Large volume tissue reduction and removal system and method

Abstract

A tissue removal system for extracting a tissue specimen from a patient is disclosed. The system has a retrieval bag, a first electrode, and a return electrode. The retrieval bag has a flexible container with an opening. The first electrode is coupled to an interior of the flexible container, and has a conductive wire with an exposure area, a first load-bearing area, a coating having a first active electrode surface area, and an impedance that is greater than an impedance of the conductive wire. The first active electrode surface area is less than the exposure area. The coating is configured to degrade during application of electrosurgical power and wherein the degradation expands the first active electrode surface area during the application of the electrosurgical power.

1 - 27 . (canceled) 
     
     
         28 . A tissue removal system for extracting a tissue specimen from a patient, the system comprising:
 a container having an opening;   a plurality of wires coupled to an interior of the container in a first configuration wherein the plurality of wires form a space for receiving the tissue specimen and wherein the plurality of wires are configured to divide the tissue specimen in response to at least one force on the plurality of wires;   an actuator coupled to the plurality of wires, the actuator configured to:
 apply at least one pretensioning motion to at least one of the plurality of wires such that the at least one of the plurality of wires advances toward the tissue specimen; 
 apply a first force to a first one of the plurality of wires to divide the tissue specimen by one or more first cuts; 
 apply a second force to a second one of the plurality of wires to divide the tissue specimen by one or more second cuts; wherein the second is initiated independently of the first force and after the first force has stopped, and wherein the one or more second cuts divides the tissue specimen across an area previously divided by the one or more first cuts; and 
   the tissue removal system further comprising a tube adapted to allow the actuator to be inserted into a laparoscopic opening in the patient.   
     
     
         29 . The tissue removal system of  claim 28 , further comprising:
 a fastening system configured to route the plurality of wires to respective pre-defined positions proximate to a proximal end of the container.   
     
     
         30 . The tissue removal system of  claim 28 , further comprising:
 a fastening system configured to sequentially release portions of the plurality of wires in response to the at least one pretensioning motion.   
     
     
         31 . The tissue removal system of  claim 29 , wherein:
 the fastening system comprises a plurality of sleeves positioning the plurality of wires relative to the container.   
     
     
         32 . The tissue removal system of  claim 28 , further comprising:
 a fastening system configured to release a first portion of a first one of the plurality of wires prior to releasing a second portion of the first one of the plurality of wires.   
     
     
         33 . The tissue removal system of  claim 28 , further comprising:
 a plurality of fasteners configured to temporarily couple the plurality of wires to the container in the first configuration;   wherein a first one of the plurality of fasteners is configured to release in response to a first force; and   a second one of the plurality of fasteners is configured to release in response to a second force, the second force greater than the first force.   
     
     
         34 . The tissue removal system of  claim 28 , further comprising:
 at least one of a mechanical or an electrically conductive coupling that connects at least two of the plurality of wires together at an end of the at least two of the plurality of wires.   
     
     
         35 . The tissue removal system of  claim 28 , further comprising:
 a first fastener shaped and positioned to removably couple a distal portion of a first one of the plurality of wires to the container; and   a second fastener shaped and positioned to removably couple a proximal portion of the first one of the plurality of wires to the container.   
     
     
         36 . The tissue removal system of  claim 35 , wherein:
 the proximal portion of the first one of the plurality of wires is removably coupled to a first pull assembly, the first pull assembly configured to selectively apply a mechanical pull force on the first one of the plurality of wires.   
     
     
         37 . The tissue removal system of  claim 28 , wherein:
 the first force is a first pull motion and the second force is a second pull motion.   
     
     
         38 . The tissue removal system of  claim 28 , further comprising:
 a pull mechanism configured to operatively engage at least one of the plurality of wires wherein engagement is not reversible.   
     
     
         39 . The tissue removal system of  claim 28 , wherein:
 the plurality of wires comprise a plurality of elongated active electrodes, each one of the plurality of active electrodes having an exposure section along at least a length of the each one of the plurality of active electrodes; and   the tissue removal specimen further comprises a return electrode electrically isolated from the exposure sections of the plurality of active electrodes.   
     
     
         40 . The tissue removal system of  claim 39 , wherein:
 at least one of the plurality of active electrodes comprises a coating on at least a portion of the at least one of the plurality of active electrodes, the coating configured to degrade when a threshold voltage is applied to the at least one of the plurality of active electrodes.   
     
     
         41 . The tissue removal system of  claim 39 , wherein:
 at least one of the plurality of active electrodes has a high impedance coating on at least a portion of the at least one of the plurality of electrodes, the high impedance coating configured to degrade during application of electrosurgical power, wherein the high impedance coating is configured to degrade when a voltage sufficient to allow an arc across the high impedance coating is applied.   
     
     
         42 . The tissue removal system of  claim 40 , further comprising:
 a first electrode set having a first set of the plurality of electrodes removably coupled to the container;   a second electrode set having a second set of the plurality of electrodes removably coupled to the container; and   a generator coupled to the first and second electrode sets, the generator configured to provide a first electrosurgical power to the first electrode set and a second electrosurgical power to the second electrode set.   
     
     
         43 . The tissue removal system of  claim 42 , wherein:
 the first electrode set and the second electrode set are positioned symmetrically about a pulling direction of the first and second electrode sets.   
     
     
         44 . The tissue removal system of  claim 39 , wherein a distal end of the tube includes a lubricious material to facilitate passage of the electrodes between the insertion tube and the specimen. 
     
     
         45 . The tissue removal system of  claim 39 , wherein a distal end of the tube includes an opening to facilitate movement of at least one of the plurality of wires. 
     
     
         46 . The tissue removal system of  claim 39 , wherein a distal end of the insertion tube is formed from a compliant material. 
     
     
         47 . A method of extracting a tissue specimen from a patient, the method comprising:
 providing a container having an opening and a plurality of wires coupled to an interior of the container in a first configuration to divide the tissue specimen in response to at least one force on the plurality of wires;   positioning the tissue specimen into the container;   applying at least one pretensioning motion to at least one of the plurality of wires such that the at least one of the plurality of wires advances toward the tissue specimen.   applying, with an actuator, a first force to a first one of the plurality of wires to divide the tissue specimen by one or more first cuts;   providing a tube adapted to allow the actuator to be inserted into a laparoscopic opening in the patient; and   applying a second force to a second one of the plurality of wires to divide the tissue specimen by one or more second cuts, wherein the second force is initiated independently of the first force after the first force has stopped, and wherein the one or more second cuts divides the tissue specimen across an area previously divided by the one or more first cuts.   
     
     
         48 . The method of  claim 47 , wherein:
 the plurality of wires are routed to respective pre-defined positions proximate to a proximal end of the container.   
     
     
         49 . The method of  claim 47 , wherein:
 the applying the at least one of the first or second forces sequentially releases portions of the plurality of wires.   
     
     
         50 . The method of  claim 47 , wherein:
 the applying the at least one of the first or second forces sequentially releases a first portion of a first one of the plurality of wires prior to releasing a second portion of the first one of the plurality of wires.   
     
     
         51 . The method of  claim 47 , wherein:
 providing a container comprises providing a plurality of fasteners configured to temporarily couple the plurality of wires to the container in the first configuration; and wherein the applying the at least one of the first or second forces comprises applying a first force to release a first one of the plurality of fasteners and applying a second force greater than the first force to release a second one of the plurality of fasteners.   
     
     
         52 . The method of  claim 47 , wherein:
 applying the at least one of the first or second forces comprises applying a first pull force on a first one of the plurality of wires prior to applying a second pull force on a second one of the plurality of wires.   
     
     
         53 . The method of  claim 47 , further comprising:
 causing a pull mechanism configured to operatively and irreversibly engage at least one of the plurality of wires.   
     
     
         54 . The method of  claim 47 , wherein:
 the plurality of wires comprise a plurality of active electrodes, and at least one of the plurality of active electrodes comprises a coating on at least a portion of the at least one of the plurality of active electrodes, the coating configured to degrade when a threshold voltage is applied to the at least one of the plurality of active electrodes; and the method further comprises applying an electrosurgical power to the at least one of the plurality of active electrodes.   
     
     
         55 . The method of  claim 54 , further comprising applying a first electrosurgical power to a first electrode set and a second electrosurgical power to a second electrode set. 
     
     
         56 . The method of  claim 47 , further comprising dividing the tissue specimen into substantially symmetrical pieces.