1 (en) * 1995-01-28 2003-05-27 Glowrange, L.L.C. Golf driving range
US6312428B1 (en) * 1995-03-03 2001-11-06 Neothermia Corporation Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue
US6575969B1 (en) * 1995-05-04 2003-06-10 Sherwood Services Ag Cool-tip radiofrequency thermosurgery electrode system for tumor ablation
US6381498B1 (en) * 1995-05-05 2002-04-30 Thermage, Inc. Method and apparatus for controlled contraction of collagen tissue
US6241753B1 (en) * 1995-05-05 2001-06-05 Thermage, Inc. Method for scar collagen formation and contraction
US6004319A (en) * 1995-06-23 1999-12-21 Gyrus Medical Limited Electrosurgical instrument
US6023638A (en) * 1995-07-28 2000-02-08 Scimed Life Systems, Inc. System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissue
US6096035A (en) * 1995-08-18 2000-08-01 Sodhi; Chris Multipolar transmural probe
US6379349B1 (en) * 1995-11-08 2002-04-30 Celon Ag Medical Instruments Arrangement for electrothermal treatment of the human or animal body
US6719754B2 (en) * 1995-11-22 2004-04-13 Arthrocare Corporation Methods for electrosurgical-assisted lipectomy
US6149620A (en) * 1995-11-22 2000-11-21 Arthrocare Corporation System and methods for electrosurgical tissue treatment in the presence of electrically conductive fluid
US6016452A (en) * 1996-03-19 2000-01-18 Kasevich; Raymond S. Dynamic heating method and radio frequency thermal treatment
US6246912B1 (en) * 1996-06-27 2001-06-12 Sherwood Services Ag Modulated high frequency tissue modification
US6259952B1 (en) * 1996-06-27 2001-07-10 Radionics, Inc. Method and apparatus for altering neural tissue function
US6122549A (en) * 1996-08-13 2000-09-19 Oratec Interventions, Inc. Apparatus for treating intervertebral discs with resistive energy
US20080051859A1 (en) * 1996-08-13 2008-02-28 Oratec Interventions, Inc. Method for treating intervertebral discs
US5782826A (en) * 1996-11-01 1998-07-21 Ep Technologies, Inc. System and methods for detecting ancillary tissue near tissue targeted for ablation
US5895386A (en) * 1996-12-20 1999-04-20 Electroscope, Inc. Bipolar coagulation apparatus and method for arthroscopy
US5971983A (en) * 1997-05-09 1999-10-26 The Regents Of The University Of California Tissue ablation device and method of use
US6161048A (en) * 1997-06-26 2000-12-12 Radionics, Inc. Method and system for neural tissue modification
USRE40279E1 (en) * 1997-06-26 2008-04-29 Sherwood Services Ag Method and system for neural tissue modification
US6102907A (en) * 1997-08-15 2000-08-15 Somnus Medical Technologies, Inc. Apparatus and device for use therein and method for ablation of tissue
US6911027B1 (en) * 1997-08-15 2005-06-28 Somnus Medical Technologies, Inc. Device for the ablation of tissue
US6524308B1 (en) * 1997-09-04 2003-02-25 Celon Ag Medical Instruments Electrode arrangement for electrothermal treatment of human or animal bodies
US6146380A (en) * 1998-01-09 2000-11-14 Radionics, Inc. Bent tip electrical surgical probe
US6337994B1 (en) * 1998-04-30 2002-01-08 Johns Hopkins University Surgical needle probe for electrical impedance measurements
US6292695B1 (en) * 1998-06-19 2001-09-18 Wilton W. Webster, Jr. Method and apparatus for transvascular treatment of tachycardia and fibrillation
US6139545A (en) * 1998-09-09 2000-10-31 Vidaderm Systems and methods for ablating discrete motor nerve regions
US6149647A (en) * 1999-04-19 2000-11-21 Tu; Lily Chen Apparatus and methods for tissue treatment
US6259945B1 (en) * 1999-04-30 2001-07-10 Uromed Corporation Method and device for locating a nerve
US6466817B1 (en) * 1999-11-24 2002-10-15 Nuvasive, Inc. Nerve proximity and status detection system and method
US7177677B2 (en) * 1999-11-24 2007-02-13 Nuvasive, Inc. Nerve proximity and status detection system and method
US6384384B1 (en) * 2000-07-28 2002-05-07 General Electric Company Boil dry detection in cooking appliances
US20020065481A1 (en) * 2000-11-24 2002-05-30 Ckm Diagnostics, Inc. Nerve stimulator output control needle with depth determination capability and method of use
US20020065567A1 (en) * 2000-11-27 2002-05-30 Kodera Electronics Co., Ltd. Game providing system in golf driving range
US6618626B2 (en) * 2001-01-16 2003-09-09 Hs West Investments, Llc Apparatus and methods for protecting the axillary nerve during thermal capsullorhaphy
US20020120260A1 (en) * 2001-02-28 2002-08-29 Morris David L. Tissue surface treatment apparatus and method
US6663627B2 (en) * 2001-04-26 2003-12-16 Medtronic, Inc. Ablation system and method of use
US6989010B2 (en) * 2001-04-26 2006-01-24 Medtronic, Inc. Ablation system and method of use
US6740084B2 (en) * 2001-12-18 2004-05-25 Ethicon, Inc. Method and device to enhance RF electrode performance
US20050177211A1 (en) * 2002-03-05 2005-08-11 Baylis Medical Company Inc. Electrosurgical device for treatment of tissue
US20050033137A1 (en) * 2002-10-25 2005-02-10 The Regents Of The University Of Michigan Ablation catheters and methods for their use
US7115124B1 (en) * 2003-11-12 2006-10-03 Jia Hua Xiao Device and method for tissue ablation using bipolar radio-frequency current
US7300435B2 (en) * 2003-11-21 2007-11-27 Sherwood Services Ag Automatic control system for an electrosurgical generator
US7282049B2 (en) * 2004-10-08 2007-10-16 Sherwood Services Ag Electrosurgical system employing multiple electrodes and method thereof
US20060089688A1 (en) * 2004-10-25 2006-04-27 Dorin Panescu Method and apparatus to reduce wrinkles through application of radio frequency energy to nerves

Cited By (405)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9375271B2 (en) 1998-10-23 2016-06-28 Covidien Ag Vessel sealing system
US9463067B2 (en) 1998-10-23 2016-10-11 Covidien Ag Vessel sealing system
US8591506B2 (en) 1998-10-23 2013-11-26 Covidien Ag Vessel sealing system
US9375270B2 (en) 1998-10-23 2016-06-28 Covidien Ag Vessel sealing system
US7815634B2 (en) 2000-03-06 2010-10-19 Salient Surgical Technologies, Inc. Fluid delivery system and controller for electrosurgical devices
US8361068B2 (en) 2000-03-06 2013-01-29 Medtronic Advanced Energy Llc Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof
US8048070B2 (en) 2000-03-06 2011-11-01 Salient Surgical Technologies, Inc. Fluid-assisted medical devices, systems and methods
US8038670B2 (en) 2000-03-06 2011-10-18 Salient Surgical Technologies, Inc. Fluid-assisted medical devices, systems and methods
US7811282B2 (en) 2000-03-06 2010-10-12 Salient Surgical Technologies, Inc. Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof
US7645277B2 (en) 2000-09-22 2010-01-12 Salient Surgical Technologies, Inc. Fluid-assisted medical device
US7651494B2 (en) 2000-09-22 2010-01-26 Salient Surgical Technologies, Inc. Fluid-assisted medical device
US7951148B2 (en) 2001-03-08 2011-05-31 Salient Surgical Technologies, Inc. Electrosurgical device having a tissue reduction sensor
US10265121B2 (en) 2001-04-06 2019-04-23 Covidien Ag Vessel sealer and divider
US10251696B2 (en) 2001-04-06 2019-04-09 Covidien Ag Vessel sealer and divider with stop members
US10687887B2 (en) 2001-04-06 2020-06-23 Covidien Ag Vessel sealer and divider
US7998140B2 (en) 2002-02-12 2011-08-16 Salient Surgical Technologies, Inc. Fluid-assisted medical devices, systems and methods
US20100185161A1 (en) * 2002-09-30 2010-07-22 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
USRE46356E1 (en) 2002-09-30 2017-04-04 Relievant Medsystems, Inc. Method of treating an intraosseous nerve
US20150335382A1 (en) * 2002-09-30 2015-11-26 Relievant Medsystems, Inc. Denervation methods
US8992522B2 (en) 2002-09-30 2015-03-31 Relievant Medsystems, Inc. Back pain treatment methods
US8613744B2 (en) 2002-09-30 2013-12-24 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
US8992523B2 (en) 2002-09-30 2015-03-31 Relievant Medsystems, Inc. Vertebral treatment
US9486279B2 (en) 2002-09-30 2016-11-08 Relievant Medsystems, Inc. Intraosseous nerve treatment
US8425507B2 (en) * 2002-09-30 2013-04-23 Relievant Medsystems, Inc. Basivertebral nerve denervation
US8419731B2 (en) 2002-09-30 2013-04-16 Relievant Medsystems, Inc. Methods of treating back pain
US10478246B2 (en) 2002-09-30 2019-11-19 Relievant Medsystems, Inc. Ablation of tissue within vertebral body involving internal cooling
US11596468B2 (en) 2002-09-30 2023-03-07 Relievant Medsystems, Inc. Intraosseous nerve treatment
US10111704B2 (en) 2002-09-30 2018-10-30 Relievant Medsystems, Inc. Intraosseous nerve treatment
US9848944B2 (en) 2002-09-30 2017-12-26 Relievant Medsystems, Inc. Thermal denervation devices and methods
US8623014B2 (en) 2002-09-30 2014-01-07 Relievant Medsystems, Inc. Systems for denervation of basivertebral nerves
US8628528B2 (en) 2002-09-30 2014-01-14 Relievant Medsystems, Inc. Vertebral denervation
US9173676B2 (en) 2002-09-30 2015-11-03 Relievant Medsystems, Inc. Nerve modulation methods
US20110034884A9 (en) * 2002-09-30 2011-02-10 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
US20130006233A1 (en) * 2002-09-30 2013-01-03 Relievant Medsystems, Inc. Basivertebral nerve denervation
US9023038B2 (en) 2002-09-30 2015-05-05 Relievant Medsystems, Inc. Denervation methods
US9421064B2 (en) 2002-09-30 2016-08-23 Relievant Medsystems, Inc. Nerve modulation systems
USRE48460E1 (en) 2002-09-30 2021-03-09 Relievant Medsystems, Inc. Method of treating an intraosseous nerve
US20120330300A1 (en) * 2002-09-30 2012-12-27 Relievant Medsystems, Inc. Intraosseous nerve denervation methods
US9017325B2 (en) 2002-09-30 2015-04-28 Relievant Medsystems, Inc. Nerve modulation systems
US8551091B2 (en) 2002-10-04 2013-10-08 Covidien Ag Vessel sealing instrument with electrical cutting mechanism
US8475455B2 (en) 2002-10-29 2013-07-02 Medtronic Advanced Energy Llc Fluid-assisted electrosurgical scissors and methods
US8945125B2 (en) 2002-11-14 2015-02-03 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US10463423B2 (en) 2003-03-28 2019-11-05 Relievant Medsystems, Inc. Thermal denervation devices and methods
US8882764B2 (en) 2003-03-28 2014-11-11 Relievant Medsystems, Inc. Thermal denervation devices
US9848938B2 (en) 2003-11-13 2017-12-26 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US10441350B2 (en) 2003-11-17 2019-10-15 Covidien Ag Bipolar forceps having monopolar extension
US8257352B2 (en) 2003-11-17 2012-09-04 Covidien Ag Bipolar forceps having monopolar extension
US8597296B2 (en) 2003-11-17 2013-12-03 Covidien Ag Bipolar forceps having monopolar extension
US8394096B2 (en) 2003-11-19 2013-03-12 Covidien Ag Open vessel sealing instrument with cutting mechanism
US7727232B1 (en) 2004-02-04 2010-06-01 Salient Surgical Technologies, Inc. Fluid-assisted medical devices and methods
US8075557B2 (en) 2004-02-04 2011-12-13 Salient Surgical Technologies, Inc. Fluid-assisted medical devices and methods
US8348948B2 (en) 2004-03-02 2013-01-08 Covidien Ag Vessel sealing system using capacitive RF dielectric heating
US10548660B2 (en) 2004-06-17 2020-02-04 Serene Medical, Inc. Ablation apparatus and system to limit nerve conduction
US20100114095A1 (en) * 2004-06-17 2010-05-06 Bioform Medical, Inc. Ablation Apparatus and System to Limit Nerve Conduction
US20070060921A1 (en) * 2004-06-17 2007-03-15 Jnj Technology Holdings Llc Ablation apparatus and system to limit nerve conduction
US9283031B2 (en) 2004-06-17 2016-03-15 Serene Medical, Inc. Ablation apparatus and system to limit nerve conduction
US9168091B2 (en) 2004-06-17 2015-10-27 Serene Medical, Inc. Ablation apparatus and system to limit nerve conduction
US20070167943A1 (en) * 2004-06-17 2007-07-19 Jnj Technology Holdings Llc Ablation apparatus and system to limit nerve conduction
US20060030845A1 (en) * 2004-08-04 2006-02-09 Baylis Medical Company, Inc. Electrosurgical treatment in conjunction with monitoring
US7799021B2 (en) * 2004-08-04 2010-09-21 Kimberly-Clark Inc. Electrosurgical treatment in conjunction with monitoring
US20060041295A1 (en) * 2004-08-17 2006-02-23 Osypka Thomas P Positive fixation percutaneous epidural neurostimulation lead
US8221397B2 (en) 2004-10-15 2012-07-17 Baxano, Inc. Devices and methods for tissue modification
US9320618B2 (en) 2004-10-15 2016-04-26 Amendia, Inc. Access and tissue modification systems and methods
US7963915B2 (en) 2004-10-15 2011-06-21 Baxano, Inc. Devices and methods for tissue access
US8257356B2 (en) 2004-10-15 2012-09-04 Baxano, Inc. Guidewire exchange systems to treat spinal stenosis
US8579902B2 (en) 2004-10-15 2013-11-12 Baxano Signal, Inc. Devices and methods for tissue modification
US8801626B2 (en) 2004-10-15 2014-08-12 Baxano Surgical, Inc. Flexible neural localization devices and methods
US7938830B2 (en) 2004-10-15 2011-05-10 Baxano, Inc. Powered tissue modification devices and methods
US9463041B2 (en) 2004-10-15 2016-10-11 Amendia, Inc. Devices and methods for tissue access
US8568416B2 (en) 2004-10-15 2013-10-29 Baxano Surgical, Inc. Access and tissue modification systems and methods
US11382647B2 (en) 2004-10-15 2022-07-12 Spinal Elements, Inc. Devices and methods for treating tissue
US7738968B2 (en) 2004-10-15 2010-06-15 Baxano, Inc. Devices and methods for selective surgical removal of tissue
US7738969B2 (en) 2004-10-15 2010-06-15 Baxano, Inc. Devices and methods for selective surgical removal of tissue
US10052116B2 (en) 2004-10-15 2018-08-21 Amendia, Inc. Devices and methods for treating tissue
US8652138B2 (en) 2004-10-15 2014-02-18 Baxano Surgical, Inc. Flexible tissue rasp
US8647346B2 (en) 2004-10-15 2014-02-11 Baxano Surgical, Inc. Devices and methods for tissue modification
US9456829B2 (en) 2004-10-15 2016-10-04 Amendia, Inc. Powered tissue modification devices and methods
US9101386B2 (en) 2004-10-15 2015-08-11 Amendia, Inc. Devices and methods for treating tissue
US9345491B2 (en) 2004-10-15 2016-05-24 Amendia, Inc. Flexible tissue rasp
US8613745B2 (en) 2004-10-15 2013-12-24 Baxano Surgical, Inc. Methods, systems and devices for carpal tunnel release
US9247952B2 (en) 2004-10-15 2016-02-02 Amendia, Inc. Devices and methods for tissue access
US8048080B2 (en) 2004-10-15 2011-11-01 Baxano, Inc. Flexible tissue rasp
US7740631B2 (en) 2004-10-15 2010-06-22 Baxano, Inc. Devices and methods for tissue modification
US8617163B2 (en) 2004-10-15 2013-12-31 Baxano Surgical, Inc. Methods, systems and devices for carpal tunnel release
US8192435B2 (en) 2004-10-15 2012-06-05 Baxano, Inc. Devices and methods for tissue modification
US8430881B2 (en) 2004-10-15 2013-04-30 Baxano, Inc. Mechanical tissue modification devices and methods
US8147489B2 (en) 2005-01-14 2012-04-03 Covidien Ag Open vessel sealing instrument
US20080262490A1 (en) * 2005-03-04 2008-10-23 Williams Donald V Minimal Device and Method for Effecting Hyperthermia Derived Anesthesia
US9031667B2 (en) * 2005-03-04 2015-05-12 InterventionTechnology Pty Ltd Minimal device and method for effecting hyperthermia derived anesthesia
US8419653B2 (en) 2005-05-16 2013-04-16 Baxano, Inc. Spinal access and neural localization
US7713266B2 (en) 2005-05-20 2010-05-11 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US7850683B2 (en) 2005-05-20 2010-12-14 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US9345526B2 (en) 2005-05-20 2016-05-24 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US20070129714A1 (en) * 2005-05-20 2007-06-07 Echo Healthcare Llc Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (FAT)
US7862558B2 (en) 2005-05-20 2011-01-04 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US11350979B2 (en) 2005-05-20 2022-06-07 Pacira Cryotech, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US7998137B2 (en) 2005-05-20 2011-08-16 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US10363080B2 (en) 2005-05-20 2019-07-30 Pacira Cryotech, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US9072498B2 (en) 2005-05-20 2015-07-07 Myoscience, Inc. Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue (fat)
US10188452B2 (en) 2005-08-19 2019-01-29 Covidien Ag Single action tissue sealer
US9198717B2 (en) 2005-08-19 2015-12-01 Covidien Ag Single action tissue sealer
US20140051999A1 (en) * 2005-09-27 2014-02-20 Nuvasive, Inc. System and Methods for Nerve Monitoring
US11712218B2 (en) 2005-09-27 2023-08-01 Nuvasive, Inc. System and methods for nerve monitoring
US11617562B2 (en) 2005-09-27 2023-04-04 Nuvasive, Inc. System and methods for nerve monitoring
US11653894B2 (en) * 2005-09-27 2023-05-23 Nuvasive, Inc. System and methods for nerve monitoring
US11540804B2 (en) 2005-09-27 2023-01-03 Nuvasive, Inc. System and methods for nerve monitoring
US10299756B1 (en) 2005-09-27 2019-05-28 Nuvasive, Inc. System and methods for nerve monitoring
US8197633B2 (en) 2005-09-30 2012-06-12 Covidien Ag Method for manufacturing an end effector assembly
US8361072B2 (en) 2005-09-30 2013-01-29 Covidien Ag Insulating boot for electrosurgical forceps
US9579145B2 (en) 2005-09-30 2017-02-28 Covidien Ag Flexible endoscopic catheter with ligasure
US8394095B2 (en) 2005-09-30 2013-03-12 Covidien Ag Insulating boot for electrosurgical forceps
US8641713B2 (en) 2005-09-30 2014-02-04 Covidien Ag Flexible endoscopic catheter with ligasure
US8062298B2 (en) 2005-10-15 2011-11-22 Baxano, Inc. Flexible tissue removal devices and methods
US8092456B2 (en) 2005-10-15 2012-01-10 Baxano, Inc. Multiple pathways for spinal nerve root decompression from a single access point
US9492151B2 (en) 2005-10-15 2016-11-15 Amendia, Inc. Multiple pathways for spinal nerve root decompression from a single access point
US8366712B2 (en) 2005-10-15 2013-02-05 Baxano, Inc. Multiple pathways for spinal nerve root decompression from a single access point
US9125682B2 (en) 2005-10-15 2015-09-08 Amendia, Inc. Multiple pathways for spinal nerve root decompression from a single access point
US7887538B2 (en) 2005-10-15 2011-02-15 Baxano, Inc. Methods and apparatus for tissue modification
US20070219547A1 (en) * 2005-12-27 2007-09-20 Oscor Inc. Neuro-stimulation and ablation system
US7949402B2 (en) 2005-12-27 2011-05-24 Neuropoint Medical, Inc. Neuro-stimulation and ablation system
US8512331B2 (en) 2006-01-17 2013-08-20 Endymed Medical Ltd. Electrosurgical methods and devices employing phase-controlled radiofrequency energy
US8206381B2 (en) 2006-01-17 2012-06-26 Endymed Medical Ltd. Electrosurgical methods and devices employing phase-controlled radiofrequency energy
US20070191827A1 (en) * 2006-01-17 2007-08-16 Endymion Medical Ltd. Electrosurgical methods and devices employing phase-controlled radiofrequency energy
US8728071B2 (en) 2006-01-17 2014-05-20 Endymed Medical Ltd. Systems and methods employing radiofrequency energy for skin treatment
US8062300B2 (en) 2006-05-04 2011-11-22 Baxano, Inc. Tissue removal with at least partially flexible devices
US8585704B2 (en) 2006-05-04 2013-11-19 Baxano Surgical, Inc. Flexible tissue removal devices and methods
US9351741B2 (en) 2006-05-04 2016-05-31 Amendia, Inc. Flexible tissue removal devices and methods
US9345900B2 (en) 2006-06-28 2016-05-24 Medtronic Ardian Luxembourg S.A.R.L. Methods and systems for thermally-induced renal neuromodulation
US10722288B2 (en) 2006-06-28 2020-07-28 Medtronic Ardian Luxembourg S.A.R.L. Devices for thermally-induced renal neuromodulation
US9314644B2 (en) 2006-06-28 2016-04-19 Medtronic Ardian Luxembourg S.A.R.L. Methods and systems for thermally-induced renal neuromodulation
US11801085B2 (en) 2006-06-28 2023-10-31 Medtronic Ireland Manufacturing Unlimited Company Devices for thermally-induced renal neuromodulation
EP2068740A4 (en) * 2006-07-28 2015-02-25 Serene Medical Inc Ablation apparatus and system to limit nerve conduction
KR101794531B1 (en) * 2006-07-28 2017-11-07 메르츠 노스 아메리카 인코포레이티드 Ablation apparatus and system to limit nerve conduction
US7857813B2 (en) 2006-08-29 2010-12-28 Baxano, Inc. Tissue access guidewire system and method
US8551097B2 (en) 2006-08-29 2013-10-08 Baxano Surgical, Inc. Tissue access guidewire system and method
US8845637B2 (en) 2006-08-29 2014-09-30 Baxano Surgical, Inc. Tissue access guidewire system and method
US9254162B2 (en) 2006-12-21 2016-02-09 Myoscience, Inc. Dermal and transdermal cryogenic microprobe systems
US10939947B2 (en) 2006-12-21 2021-03-09 Pacira Cryotech, Inc. Dermal and transdermal cryogenic microprobe systems
US7987001B2 (en) 2007-01-25 2011-07-26 Warsaw Orthopedic, Inc. Surgical navigational and neuromonitoring instrument
US8409185B2 (en) 2007-02-16 2013-04-02 Myoscience, Inc. Replaceable and/or easily removable needle systems for dermal and transdermal cryogenic remodeling
US20080200910A1 (en) * 2007-02-16 2008-08-21 Myoscience, Inc. Replaceable and/or Easily Removable Needle Systems for Dermal and Transdermal Cryogenic Remodeling
US9113855B2 (en) 2007-02-16 2015-08-25 Myoscience, Inc. Replaceable and/or easily removable needle systems for dermal and transdermal cryogenic remodeling
US20080200973A1 (en) * 2007-02-20 2008-08-21 General Electric Company Method and system using MRI compatibility defibrillation pads
US20090318916A1 (en) * 2007-03-01 2009-12-24 Daniel Lischinsky Electrosurgical Methods and Devices Employing Semiconductor Chips
US7959577B2 (en) 2007-09-06 2011-06-14 Baxano, Inc. Method, system, and apparatus for neural localization
US8303516B2 (en) 2007-09-06 2012-11-06 Baxano, Inc. Method, system and apparatus for neural localization
US11672694B2 (en) 2007-11-14 2023-06-13 Pacira Cryotech, Inc. Pain management using cryogenic remodeling
US8298216B2 (en) 2007-11-14 2012-10-30 Myoscience, Inc. Pain management using cryogenic remodeling
US10864112B2 (en) 2007-11-14 2020-12-15 Pacira Cryotech, Inc. Pain management using cryogenic remodeling
US9101346B2 (en) 2007-11-14 2015-08-11 Myoscience, Inc. Pain management using cryogenic remodeling
US8715275B2 (en) 2007-11-14 2014-05-06 Myoscience, Inc. Pain management using cryogenic remodeling
US9907693B2 (en) 2007-11-14 2018-03-06 Myoscience, Inc. Pain management using cryogenic remodeling
US10869779B2 (en) 2007-11-14 2020-12-22 Pacira Cryotech, Inc. Pain management using cryogenic remodeling
US8663228B2 (en) 2007-12-07 2014-03-04 Baxano Surgical, Inc. Tissue modification devices
US8192436B2 (en) 2007-12-07 2012-06-05 Baxano, Inc. Tissue modification devices
US9463029B2 (en) 2007-12-07 2016-10-11 Amendia, Inc. Tissue modification devices
US20090270859A1 (en) * 2008-03-20 2009-10-29 Ari Hirvi Fluid compositions and methods for the use thereof
US20110034826A1 (en) * 2008-04-10 2011-02-10 Notz Juergen Surgical apparatus comprising a nerve testing device
WO2009124726A1 (en) * 2008-04-10 2009-10-15 Erbe Elektromedizin Gmbh Surgical apparatus comprising a nerve testing device
US10441344B2 (en) 2008-04-10 2019-10-15 Erbe Elektromedizin Gmbh Surgical apparatus comprising a nerve testing device
US8784415B2 (en) * 2008-05-05 2014-07-22 Stryker Corporation Powered surgical tool with an isolation circuit connected between the tool power terminals and the memory internal to the tool
US20090275940A1 (en) * 2008-05-05 2009-11-05 Malackowski Donald W Surgical tool system including a tool and a control console, the console capable of reading data from a memory internal to the tool over the conductors over which power is sourced to the tool
US9463061B2 (en) 2008-05-05 2016-10-11 Stryker Corporation Power console for a surgical tool capable of receiving memory data over which power signals are sourced to the tool
US9314253B2 (en) 2008-07-01 2016-04-19 Amendia, Inc. Tissue modification devices and methods
US8409206B2 (en) 2008-07-01 2013-04-02 Baxano, Inc. Tissue modification devices and methods
US8398641B2 (en) 2008-07-01 2013-03-19 Baxano, Inc. Tissue modification devices and methods
US8845639B2 (en) 2008-07-14 2014-09-30 Baxano Surgical, Inc. Tissue modification devices
US9265522B2 (en) 2008-09-26 2016-02-23 Relievant Medsystems, Inc. Methods for navigating an instrument through bone
US9259241B2 (en) 2008-09-26 2016-02-16 Relievant Medsystems, Inc. Methods of treating nerves within bone using fluid
US8808284B2 (en) 2008-09-26 2014-08-19 Relievant Medsystems, Inc. Systems for navigating an instrument through bone
US10265099B2 (en) 2008-09-26 2019-04-23 Relievant Medsystems, Inc. Systems for accessing nerves within bone
US9724107B2 (en) 2008-09-26 2017-08-08 Relievant Medsystems, Inc. Nerve modulation systems
US10905440B2 (en) 2008-09-26 2021-02-02 Relievant Medsystems, Inc. Nerve modulation systems
US11471171B2 (en) 2008-09-26 2022-10-18 Relievant Medsystems, Inc. Bipolar radiofrequency ablation systems for treatment within bone
US10028753B2 (en) 2008-09-26 2018-07-24 Relievant Medsystems, Inc. Spine treatment kits
US8419730B2 (en) 2008-09-26 2013-04-16 Relievant Medsystems, Inc. Systems and methods for navigating an instrument through bone
US9039701B2 (en) 2008-09-26 2015-05-26 Relievant Medsystems, Inc. Channeling paths into bone
US8568444B2 (en) 2008-10-03 2013-10-29 Covidien Lp Method of transferring rotational motion in an articulating surgical instrument
US9113898B2 (en) 2008-10-09 2015-08-25 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US20100152715A1 (en) * 2008-12-14 2010-06-17 Pattanam Srinivasan Method for Deep Tissue Laser Treatments Using Low Intensity Laser Therapy Causing Selective Destruction of Nociceptive Nerves
US9693825B2 (en) 2008-12-14 2017-07-04 C Laser, Inc. Fiber embedded hollow needle for percutaneous delivery of laser energy
US9149647B2 (en) * 2008-12-14 2015-10-06 C Laser, Inc. Method for deep tissue laser treatments using low intensity laser therapy causing selective destruction of Nociceptive nerves
US9066712B2 (en) 2008-12-22 2015-06-30 Myoscience, Inc. Integrated cryosurgical system with refrigerant and electrical power source
US9655674B2 (en) 2009-01-13 2017-05-23 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8852228B2 (en) 2009-01-13 2014-10-07 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US20100280511A1 (en) * 2009-05-01 2010-11-04 Thomas Rachlin Electrosurgical instrument with time limit circuit
US9192430B2 (en) 2009-05-01 2015-11-24 Covidien Lp Electrosurgical instrument with time limit circuit
EP2246003A1 (en) * 2009-05-01 2010-11-03 Tyco Healthcare Group, LP Electrosurgical instrument with time limit circuit
US9345535B2 (en) 2009-05-07 2016-05-24 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8454602B2 (en) 2009-05-07 2013-06-04 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US10085794B2 (en) 2009-05-07 2018-10-02 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8858554B2 (en) 2009-05-07 2014-10-14 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US20110104632A1 (en) * 2009-05-11 2011-05-05 Colby Leigh E Therapeutic tooth ablation
US9402693B2 (en) * 2009-05-11 2016-08-02 Triagenics, Llc Therapeutic tooth bud ablation
US10820963B2 (en) 2009-05-11 2020-11-03 TriAgenics, Inc. Therapeutic tooth bud ablation
US10299885B2 (en) * 2009-05-11 2019-05-28 TriAgenics, Inc. Therapeutic tooth bud ablation
US20110200961A1 (en) * 2009-05-11 2011-08-18 Colby Leigh E Therapeutic tooth bud ablation
US10265140B2 (en) * 2009-05-11 2019-04-23 TriAgenics, Inc. Therapeutic tooth bud ablation
US20110200960A1 (en) * 2009-05-11 2011-08-18 Colby Leigh E Therapeutic tooth bud ablation
US10335248B2 (en) * 2009-05-11 2019-07-02 TriAgenics, Inc. Therapeutic tooth bud ablation
US10285778B2 (en) 2009-05-11 2019-05-14 TriAgenics, Inc. Therapeutic tooth bud ablation
US9827068B2 (en) * 2009-05-11 2017-11-28 Triagenics, Llc Therapeutic tooth bud ablation
US20180014910A1 (en) * 2009-05-11 2018-01-18 Triagenics, Llc Therapeutic Tooth Bud Ablation
US11197681B2 (en) 2009-05-20 2021-12-14 Merit Medical Systems, Inc. Steerable curvable vertebroplasty drill
US8394102B2 (en) 2009-06-25 2013-03-12 Baxano, Inc. Surgical tools for treatment of spinal stenosis
US8523898B2 (en) 2009-07-08 2013-09-03 Covidien Lp Endoscopic electrosurgical jaws with offset knife
US11751942B2 (en) * 2009-09-08 2023-09-12 Medtronic Advanced Energy Llc Surgical device
US9028493B2 (en) 2009-09-18 2015-05-12 Covidien Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US9931131B2 (en) 2009-09-18 2018-04-03 Covidien Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US9265552B2 (en) 2009-09-28 2016-02-23 Covidien Lp Method of manufacturing electrosurgical seal plates
US8898888B2 (en) 2009-09-28 2014-12-02 Covidien Lp System for manufacturing electrosurgical seal plates
US11026741B2 (en) 2009-09-28 2021-06-08 Covidien Lp Electrosurgical seal plates
US11490955B2 (en) 2009-09-28 2022-11-08 Covidien Lp Electrosurgical seal plates
US9750561B2 (en) 2009-09-28 2017-09-05 Covidien Lp System for manufacturing electrosurgical seal plates
US10188454B2 (en) 2009-09-28 2019-01-29 Covidien Lp System for manufacturing electrosurgical seal plates
US20110106076A1 (en) * 2009-11-04 2011-05-05 Gregorio Hernandez Zendejas Myoablation system
US20110137305A1 (en) * 2009-12-06 2011-06-09 Gregorio Hernandez Zendejas Thermal neuroablator
US8535309B2 (en) 2010-01-07 2013-09-17 Relievant Medsystems, Inc. Vertebral bone channeling systems
US8414571B2 (en) 2010-01-07 2013-04-09 Relievant Medsystems, Inc. Vertebral bone navigation systems
US10206742B2 (en) 2010-02-21 2019-02-19 C Laser, Inc. Fiber embedded hollow spikes for percutaneous delivery of laser energy
US9265576B2 (en) 2010-02-21 2016-02-23 C Laser, Inc. Laser generator for medical treatment
US9782221B2 (en) * 2010-02-21 2017-10-10 C Laser, Inc. Treatment using low intensity laser therapy
US20160015997A1 (en) * 2010-02-21 2016-01-21 C Laser, Inc. Treatment Using Low Intensity Laser Therapy
US10327841B2 (en) * 2010-04-29 2019-06-25 Dfine, Inc. System for use in treatment of vertebral fractures
US10624652B2 (en) 2010-04-29 2020-04-21 Dfine, Inc. System for use in treatment of vertebral fractures
US10631912B2 (en) 2010-04-30 2020-04-28 Medtronic Xomed, Inc. Interface module for use with nerve monitoring and electrosurgery
WO2011136962A1 (en) * 2010-04-30 2011-11-03 Medtronic Xomed, Inc. Interface module for use with nerve monitoring and electrosurgery
US10980593B2 (en) 2010-04-30 2021-04-20 Medtronic Xomed, Inc. Interface module for use with nerve monitoring and electrosurgery
US9345530B2 (en) 2010-10-25 2016-05-24 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
US9750560B2 (en) 2010-10-25 2017-09-05 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
US9066720B2 (en) 2010-10-25 2015-06-30 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
US11006999B2 (en) 2010-10-25 2021-05-18 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
US10179020B2 (en) 2010-10-25 2019-01-15 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems and methods for evaluation and feedback of neuromodulation treatment
WO2012078278A1 (en) * 2010-12-10 2012-06-14 Salient Surgical Technologies, Inc. Bipolar electrosurgical device
US10383649B2 (en) 2011-01-14 2019-08-20 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
US11660108B2 (en) 2011-01-14 2023-05-30 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
US20140025051A1 (en) * 2011-03-25 2014-01-23 Lutronic Corporation Apparatus for optical surgery and method for controlling same
US20130023871A1 (en) * 2011-07-19 2013-01-24 Tyco Healthcare Group Lp Microwave and rf ablation system and related method for dynamic impedance matching
US20130023870A1 (en) * 2011-07-19 2013-01-24 Tyco Healthcare Group Lp Microwave and rf ablation system and related method for dynamic impedance matching
US8968297B2 (en) * 2011-07-19 2015-03-03 Covidien Lp Microwave and RF ablation system and related method for dynamic impedance matching
US9028482B2 (en) * 2011-07-19 2015-05-12 Covidien Lp Microwave and RF ablation system and related method for dynamic impedance matching
US20220022962A1 (en) * 2011-09-09 2022-01-27 Boston Scientific Scimed, Inc. Split surgical laser fiber
US9005100B2 (en) 2011-12-15 2015-04-14 The Board Of Trustees Of The Leland Stanford Jr. University Apparatus and methods for treating pulmonary hypertension
US9028391B2 (en) 2011-12-15 2015-05-12 The Board Of Trustees Of The Leland Stanford Jr. University Apparatus and methods for treating pulmonary hypertension
US10694953B2 (en) * 2011-12-20 2020-06-30 Facebook Technologies, Llc Integrated medical device
US20150148643A1 (en) * 2011-12-20 2015-05-28 Mled Limited Integrated medical device
US11471210B2 (en) 2011-12-30 2022-10-18 Relievant Medsystems, Inc. Methods of denervating vertebral body using external energy source
US10390877B2 (en) 2011-12-30 2019-08-27 Relievant Medsystems, Inc. Systems and methods for treating back pain
USD680220S1 (en) 2012-01-12 2013-04-16 Coviden IP Slider handle for laparoscopic device
US9241753B2 (en) 2012-01-13 2016-01-26 Myoscience, Inc. Skin protection for subdermal cryogenic remodeling for cosmetic and other treatments
US9155584B2 (en) 2012-01-13 2015-10-13 Myoscience, Inc. Cryogenic probe filtration system
US10188444B2 (en) 2012-01-13 2019-01-29 Myoscience, Inc. Skin protection for subdermal cryogenic remodeling for cosmetic and other treatments
US11857239B2 (en) 2012-01-13 2024-01-02 Pacira Cryotech, Inc. Cryogenic needle with freeze zone regulation
US10213244B2 (en) 2012-01-13 2019-02-26 Myoscience, Inc. Cryogenic needle with freeze zone regulation
US9314290B2 (en) 2012-01-13 2016-04-19 Myoscience, Inc. Cryogenic needle with freeze zone regulation
US9017318B2 (en) 2012-01-20 2015-04-28 Myoscience, Inc. Cryogenic probe system and method
US10076383B2 (en) 2012-01-25 2018-09-18 Covidien Lp Electrosurgical device having a multiplexer
US9693816B2 (en) 2012-01-30 2017-07-04 Covidien Lp Electrosurgical apparatus with integrated energy sensing at tissue site
US8810805B2 (en) * 2012-03-05 2014-08-19 Sick Ag Light source for a sensor and a distance-measuring optoelectronic sensor
US20130229668A1 (en) * 2012-03-05 2013-09-05 Sick Ag Light source for a sensor and a distance-measuring optoelectronic sensor
US11272909B2 (en) 2012-03-13 2022-03-15 Medtronic Xomed, Inc. Surgical system including powered rotary-type handpiece
AU2013251660B2 (en) * 2012-04-25 2017-10-05 Medtronic Xomed, Inc. Stimulation probe for robotic and laparoscopic surgery
KR20150014451A (en) * 2012-04-25 2015-02-06 메드트로닉 좀드 인코퍼레이티드 Stimulation Probe for Robotic and Laparoscopic Surgery
WO2013163307A3 (en) * 2012-04-25 2014-07-10 Medtronic Xomed, Inc. Stimulation probe for robotic and laparoscopic surgery
US11351369B2 (en) 2012-04-25 2022-06-07 Medtronic Xomed, Inc. Stimulation probe for robotic and laparoscopic surgery
US11103700B2 (en) 2012-04-25 2021-08-31 Medtronic, Inc. Stimulation probe for robotic and laparoscopic surgery
KR102146333B1 (en) * 2012-04-25 2020-08-20 메드트로닉 좀드 인코퍼레이티드 Stimulation Probe for Robotic and Laparoscopic Surgery
EP3871587A1 (en) * 2012-04-25 2021-09-01 Medtronic Xomed, Inc. Stimulation probe for robotic and laparoscopic surgery
US9730754B2 (en) * 2012-07-19 2017-08-15 Covidien Lp Ablation needle including fiber Bragg grating
US10117708B2 (en) * 2012-07-19 2018-11-06 Covidien Lp Ablation needle including fiber Bragg grating
US20170333117A1 (en) * 2012-07-19 2017-11-23 Covidien Lp Ablation needle including fiber bragg grating
US20150216442A1 (en) * 2012-07-24 2015-08-06 Lev Lavy Multilayer coaxial probe for impedance spatial contrast measurement
US20200281646A1 (en) * 2012-09-12 2020-09-10 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US20210361351A1 (en) * 2012-09-12 2021-11-25 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US20210361350A1 (en) * 2012-09-12 2021-11-25 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US11737814B2 (en) * 2012-09-12 2023-08-29 Relievant Medsystems, Inc. Cryotherapy treatment for back pain
US11701168B2 (en) * 2012-09-12 2023-07-18 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US11690667B2 (en) * 2012-09-12 2023-07-04 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US10588691B2 (en) 2012-09-12 2020-03-17 Relievant Medsystems, Inc. Radiofrequency ablation of tissue within a vertebral body
US11234764B1 (en) 2012-11-05 2022-02-01 Relievant Medsystems, Inc. Systems for navigation and treatment within a vertebral body
US10357258B2 (en) 2012-11-05 2019-07-23 Relievant Medsystems, Inc. Systems and methods for creating curved paths through bone
US11160563B2 (en) 2012-11-05 2021-11-02 Relievant Medsystems, Inc. Systems for navigation and treatment within a vertebral body
US10517611B2 (en) 2012-11-05 2019-12-31 Relievant Medsystems, Inc. Systems for navigation and treatment within a vertebral body
US11291502B2 (en) 2012-11-05 2022-04-05 Relievant Medsystems, Inc. Methods of navigation and treatment within a vertebral body
US9775627B2 (en) 2012-11-05 2017-10-03 Relievant Medsystems, Inc. Systems and methods for creating curved paths through bone and modulating nerves within the bone
US10874454B2 (en) 2012-11-13 2020-12-29 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US9820800B2 (en) 2012-11-13 2017-11-21 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US9918776B2 (en) 2012-11-13 2018-03-20 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US9872720B2 (en) 2012-11-13 2018-01-23 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US11241267B2 (en) 2012-11-13 2022-02-08 Pulnovo Medical (Wuxi) Co., Ltd Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US9827036B2 (en) 2012-11-13 2017-11-28 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US10765490B2 (en) 2013-03-15 2020-09-08 TriAgenics, Inc. Therapeutic tooth bud ablation
US9713490B2 (en) 2013-03-15 2017-07-25 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US20150374456A1 (en) * 2013-03-15 2015-12-31 Triagenics, Llc Therapeutic Tooth Bud Ablation
US11134999B2 (en) 2013-03-15 2021-10-05 Pacira Cryotech, Inc. Methods and systems for treatment of occipital neuralgia
US9295512B2 (en) 2013-03-15 2016-03-29 Myoscience, Inc. Methods and devices for pain management
US11642241B2 (en) 2013-03-15 2023-05-09 Pacira Cryotech, Inc. Cryogenic enhancement of joint function, alleviation of joint stiffness and/or alleviation of pain associated with osteoarthritis
US9561070B2 (en) 2013-03-15 2017-02-07 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US10016229B2 (en) 2013-03-15 2018-07-10 Myoscience, Inc. Methods and systems for treatment of occipital neuralgia
US9610112B2 (en) 2013-03-15 2017-04-04 Myoscience, Inc. Cryogenic enhancement of joint function, alleviation of joint stiffness and/or alleviation of pain associated with osteoarthritis
US10314739B2 (en) 2013-03-15 2019-06-11 Myoscience, Inc. Methods and devices for pain management
US10298255B2 (en) 2013-03-15 2019-05-21 TriAgenics, Inc. Therapeutic tooth bud ablation
US10888366B2 (en) 2013-03-15 2021-01-12 Pacira Cryotech, Inc. Cryogenic blunt dissection methods and devices
US9668800B2 (en) 2013-03-15 2017-06-06 Myoscience, Inc. Methods and systems for treatment of spasticity
US11399915B2 (en) 2013-03-15 2022-08-02 TriAgenics, Inc. Therapeutic tooth bud ablation
US10918434B2 (en) 2013-03-15 2021-02-16 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US11730564B2 (en) 2013-03-15 2023-08-22 TriAgenics, Inc. Therapeutic tooth bud ablation
WO2014150455A1 (en) * 2013-03-15 2014-09-25 St. Jude Medical, Cardiology Division, Inc. Multi-electrode ablation system with means for determining a common path impedance
US10085881B2 (en) 2013-03-15 2018-10-02 Myoscience, Inc. Methods, systems, and devices for treating neuromas, fibromas, nerve entrapment, and/or pain associated therewith
US10085789B2 (en) 2013-03-15 2018-10-02 Myoscience, Inc. Methods and systems for treatment of occipital neuralgia
US11865038B2 (en) 2013-03-15 2024-01-09 Pacira Cryotech, Inc. Methods, systems, and devices for treating nerve spasticity
US10080601B2 (en) 2013-03-15 2018-09-25 St Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US11253393B2 (en) 2013-03-15 2022-02-22 Pacira Cryotech, Inc. Methods, systems, and devices for treating neuromas, fibromas, nerve entrapment, and/or pain associated therewith
US11864961B2 (en) 2013-03-15 2024-01-09 TriAgenics, Inc. Therapeutic tooth bud ablation
US9855112B2 (en) 2013-03-15 2018-01-02 Triagenics, Llc Therapeutic tooth bud ablation
US11058474B2 (en) 2013-03-15 2021-07-13 St. Jude Medical, Cardiology Division, Inc. Ablation system, methods, and controllers
US10596030B2 (en) 2013-03-15 2020-03-24 Pacira Cryotech, Inc. Cryogenic enhancement of joint function, alleviation of joint stiffness and/or alleviation of pain associated with osteoarthritis
US11173012B2 (en) 2013-03-15 2021-11-16 TriAgenics, Inc. Therapeutic tooth bud ablation
US10022202B2 (en) * 2013-03-15 2018-07-17 Triagenics, Llc Therapeutic tooth bud ablation
US10603102B2 (en) 2013-07-18 2020-03-31 Covidien Lp Limited-use surgical devices
US9566109B2 (en) 2013-07-18 2017-02-14 Covidien Lp Limited-use surgical devices
US11065046B2 (en) 2013-08-08 2021-07-20 Relievant Medsystems, Inc. Modulating nerves within bone
US10456187B2 (en) 2013-08-08 2019-10-29 Relievant Medsystems, Inc. Modulating nerves within bone using bone fasteners
US9724151B2 (en) 2013-08-08 2017-08-08 Relievant Medsystems, Inc. Modulating nerves within bone using bone fasteners
WO2015038167A1 (en) * 2013-09-16 2015-03-19 Empire Technology Development, Llc Nerve location detection
US11364068B2 (en) 2013-09-16 2022-06-21 Covidien Lp Split electrode for use in a bipolar electrosurgical instrument
US9585618B2 (en) 2013-09-16 2017-03-07 Empire Technology Development Llc Nerve location detection
US9943357B2 (en) 2013-09-16 2018-04-17 Covidien Lp Split electrode for use in a bipolar electrosurgical instrument
CN103479351A (en) * 2013-09-27 2014-01-01 中国科学院深圳先进技术研究院 Electrophysiological recording device
US10433902B2 (en) 2013-10-23 2019-10-08 Medtronic Ardian Luxembourg S.A.R.L. Current control methods and systems
US10130409B2 (en) 2013-11-05 2018-11-20 Myoscience, Inc. Secure cryosurgical treatment system
US10864033B2 (en) 2013-11-05 2020-12-15 Pacira Cryotech, Inc. Secure cryosurgical treatment system
US11690661B2 (en) 2013-11-05 2023-07-04 Pacira Cryotech, Inc. Secure cryosurgical treatment system
US10610292B2 (en) 2014-04-25 2020-04-07 Medtronic Ardian Luxembourg S.A.R.L. Devices, systems, and methods for monitoring and/or controlling deployment of a neuromodulation element within a body lumen and related technology
US20160074668A1 (en) * 2014-09-12 2016-03-17 Albert Nunez Apparatus and method for providing hyperthermia therapy
US11324961B2 (en) * 2014-09-12 2022-05-10 Albert Nunez Apparatus and method for providing hyperthermia therapy
US10456190B2 (en) 2014-12-08 2019-10-29 Invuity, Inc. Methods and apparatus for electrosurgical illumination and sensing
AU2020220081B2 (en) * 2014-12-08 2022-12-15 Invuity, Inc. Electrosurgical instrument and method of using same
EP3229899A4 (en) * 2014-12-08 2018-07-04 Invuity, Inc. Methods and apparatus for electrosurgical illumination and sensing
US20160206372A1 (en) * 2015-01-15 2016-07-21 Daniel Rivlin Method of nerve ablation and uses thereof
US9113912B1 (en) 2015-01-21 2015-08-25 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US9119628B1 (en) 2015-01-21 2015-09-01 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US20160206362A1 (en) * 2015-01-21 2016-07-21 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US9693817B2 (en) 2015-01-21 2017-07-04 Serene Medical, Inc. Systems and devices to identify and limit nerve conduction
US11690672B2 (en) 2015-05-12 2023-07-04 National University Of Ireland, Galway Devices for therapeutic nasal neuromodulation and associated methods and systems
US11771497B2 (en) 2015-05-12 2023-10-03 National University Of Ireland, Galway Devices for therapeutic nasal neuromodulation and associated methods and systems
US10799670B2 (en) 2015-06-18 2020-10-13 Avent, Inc. Expandable sleeve for a catheter assembly
US11446078B2 (en) 2015-07-20 2022-09-20 Megadyne Medical Products, Inc. Electrosurgical wave generator
US10987159B2 (en) 2015-08-26 2021-04-27 Covidien Lp Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread
US10213250B2 (en) 2015-11-05 2019-02-26 Covidien Lp Deployment and safety mechanisms for surgical instruments
US11311327B2 (en) 2016-05-13 2022-04-26 Pacira Cryotech, Inc. Methods and systems for locating and treating nerves with cold therapy
EP3245973A1 (en) * 2016-05-19 2017-11-22 Covidien LP Modular microwave generators and methods for operating modular microwave generators
US11583336B2 (en) 2016-05-19 2023-02-21 Covidien Lp Modular microwave generators and methods for operating modular microwave generators
AU2019201379B2 (en) * 2016-05-19 2021-02-25 Covidien Lp Modular microwave generators and methods for operating modular microwave generators
EP4303486A3 (en) * 2016-10-24 2024-03-13 Invuity, Inc. Lighting element
US11344350B2 (en) 2016-10-27 2022-05-31 Dfine, Inc. Articulating osteotome with cement delivery channel and method of use
US10478241B2 (en) 2016-10-27 2019-11-19 Merit Medical Systems, Inc. Articulating osteotome with cement delivery channel
US11026744B2 (en) 2016-11-28 2021-06-08 Dfine, Inc. Tumor ablation devices and related methods
US11116570B2 (en) 2016-11-28 2021-09-14 Dfine, Inc. Tumor ablation devices and related methods
US10463380B2 (en) 2016-12-09 2019-11-05 Dfine, Inc. Medical devices for treating hard tissues and related methods
US11540842B2 (en) 2016-12-09 2023-01-03 Dfine, Inc. Medical devices for treating hard tissues and related methods
US10470781B2 (en) 2016-12-09 2019-11-12 Dfine, Inc. Medical devices for treating hard tissues and related methods
US10660656B2 (en) 2017-01-06 2020-05-26 Dfine, Inc. Osteotome with a distal portion for simultaneous advancement and articulation
US11607230B2 (en) 2017-01-06 2023-03-21 Dfine, Inc. Osteotome with a distal portion for simultaneous advancement and articulation
WO2018144297A1 (en) * 2017-02-01 2018-08-09 Avent, Inc. Emg guidance for probe placement, nearby tissue preservation, and lesion confirmation
US20200038096A1 (en) * 2017-02-01 2020-02-06 Avent, Inc. EMG Guidance for Probe Placement, Nearby Tissue Preservation, and Lesion Confirmation
WO2018156160A1 (en) * 2017-02-27 2018-08-30 Avent, Inc. Method and system for improving location accuracy of a radiofrequency ablation procedure via fiducial marking
US11759271B2 (en) 2017-04-28 2023-09-19 Stryker Corporation System and method for indicating mapping of console-based surgical systems
US11134998B2 (en) 2017-11-15 2021-10-05 Pacira Cryotech, Inc. Integrated cold therapy and electrical stimulation systems for locating and treating nerves and associated methods
US11622805B2 (en) 2018-06-08 2023-04-11 Acclarent, Inc. Apparatus and method for performing vidian neurectomy procedure
US11510723B2 (en) 2018-11-08 2022-11-29 Dfine, Inc. Tumor ablation device and related systems and methods
US11576719B2 (en) 2018-12-11 2023-02-14 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11666378B2 (en) 2018-12-11 2023-06-06 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11419671B2 (en) 2018-12-11 2022-08-23 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11547472B2 (en) 2018-12-11 2023-01-10 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11547473B2 (en) 2018-12-11 2023-01-10 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11701167B2 (en) 2018-12-11 2023-07-18 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11684414B2 (en) 2018-12-11 2023-06-27 Neurent Medical Limited Systems and methods for therapeutic nasal neuromodulation
US11786296B2 (en) 2019-02-15 2023-10-17 Accularent, Inc. Instrument for endoscopic posterior nasal nerve ablation
US11534235B2 (en) 2019-04-04 2022-12-27 Acclarent, Inc. Needle instrument for posterior nasal neurectomy ablation
US11865045B2 (en) 2019-04-19 2024-01-09 Elios Vision, Inc. Systems and methods for performing an intraocular procedure for treating an eye condition
US11672475B2 (en) 2019-04-19 2023-06-13 Elios Vision, Inc. Combination treatment using ELT
US11633234B2 (en) 2019-04-19 2023-04-25 Elios Vision, Inc. Enhanced fiber probes for ELT
US11666482B2 (en) 2019-04-19 2023-06-06 Elios Vision, Inc. Personalization of excimer laser fibers
US11529260B2 (en) 2019-04-19 2022-12-20 Elios Vision, Inc. Systems and methods for performing an intraocular procedure for treating an eye condition
US11583337B2 (en) 2019-06-06 2023-02-21 TriAgenics, Inc. Ablation probe systems
US11607267B2 (en) 2019-06-10 2023-03-21 Covidien Lp Electrosurgical forceps
US11452559B2 (en) 2019-06-25 2022-09-27 Covidien Lp Electrosurgical plug for energy activation of surgical instruments
US11504179B2 (en) 2019-06-25 2022-11-22 Covidien Lp Electrosurgical plug for energy activation of surgical instruments
WO2020260950A3 (en) * 2019-06-28 2021-02-04 Neurent Medical Limited Systems and methods for targeted therapeutic nasal neuromodulation
US11123103B2 (en) 2019-09-12 2021-09-21 Relievant Medsystems, Inc. Introducer systems for bone access
US11426199B2 (en) 2019-09-12 2022-08-30 Relievant Medsystems, Inc. Methods of treating a vertebral body
US11207100B2 (en) 2019-09-12 2021-12-28 Relievant Medsystems, Inc. Methods of detecting and treating back pain
US11202655B2 (en) 2019-09-12 2021-12-21 Relievant Medsystems, Inc. Accessing and treating tissue within a vertebral body
US11007010B2 (en) 2019-09-12 2021-05-18 Relevant Medsysterns, Inc. Curved bone access systems
CN113456211A (en) * 2020-03-30 2021-10-01 奥林匹斯冬季和Ibe有限公司 Electrosurgical system, electrosurgical instrument and electrosurgical generator
US20210298822A1 (en) * 2020-03-31 2021-09-30 Boston Scientific Scimed, Inc. Smart probe identification for ablation modalities
US11883091B2 (en) 2020-04-09 2024-01-30 Neurent Medical Limited Systems and methods for improving sleep with therapeutic nasal treatment
US11896818B2 (en) 2020-04-09 2024-02-13 Neurent Medical Limited Systems and methods for therapeutic nasal treatment
US11717346B2 (en) 2021-06-24 2023-08-08 Gradient Denervation Technologies Sas Systems and methods for monitoring energy application to denervate a pulmonary artery
US11744640B2 (en) 2021-06-24 2023-09-05 Gradient Denervation Technologies Sas Systems and methods for applying energy to denervate a pulmonary artery
US11877951B1 (en) 2022-08-30 2024-01-23 Elios Vision, Inc. Systems and methods for applying excimer laser energy with transverse placement in the eye
US11903876B1 (en) 2022-08-30 2024-02-20 Elios Vision, Inc. Systems and methods for prophylactic treatment of an eye using an excimer laser unit
US11918516B1 (en) 2022-08-30 2024-03-05 Elios Vision, Inc. Systems and methods for treating patients with closed-angle or narrow-angle glaucoma using an excimer laser unit

Also Published As

Publication number Publication date
US20160066984A1 (en) 2016-03-10
US10548660B2 (en) 2020-02-04
EP1769320A2 (en) 2007-04-04
US20130046292A1 (en) 2013-02-21
US9283031B2 (en) 2016-03-15
NO20070184L (en) 2007-03-16
US20070167943A1 (en) 2007-07-19
US9168091B2 (en) 2015-10-27
RU2006144073A (en) 2008-07-27
WO2006009705A2 (en) 2006-01-26
CN1981256A (en) 2007-06-13
KR20070047762A (en) 2007-05-07
WO2006009705A3 (en) 2007-01-11
US20100114095A1 (en) 2010-05-06
BRPI0512233A (en) 2008-02-19
MXPA06014889A (en) 2007-12-12
ZA200610576B (en) 2008-07-30
IL179503A0 (en) 2007-05-15
US20070060921A1 (en) 2007-03-15
CR8817A (en) 2008-03-18
JP2008503255A (en) 2008-02-07
CA2570911A1 (en) 2006-01-26

Similar Documents

Publication Publication Date Title
US10548660B2 (en) Ablation apparatus and system to limit nerve conduction
EP2068740B1 (en) Ablation apparatus and system to limit nerve conduction
US20150351831A1 (en) Ablation apparatus and system to limit nerve conduction
AU2016209266B2 (en) Systems and devices to identify and limit nerve conduction
US9693817B2 (en) Systems and devices to identify and limit nerve conduction
US20160206362A1 (en) Systems and devices to identify and limit nerve conduction
US9119628B1 (en) Systems and devices to identify and limit nerve conduction
US6139545A (en) Systems and methods for ablating discrete motor nerve regions
US20100106145A1 (en) Ablation technique for cosmetic surgery
WO2001012089A1 (en) Nerve stimulation and tissue ablation apparatus and method
JP7184490B2 (en) EMG guidance for probe placement, protection of surrounding tissue, and injury confirmation
AU2005264967A1 (en) Ablation apparatus and system to limit nerve conduction
KR101780269B1 (en) Electrosurgical apparatus
Park Preoperative percutaneous cranial nerve mapping in head and neck surgery

Legal Events

Date Code Title Description
AS Assignment

Owner name: JNJ TECHNOLOGY HOLDINGS, L.L.C., COLORADO

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:JANSSEN, WILLIAM MICHAEL;NEWMAN, JAMES PAUL;JONES, JAMES WHITNEY;AND OTHERS;REEL/FRAME:016333/0732;SIGNING DATES FROM 20050607 TO 20050610

AS Assignment

Owner name: BIOFORM MEDICAL, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:JNJ TECHNOLOGY HOLDINGS, LLC;REEL/FRAME:021468/0066

Effective date: 20080424

STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION

AS Assignment

Owner name: SERENE MEDICAL, INC., CALIFORNIA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:BIOFORM MEDICAL, INC.;REEL/FRAME:027611/0726

Effective date: 20110907