Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
CA 02555922 2000-01-25
FIELD OF THE INVENTION
The invention relates to medical devices, and more particularly to minimally
invasive
surgical systems.
BACKGROUND OF THE INVENTION
Medical devices configured for minimally invasive surgery are rapidly becoming
the
tools of choice for many surgical procedures. Not only do these devices
provide an
alternative-to more invasive surgical tools and procedures, but they have also
fostered the
development of entirely new procedures.
Devices including highly flexible catheters, as well as rigid and semi-
flexible probes have
received increased attention in recent years and continue to be refined for
cardiovascular,
pulmonary, urogenital, and other applications. Devices for each of these
applications
present different technology and material challenges. Angioplasty catheters,
for example,
can require fluid-tight passages or channels for circulating a cooling fluid
(liquid or gas)
through a catheter to cool an electro-surgical structure, such as radio
frequency ablation
electrode, to prevent overheating of the electrode or of surrounding tissue.
Similarly, a
cooling or cryogenic fluid can reduce the temperature of a structure, such as
an ablation
surface, to a therapeutic temperature. Some cooling fluids, however, can be
harmful or
fatal to the patient if they unintentionally escape from the surgical device.
Although careful fabrication techniques, quality materials, and thorough
testing can
reduce the chances of cooling fluid leakage, it would be desirable to provide
additional
system features that further minimize the occurrence of leaks; and should a
leak occur,
provide features that detect cooling fluid loss or escape immediately so that
use of the
surgical device can be terminated and patient remediation efforts can be
undertaken if
required.
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SUMMARY OF THE INVENTION
The present invention provides an improved surgical device including a device
body
defining a sealed fluid path having a first end and a second end, a
refrigerant supply in
communication with the first end of the sealed fluid path, and a vacuum source
in
communication with the second end of the sealed fluid path. Leak detection
apparatus can
be provided in communication with the sealed fluid path.
Exemplary leak detection apparatus include an impedance measurement circuit,
an
infrared sensor, and a pulsed ultrasonic device. A control unit that is in
communication
with the leak detection apparatus is responsive to output from the leak
detection
apparatus to control fluid flow through the sealed fluid flow path.
The present application therefore provides a surgical device comprising: a
catheter
having proximal and distal end portions, and having a sealed flow lumen, the
flow lumen
having first and second end portions; a supply of a cryogenic fluid in
communication
with the first end portion of the flow lumen; a vacuum source in communication
with the
second end portion of the flow lumen; an impedance measurement circuit
disposed inside
the flow lumen, including a first conductive element disposed on the distal
end portion of
the catheter, and a second conductive element disposed within the sealed flow
lumen, the
first conductive element being electrically isolated from the second
conductive element.
The present application further provides a surgical device comprising: a
device body
defining a sealed fluid path having a first end and a second end; a supply of
a cryogenic
fluid in communication with the first end of the sealed fluid path; a vacuum
source in
communication with the second end of the sealed fluid path; and a leak
detection
apparatus in optical communication with the sealed fluid path.
The present application still further provides a surgical device comprising: a
catheter
having a proximal end and a distal end, and a fluid path through at least a
portion of the
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catheter, the catheter having a fluid inlet and a fluid exhaust; a console
including a
reservoir containing a supply of cryogenic fluid in communication with the
fluid inlet of
the catheter, a vacuum pump in communication with the fluid exhaust, and a
control unit
for controlling fluid movement from the reservoir; a handle unit connecting
the catheter
to the console; a first leak detector in the catheter, the first leak detector
including a first
optical sensor; a second leak detector in the handle unit, the second leak
detector
including a second optical sensor; and a third leak detector in the console,
the third leak
detector including a third optical sensor.
The present application further provides a surgical device comprising: a
catheter having
proximal and distal end portions, and having a sealed first flow lumen, the
first flow
lumen having first and second portions; a supply of a cryogenic fluid in
communication
with the first portion of the first flow lumen; a vacuum source in
communication with the
second portion of the first flow lumen; a first optically transparent window
disposed in
the catheter; and a first leak detector disposed externally to the first flow
lumen and
proximate to the first optically transparent window, said first leak detector
being in
optical communication with the second portion of the first flow lumen through
the first
optically transparent window.
BRIEF DESCRIPTION OF THE DRAWINGS
The invention will be more fully understood from the following detailed
description
taken in conjunction with the accompanying drawings in which:
FIG. I is a schematic view of a minimally invasive surgical system including a
leak
detection system in accordance with the invention;
FIG. 2 illustrates an exemplary cryocatheter tip with a leak detection
circuit;
FIG. 3 illustrates a porous, insulated, conductive wire within a cryocatheter
tip; and
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FIG. 4 illustrates another leak detection device.
DETAILED DESCRIPTION OF THE INVENTION
In the discussion which follows, "surgical device" is intended to encompass
any surgical
implement used in association with human or animal medical treatment,
diagnosis, study,
or analysis. More particularly, a surgical device is intended to encompass any
implement
or portion thereof that is entirely or partially inserted into a human or
animal body by any
means of entry, such as through a natural body orifice, an incision, or a
puncture. The
term surgical device is not intended to connote a limitation to treatment of a
single body
system, organ, or site. The surgical device can be rigid as a thick steel
pipe, completely
flexible and pliant like a thread, or have a flexibility between the two
extremes. The
surgical device can have a diameter that ranges from inches to microns.
As used herein, "fluid" is intended to encompass materials in a liquid state,
a gas state, or
in a transition state between liquid and gas, and liquid and solid. The fluid
can be a
"cryogenic fluid" capable of reaching or creating extremely cold temperatures
well below
the freezing point of water, such as below minus 20 degrees Centigrade; a
"cooling fluid"
that does not reach or create temperatures below the freezing point of water;
a fluid
capable of transferring heat away from a relatively warmer structure or body
tissue; a
fluid capable of transferring heat to a relatively cooler structure or body
tissue; a fluid at
or capable of creating a temperature between the freezing and boiling points
of water; and
a fluid at or capable of reaching or creating a temperature above the boiling
point of
water.
A "fluid path" as used herein is intended to encompass any boundary, channel
or guide
through which a fluid can travel. It can include concentrically disposed
catheters, multi-
lumen catheters, or a single loop of tubing within a sheath. The fluid path
can also
include connectors and valves, as well as passages in support equipment, such
as the
console disclosed herein.
CA 02555922 2000-01-25
Referring now to FIG. 1, an exemplary surgical device is illustrated for
minimally
invasive surgery. The surgical device includes a console 10 and a multi-lumen
catheter
12. The console 10 houses electronics and software for controlling and
recording a
surgical procedure, such as ablation, and it controls delivery of liquid
refrigerant under
high pressure from a supply container 13, through an umbilical 14, to the
catheter 12. A
second umbilical 16 is provided for transferring refrigerant from the catheter
12 to
console 10. The console 10 is provided with apparatus 15 for recovery of
expanded
refrigerant vapor from the catheter and recompression of the vapor.
Either or both of the catheter 12 and the console 10 can be provided with
detection
devices that are in electrical communication with the console and which
provide a signal
output that can be representative of an event that indicates flow path
integrity loss or a
leak within a sealed catheter and/or console. As shown in FIG. 1, a first
detection device
or leak detector 18 can be provided in a body or tip portion of the catheter
12. A second
leak detector 20 can be provided in the handle portion 21 of the catheter 12;
and a third
leak detector 22 can be provided in the console 10. The console 10 can be
configured to
respond to signal output from the leak detectors and initiate a predetermined
sequence of
events, such as discontinuing refrigerant injection, changing the pressure
within the
system, and controlling removal of refrigerant from the catheter 12.
The purpose and function of the leak detectors is better understood once
another feature
of the invention is introduced, namely, a vacuum pump 24, as shown in FIG. 1
in fluid
communication with a catheter 12. The third leak detector 22 can be interposed
between
the vacuum pump 24 and the catheter 12. The vacuum pump 24 is controllable to
reduce
the pressure within the return lumen of the catheter 12 and the second
umbilical 16 to
provide a pressure ranging from a pure vacuum to a pressure just below a
patient's blood
pressure. For example, the vacuum can maintain a selected pressure between 80
mm Hg
and 0 mm Hg. The provision of reduced pressure within the return flow path of
the
catheter significantly enhances patient safety because, should a leak occur,
refrigerant
will not squirt from the leak into the patient. Rather, bodily fluids in the
treatment site
will be aspirated into the catheter whereupon they are sensed by one or more
of the leak
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detectors. In one mode of operation, when a leak is detected, the refrigerant
injection is
turned off automatically and vacuum is kept on to ensure that no refrigerant
enters the
patient's body.
Although a single type of leak detector could be functional, an exemplary
embodiment of
the invention is provided with three different types of leak detectors for
enhanced
detection probability. For example, the first leak detector 18 can be a simple
circuit
formed by a wire, such as a pull-wire used to help steer the catheter tip, and
a conductive
catheter tip portion. Specifically, as shown in FIG. 2, a wire 26 is
electrically isolated
from a metal catheter tip 28 and metal electrode rings 29. In the illustrated
embodiment,
the wire is secured to a non-conductive support element 30. Also shown is a
refrigerant
injection tube 32. The electrical impedance between the wire 26 and the
catheter tip 28 is
monitored. If a liquid enters the catheter 12 and touches the wire 26 and the
tip 28, a short
is created which is detectable by circuitry in the console. Alternatively, the
wire 26 and
one or more of the electrode rings 29 can be included in the impedance
circuit.
However, some catheters 12 may include multiple conductors running within one
or more
lumens and electrical insulation on the conductors is necessary to avoid
unwanted
electrical connections and interferences. Many such catheters also contain
uninsulated
wires, for example as mechanical deflectors to alter catheter configuration,
or for
example as stiffening agents to alter catheter flexibility or pushability.
However, if the
pull wire (or other wire that is part of the leak detection circuit) contacts
another
uninsulated wire, electrode ring or other conductive element, a false leak
detection signal
could be generated. Accordingly, a form of insulation that provides mechanical
insulation
while allowing fluid conductivity is desirable.
FIG. 3 discloses a wire 34 (such as a pull wire) that is part of the leak
detection circuit.
The wire 34 is covered with a porous materia136, such as a fabric, salt-
depleted polymer,
or laser drilled polymer, that provides mechanical insulation in the dry state
by the
physical bulk and separation of the porous material, which allows passage of
ionic fluids
to the thus insulated wire to complete the electrical leak detection circuit.
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CA 02555922 2008-08-29
Although the first leak detector 18 is well suited for detecting leaks at or
near the distal end of
the catheter 12, a leak may develop between the distal end and the handle
portion 21 of the
catheter and an infrared sensor can be disposed in the handle as the second
leak detector 20. As
soon as the first and/or second leak detectors output a signal to the console
indicative of a leak,
the refrigerant injection can be stopped. In an exemplary embodiment, shown in
FIG. 4, an
infrared sensor 38 with a wavelength sensitive to blood composition is
disposed in sensing range
with a transparent window 40 or tube along or forming part of the return fluid
flow path 42.
Even though refrigerant injection is stopped, it can still be desirable to
apply vacuum to the
catheter to withdraw refrigerant already introduced into the catheter, along
with refrigerant
contaminated blood. Thus, a third leak detector 22 (shown in FIG. 1) is
provided further
downstream in the fluid flow path to not only provide a last opportunity for
detection, but to also
detect when a selected volume of blood has been aspirated (a relatively small
amount) and to
then terminate vacuum operation or aspiration. Depending on placement of the
third leak
detector, it can prevent blood contamination of the entire fluid flow path
within the console 10.
Additionally, the handle may include an optically transparent window having a
leak detector
disposed externally to the window, the leak detector being in optical
communication with a
flow lumen on the opposite side of the transparent window, This leak detector
may also output
a signal to the console indicative of a leak.
Although the invention has been shown with respect to exemplary embodiments
thereof,
various other changes, omissions and additions in form and detail thereof may
be made therein
without departing from the spirit and scope of the invention.
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