Abstract: A communication apparatus notifies existence of content data in a recording medium of an image processing apparatus to an external apparatus according to a request from the external apparatus. When the content data in the recording medium includes the content data having a first format, the communication apparatus notifies existence of the content data having the second format corresponding to the content data having the first format.

Abstract: Systems, methods, and apparatus for providing a fluid and reduced-toxicity optical media with optical analysis and therapeutic energy delivery. An aspect of the invention provides an aqueous solution of increased-salinity of between about 1% and 35%. An increasing salinity in accordance with the invention provides improved transmissive efficiency at many wavelengths and less toxicity than many existing systems and methods. A catheter having integrated fibers for probing or treating internal lumens or other tissues can include a liquid-inflatable balloon or flushing mechanism using the solution for displacing blood or other obstructions in an optical path between the fiber and targeted tissue. Methods including spectroscopy can be employed with the solution for diagnosing medical conditions associated with diseased vessels or other tissues while reducing the risk of permanent damage resulting from the diagnosis.

Abstract: A method and apparatus for treatment of pulmonary conditions, including a device having an end effector sized and shaped to contact a nerve component on the exterior of a bronchial segment and apply energy to that nerve component.

Abstract: An apparatus includes a body, a shaft, an ultrasonic element, and an annular clamp pad. The shaft extends distally from the body. The ultrasonic element is located at the distal end of the shaft. The ultrasonic element includes a distally presented annular face. The clamp pad is movable toward the distally presented annular face of the ultrasonic element. When tissue is compressed between the clamp pad and the distally presented annular face of the ultrasonic element, the ultrasonic element may be activated with ultrasonic energy. The resulting ultrasonic vibrations may sever and seal the tissue captured between the distally presented annular face and the clamp pad, resulting in an anastomosis. The apparatus may thus be used to join two hollow tubular tissue structures, such as portions of a gastrointestinal tract.

Abstract: A method of treating a skin tissue area (3) having a skin surface (5) is provided. The method comprises the steps of: deforming the skin tissue area into a deformed shape comprising a plurality of folds (17) in the skin tissue area; arranging radiofrequency electrodes (13) in contact with the skin surface on opposite sides of the deformed skin tissue area; and, while maintaining the skin tissue area in said deformed shape, providing a spatially continuous radiofrequency energy flow between the radiofrequency electrodes on opposite sides of the deformed skin tissue area through the deformed skin tissue area, thereby heating at least a portion (19) of the deformed skin tissue area; and releasing the skin tissue area from said deformed shape, thereby deforming said heated portion (19) into a wave-shaped zone of heated skin tissue having a depth relative to the skin surface that varies between a minimum and a maximum value in a direction between said opposite sides.

Abstract: An operation device for performing a procedure on a lumen in a body comprises: a single protection tube formed of a flexible material; first and second tube members provided in the protection tube; and first and second clamp-type effectors respectively provided at respective front ends of the first and second tube members, wherein operational wires, respectively, are inserted into the first and second tube members to connect the clamp-type effectors positioned at the front ends thereof with first and second manipulation handles positioned at rear ends thereof, wherein the first and second clamp-type effectors are manipulated by moving the operational wires using the first and second manipulation handles in front or rear directions, and wherein electric lines are connected with the first and second clamp-type effectors to electrothermally treat a lesion portion in the body.

Abstract: Methods for treating erectile dysfunction with therapeutic neuromodulation and associated systems and methods are disclosed herein. Erectile dysfunction can be characterized by the inability to develop and/or maintain an erection during sexual arousal or activity. One aspect of the present technology is directed to methods that at least partially inhibit sympathetic neural activity in nerves innervating the penis of a patient. Sympathetic drive in the patient can thereby be reduced in a manner that treats the patient for erectile dysfunction. Sympathetic nerve activity can be modulated along afferent and/or efferent pathways. The modulation can be achieved, for example, using an intravascularly positioned catheter carrying a therapeutic assembly, e.g., a therapeutic assembly configured to use electrically-induced, thermally-induced, and/or chemically-induced approaches to modulate the nerves.

Abstract: Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Abstract: A method and system for providing ultrasound treatment to a tissue that contains a lower part of dermis and proximal protrusions of fat lobuli into the dermis. An embodiment delivers ultrasound energy to the region creating a thermal injury and coagulating the proximal protrusions of fat lobuli, thereby eliminating the fat protrusions into the dermis. An embodiment can also include ultrasound imaging configurations using the same or a separate probe before, after or during the treatment. In addition various therapeutic levels of ultrasound can be used to increase the speed at which fat metabolizes. Additionally the mechanical action of ultrasound physically breaks fat cell clusters and stretches the fibrous bonds. Mechanical action will also enhance lymphatic drainage, stimulating the evacuation of fat decay products.

Abstract: Methods and apparatus are provided for treating hypertension, e.g., via a pulsed electric field, via a stimulation electric field, via localized drug delivery, via high frequency ultrasound, via thermal techniques, etc. Such neuromodulation may effectuate irreversible electroporation or electrofusion, necrosis and/or inducement of apoptosis, alteration of gene expression, action potential attenuation or blockade, changes in cytokine up-regulation and other conditions in target neural fibers. In some embodiments, neuromodulation is applied to neural fibers that contribute to renal function. In some embodiments, such neuromodulation is performed in a bilateral fashion. Bilateral renal neuromodulation may provide enhanced therapeutic effect in some patients as compared to renal neuromodulation performed unilaterally, i.e., as compared to renal neuromodulation performed on neural tissue innervating a single kidney.

Abstract: Thermochemical ablation techniques may provide ablation of bodily tissue using chemical reaction energy. The chemical reaction energy is provided by chemical reactions including a highly reactive electrophilic reagent provided to a target tissue location.

Abstract: There is provided in accordance with an exemplary embodiment of the invention a method and/or a device of treating tissue near a first lumen comprising inserting an energy emission element into a second lumen and delivering energy in an amount sufficient to cause one or more spaced apart areas of tissue damage at preselected locations in tissue near the first lumen. There is also provided a method and/or a device for treating a carotid artery wall, for example, to reduce signal conduction. There is also provided a method and/or a device for treating a wall of a lumen in a limb, for example, to increase blood flow. There is also provided a method and/or a device for treating a wall of a heart, for example, to stop abnormal signal propagation.

Abstract: A particle includes a ferromagnetic material, a radiopaque material, and/or an MRI-visible material.

Abstract: A tissue closure device and a treatment method for closing an opening in a tissue wall are described. The tissue closure device comprises a heating element and a removable anchor having an anchor shaft and an occluding element at or near a distal end of the anchor shaft. The occluding element of the anchor is configured to be expanded and collapsed. The treatment method comprises introducing the occluding element of the anchor into a body canal through an opening in a tissue wall of the body canal, and deploying the anchor such that the occluding element expands to temporarily occlude the opening in the tissue wall. The tissue region surrounding the opening is then heated to cause shrinkage of collagen-containing tissue, thereby contracting the opening in the tissue wall. When a predefined trigger associated with the treatment method is met, the anchor is automatically undeployed and retracted from the body canal.

Abstract: The present invention relates to covered endoprosthetic devices. Covered endoprosthetic devices comprise an endoprosthesis and a sheath. The sheath comprises a central portion and outer portions, wherein the central portion preferentially restricts or causes a restriction of blood flow. Blood flow can be reduced by the central portion of the sheath by varying the permeability of the sheath or by having projections on the sheath that slow blood flow. Permeability may be provided by perforations or holes in the material of the sheath or by varying the polymer structure that makes up the sheath itself. The outer portions of the sheath do not substantially reduce blood flow. Methods of using sheath-covered endoprosthetic devices of the invention to treat aneurysms, especially aneurysms in proximity to small perforator vessels or arteries, are also encompassed.

Abstract: Methods for treating polycystic ovary syndrome with therapeutic ovarian neuromodulation and associated systems and methods are disclosed herein. Polycystic ovary syndrome can be associated, for example, with a condition including at least one of oligo/amenorrhea, infertility, hirsutism, obesity, metabolic syndrome, insulin resistance, and increased cardiovascular risk profile. One aspect of the present technology is directed to methods that at least partially inhibit sympathetic neural activity in nerves proximate an ovarian artery of an ovary of a patient. Sympathetic drive in the patient can thereby be reduced in a manner that treats the patient for the polycystic ovary syndrome. Ovarian sympathetic nerve activity can be modulated along afferent and/or efferent pathways. The modulation can be achieved, for example, using an intravascularly positioned catheter carrying a therapeutic assembly, e.g.

Abstract: A probe treating a living tissue in cooperation with a jaw pivoting on a supporting point includes a treatment portion including a proximal end to which ultrasonic vibration generated from an ultrasonic transducer unit is transmitted; a distal end to which the ultrasonic vibration is transmitted from the proximal end; a holding surface holding the living tissue between the holding surface and the jaw; a back surface serving as a rear surface of the holding surface; a side surface extending from the proximal end to the distal end and being different from the holding surface; and a stress release portion provided between the distal end and the proximal end and on the side surface and releasing stress to stop development of a crack when the crack is produced in the holding surface or the back surface by external forces applied during the treatment of the living tissue.

Abstract: A method of treating pancreatic cancer includes: inserting a device into a stomach or a duodenum; securing at least a portion of the device in position relative to the stomach or the duodenum; and delivering ultrasonic energy from the device to treat a target site in a pancreas.

Abstract: An electro-mechanical surgical device, system and/or method may include a housing, at least two opposing jaw, and at least one electrical contact associated with at least one of the jaws. The electrical contact may include at least one of a bipolar electrical contact and an ultrasonic electrical contact. The electrical contact may be a row of electrodes located on one or all of the jaws. A sensor may also be associated with any tissue located between the jaws to sense and report the temperature of that tissue. A pierceable ampulla containing fluid may also be placed on at least one of the jaws so that the fluid is releasable when the jaws are in closed position and the electrode(s) pass through the tissue into the pierceable ampulla.

Abstract: Apparatus and method for ablating target tissue including a non-linear area of tissue in the left atrium of a patient. The method can include selecting an ablation apparatus having an ablator with a tissue engagement section, penetrating a chest cavity of the patient, and identifying the target tissue. The method can also include positioning the ablation apparatus adjacent to the target tissue so that the tissue engagement section can transfer ablation energy to the target tissue. The method can further include energizing the tissue engagement section with ablation energy in order to create a footprint on the non-linear area of tissue in the left atrium and to reduce an overall mass of excitable tissue in the left atrium.

Abstract: A surgical instrument includes a handpiece, an elongate shaft extending distally from the handpiece, an end effector disposed at a distal end of the elongate shaft, and a firing beam. The end effector has a first jaw and a second jaw. The first jaw is pivotable toward and away from the second jaw to capture tissue. The end effector further comprises a preheating element and an electrode. The preheating element is configured to provide heat to the captured tissue, thereby increasing electrical conductivity of the tissue. The electrode is configured to seal the captured-preheated tissue by providing RF energy to the tissue. The firing beam is configured to sever the sealed tissue.

Abstract: A system for treatment target tissue comprises an ablation device and an energy delivery unit. The ablation device comprises an elongate tube with an expandable treatment element. The system delivers a thermal dose of energy to treat the target tissue. Methods of treating target tissue are also provided.

Abstract: A system and method for occluding a pulmonary vein. The device includes a treatment device comprising an inner balloon, an outer balloon, and a space therebetween. Delivery of fluid to the inner balloon inflates the treatment element to a first diameter. If a greater treatment element diameter is required to completely occlude a pulmonary vein, fluid is delivered to the space between the first and second balloons, which expands the second balloon and causes the treatment element to have a second diameter that is greater than the first diameter. The fluid delivered to the inner balloon and fluid delivered to the space between the balloons may be from different sources and may be delivered and exhausted independently. Once the treatment element is caused to have a diameter sufficient to completely occlude the pulmonary vein, the treatment element is activated to cool or heat ostial tissue.

Abstract: This invention relates to medical instruments and systems for applying energy to tissue. Variations of the systems and methods described herein include ablating, sealing, and extracting tissue with high pressure flows of fluids that in part utilizes a vapor-to-liquid phase change of flow media to apply thermal energy to the tissue.

Abstract: A therapeutic apparatus (300, 400, 500) comprising a high intensity focused ultrasound system (302) comprising an ultrasound transducer (306). The ultrasound transducer has an electronically adjustable focus (318). The high intensity focused ultrasound system has a beam deflection zone (322, 608, 704, 1010). The intensity of ultrasound at the electronically adjustable focus divided by the acoustic power emitted is above a predetermined threshold (606, 1008) within the beam deflection zone. The therapeutic apparatus further comprises a processor (328) for controlling the therapeutic apparatus. Execution of machine executable instructions (350, 352, 354) causes the processor to: receive (102, 202) real time medical data (342, 424, 506) descriptive of the location of a moving target (320, 802); adjust (104, 204) the electronically adjustable focus to target the moving target using the real time medical data; and sonicate (106, 206) the moving target when the moving target is within the beam deflection zone.

Abstract: A coil-integrated pad assembly for inductively heating a hyperthermia needle device includes a barrier pad and an electromagnetic unit. The barrier pad is adapted to be inserted into a patient's body and to be placed between the hyperthermia needle device and a non-target tissue of the patient's body when the hyperthermia needle device penetrates a target tissue. The electromagnetic unit has a coil that is at least partially disposed in the barrier pad and that is electrifiable to generate a magnetic field sufficient to inductively heat the hyperthermia needle device.

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: The present disclosure relates to a method and a device for treating heart failure by normalizing elevated blood pressure in the left and right atria of a heart of a mammal The present disclosure includes methods for creating and maintaining an opening in the atrial septum. Tools for making an opening and enlarging the opening are also disclosed. Use of the techniques and tools described herein prolongs the patency of an intra-atrial pressure relief opening.

Abstract: The present invention is directed to an assembly, and methods thereof, for cutting the pericardium of a subject. The assembly is designed for insertion into the thoracic cavity via a thoracic passage localized between adjacent ribs of the subject. The assembly is particularly useful for cutting a window in the pericardium to allow for access to the heart for performing further procedures.

Abstract: A system and device for treating a target tissue is provided herein. The treating device and system is based on a fractional treatment of an incision edge prior to closure of the incision to prevent scar formation.

Abstract: An apparatus and method for thermally destroying tumors. A tip has a plurality of deployable thermal conductive elements whose temperatures are individually controllable. This allows the shape of the thermal field to be controlled and for specific areas to be protected from excessive heat by cooling those specific areas while ablating other areas. In another embodiment, the deployable thermal conductive elements are individually deployable to various lengths to further aid in shaping the thermal field. The temperatures and the shape of the thermal field may be monitored and controlled by a data processing device, such as a microprocessor. Further selectivity in defining the area of tissue to be treated may be achieved by introducing into the tissue thermal additives that alter the thermal properties of the tissue.

Abstract: Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues.

Abstract: A long-term implantable ultrasound therapy system and method is provided that provides directional, focused ultrasound to localized regions of tissue within body joints, such as spinal joints. An ultrasound emitter or transducer is delivered to a location within the body associated with the joint and heats the target region of tissue associated with the joint from the location. Such locations for ultrasound transducer placement may include for example in or around the intervertebral discs, or the bony structures such as vertebral bodies or posterior vertebral elements such as facet joints. Various modes of operation provide for selective, controlled heating at different temperature ranges to provide different intended results in the target tissue, which ranges are significantly effected by pre-stressed tissues such as in-vivo intervertebral discs. In particular, treatments above 70 degrees C., and in particular 75 degrees C.

Abstract: Systems and methods for mechanically heated catheter tips are provided. The systems include, for example: a catheter body with an axial lumen; a catheter tip with at least some of the tip constructed out of a high-friction, thermally-conductive material; a friction producing plug disposed in the axial lumen of the catheter tip and constructed at least in part out of a high-friction material; a drive wire running through the axial lumen of the catheter body being connected on the proximal end to a power source and on the distal end to the friction producing plug. Methods include using the drive wire to rotationally or axially translationally move the friction producing plug within the catheter tip. The friction produced by the movement of the friction producing plug and the inner wall of the catheter tip generates heat which can be conducted outward by the thermally conductive material.

Abstract: Systems for nerve and tissue modulation are disclosed. An example system may include an intravascular nerve modulation system including an elongated shaft having a first tubular member and a second tubular member. Each of the tubular members may have a proximal end a distal end. The distal end of the second tubular member may be extended distally beyond the distal end of the first tubular member. The system may further include at least one transducer affixed to the distal end region of the second tubular member. In addition, the system may include an infusion sheath having a proximal end and a distal end and the proximal end of the infusion sheath may be fixedly secured to the catheter shaft adjacent the distal end of the first tubular member.

Abstract: The invention relates to devices, systems, and methods for heating tissue, including ablating a tumor, using the catalyzed heat of decomposition of hydrogen peroxide solutions. A hydrogen peroxide solution is contacted with a catalyst to decompose the hydrogen peroxide and heat the distal tip of a catheter to a temperature effective to ablate a target tissue.

Abstract: An interstitial ultrasound thermal ablation applicator for conformal treatment of inhomogeneous tumor lesions includes: a body having a longitudinal axis, the body defining a hollow central channel along the longitudinal axis; and a plurality of CMUT array transducers mounted on the body, arranged side by side to form a cylindrical shape, having azimuth plans parallel to a longitudinal axis of the body, each of the plurality of CMUT array transducers having elevation dimensions predetermined to steer emitted ultrasonic waves to obtain a conformal volume treatment of the tumor lesions. An electronic driving method for driving an applicator having multiple independent transducer elements arranged in rows and columns includes: controlling focal parameters of each row and column of transducer elements; and controlling a contribution of each row and column of transducer elements in a manner to provide a conformal ablated volume.

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: Systems, assemblies, and methods to treat pulmonary diseases are used to decrease nervous system input to distal regions of the bronchial tree within the lungs. Treatment systems damage nerve tissue to temporarily or permanently decrease nervous system input. The treatment systems are capable of heating nerve tissue, cooling the nerve tissue, delivering a flowable substance that cause trauma to the nerve tissue, puncturing the nerve tissue, tearing the nerve tissue, cutting the nerve tissue, applying pressure to the nerve tissue, applying ultrasound to the nerve tissue, applying ionizing radiation to the nerve tissue, disrupting cell membranes of nerve tissue with electrical energy, or delivering long acting nerve blocking chemicals to the nerve tissue.

Abstract: Methods, devices, and systems for carotid body modulation via accessing a target site with an endovascular approach through a superficial temporal artery.

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: There are disclosed embodiments of a system for thermochemical tissue ablation. An ablation needle in the form of a cannula with a tip and a plurality of tubes or lumens therethrough is provided, with the tip forming a hollow mixing chamber without external openings. Liquid reagents are passed through the lumens or tubes to the mixing chamber, where an exothermic reaction results, heating the tip. The heated tip is used for tissue ablation. The reaction product can be at least partially evacuated from the mixing chamber through a tube or lumen that empties into a container.

Abstract: Systems, assemblies, and methods to treat pulmonary diseases are used to decrease nervous system input to distal regions of the bronchial tree within the lungs. Treatment systems damage nerve tissue to temporarily or permanently decrease nervous system input. The treatment systems are capable of heating nerve tissue, cooling the nerve tissue, delivering a flowable substance that cause trauma to the nerve tissue, puncturing the nerve tissue, tearing the nerve tissue, cutting the nerve tissue, applying pressure to the nerve tissue, applying ultrasound to the nerve tissue, applying ionizing radiation to the nerve tissue, disrupting cell membranes of nerve tissue with electrical energy, or delivering long acting nerve blocking chemicals to the nerve tissue.

Abstract: An energy delivering probe is used for thermally coagulating and/or constricting hollow anatomical structures (HAS) including, but not limited to, blood vessels such as perforator veins. The probe includes a shaft and an energy source.

Abstract: A method of modulating tissue of an internal organ in vivo is disclosed. The method comprises: fixating the tissue on a shaped device so as to shape the tissue generally according to a shape of the device; and focusing radiation on the fixated tissue using a radiation-emitting system so as to modulate the tissue, wherein the radiation-emitting system is non-local with respect to the shaped device.

Abstract: An ablation device includes a handle assembly including a distal end and a probe extending distally from the distal end of the handle assembly. The probe includes a heat-transfer portion and at least one fluid-flow path in fluid communication with the heat-transfer portion. The handle assembly includes at least one fluid reservoir in fluid communication with the at least one fluid-flow path and at least one apparatus configured to cause fluid flow between the at least one fluid reservoir and the heat-transfer portion. The probe is configured to apply thermal energy released by an exothermic chemical reaction that occurs when fluid from the at least one fluid reservoir is caused to flow to the heat-transfer portion.

Abstract: An improved electrosurgical scalpel, with light emission, for generating electrical signals intended for applications to the body of a patient via an electrosurgical electrode is provided. An electrosurgical scalpel includes a handle with a receptacle portion of a conductive member for mounting and retaining an electrode blade, a light source with a power source encapsulated within the handle and a means to direct the light emitted outwardly towards the electrode tip. Operation of a switch on the handle to an on position serves to complete a circuit, activating the light source and, thereby directing light through an opening or upper portion and out from the first end of the handle towards the distal end of the electrode blade.

Abstract: A surgical instrument for thermally-mediated therapies in targeted tissue volumes and for causing thermal effects in polymer tissue-contacting members. In one embodiment, the instrument has a working end with an interior chamber that is supplied with a biocompatible liquid. An energy source causes a liquid-to-vapor phase change within the interior of the instrument. The vapor phase media then is ejected from the working surface of the instrument, and a controlled vapor-to-liquid phase change in an interface with tissue applies thermal energy substantially equal to the heat of vaporization to ablate tissue. The vapor-to-liquid phase transitions, or internal energy releases, can be provided about thin-film flexible structures for engaging body lumens and cavities. An exemplary embodiment can be used for shrinking, sealing, welding or creating lesions in tissue—while causing limited collateral thermal damage and while totally eliminating electrical current flow in the engaged tissue.

Abstract: An instrument and method for applying thermal energy to targeted tissue. An instrument and method for tissue thermotherapy. In one embodiment, a method includes providing a vapor source comprising a pump configured for providing a flow of liquid media from a liquid media source into a vaporization chamber having a heating mechanism, actuating the pump to provide the liquid into the vaporization chamber, applying energy from the heating mechanism to convert a substantially water liquid media into a minimum water vapor level for causing an intended effect in tissue. For examples such levels can comprise at least 60% water vapor, at least 70% to water vapor, at least 80% water vapor or at least 90% water vapor for causing an intended effect in tissue.

Abstract: This invention relates to the working end of a medical instrument that applies energy to tissue. In one embodiment, the instrument has a microfluidic tissue-engaging surface fabricated by soft lithography means together with optional superlattice cooling means that allows for very precise control of energy application, for example in neurosurgery applications. The tissue-engaging surface can eject a high-heat content vapor into the engaged tissue for treating tissue, while the superlattice cooling structure can prevent collateral thermal damage. Also, the superlattice cooling structure can be used to localize heat at a selected depth in tissue and prevent surface ablation. Also, the superlattice cooling structure can be used to prevent tissue sticking to a thermal energy delivery surface. In another embodiment, the tissue-engaging surface can be used in a jaw structure for sealing tissue together with hydrojet means for transecting the tissue.