Accurate cutting about and into tissue volumes with electrosurgically deployed electrodes

Abstract

Method, system and apparatus for carrying out accurate electrosurgical cutting. A thin resilient electrode is utilized at the forward end region of an instrument which is deployable from a longitudinally disposed slot positioned rearwardly of the tip of the instrument. Lateral sides of the slot extend between a forward location adjacent the tip and a rearward location. The electrode is deployed by urging it forwardly in compression to form an arch profile supported by the abutting slot sides adjacent the forward and rearward locations. Electrosurgically excitable with a cutting output, the electrode may carry out a cutting action both during its deployment and retraction into the noted slot. This permits a pivoting maneuver effective for circumscribing a volume of targeted tissue.

1 - 9 . (canceled)  
   
   
       10 . The system of  claim 30  in which said second fluid outlet is located adjacent said forward location.  
   
   
       11 . (canceled)  
   
   
       12 . The system of  claim 31  including a shroud severing member slideably mounted over said support member, having a forwardly disposed cutting edge positionable rearwardly of said deployment portion when in a retracted orientation and slideable over said deployment portion from said retracted orientation when said electrode is retracted into said deployment portion subsequent to its deployment to sever said shroud from its connection said electrode and said deployment portion.  
   
   
       13 - 19 . (canceled)  
   
   
       20 . The apparatus of  claim 39  in which said retention insert second channel depth is less than said first channel depth an amount effective to mechanically bias said electrode outwardly during said insertion mode.  
   
   
       21 - 25 . (canceled)  
   
   
       26 . The system of claim  24  in which: 
 said support member includes a deflector guide component located within said electrode deployment portion intermediate said forward location and said rearward location; and    said electrode is in freely abutting, outwardly biased relationship with said deflector guide during said insertion mode.    
   
   
       27 - 29 . (canceled)  
   
   
       30 . A system for causing the necrosis of a volume of targeted tissue exhibiting a given peripheral extent, comprising: 
 an electrosurgical generator assembly, having an electrosurgical return, responsive to a first control input to generate a first output for carrying out electrosurgical cutting;    a support member extending between a base region and a tip, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said tissue volume peripheral extent, and said forward end region having a deployment portion adjacent said tip;    said support member forward end region being cylindrical and said deployment portion is an outwardly open slot extending along said longitudinal axis between a forward location and a rearward location, having a slot width and extending inwardly along oppositely disposed electrically insulative slot side surfaces to an electrically insulative slot bottom surface, said support member including a barrier fluid delivery channel having a fluid input in the vicinity of said base region and an electrically insulative fluid outlet having a predetermined channel width and a channel slot and extending within said open slot in adjacency with said rearward location;    said support member including a second barrier fluid delivery channel having a second fluid input in the vicinity of said base region and extending within said open slot beneath said electrode to a second fluid outlet;    an electrode having a deployable portion extending within said forward end region deployment portion during said insertion mode, deployable to move outwardly from two spaced apart locations at said deployment portion to an outer circumscription location adjacent said tissue peripheral extent and retractable to move toward said deployment portion;    said electrode being thin, elongate and resilient, having a distal end connected with said support member at a connection location adjacent said forward location and extending above said fluid outlet an arch defining distance within said support member beyond said rearward location;    an actuator assembly extending along said support member from said base region, coupled with said electrode and actuable for effecting the deployment and refraction thereof;    said actuator assembly being configured to deploy said electrode by urging it forwardly in compression to effect outward movement thereof generally transversely to said longitudinal axis to an extent curving it into an outwardly depending arch formation and extending through said fluid outlet channel slot and between said rearward location and said forward location, and said actuator assembly effecting retraction of said electrode by urging it rearwardly to effect inward movement thereof toward said deployment portion; and    a control assembly in electrical communication with said electrosurgical generator and said electrode, actuable in correspondence with said electrode deployment and retraction to effect derivation of said first control input and the application of said first output to said electrode in electrical communication with said electrosurgical return.    
   
   
       31 . A system for causing the necrosis of a volume of targeted tissue exhibiting a given peripheral extent, comprising: 
 an electrosurgical generator assembly, having an electrosurgical return, responsive to a first control input to generate a first output for carrying out electrosurgical cutting;    a support member extending between a base region and a tip, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said tissue volume peripheral extent, and said forward end region having a deployment portion adjacent said tip;    said support member forward end region electrode deployment portion being outwardly open, extending along said forward end region between a forward location adjacent said tip and a rearward location;    an electrode having a deployable portion extending within said forward end region deployment portion during said insertion mode, deployable to move outwardly from two spaced apart locations at said deployment portion to an outer circumscription location adjacent said tissue peripheral extent and retractable to move toward said deployment portion;    said electrode being thin, elongate and resilient, having a distal end connected with said support member at a connection location adjacent said forward location and extending above said fluid outlet an arch defining distance within said support member beyond said rearward location;    an actuator assembly extending along said support member from said base region, coupled with said electrode and actuable for effecting the deployment and refraction thereof;    a control assembly in electrical communication with said electrosurgical generator and said electrode, actuable in correspondence with said electrode deployment and retraction to effect derivation of said first control input and the application of said first output to said electrode in electrical communication with said electrosurgical return; and    including a thin flexible anatomically resorbable barrier shroud having an outer edge coupled with said electrode, extending within said deployment portion during said insertion mode and deployable with said electrode for positioning about said volume of targeted tissue, said shroud being formed of a material effective to retard neovascularization across the interface of an electrosurgical cut formed by said electrode.    
   
   
       32 . A system for causing the necrosis of a volume of targeted tissue exhibiting a given peripheral extent, comprising: 
 an electrosurgical generator assembly, having an electrosurgical return, responsive to a first control input to generate a first output for carrying out electrosurgical cutting;    a support member extending between a base region and a tip, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said tissue volume peripheral extent, and said forward end region having a deployment portion adjacent said tip;    said support member forward end region electrode deployment portion being outwardly open, extending along said forward end region between a forward location adjacent said tip and a rearward location;    an electrode having a deployable portion extending within said forward end region deployment portion during said insertion mode, deployable to move outwardly from two spaced apart locations at said deployment portion to an outer circumscription location adjacent said tissue peripheral extent and retractable to move toward said deployment portion;    said electrode being thin, elongate and resilient, having a distal end connected with said support member at a connection location adjacent said forward location and extending above said fluid outlet an arch defining distance within said support member beyond said rearward location;    said electrode being configured having an interior fluid transfer cavity and slidably extends along said support member to driven connection with said actuator assembly at an electrode fluid input, said electrode having at least one fluid outlet at said forward end region in fluid transfer relationship with said fluid transfer cavity;    an actuator assembly extending along said support member from said base region, coupled with said electrode and actuable for effecting the deployment and refraction thereof;    said actuator assembly being configured to deploy said electrode by urging it forwardly in compression to effect outward movement thereof generally transversely to said longitudinal axis to an extent curving it into an outwardly depending arch formation with an electrode apex representing a maximum displacement from said longitudinal axis and extending between said forward location and said rearward location, and said actuator assembly effecting retraction of said electrode by urging it rearwardly to effect inward movement thereof toward said deployment portion;    a control assembly in electrical communication with said electrosurgical generator and said electrode, actuable in correspondence with said electrode deployment and retraction to effect derivation of said first control input and the application of said first output to said electrode in electrical communication with said electrosurgical return; and    including a barrier fluid delivery assembly having a flexible fluid input conduit extending in fluid transfer relationship from a remote external fluid input to fluid transfer connection with said electrode fluid input.    
   
   
       33 - 34 . (canceled)  
   
   
       35 . Apparatus for electrosurgically cutting a targeted region of tissue, utilizing the output, including a return, of an electrosurgical generator, comprising: 
 a support member extending between a tip and a base region, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said targeted region of tissue, and having a deployment portion at said forward end region adjacent said tip;    said support member forward end region being substantially cylindrical and said deployment portion including an outwardly open slot extending along said longitudinal axis from a securement region adjacent said tip to a forward location, thence along a deployment slot region to a rearward location, having a slot width defined between oppositely disposed slot sides extending a slot depth to a slot bottom, including an electrically insulative surface located at said slot sides and bottom,    said support member forward end region slot depth exhibiting a first dimensional extent from said securement region to an output location, and exhibiting a second dimensional extent greater than said first dimensional extent therefrom rearwardly toward said base region,    said support member including a barrier fluid delivery channel having a fluid input in the vicinity of said base region and extending within said slot beneath said electrode to said output location,    a thin, resilient electrode extending within said deployment portion during said insertion mode and deployable to move outwardly from two spaced apart support locations to define an electrode cutting portion and retractable to move toward said deployment portion;    said electrode having a distal end positioned within said slot securement region and extending an arch defining distance beyond said rearward location;    an actuator and electrical circuit assembly extending along said support member from said base region, mechanically connected with said electrode for effecting said deployment and retraction thereof, and having a terminal assembly electrically connectable with said generator for coupling a first said applied output to said electrode providing, in operative association with said return, electrosurgical cutting of said tissue by said electrode along said cutting portion when deployed;    including a forward retainer component positioned over said electrode within said slot securement region and retaining it within said slot, and a rearward retainer component positioned within said slot over said electrode, said electrode being slidably mounted there beneath; and    said actuator assembly being configured to deploy said electrode by urging it forwardly in compression to effect outward movement thereof generally transversely to said longitudinal axis to an extent curving it into an outwardly depending arch formation, and effecting retraction of said electrode by urging it rearwardly to effect inward movement thereof toward said slot.    
   
   
       36 . Apparatus for electrosurgically cutting a targeted region of tissue, utilizing the output, including a return, of an electrosurgical generator, comprising: 
 a support member extending between a tip and a base region, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said targeted region of tissue, and having a deployment portion at said forward end region adjacent said tip;    said support member forward end region being substantially cylindrical and said deployment portion including an outwardly open slot extending along said longitudinal axis from a securement region adjacent said tip to a forward location, having oppositely disposed slot sides extending a slot depth to a slot bottom, and said forward end region having an electrically insulative, generally channel-shaped retention insert fixed within said slot, having an outwardly opening electrode receiving channel with oppositely disposed internal side surfaces extending a channel depth to a channel bottom, having a securement region extending at a first channel depth from said slot securement end to a forward location, thence extending along a channel deployment region having a second depth, thence having a rearward location with a channel depth corresponding with said first channel depth;    said support member including a barrier fluid delivery channel having a fluid input in the vicinity of said base region and extending within said slot above said electrode to a fluid outlet extending from said rearward location within said retention insert channel deployment region, said fluid outlet having a channel width and a channel slot defining oppositely disposed channel outlet regions;    a thin, resilient electrode extending within said deployment portion during said insertion mode and deployable to move outwardly from two spaced apart support locations to define an electrode cutting portion and retractable to move toward said deployment portion;    said electrode having a distal end fixed with said retention insert securement region at said channel bottom and extending therefrom along said channel deployment region and beyond said rearward location an arch defining distance;    an actuator and electrical circuit assembly extending along said support member from said base region, mechanically connected with said electrode for effecting said deployment and retraction thereof, and having a terminal assembly electrically connectable with said generator for coupling a first said applied output to said electrode providing, in operative association with said return, electrosurgical cutting of said tissue by said electrode along said cutting portion when deployed;    said actuator assembly being configured to deploy said electrode by urging it forwardly in compression to effect outward movement thereof generally transversely to said longitudinal axis to an extent curving it into an outwardly depending arch formation, and effecting retraction of said electrode by urging it rearwardly to effect inward movement thereof toward said slot; and    said actuator assembly being configured to effect movement of said electrode adjacent said rearward location into said channel slot during said outward movement.    
   
   
       37 . A system for cutting about a volume of targeted tissue exhibiting a given peripheral extent, comprising: 
 an electrosurgical generator, having an electrosurgical return, responsive to a first control input to generate a first output for carrying out electrosurgical cutting;    a support member having an external surface and extending along a longitudinal axis between a base region and a tip, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said tissue volume peripheral extent, and said forward end region having a deployment portion adjacent said tip, said deployment portion comprising an outwardly open slot extending along said longitudinal axis between a forward location and a rearward location, having a slot width and extending inwardly along oppositely disposed slot side surfaces, said support member being rotatable about said axis subsequent to said insertion mode;    a thin, resilient electrode having a deployable portion extending within said forward end region deployment portion slot during said insertion mode, deployable to move outwardly between said deployment portion forward location and said rearward location to an outer circumscription location adjacent said tissue peripheral extent then rotatable with said support member along said tissue peripheral extent and then retractable to move toward said deployment portion to surgically isolate said targeted tissue said electrode having a distal end fixed to said support member at a connection location adjacent said forward location extending in said deployment mode an arch defining distance beyond said rearward location and moveable outwardly from said slot generally transversely to said longitudinal axis when deployed to exhibit an arch formation extensible toward said circumscription location, and being configured to define an arch supporting abutment with said slot sides adjacent said forward location and said rearward location when deployed and retracted effective to buttress said deployable portion when said support member is rotated about said longitudinal axis;    a thin and resilient inner electrode extending within said deployment portion during said insertion mode, having a distal end connected with said support member at a connection location adjacent said forward location and extending an inner arch defining distance less than said electrode arch defining distance beyond said rearward location;    an actuator assembly extending along said support member from said base region, coupled with said electrode and actuable for effecting the deployment thereof by urging said electrode forwardly in compression to effect said outward movement thereof to said circumscription location and to effect the retraction thereof by urging it rearwardly to cause inward movement thereof toward said deployment portion, said actuator assembly being configured to deploy said inner electrode by urging it forwardly in compression to effect outward movement thereof generally transversely to said longitudinal axis along a locus substantially defined by said deployment of said electrode into an outwardly depending arch formation with an inner electrode apex representing an inner maximum displacement from said longitudinal axis less than said electrode apex, and extending substantially between said forward location and said rearward location, and said actuator assembly effecting retraction of said inner electrode by urging it rearwardly to effect inward movement thereof toward said deployment portion; and    a control assembly in electrical communication with said electrosurgical generator and said electrode, actuable simultaneously with said electrode deployment, rotation and retraction to effect derivation of said first control input and the application of said first output to said electrode in electrical communication with said electrosurgical return, said control assembly being electrically coupled with said inner electrode and responsive to effective application of said first output thereto.    
   
   
       38 . A system for cutting about a volume of targeted tissue exhibiting a given peripheral extent, comprising: 
 an electrosurgical generator, having an electrosurgical return, responsive to a first control input to generate a first output for carrying out electrosurgical cutting;    a support member having an external surface and extending along a longitudinal axis between a base region and a tip, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said tissue volume peripheral extent, and said forward end region having a deployment portion adjacent said tip, said deployment portion comprising an outwardly open slot extending along said longitudinal axis between a forward location and a rearward location, having a slot width and extending inwardly along oppositely disposed slot side surfaces, said support member being rotatable about said axis subsequent to said insertion mode;    a thin, resilient electrode having a deployable portion extending within said forward end region deployment portion slot during said insertion mode, deployable to move outwardly between said deployment portion forward location and said rearward location to an outer circumscription location adjacent said tissue peripheral extent then rotatable with said support member along said tissue peripheral extent and then retractable to move toward said deployment portion to surgically isolate said targeted tissue said electrode having a distal end fixed to said support member at a connection location adjacent said forward location and moveable outwardly from said slot generally transversely to said longitudinal axis when deployed to exhibit an arch formation extensible toward said circumscription location, and being configured to define an arch supporting abutment with said slot sides adjacent said forward location and said rearward location when deployed and retracted effective to buttress said deployable portion when said support member is rotated about said longitudinal axis, said electrode being formed having an interior fluid transfer cavity, an electrode fluid input in fluid transfer relationship with said fluid transfer cavity and at least one fluid outlet in fluid transfer communication with said fluid transfer cavity at said forward end region assembly;    said support member includes a barrier fluid delivery assembly extending in fluid transfer relationship from a fluid input to said electrode fluid input    an actuator assembly extending along said support member from said base region, coupled with said electrode and actuable for effecting the deployment thereof by urging said electrode forwardly in compression to effect said outward movement thereof to said circumscription location and to effect the retraction thereof by urging it rearwardly to cause inward movement thereof toward said deployment portion; and    a control assembly in electrical communication with said electrosurgical generator and said electrode, actuable simultaneously with said electrode deployment, rotation and retraction to effect derivation of said first control input and the application of said first output to said electrode in electrical communication with said electrosurgical return.    
   
   
       39 . Apparatus for electrosurgically cutting a targeted region of tissue, of given peripheral extent utilizing the output, including a return, of an electrosurgical generator, comprising: 
 a rigid support member extending between a tip and a base region, having a substantially cylindrical forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said peripheral extent of said targeted region of tissue, and having a sidewall containing deployment portion at said forward end region adjacent said Up which is outwardly open, extending between a forward location and a rearward location and includes an outwardly open slot extending along said longitudinal axis from a securement end adjacent said tip to a rearward location, having oppositely disposed said sidewalls extending a slot depth to a slot bottom, said forward end region having an electrically insulative, generally channel-shaped retention insert fixed within said slot, having an outwardly opening electrode receiving channel with oppositely disposed internal side surfaces extending a channel depth to a channel bottom, having a securement region extending at a first channel depth from said slot securement end to a forward location, thence extending along a channel deployment region having a second depth, thence having a rearward location with a channel depth corresponding with said first channel depth, said support member being rotatable about said axis subsequent to said insertion mode;    a thin, resilient electrode extending within said deployment portion during said insertion mode and deployable to move outwardly from between said forward and rearward locations to define an arch-shaped electrode cutting portion extending outwardly of said tissue region peripheral extent when said support member is rotated and retractable subsequent to said rotation of said support member to move toward said deployment portion, said electrode having a distal end fixed within said retention insert securement region at said channel bottom and extending therefrom along said channel deployment region and beyond said rearward location an arch defining distance;    said deployment portion being configured adjacent said forward and rearward locations to provide a buttressing engagement with said electrode effective to support said electrode when said support member is rotated; and    an actuator and electrical circuit assembly extending along said support member from said base region, mechanically connected with said electrode for effecting said deployment and retraction thereof, and having a terminal assembly electrically connectable with said generator for coupling a first said applied output to said electrode providing, in operative association with said return, electrosurgical cutting of said tissue by said electrode along said cutting portion during said deployment, when deployed during rotation of said support member, and during said retraction, said actuator and electrical circuit assembly being configured to deploy said electrode by urging it forwardly in compression to effect outward movement thereof generally transversely to said longitudinal axis to an extent curving it into an outwardly depending arch formation defining said cutting portion and effecting retraction of said electrode by urging it rearwardly to effect inward movement thereof toward said slot.    
   
   
       40 . A system for electrosurgically cutting a targeted region of tissue exhibiting a given peripheral extent, comprising: 
 an electrosurgical generator assembly, having an electrosurgical return, responsive to a first control input to generate a first output for carrying out electrosurgical cutting;    a support member extending between a base and tip region, having a forward end region extending along a longitudinal axis from said tip and positionable in an insertion mode into adjacency with said peripheral extent of said targeted region of tissue, and said forward end region having a sidewall containing deployment portion which is outwardly open adjacent said tip extending between a forward location adjacent said tip and a rearward location, said support member being rotatable about said axis subsequent to said insertion mode;    a thin, resilient electrode having a deployable portion extending within said forward end region deployment portion during said insertion mode, deployable to move transversely outwardly from said longitudinal axis to outwardly of said peripheral extent of said region of tissue define an electrode cutting portion extending substantially between said forward location and said rearward location then rotatable with said support member along said tissue peripheral extent and retractable to move toward said deployment portion;    said deployment portion being configured adjacent said forward and rearward locations to provide a buttressing engagement with said electrode during rotation of said support member;    a return electrode mounted as a surface upon said support member at a location in electrical coupling association with said tissue when said electrode is deployed and retracted;    an actuator assembly extending along said support member from said base region, coupled with said electrode and actuable for effecting the deployment and retraction thereof; and    a control assembly in electrical communication with said electrosurgical generator and said electrode, actuable during said electrode deployment, when deployed during rotation of said support member, and during said retraction to effect derivation of said first control input and the application of said first output to said electrode in electrical communication with said electrosurgical return, said control assembly being configured to couple said electrosurgical return with said return electrode.