WO2009155078A1

WO2009155078A1 - Electrical ablation device

Info

Publication number: WO2009155078A1
Application number: PCT/US2009/045566
Authority: WO
Inventors: Gary L. Long; Andrew M. Zwolinski
Original assignee: Ethicon Endo-Surgery, Inc.
Priority date: 2008-05-30
Filing date: 2009-05-29
Publication date: 2009-12-23
Also published as: US20090299362A1; US8114072B2

Abstract

An electrical ablation apparatus includes a housing extending along a longitudinal axis. A first electrode and a second electrode are disposed within the housing. The electrodes are configured to connect to electrically conductive wires. The first and second electrodes are separated by a gap. The second electrode includes first and second prongs defining an opening suitable to receive tissue to be ablated therebetween. When the first and second electrodes are energized at a predetermined energy level, an electric current suitable to ablate the tissue flows across the gap and forms an electric arc between the distal end of the first electrode and the tissue. A system includes an energy source to drive the electrical ablation apparatus. A method includes introducing the electrical ablation apparatus into a patient and ablating tissue with the electric arc.

Description

ELECTRICAL ABLATION DEVICE

BACKGROUND

[0001] Electrical ablation has been employed in medicine to remove certain abnormal tissues or growths, such as cancers or tumors, from the body. Electrodes attached to therapy probes are positioned in proximity to or in contact with the diseased tissue. The electrodes are then energized by an energy source to remove the abnormal tissue. Conventional electrical therapy probes, however, are not effective for ablating or cutting through certain types of abnormal tissues such as adhesions, which develop in a majority of patients after surgery. Adhesions can be challenging to ablate using conventional electrical ablation therapy techniques. Thus, there is a need for electrical ablation devices that are suitable for ablating a variety of abnormal tissues, including adhesions and other abnormal fibrous growths. There is a further need for such electrical ablation devices to be introduced into the treatment region using minimally invasive surgical techniques.

FIGURES

[0002] The novel features of the various embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with the advantages thereof, may be understood by reference to the following description taken in conjunction with the accompanying drawings as follows.

[0003] FIG. 1 is a perspective view of one embodiment of an electrical ablation apparatus with first and second electrodes in an extended position.

[0004] FIG. 2 is a side view of one embodiment of the electrical ablation apparatus shown in FIG. 1. [0005] FIG. 3 is a front view of one embodiment of the electrical ablation apparatus shown in

FIG. 1.

[0006] FIG. 4 is a rear view of one embodiment of the electrical ablation apparatus shown in

FIG. 1.

[0007] FIG. 5 is a top view of one embodiment of the electrical ablation apparatus shown in

FIG. 1.

[0008] FIG. 6 is a bottom view of one embodiment of the electrical ablation apparatus shown in FIG. 1.

[0009] FIG. 7 is a cross-sectional view of one embodiment of the electrical ablation apparatus taken along line 7 — 7 as shown in FIG. 1.

[0010] FIG. 7A is a cross-sectional view of an arm portion of a prong of the electrical ablation apparatus taken along line 7A — 7A as shown in FIG. 7.

[0011] FIG. 8 is a perspective view of one embodiment of the electrical ablation apparatus shown in FIG. 1 with the first and second electrodes in a retracted position.

[0012] FIG. 9 is a cross-sectional view of one embodiment of the electrical ablation apparatus taken along line 9 — 9 as shown in FIG. 8.

[0013] FIG. 10 illustrates one embodiment of an electrical ablation system.

[0014] FIG. 11 illustrates one embodiment of the electrical ablation apparatus shown in FIG. 1 with the first and second electrodes in a retracted position protruding from the working channel of an endoscope.

[0015] FIG. 12 illustrates one embodiment of the electrical ablation apparatus shown in FIG. 1 with the first and second electrodes in an extended position protruding from the working channel of an endoscope.

[0016] FIG. 13 illustrates one embodiment of the electrical ablation apparatus shown in FIG. 1 with the first and second electrodes in an extended position and engaging tissue being ablated by an electric arc formed between the first electrode and the tissue. [0017] FIG. 14 illustrates a flexible endoscopic portion of a gastroscope inserted into the upper gastrointestinal tract of the patient and into the stomach to position one embodiment of the electrical ablation apparatus shown in FIG. 1 for ablating tissue therein.

DESCRIPTION

[0018] Various embodiments are described to provide an overall understanding of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non- limiting embodiments and that the scope of the various embodiments is defined solely by the claims. The features illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the claims.

[0019] It will be appreciated that the terms "proximal" and "distal" are used herein with reference to a clinician manipulating one end of an instrument that protrudes out of a natural orifice (or opening) of the patient. The term "proximal" refers to the portion of the instrument closest to the clinician and the term "distal" refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as "vertical," "horizontal," "up," and "down" may be used herein with respect to the drawings. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute.

[0020] The various embodiments described herein are directed to electrical ablation devices and techniques. The electrical ablation devices and techniques may be employed to remove various abnormal tissues, including, for example, abnormal masses, tumors, lesions (diseased tissue), and/or adhesions. In one embodiment, the electrical ablation devices comprise electrodes that can be positioned into or in proximity to a treatment region (e.g., target site) inside a patient where there is evidence of abnormal tissue growth. Once positioned, the electrodes are energized by an energy source to deliver electrical current to the treatment region to remove the abnormal tissue. The electrical current flows between the electrodes based on the voltage applied to the electrodes. The electrodes may be energized with direct current (DC) voltages and currents at various polarities and amplitudes or time-varying voltages and currents. Time- varying voltages and currents may be produced by a suitable energy source comprising an electrical waveform generator adapted to deliver electrical energy top the electrodes. The electrical energy produces by the electrical waveform generator may be characterized in terms of frequency, amplitude, pulse width, and polarity. Depending on the diagnostic or therapeutic treatment rendered, the therapy probes may comprise one electrode containing both a cathode and an anode or may contain a plurality of electrodes with at least one serving as a cathode and at least one serving as an anode.

[0021] In one embodiment, an electrical ablation device comprising a first and second electrode may be positioned on a distal end of a housing, such as a catheter, suitable for insertion within a patient. In one embodiment, the housing may be a flexible housing. A first electrode is coupled to one pole of an energy source and a second electrode is coupled to another pole of the energy source. The first and second electrodes may be retractable or collapsible within the housing to facilitate insertion of the electrical ablation device inside the patient. For example, the electrical ablation device may be introduced through a narrow working channel of an endoscope, for example. Once the electrical ablation device is positioned near the treatment region, the first and second electrodes are extended distally. In the extended position, the second electrode comprises prongs that separate laterally to form fork-like hook-shaped portions suitable to grasp and hold the abnormal tissue to be ablated. The distance between the distal ends of the first and second electrodes is selected such that no current flows across a gap between the first and second electrodes, when the electrodes are energized at a predetermined energy level. When tissue is located in the fork- like prongs, however, the distance between the distal ends of the first and second electrodes is reduced. This enables current to flow across the gap and produce an electric arc between the distal end of the first electrode and the tissue. The energy delivered by the electric arc is sufficient to ablate the tissue.

[0022] FIGS. 1-7 illustrate one embodiment of an electrical ablation device 10 with electrodes in an extended position. In one embodiment, the electrical ablation device 10 comprises a housing 12. The housing 12 comprises a proximal end 14 and a distal end 16. The housing 12 extends along a longitudinal axis "A." In one embodiment, the housing 12 may be formed as an elongated tubular flexible member that is slidably receivable within a flexible portion of an endoscope. The elongated tubular flexible member may be slidably receivable within a working channel of the endoscope. In one embodiment, the elongated tubular flexible member is formed as a flat spring coil pipe.

[0023] In one embodiment, a first electrode 18 comprises a proximal end 20 and a distal end 22 and is disposed within the housing 12. The proximal end 20 is configured to connect to a first electrically conductive wire 56 A. A second electrode 24 comprises a proximal end 26 and a distal end 28. The first and second electrodes 18, 24 may be formed of any suitable electrically conductive materials (e.g., brass, stainless steel) to implement electrically conductive electrodes. The proximal end 26 is configured to connect to a second electrically conductive wire 56B. The first and second electrically conductive wires are adapted to be coupled to an energy source 110 (FIGS. 10, 13). The electrically conductive wire may be received in a channel 27 formed in the housing 12. In one embodiment, the distal end 22 of the first electrode 18 and the distal end 28 of the second electrode 24 are separated by a gap "Gi" having a distance when the first and second electrodes 18, 24 are in the extended position as indicated by direction arrow "E." The second electrode 24 comprises a first prong 30 and a second prong 32. The first prong 30 comprises a proximal end 34 and a distal end 36. The second prong 32 comprises a proximal end 38 and a distal end 40. The distal ends 36, 40 of the respective first and second prongs 30, 32 define respective first and second hook portions 47, 49 to grasp the tissue to be ablated. The first and second hook portions 47, 49 define respective first and second proximal ends 46, 48 of the respective first and second prongs 30, 32. A gap "G₂" is a distance defined between the distal end 22 of the first electrode 18 and either one of the distal ends 46, 48 of the respective hook portions 47, 49. The proximal ends 20, 26 of the respective first and second prongs 30, 32 are electrically coupled. The distal ends 36, 40 of the respective first and second prongs 30, 32 are separated by a distance "Di" when the second electrode 24 is extended distally in direction "E" and the first and second prongs 30, 32 are fully extended. The proximal ends 46, 48 of the respective first and second hook portions 47, 49 are separated by a distance "D₂" when the second electrode 24 is extended distally in direction "E" and the first and second prongs 30, 32 are fully extended. In one embodiment, a first distance defined by the gap "G2" is greater than a second distance defined by the distance "D₂."

[0024] In one embodiment, the first and second electrodes 18, 24 are slidably extendable in direction "E" and are slidably retractable in direction "R." The first and second electrodes 18, 24 may be slidably extended and retracted independently of each other or may be me slidably extended and retracted dependently, e.g., as a unit. The first electrode 18 is slidably receivable within the housing 12 when it is retracted in direction "R." The first and second prongs 30, 32 comprise respective first and second arms 50, 52 that are slidably movable in directions "R" and "E" within a sleeve 54 formed on the distal end 16 of the housing 12. The first and second prongs 30, 32 are collapsible to be slidably received within the sleeve 54 when the second electrode 24 is retracted in direction "R." The first and second electrodes 18, 24 may be coupled to respective first and second actuator members 58A and 58B to extend and retract the first and second electrodes 18, 24. The first actuator member 58A is coupled to the proximal end 20 of first electrode 18 and is disposed within the housing 12. The second actuator member 58B is coupled to the proximal end 26 of second electrode 24 and is disposed within the channel 27. The actuator members 58 A, B may be formed as a solid rod or a tube. The actuator members 58 A, B are coupled to an actuator 102 (FIG. 10). The actuator members 58 A, B move reciprocally in directions "E" and "R" to respectively extend and retract the first and second electrodes 18, 24. [0025] The first and second arms 50, 52 comprise an electrically insulative portion as well as an electrically conductive portion. As shown in FIG. 7 A, the second arm 52 comprises an electrically insulative portion 52 A and an electrically conductive portion 52B. Although not shown, the first arm 50 comprises an electrically insulative portion similar to the electrically insulative portion 52A of the second arm 52 and an electrically conductive portion similar to the electrically conductive portion 52B of the second arm 52. The electrically insulative portions of the first and second arms 50, 52 may be fabricated from polyimide TEFLON® materials, which provide a substantially lubricious surface and are good electrical insulators. [0026] In one embodiment, the electrical ablation apparatus 10 comprises an electrically insulative sleeve 42 located between the housing 12 and the first electrode 18. The electrically insulative sleeve 42 may be formed of any electrically insulative material to electrically isolate the first electrode 18 from the housing 12 and the second electrode 24. The electrically insulative sleeve 42 may be formed of a substantially frictionless (e.g., lubricious) material. The electrically insulative sleeve 42 may be fabricated from polyimide TEFLON® materials, which provide a substantially lubricious surface and are good electrical insulators. [0027] In one embodiment, the distal end 22 of the first electrode 18 defines a tapered surface 44. In various embodiments, the tapered surface 44 may be formed in a variety of shapes such as any one of a cone, frustro-cone, oblique-cone, right-cone, and right frustro-cone, among other tapered geometric forms. In other embodiments, the distal end 22 of the first electrode 18 may define a blunt surface, a spherical surface, or any suitable geometric form. [0028] In one embodiment, the housing 12 may have a diameter "B" (FIG. 6) of about 2.5 millimeters such that it may be easily inserted in a working channel of an endoscope. For endoscopic applications, the diameter "B" may be selected to be any size that is suitable for insertion within the working channel of the particular endoscope. In one embodiment, the opening "D" between the first and second prongs 30, 32 is about 2 to 4 millimeters. The distance, however, may be selected to be any distance that is suitable for grasping and holding tissue to be ablated. In one embodiment, the gap "Gi" between the distal end 22 of the first electrode 18 and the distal end 28 of the extended second electrode 24 is about 3.66 millimeters. The gap "G₂" may be about 2.95 millimeters. The gaps "Gi" and "G₂" may be selected to be any suitable lengths and may be greater than or less than the distances described herein based on energy levels and the materials used to make the first and second electrodes 18, 24, for example. In one embodiment, the angle G₁ between the first and second prongs 30, 32 is about 40°. The angle G₁ may be selected to suit any particular implementation. The insulative sleeve 42 may be defined by a first radius r\ and a second radius r₂ from the center of the housing 12. In one embodiment, the first radius is about 0.75 millimeters and the second radius r₂ is about 0.95 millimeters. Accordingly, in one embodiment, the thickness of the insulative sleeve 42 may be about 0.2 millimeters (r₂ - r{). The thickness of the insulative sleeve 42 may be selected based on the energy levels delivered by the energy source 110 (FIGS. 10, 13) so as to provide adequate electrical insulation between the first electrode 18 and the housing 12 and the first and second electrodes 18, 24. Those skilled in the art will appreciate that the dimensions described herein may be modified or selected to suit other specific embodiments taking into account the particular environment, application, and/or implementation of the electrical ablation device 10. Therefore, the embodiments described herein are not limited in this contest.

[0029] FIGS. 8 and 9 illustrate the embodiment of the electrical ablation device 10 illustrated in FIGS. 1-7 with the first and second electrodes 18, 24 in a retracted position. As previously discussed, the first and second electrodes 18, 24 may be retracted in direction "R" either independently or in unison depending on the particular implementation of the electrical ablation device 10. In general, the first and second electrodes 18, 24 are retracted in direction "R" to insert the electrical ablation device 10 through the working channel of an endoscope. Once the electrical ablation device 10 is located in proximity of the treatment region, the first and second electrodes 18, 24 are deployed by advancing them in direction "E." As previously discussed, the first and second electrodes 18, 24 may be advanced and retracted using the respective first and second actuator members 58A and 58B. [0030] FIG. 10 illustrates one embodiment of an electrical ablation system 100. In one embodiment, the electrical ablation system 100 comprises an energy source 110, an actuator 102, an endoscope 120, and the electrical ablation device 10. In the illustrated embodiment, the electrical ablation device 10 is electrically coupled to the energy source 110 through an electrical connection in the actuator 102. The housing 12 is introduced into a port 122 in communication with a working channel of the endoscope 120. The electrical ablation device 10 protrudes from the distal end of a flexible endoscopic portion 124 of the endoscope 120.

[0031] Referring now to FIGS. 10-13, the energy source 110 is employed to energize the first and second electrodes 18, 24 with an electrical energy level suitable to produce an arc 130 between the distal end 22 of the first electrode 18 and tissue 128 located between the first and second prongs 30, 32. The electric arc 130 is suitable to ablate fibrous tissues such as adhesions growing between internal organs of a patient, for example. The input to the energy source 110 is connected to a commercial power supply by way of a plug 118. The output of the energy source 110 is coupled to the actuator 102 through first and second electrically conductive wires 112 A, B, a socket 114, and a plug 116 that is part of the actuator 102. The plug 116 is adapted to electrically connect to the socket 114. The first and second electrically conductive wires 112 A, B are electrically connected to the respective first and second electrically conductive wires 56 A, B, which are connected to the first and second electrodes 18, 24.

[0032] In one embodiment, the energy source 110 comprises a timing circuit to interrupt the output of the energy source 110 and produce a cyclical pattern. The timing circuit may comprise suitable switching elements to produce a cyclical or pulsed output energy signal to drive the electrical ablation device 10. For example, the energy source 110 may produce a series of/? pulses suitable to generate the electric arc 130, when the pulsed energy is applied to the first and second electrodes 18, 24.

[0033] In one embodiment, the energy source 110 comprises an electrical waveform generator to produce an electrical waveform. The electrical waveform generator produces electric potentials at predetermined frequencies, amplitudes, polarities, and pulse widths. When applied to the first and second electrodes 18, 24, the electric potential causes a current to flow between the distal end 22 of the first electrode 18 and the tissue to generate the electric arc 130. [0034] In one embodiment, the energy source 110 comprises a radio frequency (RF) generator to produce RF waveforms at predetermined frequencies, amplitudes, polarities, and pulse widths. The RF generator may be a conventional, bipolar/monopolar electrosurgical generator such as one of many models commercially available, including Model Number ICC 350, available from Erbe, GmbH.

[0035] In one embodiment, the energy source 110 may be a conventional, bipolar/monopolar Pulsed DC generator such as one of many models commercially available, including Model Number ECM 830, available from BTX Molecular Delivery Systems Boston, MA. In bipolar mode the first electrode 18 may be electrically coupled to one polarity and the second electrode 24 may be electrically coupled to the opposite polarity.

[0036] In various embodiments, the energy source 110 produces direct current (DC) electrical pulses delivered at frequencies in the range of 1-20Hz, amplitudes in the range of ±100 to ±IOOOVDC, and pulse widths in the range of 0.01-lOOms. For example, an electrical waveform having amplitude of +500 VDC and pulse duration of 20ms may be delivered at a pulse repetition rate or frequency of IOHZ to ablate the tissue 128. In one embodiment, the polarity of the first and second electrodes 18, 24 may be electronically reversed. For example, the polarity of electrical pulses initially delivered at amplitudes in the range of +100 to +1000 VDC may be reversed to -100 to -1000 VDC.

[0037] The actuator 102 may be employed to advance and retract the first and second electrodes 18, 24 in the manner previously discussed and to energize the first and second electrodes 18, 24 when the tissue 128 to be ablated is located between the first and second prongs 30, 32. In the illustrated embodiment, the actuator 102 comprises a first slidable element 104A connected to the first actuator member 58A and a second slidable element 104B connected to the second actuator member 58B. The first slidable element 104 A is used to advance and retract the first electrode 18 in respective directions "E" and "R" and the second slidable element 104B is used to advance and retract the second electrode 24 in respective directions "E" and "R." A switch 126 is used to energize the first and second electrodes 16, 24 with energy supplied by the energy source 110.

[0038] The endoscope 120 comprises a handle 128 and an elongated relatively flexible endoscopic portion 124. The distal end of the endoscopic portion 124 may comprise a light source 132, a viewing port 134, and a working channel 126. The viewing port 132 transmits an image within its field of view to an optical device such as a charge coupled device (CCD) camera within the endoscope 120 so that an operator may view the image on a display monitor (not shown). In the illustrated embodiment, the housing 12 is introduced through a port 122 coupled to the working channel 126 of the endoscope 120. The endoscope 120 comprises a flexible endoscopic portion 124 that is suitable to be inserted inside the patient through various natural orifices. In one embodiment, the endoscope 120 may be a GIF-100 model available from Olympus Corporation. The flexible endoscopic portion 124 of the endoscope 120 may be introduced into the patient trans-anally, trans-vaginally, orally, or through the abdomen via an incision or keyhole. The endoscope 120 assists the surgeon to guide and position the electrical ablation device 10 near the treatment region to treat the diseased tissue 128 growing on organs such as the liver or the intestines.

[0039] As shown in FIG. 11, the first and second electrodes 18, 24 are retracted in direction "R" when the electrical ablation device 10 is introduced through the working channel 126 of the flexible endoscopic portion 124. Once the electrical ablation device 10 is positioned in proximity to the treatment region, the first and second electrodes 18, 24 are extended in direction "E," as shown in FIG. 12.

[0040] FIG. 13 illustrates one embodiment of the electrical ablation device 10 shown in FIG. 1 with the first and second electrodes 18, 24 in an extended position and engaging the tissue 128 being ablated by the electric arc 130 formed between the first electrode 18 and the tissue 128. When the first and second electrodes 18, 24 are energized at a predetermined energy level, electric current flows across the gap defined between the distal end 22 of the first electrode 18 and the tissue 128. The current flowing across the gap forms the electric arc 130 that is suitable to ablate the tissue 128. The electric arc 130 is formed when the tissue 128 is located in the opening defined between the distal end 22 of the first electrode 18 and the first and second prongs 30, 32.

[0041] The various embodiments of the electrical ablation device 10 described herein may be introduced within a patient using minimally invasive surgical techniques or conventional open surgical techniques. In some instances in may be advantageous to introduce the electrical ablation device 10 into the patient using a combination of minimally invasive and open surgical techniques. Minimally invasive techniques provide more accurate and effective access to the treatment region for diagnostic and treatment procedures. Some minimally invasive procedures are performed by the introduction of various medical devices into the patient through a natural opening of the patient. These procedures are known as Natural Orifice Translumenal Endoscopic Surgery (NOTES™). Accordingly, the various embodiments of the electrical ablation device 10 described herein may be used in endoscopic and/or laparoscopic surgical procedures, conventional laparotomies, or any combinations thereof.

[0042] To reach the treatment region, in one embodiment, the electrical ablation device 10 may be inserted through a natural orifice of the body. Natural orifices include the mouth, anus, and/or vagina, for example. Internal organs may be reached using trans-organ or trans-lumenal surgical procedures. In a typical natural orifice endoscopic translumenal procedure (e.g., NOTES™), the flexible endoscopic portion 124 of the endoscope 120 may be introduced into the patient through one or more natural orifices to view the treatment region using direct line-of-sight, a camera, or other visualization devices. The working channel 126 of the endoscope 120 is used for introducing surgical devices, such as the electrical ablation device 10, to the treatment region to perform key surgical activities (KSA). A KSA includes ablating abnormal fibrous tissue generally known as adhesions.

[0043] FIG. 14 illustrates the flexible endoscopic portion 124 of the endoscope 120 (e.g., gastroscope) inserted into the upper gastrointestinal tract of a patient and into the stomach 136 to position the electrical ablation device 10 in proximity of abnormal tissue to be ablated. With reference to FIGS. 10-14, the flexible endoscopic portion 124 of the endoscope 120 is positioned in proximity of the treatment region. The electrical ablation device 10 is inserted through the working channel 126 of the flexible endoscopic portion 124 of the endoscope 120. During the insertion phase, the electrical ablation device is in the retracted. Once the electrical ablation device 10 is positioned in the treatment region, the first and second electrodes 18, 24 are extended through the distal end of the tubular flexible member 12. In the fully extended position, the first and second prongs 30, 32 of the second electrode 24 spring open and separate to form a hook-like fork at the distal end of the second electrode 24. The tissue 128 to be ablated is grasped by the first and second prongs 30, 32. The first and second electrodes 18, 24 are energized by the energy source 110 to ablate the tissue 128 with the electric arc 130 formed by electric current flowing between the distal end 22 of the first electrode 18 and the tissue 128. [0044] The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.

[0045] Preferably, the various embodiments of the devices described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility. [0046] It is preferred that the device is sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam. [0047] Although the various embodiments of the devices have been described herein in connection with certain disclosed embodiments, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations.

[0048] Any patent, publication, or other disclosure material, in whole or in part, said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Claims

1. An electrical ablation apparatus, comprising: a housing comprising a proximal end and a distal end, the flexible housing extending along a longitudinal axis; a first electrode comprising a proximal end and a distal end is disposed within the housing, the proximal end is adapted to couple to an energy source; and a second electrode comprising a proximal end and a distal end is disposed within the flexible housing, the proximal end is adapted to couple to an energy source, wherein the distal ends of the first and second electrodes are separated by a gap, the second electrode comprising: a first prong comprising a proximal end and a distal end; and a second prong comprising a proximal end and a distal end, the first and second prongs are electrically coupled at the proximal end and are configured to separate and define an opening when the second electrode is extended distally.

2. The electrical ablation apparatus of claim 1, wherein the size of the opening is selected such that when the first and second electrodes are energized by the energy source at a predetermined energy level, an electric current suitable to ablate tissue located within the opening flows across the gap and forms an electric arc between the distal end of the first electrode and the tissue.

3. The electrical ablation apparatus of claim 1, wherein the first electrode is movable to retract within the flexible housing.

4. The electrical ablation apparatus of claim 1, comprising an electrically insulative sleeve between the flexible housing and the first electrode.

5. The electrical ablation apparatus of claim 1, wherein the distal end of the first electrode defines a tapered surface.

6. The electrical ablation apparatus of claim 5, wherein the tapered surface defines any one of a conical, frustro-conical, oblique-conical, right-conical, and right frustro-conical surface.

7. The electrical ablation apparatus of claim 1, wherein the distal end of the first electrode defines blunt surface.

8. The electrical ablation apparatus of claim 1, wherein the distal end of the first electrode defines a spherical surface.

9. The electrical ablation apparatus of claim 1, wherein the second electrode is movable to retract within a sleeve located at the distal end the housing.

10. The electrical ablation apparatus of claim 9, wherein the first and second prongs are collapsible to be slidably received within the sleeve when the second electrode is retracted.

11. The electrical ablation apparatus of claim 1 , wherein the distal ends of the first and second prongs define respective first and second hooks to grasp tissue to be ablated.

12. The electrical ablation apparatus of claim 1, wherein the first and second prongs of the second electrode extend distally at an angle relative to the longitudinal axis.

13. The electrical ablation apparatus of claim 1, wherein the proximal end of the first prong of the second electrode is located at a first distance from the distal end of the first electrode and the proximal end of the second prong of the second electrode is located at the first distance from the distal end of the first electrode, and wherein the first distance is greater than a second distance defined between the proximal ends of the first and second prongs of the second electrode.

14. The electrical ablation apparatus of claim 1, wherein the housing is formed as an elongated tubular flexible member that is slidably receivable within a flexible portion of an endoscope.

15. The electrical ablation apparatus of claim 14, wherein the elongated tubular flexible member is slidably receivable within a working channel of the flexible portion of the endoscope.

16. A method of preparing an instrument for surgery, comprising: obtaining the electrical ablation apparatus of claim 1 ; sterilizing the electrical ablation apparatus; and storing the electrical ablation apparatus in a sterile container.

17. An electrical ablation system, comprising: an energy source; an electrical ablation apparatus coupled to the energy source, the electrical ablation apparatus comprising: a housing comprising a proximal end and a distal end, the housing extending along a longitudinal axis; a first electrode comprising a proximal end and a distal end is disposed within the housing, the proximal end is configured to couple to the energy source; and a second electrode comprising a proximal end and a distal end is disposed within the housing, the proximal end is configured to couple to the energy source, the distal ends of the first and second electrodes are separated by a gap, the second electrode comprising: a first prong comprising a proximal end and a distal end; and a second prong comprising a proximal end and a distal end, the first and second prongs are electrically coupled at the proximal end and are configured to separate and define an opening when the second electrode is extended distally.

18. The system of claim 17, wherein the size of the opening is selected such that when the first and second electrodes are energized by the energy source at a predetermined energy level, an electric current suitable to ablate tissue located within the opening flows across the gap and forms an electric arc between the distal end of the first electrode and the tissue.

19. The electrical ablation apparatus of claim 17, wherein the first electrode is movable to retract within the housing.

20. The electrical ablation apparatus of claim 17, wherein the second electrode is movable to retract within a sleeve located at the distal end of the housing.

21. A method of endoscopically ablating tissue, the method comprising: inserting a portion of an endoscope into a natural opening of a patient to a target site; inserting an electrical ablation apparatus through a working channel of the portion of the endoscope, the electrical ablation apparatus comprising: a housing comprising a proximal end and a distal end, the housing extending along a longitudinal axis; a first electrode comprising a proximal end and a distal end is disposed within the housing, the proximal end is configured to connect to a first electrically conductive wire; and a second electrode comprising a proximal end and a distal end is disposed within the housing, the proximal end is configured to connect to a second electrically conductive wire, the distal ends of the first and second electrodes are separated by a gap, the second electrode comprising: a first prong comprising a proximal end and a distal end; and a second prong comprising a proximal end and a distal end, the first and second prongs are electrically coupled at the proximal end and are configured to separate and define an opening when the second electrode is extended distally; extending the distal ends of the first and second electrodes through the distal end of the elongated tubular member to separate the first and second prongs; receiving tissue to be ablated between the first and second prongs; energizing the first and second electrodes; and ablating the tissue located in the gap with an electric current that forms an electric arc between the first electrode and the tissue.