DE102018112457A1 - Medical handpiece for transmitting energy to biological tissue via an optical fiber - Google Patents

Abstract

The invention relates to a medical handpiece (1) for transmitting energy to biological tissue via an optical fiber (2) comprising a primary fiber (3) and a secondary fiber (4) coupled via a coupling site (5), the handpiece (1) a guide for the optical fiber (2), a coupling element (6), which encloses the coupling point (5), and a suction channel (20). The object of the invention, a cost-manufacturable medical handpiece (1) for transmission of energy in biological tissue via an optical fiber (2), which allows easy replacement of individual components and avoids heating of the handpiece (1) is achieved in that the suction channel (20) the coupling element (6) at the coupling point ( 5) surrounds.

Description

The invention relates to a medical handpiece for transmitting energy in biological tissue via an optical fiber, which is formed according to the preamble of claim 1.

In laser surgery on human or animal tissue, energy is transferred via optical fibers into the tissue to be treated. Especially in eye surgery, especially in cataract surgery, the protection of the surrounding, healthy tissue is required.

From the prior art, such as from the European patent EP 0 497 908 B1 , Devices for laser surgery are known in which a target plate is excited by the radiation energy of a laser to oscillations. The shock waves generated thereby serve to fracture the surrounding tissue, which is subsequently removed via a suction passage. For a gentle and controlled removal of the tissue to be treated, the direct introduction of the radiation energy via an optical fiber into the tissue to be treated without the use of a target plate is advantageous.

From the American patent US 6 120 498 is a handpiece for laser surgical applications for directly introducing the radiation energy into the tissue to be treated, in which the optical fiber is guided within an integrated suction channel. By means of suction, tissue is guided in front of the optical fiber for efficient and safe removal and the ablated tissue is suctioned off.

It has been found that the optical fibers which are used in the known laser surgical devices and are usually made of sapphire or quartz, in particular the region of the fiber tip, already after a few inserts have high wear, whereby the entire optical fiber are replaced got to. To solve this problem proposes the European patent EP 1 024 760 B1 a demountable handpiece having a first optical fiber over which the laser radiation from the laser source to the handpiece is guided, and a second optical fiber, which is referred to as a light guide, which is releasably coupled to the first optical fiber and for radiation the laser energy is used in the tissue to be treated. The light guide can be removed from the handpiece and replaced with an unused light guide. There are numerous adjustment surfaces for aligning the optical axis of the optical fiber with respect to a suction cannula, which serves for the extraction of crushed tissue, as well as with respect to the first optical fiber. The handpiece can be removed after an operation, cleaned and then reused. However, such handpieces, due to the narrow spaces and the numerous Justierflächen, often difficult, hygienic requirements, clean.

It has been shown that a warming of the handpiece must be prevented in order to ensure its functionality and stability, especially during an intervention, as well as the handling for the surgeon. In particular, at the coupling point of two fibers occur while thermal effects due to coupling losses and cladding modes, which can lead to heating and thereby affect the functionality and the handling of the handpiece. Coupling losses arise in particular due to a longitudinal or transverse offset or an angular offset of the fiber ends and due to surface reflections at these. Furthermore, thermal power dissipation may occur due to insertion losses, particularly reflection in the tissue to be treated and reincorporation into the fiber, as well as intrinsic losses in the fiber. The energy transfer via the fiber can also be done with a thermal power loss due to cladding modes. Optical fibers have a core-sheath structure wherein the light-guiding core is surrounded by a sheath having a lower refractive index than the core. Sheath modes occur in particular by the coupling of two fibers or by the reflection in the tissue to be treated and reincorporation into the fiber, the sheath modes lead in particular at the coupling point of two fibers to thermal losses and thus to a heating of the handpiece.

The object of the invention is to provide a cost-manufacturable medical handpiece for transmitting energy in biological tissue via an optical fiber, which allows easy replacement of individual components and avoids heating of the handpiece.

The invention solves the problem by a medical handpiece with the features of claim 1. Advantageous embodiments and advantageous developments of the invention are specified in the dependent claims.

The medical handpiece according to the invention for transmitting energy into biological tissue via an optical fiber, which has a primary fiber and a secondary fiber, which are optically coupled to one another via a coupling point, comprises a guide for the optical fiber, a coupling element which connects the coupling point of the primary and the Secondary fiber surrounds, and a suction channel through which the treated and ablated tissue can be aspirated. The medical handpiece according to the invention is characterized in that the suction channel surrounds the coupling element at the coupling point. The primary fiber serves to guide the emanating from a laser source radiation energy to the medical handpiece. Via the coupling point, the radiation energy is transferred from the primary fiber to the secondary fiber, the secondary fiber serving to radiate the radiation energy into the tissue to be treated. Through the suction of the aspirated liquid (which may be in particular an emulsion consisting of body water or an externally supplied rinsing liquid, such as a balanced salt solution, and ablated tissue material) via the suction creates a continuous suction in the suction. The aspirated liquid is used to cool the optical fiber. In addition, the aspirated liquid prevents the generation of cladding modes and resulting heat due to the coupling of cladding modes from the secondary fiber. In order to prevent heating of the handpiece, at least part of the optical fiber, in particular the secondary fiber, as well as at least a part of the coupling element, in particular the region of the coupling element at the coupling point, is arranged inside the suction channel.
In an advantageous embodiment of the medical handpiece, the coupling element is designed as a coupling sleeve. The primary fiber and the secondary fiber can be easily introduced into the coupling sleeve and optically and largely lossless coupled at the coupling point optically. This avoids high coupling losses and thereby a heating of the handpiece.

Preferably, the coupling element made of metal or a metal alloy, in particular made of brass, an aluminum alloy, medical grade stainless steel or a nickel silver alloy to absorb and dissipate the heat occurring at the coupling point can.

The thermal conductivity of the coupling element is preferably greater than 10 W / (m * K), preferably greater than 50 W / (m * K), particularly preferably greater than 80 W / (m * K). Due to a high thermal conductivity, the heat occurring at the coupling element, in particular at the coupling point, can be dissipated quickly, for example due to coupling losses or jacket modes, and excessive heating of the medical handpiece can be prevented.

In an advantageous embodiment of the medical handpiece, the secondary fiber is watertightly connected to the coupling element in order to protect the coupling point from moisture, which may affect the coupling between the primary fiber and the secondary fiber. Preferably, the secondary fiber for this purpose with the coupling element, in particular with the coupling sleeve glued. It is important to ensure that the proximal end of the secondary fiber, where the coupling with the distal end of the primary fiber takes place, is free of adhesives to prevent coupling losses. Under a proximal end are the ends facing away from the tissue to be treated and at a distal end to understand the tissue to be treated facing ends of an element of the handpiece.

The medical handpiece in a preferred embodiment comprises a housing, a guide tube forming the optical fiber guide disposed within the housing, and a tip unit connected to the housing. Appropriately, the guide tube can be removed from the housing, so that the guide tube or the housing can be cleaned and replaced separately. The housing, the guide tube and the tip unit are preferably made of plastic, in particular a plastic for injection molding applications, for example, due to its high thermal stability, good chemical resistance and strength, of polyoxymethylene or of another plastic that is suitable for medical applications, such as eg Polyethylene or polypropylene. In the event that a reuse of the component is to be excluded, at least one of the components should not be autoclavable and make the handpiece unusable in the case of a preparation, in particular by the melting of one of the components.

In an advantageous embodiment, the coupling element is connected in a watertight manner to the guide tube and engages at least partially in the guide tube in order to prevent moisture from penetrating and impairing the coupling of the primary fiber to the secondary fiber. In particular, the coupling element can be glued to the guide tube. Preferably, the coupling point is within the tip unit, which is designed so that the coupling element is completely surrounded by the suction channel in the region of the coupling point. As a result, in particular the heat occurring at the coupling point can be dissipated via the aspirated liquid surrounding the coupling element and thus heating of the medical handpiece can be prevented.

In a preferred embodiment, the suction channel extends through the tip unit and at least partially through the housing. The tip unit preferably comprises a hollow needle, wherein the suction channel through the Hollow needle extends, in particular to the distal end of the tip unit, which is guided to the tissue to be treated. The optical fiber, especially the secondary fiber, is guided through the hollow needle. In particular, the secondary fiber is arranged centrally within the hollow needle and completely surrounded by the suction channel. As a result, in particular cladding modes that occur due to reflections in the tissue to be treated and reincorporation into the fiber or the resulting thermal losses can be absorbed and removed.

In a production-technically advantageous embodiment, the guide tube has on its circumference a recess for the formation of the suction channel. The suction channel is thus formed by the guide tube, or by the recess of the guide tube and the housing. As a result, no additional holes or channels within the medical handpiece for the formation of the suction channel are necessary. By thus allowing removal of the guide tube from the housing a simple cleaning of the system is possible.

Preferably, the medical handpiece on a limiting element which engages in the recess of the guide tube. By the limiting element in particular a rotation of the guide tube within the housing, and thus also a rotation of the suction channel formed by the recess of the guide tube, prevented.

In an advantageous embodiment of the medical handpiece, the housing has an opening connected to the suction channel, to which a suction adapter and / or a suction hose can be connected. Via the suction adapter or the suction hose, the suction channel can be connected to a pump for generating a continuous suction. In an advantageous embodiment of the suction adapter or the suction hose engages in a groove of the guide tube, wherein the groove is preferably the recess forming the suction channel. The limiting element, which is intended to prevent a twisting of the guide tube within the housing, can thus be formed by the suction adapter or the suction hose, which promotes a simple and cost-effective production of the handpiece.

In a preferred embodiment, the suction adapter comprises a Luer lock connection. The use of the Luer system ensures high compatibility of the connection of a medical suction tube with the medical handpiece.

In a preferred embodiment, the guide tube has a receptacle for a clamping piece, which serves for easy and releasable attachment of the primary fiber within the guide tube. The clamping piece expediently has a bore through which the primary fiber can be guided. By introducing the clamping piece in the receptacle of the guide tube, the primary fiber is fixed within the clamping piece and thus also within the guide tube. Preferably, the receptacle of the guide tube has a thread over which the clamping piece can be screwed in and out. However, it is also possible to fix the clamping piece via a clamping connection or a locking connection on the guide tube.

Preferably, the optical fiber is displaceable along a longitudinal axis of the medical handpiece. By the displaceability, the distance of the distal end of the optical fiber relative to the distal end of the medical handpiece or the distal end of the tip unit, which faces the tissue to be treated, can be changed. This is particularly advantageous in order to adjust the position of the optical fiber relative to the housing according to the particular circumstances, in particular due to different textures of the tissue to be treated.

In an advantageous embodiment, the guide tube comprises a thread which engages in a complementary thread of the tip unit. The detachable attachment of the guide tube within the medical handpiece takes place via the tip unit connected to the housing or via the intermeshing threads. Preferably, the tip unit is rotatably supported within the housing, wherein rotating the tip unit shifts the guide tube along the longitudinal axis of the medical handpiece relative to the housing. In particular, by rotating the tip unit connected to the housing, the optical fiber connected to the guide tube is moved along the longitudinal axis of the housing. Thereby, the position of the optical fiber can be adjusted relative to the housing via a rotation of the tip unit. The housing of the medical handpiece is not twisted and remains in its orientation, whereby no disturbing influence, for example by entanglement of possible connections, in particular a suction hose attached to the medical handpiece takes place. This also allows intraoperative adjustment of the position of the distal end of the optical fiber relative to the housing.

Preferably, the primary fiber of sapphire and the secondary fiber of quartz to a efficient and cost-effective design of the optical fiber of the handpiece, in particular due to the high wear and thereby required replacement of the secondary fiber to provide. However, other materials, in particular a germanium (IV) oxide fiber, a ZBLAN fiber or a hollow-core PCF (photonic crystal fiber) or a mirror-coated capillary are also conceivable.

In an advantageous embodiment, the medical handpiece, in particular the housing and / or the tip unit, at least partially transparent or translucent. This configuration allows the user to recognize and react to occurring blisters as well as deposits or blockages within the suction channel already during the surgical procedure, for example by changing the treatment parameters, e.g. suction vacuum, or by cleaning or replacing the medical handpiece.

The invention further relates to a medical treatment system for laser surgery, in particular for eye surgery, comprising a medical handpiece according to the invention, wherein the handpiece with a laser source, in particular an erbium YAG laser source, and a pump, preferably via a suction with the Suction channel is connected, is connected. The wavelength of the laser radiation used is preferably in the range between 1.5 μm and 4 μm, preferably between 2.5 μm and 3.5 μm, in particular 2.94 μm. In this area, water, which is an essential component of the tissue to be treated, especially in ophthalmic surgery, has an absorption maximum. Since the laser radiation is absorbed in this wavelength range within a transmission distance of a few micrometers, a targeted introduction of energy into the tissue to be treated without the use of a target is possible. The laser radiation is preferably pulsed, with preferably a frequency of 1 Hz to 10 kHz, in particular 100-300 Hz, particularly preferably 200 Hz and pulse lengths in the millisecond range are used.

For the use of the medical handpiece according to the invention in the laser and in particular in eye surgery, the primary fiber, which can be releasably introduced into the medical handpiece, optically coupled to the secondary fiber at the coupling point via the coupling element. The medical handpiece makes it possible to deliver energy targeted, controlled and largely lossless in the tissue to be treated, the emitted energy can be read by a control unit and controlled. In this case, the optical fiber is cooled in particular in the region of the coupling point by the suctioned into the suction liquid, whereby a conditional by coupling losses heating of the handpiece can be minimized.

These and other advantages and features of the invention will become apparent from the following embodiment.

• 1 eine Darstellung eines erfindungsgemäßen medizinischen Handstücks;
• 2 Explosionsdarstellung des medizinischen Handstücks aus 1;
• 3 Ausschnitt des vorderen Bereichs des medizinischen Handstücks aus 1 ohne Primärfaser;
• 4 Ausschnitt des vorderen Bereichs des medizinischen Handstücks aus 1 mit eingebrachter Primärfaser;
• 5 das Führungsrohr des medizinischen Handstücks aus 1;
• 6 Ausschnitt des vorderen Bereichs des medizinischen Handstücks aus 1, wobei das Führungsrohr in einer ersten, hinteren Position relativ zum medizinischen Handstück angeordnet ist;
• 7 Ausschnitt des vorderen Bereichs des medizinischen Handstücks aus 1, wobei das Führungsrohr in einer zweiten, mittleren Position relativ zum medizinischen Handstück angeordnet ist;
• 8 Ausschnitt des vorderen Bereichs des medizinischen Handstücks aus 1, wobei das Führungsrohr in einer dritten, vorderen Position relativ zum medizinischen Handstück angeordnet ist.

The invention will be described below in detail by means of an embodiment with reference to the accompanying drawings. These show:

• 1 an illustration of a medical handpiece according to the invention;
• 2 Exploded view of the medical handpiece 1 ;
• 3 Section of the front area of the medical handpiece 1 without primary fiber;
• 4 Section of the front area of the medical handpiece 1 with primary fiber inserted;
• 5 the guide tube of the medical handpiece 1 ;
• 6 Section of the front area of the medical handpiece 1 wherein the guide tube is disposed in a first, rearward position relative to the medical handpiece;
• 7 Section of the front area of the medical handpiece 1 wherein the guide tube is disposed in a second, intermediate position relative to the medical handpiece;
• 8th Section of the front area of the medical handpiece 1 wherein the guide tube is disposed in a third, forward position relative to the medical handpiece.

An embodiment of the medical handpiece according to the invention 1 for transmitting energy into biological tissue via an optical fiber 2 is in 1 and in the corresponding exploded view of the 2 shown. The optical fiber 2 consists of a primary fiber 3 and a secondary fiber 4 , The medical handpiece 1 includes a housing 7 , one at the distal end of the housing 7 attached top unit 9 as well as inside the case 7 arranged guide tube 15 ,

The top unit 9 a hollow needle 10 includes, is, as in particular from 3 and 4 appears in the case 7 brought in. About a circumferentially formed locking element 11 the top unit 9 that is in a corresponding recess 8th of the housing 7 engages, is in the housing 7 introduced tip unit 9 with the housing 7 locked. A stop element 12 as well as in the recess 8th latched latching element 11 prevent a movement of the tip unit 9 relative to the housing 7 along the longitudinal axis L of the medical handpiece 1 , The sealing of the tip unit 9 with the housing 7 via sealing elements 13 , especially over at the tip unit 9 arranged O-rings. The top unit 9 can in this case, in particular via the stop element 12 , relative to the housing 7 around the longitudinal axis L be rotated.

The guide tube 15 which is used to guide the optical fiber 2 serves and in the housing 7 is arranged, forms a structural unit with a coupling element 6 and the secondary fiber 4 , The coupling element 6 , which has the shape of a coupling sleeve, is in the distal end of the guide tube 15 incorporated and waterproof glued to this. In the front, distal region of the coupling element 6 is the secondary fiber 4 introduced and connected via a peripherally applied adhesive waterproof with this. The secondary fiber 4 protrudes beyond the distal end of the coupling element 6 out, causing the secondary fiber 4 , in the medical handpiece 1 inserted guide tube 15 at least partially within the hollow needle 10 the top unit 9 is arranged.

About the proximal end of the housing 7 becomes the guide tube 15 introduced, which has a thread at its distal end, which in the illustrated embodiment as an external thread 16 is formed, and up to the tip unit 9 led, as in 3 is shown. The external thread 16 of the guide tube 15 engages in a complementary thread of the tip unit 9 , here as internal thread 14 is trained, one. This can be done by turning the tip unit 9 , the guide tube 15 at the top unit 9 be fixed.

The primary fiber 3 is how the 1 shows, by a proximal clamping piece 19 , the guide tube 15 and the associated coupling element 6 guided. As in particular from the 4 As can be seen, the distal end is the primary fiber 3 to a coupling point 5 passing through the proximal end of the secondary fiber 4 is defined, guided. The position of the primary fiber 3 within the medical handpiece 1 is by fixing the clamping piece 19 in a recording 17 of the guide tube 15 , set. The primary fiber 3 is in the clamping piece 19 pinched. The recording 17 in this case preferably has a thread or a clamping or latching connection, via which the clamping piece 19 detachable with the guide tube 15 connected is.

The medical handpiece comprises the removal of the tissue to be removed 1 a suction channel 20 , The suction channel 20 is there, especially the 3 and the 4 show, in the distal region of the handpiece through the space between the hollow needle 10 and the secondary fiber disposed therein 4 formed, wherein the suction channel 20 the secondary fiber 4 completely surrounds here. In the proximal direction, the suction channel extends 20 through the inside of the top unit 9 , a top channel 21 that is between the guide tube 15 and the top unit 9 is formed, and by a guide channel 22 that is between the outer circumference of the guide tube 15 and the inner circumference of the housing 7 runs. The guide channel 22 is there, as in 5 is shown, via a recess 18 of the guide tube 15 formed on its outer periphery. Over a side opening 23 of the housing 7 will, as in 1 is shown, a suction adapter 24 in the medical handpiece 1 introduced, with the suction channel 20 fluidically connected. The suction adapter 24 contains in particular a Luer-lock connection, which can be connected via a suction hose, not shown here with a pump. To twist the guide tube 15 inside the case 7 To prevent and thus the positioning of the suction channel 20 at the opening 23 to ensure the suction adapter acts 24 as a delimiter 25 into the the guide channel 22 forming recess 18 intervenes.

The cooling of the medical handpiece 1 , in particular of the coupling element 6 in the area of the coupling point 5 the primary fiber 3 and the secondary fiber 4 , takes place via the aspirated fluid which passes through the suction channel 20 is sucked off. About the coupling sleeve, which is the coupling element 6 forms and consists of a metal or a metal alloy with a high thermal conductivity, the heat, in particular at the coupling point 5 arises, recorded and on the coupling element 6 at least at the coupling point 5 surrounding aspirated liquid are discharged.

By turning the tip unit 9 , in particular via the stop element 12 , the guide tube can 15 that over the external thread 16 with the internal thread 14 the top unit 9 is connected, along the longitudinal axis L relative to the housing 7 be positioned. The 6 to 8th show by way of example a rear, a middle and a front positioning of the guide tube 15 and the associated optical fiber 2 relative to the housing 7 , Turning the top unit 9 thus allows the positioning of the optical fiber 2 , in particular also an intraoperative adjustment of the distal end of the optical fiber 2 with respect to the distal end of the medical handpiece 1 that is the tip of the hollow needle 10 ,

After use of the medical handpiece 1 can individual components, in particular the housing 7 with the top unit attached 9 and / or the guide tube 15 with the associated secondary fiber 4 , cleaned or replaced. This is the top unit 9 turned until the external thread 16 of the guide tube 15 no longer in the internal thread 14 the top unit 9 intervenes. Subsequently, the guide tube 15 , including the over the clamping piece 19 introduced primary fiber 3 , from the case 7 be removed. For cleaning or disposal of the housing 7 is still one with the suction adapter 24 Remove connected suction hose. For cleaning or disposal of the guide tube 15 is that in the recording 17 of the guide tube 15 inserted clamping piece 19 and together with the imported primary fiber 3 refer to.

Due to the modular design of the medical handpiece 1 in the case of wear of individual components does not have the entire medical handpiece 1 , in particular not the entire optical fiber 2 , but only the affected components. In addition, the structure of the medical handpiece allows 1 a simple cleaning of the individual components, in particular a sterilization in a steam sterilizer or by irradiation with gamma rays.

In the field of ophthalmic surgery, the medical handpiece 1 especially for vitrectomy and cataract surgery.

LIST OF REFERENCE NUMBERS

1

Medical handpiece

2

Optical fiber

3

primary fiber

4

secondary fiber

5

coupling point

6

coupling element

7

casing

8th

recess

9

tip unit

10

cannula

11

locking element

12

stop element

13

sealing element

14

inner thread

15

guide tube

16

external thread

17

admission

18

recess

19

clamp

20

suction

21

tip channel

22

guide channel

23

opening

24

suction

25

limiting element

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• EP 0497908 B1 [0003]
• US 6120498 [0004]
• EP 1024760 B1 [0005]

Claims (26)

A medical handpiece (1) for transmitting energy to biological tissue via an optical fiber (2) comprising a primary fiber (3) and a secondary fiber (4) coupled via a coupling site (5), said handpiece (1) having a Guide for the optical fiber (2), a coupling element (6), which encloses the coupling point (5), and a suction channel (20), characterized in that the suction channel (20), the coupling element (6) at the coupling point (5 ) surrounds. Medical handpiece (1) after Claim 1 , characterized in that the coupling element (6) is a coupling sleeve. Medical handpiece (1) after Claim 1 or 2 , characterized in that the coupling element (6) made of metal or a metal alloy, in particular brass, an aluminum alloy, medical grade stainless steel or a nickel silver alloy, is. Medical handpiece (1) according to one of the preceding claims, characterized in that the thermal conductivity of the coupling element (6) is greater than 10 W / (m * K), preferably greater than 50 W / (m * K), particularly preferably greater than 80 W / (m * K) is. Medical handpiece (1) according to one of the preceding claims, characterized in that the secondary fiber (4) is connected in a watertight manner to the coupling element (6). A medical handpiece (1) as claimed in any one of the preceding claims, characterized by a housing (7), a guide tube (15) forming the guide disposed within the housing (7) and a tip unit connected to the housing (7) ( 9). Medical handpiece (1) after Claim 6 , characterized in that the coupling element (6) with the guide tube (15) is connected watertight and at least partially into the guide tube (15) engages. Medical handpiece (1) after Claim 6 or 7 , characterized in that the coupling point (5) within the tip unit (9). Medical handpiece (1) after one of Claims 6 to 8th , characterized in that the suction channel (20) extends through the tip unit (9) and at least partially through the housing (7). Medical handpiece (1) after one of Claims 6 to 9 , characterized in that the tip unit (9) comprises a hollow needle (10), wherein the suction channel (20) extends through the hollow needle (10). Medical handpiece (1) after Claim 10 , characterized in that the optical fiber (2), in particular the secondary fiber (4), is guided through the hollow needle (10). Medical handpiece (1) after one of Claims 6 to 11 , characterized in that the guide tube (15) has at its periphery a recess (18) for forming the suction channel (20). Medical handpiece (1) after Claim 12 , characterized by a limiting element (25) which engages in the recess (18). Medical handpiece (1) after one of Claims 6 to 13 , characterized in that the housing (7) has an opening (23) connected to the suction channel (20), to which a suction adapter (24) and / or a suction hose can be connected. Medical handpiece (1) after Claim 13 or 14 characterized in that the suction adapter (24) or the suction tube engages in a groove of the guide tube (15), wherein the groove is preferably the suction channel (20) forming recess (18). Medical handpiece (1) after one of Claims 13 to 15 , characterized in that the suction adapter (24) comprises a Luer-lock connection. Medical handpiece (1) after one of Claims 6 to 16 , characterized in that the guide tube (15) has a receptacle (17) for a clamping piece (19), which serves for the releasable attachment of the primary fiber (3) within the guide tube (15). Medical handpiece (1) after Claim 17 , characterized in that the receptacle (17) comprises a thread. Medical handpiece (1) according to one of the preceding claims, characterized in that the optical fiber (2) is displaceable along a longitudinal axis (L) of the handpiece (1). Medical handpiece (1) after one of Claims 6 to 19 , characterized in that the guide tube (15) has a thread (16), which engages in a complementary thread (14) of the tip unit (9). Medical handpiece (1) after one of Claims 6 to 20 characterized in that the tip unit (9) is rotatably mounted within the housing (7), the rotation of the tip unit (9) the guide tube (15) along the longitudinal axis (L) of the housing (7) relative to the housing (7) shifts. Medical handpiece (1) according to one of the preceding claims, characterized in that the primary fiber (3) consists of sapphire and the secondary fiber (4) consists of quartz. Medical handpiece (1) according to one of the preceding claims, characterized by an at least partially transparency or translucency of the handpiece (1), in particular of the housing (7) and / or the tip unit (9). Medical treatment system for laser surgery, in particular for eye surgery, comprising a medical handpiece (1) which is connected to a laser source and a pump, characterized in that the medical handpiece (1) is designed according to one of the preceding claims. Medical treatment system after Claim 24 , characterized in that the wavelength of the laser radiation emitted by the laser source in the range of 1.5 microns to 4 microns, preferably between 2.5 microns to 3.5 microns, more preferably at 2.94 microns. Use of a medical handpiece (1) according to one of Claims 1 to 23 , characterized in that the primary fiber (3) releasably inserted in the handpiece (1) and is optically coupled to the secondary fiber (4) at the coupling point (5) via the coupling element (6).

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