WO1992020288A1 - Device for making surgical incisions with combined thermal and ionizing laser beams - Google Patents
Device for making surgical incisions with combined thermal and ionizing laser beams Download PDFInfo
- Publication number
- WO1992020288A1 WO1992020288A1 PCT/CA1992/000214 CA9200214W WO9220288A1 WO 1992020288 A1 WO1992020288 A1 WO 1992020288A1 CA 9200214 W CA9200214 W CA 9200214W WO 9220288 A1 WO9220288 A1 WO 9220288A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- laser
- laser beam
- thermal
- incision
- energy
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
-
- H—ELECTRICITY
- H01—ELECTRIC ELEMENTS
- H01S—DEVICES USING THE PROCESS OF LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION [LASER] TO AMPLIFY OR GENERATE LIGHT; DEVICES USING STIMULATED EMISSION OF ELECTROMAGNETIC RADIATION IN WAVE RANGES OTHER THAN OPTICAL
- H01S3/00—Lasers, i.e. devices using stimulated emission of electromagnetic radiation in the infrared, visible or ultraviolet wave range
- H01S3/23—Arrangements of two or more lasers not provided for in groups H01S3/02 - H01S3/22, e.g. tandem arrangements of separate active media
- H01S3/2383—Parallel arrangements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B18/26—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor for producing a shock wave, e.g. laser lithotripsy
Definitions
- This invention concerns a device for cutting into material, in particular human and animal tissue or the like with a focused light beam.
- laser beams are at present used to incise material.
- laser beams are used in the manufacture of components for electronics, in particular in the manufacture of integrated circuits. In medicine and particularly in ophthalmology they are used for heat coagulating the retina and disrupting a membrane such as a cataract.
- the energy converted at the target point as heat also has an effect in the adjacent areas whereby a desirable heat coagulation of the incision walls is achieved, but undesirable material changes can occur outside the incision.
- lasers with very high power laser beams e.g. solid-state lasers
- rapid incisions can be made, however, the incision walls can be very unstable, particularly in soft materials, since the incision walls have not undergone any stabilization by heat.
- fluid such as plant substances, human or animal tissue, fluid such as blood etc. - i ⁇
- the thermal mode laser converts its energy to heat with random molecular movement.
- the narrow spaces are provided by the energy conversion of the photodisruptive laser (ionizing laser) .
- the ensuing heat explosion disrupts tissue and supplies the force for the work that removes the tissue debris.
- the object of the invention is to provide a method for cutting with a sharply focused laser beam, with which fluid containing material can be cut with high efficiency.
- a method of making incisions in material containing fluid comprises a laser beam from a laser source consisting of a photodisruptive first laser and a thermal second laser, directing the first and second laser beams confocally and simultaneously to form an incision in the material such that the rise of temperature in the area of the material, provided by the thermal laser, causes a 4% rise of pressure within the incision being formed.
- the thermal laser beam is relatively continuous and the photodisruptive laser beam is of a pulsating nature superimposed on the continuous exposure of the thermal laser beam.
- a method for making incisions in human or animal tissue comprises a laser beam from a photodisruptive laser and another laser beam from a thermal (ion) laser whereby the two laser beams travel coaxially or on different pathways to engage on a common focal point which is the target.
- the photodisruptive pulses are superimposed in time over the continuous wave thermal laser or a pulsed thermal laser.
- the simultaneous application of different types of lasers is advantageous.
- the energy of the laser beam of the thermal laser is converted in the tissue into heat.
- the laser beam of the thermal laser provides the heat coagulation in the incision by means of which the incision walls are stabilized and the entry of further fluid into the incision is prevented.
- the energy of the thermal laser beam is deposited with increased power in a small space, the tissue is disrupted and coagulated.
- the thermal laser is an argon laser while the ionizing laser or photodisruptive laser is a Nd:YAG laser.
- the Nd:YAG laser provides one millijoule into a short period of time of ten nanoseconds thus delivering 100 kilowatts that convert to destructive pressure stresses of 100 kilopascals. This action is confined in a small space providing high pressure, thereby causing tissue to become disrupted.
- the argon laser delivers with 1 watt, only 1 pascal of pressure after relatively lengthy exposure. Force is continuously added throughout the exposure time to gain momentum requiring a gradient from solid to gas, from hot to cold, so that work is accomplished in accordance with Carnot's principle, in order to provide expulsion of debris.
- NdrYAG laser energy of one mJ that is delivered during 10 nsec m provides an example for realizing the creation of pressure:
- Argon laser energy of one Watt x 0.1 second exposure time provides:
- a trough is created by the dual laser.
- the high wattage of the Nd:YAG laser creates a disruptive pressure.
- the argon laser provided high temperature which is trapped in a small space thus creating pressure.
- the open end Toward the open end, however, it becomes kinetic energy that moves matter along the gradient from solid to gas. This directs the excretion of debris as though it were a projectile within the barrel of a gun.
- the dual laser that is the Nd:YAG laser component deepens the ablation trough in the tissue while the argon laser component provides expulsion energy for the debris to clear the relatively wide lumen in the presence of a gradient.
- the appropriately proportioned combination of destructive pressure and kinetic energy provides the surgeon with a broadly useful cost-effective and generally available laser device.
- the dual laser cuts deep sutures to abolish postoperative astigmatism. It achieves paracentesis for hyphema or pus which has been drained through a self-sterilizing opening. Large iridotomies in any colored iris are achieved with few applications of the dual laser despite foggy media.
- the heavily pigmented tissue of asian and black irides and their firm mesenchymal tissue presents no challenge for the dual laser. Its efficiency is always greatly aided by a cavitation bubble that provides a gradient to execute work.
- Figure 1 is a schematic arrangement of the device according to the invention of a thermal laser and a photodisruptive laser.
- the device is arranged in a housing 1 and consists of a gas laser 2 and a solid-state laser 3, of which the laser beams 4,5 are reflected via a mirror arrangement 6 onto a common optical axis 7.
- the laser beam 4 of the gas laser 2 is deflected via a first mirror 6a to the optical axis 7 and reflected via a mirror 6b, arranged on the optical axis 7, in the optical axis toward the outlet 8.
- the laser beam 5 of the solid state laser 3 is likewise deflected via a first mirror 6c to the optical axis 7 and diverted via a mirror on the optical axis 6d toward the outlet 8.
- the beam of the solid state laser penetrates the mirror 6b which lies on the optical axis and which for this purpose is transparently silvered.
- the mirrors 6a to 6d are accordingly mounted in an adjustable way.
- the output beam 9 of the device according to the invention can thus be the laser beam 4 of the gas laser 2 as well as the laser beam 5 of the solid state laser 3.
- the gas laser 2 is an argon laser which essentially consists of a somewhat rectangular toroidal tube filled with argon. This toroid can be arranged in three sections.
- the tube section 13 to which the energy is supplied has a considerably bigger diameter than the actual laser tube 10.
- the ion current is influenced magnetically in such a way that the ions are forced into a trajectory in the narrower tube and do not strike the walls. In this way the thermal load of the tube wall of the laser tube remains low.
- a selection prism 15 is arranged with which the wave length of the laser beam 4, emerging through the output mirror 16, can be
- the coil 12 serves as high-frequency buncher which is fed by an amplifier 17. In this case, the high-frequency energy is then only transmitted to the HF buncher 12 if the controller 20 gives an appropriate signal to its control wire 21.
- the gas laser 2 With the gas laser 2, to a large extent a continuous output beam 4 can be obtained which can have an output power of 2 W to 100 W.
- the duration of the laser beam 4 is in the range of 0.1 sec.
- the solid state laser 3 consists of a solid 18 in which neodymium is provided in an yttrium-aluminium oxide crystal lattice.
- a YAG laser consists of an internally silvered ellipsoid 19, in one axis of which the solid is arranged.
- a flash lamp 22 is provided which is supplied with energy by a switching arrangement 23. The switching arrangement then always turns on the flash lamp 22 when the controller 20 gives an appropriate signal to the control wires 24.
- the flash discharge With the flash discharge, light is pumped into the cylindrical solid 18, opposite the axial front ends of which there is in each case a mirror 25, 26.
- the mirror 26 is coated semi-transparently and lets through the laser beam 5 as soon as the beam reflected between the mirrors 25 and 26 has an energy level which makes possible the passage through the mirror 26.
- the solid state laser output energies from 1 to 100 Ws can be generated. Since a solid essentially can only be used as pulse laser of very short pulse duration in the range of 1 ms, the resulting outputs are between 1 and 100 kW.
- the laser beam 5 of the solid state laser has a pulse duration of 10 nanoseconds.
- the device according to the invention is put into operation via the controller 20.
- the control lights 30 and 31 respectively indicate the readiness of the lasers 2 and 3.
- the desired pulse duration of the laser beam can be set via the controllers 32 and 33.
- the controller 34 is used in this case to set the two lasers 2 and 3 simultaneously in operation.
- a pause can be inserted between two successive sequences. Failure of one r the other laser is indicated by control lights 36 and 37.
- the employment of different laser types is advantageous in particular in incisions in fluid containing tissues such as animal or human tissue samples.
- the advantageous application of the device according to the invention in eye surgery should be emphasized.
- the device With the device, it is possible to carry out complicated incisions with minimal bleeding which can greatly hinder the repeated cutting by means of the solid state laser.
- the obtained strength of the incision walls is advantageous which is already achieved through a slight heat coagulation without thereby stimulating a healing process.
- the implosion effect after the explosion, observed when the Nd:YAG laser is utilized at least twice, can be used advantageously.
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- Physics & Mathematics (AREA)
- Health & Medical Sciences (AREA)
- Electromagnetism (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Optics & Photonics (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Otolaryngology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Plasma & Fusion (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Laser Surgery Devices (AREA)
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP4509129A JPH06507328A (en) | 1991-05-23 | 1992-05-22 | A device that performs surgical incisions using a combination of thermal laser beam and ionizing laser beam |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA 2043072 CA2043072A1 (en) | 1991-05-23 | 1991-05-23 | Device for making surgical incisions with combined thermal and ionizing laser beams |
CA2,043,072 | 1991-05-23 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1992020288A1 true WO1992020288A1 (en) | 1992-11-26 |
Family
ID=4147642
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/CA1992/000214 WO1992020288A1 (en) | 1991-05-23 | 1992-05-22 | Device for making surgical incisions with combined thermal and ionizing laser beams |
Country Status (5)
Country | Link |
---|---|
EP (1) | EP0586414A1 (en) |
JP (1) | JPH06507328A (en) |
AU (1) | AU1697792A (en) |
CA (1) | CA2043072A1 (en) |
WO (1) | WO1992020288A1 (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5769840A (en) * | 1988-04-19 | 1998-06-23 | Schirmer; Kurt E. | Microsurgery using alternating disruptive and thermal laser beam pulses |
EP1384446A1 (en) * | 2002-07-27 | 2004-01-28 | Lux Medico ApS | Hand-held laser for skin treatment |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0297360A1 (en) * | 1987-07-01 | 1989-01-04 | AlliedSignal Inc. | Dual-wavelength laser scalpel |
DE3904287A1 (en) * | 1988-02-15 | 1989-09-07 | Kurt Dr Schirmer | Arrangement for cutting with laser beams |
EP0364801A1 (en) * | 1988-10-06 | 1990-04-25 | Lasag Ag | Device for the surgical treatment of a target within an eye |
EP0365754A1 (en) * | 1988-10-28 | 1990-05-02 | International Business Machines Corporation | Enhandement of ultraviolet laser ablation and etching of organic solids |
-
1991
- 1991-05-23 CA CA 2043072 patent/CA2043072A1/en not_active Abandoned
-
1992
- 1992-05-22 EP EP92909809A patent/EP0586414A1/en not_active Withdrawn
- 1992-05-22 WO PCT/CA1992/000214 patent/WO1992020288A1/en not_active Application Discontinuation
- 1992-05-22 AU AU16977/92A patent/AU1697792A/en not_active Abandoned
- 1992-05-22 JP JP4509129A patent/JPH06507328A/en active Pending
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0297360A1 (en) * | 1987-07-01 | 1989-01-04 | AlliedSignal Inc. | Dual-wavelength laser scalpel |
DE3904287A1 (en) * | 1988-02-15 | 1989-09-07 | Kurt Dr Schirmer | Arrangement for cutting with laser beams |
EP0364801A1 (en) * | 1988-10-06 | 1990-04-25 | Lasag Ag | Device for the surgical treatment of a target within an eye |
EP0365754A1 (en) * | 1988-10-28 | 1990-05-02 | International Business Machines Corporation | Enhandement of ultraviolet laser ablation and etching of organic solids |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5769840A (en) * | 1988-04-19 | 1998-06-23 | Schirmer; Kurt E. | Microsurgery using alternating disruptive and thermal laser beam pulses |
EP1384446A1 (en) * | 2002-07-27 | 2004-01-28 | Lux Medico ApS | Hand-held laser for skin treatment |
WO2004010884A1 (en) * | 2002-07-27 | 2004-02-05 | Lux Medico Aps | Hand-held apparatus for skin treatment with intensive light |
Also Published As
Publication number | Publication date |
---|---|
CA2043072A1 (en) | 1992-11-24 |
JPH06507328A (en) | 1994-08-25 |
AU1697792A (en) | 1992-12-30 |
EP0586414A1 (en) | 1994-03-16 |
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