Electrosurgical handpiece for treating tissue

Abstract

An electrosurgical handpiece that is bipolar or unipolar in operation and that is configured for use in MIS. The bipolar operation confines the electrosurgical currents to a small active region between the active ends of the bipolar electrode and thus reduces the possibility that excessive heat will be developed that can damage patient tissue. The position of the active region can be controlled to avoid patient tissue that may be moire sensitive to excessive heat. In one embodiment, the handpiece is constructed with a flexible end controllable by the surgeon so as to allow the surgeon to manipulate the end as desired during the surgical procedure. This feature allows the surgeon to position the active electrode end at the optimum location within, say, a herniated disk to remove undesired regions and to provide controlled heat to shrink the tissue during surgery. In another embodiment, the handpiece is constructed to contain both a bipolar as well as a unipolar electrode, with provision made for selectively operating either of the electrodes. In still another embodiment, a replaceable element for the handpiece comprises scissors.

What is claimed is:  
     
         1 . An electrosurgical bipolar handpiece comprising: 
 (a) an elongated tubular first member having a first end and a remote flexible second end,    (b) an elongated tubular second member located within the first member, said second member comprising an electrically-insulating tube having a first end and a remote flexible second end adjacent the first member's second end and comprising electrically-insulating means dividing the second tube into first and second compartments,    (c) first and second electrically-conductive wires each positioned, respectively, in the first and second compartments and electrically-insulated from each other,    (d) first means connected to the first member at its first end for applying electrosurgical bipolar currents to the first and second wires,    (e) second means connected to the first member at its first end for selectively flexing the remote flexible end of the first member relative to the first end of the first member together with the remote flexible end of the second member,    (f) active electrically-insulated electrosurgical electrodes connected to the first and second wires and extendable at the remote flexible end, said electrosurgical electrodes flexing together with the remote flexible ends when the second means is operated while maintaining them electrically-insulated.    
     
     
         2 . An electrosurgical bipolar handpiece as claimed in    claim 1   , wherein the first member comprises a weakened section at its flexible end.  
     
     
         3 . An electrosurgical bipolar handpiece as claimed in    claim 2   , wherein the weakened section comprises at least one slot in a side of the first member close to but spaced from the remote end of the first member.  
     
     
         4 . An electrosurgical bipolar handpiece as claimed in    claim 3   , wherein the weakened section comprises a plurality of spaced slots.  
     
     
         5 . An electrosurgical bipolar handpiece as claimed in    claim 1   , wherein the divider comprises an electrically-insulating wall portion which projects outwardly from the remote end of the second member, the electrodes being positioned on opposite sides of the projecting wall portion.  
     
     
         6 . An electrosurgical bipolar handpiece as claimed in    claim 1   , wherein the second means comprises a pull wire or string positioned inside of the first member and connected at one end to the remote end of the first member, further comprising means for pulling the other end of the pull wire or string.  
     
     
         7 . An electrosurgical bipolar handpiece as claimed in    claim 1   , wherein the first member has a length of about 10-20 inches and a diameter between about 0.07-0.1 inches for insertion into an MIS cannula.  
     
     
         8 . An electrosurgical handpiece comprising: 
 (a) a handle having a grip and a part pivotable with respect to the grip, said handle having means for mounting a tubular member,    (b) an elongated tubular first member having a first end and a remote flexible second end,    (c) an elongated tubular electrically-insulating second member located within the first member, said second member comprising an electrically-insulating tube having a first end and a remote flexible second end adjacent the first member's second end,    (d) an electrically-conductive wire positioned within the second member,    (e) first means connected to the first member at its first end for applying electrosurgical currents to the electrically-conductive wire,    (f) second means connected to the pivotable part for selectively flexing the remote flexible end of the first member relative to the first end of the first member together with the remote flexible end of the second member,    (g) an active electrosurgical electrode connected to the electrically-conductive wire and extending out of the remote flexible end, said electrosurgical electrode flexing together with the remote flexible end when the pivotable part is operated.    
     
     
         9 . An electrosurgical handpiece as claimed in    claim 8   , wherein the second means comprises a pull wire or string connected at its remote end to the flexible end of the first member and connected at its proximal end to the trigger.  
     
     
         10 . An electrosurgical handpiece as claimed in    claim 9   , wherein the pull wire or string is positioned between the first and second members.  
     
     
         11 . An electrosurgical handpiece as claimed in    claim 8   , wherein the second member comprises a bipolar electrode.  
     
     
         12 . An electrosurgical handpiece as claimed in    claim 8   , wherein the second member comprises a unipolar electrode.  
     
     
         13 . An electrosurgical handpiece as claimed in    claim 8    wherein the second member is removably mounted within the first member.  
     
     
         14 . An electrosurgical handpiece comprising: 
 (a) a handle having a grip and a trigger pivotable with respect to the grip, said handle having means for mounting a tubular member,    (b) an elongated tubular first member having a first end and a remote flexible second end,    (c) an elongated tubular electrically-insulating second member located within the first member, said second member comprising an electrically-insulating tube having a first end and a remote flexible second end adjacent the first member's second end and providing clearance for gas flow between the first and second members,    (d) an electrically-conductive wire positioned within the second member,    (e) first means connected to the first member at its first end for applying electrosurgical currents to the electrically-conductive wire,    (f) second means connected to the trigger for selectively flexing the remote flexible end of the first member relative to the first end of the first member together with the remote flexible end of the second member,    (g) an active electrosurgical electrode connected to the electrically-conductive wire and extending out of the remote flexible end, said electrosurgical electrodes flexing together with the remote flexible end when the trigger is operated,    (h) suction means connected to the handle and between the first and second members and providing suction at the remote second end via the clearance between the first and second members.    
     
     
         15 . An electrosurgical handpiece as claimed in    claim 14   , wherein the second member is removably mounted within the first member.  
     
     
         16 . An electrosurgical handpiece comprising: 
 (a) a handle having a grip and a first part movable with respect to the grip, said handle having means for mounting a support member,    (b) a generally tubular first member having a first end and a remote second end and comprising one of bipolar and unipolar electrodes having a first end and a second end adjacent the first member's second end, said electrically-insulated bipolar electrodes being connected to the first part and being movable within the tubular first member,    (c) a generally tubular second member mounted on the handle alongside of the tubular first member, said tubular second member comprising the other of the bipolar and unipolar electrodes and movable within the tubular second member,    (d) first and second means connected respectively to the bipolar and unipolar electrodes for applying thereto respective bipolar and unipolar electrosurgical currents,    (e) third means for selectively making the bipolar and unipolar electrodes accessible at the remote second end and for selectively energizing the selected electrodes by applying thereto electrosurgical currents.    
     
     
         17 . An electrosurgical handpiece as claimed in    claim 16   , further comprising fourth and fifth means for selectively advancing and retracting the respective bipolar and unipolar electrodes causing the respective ends thereof to project outwardly from their respective tubular first and second members.  
     
     
         18 . An electrosurgical handpiece for MIS use comprising: 
 (a) a handle having a grip and a first part movable with respect to the grip, said handle having means for mounting a tubular member,    (b) an elongated tubular first member having a first end and a remote second end,    (c) an elongated tubular second member located within the first member, said second member comprising electrically-insulated bipolar electrodes and having a first end and a second end adjacent the first member's second end, said tubular second member being slidable within the tubular first member,    (d) a tubular third member mounted on the handle alongside of the tubular first member, said tubular third member comprising an unipolar electrode slidable within the tubular third member,    (e) first and second means connected respectively to the bipolar and unipolar electrodes for applying thereto respective bipolar and unipolar electrosurgical currents,    (f) third means for selectively advancing and retracting respectively the tubular second member and its bipolar electrodes and the unipolar electrode causing the respective ends thereof to project outwardly from their respective tubular second and third members thereby to apply selectively respective bipolar and unipolar electrosurgical currents at the respective electrode ends.    
     
     
         19 . An electrosurgical handpiece for MIS use as claimed in    claim 18   , wherein at least one of the bipolar and unipolar electrodes comprises a remote end configured so as to assume a predetermined orientation when advanced from their respective tubular member.  
     
     
         20 . An electrosurgical handpiece for MIS use as claimed in    claim 18   , wherein at least one of the bipolar and unipolar electrodes comprises a bent remote end, said one of the bipolar and unipolar electrodes being selectively removable from its respective tubular member thereby allowing replacement of said one of the bipolar and unipolar electrodes with another similar electrode with a remote end bent in a different direction.  
     
     
         21 . An electrosurgical handpiece for MIS use comprising: 
 (a) an elongated tubular first member having a first end and a remote second end,    (b) an elongated tubular second member located within the first member, said second member comprising an elongated member terminating in a pair of scissor elements, said second member being slidably removably mounted within the first member,    (c) first means connected to the pair of scissor elements for selectively extending and retracting same, said scissor elements being configured such that extending them causes the scissor elements to open and retracting them causes the scissor elements to close.    
     
     
         22 . An electrosurgical handpiece for MIS use as claimed in    claim 21   , further comprising terminal means connected to the scissor elements for applying electrosurgical currents thereto.  
     
     
         23 . An electrosurgical handpiece for MIS use as claimed in    claim 21   , wherein the scissor elements are insulated from each other allowing the application of bipolar currents thereto.  
     
     
         24 . An electrosurgical handpiece for MIS use as claimed in    claim 21   , wherein the tubular second member is removably and slidably mounted within the first member.  
     
     
         25 . A procedure for surgically treating tissue comprising: 
 (I) providing an electrosurgical handpiece comprising:    (I) providing an electrosurgical bipolar handpiece comprising: 
 (a) an elongated tubular first member having a first end and a remote flexible second end,  
 (b) an elongated tubular second member located within the first member, said second member comprising an electrically-insulating tube having a first end and a remote flexible second end adjacent the first member's second end and containing an electrically-insulating divider dividing the second tube into first and second compartments,  
 (c) first and second electrically-conductive wires each positioned, respectively, in the first and second compartments and electrically-insulated from each other,  
 (d) first means connected to the first member at its first end for applying electrosurgical bipolar currents to the first and second wires,  
 (e) second means connected to the first member at its first end for selectively flexing the remote flexible end of the first member relative to the first end of the first member together with the remote flexible end of the second member,  
 (f) active electrically-insulated electrosurgical electrodes connected to the first and second wires and selectively extendable out of their respective compartments at the remote flexible end, said electrosurgical electrodes flexing together with the remote flexible ends when the second means is operated while maintaining them electrically-insulated,  
   (II) inserting the first tubular member into a patient in the vicinity of tissue to be treated,    (III) flexing the remote flexible end to position the electrosurgical electrodes at the tissue to be treated,    (IV) applying electrosurgical currents to the first end to provide a bipolar discharge to generate heat at and treat the tissue.    
     
     
         26 . A procedure for surgically shrinking tissue as set forth in    claim 25   , wherein a cannula is first inserted into the patient and the first tubular member is then inserted into the cannula until its flexible end is adjacent the tissue, 
 after step (IV), the second tubular member is removed from the first tubular member and replaced by another second tubular member with a different electrode configuration without removing the first tubular member from the cannula, and then the electrode in the other second tubular member is energized.    
     
     
         27 . A procedure for surgically shrinking tissue as set forth in    claim 25   , wherein clearance for gas flow is provided between the first and second members, and suction is applied to the clearance.  
     
     
         28 . A procedure for surgically shrinking tissue as set forth in    claim 26   , wherein the electrosurgical handpiece is provided with a unipolar electrode and means for selectively making accessible at the remote end one of the bipolar and unipolar electrodes and for selectively energizing same, further comprising the step of first treating the tissue with one of the bipolar and unipolar electrodes and then treating the tissue with the other of the bipolar and unipolar electrodes while the first tubular member remains within the cannula.