WO2001080723A2 - Ablation of rectal and other internal body structures - Google Patents
Ablation of rectal and other internal body structures Download PDFInfo
- Publication number
- WO2001080723A2 WO2001080723A2 PCT/US2001/013144 US0113144W WO0180723A2 WO 2001080723 A2 WO2001080723 A2 WO 2001080723A2 US 0113144 W US0113144 W US 0113144W WO 0180723 A2 WO0180723 A2 WO 0180723A2
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- catheter
- region
- tissue
- substance
- balloon
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Definitions
- This invention relates to ablation of rectal and other internal body structures .
- Human beings are subject to a number of disorders in the area of the rectum and colon, including hemorrhoids (external and internal) , prolapse of the rectal muscles, rectal muscle spasms, anal fissures, polyps, diverticulosus and diverticulitus, and pilonital cysts.
- Other internal disorders in nearby regions of the body include (in men) prostate cancer, (in women) incontinence, vaginal bleeding, vaginal cysts, vaginal fibroids, prolapse of the uterus, and related tumors or cancerous tissue.
- a catheter is inserted into the rectum, and at least one electrode is disposed thereon for emitting energy to ablate body structures or other tissue in an ablation region in or near the rectum, such as the sphincter, rectum, colon, or prostate.
- the invention provides a method and system for ablation of body structures or tissue in an ablation region in or near the rectum (such as the sphincter, rectum, colon, or prostate) .
- a catheter is inserted into the rectum, and at least one electrode is disposed thereon for emitting energy to ablate body structures or other tissue, such as by cell death, dehydration, or denatura- tion.
- the environment for the ablation region is isolated or otherwise controlled, such as by blocking gas or fluid using a pair of inflatable balloons at upstream and downstream locations from the ablation region.
- balloons also serve to anchor the catheter in place and prevent the catheter from being expelled from the body.
- the catheter is flexible for reaching a selected internal organ or region
- a plurality of electrodes are disposed on the catheter and at least one such electrode is selected and advanced out of the catheter to penetrate and ablate selected tissue inside the body in ablation region in or near the rectum, such as an individual cyst, hemor- rhoid, polyp, tumor, or other selected lesion or tissue.
- the electrodes are coupled to sensors to determine control parameters of the body structure or tissue, such as impedance or temperature, and which are used by feedback technique to control delivery of energy for ablation or fluids for cooling or hydration.
- the catheter includes an optical path disposed for coupling to an external view piece, so as to allow medical personnel to view or control positioning of the catheter and operation of the electrodes.
- the catheter is disposed to deliver flowable substances for aiding in ablation, such as saline or antibiotics, or for aiding in repair of tissue (either before or after ablation) , such as collagen or another substance for covering lesions or for filling fissures in or near the ablation region, or for other medicinal effects, such as anesthetic, anti-inflammatory, or antispasmodic substances.
- the flowable substances are delivered using at least one lumen in the catheter, either from at least one hole in the catheter, from an area of the catheter covered by a microporous membrane, or from .licroporous balloons (either the same as or in addition to bal- .oons used to anchor the catheter in place or to block gas or fluid) .
- Figure 1 shows a side view of a catheter and electrode assembly.
- Figure 2 shows a cut-away view of a catheter, taken along a line 2--2 in figure 1.
- Figure 3 shows a method of treatment of a hemorrhoid.
- Figure 4 shows a method of treatment of a prolapsed or spasmodic muscle.
- Figure 5 shows a method of treatment of an anal fissure .
- Figure 6 shows a method of treatment of a tumor in the prostate.
- Figure 1 shows a side view of a catheter and electrode assembly.
- An assembly 100 for ablating rectal and other internal body structures includes a catheter 110, a control and delivery linkage 120, and a control element 130.
- the catheter 110 is coupled to the control and delivery linkage 120 using a gearing element 121, which allows the catheter 110 to be rotated with respect to the control and delivery linkage 120 by an operator using the control element 130.
- the catheter 110 includes a base 111, having a substantially cylindrical shape, coupled at a proximal end to the gearing element 121, and having a distal end.
- the catheter 110 is preferably disposed for insertion into the rectum at an angle to the control and delivery linkage 120, preferably an angle between about 30° and about 45° less than a right angle.
- the catheter 110 is between about 1 inch (2.54 cm) and about 2 inches (5.08 cm) in diameter, and between about 6 inches (15.24 cm) and about 8 inches (20.32 cm) in length.
- the catheter 110 includes a plurality of holes 112, and a plurality of electrodes 113 which may be extended from at least some of the holes 112.
- the holes 112 are spaced regularly around ..he circumference and along the length of the catheter 110, having a spacing of about 0.25 inches (0.64 cm) between adjacent ⁇ oles 112.
- the electrodes 113 are spaced regularly to occupy about one-half of the holes 112, and are between about 0.5 cm and about 1.0 cm in length.
- the electrodes 113 each include a metallic tube 114 defining a hollow lumen 115, shaped similarly to an injection needle, so as to be disposed to deliver at least one flowable substance -to a region 140 near the catheter 110.
- the deliverable flowable substance includes saline with a concentration of less than about 10% NaCl, which aids in both hydration of body structures and other tissue, and in delivery of RF energy to the region 140.
- the deliverable flowable substance includes other substances, including saline with other concentrations, systemic or topical antibiotics, collagen or another hardenable substance, or other bioactive, chemoactive, or radioactive substances (including anesthetic, anti-inflammatory, or antispasmodic substances, or tracer materials) .
- the catheter 110 includes at least one balloon 116, disposed for inflation so as to block gas or fluid from the body from entering the region 140.
- the distal balloon 116 and the proximal balloon 116 preferably each comprise ring-shaped balloons, disposed so that when inflated each surrounds the catheter 10 and makes a gas-tight or fluid-tight seal, both with the atheter 110 and with a wall 141 of the rectum or other body compture into which the catheter lib is inserted.
- the distal balloon 116 may comprise a pherical or ellipsoidal balloon disposed at the distal end of he catheter 110 in such manner that when inflated it surrounds he catheter 110 and makes a gas-tight or fluid-tight seal with he wall 141.
- the catheter 110 also includes at least one balloon 116 lisposed to anchor the catheter 110 at a selected location within .he rectum or other body structure into which the catheter 110 is .nserted.
- the balloon 116 used to an- hor the catheter 110 is the proximal balloon 116, which when inflated prevents the catheter 110 from being expelled from the )ody in like manner as the operation of a Foley catheter.
- the balloon 116 used to anchor :he catheter 110 may comprise an additional or alternative bal- .oon which is disposed solely or primarily for the purpose of an- horing the catheter 110 into its selected place, again in like nanner as the operation of a Foley catheter.
- the catheter 110 includes a fluid circulation system L17, including at least one fluid outlet port and at least one Eluid inlet port.
- the fluid circulation system 117 is disposed for providing fluid in the region near the catheter 110, such as Eor delivering fluid for cooling the region 140 and for removing other fluid for aspirating the region 140.
- the catheter 110 includes an optical view port 118, •ossibly including a lens or other transparent or translucent .overing, disposed to allow inflow of light (visible or infrared) :or transmission to an operator for viewing and control of the operation of the catheter 110.
- the catheter 110 includes at least one sensor 119, such is a sensor 119 for impedance or temperature.
- the temperature sensor 119 includes a thermocouple, but m alternative embodiments, the temperature sensor 119 may include a thermistor or other device for sensing temperature and Droviding signals responsive to temperature near the catheter L10.
- the control and delivery linkage 120 includes a metallic tube 223 defining a hollow lumen 224, and is further described with reference to figure 2.
- control and delivery linkage 120 is between about 1/2 inch (1.27 cm) and about 5/8 inches (1.59 cm) in diameter, and between about 6 inches (15.24 cm) and about 8 inches (20.32 cm) in length.
- the control element 130 includes an electrode actuation element 131 for advancing the electrodes 113 out from the catheter 110, a electrode retraction element 132 for retracting the electrodes 113 into from the catheter 110, and an operation element 133 for controlling operation of the catheter 110, including delivery of flowable substances using the holes 112 and delivery of energy using the electrodes 113.
- Figure 2 shows a cut-away view of a catheter, taken along a line 2--2 in figure 1.
- the catheter 110 comprises a rotatable element 210 which is disposed for rotation in a first direction 211 to advance the electrodes 113 out of the catheter 110 and in a second direction 212 opposite the first direction 211 to retract the electrodes 113 back into the catheter 110.
- the rotatable element 210 is coupled to a spring (not shown) or other device which holds the rotatable element 210 in a steady state with the electrodes 113 retracted into the catheter 110.
- the rotatable element 210 is coupled to the electrode actuation element 131, which forces the rotatable element 210 to rotate in the first direction 211 so as to advance the electrodes 113 out of the catheter 110.
- the spring causes the rotatable element 210 to rotate in the second direction 212 so as to retract the electrodes 113 back into the catheter 110.
- Each electrode 113 is coupled to an electrode carrier 220.
- each electrode carrier 220 is substantially bar-shaped (but is shown end-on in the figure) and is coupled to a plurality of electrodes 113, such as about between about three and about six electrodes 113, so as to substantially simultaneously advance that plurality of electrodes 113 out of the catheter 110 and retract that plurality of electrodes 113 back into the catheter.
- a plurality of electrode carriers 220 are each disposed in a set of lines corresponding to lines of electrodes 113 disposed for advancement out of the catheter 110 and retraction back into the catheter 110.
- the electrodes 113 may be disposed so that when advanced, the electrodes 113 extend to selected depths within the body structure to be ablated. These selected depths may be the same depth for all electrodes 113 which are advanced, or may include a first depth for a first set of electrodes 113 and a second depth for a second set of electrodes 113.
- the electrode carriers 220 are coupled to a set of controls (not shown) in the control element 130 for selecting one or more electrode carriers 220 independently using one or more actuation levers 221, so as to be able to independently advance one or more sets of electrodes 113 coupled thereto out of the catheter 110 and to independently retract one or more sets of electrodes 113 back into the catheter 110.
- Each electrode carrier 220 is coupled to the rotatable :lement 210 using a bearing 222, in such manner so as to trans- .ate rotation of the rotatable element 210 into linear radial lovement of the electrodes 113.
- the electrodes are advanced in a first linear movement 223, while when the rotatable element 210 is rotated in the second direction 212, the elec- rodes are retracted in a second linear movement 224.
- An interior 230 of the rotatable element 210 includes a Lumen 225 through which fluids and other flowable substances are provided, and in which conductors providing control signals and sensor signals are disposed.
- Operation of the catheter and electrode assembly 100 includes at least the following steps:
- the catheter 110 is inserted into the body at an opening, such as the rectum.
- the opening is the rectum.
- a region of the rectum is first infused with a lubricant, such as K-Y jelly, and with an anesthetic, such as lidocaine.
- a lubricant such as K-Y jelly
- an anesthetic such as lidocaine.
- An anti- inflammatory, antispasmodic, or other condign medication would also be applied as appropriate.
- the catheter 110 is inserted into the lubricated region of the rectum. Due to the potential pain induced by the presence of the catheter 110 or electrodes 113, during operation the catheter 110 infuses a mixture of saline and lidocaine into the region 140 to be ablated.
- the opening may be another opening into the body, such as a natural orifice such as the vagina or the urethra, or an opening which has been made surgically, such as an incision which allows the catheter 110 to be inserted into a blood vessel .
- the preferred size of the catheter 110 will of course be responsive to the size of the opening if other than the rectum.
- the choice of medicinal elements to be infused prior to or coeval with the catheter 110 will of course be responsive to judgments by medical personnel, and may include lubricants, anesthetics, antispasmodics, ' anti-inflammatories, antibiotics, or other materials with bioactive, chemoactive, or radioactive effect.
- the catheter 110 is positioned within the body at a selected orientation and location, such as a position near a hemor- rhoid.
- the catheter 110 is positioned in the rectum near an eternal or internal hemorrhoid, in a manner as shown in figure 3.
- the electrodes 113 are ultimately advanced into the hemorrhoid to ablate the hemorrhoid.
- the catheter 110 is positioned in the rectum near a prolapsed or spasmodic muscle, in a manner as shown in figure 4.
- the electrodes 113 are ultimately advanced into the prolapsed or spasmodic muscle to ablate selected portions of the prolapsed or spasmodic muscle .
- the catheter 110 is positioned in the rectum near an anal fissure, in a manner as shown in figure 5.
- collagen is deposited into the fissure and the electrodes 113 are ultimately advanced into a region near the collagen to harden the collagen for filling the fissure.
- the catheter 110 is positioned in the colon near a polyp, in a manner similar to that shown in figure 3.
- the electrodes 113 are ultimately advanced into the polyp to ablate the polyp.
- the catheter 110 is positioned in the rectum near a pilonital cyst, in a manner similar to that shown in figure 3.
- the electrodes 113 are ultimately advanced into the cyst to ablate the cyst .
- the catheter 110 is positioned in the rectum, colon, large intestine, or small intestine, near a cyst or tumor, in a manner similar to that shown in figure 3.
- the electrodes 113 are lltimately advanced into the cyst or tumor to ablate the cyst or
- the catheter 110 is positioned in a male patient, in the rectum near the prostate, in i manner as shown in figure 6.
- the electrodes 113 are ultimately advanced into a tumor in the pros- ;ate to ablate the tumor.
- the catheter 110 is positioned in a female patient, in the vagina, near a cyst or fi- oroid, in a manner similar to that shown in figure 3.
- the electrodes 113 are ultimately advanced into the cyst or fibroid to ablate the cyst or fibroid.
- the catheter 110 is positioned in a female patient, in the vagina, near a prolapsed uterus, in a manner similar to that shown in figure 4.
- the electrodes 113 are ultimately advanced into the prolapsed uterus selected portions of the prolapsed uterus .
- the catheter 110 is anchored into place at the selected orientation and location by inflating a balloon 116, such as the distal balloon 116 and the proximal balloon 116.
- the catheter 110 is anchored into place using the proximal balloon 116 and the proximal balloon 116 operates in similar manner as a Foley catheter.
- the catheter 110 includes a stop balloon 116, such as a ring balloon (as shown in figure 3) , iisposed outside the body so as to prevent the catheter 110 from oeing inserted "too far", i.e., beyond its selected location.
- a stop balloon 116 such as a ring balloon (as shown in figure 3)
- the region 140 near the catheter 110 is isolated from the rest of the body by inflating the distal balloon 116 and the proximal balloon 116. In a preferred embodiment, this step uses the same distal balloon 116 and the proximal balloon 116 as the step of anchoring the catheter 110 into place.
- Isolation of the region 140 near the catheter 110 from the rest of the body need not be absolute .
- the distal balloon 116 and the proximal balloon 116 are microporous, are inflated using saline or water, and thus are disposed to provide saline or water into the region 140 near the catheter 110.
- gas and fluids from the rest of the body are allowed to leak into one or more of the balloons 116 and from there are allowed to leak into the region 140 near the catheter 110.
- the seal made with the wall 141 of the region 140 by the balloon 116 is gas- tight
- that seal is allowed to be simply fluid-tight, and might allow gas to leak from the rest of the body into the region 140 near the catheter 110.
- One or more sets of electrodes 113 are selected for advancement into a selected mass of tissue in the region 140.
- the rotatable element 210 is rotated in the first direction 211, causing the- selected sets of electrodes 113 to advance out of the catheter 110 and into the selected mass of tissue.
- the selected set of electrodes 113 are just those elec- rodes 113 which are needed to penetrate the selected mass of issue for ablation.
- the selected set of elec- rodes 113 are just those electrodes 113 which are needed to
- ⁇ enetrate the hemorrhoid If a plurality of hemorrhoids are se- ected for ablation, either (1) electrodes 113 needed to pene- rate the plurality of hemorrhoids are selected, or (2) elec- rodes 113 needed to penetrate one of the hemorrhoids are se-
- the selected set of electrodes 113 are just hose electrodes 113 which are needed to penetrate the selected sody structure. If there is more' than one such selected body structure, either (1) more than one set of electrodes 113 may be selected, or (2) just one set of electrodes 113 may be selected and the operation is repeated for each individual such body structure .
- the selected body structure for ablation is muscle tissue or other tissue which is part of a larger body structure, such as a prolapsed or spasmodic muscle
- the selected set of electrodes 113 are just those one or more sets of electrodes 113 which are needed to penetrate the portion of the body structure which has been selected for ablation.
- Flowable substances are provided using the holes 112, and energy is provided to the electrodes 113, so as to ablate the mass of tissue in the region 140.
- the flowable substances are provided using the holes 112 to the region 140 near the catheter 110.
- the flowable substances may be provided, in addition or instead, (1) from an area of the catheter covered by a microporous membrane, or (2) from one or more microporous balloons.
- the microporous balloons may either be the same as or in addition to the balloons 116 used to anchor the catheter in place or to block gas or fluid.
- the flowable substances have one of the following functions: (1) to aid in ablation, such as by transmitting RF energy from the electrodes 113 to the body structure to be ablated, as is done by saline or other electrolytic solutions, (2) to rehydrate tissue, as in done by saline or water, or (3) to repair tissue, such as by flowing into cysts or fissures or voids, or by covering lesions, as is done by collagen in a soft form which can be hardened by RF energy.
- the electrodes 113 deliver RF energy having a frequency between about 435 megahertz and about 485 megahertz, for a period between about 5 minutes and about 10 minutes.
- the RF energy is received by and heats tissue and other body structures near the electrodes 113, causing ablation by means of cell death, dehydration, or denaturation.
- the electrodes 113 may deliver other forms of energy, such as heat, microwaves, or infrared or visible laser energy.
- the electrodes 113 are controlled by a feedback technique, using the at least one sensor 119.
- the feedback technique may be responsive to each sensor 119.
- the at least one sensor 119 includes a temperature sensor 119 and the feedback technique includes a microprocessor (not shown) disposed in or coupled to the control element 130 and operating under control of application software for maintaining the temperature of the body structure to be ablated at a selected temperature, such as a temperature exceeding between about 90° Celsius and about 120° Celsius.
- the microprocessor also controls delivery of fluids for cooling or hydration, so as to maintain the temperature of surrounding tissue (i.e., other than the tissue selected for ablation) at temperatures less than between about 90° Celsius and about 120° Celsius.
- the at least one sensor 119 also includes an impedance sensor 119 and the feedback technique includes a microprocessor operating to terminate delivery of RF energy when a measured impedance of the body structure to be ablated undergoes a substantial change indicative of dehydration or denaturation.
- One or more sets of electrodes 113 are selected for retraction back from the selected mass of tissue in the region 140.
- the rotatable element 210 is rotated in the second direction 211, causing the selected sets of electrodes 113 to retract out of the selected mass of tissue and back into the catheter 110.
- the catheter 110 is withdrawn from the body at the opening through which it was inserted.
- the balloons 116 are deflated so the catheter 110 is no longer anchored in place, all electrodes 113 are retracted back into the catheter 110, and the catheter 113 is configured to no longer provide flowable substances or energy for ablation.
- the catheter and electrode assembly 100 may also be used for treatments in addition to, or instead of, ablation of body structures or tissue.
- operation of the catheter and electrode assembly 100 includes at least the following steps:
- the catheter 110 is inserted into a natural body lumen, such as the urethra.
- the natural body lumen comprises a normally tubular body structure which has prolapsed, is spasmodic, or is otherwise subject to blockage (partial or complete) or damage (such as to a wall of the natural body lumen) .
- the catheter 110 infuses a hardenable substance into the natural body lumen, so as to coat at least one selected section of the wall of the natural body lumen.
- the hardenable substance includes a collagen which is capable of being flowed onto the wall of the natural body lumen and which is capable of being hardened :>y application of RF energy, heat, or another agent to be provided by the catheter and electrode assembly 100.
- the electrodes 113 are advanced and deliver energy to the hardenable substance to harden it.
- the holes 112 provide saline and the electrodes 113 deliver RF energy to the collagen to larden it, so as to form a hard covering to the wall of the natural body lumen. If appropriate, more than one layer of collagen is applied, so as to provide a hard covering having a thickness sxceeding a selected threshold, such as 0.1 inch (0.25 cm). The particular selected threshold will of course depend on the preferred diameter of the natural body lumen.
- the catheter 110 is inserted and pushed through a region where the muscle has prolapsed or blocked the rectum, colon, large intestine, or small intestine, (2) the pro- Lapsed or spasmodic muscle is partially ablated, and (3) collagen is infused and hardened to strengthen the muscle wall.
- the collagen may be infused before ablation in one or more boluses deposited within the muscle (or on the miscle or near the muscle) , so that the steps of muscle ablation and collagen hardening will occur substantially simultaneously.
- the catheter 110 is inserted into a region where the fissure has occurred, (2) a suspension of collagen and saline is infused and fills the fissure, and (3) the collagen is hardened while the saline is removed from the suspension.
- the isolated region between the distal balloon 116 and the proximal balloon 116 is maintained at a positive differential pressure with respect to the rest of the rectum, so that the collagen infuses into the fissure; this procedure or a similar procedure is also followed for treatment of diverticulo- sus and diverticulitus.
- the catheter 110 is inserted into a region where the uterus has prolapsed, (2) the prolapsed uterus is partially ablated, and (3) collagen is infused and hardened to strengthen the muscle wall.
- the collagen may be infused before ablation, so that the steps of muscle ablation and collagen hardening will occur substantially simultaneously.
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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AU2001257192A AU2001257192A1 (en) | 2000-04-25 | 2001-04-24 | Ablation of rectal and other internal body structures |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US09/557,993 US6419673B1 (en) | 1996-05-06 | 2000-04-25 | Ablation of rectal and other internal body structures |
US09/557,993 | 2000-04-25 |
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WO2001080723A2 true WO2001080723A2 (en) | 2001-11-01 |
WO2001080723A3 WO2001080723A3 (en) | 2002-04-04 |
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PCT/US2001/013144 WO2001080723A2 (en) | 2000-04-25 | 2001-04-24 | Ablation of rectal and other internal body structures |
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US (2) | US6419673B1 (en) |
AU (1) | AU2001257192A1 (en) |
WO (1) | WO2001080723A2 (en) |
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Also Published As
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US6419673B1 (en) | 2002-07-16 |
AU2001257192A1 (en) | 2001-11-07 |
US20020183735A1 (en) | 2002-12-05 |
WO2001080723A3 (en) | 2002-04-04 |
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