DE102019212197A1 - Light applicator system - Google Patents

Abstract

The present disclosure relates to a light applicator system (1) for examining and / or treating an organic body, the light applicator system (1) having at least one light applicator operating unit (3) with at least one connection (21) for connecting at least one exchangeable light applicator (5) with a distal-side LED (19), the light applicator operating unit (3) having identification means for identifying the type of light applicator (5) that can be connected to the at least one connection (21).

Description

The present disclosure relates to a light applicator system for examining and / or treating an organic body, in particular for photodynamic therapy (PDT) of pathological tissue.

It is known to use endoscopes to make video recordings of the interior of a human or animal body for the purposes of medical diagnosis and / or therapy. There is a constant effort to make the insertion section of endoscopes as thin as possible so that the smallest possible cavities can be seen and the tissue is affected as little as possible.

Endoscopes are not only used to take pictures or video recordings, but are also used as diagnostic or therapeutic means themselves. For example, for the detection and localization of premalignant and early malignant tissue, fluorescence endoscopy can be used, which does not depend on a natural, true-color representation of the tissue, but only on fluorescence excitation with which pathological tissue can be distinguished from healthy tissue . The pathological tissue excited by light radiation itself or an accumulation of bacteria indicating pathological tissue can fluoresce specifically and thus be localized in a recognizable manner in relation to the surrounding healthy tissue. Fluorescence endoscopy can be performed, for example, as part of a photodynamic diagnosis (PDD) and / or photodynamic therapy (PDT) using a photosensitizer or marker (e.g. chlorin e6), which selectively accumulates in pathological tissue.

In photodynamic therapy (PDT), light is applied directly onto or even into pathological tissue by means of a light applicator in order to promote the formation of oxygen radicals in a light-induced manner by means of the locally enriched photosensitizer or marker substance and thereby to the pathological tissue, such as a tumor to destroy. For this purpose, laser light is typically coupled into a light guide and guided into the tissue.

It is a particular challenge to reach very narrow areas of the inside of the body, such as kidney calyxes or heavily branched airways, in a minimally invasive way. For this purpose, the light applicator must be easy to bend with relatively small radii in order to be able to follow the angled areas of the inside of the body in a minimally invasive manner. The light guides therefore have to be less rigid and allow tight bending radii, which leads to the thinnest possible design as a single light guide fiber. However, this has the disadvantage that only small amounts of light can be transmitted and, with relatively high losses, a high light output must be applied by an expensive laser and coupled in on the proximal side in order to be able to couple out sufficient light output for the PDT at the distal end. In addition, very thin light applicators can be difficult to handle and only controllable to a limited extent.

This results in the task of providing a more efficient, more cost-effective and easier-to-use light applicator system that allows examination and / or treatment in very highly branched areas of an organic body.

According to a first aspect of the present disclosure, a light applicator system is provided to solve this problem, the light applicator system having at least one light applicator operating unit with at least one connection for connecting at least one replaceable light applicator with a distal LED, the light applicator operating unit having identification means for identifying the type of one of the at least one Has connection connectable light applicator.

The light applicator does not have a light guide for proximally coupled laser light, but can mainly consist of an electrical conductor in the form of a wire and / or stranded wire, the electrical conductor supplying power to a distal LED. In contrast to light guides, the electrical energy that can be transferred is much less limited by the radial expansion of the electrical conductor, so that the light applicator can be made thinner where a low bending stiffness is needed for small bending radii, and thicker where a higher bending stiffness is advantageous for the Handling is. The radial extension of the electrical conductor itself and / or its insulating sheathing can be adapted to the requirements for the local flexural rigidity. In this disclosure, flexural stiffness should also mean torsional stiffness. This means that with a non-isotropic, but directed emission characteristic, the applicator can be rotated around the longitudinal axis at the proximal end and the distal end rotates accordingly with sufficient torsional rigidity as desired, so that the light emission is aligned as desired.

When using a light applicator with a distal LED, however, depending on the type of photosensitizer or A suitable type of light applicator with coordinated emission characteristics and a coordinated light spectrum can be used for marker material. This means that the light applicator operating unit must provide a very specific supply voltage or current at the connection for the light applicator, matched to the photosensitizer or marker substance used and the appropriate light applicator.

The identification means are used to automatically and fail-safe assign the type of connected light applicator to the connection of the light applicator operating unit and thus to ensure that the light applicator is provided with a very specific supply voltage or current at its connection.

Optionally, the identification means can have, for example, a mechanical and / or a signal-based identifier, the identifier being set up to only permit those operating modes that are suitable for a specific type of light applicator via the at least one connection. The operating modes can be stored in the light applicator operating unit in the form of specific voltages, currents, powers, intervals, pulse shapes and / or treatment times, etc. assigned to specific light applicator types, so that the operating mode is automatically selected based on the identification of the light applicator type. This can prevent a type of light applicator from being operated in an operating mode that is not intended for it. It can also be the case that a selection of permitted operating modes is proposed to a user via an interface on the light applicator operating unit, from which the user can choose. The identification of the type of light applicator serves to ensure that operating modes that are not intended for the connected type of light applicator are not made available for selection.

Optionally, the light applicator operating unit can be set up to allow a specific light applicator type only for one-time operation at the at least one connection. For this purpose, the light applicator operating unit can be equipped with a memory device which can “remember” whether a certain light applicator has already been used. Alternatively or additionally, the identifier in the light applicator can change in the course of a first-time use, for example the light applicator can be digitally marked as "used" so that the (or another) light applicator operating unit is no longer allowed to operate. In this way, with such light applicators, which are provided as inexpensive disposable articles for single use, it is reliably avoided that they are used several times. PDT can thus be provided more cheaply without increasing the risk of treatment.

Optionally, the at least one light applicator operating unit can have a plurality of connections for the simultaneous operation of several light applicators. This corresponds to an advantageous application for PDT, because it can be advantageous to irradiate larger tumors or areas of pathological tissue from different angles and distributed over a large area with a plurality of light applicators. Since the therapeutic effect of light only occurs where the photosensitizer or the marker substance has accumulated, namely in the pathological tissue, large-volume illumination of an entire organ, for example, can be useful to ensure that any pathological tissue in the organ has been effectively irradiated . For this purpose, the light applicator system can have at least one organ-specific stencil or template that can be fixed at a certain point and in a defined manner in front of or on the patient's skin and provides a user with defined puncture points and / or puncture angles and / or puncture depths for the light applicators to achieve a large-volume homogeneous illumination of the organ or body area.

Light applicators with different radiation characteristics can be used to achieve the most homogeneous and targeted irradiation of the entire pathological tissue volume. A light applicator with a focused radiation characteristic can, however, require less power than a light applicator with an expanded radiation characteristic. The means of identification of the light applicators can ensure that each light applicator is automatically operated according to its type. The identification means can therefore optionally have, for example, a connection-specific mechanical and / or a signal-based identifier, the identifier differing between at least two of the connections.

Optionally, the light applicator system can have at least two different types of interchangeable light applicators, the light applicators being set up to transmit their respective type and / or an individual light applicator identifier based on signals via the at least one connection to the light applicator operating unit. This can be particularly advantageous when standardized connection connections are used between the light applicator operating unit and the light applicators. The identification means can then be transmitted from the light applicator to the light applicator operating unit in the form of an analog or preferably digital signal become. Alternatively or additionally, the light applicator can passively provide the identification means in the form of data, so that they can be called up or queried by the light applicator operating unit. For this purpose, the corresponding electronics are preferably arranged in a connection plug on the proximal side of the light applicator. The identification means can additionally or alternatively be transmitted wirelessly to the light applicator operating unit by means of an RFID chip on the light applicator.

For PDT, the light applicators described above can, for example, be pierced percutaneously or interstitially directly into an organic body with or without further aids and the distal LED can thus be brought into or onto the tissue to be irradiated. Even with the thinnest possible design of the light applicators, however, this inevitably leads to a perforation of non-pathological tissue, which should be avoided as far as possible with minimally invasive therapy. However, certain body regions can be reached via body orifices and naturally existing conductors, such as the intestines, ureters, esophagus, trachea, blood vessels, etc. The light applicator system can therefore also optionally have at least one shaft instrument with a distal insertion section, the shaft instrument having at least one working channel, wherein the at least one light applicator can be pushed distally through the working channel and its distal LED can thereby be positioned at a distal end of the insertion section. The insertion section of the shaft instrument can preferably be angled in order to be able to reach branched regions of the interior of the body in a minimally invasive manner. The design, length and lateral extent of the light applicator can be adapted to the working channel in order to ensure the simplest possible handling of the light applicator system. The shaft instrument can have an image recording device, such as an image sensor, at its distal end, in order to enable the distal end to be precisely positioned. The light applicator can thus be placed very precisely and, if necessary, pierced or attached to the pathological tissue beyond the distal end of the shaft instrument.

Optionally, the shaft instrument can have a plurality of working channels for the simultaneous operation of a plurality of light applicators and / or the light applicator system can have a plurality of shaft instruments for the simultaneous operation of a plurality of light applicators.

Optionally, the insertion section can have at least a first shaft section, a second shaft section and a third shaft section, wherein the first shaft section extends proximally from the second shaft section and the third shaft section extends distally from the second shaft section, wherein the shaft in the second shaft section can be angled and / or is less rigid than the first and / or third shaft section. The second shaft section can also be referred to as an angled area in which the working channel can follow a certain angled radius. The first and / or third shaft section can be rigid or bendable within certain limits. For example, the more rigid shaft sections could be designed to be rigid in such a way that when the shaft instrument is horizontally aligned and fixed on the proximal side, the distal end of the shaft instrument hangs down by its own weight by a maximum of 30% of the length of the shaft instrument.

Optionally, the light applicator system can have at least one replaceable light applicator with a distal LED and at least a first light applicator section, a second light applicator section and a third light applicator section, the first light applicator section running proximally from the second light applicator section and the third light applicator section distal from the second light applicator section, the second light applicator section extending less than the second light applicator section is as the first and / or third light applicator section, the second light applicator section being arranged at least partially in the second shaft section when the distal-side LED of the light applicator is positioned at the distal-side end of the insertion section. Adapted to the angled shaft instrument, the light applicator can have an angled area as a second light applicator section which, when the light applicator is in the operating position, lies in the angled area, i.e. second shaft section, of the shaft instrument. This reduces the stiffening of the second shaft section by the inserted light applicator and preserves the mobility when the shaft instrument is angled. At the same time, in the more rigid shaft sections, ie in the first and third shaft sections, the light applicator can be designed to be correspondingly more rigid and torsion-resistant, e.g. thicker, so that the distal-side LED is easier to use by manually moving the first proximal light applicator section, which protrudes at least partially proximally from the shaft instrument, is positionable.

Optionally, the light applicator system can have at least one replaceable light applicator with a distal LED and an electrical pair of conductors, consisting of a forward and a return conductor, possibly designed as a coaxial cable, for powering the LED, the conductor being sheathed, the sheathing being thinner in a length section or absent, which lays in a bendable shaft section when the distal-side LED of the light applicator is positioned at the distal-side end of the insertion section. For example, the sheath sections of tubes, preferably shrink tubes, with different wall thicknesses and / or partially overlapping tubes. The casing can simultaneously serve as an electrical insulator and / or as thermal insulation and to locally increase the flexural and torsional rigidity of the light applicator.

• - Anschließen eines auswechselbaren Lichtapplikators mit distalseitiger LED an eine Lichtapplikatorbetriebseinheit des Lichtapplikatorsystems,
• - Identifizieren des Typs des angeschlossenen Lichtapplikators mittels der Lichtapplikatorbetriebseinheit, und
• - Bereitstellen von nur bestimmten Betriebsmodi basierend auf dem identifizierten Typ des angeschlossenen Lichtapplikators.

According to a second aspect of the present disclosure, a method for preparing a light applicator system for operation is provided, the method comprising the following steps:

• - Connection of an exchangeable light applicator with distal LED to a light applicator operating unit of the light applicator system,
• - Identifying the type of connected light applicator by means of the light applicator operating unit, and
• - Provision of only certain operating modes based on the identified type of the connected light applicator.

This process ensures that a light applicator can only be operated in an operating mode intended for its type. It also allows more efficient, cheaper and simpler handling of a light applicator system, for example for a PDT. Optionally, only one operation of the light applicator can be permitted, for example in the step of providing only certain operating modes.

Optionally, the method can have a step of pushing through, wherein the light applicator is pushed distally through a working channel in a shaft instrument of the light applicator system until the distal-side LED of the light applicator is positioned at a distal-side end of an insertion section of the shaft instrument.

Optionally, in the step of pushing through, a section of the light applicator that is less rigid than other sections of the light applicator can be positioned in an angled section of the insertion section of the shaft instrument.

Optionally, in the step of connecting, several light applicators can be connected to a plurality of connections of the light applicator operating unit for simultaneous operation.

Optionally, in the step of identifying the light applicator, it can transmit its type and / or its individual light applicator identifier to the light applicator operating unit based on signals.

The terms “distalward” and “proximalward” are intended to mean a relative position that is distal or proximal of a user of the system as a reference position. The terms “distal side” and “proximal side” are intended to mean a position on a distal or proximal side of an object. The terms “distalward” or “proximalward” are intended to mean a direction that extends distally or proximally.

• 1 eine schematische Darstellung einer beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikatorsystems;
• 2 eine schematische Darstellung einer anderen beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikatorsystems;
• 3 eine schematische Darstellung eines Beispiels eines Lichtapplikators einer beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikatorsystems;
• 4 eine schematische Darstellung eines anderen Beispiels eines Lichtapplikators einer beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikatorsystems;
• 5 eine schematische Darstellung einer weiteren beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikatorsystems;
• 6 eine schematische Darstellung einer weiteren beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikators;
• 7 eine schematische Darstellung einer weiteren beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikators;
• 8 eine schematische Darstellung einer weiteren beispielhaften Ausführungsform eines hierin offenbarten Lichtapplikators;
• 9a,b einen schematischen Längsschnitt und eine schematische Draufsicht auf einen ersten Leiter mit distalseitiger LED eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems;
• 10a,b einen schematischen Längsschnitt und eine schematische Draufsicht auf einen ersten Leiter mit distalseitiger LED eines möglichen Lichtapplikators einer beispielhaften anderen Ausführungsform des hierin offenbarten Lichtapplikatorsystems;
• 11a-d schematische Darstellungen eines Einführabschnitts vier weiterer beispielhafter Ausführungsformen eines hierin offenbarten Lichtapplikators;
• 12a-c schematische Darstellungen der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems;
• 13 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems während des Betriebs;
• 14 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit zwei verschiedenen Detailvarianten;
• 15 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit vier verschiedenen Detailvarianten;
• 16 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems beim Einstich in die Haut eines Patienten;
• 17 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems beim Einstich in die Haut eines Patienten;
• 18 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems beim Einstich in die Haut eines Patienten;
• 19 einen schematischen Querschnitt der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit zwei verschiedenen Detailvarianten;
• 20 eine schematische Darstellung eines Verstärkungselements einer distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit drei verschiedenen Detailvarianten;
• 21 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems beim Einstich in die Haut eines Patienten;
• 22 einen schematischen Querschnitt der distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit drei verschiedenen Detailvarianten;
• 23 eine schematische Darstellung eines Verstärkungselements einer distalen Spitze eines möglichen Lichtapplikators einer beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems;
• 24 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit Hautöffnung beim Einstich in fünf verschiedenen Phasen;
• 25 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit zwei verschiedenen Detailvarianten;
• 26 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems mit zwei verschiedenen Detailvarianten; und
• 27 eine schematische Darstellung der distalen Spitze eines möglichen Lichtapplikators einer anderen beispielhaften Ausführungsform des hierin offenbarten Lichtapplikatorsystems.

The disclosure is explained in more detail below with reference to the exemplary embodiments shown in the drawings. Show it:

• 1 a schematic representation of an exemplary embodiment of a light applicator system disclosed herein;
• 2 Fig. 3 is a schematic representation of another exemplary embodiment of a light applicator system disclosed herein;
• 3 Fig. 3 is a schematic representation of an example of a light applicator of an example embodiment of a light applicator system disclosed herein;
• 4th Figure 12 is a schematic representation of another example of a light applicator of an example embodiment of a light applicator system disclosed herein;
• 5 a schematic representation of another exemplary embodiment of a light applicator system disclosed herein;
• 6th a schematic representation of a further exemplary embodiment of a light applicator disclosed herein;
• 7th a schematic representation of a further exemplary embodiment of a light applicator disclosed herein;
• 8th a schematic representation of a further exemplary embodiment of a light applicator disclosed herein;
• 9a, b a schematic longitudinal section and a schematic top view of a first conductor with distal LED of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein;
• 10a, b a schematic longitudinal section and a schematic top view of a first conductor with distal LED of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein;
• 11a-d schematic representations of an insertion section four others exemplary embodiments of a light applicator disclosed herein;
• 12a-c schematic representations of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein;
• 13 a schematic representation of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein during operation;
• 14th a schematic representation of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein with two different detail variants;
• 15th a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein with four different detail variants;
• 16 a schematic illustration of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein when puncturing the skin of a patient;
• 17th a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein when puncturing the skin of a patient;
• 18th a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein when puncturing the skin of a patient;
• 19th a schematic cross section of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein with two different detail variants;
• 20th a schematic representation of a reinforcement element of a distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein with three different detail variants;
• 21st a schematic illustration of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein when puncturing the skin of a patient;
• 22nd a schematic cross section of the distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein with three different detail variants;
• 23 a schematic representation of a reinforcement element of a distal tip of a possible light applicator of an exemplary embodiment of the light applicator system disclosed herein;
• 24 a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein with skin opening during the puncture in five different phases;
• 25th a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein with two different detail variants;
• 26th a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein with two different detail variants; and
• 27 a schematic representation of the distal tip of a possible light applicator of another exemplary embodiment of the light applicator system disclosed herein.

1 shows a light applicator system 1 with a light applicator operating unit 3 and a replaceable light applicator 5 . The light applicator 5 consists essentially of a flexible cable section 7th that extends from a proximal connector 9 to a distal insertion section 11 extends. The lead-in section 11 is in contrast to the cable section 7th the section of the light applicator 5 which is intended to be used in organic tissue of a body 13 to be stabbed. The light applicator 5 is suitable here for percutaneous PDT and shown in PDT mode. The lead-in section 11 is designed here as a rigid needle section which, for example, supports CT or ultrasound from the outside through the skin 13 of a patient and underlying healthy tissue 15th with the distal tip into pathological body tissue 17th , e.g. B. a malignant tumor is stung.

The insertion or needle section has at the distal tip 11 a distal LED 19th for the in-situ generation of excitation light for the PDT. If, for example, chlorine e6 is used as a sensitizer for PDT, the specially designed LED 19th Emit excitation fish as isotropically as possible in the wavelength range of 660-670 nm. Chlorin e6, which was previously found as a sensitizer in pathological body tissue 17th has selectively enriched, produced by exposure to light oxygen radicals, which the pathological body tissue 17th to destroy. Because the chlorin e6 is not in healthy tissue 15th enriches, the healthy tissue remains 15th essentially unaffected by light.

The LED 19th is via an electrical conductor in the cable section 7th and lead-in section 11 from the light applicator operating unit 3 powered. The proximal connector 9 of the light applicator 5 is for this in a connection 21st on the light applicator operating unit 3 plugged. For powering the light applicator 5 has the light applicator operating unit 3 an electrical supply module 23 that is set up for this at the connection 21st a certain operating current for the connectable light applicator 5 to provide. In addition, the light applicator operating unit 3 a control module 25th that is set up to do this, the plug 9 identify and the supply module 23 to provide an appropriate operating current.

The connection 21st For example, it can be a connector strip with a plurality of slots, whereby only certain plug shapes fit into certain slots as an identification means in the form of a mechanical identifier, so that when the plug is inserted 9 it is clearly determined which type of light applicator 5 is in a slot. The control module 25th can then provide defined operating parameters (current, voltage, operating time, etc.) per slot. Alternatively or in addition, the applicator type can be used as an identification means in the form of a signal-based identifier from the control module 25th readable in the connector 9 be stored and the supply module 23 controlled accordingly. With a signal-based identifier, the light applicator 5 even active on the control module 25th "Register" and identify and / or passively from the control module 25th be queried. It can also be a previous use of the light applicator 5 in the control module 25th and / or in the connector 9 be saved so that only a single use of the light applicator 5 can be allowed.

In 2 instructs the light applicator system 1 a plurality of light applicators 5 at the same time on a plurality of connections 21st are connected to work together for a PDT of an entire organ 27 to be used. The light applicators 5 can all be of the same type or at least partially of different types. The light applicators 5 are distributed in different places through the skin and with different penetration depths in the organ 27 pricked so that the LEDs 19th illuminate the organ as homogeneously as possible with excitation light. This is particularly useful in the case of large and / or not precisely localizable tumors. Since healthy tissue is not damaged by PDT, it makes sense to illuminate a volume or an entire organ around the tumor generously in order to reduce the risk of pathological tissue remaining untreated. The individual light applicators 5 can be fixed with a certain type, at a certain position, with a certain puncture angle and depth, for example by means of an auxiliary stencil or template stuck to the skin or otherwise fixed. The corresponding assignment of the light applicators 5 to the connections 21st can be specified via the identification means, so that for a specified type of PDT on a specific organ 27 automatically at every connection 21st from the control module 25th the correct operating parameters are provided. The risk of errors in the complex setting of a large number of light applicators 5 can thus be reduced.

In 3 is shown schematically that a plurality of light applicators 5 for interstitial or percutaneous PDT in the flexible cable section 7th can be bundled at least in sections, for example in the form of a multi-core flat cable 29 . The light applicators 5 however, they can also be bundled or passed individually through one or more working channels of an endoscope or trocar.

In 4th is one embodiment of a light applicator system 1 shown with a light applicator 5 for interstitial PDT through a working channel 31 in the shaft 33 of a shaft instrument 35 is performed in the form of an endoscope. The shaft 33 has an insertion section 37 which is intended to be introduced into a patient's body. Optionally, at the distal end of the insertion section 37 an image sensor 39 be arranged to take a picture of the interior of the patient's body can. The lead-in section 37 has a first shaft portion 41 , a second shaft portion 43 and a third shaft portion 45 on, the first shaft portion 41 proximal of the second shaft section 43 and the third shaft portion 45 distal from the second shaft section 43 runs. The shaft 33 is in the second shaft section 43 bendable and / or less rigid than the first and / or third shaft section 41 , 45 . This allows the distal end of the insertion section 37 be placed in a minimally invasive way on angled areas of the inside of the body, such as kidney calyx or heavily branched airways.

According to the shaft sections 41 , 43 , 45 also instructs the light applicator 5 different light applicator sections, namely a first light applicator section A. , a second light applicator section B. and a third light applicator section C. , wherein the first light applicator section A. proximal of the second light applicator section B. and the third light applicator section C. distal from second light applicator section B. runs. The second light applicator section B. is less rigid than the first A and / or third light applicator section C. . The second light applicator section B. is at least partially in the second shaft section 43 arranged when the distal side LED 19th of the light applicator 5 is positioned at the distal end of the insertion section. The light applicator sections A. , B. , C. are therefore matched in length to the shaft 33 of the endoscope 35 so on the one hand the light applicator 5 there is designed to be flexurally and torsionally rigid enough to accommodate the distal end of the light applicator 5 to be able to control and on the other hand is designed there flexibly enough to allow the shaft to be angled in the second shaft section 43 to affect as little as possible. The light applicator 5 in this exemplary embodiment also has an optional fourth light applicator section D. in the proximal flexible cable section 7th , the proximal side of the first light applicator section A. and can be wound up in a certain radius outside of the endoscope 35 runs. The distal insertion section 11 of the light applicator 5 can be at the distal end of the working channel 31 protrude and for interstitial PDT in pathological tissue 17th to be stabbed. The distal insertion section 11 of the light applicator 5 can for this purpose be flexible or, as a needle section, relatively rigid. A rigid needle section 11 can increase the depth of penetration into the tissue, whereas a flexible insertion section 11 better through an angled working channel 31 can be pushed or pulled.

sodass die Biegesteifigkeit mit der vierten Potenz des Radius skaliert, wobei R der Außenradius der Ummantelung und r der Innenradius der Ummantelung ist. Für einen Ummantelungsquerschnitt mit quadratischem Kastenprofil mit Außenbreite A und Innenbreite a gilt entsprechend $I_r=\frac{1}{12}\left(A^4-a^4\right).$

Selbst geringste Unterschiede der Dicke der Ummantelung zwischen den Lichtapplikatorabschnitten A bis D im Bereich von 10µm können daher einen signifikanten Einfluss auf die Biege- und Torsionssteifigkeit bewirken.As in 5 shown is the light applicator 5 in the second light applicator section B. thinner than in the light applicator sections A. and C. designed because a lower bending and torsional stiffness is required for small bending radii. In the light applicator sections A. and C. it is thicker, where a higher flexural and torsional stiffness is advantageous for handling. The radial extension of the electrical conductor itself and / or its insulating sheathing can be adapted to the requirements for local flexural and torsional rigidity. The light applicator 5 does not have to have different thicknesses as a whole in the various light applicator sections AD but it can be, for example, just a stiffening jacket of different thicknesses in the various light applicator sections AD be. A very simple solution is to use a radial jacket 49 as electrical insulator and / or thermal insulation in sections as tubes with different wall thicknesses and / or in different numbers as at least partially overlapping tubes and thus different flexural and torsional stiffnesses in the light applicator sections AD to achieve. The tubes can be designed as shrink tubes. The wall thickness of the casing can be made comparatively thin, since the increase in flexural rigidity brought about by the casing correlates with the geometrical moment of inertia I _r . For example, in the case of a circular ring, the cross-sectional shape of the casing applies ${\mathrm{I.}}_r=\frac{\pi }{\mathrm{4th}}\left({\mathrm{R.}}^{\mathrm{4th}}-r^{\mathrm{4th}}\right),$

so that the bending stiffness is scaled to the fourth power of the radius, where R is the outer radius of the cladding and r is the inner radius of the cladding. For a cladding cross-section with a square box profile with an external width A. and inside width a applies accordingly ${\mathrm{I.}}_r=\frac{1}{12}\left({\mathrm{A.}}^{\mathrm{4th}}-a^{\mathrm{4th}}\right).$

Even the slightest differences in the thickness of the jacket between the light applicator sections A. to D. in the range of 10 µm can therefore have a significant influence on the flexural and torsional rigidity.

6th Figure 3 shows an embodiment of the light applicator 5 , in which a so-called flip chip is used as an LED 19th is used in which both the first electrical contact 50 (here anode contact) as well as the second electrical contact 51 (here cathode contact) are arranged on the proximal side. The LED chip 19th is here for example with a thin conductive adhesive layer (not shown) on an adapter piece 53 glued on, which is designed in terms of its lateral dimensions so that a large-area system of the LED chip 19th is made possible and thus a good proximalward heat flow from the LED 19th to the adapter piece 53 is achieved. The adapter piece 53 can be used as in 6th made of two metal halves 55 , 57 exist, each with the contacts 50 , 51 the LED are in electrically conductive contact and against each other by means of a thin insulator layer 59 are electrically isolated. Alternatively, the adapter piece 53 For example, be designed as a one-piece ceramic piece with metallic bushings. The LED runs the length of the light applicator 5 with an electrical conductor 61 supplied with power, here the electrical conductor 61 as a twin strand 61a , b, with one of the twin seats 61a , b the power supply and the other of the twin strands 61b , a is used to conduct current. The adapter piece 53 has contacts on the proximal side 63 , 65 on which the distal end of the electrical conductor 61 can be connected in an electrically conductive manner. The electrical conductor 61 can be designed to be flexible or rigid, at least in sections. Whether flexible or rigid, it is always advantageous for the proximal side heat dissipation if the electrical conductor 61 as large a cross-sectional proportion as possible, for example at least 70%, on the light applicator 5 has since the electrical conductor 61 is a better conductor of heat than an electrical conductor 61 surrounding insulating sheath 49a , b.

In contrast to the embodiment according to 6th is in 7th a light applicator 5 shown with an LED chip 19th , which has a second electrical contact with a large area on the proximal side 51 , which simultaneously functions as a light reflector in the distal direction, and a distal-side, relatively small-area first electrical contact 50 having. The electrical conductor 61 is designed here as a coaxial cable, with its soul 61a on the distal side by means of conductive adhesive or solder with the second electrical contact on the proximal side 51 the LED 19th is conductively connected. For the best possible proximal heat dissipation from the LED 19th about the soul 61 a this has a relatively large proportion of the cross-sectional area of the electrical conductor 61 or on the entire light applicator 5 , e.g. at least 70%. An outer conductor 61b and one between outer conductor 61b and soul 61a arranged insulator layer 59 are accordingly made as thin as possible. Outwardly is the outer conductor 61 b of at least one insulating sheath that is as thin as possible (not in 7th shown). As in 5 can, via the thickness and / or number of layers of the sheathing, the flexural rigidity of the light applicator in sections 5 be defined. The soul 61 a can be designed as a relatively rigid solid wire or as a flexible strand bundle.

The outer conductor 61b in 7th serves as a return conductor, which has a metallic sleeve on the distal side 67 that is about the LED 19th with the first electrical contact 50 the LED 19th is electrically connected. For the electrical contact between the first electrical contact 50 and the sleeve 67 a contact clip protrudes 69 the sleeve 67 radially inwards. Although not shown in all figures, in all embodiments a light beam-shaping component is advantageously arranged distally from the LED in order to achieve a desired emission characteristic. For example, isotropic radiation can be desired for PDT, so that a diffuser 71 (please refer 8-10 and 13-27 ) can form the light beam shaping component. If it is desired to focus the light, a lens can be used as a light beam-shaping component on the distal side of the LED chip 19th be arranged.

In 8th is one embodiment of the light applicator 5 shown which is particularly beneficial for percutaneous PDT. In 8th is a separate top view of the LED on the right 19th shown. The proximal cable section 7th of the light applicator 5 with connector on the proximal side 9 for connection to a light applicator operating unit 3 is flexible and has a detachable connection port on the distal side 73 for a relatively rigid distal needle section 11 on. The needle section 11 serves wholly or partially as an insertion section for piercing tissue of a body. The needle section 11 receives its flexural rigidity mainly from a central, massive, rigid, rod-shaped first electrical conductor 61a . Analogous to 7th is on the distal side of the first electrical conductor 61a an LED 19th connected. From the top view of the LED 19th right in 8th it becomes clear that the electrical conductor 61a like the LED 19th has a substantially square cross-section that is only slightly larger than the LED 19th . The cross-section of the smallest possible LED currently available or producible on the market 19th sets a lower limit for the miniaturization of the light applicator 5 , which is as minimally invasive as possible, i.e. thin, and thus as little as possible over the lateral dimensions of the LED 19th should protrude. For example, light applicator cross-sections of significantly less than 1 mm ² can be achieved at the moment, for example 0.25 mm ² and less.

Another electrical conductor 61b can be used as a return conductor in the form of a against the first electrical conductor 61a insulated very thin flex board or enamelled wire on one side of the first electrical conductor 61a guided along and folded or bent in an L-shape at its distal end, around the distal-side first electrical contact 50 the LED 19th to contact. The metallic sleeve 67 out 7th can then be omitted in both cases. The ladder 61a , 61b are here with a thin sheath 49 encased, which is preferably made of plastic as a shrink tube biocompatible and the sliding behavior of the needle section 11 improved by body tissue. The sheathing is also used 49 as electrical insulation and thermal insulation to the outside.

In 8th is one distal from the LED 19th arranged light beam-shaping component in the form of a light-transparent diffuser 71 shown as a distally tapered needle tip of the needle section 11 acts. In 12 to 27 advantageous configurations of the needle tip are shown in more detail.

dick, damit die Ecken der LED 19 nicht lateral über den Leiter 61 hinausragen. In 10a,b ist der Querschnitt des Leiters 61 wie die LED 19 in etwa quadratisch, wobei der Querschnitt des Kupferkerns 74 in etwa dem Querschnitt der LED 19 entspricht. Der Stahlmantel 76 ist hier wesentlich dünner als in 9a,b, z.B. weniger als 0,15 · a dick.In order to achieve a high flexural strength of the first electrical conductor with cross sections of less than 1 mm ² 61a To achieve, it is advantageous to use a material with the highest possible modulus of elasticity as the first electrical conductor. For example, steel has a high modulus of elasticity of over 200 MPa. However, steel has the disadvantage that its thermal conductivity is well below 100 W / (Km) at 20 ° C, usually in the range of 50 W / (Km) at 20 ° C. Because the first electrical conductor 61a A first electrical conductor would be a first electrical conductor for heat conduction not only to be rigid but also to dissipate the waste heat from the LED proximally as well as possible 61a made of copper or silver with a thermal conductivity of more than 400 W / (Km) at 20 ° C makes sense, or at least made of aluminum with a thermal conductivity of more than 200 W / (Km) at 20 ° C. However, with less than 100 MPa, copper, aluminum and silver have a significantly lower modulus of elasticity than steel. To achieve high flexural rigidity at the same time high thermal conductivity is the electrical conductor 61a , as in 9a, b and 10a, b shown with a copper core 74 and a steel jacket 76 executed. The steel jacket 76 can be relatively thin compared to the radius of the copper core 74 because the stiffening effect is scaled to the power of four with the radius. At the same time, the heat conduction on the proximal side is better the larger the cross section of the copper core 74 is. For the best possible heat dissipation, the diameter of the copper core is 74 to the lateral dimensions of the LED 19th customized. In 9a, b is the cross section of the conductor 61 round and the LED 19th roughly square with a side length a, so that the diameter of the copper core 74 is approximately a. The steel jacket 76 is here at least $\left(\sqrt{2}-1\right)a$

thick so the corners of the LED 19th not laterally across the ladder 61 protrude. In 10a, b is the cross section of the conductor 61 like the LED 19th roughly square, with the cross section of the copper core 74 roughly the cross section of the LED 19th corresponds. The steel jacket 76 is much thinner here than in 9a, b , for example less than 0.15 · a thick.

In 11a and 11b is the thermal management in the lead-in section 11 of the light applicator 5 clear. The lead-in section 11 can be rigid or flexible here, i.e. the electrical conductor 61 be designed as a solid rod or as a flexible strand bundle. There is a technical challenge in reducing the waste heat from the LED in the case of small cross-sections, in particular cross-sections of less than 1 mm ² 19th on the one hand to derive so well that the LED 19th is not damaged and the level of the emitted optical power can be maintained even as the LED is switched on, because the emitted optical power decreases with increasing LED temperature. On the other hand, the surrounding body tissue must not be heated so much that it is damaged. Too much thermal insulation damages the LED 19th and too weak thermal insulation is harmful due to an extremely inhomogeneous radial heat flow and above all in the area of the LED 19th very excessive radial heat flow from the applicator to the surrounding tissue there the tissue. To solve this problem, the radial insulation takes place proximally from the LED 19th from. In the exemplary embodiments shown, this takes place in stages between several thermal insulation sections E, F, G. In a first distal thermal insulation section E, which contains the LED 19th surrounds radially, the radial thermal insulation is strongest, so that in this area of the insertion section 11 , i.e. in the area of LEDs 19th as a heat source where the heat flow dQ / dt in the light applicator 5 Overall, because almost no heat could be given off to the outside environment there, the radial heat flow dQ / dt from the light applicator is very high due to good radial thermal insulation 5 to the tissue is dampened to a moderate level so as not to damage the surrounding tissue. For this purpose, the thermal insulation in the distal thermal insulation section E has three layers.

Radial on the inside acts as the first thermal insulation layer 75 in the first distal thermal insulation section E a sleeve-shaped around the LED 19th extending proximal section 75 the needle point 71 that are distal from the LED 19th forms a light-transparent diffuser. The diffuser 71 causes the light to be radiated as isotropically as possible in the largest possible solid angle. The first thermal insulation layer 75 points like the diffuser 71 even a plastic, for example epoxy resin, as the main component. Plastics are advantageously characterized by a comparatively low thermal conductivity. A first heat-shrink tube surrounds the second heat-insulating layer in the first distal heat-insulating section E 77 made of plastic, for example polyethylene terephthalate (PET), the first thermal insulation layer 75 . A second heat-shrink tube surrounds the first distal heat insulation section E as a third heat insulation layer 79 made of plastic, for example polyethylene terephthalate (PET), the second thermal insulation layer 77 .

From the first distal thermal insulation section E, a second thermal insulation section F, which consists of the second thermal insulation layer, extends proximally 77 and the third thermal barrier coating 79 consists. The first thermal insulation layer 75 from the proximal sleeve portion of the needle tip 71 does not extend into the second thermal insulation section F. This allows the conductor 61 give off the heat radially better than in the first heat insulation section E, so that a build-up of heat is avoided and a proximalward heat dissipation from the LED 19th through the head 61 remains guaranteed. A third thermal insulation section G, which consists only of the third thermal insulation layer, extends proximally from the second distal thermal insulation section F 79 consists. The second thermal insulation layer 77 does not extend into the third thermal insulation section G. This allows the conductor 61 give off the heat radially even better than in the second heat insulation section F, so that here too a build-up of heat is avoided and a proximal-side heat flow from the LED is avoided 19th through the head 61 remains guaranteed. As a result, it operates proximally from the LED 19th decreasing radial thermal insulation a distribution of the radial heat flow over the length of the insertion section 11 so that the longitudinal temperature gradient ΔT / ΔL on the outer radius of the third thermal insulation layer 79 is as low as possible over the thermal insulation sections E, F, G and thus temperature peaks that damage tissue are avoided. As indicated by the size of the white block arrows in 11a, b indicated, the difference in the radial temperature gradient ΔT / Δr between the thermal insulation sections E, F, G is compensated as far as possible by the different thicknesses of the radial thermal insulation and the resulting different radial thermal resistances of the thermal insulation sections E, F, G, so that the respective thermal insulation sections E, F, G radially outwardly transmitted heat output dQ / dt is as equal as possible.

In the 11a and 11b the thickness of the thermal insulation is mainly determined by the total thickness of the thermal insulation. As in 11a shown, the light applicator 5 therefore be made thinner proximally. However, this is not a great advantage because of the maximum cross-section of the light applicator 5 is determined by the first thermal insulation layer E with three thermal insulation layers. In 1 1b it is shown that the cross section of the conductor changes in accordance with the thickness of the thermal insulation decreasing proximally 61 can enlarge so that the cross section of the light applicator 5 is essentially constant across the thermal insulation sections E, F, G. This means that the thermal conduction on the proximal side is dQ / dt through the conductor 61 improved accordingly.

In the 11c and 11d is shown as an additional improvement in the fastening security for the needle tip 71 can be achieved. The head 61 has for this purpose at least one recess on the outside in a distal end section 80 (please refer 11c ) and / or widening 82 (please refer 11d ), for example as a local cross-sectional tapering and / or enlargement. This ensures that the sleeve-shaped proximal section 75 the needle point 71 with the first conductor 61 forms a form fit. The needle point 71 can be designed as a plastic cast part or as a plastic injection molded part, which is, for example, molded or encapsulated with the recess on the outside 80 or widening 82 of the head 61 a form fit by means of an undercut 84 can form.

In the 12 to 27 are different configurations of the needle tip or the diffuser 71 shown. 12a-c each show a basic sleeve-shaped structure of a beam-shaping component distal side of the LED (not shown). In 12a the needle tip is essentially cup-shaped with a flat face 81 and slightly rounded edges 83 . The needle point in 12a is therefore relatively blunt. This can be advantageous if no tissue is to be cut, but only to be pushed away. However, such a needle tip is less suitable for percutaneous PDT because of the high resistance during insertion. In 12b is the face 81 completely rounded, which on the one hand the resistance when piercing against the flat face 81 out 12a and on the other hand, a lens effect is achieved. In 12c the needle tip tapers conically in the distal direction to a relatively blunt tip 85 . The cone volume is here largely with a light-scattering material 87 filled out.

13 shows a percutaneous (through the skin 13 ) in pathological tissue 17th pierced light applicator 5 with distal needle tip, which acts as a dome-shaped diffuser 71 is trained. The diffuser 71 scatters that from the LED 19th light emitted according to the emission characteristics of a Lambertian radiator 89 such that that the diffuser 71 leaving light 91 is emitted as isotropically as possible in the largest possible solid angle. That from the diffuser 71 As a result, emitted light sometimes also has directional components directed proximally.

In interstitial or percutaneous PDT, the mechanical action on the skin is intended 13 and tissue 15th , 17th , especially healthy tissue 15th possibly on the way to the pathological tissue 17th must be done as minimally invasive as possible. It is the primary goal that the puncture does not cause permanent skin damage 13 and healthy tissue 15th brings about. In addition, the puncture should heal as quickly as possible and leave no or the smallest possible scars. For this purpose it can be advantageous to use the tip of the light applicator 5 to be particularly pointed and / or sharp. However, it can be technically difficult to make the distal tip and / or the edge sharp enough from the light-transparent material of the diffuser 71 to be able to manufacture. For example, like most other plastics, epoxy resin is relatively soft and can bend at the tip and / or edge when punctured. Harder, light-transparent material such as quartz glass is more rigid, but processing is much more complex and therefore associated with significantly higher costs. In addition, harder, transparent materials such as quartz glass are brittle, so that the risk of splintering would be very high. To solve this problem, as described in 14th shown, a needle tip end portion 93 of the, for example, conical or pyramidal diffuser 71 a reinforcement element 95 on. The reinforcement element 95 is made of a hard metal such as steel and is at least partially embedded in a relatively soft diffuser material such as epoxy. In the embodiment of 14th is the reinforcement element 95 designed as a relatively short mandrel to reinforce the needle tip end area 93 can be completely embedded to increase both the flexural rigidity and the flexural strength (see detailed view at the top right in 14th ) or to sharpen the needle tip distally from the Diffuser 71 protrudes (see detailed view bottom right in 14th ). The cross-sectional area of the reinforcement element 95 is relatively small so that it casts as few shadows as possible on the distal side. For this purpose, it is also advantageous to use the reinforcing element 95 to be as short as possible, whereas the stiffening effect of the needle tip end area 93 is larger if the mandrel is longer 95 .

In 15th is such a longer version of the mandrel 95 shown as a reinforcement element. The thinner version has a slightly larger shadow than the short thorn 95 out 14th negligible. Due to the deeper embedding of the thorn 95 into the diffuser 71 is the thorn 95 better stabilized and can, if necessary, further distal out of the diffuser 71 protrude (see detailed views on the right in 15th ).

In 16 is the principal percutaneous (through the skin 13 ) Piercing a light applicator 5 in tissue 17th clarified. The pierced skin is opened with the tip of the needle, which tapers in the distal direction 13 and the fabric 17th widened so far that the light applicator 5 fits through. The more pointed the tip of the needle, the more carefully this expansion of the skin occurs 13 and the fabric 17th and the lower the force that the user has to apply.

In 17th is the reinforcement element 95 executed as a triangular thin sharp blade, which is in the cone-shaped diffuser 71 is embedded and both distally and laterally from the diffuser 71 protrudes. The blade 95 defines a longitudinal section plane S1 that are parallel to the longitudinal axis L. of the light applicator 5 runs. The blade 95 pierces and cuts when the light applicator punctures 5 the tissue to be passed in order to facilitate tissue expansion and reduce drag. Especially with solid tissue 17th and this is useful for penetrating tough skin layers.

In 18th an embodiment is shown in which the diffuser 71 is pyramidal with a substantially square base. As in 19th has the lead-in section 11 of the light applicator 5 here a square cross-section. The reinforcement element 95 is also designed here as a triangular, thin, sharp blade, but which is completely inserted into the conical diffuser 71 is embedded and not or hardly distally or laterally from the diffuser 71 protrudes. The longitudinal section plane S1 in which the blade 95 is here from the diagonal of the square base of the diffuser 71 and the longitudinal axis L. of the light applicator 5 stretched. The edges 97 of the scattering body 71 form here from the blade 95 reinforced cut edges (see detailed views on the right in 19th ). In 19th the reinforcing element is shown as two blades arranged in cross section at right angles to one another. This creates a cross cut when piercing, with which the tissue can be expanded particularly easily.

As in 20th shown can the crossed blades 95 be sharpened in various ways on the cutting edge. The two blades 95 can have corresponding slots 99 so that the blades can be inserted crossed into one another. The slots 99 each extend in the longitudinal direction approximately over half of the blades 95 . The width of the slots 99 corresponds roughly to the thickness of the blades 95 .

From the 21st and 22nd it becomes clear that even with a pyramidal diffuser 71 with a square base the reinforcement element 95 in the form of crossed blades 95 to form sharper cutting edges 101 about the diffuser 71 can protrude both distally and laterally.

This in 23 Reinforcing element shown 95 is a V-shaped blade around that of the blade 95 in the diffuser 71 to reduce the opaque area formed in the cutting plane. According to the blades 17th to 22nd however, the blade surface can be designed to reflect light so that this can be well compensated for.

The in 24 to 27 The embodiments shown are deliberately based on a crossed configuration of two blades as a reinforcing element 95 dispensed with and only a blade as a reinforcement element 95 used. The healing and scarring process of a crossed skin or tissue incision can in some cases be worse than a single longitudinal incision. Also is the embedding of a single blade 95 into the diffuser 71 easier to manufacture.

The diffuser 71 has in the in 24 to 27 Embodiments shown have a special polyhedral shape with a square base. The diffuser 71 runs in a first longitudinal section plane S1 at a first angle α pointed distally and in a plane of the first longitudinal section S1 perpendicular second longitudinal sectional plane S2 at a second angle β pointed distally, the second angle β is more acute than the first angle α . In the first longitudinal section plane S1 is the blade 95 embedded as a reinforcing element and protrudes distally but not laterally from the diffuser 71 out. The cut edges 101 the blade 95 run at an angle α to each other and form a point 103 . In the second longitudinal section plane S2, the tissue is not cut, but rather carefully pressed apart, namely only when the cut is made in the first longitudinal section plane S1 for the most part already done has been. The obtuse angles of the edges of the scattering body also help to gently push the tissue apart in the longitudinal section plane S2 71 in the longitudinal section plane S2.

In 24 The phases ae of the skin or tissue opening are shown below when the needle tip has reached the correspondingly marked penetration depth. Initially in phase a is only in the first longitudinal section plane S1 cut and, in phase b, the tissue is only pushed apart a little in the second longitudinal section plane S2. In phase c, the section is in the first longitudinal section plane S1 accomplished. The majority of the widening of the skin or tissue opening in the second longitudinal section plane S2 only takes place in phases d and e, that is to say when the tissue opening has already been achieved by a defined cut.

The diffuser 71 according to the in 24 to 27 Embodiments shown has a first proximal diffuser section 105 with a square cross-section (see phase e). Distal from the first section of the diffuser 105 a second diffuser section extends 107 and distal to the second diffuser section 107 a third diffuser section extends 109 . The second diffuser section 107 has a substantially octagonal cross-section (see phase d) and the third diffuser section 109 has an essentially diamond-shaped cross-section (see phases b and c). The reinforcement element 95 runs in the longitudinal section plane S1 along the longer diamond diagonal in the third diffuser section 109 .

As in 25th and 26th shown, the blade can 95 also via the second diffuser section 107 extend and laterally with the diffuser 71 to lock ( 25th ) or protrude laterally ( 26th ). A larger blade can be used for stronger tissue 95 ( 26th ), a smaller blade for softer tissue 95 ( 25th ). In the 26th shown laterally across the diffuser 71 protruding blade 95 creates a defined tissue cut along the blade 95 . Before the tissue tears open at an undefined other point by the process of expanding while the applicator is being advanced, it should be targeted in the plane of the blade 95 cut open to enlarge the tissue opening.

In 27 an advantageous embodiment is shown in which the blade 95 as in 26th protrudes laterally, and its cut edges 101 run more acute to each other than the angle a and thus a more acute point 103 form. The reinforcement element 95 therefore protrudes with the tip 103 in the radial center of the diffuser 71 further distal out of the diffuser 71 than on the radial outer area of the diffuser 71 . This simplifies the puncture into solid tissue, whereby the force to be applied by the user is reduced, among other things.

The numbered designations of the components or directions of movement as “first”, “second”, “third” etc. are chosen here purely arbitrarily to distinguish the components or directions of movement from one another and can be chosen differently as desired. It is not associated with any rank of importance. A designation of a component or technical feature as “first” should not be misunderstood to the effect that there must be a second component or technical feature of this type. In addition, any method steps, unless explicitly stated otherwise or absolutely necessary, can be carried out in any order and / or partially or completely overlapping in time.

Equivalent embodiments of the parameters, components or functions described herein that appear obvious to a person skilled in the art in view of this description are included herein as if they were explicitly described. Accordingly, the scope of the claims is intended to include such equivalent embodiments. “Can” features designated as optional, advantageous, preferred, desired or similar are to be understood as optional and not as limiting the scope of protection.

The described embodiments are to be understood as illustrative examples and do not represent an exhaustive list of possible embodiments. Each feature that has been disclosed in the context of an embodiment can be used alone or in combination with one or more other features, regardless of the embodiment in which the characteristics have been described in each case. While at least one exemplary embodiment is described and shown herein, modifications and alternative embodiments that appear obvious to a person skilled in the art in view of this description are included within the scope of this disclosure. In addition, the term “have” is not intended to exclude other additional features or method steps, nor is “a” or “an” intended to exclude a plurality.

List of reference symbols

1

Light applicator system

3

Light applicator operating unit

5

Light applicator

7th

Cable section of the light applicator

9

Plug of the light applicator

11

Insertion section of the light applicator

13

skin

15th

healthy tissue

17th

pathological tissue

19th

LED

21st

Connection of the light applicator operating unit

23

Supply module

25th

Control module

27

organ

29

Ribbon cable

31

Working channel

33

shaft

35

Shaft instrument

37

Insertion section of the endoscope

39

Image sensor

41

first shaft section

43

second shaft section

45

third shaft section

49, 49a, 49b

Casing of the light applicator

50

first electrical contact of the LED

51

second electrical contact of the LED

53

Adapter piece

55

Metal half

57

Metal half

59

Insulator layer

61

electrical conductor

61a

first electrical conductor

61b

second electrical conductor

63

contact

65

contact

67

Sleeve

69

Contact bracket

71

Diffuser

73

Connection port

74

Core of the first electrical conductor

75

proximal needle tip section or first thermal barrier coating

76

Sheath of the first electrical conductor

77

second thermal insulation layer

79

third thermal insulation layer

80

deepening

81

Face of the diffuser

82

Widening

83

Edge of the diffuser

84

Undercut

85

Tip of the diffuser

87

light diffusing material

89

light emitted by the LED

91

light emitted by the diffuser

93

Needle tip end area of the diffuser

95

Reinforcement element

97

Edges of the diffuser

99

Slots in the reinforcement element

101

Cutting edges of the reinforcement element

103

Tip of the reinforcement element

105

first diffuser section

107

second diffuser section

109

third diffuser section

A.

first light applicator section

B.

second light applicator section

C.

third light applicator section

D.

fourth light applicator section

L.

Longitudinal axis of the light applicator

S1

first longitudinal section plane

S1

second longitudinal section plane

α

first angle

β

second angle

Claims (19)

Light applicator system (1) for examining and / or treating an organic body, the light applicator system (1) having at least one light applicator operating unit (3) with at least one connection (21) for connecting at least one replaceable light applicator (5) with a distal LED (19) wherein the light applicator operating unit (3) has identification means for identifying the type of a light applicator (5) that can be connected to the at least one connection (21). Light applicator system (1) Claim 1 , the identification means having a mechanical and / or a signal-based identifier, the identifier being set up to only allow those operating modes that are suitable for a specific type of light applicator via the at least one connection (21). The light applicator system (1) according to any one of the preceding claims, wherein the light applicator operating unit (3) is set up to allow a specific type of light applicator only for one-time operation at the at least one connection (21). Light applicator system (1) according to one of the preceding claims, wherein the at least one light applicator operating unit (3) has a plurality of connections (21) for the simultaneous operation of a plurality of light applicators (5). Light applicator system (1) Claim 4 , wherein the identification means have a connection-specific mechanical and / or a signal-based identifier, the identifier differing between at least two of the connections (21). The light applicator system (1) according to one of the preceding claims, further comprising at least two different types of interchangeable light applicators (5), the light applicators (5) being set up to signal their respective type and / or an individual light applicator identifier via the at least one connection (21 ) to be transmitted to the light applicator operating unit (3). Light applicator system (1) according to one of the preceding claims, further comprising at least one shaft instrument (35) with a shaft (33) with a distal insertion section (37), the shaft instrument (35) having at least one working channel (31), the at least one light applicator (5) can be pushed distally through the working channel (31) and its distal-side LED (19) can thereby be positioned at a distal-side end of the insertion section (37). Light applicator system (1) Claim 7 , the shaft instrument (35) having a plurality of working channels (31) for the simultaneous operation of several light applicators (5) and / or the light applicator system (1) having a plurality of shaft instruments (35) for the simultaneous operation of several light applicators (5). Light applicator system (1) Claim 7 or 8th , wherein the insertion section (37) has at least a first shaft section (41), a second shaft section (43) and a third shaft section (45), the first shaft section (41) proximal to the second shaft section (43) and the third shaft section (47 ) runs distally from the second shaft section (45), the shaft (33) in the second shaft section (43) being angled and / or less rigid than the first (41) and / or third shaft section (45). Light applicator system (1) Claim 9 , the light applicator (5) having at least a first light applicator section (A), a second light applicator section (B) and a third light applicator section (C), the first light applicator section (A) proximal to the second light applicator section (B) and the third light applicator section (C) ) runs distally from the second light applicator section (B), the second light applicator section (B) being less rigid than the first (A) and / or third light applicator section (C), the second light applicator section (B) at least partially in the second shaft section (43) is arranged when the distal-side LED (19) of the light applicator (5) is positioned at the distal-side end of the insertion section (37). Light applicator system (1) Claim 10 , the light applicator (5) having an electrical conductor (61) for supplying power to the LED (19), the conductor (61) being sheathed, the sheathing (49) in the second light applicator section (B) being at least partially thinner or missing. Light applicator system (1) Claim 11 wherein the sheathing (49) has at least one tube with a different thickness in sections and / or in a different number in sections. Light applicator system (1) Claim 12 , wherein the at least one tube is designed as a shrink tube. A method for preparing a light applicator system (1) for operation, the method comprising the following steps: connecting an exchangeable light applicator (5) with distal LED (19) and proximal plug (9) to a light applicator operating unit (3) of the light applicator system (1), Identifying the type of the connected light applicator (5) by means of the light applicator operating unit (3), and - providing only certain operating modes based on the identified type of the connected light applicator (5). Procedure according to Claim 14 , wherein in the step of providing only certain operating modes, only a single operation of the light applicator (5) is permitted. Procedure according to Claim 14 or 15th , further comprising a step of pushing the light applicator (5) distally through a working channel (31) in a shaft (33) of a shaft instrument (35) of the light applicator system (1) to the distal-side LED (19) of the light applicator (5) on a distal-side End of an insertion portion (37) of the shaft instrument (35) is positioned. Procedure according to Claim 16 wherein, in the step of pushing through, a light applicator section (B), which is less rigid than other light applicator sections (A, C, D), is positioned in an angled section (43) of the insertion section (37) of the shaft instrument (35). Method according to one of the Claims 14 to 17th wherein in the step of connecting a plurality of light applicators (5) are connected to a plurality of connections (21) of the light applicator operating unit (3) for simultaneous operation. Method according to one of the Claims 14 to 18th , wherein in the step of identifying the light applicator (5) it transmits its type and / or its individual light applicator identifier to the light applicator operating unit (3) based on signals.

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