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EP-3351196-B1 - SYSTEM FOR AUTOMATED IMAGE-GUIDED TISSUE RESECTION

EP3351196B1EP 3351196 B1EP3351196 B1EP 3351196B1EP-3351196-B1

Inventors

  • ALJURI, NIKOLAI
  • MANTRI, SURAG
  • BAEZ, LUIS
  • SURJAN, GEORGE
  • SASNETT, MICHAEL W.
  • FOOTE, JONATHAN

Dates

Publication Date
20260506
Application Date
20130228

Claims (15)

  1. An apparatus to treat tissue of a patient, comprising: an elongate treatment probe (450) configured for insertion into a urethra of the patient to treat the patient, the elongate treatment probe extending along an elongate treatment probe axis, the elongate treatment probe comprising an outer elongate structure having a working channel and an inner carrier (380) rotatable and translatable within the working channel to position and orient an energy source to release energy toward a target tissue; an elongate imaging probe (460), the elongate imaging probe extending along an elongate imaging probe axis, the elongate imaging probe (460) configured to generate a sagittal view and an axial view of the target tissue; a coupling (440) to couple the elongate treatment probe (450) to the elongate imaging probe (460) when the elongate treatment probe and the elongate imaging probe have been inserted into the patient; and a first linkage (430) connected to the inner carrier (380); and a second linkage connected to the elongate imaging probe (460); wherein one or more controllers (424) are configured to move the first linkage (430) to move the inner carrier (380) along a treatment axis and move the second linkage to move the elongate imaging probe (460) along the elongate imaging probe axis in order to view interaction of the inner carrier with tissue as the inner carrier moves along the treatment axis; and wherein a user interface (500) is configured to show a first treatment profile overlaid on the axial view and a second treatment profile overlaid on the sagittal view.
  2. An apparatus as in claim 1, wherein the coupling comprises: a base (440); a first arm (442) extending from the base (440) and connected to a proximal end of the elongate treatment probe; and a second arm (444) extending from the base and connected to a proximal end of the elongate imaging probe; wherein the base (440) supports the elongate treatment probe (450) and the elongate imaging probe (460) when the first arm (442) comprises a stiff configuration and the second arm (444) comprises a stiff configuration.
  3. An apparatus as in claim 2, wherein the second arm (444) comprises an actuator to manipulate the elongate imaging probe (460) under user control when the first arm (442) maintains a position and orientation of the elongate treatment probe (450).
  4. An apparatus as in claim 1, wherein the coupling is configured to maintain alignment of the elongate treatment probe (450) in relation to the elongate imaging probe (460) when the elongate imaging probe (460) and the elongate treatment probe (450) have been inserted from opposite sides of the patient.
  5. An apparatus as in claim 1, wherein the coupling (440) is configured: to maintain an alignment of the elongate treatment probe axis of the elongate treatment probe (450) with the elongate imaging probe axis of the elongate imaging probe (460) when a nozzle is advanced proximally and distally and rotated, optionally wherein the coupling is configured to align the elongate treatment probe axis of the elongate treatment probe (450) parallel with the elongate imaging probe axis of the elongate imaging probe (460); or to maintain a fixed position and orientation of the elongate treatment probe (450) in relation to the elongate imaging probe (460).
  6. An apparatus as in claim 1, wherein the coupling comprises a first stiff arm (442) coupled to the elongate treatment probe (450) and a second stiff arm (444) coupled to the elongate imaging probe (460), the first stiff arm (442) fixedly coupled to the second stiff arm (444), and wherein the elongate treatment probe (450) comprises stiffness to inhibit deflection transverse to the elongate treatment probe axis and the elongate imaging probe (460) comprises stiffness to inhibit deflection transverse to the elongate imaging probe axis.
  7. An apparatus as in claim 1, wherein the coupling comprises magnets to maintain a fixed position and orientation of the elongate treatment probe (450) in relation to the elongate imaging probe (460), or wherein the coupling comprises a plurality of magnets arranged at a plurality of axial locations along one or more of the elongate treatment probe (450) or the elongate imaging probe (460).
  8. An apparatus as in claim 1, wherein the coupling is configured to couple the elongate treatment probe (450) to the elongate imaging probe (460) through a wall of a first lumen extending over a portion of the elongate treatment probe and a wall of a second lumen extending over a portion of the elongate imaging probe.
  9. An apparatus as in claim 1, wherein the elongate imaging probe (460) is configured for insertion into a rectum of the patient , and wherein the coupling is configured to align the elongate treatment probe (450) with the elongate imaging probe (460) when the elongate treatment probe (450) is placed within the urethra and the elongate imaging probe is placed within the rectum.
  10. An apparatus as in claim 1, wherein the outer elongate structure comprises a spine to add stiffness to the elongate treatment probe (450) such that the outer elongate structure inhibits deflection of the elongate treatment probe (450) transverse to the elongate treatment probe axis.
  11. An apparatus as in claim 1, wherein the elongate imaging probe (460) comprises at least a stiff distal portion to inhibit deflection of the elongate imaging probe transverse to the elongate imaging probe axis of the elongate imaging probe and to fix an orientation of the elongate imaging probe axis of the elongate imaging probe (460) in relation to the elongate treatment probe axis of the elongate treatment probe (450).
  12. An apparatus as in claim 1, further comprising: a processor (492) coupled to the elongate imaging probe (460), the elongate treatment probe (450) and the first linkage (430) and wherein the processor (492) comprises instructions to determine a pressure, an axial location and an orientation of a nozzle to ablate a target location of the tissue identified on an image of the elongate imaging probe.
  13. An apparatus as in claim 12, wherein the processor (492) comprises instructions to determine the pressure, the axial location and orientation of the nozzle in response to the target location on the image: when the elongate treatment probe (450) has been inserted on a first side of the patient and the elongate imaging probe (460) has been inserted on a second side of the patient opposite the first side; or when the elongate treatment probe (450) has been coupled to the elongate imaging probe through a wall of a first lumen and a wall of a second lumen extending between the elongate treatment probe (450) and the elongate imaging probe (460).
  14. An apparatus as in claim 12, wherein the processor (492) comprises instructions to determine a first image coordinate reference of a first input target location of the image and a second image coordinate reference of a second input target location of the image and instructions to map the first image coordinate reference of the image to a first target coordinate reference of the elongate treatment probe (450) and to map the second input target location of the image to a second target coordinate reference of the elongate treatment probe (450) and wherein the processor (492) comprises instructions to determine pressures and axial and rotational positions of the nozzle to provide a cut profile extending from the first input target location to the second input target location.
  15. An apparatus as in claim 1, wherein the apparatus comprises a fluid flushing port (34) and an aspiration port (36) configured to remove living cells of the tissue in order to provide the living cells outside the patient.

Description

CROSS-REFERENCE The present PCT application claims priority to U.S. Provisional Patent Application Serial No. 61/604,932, filed on 29-Feb-2012, entitled "AUTOMATED IMAGE-GUIDED INTRA-ORGAN RESECTION AND TREATMENT. This subject matter of this PCT application is related to the complete disclosures of the following commonly owned U.S. Patents and pending applications: 12/399,585, filed March 6, 2009, entitled "TISSUE ABLATION AND CAUTERY WITH OPTICAL ENERGY CARRIED IN FLUID STREAM" published as US 20090227998; application Serial No. 12/700,568, filed February 4, 2010, entitled "MULTI FLUID TISSUE RESECTION METHODS AND DEVICES", published as US 20110184391; and 7,882,841, issued 08-Feb-2011, entitled "MINIMALLY INVASIVE METHODS AND DEVICES FOR THE TREATMENT OF PROSTATE DISEASES" The subject matter of the present application is also related to PCT Application PCT/US2011/023781 filed on April 8, 2007, published as WO2011097505 on November 8, 2011, entitled "MULTI FLUID TISSUE RESECTION METHODS AND DEVICES". BACKGROUND The field of the present invention is related to the treatment of tissue with energy, and more specifically to the treatment of an organ such as the prostate with fluid stream energy. Prior methods and apparatus of treating subjects such as patients can result in less than ideal removal in at least some instances. For example, prior methods of prostate surgery can result in longer healing time and less than desirable outcome than would be ideal in at least some instances. Prior methods and apparatus of imaging tissue can be less than ideal for imaging a treated tissue. For example, prior ultrasound methods and apparatus may not be well suited to view the treatment sight during treatment, and alignment of diagnostic images with treatment images can be less than ideal. Also, at least some of the prior treatment methods and apparatus of treating tissue may not be well suited from combination with imaging systems of the prior art. In at least some instances, it would be helpful to provide improved imaging of tissue during surgery, for example to provide real time imaging of tissue that would allow a user to adjust the treatment based on real time images of the tissue. At least some of the prior methods and apparatus to image tissue during surgery can be somewhat cumbersome to use, and can result in delays in the patient treatment. Prior methods and apparatus to treat an organ such as the prostate may provide a user interface that is somewhat cumbersome for the user, and can provide less than ideal planning of the surgery. Also, at least some of the prior methods and apparatus to treat tissue such as the prostate tissue can be somewhat less accurate than would be ideal. In at least some instances, the prior methods and apparatus may provide a less than ideal user experience. Also, at least some of the prior interfaces may provide less than ideal coupling of the treatment apparatus with tissue structures. Improved methods for tissue resection are described in U.S. Patent No. 7,882,841 and pending applications U.S. 12/700,568 and U.S. 12/399,585. The methods and systems described in this patent and these patent applications rely on the positioning of a probe such as a uretheral probe, which directs a fluid stream radially outwardly for controlled resection of tissue such as the prostate and luminal tissues. Optionally, the fluid stream may be used to deliver light, electrical, heat or other energy sources to aid in resection and/or to cauterize the treated tissue. While these methods are very effective and a significant advance over prior luminal tissue treatment protocols, it would be desirable to provide improvements to assist in more accurate tissue removal in both fully automated and physician assisted operating modes. At least some of these objectives will be met by the inventions described hereinafter. US 2010/0179522 describes an integrated, robotic treatment subsystem for the purpose of providing a patient friendly system and method for removing tumors detected by said diagnostic system. A laser-based endosurgical thermal treatment system that utilizes historical cancer mapping data together with real-time ultrasonic and other data to reliably target and control the eradication of cancer conditions. The system contains computer aided robotic control such that control of the boundary, size, position and orientation of the ablated volume of tissue has a tolerance of less than a millimetre. The disclosed system provides multi-modal scanning methods for identification and localization of detected tumors, including multi-focal tumors. US 4,672,963 describes a surgical system for destroying unwanted internal structures, including a laser device, an ultrasonic probe and a computer system. The ultrasonic probe provides data signals that are processed by the computer system to provide an image of the structures involved in the laser irradiation procedure. The laser device can be inserted in the body and act