WO2006097934A2 - Electrode pour pancreas - Google Patents

Electrode pour pancreas Download PDF

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Publication number
WO2006097934A2
WO2006097934A2 PCT/IL2006/000345 IL2006000345W WO2006097934A2 WO 2006097934 A2 WO2006097934 A2 WO 2006097934A2 IL 2006000345 W IL2006000345 W IL 2006000345W WO 2006097934 A2 WO2006097934 A2 WO 2006097934A2
Authority
WO
WIPO (PCT)
Prior art keywords
pancreas
electrode
thread
implant device
sleeve
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IL2006/000345
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English (en)
Other versions
WO2006097934A3 (fr
Inventor
Paul Richard Spehr
Tamir Levi
Benny Rousso
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Metacure Ltd
Original Assignee
Metacure Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from PCT/IL2005/000316 external-priority patent/WO2005087310A2/fr
Application filed by Metacure Ltd filed Critical Metacure Ltd
Priority to US11/886,154 priority Critical patent/US8244371B2/en
Publication of WO2006097934A2 publication Critical patent/WO2006097934A2/fr
Publication of WO2006097934A3 publication Critical patent/WO2006097934A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode

Definitions

  • the field of the invention relates to electrodes implanted in the body, for example in the pancreas.
  • Electrode for cardiac stimulation in the shape of a flexible helical coil.
  • the electrode is coated with a layer of titanium nitride or iridium oxide, which provides a low impedance and high capacitance coupling between the electrode and the heart tissue.
  • the coating with a microscopic structure that gives it a very high effective surface area, prevents irreversible loss of ions from the tissue and from the electrode.
  • a stiffening stylet may be inserted into the central lumen of the helix.
  • Multi-wire leads are used to independently supply power to several electrodes positioned at different locations in the heart.
  • An aspect of some embodiments of the invention relates to implanting an electrical stimulation device, comprising an electrode, in the pancreas or another organ, which device changes its properties after implantation in such a way that it will cause less irritation which could lead to fibrosis and/or other damage to the pancreas.
  • One or more of these measures may tend to decrease the stresses that the electrode exerts on the pancreatic tissue, and/or damage that the electrode may do to the pancreatic tissue, as a result of relative motion between the pancreas and the electrode lead.
  • the electrode is used in an organ other than the pancreas, for example in another organ comprising spongy tissue, such as the liver, or in an organ comprising muscular tissue, such as the stomach or elsewhere in the digestive track.
  • a very flexible electrode in the wall of the stomach for example, has the potential advantage over using a stiff electrode, that the flexible electrode may be less likely to penetrate through the wall.
  • the electrode is mechanically decoupled from the lead by using a lead shaped like a helical coil, which provides strain relief to the lead.
  • strain relief is provided to the lead by having the lead form a loop between a point where the lead is anchored, for example on the duodenum, and a point where the electrode is anchored on the pancreas.
  • the electrode is mechanically decoupled from the lead by attaching the electrode directly or indirectly to the outer membrane of the pancreas, at a point close to the point where the electrode is implanted in the pancreas, so that any forces exerted on the lead produce stresses at the point of attachment on the outer membrane of the pancreas, rather than on the interior. Stresses on the outer membrane are likely to be less damaging than stresses on the softer interior tissue of the pancreas.
  • the electrode has a thin coating with high dielectric constant, such as titanium nitride or iridium oxide, which provides a low impedance AC coupling between the electrode and the pancreatic tissue.
  • An aspect of some embodiments of the invention relates to an electrical stimulation device for implanting in the pancreas, comprising an electrode surrounded by a soft sleeve, which causes less irritation and/or damage to the pancreas than the electrode would cause if it were implanted directly in the pancreas without a sleeve.
  • an electrical stimulation device for implanting in the pancreas, comprising an electrode surrounded by a soft sleeve, which causes less irritation and/or damage to the pancreas than the electrode would cause if it were implanted directly in the pancreas without a sleeve.
  • there is relative motion between the electrode and the sleeve there is relative motion between the electrode and the sleeve.
  • an implant device comprising an electrode for electrical stimulation of the pancreas, the device being adapted to be inserted into the pancreas, and to change at least one of its properties after being inserted into the pancreas, so that it will cause less irritation to the pancreas than before changing said property.
  • the device comprises an inserting element adapted to assist the device in being inserted into the pancreas, and the device is adapted to become mechanically decoupled from the inserting element after the device is inserted into the pancreas.
  • the device is adapted to have the inserting element removed from the pancreas after the device is inserted into the pancreas.
  • the inserting element comprises a needle which is adapted to go through the pancreas and to pull the electrode into the pancreas.
  • the inserting element comprises a stiffening element.
  • the electrode is hollow with the stiffening element inside.
  • the stiffening element is a thread coupled to the device, and the device includes a trigger element which releases the thread from being coupled to the device.
  • the thread is coupled to the device by forming a loop which is pulled tight around the trigger element, and the trigger element releases the thread by being pulled out from the loop.
  • the device includes a plate, attached to the device, with a hole in it that an end of the thread is threaded through, and the thread is coupled to the device by having said end of the thread knotted, and the trigger element comprises a cutting implement which releases the thread by cutting off the knotted portion of the thread.
  • the electrode comprises a crimp in its hollow interior which couples the thread to the device, and an opening which makes a portion of the thread accessible from outside the electrode, and the trigger element comprises a cutting implement which releases the thread by cutting the thread through the opening.
  • the device includes a sleeve surrounding the electrode, adapted to be sufficiently well electrically coupled to the electrode and to the pancreas for electrical stimulation therapy of the pancreas by the electrode, when the device is inserted into the pancreas.
  • the sleeve is adapted to become better coupled mechanically to the pancreas after the device is inserted into the pancreas.
  • the sleeve comprises one or more tines adapted to become set in the pancreas.
  • the sleeve is adapted to expand inside pancreas, thereby increasing its mechanical coupling to the pancreas.
  • the sleeve is adapted to become glued to the pancreas after the device is inserted into the pancreas.
  • the sleeve is adapted to become mechanically less coupled from the electrode after the device is inserted into the pancreas.
  • the sleeve is sufficiently soft so that it causes less irritation to the pancreas than the electrode would cause if the electrode were directly in contact with the interior of the pancreas without a sleeve.
  • the device is adapted to become one or both of softer and more flexible after the device is inserted into the pancreas.
  • the device comprises a coating of a hard material adapted to dissolve inside the pancreas.
  • the hard material comprises a sugar.
  • the coating is on the outside of the electrode.
  • the electrode is hollow, and the coating is inside the electrode, thereby making the electrode stiffer.
  • the device also includes a lead for supplying current to the electrode, the lead being adapted to being anchored at an anchoring point inside the body, and being sufficiently long and flexible so that a one centimeter increase in distance between the anchoring point and the implanted electrode causes the lead to exert a force no greater than 0.01 newtons on the pancreas.
  • the device also includes tines coupled to the electrode, oriented so as to prevent the electrode from moving back out of the pancreas after the electrode is implanted in the pancreas.
  • the electrode is coated with a layer of material capable of reversibly holding at least 100 microcoulombs of ions.
  • an implant device comprising: a) an electrode for electrical stimulation of the pancreas; and b) a sleeve, through which the electrode is electrically coupled to the pancreas with a resistance less than 20 ohms.
  • the sleeve is one or both of sufficiently soft and sufficiently well-coupled mechanically to the pancreas so that the sleeve causes less irritation to the pancreas than the electrode would if the electrode were directly in contact with the interior of the pancreas without a sleeve.
  • a method of implanting an electrical stimulation device in the pancreas comprising: a) inserting the device into the pancreas; and b) changing at least one property of the device after inserting it into the pancreas, so that it causes less irritation to the pancreas.
  • Fig. 1 shows a schematic perspective view of an electrical stimulation device, according to an exemplary embodiment of the invention
  • Figs. 2A-2D show schematic perspective views illustrating a method of implanting the device of Fig. 1 in the pancreas, according to an exemplary embodiment of the invention
  • FIGS. 3, 4, and 5 show schematic perspective views of electrical stimulation devices according to other exemplary embodiments of the invention.
  • Figs. 6 and 7 show schematic cross-sectional views of the pancreas, with implanted electrodes according to two different exemplary embodiments of the invention
  • Fig. 8 shows a schematic perspective view of an electrical stimulation device implanted in the pancreas, according to another exemplary embodiment of the invention
  • Fig. 9 shows a schematic perspective view of an electrode, according to an exemplary embodiment of the invention.
  • Figs. 1OA and 1OB show schematic perspective views illustrating a method of providing strain relief for a lead supplying power to an electrode implanted in the pancreas, according to an exemplary embodiment of the invention
  • Fig. 11 shows a schematic perspective view illustrating a method of providing strain relief for a lead supplying power to an electrode implanted in the pancreas, according to another exemplary embodiment of the invention
  • Fig. 12 shows a schematic side cut-away view of part of an electrode, according to an exemplary embodiment of the invention.
  • Fig. 13 shows a schematic perspective view of an electrical stimulation device with two electrodes implanted in the pancreas, according to an exemplary embodiment of the invention.
  • Fig. 1 shows a schematic perspective view of an electrical stimulation device 100 suitable for implantation in the pancreas, according to an embodiment of the invention.
  • Device 100 may also be suitable for implanting in other organs, such as the liver, stomach, heart, and large intestine.
  • Device 100 has features which provide good electrical contact with the pancreas and allow the use of relatively high currents for electrical stimulation therapy over relatively long periods of time, while largely avoiding fibrosis or other damage caused by stresses exerted on the pancreas due to motion of the device relative to the pancreas.
  • a lead that is too stiff may not be suitable for use in the pancreas, since it may irritate the pancreas, causing necrosis, or causing fibrosis around the electrode which increases the electrical impedance of the tissue in the vicinity of the electrode.
  • Temporary cardiac pacing wire from A&E Medical Corp., catalog number 025-200 is flexible enough for use as an electrode in the pancreas, and uses tines to anchor it in place. The use of tines for holding an electrode in place is described by US patent 3,902,501, the disclosure of which is incorporated herein by reference.
  • the inventors have found that this wire is too thin to use as an electrode for electrical stimulation therapy in the pancreas, which requires up to 10 mA of current.
  • the wire deteriorates over time when it is used for this purpose, because the electrode surfaces (the exposed surfaces at the ends of the wire) do not reversibly hold enough tissue ions after the ions have interacted with the electrode, leading to irreversible loss of tissue ions (bubble formation) and electrode atoms (etching).
  • the electrode optionally can reversibly hold at least 100 microcoulombs of tissue ions which have interacted with the electrode. This allows a 10 mA current to persist for 10 milliseconds before reversing polarity, typical of the currents and durations used in electrical stimulation therapy of the pancreas.
  • Device 100 comprises an electrode 106, which is optionally in the form of a helical coil.
  • electrode 106 has great enough surface area so that it can provide sufficient current, for example at least 10 mA over periods of 10 milliseconds, without deteriorating. For example, there is voltage drop of less than 1 volt across the electrode tissue interface, when electrode 106 is providing a current of 10 mA.
  • there is voltage drop of less than 1 volt across the electrode tissue interface when electrode 106 is providing a current of 10 mA.
  • no corrosion was observed on an electrode with a titanium nitride coating when the voltage drop across the electrode-tissue interface was 1.1 volts, so keeping the voltage drop less than 1 volt for electrode 106 is expected to keep the electrode from deteriorating, with some safety margin. .
  • electrode 106 also makes it sufficiently flexible and stretchable that it will tend not to irritate the pancreas, since it can move, bend, and stretch, conforming to changes in the position, orientation and shape of the pancreas, without exerting much force on the surrounding pancreatic tissue.
  • electrode 106 can stretch in length by at least 20% without the material exceeding its infinite-cycle strain limit.
  • the electrode is made of grade 2, cold- worked titanium wire, 0.03 mm in diameter, wrapped into a helix with 4 wires in parallel, 0.50 mm in outer diameter, 0.44 mm in inner diameter, and 10 mm in length, with a pitch of 0.15 mm, so there are 66.7 turns.
  • the longitudinal spring constant for this design is 0.0026 N/mm, and the bending stiffness is 3.6xlO "5 N-mm/radian.
  • the resistance of each wire is 18 ohms, so the resistance of the 4 wires in parallel is 4.5 ohms.
  • any of the dimensions is greater or less than these numbers, for example by up to 25%, or by up to 50%, or more, and any other bio-compatible metal is used.
  • an electrical lead 102 which supplies electric power to electrode 106, is also in the form of a helical coil, giving it enough flexibility so that it can move relative to a connector or a power supply, accommodating motion of the pancreas for example, without exerting much force on electrode 106 and hence on the pancreas.
  • lead 102 is connected to electrode 106 by a tube 104, whose purpose will be explained below.
  • a thread 108 passes through electrode 106, at least initially when electrode 106 is implanted, and optionally thread 108 is anchored to device 100, so that thread 108 can be used to pull device 100 into position when it is implanted.
  • Thread 108 extends some distance beyond the end of electrode 106, and the distal end of thread 108 is attached to a surgical needle 110 which is used to implant electrode 106 in the pancreas.
  • needle 110 is simply a continuation of thread 108, made of the same material and sharpened at the end.
  • Such a configuration has the potential advantage that there need not be any increase in the diameter of the needle and thread where they are attached, due to an eye of the needle or a knot in the thread, for example.
  • the needle and thread having a uniform diameter over their length, they are more likely to go smoothly through a hole in the pancreas made by the needle when the electrode is implanted, without exerting undue stress on pancreatic tissue surrounding the opening.
  • thread 108 is anchored to device 100 in such a way that a release mechanism can be used to easily free thread 108 from being anchored.
  • thread 108 extends through the entire length of electrode 106 and tube 104, and optionally part way into electrode 102.
  • a loop 112 of thread 108 extends out from an opening 114 in the side of tube 104, and a trigger suture 116, passing through loop 112, prevents loop 112 from going back into tube 104 when someone pulls on thread 108, for example by pulling on needle 110, and prevents thread 108 from being pulled out of device 100 by pulling on thread 108 or needle 110.
  • Trigger suture 116 prevents thread 108 from being pulled out because, for example, a force pulling on thread 108 causes the surface of thread 108 to press against trigger suture 116, and/or against the edge of opening 114, with a force that increases with the force pulling on thread 108, and the resulting friction force on thread 108 is enough to prevent thread 108 from moving.
  • This mechanism is similar to the mechanism by which a thread can be anchored to another body by winding it or knotting it around the body.
  • tube 104, the parts of lead 102 and electrode 106 adjacent to tube 104, loop 112, and part of trigger suture 116 are embedded in a silicone plate 118, which may be sutured to the outer surface of the pancreas to hold device 100 in place after it has been implanted.
  • An end 120 of trigger suture 116 optionally extends outside silicone plate 118, however, so that trigger suture 116 may be removed, after device 100 has been implanted, allowing thread 108 to be removed.
  • Silicone plate 118 optionally has two holes 122 and 124, or a different number of holes, which may be used to suture plate 118 to the outer surface of the pancreas.
  • Lead 102 is optionally covered by a sheath 126, which optionally has a proximal end outside of the body, and a distal end near the point where lead 102 joins tube 104.
  • the distal end of sheath 126 is embedded in silicon plate 118.
  • Sheath 126 is shown as transparent in Fig. 1, so that lead 102 will be visible, but sheath 126 need not be transparent.
  • Sheath 126 also optionally covers lead 102 in any of the embodiments of the invention shown in the drawings, but for clarity sheath 126 is not shown in the other drawings.
  • Figs. 2A-2D schematically illustrate how device 100 is implanted in the pancreas, in an embodiment of the invention.
  • the procedure is performed with endoscopic or laparoscopic surgery.
  • surgical needle 110 attached to the end of thread 108, is inserted into pancreas 200.
  • Needle 110 is optionally curved, so that it can be inserted into a location 202 in the pancreas, and can emerge from another location 204, without distorting the shape of the pancreas, as shown in Fig. 2B.
  • needle 110 is straight, and the pancreas is manipulated by the surgeon to make a curved hole. Needle 110 is then pulled through the pancreas and out from location 204, so that thread 108 goes through the pancreas along the curved path followed by the needle, as shown in Fig. 2C.
  • Needle 110 is then pulled, pulling thread 108 with it, until a portion of electrode 106, which surrounds thread 108, passes into the hole made by the needle at location 202, as shown in Fig. 2D.
  • Thread 108 pulls electrode 106 with it when thread 108 is pulled through the hole, because trigger suture 116 locks loop 112 in place, and prevents from thread 108 from sliding relative to tube 104 and electrode 106.
  • electrode 106 Once electrode 106 is inside the hole at location 202, electrode 106 will generally remain in place and continue to make good electrical contact with the pancreas for electrical stimulation therapy.
  • needle 110 is a blunt tapered needle, which has the potential advantage, in the pancreas or other spongy tissue, that it only pushes aside tissue in order to make a hole, and does not produce a cut which may propagate.
  • needle 110 is a cutting tapered needle that cuts tissue in order to make a hole, which may be advantageous to use in muscular tissue, such as the digestive track.
  • needle 110 comprises a distal portion of thread 108 with a sharpened end
  • thread 108 is sufficiently stiff, or at least the distal portion of thread 108 is sufficiently stiff, so that the distal portion of thread 108 can act like a needle, making a curved hole through the pancreas.
  • the distal portion of thread 108 is curved, and stiff enough to hold its curved shape.
  • the distal portion of thread 108 is not curved, and need not be stiff enough to hold a curved shape, but the pancreas is manipulated by the surgeon so that a straight needle can make a curved hole.
  • the extra stiffness that thread 108 gives to electrode 106 is advantageous, since it helps electrode 106 to go through the hole made by the needle, without collapsing.
  • electrode 106 Once electrode 106 is in place inside the pancreas, however, it may be advantageous for it to be very flexible, so that it moves with the pancreas, and does not exert any stress on the pancreas, when the pancreas moves or bends relative to lead 102. Such stresses could induce fibrosis or other damage to the pancreas.
  • thread 108 is removed from electrode 106 once electrode 106 is in place inside the pancreas.
  • Removing thread 108 also reduces the amount of foreign material in contact with the pancreas, which may also reduce damage to the pancreas.
  • thread 108 is removed carefully, to avoid exerting forces that might damage the pancreas during the removal of the thread.
  • trigger suture 116 is pulled out of loop 112, by pulling on end 120 of trigger suture 116, which end is not embedded in silicone plate 118. This is done, for example, via an endoscope. Once trigger suture 116 is removed, thread 108 is pulled out of electrode 106 and tube 104, for example by pulling on needle 110.
  • Silicone plate 118 is optionally sutured to the surface of the pancreas, using holes 122 and 124. This is optionally done before thread 108 is removed from electrode 106. Alternatively, it is done after thread 108 is removed from electrode 106.
  • the sutures used to attach silicone plate 118 to the surface of the pancreas may not cause so much irritation, even if the sutures are as stiff as thread 108, since the surface of the pancreas comprises a membrane that is tougher than the soft interior of the pancreas.
  • a proximal end portion 302 of thread 108 emerges from opening 114, and ends in a knot 304 embedded in silicone plate 118.
  • Knot 304 being wider than the path made by thread 108 in the silicone, keeps the proximal end of thread 108 anchored in silicone plate 118, so thread 108 will not be pulled out of electrode 106 when the distal end of thread 108 is pulled, for example by pulling on needle 110.
  • portion 302 of thread 108 comprises a loop that extends outside silicone plate 118, as shown in Fig. 3.
  • thread 108 is removed from electrode 106, once electrode 106 is implanted in the pancreas, portion 302 is cut, so thread 108 will no longer be anchored in silicone plate 118. Pulling on the distal end of thread 108, for example by pulling on needle 110, then removes thread 108 from tube 104 and electrode 106.
  • thread 108, silicone plate 118, or both is coated with Teflon or another low friction material, so that thread 108 will slide more easily when it is pulled out.
  • proximal portion of thread 108 does not emerge from tube 104 at all, but thread 108 passes by opening 114.
  • Tube 104 is optionally crimped, at a crimp location 402 proximal to opening 114, and crimp 402 anchors thread 108 to tube 104, preventing thread 108 from being pulled out of tube 104 and electrode 106 if the distal end of thread 108 is pulled.
  • thread 108 is anchored to tube 104 in another way, for example the proximal end of thread 108 is knotted, and the knot is too big to pass through tube 104.
  • thread 108 is anchored to lead 102 or to sheath 126, or extends to the outside of the body and is anchored there.
  • a sharp instrument 404 is inserted through opening 114 into tube 104, and cuts thread 108.
  • Instrument 404 also optionally cuts through silicone plate 118 to reach opening 114, if there is a silicone plate, although for clarity the silicone plate is not shown in Fig. 4.
  • instrument 404 is imbedded in the silicone plate, for example pre-positioned with its sharp tip inserted into opening 114, or directed toward opening 114, and with the other end of instrument 404 extending outside the silicone plate, so that instrument 404 can be readily manipulated to cut thread 108. Once thread 108 has been cut, it is no longer anchored to tube 104, and may be removed from tube 104 and electrode 106 by pulling on needle 110, for example.
  • a proximal end portion 502 of thread 108 emerges from opening 114 in tube 104, and extends outside silicone plate 118.
  • a clip 504 is clipped to end portion 502 of thread 108.
  • Clip 504 prevents thread 108 from being pulled out of silicone plate 118, since clip 504 is too big to pass through the hole in silicone plate 118 made by thread 108. Hence thread 108 cannot be pulled out of electrode 106 by pulling on the distal end of thread 108, as long as clip 504 is in place.
  • Thread 108 is then removed from tube 104 and electrode 106 by pulling on needle 110, for example.
  • Fig. 6 shows a schematic side cross-sectional view of electrode 106 implanted in pancreas 200, according to an embodiment of the invention. Electrode 106 could have been implanted using any of the methods shown in Figs. 2-5, for example. There are one or more tines 602 on the sides of electrode 106, which point in a direction opposite to the direction that the electrode travels when it is being implanted. These tines, which act like barbs, do not prevent the forward motion of the electrode when it is being implanted, but prevent the electrode from moving backwards, out of the pancreas.
  • the electrode is pulled back slightly, for example by pulling on lead 102, to set the tines in the pancreatic tissue.
  • the distance that lead 102 has to be pulled back, in order to set the tines may be considerably longer than the length of the tines, depending on the axial compliance of lead 102 and electrode 106.
  • the tines shown in Fig. 6 are relatively short in length, comparable to the diameter of the electrode 106, optionally the tines are much longer. It is potentially advantageous for the tines to extend to the outside of the pancreas, where the sharp ends of the tines cannot damage the pancreas if the tines move relative to the pancreas.
  • the tines are made of ETFE, and they are 2 to 5 mm long, 0.1 to 0.3 mm thick, and 0.3 to 0.8 mm wide. With this design, the tines are flexible enough to be pulled against electrode 106 when the electrode is pulled into the pancreas, but rigid enough to keep the electrode from pulling out of the pancreas once the tines are set. Other compositions and dimensions for the tines are also possible.
  • electrode 106 has a longitudinal stiffness that increases toward the distal end. Then, if the tines are located only at the distal end, the additional longitudinal stiffness will tend to hold the entire electrode in place, while the proximal end will still be stretchable enough to allow sufficient relative motion between the pancreas and lead 102.
  • electrode 106 is provided with additional longitudinal stiffness, without increasing its bending stiffness, by one or more thin fibers which run longitudinally through electrode 106, at least along part of its length, and are bonded to electrode 106 at several locations along its length.
  • Fig. 7 schematically illustrates another method of keeping electrode 106 from irritating the pancreas, according to an embodiment of the invention. The method shown in Fig.
  • sleeve 702 may be used instead of, or in addition to, any of the methods shown in Figs. 2-5 which involve removing thread 108 from electrode 106 and making electrode 106 more flexible.
  • part or all of electrode 106 is surrounded by a sleeve 702.
  • sleeve 702 also extends over part or all of the portion of thread 108 that is inside the pancreas after electrode 106 is implanted.
  • sleeve 702 is well coupled to electrode 106 electrically, for example with a resistance of less than 20 ohms, or less than 5 ohms, but largely uncoupled from electrode 106 mechanically.
  • sleeve 702 comprises an electrically conductive material, and there is a gap between electrode 106 and sleeve 702 that is filled with a conducting electrolytic fluid, such as a body fluid or a saline solution.
  • a conducting electrolytic fluid such as a body fluid or a saline solution.
  • sleeve 702 is flexible enough so that it can conform to bending and other changes in shape of the pancreas, without exerting forces that could irritate or damage the pancreas.
  • sleeve 702 is well coupled mechanically to the surrounding pancreatic tissue, and may move together with the pancreas, if the pancreas moves relative to the lead 102. Electrode 106 is largely decoupled mechanically from sleeve 702, so if lead 102 moves relative to the pancreas, electrode 106 may also move relative to the pancreas, sliding inside sleeve 702. But because electrode 106 is not directly in contact with the pancreas mechanically, it does not irritate the pancreas when it moves relative to the pancreas.
  • sleeve 702 becomes well coupled to the pancreas by expanding radially after it is inserted, for example by setting sleeve 702 like a stent, or by absorption of fluid.
  • sleeve 702 has barbs which couple it to the pancreas once they are set.
  • sleeve 702 is attached to thread 108, and pulled into the pancreas by thread 108. In that case, thread 108 is optionally detached from sleeve 702 after sleeve 702 is in place, so that thread 108 may be removed.
  • sleeve 702 becomes well coupled to the pancreas by growth of tissue around it after it is inserted.
  • sleeve 702 becomes well coupled to the pancreas by an adhesive coating, which does not set until after it is inserted.
  • sleeve 702 does move relative to the pancreas, at least to some extent, when lead 102 moves relative to the pancreas, but sleeve 702 is optionally soft enough so that it does not irritate or damage the pancreas when it moves.
  • needle 110 goes into and out of the pancreas twice, or more times, pulling thread 108 behind it.
  • electrodes 802 and 804 there are two electrodes, 802 and 804, arranged along thread 108, and when the electrodes are pulled into place, they are each located at different locations inside the pancreas.
  • electrodes 802 and 804 are in fact only a single long electrode, which extends into the pancreas, out of the pancreas, and into the pancreas again, when it is implanted.
  • lead 102 comprises a single wire connected to both electrodes 802 and 804, applying the same voltage to both of them.
  • lead 102 comprises two separate wires in parallel, one wire connected to each electrode, and different voltages may be applied to the two electrodes.
  • the needle optionally goes into and out of the pancreas once for each electrode, or there is one long electrode which goes into the pancreas at three or more different locations.
  • Having multiple electrodes, or one long electrode, which go into and out of the pancreas more than once, has the potential advantage that the electrodes are not implanted very deep in the pancreas, and may be less likely to damage the pancreas.
  • Having a single electrode, which enters the pancreas only at one point has the potential advantage that it may be less likely to pull out of the pancreas accidentally.
  • thread 108 is attached only to the most distal electrode, which in turn pulls the other electrode or electrodes.
  • thread 108 may run through all the electrodes, and to be mechanically attached only to the most proximal electrode, or to be mechanically coupled to some extent, for example by friction, to all of the electrodes, in order to avoid exerting a tensile force on one or more of the electrodes when they are pulled by the thread, which could damage or break the electrodes.
  • electrode 106 is also stiffened by a soluble coating or filling.
  • Fig. 9 schematically shows electrode 106 with a soluble coating 902, made of sugar, for example, or polyethylene glycol 3350, according to an embodiment of the invention.
  • the coating is produced, for example, by dipping electrode 106 into a saturated sugar solution, then allowing the coating to dry, and optionally buffing the coating to remove any sharp edges.
  • Coating 902 gives electrode 106 extra stiffness, making it easier to pull electrode 106 into the hole in the pancreas made by the needle, or, in some embodiments of the invention, to push electrode 106 into the pancreas.
  • the coating may also provide lubrication to help pull or push electrode 106 into the pancreas, and for this purpose polyethylene glycol may be particularly suitable.
  • electrode 106 has a soluble coating to stiffen it, then thread 108 is attached only to the end of electrode 106, and is used to pull electrode 106 through the hole made by the needle, rather than thread 108 going through electrode 106 and contributing to the stiffness of electrode 106.
  • thread 108 does go through electrode 106, as in the embodiments shown in the other drawings, and optionally contributes to the stiffness of electrode 106, together with coating 902.
  • thread 108 goes through electrode 106, it is attached to electrode 106 by soluble coating 902, or by a soluble filling, or it is held in place by a soluble crimp, and thread 108 becomes detached from electrode 106 when the soluble material dissolves, for example after a well-defined time.
  • coating 902 makes electrode 106 stiff enough to push it into the pancreas, assisted for example by a sharpened tip, rather than pulling electrode 106 into the pancreas.
  • coating 902 dissolves, completely or partially, making electrode 106 more flexible, so that it will not cause fibrosis or other damage to the pancreas.
  • coating 902 comprises a drug, for example particles of a drug slowly released from a matrix, and the drug is released into the pancreas when the coating dissolves.
  • coating 902 dissolves relatively quickly, for example within 10 or 15 minutes after electrode 106 is implanted in the pancreas, so that electrode 106 may be tested during the surgical procedure to verify that it is in good electrical contact with the pancreas.
  • electrode 106 instead of or in addition to coating electrode 106 on the outside, it is filled on the inside, and/or between the turns of electrode 106 with a similar soluble material that stiffens the electrode, and dissolves after the electrode is implanted.
  • the optionally helical shape of lead 102 helps to decouple it mechanically from electrode 106, allowing the pancreas to move relative to lead 102 without electrode 106 exerting stress on the pancreas.
  • Figs. 1OA and 1OB This is illustrated schematically in Figs. 1OA and 1OB, according to an embodiment of the invention.
  • electrode 106 implanted in a hole in the pancreas, is attached to tube 104 and lead 102.
  • the other end of lead 102 (not shown in the drawing) is pulled. This can happen, for example, if lead 102 is anchored in the duodenum, and the duodenum moves relative to the pancreas, and lead 102 does not include a loop for strain relief.
  • the force on lead 102 causes the turns of the helix to unwind somewhat, accommodating the force, and transferring little or no force to electrode 106, or to tube 104 which is optionally attached to the pancreas (for example via silicone plate 118, shown in Fig. 1).
  • the helix of lead 102 has a pitch, for example, of between 82 and 85 degrees to the axis, when there is no force pulling on lead 102.
  • a design for lead 102 it is made of 3 strands in parallel of 0.076 mm MP35N shell with silver core wire, with outer diameter 0.54 mm.
  • the spring constant of lead 102 is comparable to, or as much as an order of magnitude smaller than, the spring constant of electrode 106, for example, depending on the length of lead 102.
  • tube 104 is attached to the pancreas, that may further reduce any force on electrode 106 caused by the motion of lead 102. Although forces on tube 104 may then be transferred to the pancreas, this may cause less damage to the pancreas than forces on electrode 106, if tube 104 is attached to the outer membrane of the pancreas, which is tougher than the interior of the pancreas that electrode 106 is in contact with. Additionally or alternatively, tube 104 may be attached to fat layers or other tissue that is adjacent to the pancreas, to prevent or reduce damage to the pancreas. Fig.
  • FIG. 11 schematically illustrates another method of relieving strain in lead 102 according to an embodiment of the invention, instead of or in addition to the strain relief provided by making lead 102 helical, described above.
  • lead 102 is attached to tube 104, which is embedded in silicone plate 118 which is sutured to pancreas 200, and electrode 106, implanted in the pancreas, is attached to the other end of tube 104.
  • Lead 102 is also optionally anchored in duodenum 1102, for example using a plate 1104 which is sutured to the duodenum.
  • lead 102 optionally forms a loop 1106 between the duodenum and the pancreas.
  • lead 102 is sufficiently long and flexible so that a one centimeter increase in distance between anchoring plate 1104 and electrode 106 causes the lead to exert a force no greater than 0.05 newtons on the pancreas, or no greater than 0.01 newtons, or no greater than 0.002 newtons.
  • the electrode is optionally coated with a thin layer of a material with high dielectric constant and high effective surface area.
  • a thin layer 1202 of such a material is shown schematically in Fig. 12, which is a cross-sectional view of electrode 106 according to an embodiment of the invention.
  • Layer 1202 may be, for example, iridium oxide, or titanium nitride.
  • the layer is vapor deposited on the electrode, while the electrode is held on a mandrel, in some embodiments of the invention. Such a vapor deposited layer tends to be thicker on the outer surface of the electrode than on the inner surface, which the vapor cannot reach as easily.
  • layer 1202 is thin and has a high dielectric constant and high effective surface area, then it will have a high capacitance, and hence a low impedance to the alternating or pulsed current that the electrode supplies to the pancreas. (In some medical therapies, only alternating or pulsed current is used, in some cases for safety reasons.)
  • the high effective surface area of layer 1202 due to its porous microscopic structure, allows layer 1202 to capture ions that are neutralized by the electrode, so they can be charged again and return to the tissue when the electrode changes polarity, rather than being irreversibly lost from the tissue, which can cause tissue damage.
  • the currents used in electrical stimulation therapy of the pancreas may be relatively lower in frequency and higher in amplitude than the currents typically applied in cardiac stimulation, for example, so having such a surface layer may be more important for an electrode used in the pancreas than for a cardiac electrode.
  • layer 1202 has a capacitance of several microfarads per square millimeter, or several tens of microfarads per square millimeter, many orders of magnitude greater than electrode 106 would have without layer 1202.
  • layer 1202 is between 1 and 10 micrometers thick, for example about 5 micrometers thick.
  • layer 1202 has a capacity to capture at least 100 microcoulombs of neutralized ions.
  • layer 1202 extends around the part of the surface of each wire which is on the outer surface of electrode 106, and if electrode 106 is 10 mm long and 0.5 mm in diameter, for example, then an average storage capacity of 4 microcoulombs per square millimeter would give a total of about 100 microcoulombs, which, as noted above, is a typical integrated current used for electrical stimulation therapy of the pancreas.
  • These are typical parameters for vapor deposited titanium nitride coatings used on electrodes inside the body. Any material and method known in the art for coating electrodes used inside the body is optionally used to produce layer 1202, and the parameters may differ from those described above, depending on the material and method used to form layer 1202.
  • Fig. 13 schematically shows an embodiment of the invention in which two electrodes 1302 and 1304 are implanted in the pancreas in parallel.
  • Each electrode optionally has the configuration of any of the electrodes described previously, and is implanted using any of the methods described previously.
  • Electrodes 1302 and 1304 optionally have their own leads 1306 and 1308, respectively, which split off from a single multi-wire lead 1310. Hence, the voltages applied to electrodes 1302 and 1304 optionally can be controlled independently.
  • leads 1306 and 1308 split off from a single wire in lead 1310, and always have the same voltage. It may be advantageous to make the split close to the pancreas, to minimize the area of the leads in contact with body tissue.

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  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Electrotherapy Devices (AREA)
  • External Artificial Organs (AREA)

Abstract

L'invention concerne un dispositif implanté comprenant une électrode de stimulation électrique du pancréas, le dispositif étant conçu pour être inséré dans le pancréas et pour changer au moins une de ses propriétés après son insertion dans le pancréas, de manière qu'il provoque moins d'irritation du pancréas avant qu'il ne change ladite propriété.
PCT/IL2006/000345 2005-03-18 2006-03-16 Electrode pour pancreas Ceased WO2006097934A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US11/886,154 US8244371B2 (en) 2005-03-18 2006-03-16 Pancreas lead

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
ILPCT/IL2005/000316 2005-03-18
PCT/IL2005/000316 WO2005087310A2 (fr) 2004-03-18 2005-03-18 Procedes et appareils gastro-intestinaux destines a etre utilises dans le traitement des troubles et le controle de glycemie
US71942105P 2005-09-22 2005-09-22
US71951705P 2005-09-22 2005-09-22
US60/719,421 2005-09-22
US60/719,517 2005-09-22

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WO2006097934A3 WO2006097934A3 (fr) 2007-06-07

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Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080051849A1 (en) * 1997-07-16 2008-02-28 Shlomo Ben-Haim Smooth muscle controller
EP2110154A1 (fr) * 2008-04-14 2009-10-21 BIOTRONIK CRM Patent AG Dispositif de réduction de l'occurrence de pannes pour implants allongés
WO2010005627A1 (fr) * 2008-06-20 2010-01-14 Cochlear Americas Réducteur de tension intégré à un ensemble électrodes implantable
US9233075B2 (en) 2005-08-09 2016-01-12 Metacure Limited Satiety
US9713723B2 (en) 1996-01-11 2017-07-25 Impulse Dynamics Nv Signal delivery through the right ventricular septum
US9931503B2 (en) 2003-03-10 2018-04-03 Impulse Dynamics Nv Protein activity modification
US10352948B2 (en) 2004-03-10 2019-07-16 Impulse Dynamics Nv Protein activity modification
US11439815B2 (en) 2003-03-10 2022-09-13 Impulse Dynamics Nv Protein activity modification
US11779768B2 (en) 2004-03-10 2023-10-10 Impulse Dynamics Nv Protein activity modification

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9289618B1 (en) 1996-01-08 2016-03-22 Impulse Dynamics Nv Electrical muscle controller
JP4175662B2 (ja) 1996-01-08 2008-11-05 インパルス ダイナミクス エヌ．ヴイ． 電気的筋肉制御装置
US9101765B2 (en) 1999-03-05 2015-08-11 Metacure Limited Non-immediate effects of therapy
US8934975B2 (en) 2010-02-01 2015-01-13 Metacure Limited Gastrointestinal electrical therapy

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5954761A (en) * 1997-03-25 1999-09-21 Intermedics Inc. Implantable endocardial lead assembly having a stent
US8019421B2 (en) * 1999-03-05 2011-09-13 Metacure Limited Blood glucose level control
DE10316177B4 (de) * 2003-04-10 2007-05-31 Cardiac Pacemakers, Inc., St. Paul Herzschrittmacher-Elektrodenanordnung
US7529592B2 (en) * 2003-04-11 2009-05-05 Cardiac Pacemakers, Inc. Subcutaneous electrode and lead with temporary pharmacological agents

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9713723B2 (en) 1996-01-11 2017-07-25 Impulse Dynamics Nv Signal delivery through the right ventricular septum
US20080051849A1 (en) * 1997-07-16 2008-02-28 Shlomo Ben-Haim Smooth muscle controller
US9931503B2 (en) 2003-03-10 2018-04-03 Impulse Dynamics Nv Protein activity modification
US11439815B2 (en) 2003-03-10 2022-09-13 Impulse Dynamics Nv Protein activity modification
US10352948B2 (en) 2004-03-10 2019-07-16 Impulse Dynamics Nv Protein activity modification
US11779768B2 (en) 2004-03-10 2023-10-10 Impulse Dynamics Nv Protein activity modification
US12268882B2 (en) 2004-12-09 2025-04-08 Impulse Dynamics Nv Beta blocker therapy with electrical administration
US9233075B2 (en) 2005-08-09 2016-01-12 Metacure Limited Satiety
EP2110154A1 (fr) * 2008-04-14 2009-10-21 BIOTRONIK CRM Patent AG Dispositif de réduction de l'occurrence de pannes pour implants allongés
US8923983B2 (en) 2008-04-14 2014-12-30 Biotronik Crm Patent Ag Device for reducing the fault susceptibility of elongated implants
WO2010005627A1 (fr) * 2008-06-20 2010-01-14 Cochlear Americas Réducteur de tension intégré à un ensemble électrodes implantable

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