Abstract: A sheath for use on a closed loop Joule-Thomson cryosurgical probe, and the combination of the and the closed loop probe. The sheath is slipped over the probe, thereby separating the probe from the environment. The sheath has a grip which fits over the handle of the cryosurgical probe, and an extendible shroud which can be longitudinally extended to cover tubing and which are attached to the handle. The sheath has a hollow multi-lumen catheter shaped and sized to fit snugly over the cannula of the cryosurgical probe. The catheter is not thermally conductive, preventing transfer of heat from the ambient to the gas mixture, and preventing the freezing of tissues at undesired locations along the catheter. A thermally conductive cap or tip is attached to the distal end of the hollow catheter. The thermally conductive cap or tip fits snugly over the cold tip on the probe, and it efficiently transfers heat from the target tissue to the cold tip, which in turn transfers heat to the expanded gas mixture.

Abstract: A guidable catheter for heating or cooling a surrounding fluid in a feeding vessel in a vasculature of a patient. The catheter includes a heat transfer element, the heat transfer element having a plurality of exterior surface irregularities shaped and arranged to create turbulence in a surrounding fluid. The surface irregularities have a depth at least equal to the boundary layer thickness of flow of the surrounding fluid in the feeding vessel. The catheter assembly also includes a supply catheter having a portion disposed within the heat transfer element to deliver a working fluid to an interior of the heat transfer element. The catheter assembly further includes a return catheter to return a working fluid from the interior of the heat transfer element. A guidewire tube is provided adjacent one of the supply catheter or the return catheter and runs substantially parallel to the axis of the guidable catheter to receive a guidewire disposed within the guidewire tube.

Abstract: A cryosurgical probe incorporating various forms of auxiliary instrumentation mounted on the catheter or conductive tip, such as a temperature sensor, a heater, an ultrasonic transducer, or an optical element of a viewing, illumination, or laser system, and a method for employing such a probe for ablation of uterine tissue.

Abstract: A cryosurgical system comprises a compressor unit and a probe assembly. A secondary refrigerant stream from the compressor unit pre-cools a heat exchanger within the probe assembly in a standby mode of operation. After the heat exchange is pre-cooled, a primary refrigerant stream can be passed through the cooled heat exchanger and thereafter expanded within a tissue-contacting portion of the probe assembly to achieve very low temperatures, typically minus 100° C. or lower. After cooling, the refrigerant stream may be passed through the probe assembly with no or partial expansion to warm the tissue-contacting surface of the probe. A probe sheath can be used to provide sterility.

Abstract: A cryoplasty catheter and method for preventing or slowing reclosure of a lesion following angioplasty. The cryoplasty catheter includes a shaft having proximal and distal ends and a dilatation balloon disposed at the distal end. An intake lumen and exhaust lumen are defined by the shaft to deliver coolant to the balloon and to exhaust or drain coolant from the balloon. The method in accordance with the present invention includes cooling a lesion to aid in remodeling the lesion through dilatation and/or freezing a portion of the lesion adjacent the dilatation balloon to kill cells within the lesion to prevent or retard restenosis.

Abstract: A catheter is attached to an elongated catheter body adapted for endovascular insertion with a balloon assembly at its distal end. Coolant injected through the catheter body may, in different embodiments, directly cool tissue contacting the balloon, or may cool a separate internal chamber. In the first case, the coolant also inflates the balloon, and spent coolant is returned to the handle via a return passage extending through the body of the catheter. A valve may regulate back pressure in the return passage to coordinate the flow of coolant into and out of the balloon so as to both inflate the balloon and achieve cryogenic cooling at the surface of the balloon. The coolant is biologically safe, and may be liquid carbon dioxide. Plural balloons may be provided adjacent the cooling segment, and one balloon may be shaped to treat the ostium of a vessel.

Abstract: A cryogenic catheter includes an outer flexible member having a cryogenic fluid path defined by an injection tube disposed in the outer flexible member. The injection tube is slidably disposed within the outer flexible member. A guide member may be provided to support the injection tube within the outer flexible member. A wire is attached to the injection tube at one end and further attached to a spool to provide for take-up of the wire.

Abstract: Methods and apparatus for dermatology treatment are provided which involve the use of continuous wave (CW) radiation, preheating of the treatment volume, precooling, cooling during treatment and post-treatment cooling of the epidermis above the treatment volume, various beam focusing techniques to reduce scattering and/or other techniques for reducing the cost and/or increasing the efficacy of optical radiation for use in hair removal and other dermatological treatments. A number of embodiments are included for achieving the various objectives indicated above.

Abstract: A cryocatheter for treatment of tissue includes a coolant line communicating with a cryochamber having a coolant receiving interior and a thermally conductive wall for contacting and conductively treating tissue. A return line returns spent coolant, and an insert or partition in the cryochamber conditions flow or channels fluid from the coolant line to the return line to enhance the rate or uniformity of cooling. The partition may extend axially to define an elongated sub-chamber which is preferentially cooled, or it may isolate one side to define an uncooled side of the cryochamber. The partition may extend axially to define a sub-chamber extending along a segmented length around a partial circumference of the catheter tip, or may channel the coolant from a central region outwardly against the peripheral wall of the cryochamber. The return line may be a vacuum return line.

Abstract: A catheter for ablating tissue, for example to treat a cardiac arrhythmia, includes a handle, a shapeable shaft and a distal ablation segment. The shaft retains a first position until manipulated to a further position with the application of moderate manual pressure. The shaft incorporates plastically deformable elements and is shapeable to conform to an insertion path or the particular anatomy of a patient for accessing a site to be ablated. Once shaped, the shaft retains its shape as the catheter is inserted or manipulated to the predetermined tissue treatment location and the distal segment is urged into contact with the tissue site. A deflection mechanism may be provided to facilitate navigation to, or to deflect the ablation segment into conformal contact with, the tissue target. In a further or alternative embodiment, a second or auxiliary shaft member extends distally from the ablation segment, allowing the segment to be threaded by or pulled past occluding tissue to a remote target tissue site.

Abstract: A sheath for use on a closed loop Joule-Thomson cryosurgical probe, and the combination of the sheath and the closed loop probe. The sheath is slipped over the probe, thereby separating the probe from the environment. The sheath has a grip which fits over the handle of the cryosurgical probe, and an extendible shroud which can be longitudinally extended to cover tubing and which are attached to the handle. The sheath has a hollow multi-lumen catheter shaped and sized to fit snugly over the cannula of the cryosurgical probe. The catheter is not thermally conductive, preventing transfer of heat from the ambient to the gas mixture, and preventing the freezing of tissues at undesired locations along the catheter. A thermally conductive cap or tip is attached to the distal end of the hollow catheter. The thermally conductive cap or tip is biased against the cold tip on the probe by a biasing element in the sheath assembly, to promote heat transfer.

Abstract: The present invention features various methods and systems for performing radiation treatment of skin in connection with dynamic cooling of tissue, while minimizing or preventing occurrence of light flash during the treatment.

Abstract: A cryoprobe system with a vented high pressure gas supply line. Venting of the gas supply line upon cut-off of high pressure gas quickens the warming process of the cryoprobe.

Abstract: The present invention provides a cryogenic device and system for treating biological tissue, which includes at least two media-flow lumens and a media-expansion element for cooling media flowing within the device. A cooling portion of the device is located along a portion of one of the media-flow lumens. The cooling portion is of a construction suitable for good contact with tissue selected for treatment. Preferably, the device and system employ one or more closed media-flow pathways for efficient recycling of the media employed. Preferably, the device and system also employ efficacious heat-exchange relationships between media-flow conduits for optimal cooling. The device and system are particularly designed for the formation of lesions in biological tissue, most particularly, the formation of deep, elongated and continuous lesions in cardiopulmonary tissue. The present invention also provides a method of using the cryogenic device and system in the treatment of biological tissue.

Abstract: A method and apparatus for performing hypothermia of a selected organ without significant effect on surrounding organs or other tissues. A flexible catheter is inserted through the vascular system of a patient to place the distal tip of the catheter in an artery feeding the selected organ. A compressed refrigerant is pumped through the catheter to an expansion element near the distal tip of the catheter, where the refrigerant vaporizes and expands to cool a flexible heat transfer element in the distal tip of the catheter. The heat transfer element cools the blood flowing through the artery, to cool the selected organ, distal to the tip of the catheter.

Abstract: A cryogenic catheter having an elongate outer member and a plurality of inner members disposed within the elongate outer member is provided. The inner members define at least one cryogenic path through the outer member. At least one of the inner members has at least one controllable opening formed thereon to selectively release cryogenic fluid. The inner members also include an overtube and an injection tube slideably disposed to one another.

Abstract: A method for performing radiation treatment of skin in connection with dynamic cooling of tissue, while minimizing or preventing occurrence of light flash during the treatment.

Abstract: A cryosurgical instrument includes a cryoprobe operative to form an ice ball in tissue of a patient targeted for cryosurgery upon activation, a sheath disposed over the cryoprobe and at least one measuring device supported by the sheath for measuring a parameter of the tissue of the patient. The instrument includes a processor for predicting formation of the ice ball by the cryoprobe over time and a display for displaying the prediction of ice ball formation. The processor is responsive to an output signal provided by the measuring device and a model of the effective thermal conductivity of the tissue of the patient targeted for surgery. In one embodiment, the measuring device is embedded in the sheath and measures temperature, thermal conductivity, blood perfusion rate and/or thermal diffusivity. The processor may be further responsive to an impedance measurement circuit for verifying the prediction.

Abstract: A cryosurgical probe incorporating various forms of auxiliary instrumentation mounted on the catheter or conductive tip, such as a temperature sensor, a heater, an ultrasonic transducer, or an optical element of a viewing, illumination, or laser system, and a method for employing such a probe for ablation of uterine tissue.

Abstract: A miniature mixed gas refrigeration system is disclosed, having a coaxial catheter with an inner high pressure supply lumen and an outer low pressure return lumen. The gas mixture is pressurized by a compressor to a pressure less than 420 psia, for safety reasons. The distal portion of the outer lumen contains a micro-miniature heat exchanger constructed of laminated plates or sheets. The plates or sheets establish high pressure and low pressure passageways, with high surface area, having a tortuous path for the gas flow to maximize heat exchange. The high pressure outlet of the heat exchanger is connected to a Joule-Thomson expansion element where the high pressure gas is expanded isenthalpically to a lower temperature at least as low as 180K. This low temperature gas cools a heat transfer element mounted in the outer wall of the catheter, to cool an external object. Return gas flows back through the heat exchanger to pre-cool the incoming high pressure gas mixture.

Abstract: A high resolution cryosurgical method and device for treating a patient's prostate are provided. The method includes the steps of (a) introducing a plurality of cryosurgical probes to the prostate, the probes having a substantially small diameter, the probes being distributed across the prostate, so as to form an outer arrangement of probes adjacent the periphery of the prostate and an inner arrangement of probes adjacent the prostatic urethra; (b) producing an ice-ball at the end of each of said cryosurgical probes, so as to locally freeze a tissue segment of the prostate.

Abstract: A system for assisting surgeons in performing cryosurgery of the prostate by calculating optimal positions for cryoprobes and providing display based templates for overlay over an ultrasound image display, and displaying actual cryoprobe ultrasound images together with template images so that the surgeon may compare suggested and actual placement of the cryoprobes, and adjust placement accordingly.

Abstract: A method for treating wrinkles in skin involves the use of a beam of pulsed, scanned or gated continuous wave laser or incoherent radiation. The method comprises generating a beam of radiation, directing the beam of radiation to a targeted dermal region between 100 microns and 1.2 millimeters below a wrinkle in the skin, and thermally injuring collagen in the targeted dermal region. The beam of radiation has a wavelength of between 1.3 and 1.8 microns. The method may include cooling an area of the skin above the targeted dermal region while partially denaturing the collagen in the targeted dermal region. The method may also include cooling an area of the skin above the targeted dermal region prior to thermally injuring collagen in the targeted dermal region.

Abstract: A medical device includes a flexible member having a variable geometry tip with a thermally-transmissive region. A smooth fluid path is provided through the flexible member to and from the variable geometry, thermally-transmissive region. The thermally-transmissive region can be deformed.

Abstract: The invention relates to a medical cryo-surgical device. Hitherto, such devices have employed the Joule-Thompson cooling effect, liquid nitrogen, or a sprayed volatile liquid. All such devices will serve the required purpose of cooling tissue to the level that will cause ice crystal formation, but all are relatively inefficient. The invention seeks to provide an improved device, an objective met by a construction comprising a primary heat extraction means (1), a secondary heat extraction means (12) associated with a part to be applied to a patient, and a coolant circuit (14) connecting the primary and secondary heat extraction means. The heat extraction means may be thermo-electric devices that can be sequentially or concurrently activated.

Abstract: In methods and apparatus for cooling surfaces, a pressurized liquid refrigerant is dispensed through a shaped member composed of an open celled foam. The method is particularly useful for localized freezing of a wart or other growth prior to its removal from skin of a human being or another animal.

Abstract: A method and apparatus for performing hypothermia of a selected organ without significant effect on surrounding organs or other tissues. A flexible catheter is inserted through the vascular system of a patient to place the distal tip of the catheter in an artery feeding the selected organ. A compressed refrigerant is pumped through the catheter to an expansion element near the distal tip of the catheter, where the refrigerant vaporizes and expands to cool a flexible heat transfer element in the distal tip of the catheter. The heat transfer element cools the blood flowing through the artery, to cool the selected organ, distal to the tip of the catheter.

Abstract: The invention features an apparatus and method for protecting tissue from freeze damage during cryosurgery. According to the method, a cryoprotective agent is introduced to a tissue to be protected in an amount sufficient to protect the tissue from damage during cryosurgery, and cryosurgery is performed on tissue to be destroyed.

Abstract: The present invention pertains to an apparatus for cryosurgery. The apparatus comprises a cryoneedle having a diameter less than 3.2 mm. The apparatus is also comprised of a thermal insulation shell disposed about a portion of the cryoneedle for reduction of heat transfer from surrounding tissues or freezing prevention of surrounding tissues during application of the cryoneedle with the shell. The cryoneedle and shell are configured for insertion into a body of a patient. The present invention pertains to a method for freezing tissues. The method comprises the steps of bringing into contact a cryoneedle having a diameter of less than 3.2 mm with a patient's body. Next, there is the step of flowing the cryofluid through the cryoneedle.

Abstract: A hand-held cryosurgical instrument is provided with an insulating, cold-resistive, non-slip grip, which fits onto the neck of a cryosurgical instrument by means of machined threads. The grip has a lip for the users hand to rest against to protect it from the cold metal of the instrument.

Abstract: An apparatus is described which is suitable for thermal treatment of the human or animal skin and underlying tissue, substituting ice frictions, and cold sprays. This cryoprobe is characterised by a Peltier module with a cold and a hot side. An electrical power supply drives the Peltier module. The cold side is mounted at a cooling head, by which the skin is treated, whereas the hot side is cooled by a heat dissipation element which is itself cooled by a cooling fluid. A temperature sensor in the cooling head allows to control the temperature of treatment. The cryoprobe may be controlled by a micro-controller or by a personal computer.

Abstract: Cryosurgery method and device for performing trans myocardial revascularization are provided. The method includes: forming trans myocardial channels by cryoablating selected portions of the myocardial tissue.

Abstract: A method and apparatus for performing hypothermia of a selected organ without significant effect on surrounding organs or other tissues. A flexible catheter is inserted through the vascular system of a patient to place the distal tip of the catheter in an artery feeding the selected organ. A compressed refrigerant is pumped through the catheter to an expansion element near the distal tip of the catheter, where the refrigerant vaporizes and expands to cool a flexible bellows shaped heat transfer element in the distal tip of the catheter. The heat transfer bellows cools the blood flowing through the artery, to cool the selected organ, distal to the tip of the catheter.

Abstract: A cryosurgical probe and method for treating cancer by cryosurgically destroying cancer cells by way of an ice ball formed at the distal end of the cryosurgical probe being located in proximity to the cancerous tissue to be treated. The probe is surrounded by a thermally insulating sheath. By varying the length and thickness of the thermally insulating sheath as well as the length of the unsheathed distal tip of the probe, the size and shape of the ice ball produced by the cryosurgical probe can be controllably tailored to correspond to the size, shape and location of the cancerous tissue so as to localize the cryogenic effect. Alternatively, the size and shape of the ice ball can be controlled by surrounding the cryosurgical probe with a heated sheath having a heating element and a temperature sensor to detect the temperature to which the sheath is heated.

Abstract: Cryosurgery method and device for performing trans myocardial revascularization are provided. The method includes: forming trans myocardial channels by cryoablating selected portions of the myocardial tissue.

Abstract: Apparatus is described for feeding a cryosurgical device by passing a liquid cryogen (e.g. liquid nitrogen) through the device to produce cooling by vaporization, and to enable thawing of the device by passing a heated inert thaw gas (e.g. nitrogen gas) through the device when the liquid cryogen is turned off. The thaw gas is passed through the device in the same direction of flow as the liquid cryogen. The apparatus can supply a plurality of cryosurgical devices, and provide independent control of cryogen and thaw for each probe. Novel valve arrangements are also disclosed for controlling the supply of liquid cryogen and the supply of the thaw gas.

Abstract: A cryosurgical instrument comprises a metal cooling tip operable to be cooled by a flow of cryogenic fluid within the tip, at least a boiling region of the tip being coated with a heat-insulating coating. The presence of the heat-insulating coating can promote nucleate boiling of the fluid rather than film boiling. Nucleate boiling within the tip provides a greater cooling efficiency of the tip than film boiling.

Abstract: A cryoprobe instrument for endoscopic use has been provided that permits the delivery of liquid or gaseous cryogens in the form of a spray. In an embodiment, the cryoprobe instrument includes an elongated, flexible tube having a fluid passage defined therethrough; a proximal connector portion provided at the proximal end of the tube for coupling the tube to a pressurized source of cryogenic refrigerant; and a nozzle tip mounted to the distal end of the tube. The nozzle tip has an outlet orifice constructed and arranged such that through the Joule-Thompson effect, cryogenic refrigerant exiting through the outlet orifice rapidly and substantially expands and cools.

Abstract: Devices and method for freezing of tissues. Devices comprise a cryosurgical probe that can be very slim with diameter up to a fraction of a millimeter for very focal freezing application, and an insulating canula for adjusting freeze zone. A cryosurgical probe with solid and liquid cold sources, wherein the solid cold source forms the portion of the probe inserted to tissue for thermal exchange while the liquid cold source maintains the operating temperature of said solid cold source. Method for rupturing targeted cells during freezing while minimizing freezing of nearby tissues and vasculatures.

Abstract: A method for treating wrinkles in skin involves the use of a beam of puls scanned or gated continuous wave laser or incoherent radiation. The method comprises generating a beam of radiation, directing the beam of radiation to a targeted dermal region between 100 microns and 1.2 millimeters below a wrinkle in the skin, and thermally injuring collagen in the targeted dermal region. The beam of radiation has a wavelength of between 1.3 and 1.8 microns. The method may include cooling an area of the skin above the targeted dermal region while partially denaturing the collagen in the targeted dermal region. The method may also include cooling an area of the skin above the targeted dermal region prior to thermally injuring collagen in the targeted dermal region.

Abstract: The cryo-ablation catheter comprises a generally tubular body having a proximal end and a distal end. The distal end includes a hollow closed head made of a thermally conductive material. A pressure line is received in and extends in the catheter from a location near the proximal end to a location near the head. The catheter includes a discharge channel extending from the head to the proximal end. The pressure line is made of a synthetic material which has, compared to metal, a low modulus of elasticity and a high thermal resistance coefficient.

Abstract: Cryocoolers for use in cryosurgery and other applications comprising finned tube helical coil heat exchangers and warming gas flow through a warming gas supply line fitted Joule-Thomson nozzle. The cryocoolers use helium, hydrogen or neon as a warming gas which is expanded from the Joule-Thomson nozzle to heat the probes.

Abstract: Cryocoolers for use in cryosurgery and other applications comprising finned tube helical coil heat exchangers and a flow directing sheath covering portions of the heat exchanger coil and isolating portions of the heat exchanger coil from the outer sheath of the cryocooler. The size and shape of iceballs created by the probes is controlled by the extent and location of the flow directing sheath.

Abstract: A cryosurgical probe comprises a probe head operable to be cooled by the expansion of a refrigerant gas within the probe head; a probe handle having means for precooling the refrigerant gas; and a flexible catheter linking the probe handle and the probe head, the catheter defining a channel for carrying precooled refrigerant gas from the probe handle to the probe head.

Abstract: A miniature mixed gas refrigeration system and method of operation are disclosed. An optimum gas mixture is formulated from a group of component fluids, according to calculated thermodynamic properties of a group of candidate fluid mixtures. The gas mixture is pressurized by a compressor to a pressure less than 420 psia, for safety reasons. The compressed gas mixture is passed through a primary heat exchanger, and then through a primary-to-secondary heat exchanger, to precool the gas mixture. The secondary side of the primary/secondary heat exchanger is cooled by a secondary Joule-Thomson refrigeration system. Properly sized flow restrictions in the primary side of the primary/secondary heat exchanger can solidify and trap liquid contaminants that may be in the gas mixture. The gas mixture exiting the primary outlet of the primary/secondary heat exchanger passes to a primary Joule-Thomson expansion element where the high pressure gas is expanded isenthalpically to a lower temperature at least as low as 183K.

Abstract: A method for cryogenic treatment of a lesion which includes the steps of delivering a fluorochemical liquid to the lesion, placing at least one cryoprobe into the lesion, and circulating cryogenic fluid through the cryoprobe, the cryogenic fluid causing an ice ball to form in a vicinity around the cryoprobe, wherein the ice ball obliterates at least a portion of the lesion. The fluorochemical liquid is utilized to augment the cryosurgical procedure and is perfused or injected into and/or around the lesioned site prior and/or during the application of a cryoprobe to the site. In one embodiment of the invention, the fluorochemical liquid acts as a contrast agent to enhance real-time medical imaging of the lesioned area and modifies the environment in and around the lesioned area. In another embodiment of the invention, the fluorochemical liquid augments cryosurgical procedures by controlling the size and shape of ice balls formed during the cryosurgical procedures.

Abstract: In methods and apparatus for cooling surfaces, a pressurized liquid refrigerant is dispensed through a shaped member composed of an open celled foam. The method is particularly useful for localized freezing of a wart or other growth prior to its removal from skin of a human being or another animal.

Abstract: The disclosure relates generally to cryogenic techniques the mapping and ablation of arrhythmias or tachycardia in atrial or ventricle heart muscles and, more particularly, to an epicardial approach which either addresses the heart directly through an open chest or employs transcutaneous subxiphoid pericardial approach for the mapping and ablation of tachycardia using laparoscopy/thoracoscopy techniques via an intrapericardial/epicardial approach. The technique involves electrograms recording and cryogenic verification and ablation, although RF ablation can also be used.

Abstract: An improved cryosurgical system includes means for cooling the cryoprobe instrument to temperatures below the normal boiling point of liquid nitrogen as well as means for recovering the sub-cooled liquid coolant. A unique cryoprobe instrument of simplified construction uses an active vacuum for thermal insulation. Means are provided for controllably adjusting the length of the freezing zone of the cryoprobe to allow the freezing zone to be adjusted for different sizes and shapes of tumors which may be "observed" before surgery by ultrasound imaging. Multiple, disposable cryoprobe instruments can be individually controlled for both operating temperature and freeze zone length. A preferred refrigeration system for sub-cooling liquid nitrogen refrigerant or other cryogenic liquid refrigerant is based on the principles of evaporative cooling.

Abstract: A process for removing obstructions to sinus drainage of patient. A cryoprobe cooled to about -100.degree. C. is inserted into one nostril of the patient and lodged inferiorly against the bone and lateral wall of the nose of the patient. The is maintained in this position for a period of about 90 seconds. Then the cryoprobe is moved within the first nostril to superior position and lodged against the sphenoid bone and cribriform plate of the ethmoid bone of the patient and maintained for about 90 seconds. The cryoprobe is then inserted into the other nostril and placed in the above two mentioned positions with the result that sinus drainage is markedly improved as is the sense of smell.