FR2632075A1 - DEVICE FOR TRANSFERRING A RADIUS OR OPTICAL BEAM EMITTED BY A LASER ONTO AN OPTICAL FIBER, AND APPARATUS FOR GENERATING SHOCKWAVES FOR THE DESTRUCTION OF TARGETS, IN PARTICULAR TISSUES, LITHIASES OR CONCRETIONS, PROVIDED WITH SUCH A DEVICE - Google Patents

Abstract

The invention relates to a device for transfering an optical ray or beam on an optical fiber. This device comprises means (100) for focusing the optical ray or beam (12) to a focal point (102) situated on the optical axis, and means (106) for positioning the free end (42a) of the fibre (42) receiving the optical ray or beam, substantially at the focal point, characterised in that the positioning means (106) include means (108) for displacing the extremity (42a) of the optical fiber (42), said means (108) receiving the optical ray or beam (12) in a plan substantially perpendicular to the optical axis.

Description

Device for transferring an optical ray or beam emitted by a laser onto an optical fiber, and device for generating shock waves for destroying targets, in particular tissues, lithiasis or concretions, provided with such a device.

 The invention relates essentially to a device for transferring an optical ray or beam emitted by a laser onto an optical fiber and an apparatus for generating shock waves for destroying targets, in particular tissues, lithiasis or concretions, provided of such a device.

 We know that in lithotripsy, various devices are now available for the destruction of tissues, lithiasis or concretions, intended to be removed from inside the human body.

 Is known for example from US Patent RIEBER 2,559,227, a high frequency shock wave generator comprising a truncated ellipsoidal reflector (30) generating shock waves at the first focus of the ellipsoid which are focused at the second focus of the ellipsoid - where is the target to destroy. This device is used in the medical field, in particular to destroy tissue, and can also be used to destroy lithiasis or concretions.

We also know the destruction of lithiasis or concretion by shock waves produced by ultrasound, (see
DE-31 19 295 = US-A-4 526 168).

Finally, devices are also known for generating shock waves for destroying targets, in particular lithiasis or concretions, from laser radiation. For example, document WO-A-86/06269 describes the use of laser for the destruction of lithiasis or concretions as well as other materials to be removed from the human body. The laser radiation is transmitted to the concretion to be destroyed via an optical fiber. The laser used delivers pulses having a wavelength, energy, intensity and duration of pulses capable of causing the destruction of the concretions, without the energy delivered being sufficient to cause damage to other tissues in the neighborhood. This document also corresponds to
FR-A-2 580 922. It underlines therein that the laser is preferably of the pulsed dye type, the pulses of which have durations of at least 10 nanometers, (preferably between 0.05 and 5 microseconds), and the energy of the pulse does not exceed 0.200 joules. The fiber is flexible and has a core diameter which does not exceed 1000 micrometers and which is preferably between 60 and 600 micrometers, and more precisely 200 micrometers. The laser pulses are applied in a short burst, preferably having a frequency higher than 10 Hertz, and the remaining fragments are crushed by single pulses.

 The wavelength used is preferably between 350 and 550 nanometers in the case of urinary calculi. Particularly preferred wavelengths are 251.504 to 450 nanometers (see page 2, lines 1 to 20 of FR-A-2 580 922).

 A device (16, 18) for transferring the radiation (20) emitted by the laser (22) comprises means for focusing the ray or optical beam (20) at a focal point, by means of a lens (18 ) focusing, constituting means. focusing, and a device (16) for mounting the optical fiber (12) so that it receives the optical radiation. The fiber (12) naturally passes through a uteroscope (14) to be brought close to the fiber to be destroyed, such as a lithiasis or concretion (10) (see page 3, lines 6 to 28).

 One can also cite as an earlier document Lasers in Surgery and Medicine ", vol 5, N02, 1985, page 160, abstract 82 and page 178, abstract 133, and page 189, abstract 163.

Another document is also made up of the journal
Photonics Spectra from September 1986 titled "The Dyes
Laser's Surgical Sucesses "written by Ronald L. CARROLL, or even the journal Lasers and Applications", from April 1987, pages 69-70.

 Lasers have also been used to treat angioplasties (see EP-A-225 913 from international application WO 86/0642).

 It has been observed that with the known devices the transfer of the optical radiation emitted by the laser to the optical fiber was carried out in an imprecise manner, which resulted in a reduction in the energy emitted and therefore in a loss of destruction destruction efficiency. target.

 The present invention therefore aims to solve the new technical problem consisting in the supply of a solution making it possible to achieve reproducible, reliable positioning of the optical fibers in order to ensure the transfer of a radiation or optical beam on optical fibers, in the best conditions.

 Another object of the present invention is to solve the new technical problem consisting in providing a solution making it possible to carry out a transfer of an optical radiation or beam on optical fibers, making it possible to use standard optical fibers.

 The present invention has again the aim of solving the new technical problem consisting in the supply of a solution making it possible to transfer an optical radiation or beam on optical fibers in a very precise manner by a very precise positioning of the extremity of the optical fiber at a point of transfer of the radiation or optical beam, called the focal point.

 The object of the present invention is to solve the new technical problem consisting in providing a solution making it possible to transfer an optical radiation or beam onto an optical fiber allowing movement in the plane perpendicular to the optical axis so as to bring the end of the optical fiber at a specific point of transfer, within wide limits of initial positioning of the end of the optical fiber.

 All these technical problems are solved simultaneously by the present invention, in a satisfactory manner, usable on an industrial scale.

 Thus, the present invention, according to a first aspect, provides a device for transferring an optical radiation or beam traversing a path defining an optical axis, in particular coming from a laser, on an optical fiber, so as to convey this radiation or optical beam at a place of use, comprising means for focusing the radiation or optical beam at a focal point situated on the optical axis, and means for positioning the free end of the fiber intended to receive the radiation or optical beam, substantially at the focal point, characterized in that the positioning means comprise means for moving the end of the optical fiber, intended to receive the radiation or optical beam in a plane substantially perpendicular to the optical axis.

 According to an advantageous embodiment, the aforementioned displacement means comprise a set of two crossed plates, preferably of the micrometric type, moving respectively in two perpendicular directions.

 According to another advantageous embodiment of the invention, the aforementioned positioning means comprise a support member for the optical fiber coming to be introduced into a reception member for the support member, which is integral in displacement with the aforementioned displacement means .

 According to a particularly advantageous embodiment of the invention, the aforementioned support member comprises a substantially cylindrical sleeve provided with a central through hole having an axial narrowing of appropriate diameter to allow the optical fiber to pass substantially without play, this narrowing being preferably substantially close to one end of the sleeve intended to be located on the receiving side of the radiation or optical beam.

 According to another advantageous embodiment of the device according to the invention, a wedge element is temporarily arranged in the central orifice of the above-mentioned substantially cylindrical sleeve to serve as a stop for the insertion of the end of the optical fiber, so as to achieve a precise positioning of the end of the optical fiber in the sleeve. Then, the optical fiber is secured to the support member by any suitable means, for example by bonding with any suitable bonding means.

According to another particular characteristic of the device according to the invention, the aforementioned focusing means comprise a focusing lens
According to another preferred characteristic of the device according to the invention, the aforementioned focusing means are mounted on a system of optical objectives comprising said focusing lens, making it possible to translate the position of the focal point on the optical axis. Preferably, this objective system comprises an external control member for translational movement, preferably without rotation, of an internal member supporting the aforementioned focusing means.

 According to a second aspect, the present invention also relates to an apparatus for generating shock waves for destroying targets, in particular tissues, lithiasis or concretions, comprising a device for generating an optical beam or radiation, preferably of the type laser, characterized in that it comprises a device for transferring an optical radiation or beam as defined above.

 According to a particular embodiment of this device for generating shock waves, it is characterized in that the device for generating the aforementioned radiation or optical beam comprises at least one dye laser, preferably of the pulsed type.

 According to a particular embodiment of this shock wave generation apparatus, it is characterized in that it comprises a fixed reservoir of dye connected in closed circuit with the dye laser.

 According to another particular characteristic of the shock wave generation apparatus according to the invention, it comprises means for withdrawing the dye for withdrawing the dye from the closed circuit in a drain tank, preferably mobile, and means for reintroducing the dye into the closed drained circuit, preferably also using a mobile tank introduced in place of the mobile drain tank.

 According to another particular embodiment of this shock wave generation apparatus according to the invention, it is characterized in that it comprises an internal loop for reprocessing the dye, advantageously via a filter, in particular with carbon active.

 According to another particular embodiment of the shock wave generation apparatus according to the invention, it is characterized in that it comprises an external module for reprocessing the dye.

 According to yet another particularly advantageous embodiment of the shock wave generation apparatus according to the invention, it is characterized in that it comprises means for controlling the emission power of the laser by output at the detected intensity of the radiation or optical beam emitted by the laser.

 It is thus understood that one obtains all the determining technical advantages previously mentioned, by solving the technical problems previously stated.

 In particular, "standard" optical fibers can be used, which constitutes a considerable advantage compared to the prior device.

 Likewise, a reproducible, reliable and extremely precise positioning of the optical fibers can be obtained, on the one hand thanks to the possibility of bringing the optical fiber to the optical axis by a displacement in a plane perpendicular to the optical axis, as well as the possibility of moving the focal point by translation on the optical axis, in particular by the use of a lens system as previously defined.

 Other objects, characteristics and advantages of the invention will become clear in the light of the explanatory description which follows, given with reference to the appended drawings representing a currently preferred embodiment of a shock wave generation apparatus for the destruction of targets, in particular tissues, lithiases or concretions, according to the invention, incorporating a device for transferring an optical radiation or beam on an optical fiber.

Figure 2 schematically shows the closed circuit of the dye of the dye laser shown in Figure 1; and
FIG. 3 represents in axial section in a plane passing through the optical axis the device for transferring the radiation or optical beam coming here from the laser, on the optical fiber.

 With reference, first of all to FIG. 1, there is shown an apparatus for generating shock waves, represented by the general reference number 1.

 The apparatus includes a device (10) for generating an optical beam or optical radiation (12).

 Preferably, according to the invention, this optical radiation is emitted by a laser which is advantageously of the dye type, preferably emitting pulses. Such pulsed dye lasers are known, in particular from the documents cited in the introductory part of the description, and are therefore commercially available.

 These dye lasers usually include a dye cell (14) filled with dye, circulating in a closed circuit (18) shown in detail in Figure 2 and leading to an inlet (1.6) and an outlet (17) of dye by report to the cell (14). This laser also comprises, conventionally, a flash enclosure (20), emitting flashes by means of a rectilinear lamp (22) with flash. A cooling circuit (24) can be provided to cool the rectilinear lamp (22). For other characteristics of the laser, reference may be made to the above-mentioned prior documents.

 It is preferred to use a pulsed dye type laser giving relatively long pulse durations, of a duration of at least 10 nanometers, preferably between 0.05 and 5 microseconds. The wavelength of the pulse is preferably between 350 and 550 nanometers, and the energy of the pulse does not exceed 0.200 joules and preferably is between 0.005 and 0.200 joules.

 The laser pulses are applied in short burst, preferably having a frequency greater than 10 Hertz.

 We prefer to use a dye working at a wavelength from 450 nanometers (blue) to 504 nanometers (green).

The preferred dye according to the invention is coumarin.

 Upstream of the optical beam generation device (12), there is a total reflection cavity mirror (26) for the purpose of transmitting all of the optical radiation or of the optical beam (12) at the output of the device (10) .

 At the output of the device (10), here a laser, there can be provided a removable shutter (28) making it possible to interrupt the optical radiation at will, as well as a second so-called cavity mirror (30) with partial reflection, for example around 30 a.

35%, as is also known in lasers. Then, it is possible to interpose at least temporarily a separating device (32), making it possible to separate part of the radiation or optical beam (12) into a fraction (12a) which is then used to calculate the intensity of the radiation or optical beam (12 ) emitted by the laser (10), as will be explained later.

 This separating device can be constituted by a simple block of glass having a refractive index n = 1.5 arranged obliquely, for example at 450, with respect to the optical axis which is here confused with the representation of optical radiation (12) .

 Then, downstream, there is shown the transfer device according to the invention referenced (40) of the fraction (12b) of optical radiation (12) not separated by the separation device (32) on an optical fiber (42) whose the opposite part (42b) can advantageously be incorporated into a uteroscope, so as to be disposed near the target to be destroyed referenced (44), for example constituted by a tissue, a lithiasis or a concretion, for example a renal lithiasis.

 According to the invention, according to another advantageous characteristic, provision is made to permanently mark the optical axis by the use of a laser preferably of the HeNe type, emitting continuously, referenced (50), commercially available, emitting optical radiation (52) which can be appropriately returned by the presence of deflection mirrors (54, 56) to then pass through the dye cell (14). This radiation makes it possible to carry out the adjustments of the transfer device (40), as explained below.

Referring to Figure 2, there is shown the closed circuit (18) of the dye laser. This closed circuit (18) comprises a line (18a) leading to the outlet (17) of the dye cell (14) of the dye laser (10), as well as to a dye reservoir (60), fixed, internal to the device and therefore integrated therein. Then, a pipe (18b) connects the fixed reservoir (60) to the inlet (16) of the dye cell (14) by means of recirculation means (62) such as a pump, possibly via '' a refrigeration device (64), for example with coils, and also optionally by means of a purification device (66) comprising for example a filter
(68) arranged vertically, eliminating impurities as well as air bubbles possibly contained in the circuit. It can be for example a filter (68) of melamine type, so as to introduce a dye in the cell to dye (14) of extreme purity, not containing air bubbles (or microbubbles).

The porosity of this filter is therefore intended to also eliminate microbubbles.

 According to the invention, means are provided for withdrawing dye (70) for withdrawing the dye from the closed circuit (18) in a drain tank (72), preferably mobile. Withdrawal can be carried out at any point on the closed circuit (18). Here, two possibilities of withdrawal have been shown, on the one hand between the fixed tank (60) and the recirculation pump (62) by a bypass (70a), as well as at the base of the filtration device (66) by a bypass (70b) on which a non-return valve or valve (74) is provided. It is also possible to provide a withdrawal pump (76). Means (78) are also provided for reintroducing dye into the drained closed circuit (18). These reintroduction means are preferably provided to allow reintroduction from a mobile tank inserted in place of the mobile emptying tank (72). In this case, the last reintroduction means (78) are integrated and the reintroduction is facilitated for example by the use of pumping means (80).

 It is thus understood that according to the invention, it is possible to completely drain the dye circuit in an extremely simple manner, by the use of a dye auxiliary tank, mobile, external to the device, which can be connected by means of simple connection externally to the apparatus, to effect its emptying. The same can be done when filling the dye circuit with a virgin dye.

 According to the invention, an external dye reprocessing module can be provided.

 One can also provide an internal branch (90a, 90b) for reprocessing the dye mounted as a bypass to the closed circuit (18), as shown in FIG. 2, making it possible to reprocess the dye via a filter (92), preferably using activated carbon with the presence of a valve (94), it is thus possible to significantly increase the life of the dye.

 Referring to Figure 3, there is shown in detail a device for transferring the radiation or optical beam (12) on the optical fiber (42).

 This transfer device (40) comprises means (100) for focusing in radiation or optical beam (12), (here 12b), at a focal point (102) located on the optical axis (104) which is advantageously defined materially. by the radiation (52) of the auxiliary laser (50).

 This transfer device also comprises means (106) for positioning the free end (42a) of the optical fiber (42), intended to receive the radiation or optical beam (12b) substantially at the focal point (102).

 These positioning means (106) comprise means (108) for moving the end (42a) of the optical fiber (42) in a plane substantially perpendicular to the optical axis.

 Advantageously, these displacement means (108) comprise a set of two crossed plates, preferably of the micrometric type, respectively referenced (110, 112), mounted one on the other substantially perpendicular to one another. .

This set of two crossed plates (110, 112) is itself mounted movable relative to a fixed support frame (114) integral with the frame of the shock wave generating apparatus, each of these two plates (110, 112 ) includes an axial hole
(116, 118), for the passage of the optical beam (12b) and naturally of the optical axis (104) materialized by the radiation
(52). For example, the plate (112) mounted on the frame (114) is mounted movable horizontally, perpendicular to the optical axis (104) while the plate (110) is mounted on the plate
(112) so as to be vertically movable, perpendicular to the optical axis (104) and the direction of horizontal movement of the plate (112), in order to allow displacement in the whole plane perpendicular to the optical axis
(104), and this in an extremely precise manner thanks to micrometric screws such as the screw (120). On the second deck
(110) is integral with a member (122) for receiving a support member (124) proper of the optical fiber (42). The receiving member (122) therefore comprises a housing (126), for example substantially cylindrical, for receiving the support member (124) comprising a flared disc-shaped front part (128) serving for the precise positioning of the support member (124) in the receiving member (122). The support member (124) is provided at its front part with a substantially cylindrical sleeve (130) integral with the cylindrical disc, provided with a central through hole (132) having an axial narrowing (134) of suitable diameter to allow passage the optical fiber (42), substantially free of play. Preferably, this narrowing (134) is close to the free end (130a) of the sleeve (130), intended to be located on the receiving side of the optical radiation, as is this is clearly understandable from the consideration of FIG. 3. The central hole (132) is coaxial with a hole (136), central, passing through the support member (124), to allow free passage to the optical fiber (42). At the rear part (124a) of the optical fiber outlet (42) from the support member (124), there is provided a nozzle (140) comprising an axial orifice (142) passing through it being inserted into a corresponding housing ( 144) constituting a widening of the through orifice (136).

 The optical fiber (42) can be secured in the endpiece (140) by any securing means, such as by bonding, once the optical fiber is correctly positioned in the support member (124).

 For correct positioning of the optical fiber (42), which is preferably a standard type optical fiber, for example with a diameter of 100 microns, the optical fiber is introduced into the support member (124) while a wedge in the form of a disc of predetermined thickness has been introduced into the central part (132b) of the orifice (132) opening at the end (130a) of the sleeve (130), so that the optical fiber (42) comes in abutment against this wedge exactly at the point intended to coincide with the focal point (102). Once the optical fiber (42) thus wedged, the optical fiber (42) is secured to the end piece (140), then the shim is removed.

 Next, the support member (124) is placed in the receiving member (122), then the end (42a) of the optical fiber (42) is brought exactly to the focal point (102).

 According to the invention, the positioning of the focal point (102) can be adjusted, thanks to the fact that the focusing means (100), advantageously comprising a focusing lens (101), are mounted on an objective system (160) comprising the lens (101), making it possible to translate the position of the focal point (102) on the optical axis (104>.

 Preferably, this objective system comprises an external member (162), for translational displacement control, preferably without rotation, of an internal member (164) supporting the focusing means (100). To do this, the external member (160) comprises a thread (166) meshing with a corresponding thread (168) of the internal member (164).

Naturally, the external organ (162) and the internal organ
(164) comprise through orifices (170, 172) for the free passage of the optical radiation (12b) and also of the optical axis (104).

 It is preferred that when the external member (162) is rotated, it causes only a translation of the internal member (164) without causing it to rotate.

To do this, there is provided in the internal member (164) an annular slot (176), of predetermined length to fix the length of the displacement of the focal point (102). In this annular slot (176) move two fingers (178, 180) integral with the external member (162) as well as with an annular piece (182) having a radial shoulder (182a) which is inserted inside a part (184) mounted on the frame (114), while also being fixed, like the frame (114). Thus, during the rotation of the external member (162), this rotation is guided by the part
(182) and thanks to the cooperating threads (166, 168), an advancement by translation of the external member (164) is obtained so as to translate the focal point (102) on the optical axis (104).

 It is thus understood that one can position in an extremely precise, reproducible and reliable manner, the end (42a) of the optical fiber (42) exactly at the focal point (102), by playing on the one hand on the positioning of the point focal (102) and on the supply from the end (42a) of the optical fiber (42) to this focal point (102) using crossed plates (110, 112) moving in a plane perpendicular to the optical axis (104), that is to say in an X axis and along a Y axis.

 In addition, during operation, it is extremely easy to change the optical fiber and to carry out a new adjustment.

 Furthermore, according to the invention, a self-draining system is obtained by providing the dye circuit, as shown in FIG. 2.

 Furthermore, the transfer device as shown in FIG. 3 is an integral part of the invention, as well as the dye circuit shown in FIG. 2.

 It is the same for the circuit of FIG. 1.

 It will be observed that according to other advantageous characteristics of the invention, there is interposed on the path of the part (12a) separated from the beam (12) means (200) for controlling the laser emission power at the output to the intensity (204) detected of the radiation or optical beam emitted by the laser. These control means (200) comprise for example a photodiode (202), which provides a peak (204) of intensity measured during a pulse of the optical radiation emitted by the laser (10). The surface of this peak (204) is integrated and constitutes a measure of the intensity of the radiation (12) emitted by the laser device (10). We compare this measured value with a reference value, and when this measured value of intensity is lower than the reference value, a conventional servo device makes it possible to increase the power supply of the flash tube (22) to increase the power of the laser (10). It is thus possible to emit an intensity of optical radiation which is substantially constant over time.

 In other words, the device (200) for measuring the intensity of the light radiation makes it possible to slave the power of the laser in order to provide optical radiation of a substantially constant intensity over time.

 This therefore constitutes another particularly preferred characteristic of the invention, forming an integral part of the invention. Also, the use of an auxiliary laser (50) to materialize the optical axis (42) for the permanent observation of the target and the adjustments is an integral part of the invention.

Claims (17)

1. Device for transferring an optical radiation or beam (12) traversing a path defining an optical axis, in particular coming from a laser (10), on an optical fiber (42), so as to convey this radiation or beam optical (42) at a place of use (14), comprising means (100) for focusing the radiation or optical beam (12) at a focal point (102) -located on the optical axis, and means (106 ) for positioning the free end (42a) of the fiber (42) intended to receive the radiation or optical beam, substantially at the focal point, characterized in that the positioning means (106) comprise displacement means (108) from the end (42a) of the optical fiber (42), intended to receive the radiation or optical beam (12) in a plane substantially perpendicular to the optical axis. 2. Device according to claim 1, characterized in that the above-mentioned displacement means (108) comprise a set of two crossed plates (110, 112), preferably of micrometric type, moving respectively in two perpendicular directions. 3. Device according to claim 1 or 2, characterized in that the aforementioned positioning means (106) comprise a member (114) supporting the optical fiber coming to be introduced into a receiving member (122) of the support member (124), which is integral in displacement with the aforementioned displacement means (110, 112). 4. Device according to claim 3, characterized in that the support member (124) mentioned above comprises a sleeve (130) substantially cylindrical provided with a central through hole (132) having an axial narrowing (134) of suitable diameter to leave pass the optical fiber substantially without play, this narrowing (134) preferably being substantially close to the end (130a) of the sleeve (130) intended to be located on the receiving side of the radiation or optical beam (12). 5. Device according to claim 4, characterized in that it is provisionally arranged a wedge element in the central orifice (132) of the substantially cylindrical sleeve (130) above to serve as a stop for the insertion of the end ( 42a) of the optical fiber (42), so as to achieve a precise positioning of the end (42a) of the optical fiber (42) in the sleeve (130), preferably at the support member (124) by any suitable means, for example by bonding with any suitable bonding means. 6. Device according to claim 1 to 5, characterized in that the aforementioned focusing means (100) comprise a focusing lens (101). 7. Device according to claim 1 or 6, characterized in that the aforementioned focusing means (100) are mounted on an optical objective system (160) comprising said focusing lens (101), making it possible to translate the position of the point focal (102) on the optical axis. 8. Device according to claim 7, characterized in that this objective system (110) comprises an external member (162) for movement control by translation, preferably without rotation, of an internal member (164) supporting the means focusing (100) above. 9. Apparatus for generating shock waves for destroying targets, in particular tissues, lithiasis or concretions, comprising a device (10) for generating an optical beam or radiation, preferably of the laser type, characterized in that 'It comprises a device for transferring a radiation or optical beam according to any one of Claims 1 to 8. 10. Apparatus for generating shock waves according to claim 9, characterized in that the device (10) for generating the aforementioned radiation or optical beam comprises at least one dye laser, preferably of the pulsed type. 11. Apparatus for generating shock waves according to claim 10, characterized in that it comprises a fixed reservoir (60) of dye connected in closed circuit (18) with the dye laser (10). 12. Apparatus for generating shock waves according to claim 11, characterized in that it comprises means (70) for withdrawing the dye to withdraw the dye from the closed circuit (18) in a drain tank (72) , preferably mobile, and means (78) for reintroducing the dye into the closed circuit (18) drained, preferably also using a mobile tank introduced in place of the mobile tank (72) for emptying. 13. Apparatus for generating shock waves according to claim 11 or 12, characterized in that it comprises an internal loop (90a, 90b) for reprocessing the dye, advantageously via a filter (92), in particular at charcoal. 14. Apparatus for generating shock waves according to claim 11, 12 or 13, characterized in that it comprises an external module for reprocessing the dye.  15. Apparatus for generating shock waves according to one of claims 9 to 14, characterized in that it comprises means (200, 202) for controlling the emission power of the laser (lû), in output at the detected intensity (204) of the radiation or optical beam emitted by the laser (10). 16. Apparatus according to any one of claims 9 to 15, characterized in that the optical fibers (42) are "standard" optical fibers. 17. Apparatus according to one of claims 9 to 16, characterized in that it comprises an auxiliary laser (50) for materializing the optical axis (42) for the permanent observation of the target (44) and the adjustments.