Abstract: A therapeutic apparatus comprising a high intensity focused ultrasound system (302) for sonicating a sonication volume (324) of a subject (320). The therapeutic apparatus further comprises a magnetic resonance imaging system (300) for acquiring magnetic resonance thermometry data (350) within an imaging volume (316). The sonication volume is within the imaging volume. The therapeutic apparatus further comprises a controller (304) for controlling the therapeutic apparatus. The treatment plan comprises instructions for controlling the operation of the high intensity focused ultrasound system. The controller is adapted for sonicating (100) the target volume using the high intensity focused ultrasound system. The controller is adapted for repeatedly acquiring (102) magnetic resonance thermometry data using the magnetic resonance imaging system during execution of the treatment plan.

Abstract: An instrument and method for tissue thermotherapy including an inductive heating means to generate a vapor phase media that is used for interstitial, intraluminal, intracavity or topical tissue treatment. In one method, the vapor phase media is propagated from a probe outlet to provide a controlled vapor-to-liquid phase change in an interface with tissue to thereby apply ablative thermal energy delivery.

Abstract: A cardiac ablation device, including a steerable catheter (10) and an expandable ablation element (18) incorporating one or more balloons (20,22) at the distal end of the catheter, has a continuous passageway (28, 30) extending through it from the proximal end of the catheter to the distal side of the expandable ablation element. A probe (72) carrying electrodes is introduced through this passageway and deploys, under the influence of its own resilience, to a structure incorporating a loop (82) which is automatically aligned with the axis of the expandable ablation device, so that minimal manipulation is required to place the sensor probe.

Abstract: A system for transmitting electrosurgical energy from a generator to an electrosurgical instrument for electro-thermal ablation is disclosed. The generator includes one or more active output terminals which supply energy to tissue and are operatively connected to one or more supply lines. The generator also includes one or more return output terminals which return energy from the tissue and are operatively connected to one or more return lines. The system also includes an electrosurgical cable housing a portion of the one or more supply lines and one or more return lines. The electrosurgical instrument includes a helical electro-thermal element operatively connected to the one or more supply lines and the one or more return lines. The one or more supply lines and one or more return lines are wound in a double helix arrangement such that the electrical field along the cable and helical electro-thermal element is mitigated along the lengths thereof.

Abstract: One embodiment comprises an apparatus for applying energy to a hollow anatomical structure having an inner wall. The apparatus comprises an elongate shaft having a distal end and a proximal end opposite the distal end; and a capacitive treatment element located near the distal end. The capacitive treatment element is sized for insertion into the hollow anatomical structure and placement near the inner wall. The capacitive treatment element is configured to create an electric field that extends at least partially into the inner wall. Other devices and methods for treatment of hollow anatomical structures are disclosed as well.

Abstract: An ultrasonic clamp coagulator assembly that is configured to permit selective cutting, coagulation and clamping of tissue during surgical procedures. An elongated portion of the instrument can be configured for endoscopic applications and has an outside diameter of less than 6 mm. The construction includes a clamping mechanism, including a clamp arm pivotally mounted at the distal portion of the instrument, which is specifically configured to create a desired level of tissue clamping forces, exceeding 4 pounds when the trigger is fully closed. The clamping mechanism includes a two-piece pad design and pad material that enables the higher tissue clamping forces and a force-limiting mechanism that effectively smooths out abusive tissue forces. The assembly also features hand activation configured to provide an ergonomical grip and operation for the surgeon. Hand switches are placed in the range of the natural swing of the surgeon's thumb, whether gripping the surgical instrument right-handed or left handed.

Abstract: A surgical instrument comprising a surgical instrument with opposing jaw members for clamping tissue therebetween. The surgical instrument may comprise a latch at a distal end of the end effector. The latch latches the distal end of the first jaw member to the distal end of the second jaw when the jaw members are in the closed position. Also, one of the jaw members may comprise a moveable tissue-contacting portion and a thermally-controlled spring adjacent to the tissue-contacting portion. The thermally-controlled spring is transitionable between a contracted state and an expanded state. The thermally-controlled spring may comprise a temperature-dependent, two-way memory effect, shape memory material. In the expanded state, the thermally-controlled spring urges the moveable tissue-contacting portion in a direction toward the other jaw member when the jaw members are in the closed position.

Abstract: A technique for detecting and providing alerts or indications that can be used for controlling or altering the displacement speed of an applicator coupling skin heating energy across a treated skin. A temperature sensor monitors the rate of skin temperature change and provides feedback related to altering the applicator displacement speed according to the rate of skin temperature change. Disclosed is also an applicator for implementing this method.

Abstract: Devices and methods for shaping an ablation treatment volume formed in fluid enhanced ablation therapy are provided. The devices and methods disclosed herein utilize the interaction of fluids to create ablation treatment volumes having a variety of shapes. In one embodiment, a method for forming an ablation treatment volume having a desired shape includes delivering therapeutic energy to tissue to form an ablation treatment volume and simultaneously delivering a first fluid and a second fluid to the tissue. The first and second fluids can convect the therapeutic energy in a desired direction such that the ablation treatment volume has a desired shape.

Abstract: A vapor delivery needle is provided that may include any of a number of features. One feature of the energy delivery probe is that it can apply condensable vapor energy to tissue, such as a prostrate, to shrink, damage, denaturate the prostate. In some embodiments, the needle can ablate a continuous lobe region in the prostate parallel to the urethral wall. Another feature of the vapor delivery needle is that it can introduce a cooling fluid into the urethra during treatment. Methods associated with use of the energy delivery probe are also covered.

Abstract: The present invention relates to an improved system for use in rehabilitation and/or physical therapy for the treatment of injury or disease to the lower limbs or extremities. The system can enable an amputee to proceed over any inclined or declined surface without overbalancing. The system is mechanically passive in that it does not utilize motors, force generating devices, batteries, or powered sources that may add undesirable weight or mass and that may require recharging. In particular the system is self-adapting to adjust the torque moment depending upon the motion, the extent of inclination, and the surface topography. An additional advantage of the improvement is that the system can be light and may also be simple to manufacture.

Abstract: Methods and systems for separating an object, such as a lead, from formed tissue are provided. Specifically, a tissue slitting device is configured to engage patient formed tissue at a slitting engagement point. While the object is subjected to a first traction force, the tissue slitting device is caused to move further into the engaged tissue and slit the tissue past the point of engagement. The slitting device causes the tissue to separate along an axial direction of the length of the formed tissue and releases at least some of the force containing the object. The methods and systems are well suited for use in cardiac pacing or defibrillator lead explant procedures.

Abstract: A device and method is disclosed for creating a lesion in adventitia tissue of a renal artery and/or a region of tissue surrounding the adventitia tissue while protecting intima and media tissue of the renal artery from injury. A catheter carrying a microwave antenna is positioned within the renal artery. Cooling fluid is circulated around the microwave antenna in thermal contact with the intima of the renal artery. Power is supplied to the microwave antenna to cause microwave energy to be emitted omnidirectionally from the microwave antenna. The power supplied to the microwave antenna and the cooling fluid circulated around the microwave antenna are controlled to cause the adventitia tissue and/or the region of tissue surrounding the adventitia tissue to be heated to a temperature sufficient to cause thermal damage while the intima and media tissue are maintained at a temperature where thermal damage does not occur.

Abstract: A method of ablating tissue is provided, including positioning an expandable element of a catheter in a blood vessel; inflating the expandable element with a volume of refrigerant to substantially occlude the blood vessel; measuring the volume of refrigerant used to inflate the expandable element; correlating the measured volume to an inflated dimension of the expandable element; defining at least one of a target pressure within the expandable element and a target flow rate for refrigerant delivery to the expandable element based at least in part on the inflated dimension; regulating refrigerant delivery to the expandable element to attain the at least one defined target pressure within the expandable element or defined target flow rate for fluid delivery to the expandable element; and ablating at least a portion of the blood vessel with the expandable element.

Abstract: Methods and apparatus for the treatment of a body cavity or lumen are described where a heated fluid and/or gas may be introduced through a catheter and into treatment area within the body contained between one or more inflatable/expandable members. The catheter may also have optional pressure and temperature sensing elements which may allow for control of the pressure and temperature within the treatment zone and also prevent the pressure from exceeding a pressure of the inflatable/expandable members to thereby contain the treatment area between these inflatable/expandable members. Optionally, a chilled, room temperature, or warmed fluid such as water may then be used to rapidly terminate the treatment session.

Abstract: According to some embodiments, a method of treating a subject having diabetes or symptoms associated with diabetes is provided. The method includes delivering a neuromodulation catheter within a vessel (e.g., hepatic artery) having surrounding nerves that innervate the liver (e.g., sympathetic nerves of the hepatic plexus). The method may also include modulating (e.g., disrupting, ablating, stimulating) the nerves by mechanical compression, energy delivery, or fluid delivery.

Abstract: A tissue treatment device comprises an insertion section sized and shaped for insertion into the body via a trocar and a diagnostic element coupled to the insertion section, the diagnostic element illuminating tissue with light of a wavelength selected to facilitate identification of target tissue in combination with an ultrasound element coupled to the insertion section for delivering to a portion of tissue illuminated by the diagnostic element ultrasound energy.

Abstract: In one general aspect, various embodiments are directed to a surgical instrument that can supply mechanical energy and electrical energy to an end effector of the surgical instrument. The surgical instrument may be operated in a first operating mode in which a transducer of the surgical instrument produces mechanical energy, or vibrations, that are transmitted to the end effector and a second operating mode in which electrical energy, or current, can flow through the end effector to perform electrosurgery. In another general aspect, the surgical instrument may comprise a clamp, or jaw, which can be moved into a closed position to hold tissue against a waveguide, or blade, of the end effector. In the second operating mode of the surgical instrument, current can flow from a power source, through the waveguide, and return to the power source through a path comprising the jaw.

Abstract: The invention presents methods and systems for accessing a pericardial space and preventing strokes arising from a left atrial appendage (“LAA”) by achieving a complete occlusion of the LAA using an epicardial approach without creating a puckering of the LAA ostium. A complete occlusion of the LAA is desired because bleeding arising from the LAA often leads to embolic strokes. Due to the peculiar anatomy of the LAA ostium, traditional LAA ligation techniques using sutures can lead to puckering, thus compromising the occlusion of the LAA. The invention achieves a complete occlusion and a more effective hemostatic seal with the use of inflatable balloons having electromagnetic coils internally, as well as hydrogels, sponges, and caliber tubes attached to the respective balloon's exterior, anchoring balloons, a closure device having a suture looped through two semi-rigid hollow tube that can be coated with hydrogel or silicone, and locking mechanisms.

Abstract: A method and related apparatus to treat a cataract where the cataractous lens is pierced and the resulting opening is mechanically maintained using a lens system device such as a pinhole device, expandable tubular leas, a stent or similar small diameter device, some of which are capable of supporting a secondary intraocular lens. The resulting passageway or lumen created in the cataractous lens allows visible light to better reach the retina, thus improving vision. This lens system device that can be placed into an in situ cataract provides for a much simpler surgical technique and reduces related pre and post operative procedures and potential complications. Intraocular lenses may also be used in concert with this invention. The apparatus and technique can be applied to humans as well as animals.

Abstract: A physiological thermal stimulation probe, comprising: (a) an electrically controlled heat control element with a relatively low thermal capacity and adapted for contact with tissue on one side thereof; (b) a thermal sink/source with a relatively high effective thermal capacity and a relatively low thermal impedance, such that said thermal sink/source sink can rapidly change a temperature of said heat control element, at a rate above 10 degrees Celsius per second, from a temperature of below 100 degrees Celsius; and (c) circuitry which activates said heat control element to achieve a desired temperature stimulation profile of said tissue.

Abstract: There is provided in accordance with an exemplary embodiment of the invention an ultrasound transducer for intrabody medical therapy comprising; an element adapted to transmit ultrasound energy; at least two electrodes configured to apply a voltage across at least some volume of the element; and a gas bubble containment area adapted to retain the gas bubble when in blood.

Abstract: Apparatus and methods are provided to concentrate energy delivery in non-superficial target tissue within a trigone region of a human bladder wall to modulate bladder function.

Abstract: The current invention concerns systems, devices and methods for the ablation of a vessel's wall from the inside, more specifically to implant devices and to the ablation of the wall of one or more pulmonary veins (PV) from the inside, preferably transmural ablation and preferably at the level of the antrum. Hereby, one or more implant devices can be implanted in the vessels and can subsequently be heated by external energy-providing means.

Abstract: This invention relates to a novel surgical device scalable to small dimensions for thermally-mediated treatments or thermoplastics of targeted tissue volumes. An exemplary embodiment is adapted for fusing, sealing or welding tissue. The instruments and techniques utilize a thermal energy delivery means, for example an electrical energy source, to instantly elevate the temperature of a biocompatible fluid media within an electrically insulated instrument portion. The altered media which may then be a gas is characterized by a (i) a high heat content, and (ii) a high exit velocity from the working end, both of which characteristics are controlled to hydrate tissue and at the same time denature proteins to fuse, seal, weld or cause any other thermally-mediated treatment of an engaged tissue volume—while causing limited collateral thermal damage and while totally eliminating electrical current flow the engaged tissue volume.

Abstract: A medical device comprising a cell including an ablation element and a carrier configured to receive at least a portion of said ablation element is disclosed. The medical device further comprises a tube enclosing the cell. At least a portion of the tube includes a membrane and the tube includes at least one hole proximate the ablation element for facilitating fluid flow. The medical device further comprises a fluid inlet for providing fluid to the interior of the tube. A method of using the medical device is also disclosed.

Abstract: The disclosure relates to a variety of systems and methods for sensing electrical events about a selected annulus region of the heart and for treating tissue in the selected annulus region. Wherein the system includes a first catheter that has an expandable member, an ablation element, and a lumen configured to allow a second catheter therethrough. The second catheter includes a distal section in a ring shape and a plurality of electrodes coupled around the ring. Optionally a second lumen can be included through the first catheter that allows for contrast media to be delivered to the distal end of the system.

Abstract: A system is for thermal ablation and includes (a) a heating element heating an ablation fluid flowing through an ablation device and to a target region of a body and (b) a computing arrangement controlling power supplied to the heating element supplying power to heat the ablation fluid to a desired temperature. The computing arrangement reduces the supplied power when a detected ablation fluid temperature exceeds a desired temperature and increases the supplied power when the detected ablation fluid temperature is below the desired temperature. The computing arrangement monitors a percentage of heat supplied by the heating arrangement to heat the fluid to the desired temperature as a function of a maximum amount of heat which the heating element is capable of supplying.

Abstract: A vapor delivery needle is provided that may include any of a number of features. One feature of the energy delivery probe is that it can apply condensable vapor energy to tissue, such as a prostrate, to shrink, damage, denaturate the prostate. In some embodiments, the needle can ablate a continuous lobe region in the prostate parallel to the urethral wall. Another feature of the vapor delivery needle is that it can introduce a cooling fluid into the urethra during treatment. Methods associated with use of the energy delivery probe are also covered.

Abstract: Apparatus and methods for insulating tissue during therapeutic procedures.

Abstract: Medical methods and systems are provided for effecting lung volume reduction by selectively ablating segments of lung tissue.

Abstract: A device for cauterising tissue is arranged to be mounted to a biopsy and/or sampling instrument and includes a conductive cauterising portion and means for heating the cauterising portion. The device may be mounted either permanently or releasably removable from the biopsy and/or sampling instrument.

Abstract: A cassette for a heated fluid ablation system, comprises a fluid supply lumen receiving an ablation fluid from an external fluid source and a fluid chamber containing a therapeutic agent in combination with an impeller pumping the ablation fluid out of the cassette via to a fluid delivery lumen when the cassette is in a first configuration and pumping the therapeutic agent out of the cassette via the fluid delivery lumen when the cassette is in a second configuration.

Abstract: A surgical device comprises an ex vivo magnet and an in vivo sled magnetically attracted to the ex vivo magnet. The sled can be positioned and anchored within a patient by moving the ex vivo magnet. The sled defines a longitudinal axis. An arm extends from the sled. The arm being moveable relative the sled between a retracted position and an extended position. The arm comprises an end effector. A locking mechanism operatively connected to the arm to lock the arm in the retracted and extended positions. The mechanism may include a rack that both rotates about a pinion and translates tangentially about the pinion.

Abstract: Apparatus is provided that includes an ultrasound ablation system, which includes a reflection-facilitation element, configured to be placed at an extramyocardial site of a subject, and to provide an extramyocardial reflective region. The system further includes an ultrasound tool, which comprises at least one ultrasound transducer configured to be positioned within a heart chamber of the subject, and to ablate myocardial tissue by applying ultrasound energy to the myocardial tissue such that at least a portion of the transmitted energy is reflected by the reflective region onto the myocardial tissue. Other embodiments are also described.

Abstract: Methods of treating a subject for a cardiac arrhythmia are provided. Aspects of the methods include thoracoscopically producing a cardiac Cox maze III set of lesions in cardiac tissue of the subject in a manner sufficient to treat the subject for the cardiac arrhythmia.

Abstract: A thermal surgical instrument having a system to control the delivery of power from an energy source to active element located on a tip. The system for controlling delivery to the tip may include a control algorithm which uses one or more measurements, such as tip current, SWR, and rapid changes in reflected power, to manage power without affecting cutting efficacy, and in a manner that may be imperceptible by a surgeon. The system may utilize a state machine to determine the current environment in which the tip may be in. Power delivered to the tip may be selectively managed according to a fixed power index or a repeatedly executed power profile.

Abstract: Systems, methods and devices for the treatment of tissue are disclosed. A system includes an elongate tube with a distal portion. A treatment element is positioned on the elongate tube distal portion, the treatment element constructed and arranged to treat target tissue. In one embodiment, gastrointestinal tissue is modified for the treatment of diabetes.

Abstract: A method for sealing fluid-carrying vessels in a living organism using high temperature plasma is disclosed. A flow rate of 0.25-0.5 L/min of room-temperature plasma generating gas and the initial temperature of the discharged plasma of 12.5-15.5 kK ensure a laminar plasma flow and its ability to penetrate into the vessel. The plasma flow is directed into the vessel, where it keeps a portion of the vessel free of liquid. Heat is transferred to the vessel walls, and the denaturing of collagen in the vessel walls causes the walls to contract until complete occlusion occurs. The method may be used with devices adapted for tissue dissection and coagulation.

Abstract: Methods, apparatus and systems for incapacitating eccrine glands are disclosed herein. A method for incapacitating eccrine glands may comprise inserting a tissue dissecting and modifying wand (TDM) into an incision in a patient's skin. The TDM may comprise a tip having a plurality of protrusions with lysing segments positioned between the protrusions. The TDM may also comprise an energy window positioned on top of the TDM that is configured to deliver energy to incapacitate eccrine glands. After separating tissue using the lysing segment(s) to define a target region, the energy window may be activated and moved around within the target region to incapacitate eccrine glands. In some implementations, the energy window may be activated prior to separating the tissue such that the tissue is separated while eccrine glands are incapacitated within the target region.

Abstract: A treatment system includes a high-frequency power source, a heat generation power source, a grasping member having an electric conductor which applies high-frequency power energy to a living tissue and a heating element which applies thermal energy, a memory where a predetermined impedance value or a predetermined rate of increase in impedance that is a threshold value, at which application of the high-frequency power energy is ended, is stored in advance, a first control section which controls the high-frequency power source based on the threshold value to end application of the high-frequency power energy, and a second control section which performs constant temperature control on the heat generation power source such that the heating element reaches a setting temperature that is set to be higher than a temperature of the heating element calculated from a resistance value of the heating element when application of the high-frequency power energy ends.

Abstract: Methods, apparatus and systems for modifying apocrine glands are disclosed herein. A method for modifying apocrine glands may comprise inserting a tissue dissecting and modifying wand (TDM) into an incision in a patient's skin. The TDM may comprise a tip having a plurality of protrusions with lysing segments positioned between the protrusions. The TDM may also comprise an energy window positioned on top of the TDM that is configured to deliver energy to incapacitate apocrine glands. After separating tissue using the lysing segment(s) to define a target region, the energy window may be activated and moved around within the target region to incapacitate apocrine glands. In some implementations, the energy window may be activated prior to separating the tissue such that the tissue is separated while apocrine glands are incapacitated within the target region.

Abstract: An array advancing device that attaches to a tissue ablation probe comprises a housing sized for receiving the handle and reciprocating plunger of the ablation probe, the housing having a proximal section configured to engage the plunger, and a distal section configured to engage the handle, the proximal housing section being controllably moveable relative to the distal housing section to thereby controllably move the plunger relative to the handle.

Abstract: A tissue ablation system for treating fibrillation in a patient comprises a steerable interventional catheter having an energy source that emits a beam of energy to ablate tissue thereby creating a conduction block for aberrant electrical pathways. The system also includes a handle disposed near a proximal end of the interventional catheter and has an actuation mechanism for steering the interventional catheter. A console allows the system to be controlled and provides power to the system, and a display pod is electrically coupled with the console. The display pod has a display panel to display system information to a user and allows the user to control the system. A catheter pod is releasably coupled with the handle electrically and mechanically, and also electrically coupled with the display pod.

Abstract: Various devices, systems, and methods are capable of killing tumor cells by delivering cell-disrupting agents into a tumor in an inward direction from a peripheral border about the tumor. In some examples, a covering that includes one or more emissive elements encompasses at least a portion of a tumor such that the emissive element is directed inwardly toward the tumor so as to be able to introduce a cell-disrupting agent into the tumor. In further examples, the covering is incorporated into a glove.

Abstract: Devices, systems and methods for in-vivo cauterization. An autonomous in-vivo device may include a heating mechanism to cauterize in-vivo tissue. A system may include an autonomous in-vivo heating device having a heating mechanism to cauterize in-vivo tissue, and an in-vivo imaging device to acquire in-vivo images.

Abstract: A pulmonary treatment system includes a compact configuration for delivery to a first airway of a patient. An energy delivery system of the pulmonary treatment system delivers energy to target tissue in or along an airway wall of the first airway to reduce airway resistance in a second airway distal to the first airway. The pulmonary treatment system protects tissue in the airway wall of the first airway located between the target tissue and the energy delivery system by at least one of thermodynamically cooling, circulating a liquid coolant through the pulmonary treatment system, and shielding a portion of the energy delivery system.

Abstract: A lower esophageal sphincter tightening device for treating gastro esophageal reflux disease which includes an insertion device, an energy source, and an energy transmitting device. The insertion device, by insertion through a body opening, positions the energy transmitting device in the proximity of the lower esophageal sphincter. The energy generates and transmits energy via the insertion device to the energy transmitting device which directs the transmitted energy onto the lower esophageal sphincter which is comprised largely of collagen. The energy source transmits energy at a level sufficient to cause heating of the sphincter's collagen resulting in a shrinkage of the collagen and a tightening of the sphincter.

Abstract: Systems and methods for noncontact ablation of tissues or materials in/on the body using a luminal catheter and a catheter inserted into the lumen. In one embodiment, the luminal catheter is an ablation catheter and the other catheter is a recording/measurement/positioning catheter. The luminal catheter incorporates a noncontact ablation element such as an ultrasonic transducer. The luminal catheter can be inserted through the skin and into the body (e.g., into the heart) and the recording/measurement/positioning catheter can be inserted into the lumen so that the ablation and recording/measurement/positioning catheters are simultaneously positioned to record/measure the electrical activity of the target tissue and ablate the target tissue without causing the trauma that results from the introduction of additional catheters. Either of the ablation and recording/measurement/positioning catheters can be steerable, and either may incorporate recording/measurement electrodes.

Abstract: Thermochemical ablation techniques may provide ablation of bodily tissue using chemical reaction energy.