Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
  • A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
  • A61B5/0084—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
  • A61B5/0086—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters using infrared radiation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
  • A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
  • A61B5/0088—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for oral or dental tissue
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
  • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/32—Surgical cutting instruments
  • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
  • A61B17/3421—Cannulas
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00022—Sensing or detecting at the treatment site
  • A61B2017/00057—Light
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
  • A61B2017/00119—Electrical control of surgical instruments with audible or visual output alarm; indicating an abnormal situation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/20—Measuring for diagnostic purposes; Identification of persons for measuring urological functions restricted to the evaluation of the urinary system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
  • A61B5/4528—Joints

Definitions

• Patent No. 5,423,321 issued June 13, 1995 and assignable to the same assignee as the present invention.
• the present invention relates to methods and apparatus for transillumination of various parts of a living body to avoid damaging such parts during an invasive procedure and more specifically to the use of two different light sources in such procedures.
• Yet another object of the present invention is to emit continuously, electromagnetic energy from a body member to be protected during an invasive procedure in a region adjacent thereto and to pulse a light employed to illuminate the region during the procedure.
• Another object of the present invention is to synchronize emissions of electromagnetic energy from a body to be protected during a surgical procedure in a region adjacent thereto with emission of light into the region for illumination thereof.
• Still another object of the present invention is to synchronize a camera shutter with periodic emission of light into a region being subjected to an invasive procedure with periodic emission of detectable energy from a body member to be protected from injury during such invasive procedure.
• Yet another object of the present invention is to couple an optical fiber employed to detect light emitted by a source located in a body part to be protected, to a surgical instrument to be inserted into a body cavity in which a procedure is to be conducted. It is still another object of the present invention to emit infrared energy from a body member to be protected during surgery into a region illuminated by an endoscopic light source from which infrared energy has essentially been removed.
• Another object of the present invention is to employ an infrared energy source to illuminate a region of a body and view the region with a camera sensitive to both visible and infrared light energy.
• Yet another object of the present invention is to transilluminate a body member or region with infrared energy to enhance the view of the region whereby to facilitate a surgical procedure.
• Still another object of the present invention is to transmit infrared light energy down a nerve to be protected during a surgical procedure to cause the nerve to become an infrared light energy emitter.
• infrared emission detection is central to the technology of the present invention.
• the technology takes advantage of the inherent transmissivity of infrared through biological tissues in the range from 700 nm to 1,300 nm.
• all biological tissues are considered composite structures consisting of a scattering medium imbibed with various molecular components that absorb light at specific wavelengths. The amount of light absorbed by different molecules is dependent on the chemical and physical properties of the molecule.
• intense absorption due to hemoglobin and light loss caused by scattering prevents transmission of visible light over more than a few millimeters of tissue.
• the present invention makes use of the fact that infrared energy can be transmitted through several centimeters of biological tissues to implement various procedures such as protection of organs, etc., during invasive procedures adjacent an organ, to transilluminate an organ to locate it and view it and to render nerves visible over a length thereof.
• a probe is employed to detect infrared energy during a laparoscopic operation.
• An endoscopic light source is pulsed while continuous emissions of infrared energy are provided from a body member to be protected, such as a ureter, duct, colon, blood vessel or other body member.
• the visible and infrared light energies are directed by the probe to a video camera to a monitor.
• the endoscopic light source is pulsed on at every other frame or half frame of an interlaced display on a monitor so that every other full frame or half frame displays both the member to be protected and the area of the operation and the next frame or half of the interlaced frame displays only the emission from the body member to be protected.
• the body member emission is enhanced.
• an infrared light source disposed in a body member to be protected during surgery or other invasive procedure in the region of said body member is pulsed on when visible light from the endoscopic light source is projected into such region is off and vice versa.
• the on-time of the source in the body member is synchronized with operation of the shutter of a video camera employed to project an image of a body member on a monitor.
• the body member and the region of the invasion of the body are displayed in alternate frames on the monitor.
• the visible light source is the standard overhead array of lights in an operating room
• the visible lights cannot be pulsed so that only the infrared source is pulsed.
• the detectors then must be sensitive only to infrared and/or to a 12 KHz signal imposed on the infrared light.
• the light -fiber employed to detect light from a body member in the surgical area is secured to a surgical instrument to be inserted into and used in such area.
• the fiber may be carried by a sleeve slipped over the instrument which may be a scissor, a stapler, or the like.
• the fiber may be mounted so as to be a forward looking or single or multiple fibers may be mounted so as to be side looking or both as determined by the requirements of the surgical site and instrument.
• an audible alarm can be used in the former two embodiments of the invention and is synchronized with the infrared light source.
• Such alarm does not respond to infrared energy of the endoscopic light source and the level of infrared energy to produce detection may as a result be reduced to provide information at an even greater distance from the member to be protected than might otherwise be the case.
• the alarm may be of constant amplitude or may vary as a function of the distance of the probe from the infrared emitter.
• infrared light energy is emitted from a body part to be protected during laparoscopic procedures while the rest of the surgical site is infrared free, this being accomplished by removing infrared energy from the light emitted by the endoscopic light source employed to illuminate the surgical site.
• This effect is achieved by employing an infrared blocking filter between the endoscopic light source and the surgical site.
• the endoscope has an annulus of optic fibers for conducting light from an endoscopic light source to the surgical site and a centrally located lens for transmitting light from the surgical site to a CCD of a video camera, the lens having a focal length to accommodate the length of the endoscope.
• the infrared blocking filter may be inserted into the light path from the endoscopic light source whereby infrared light energy from an emitter in or adjacent to an organ or the like to be protected will be the only substantial source of infrared energy in the operative region.
• response of the alarm will be limited to infrared energy from the body to be protected.
• the video camera is made sensitive to both visual and infrared energy the infrared energy source will be clearly identified.
• the present invention also discloses the use of transillumination of a region subject to a surgical procedure.
• an infrared energy source is inserted into the region of the knee joint and an infrared energy probe connected to a video camera and monitor is either inserted into the opposite side of the joint or placed on the surface of the skin on the opposite side of the joint.
• the transillumination yields improved overall illumination of the surgical site while improving definition of the structures lying between the source and the probe.
• an infrared energy source used to transilluminate internal organs, tissues, bones, etc. may be detected by an infrared detector probe and positioning is rendered less difficult.
• An endoscopic source and detector probe may then be accurately positioned in the operative region for detection of the region to be treated.
• the infrared energy source in the original system of the present invention was a 5 milliwatt source.
• the system has been configured to utilize a 1 watt source and in fact uses two such sources. In tests conducted to date only 250 mW have been used.
• the second source is used to transilluminate an organ such as the bladder while an infrared emitter is inserted for instance in the ureter.
• the transillumination may assist in locating various members at the actual surgical site.
• blood vessels, ligaments, ducts, stones in various organs, all or any one of which may be involved in the surgical procedure can be located while at the same time the ureter, etc. are protected utilizing the other laser source.
• a polarizing filter may be placed in the light path to the camera to reduce glare.
• All of the above systems may be operated with NTSC, PAL or SECAM video systems so that as appropriate frames may be interlaced as indicated hereinafter if so desired.
• Figure 3 illustrates a surgical scissor with a fiber bearing sleeve disposed about the instrument
• Figure 4 illustrates the endoscope and related equipment provided in accordance with the present invention
• Figure 5 illustrates a side and end view of the endoscope employed with adapters that can accommodate various filters
• Figure 6 illustrates a block diagram of the control circuits of a preferred embodiment of the invention
• Figure 7 illustrates the preferred embodiment utilizing the light from both diode lasers of Figure 6
• Figure 8 illustrates the use of the IR emitter and probe to locate a body to be subject to a procedure
• Figure 9 illustrates the use of the present invention to illuminate and view a knee joint during arthriscopic surgery.
• Figure 10 illustrates the use of IR energy to define the location of a nerve or nerve bundle.
• FIG. 1 of the accompanying drawings there is illustrated a diagram of a system employing a pulsed laparoscopic visible light source 2.
• the source 2 is turned on and off by a source of energizing pulses 4 at a rate that is synchronized with the frame rate of a monitor 12 via lead 7.
• the endoscope 6 consists of a lens system surrounded by a fiber optic bundle 6a.
• the light cable 3 couples the endoscopic light source 6 to the fiber optic bundle 6a of the endoscope.
• the surgical field is illuminated using the endoscope 6 coupled to the endoscopic light source 2 via the light cable 3.
• the distal end of the endoscope 6 located internally of a body in a region to be illuminated.
• the proximal end of the endoscope 6 has an adapter 52 ( Figure 4) that couples the distal end of the light cable 3 to the proximal end of the internal fiber optic bundle 6a of the endoscope 6.
• the proximal end of the light cable 3 is coupled to the light source 2.
• Standard endoscopic optics directs light supplied by the light source 2 and reflected by the body tissue in such regions to the camera where the signals are processed and displayed on the monitor.
• Normally such cameras have a filter over the sensing chip to block out infrared. In this instance such filter is not used so that the camera can respond to energy of such wavelengths emitted from the fiber optic light guide 6a as well as visible light.
• an IR filter normally found in video cameras is removed from the CCD of the camera and is replaced by a sapphire window placed over the CCD to render it responsive to both IR and visible light.
• an infrared energy filter is inserted into the light path from the source 2.
• the body member to be protected is a ureter designated by reference numeral 14.
• a catheter 16 is inserted into the ureter and a fiber optic light guide 17 is inserted into the catheter and may be conditioned to emit infrared energy in all directions as fully disclosed in said parent of this continuation-in- part application, the full disclosure of which is incorporated by reference.
• the infrared energy is supplied by a 50 mW to 250 mW infrared or visible range light source 18 coupled to the fiber optic light guide 17.
• the continuous infrared energy is transmitted to the fiber optic light guide 17 and via light guide 6 (see discussion of Figure 2) to the video camera which provides an image on the screen of the monitor 12.
• the intermittent visible light is also displayed on the monitor thereby displaying a view of the region being investigated but the display of the infrared image is stronger and readily locates the ureter in this case in the field of view appearing on the monitor.
• the display of the ureter light source clearly predominates.
• IR is removed from the light supplied by source 2
• pulsing of this source is no longer necessary and the IR source may be pulsed to render it more readily detected. This latter embodiment is preferred.
• FIG. 2 there is illustrated a second embodiment of the present invention employing synchronization of various elements of the system.
• light source 18 supplies infrared energy to the fiber optic light guide 17 but the source 18 is pulsed via a lead 20 from a sync source 22.
• the sync source 22 provides pulses to a camera microprocessor 24 that controls the shutter of the camera 10 and the sweep of the monitor 12.
• the sync generator also controls the energization of the light source 2.
• an infrared light sensor 26 that produces an audible sound (and/or visual display) whenever infrared is transmitted thereto via a light guide 28 also introduced into the region of interest via a trocar 30. Note in Figure 2, a dashed line 32.
• This line comes from the sync generator 22 and pulses the light sensor 26 in synchronism with the light source 18. With such procedure, the sensor 26 cannot be triggered by light from the endoscope source 2 and a low threshold may be used so that infrared emission from the ureter may be detected at a greater distance than would be possible otherwise.
• the sync generator 22 alternates energization of the light sources 2 and 18 so that the catheter light is on when the endoscope light source 2 is off and vice versa. Such operation provides great flexibility of the display on the monitor. If the camera is turned on only when the source 18 is energized then only the ureter is displayed.
• the system is established such that the camera 10 is turned on with each light source so that with proper synchronization and preferably the use of an NTSC system the two areas are displayed in alternate interlaced frames on the monitor.
• the sync generator 22 may reverse the on/off cycles relative to the opening and closing of the camera shutter. Specifically maximum view of the ureter is achievable with a reversal of the cycles of the IR source and the endoscope source relative to the camera shutter opening and closing. TABLE 1
• the probe 28 and associated circuitry from the light sensor provide an audible signal (light may be employed) the intensity of which may or may not vary with proximity of the probe 28 to the ureter (see the discussion of Figure 6) . If the signal does vary the location of the ureter may be determined with greater precision than may be possible with the probe 6 - monitor 12 system.
• the probe 28 shows on the monitor and the relative position of the surgical instrument relative to the ureter is more readily determinable by the position of the surgical instrument relative to the probe 28.
• a surgical scissor generally designated by the reference numeral 34.
• the two blades of the scissor are carried at the end of a hollow shaft 38 having the operating mechanism for the scissor disposed therein.
• the scissor is actuated by squeezing together two hand grip members 40 and 42.
• a sleeve 44 is slipped over the shaft 38 and carries- an optical fiber 46 in a passage formed in the sleeve.
• An end 48 of the fiber is connected to a light sensor such as camera 10 or light sensor 26 of Figure 2 or other suitable sensor such as illustrated in the aforesaid application.
• Serial No. 08/190,516 filed February 2, 1994.
• the element designated 50 in Figure 3 is the infrared emitting fiber 17 in the organ to be protected, for instance, a ureter.
• the fiber 46 illustrated in Figure 3 is a forward looking fiber but could also be a side looking fiber.
• Following on Page 20 is a Truth Table, Table 2, of operation with the system of Figure 2, with the camera shutter open and a 5 mW source. When both lights are on continuously the response relative to both of the light sources by the monitor and the audible source is acceptable but enhancement is preferred.
• the monitor display does not provide the sharp differentiation that would be preferred.
• the display of the ureter is clear and sharp since infrared from the endoscopic source does not interfere with the signal generator 26. If the threshold on the audible detector is low enough an audible signal may be detected even though the infrared source is off. This problem may be addressed by pulsing the audible signal source "on” via lead 32 only when the infrared source is energized or by eliminating the IR energy from the endoscopic source. Under either of these circumstances there is no problem with the visual light and the threshold can be set relatively low on this detector. When the camera shutter is closed the Truth
• the pulsing of the infrared or a visible light source 18 coupled to the fiber optic light guide 17 greatly enhances the ability of the surgeon or other health care operative to distinguish between light emanating from the infrared source and visual light reflected from the tissue illuminated by light from an endoscopic or ambient light source.
• the audible signal may be modulated with an identifiable signal to insure that the sound does not simply fade into the background of consciousness. For instance, a 1500 cycle per second tone can be imposed on the output during each "on" cycle. This approach reduces the effect of noise from the light sources.
• the 1500 Hz signal may be applied to a 50% duty cycle 12 KHz square wave.
• the audible signal generator could also be a visual light source that would blink at a rate that varies with proximity of the probe to the body member to be protected or just blink when the ureter is approached.
• Typical specifications for this system are:
• a 5 W infrared LED or two variable 250 mW infrared laser diodes 1.
• the light guide is an Eska Fiber from Mitsubishi. 7. Light source spectrum of 620 nm to 1,000 nm.
• the camera is a Model 2070D manufactured by Envision Medical Corporation of Santa Barbara, California.
• a further embodiment of the present invention is illustrated in Figures 4 and 5 of the accompanying drawings.
• the system illustrated in Figure 4 is similar to that illustrated in Figure 1 and where appropriate the reference numerals of Figure 1 are employed. It is the desire of this embodiment to create an essentially infrared free zone, except for emissions from the ureter, in an effort to unerringly distinguish the light from the ureter from any other source. In order to accomplish this result, an adapter 52 is employed.
• the light source 2 is a halogen or Xenon light source both of which are typically rich in infrared energy.
• a Cyon (#2) filter (not illustrated) is inserted into the adapter 52 or into the light cable 3 of Figure 1 to block the infrared energy.
• the filter is available from Hoyo, No. 8405.
• the filtered light is applied to endoscope 6 which transmits the filtered IR free light to the surgical site 54 via fiber optic bundle 6a of Figures 1 and 5.
• a lens system (diagrammatically 56) is disposed inside of the endoscope 6 and focuses light on the CCD of a camera 10 through a camera coupler 58.
• the camera coupler may have a polarizing filter to minimize glare from the illuminated surgical field.
• the adapter 52 may be constructed to receive removably an IR filter so that if the system of the present invention is not to be used the filter may be removed.
• a power supply 60 is controlled by an on/off switch 62 .
• the supply 60 provides power to two voltage regulators 64 and 66 associated with an audio section 68 and an IR source section 70, respectively.
• the audio section 68 includes a port 72 for a light " detector probe, such as probe 28 of Figure 2.
• the port feeds a voltage controlled oscillator 74 via a tone decoder 76 and an inverter and integrator 78.
• the tone decoder passes a signal at the frequency of modulation provided by a pulse generator 80 in the IR section 70, 12 KHz.
• the voltage control oscillator provides a fixed frequency whenever the signal from the inverter and integrator element 78 exceeds a certain threshold. A variable frequency may also be employed if desired.
• the signal developed by the integrator 78 is supplied to the VCO and thence to an amplifier 82 feeding a speaker 84 or perhaps a light.
• the frequency output of the VCO can vary between 440 Hz and 4400 Hz but as indicated above is currently set to a single tone.
• a volume control 83 controls the output signal from the amplifier 82.
• the voltage regulator 66 is coupled to pulse generator 80.
• the pulse generator can be switched between continuous wave or pulsed operation. In the pulsed mode operation may be at 4 Hz with a 12 KHz tone. In the continuous mode a 12 KHz signal with or without 1500 Hz tone is emitted.
• the pulse generator imposes the tone on the signal produced by the generator.
• the pulse generator supplies its output signal to a laser driver circuit 85.
• the drive circuit drives two laser diodes 86 and 88.
• the laser diodes currently employed are set to operate at a maximum power of 250 mW.
• Potentiometers 96 and 98 on the laser drive circuit 85 are employed to initially set the maximum output of the laser diodes. Once the maximum output is set the wattage output may be varied from 50 mW to 250 mW; control being affected by a laser power control operated by a knob 90.
• the IR outputs from the laser diodes 86 and 88 are supplied to probes, such as the probe 28 of Figure 2 via ports 92 and 94, respectively.
• Transillumination and electronic detection of the test tissue using the system of Figure 6 is approximately three fold more efficient when compared to the Bush Ureteral Illuminator (Rusch, Inc.) and the Bush DLTM Ureteral Illuminating Catheter (Cook Urological) under simulated open and laparoscopic procedures. It should also be noted that detection by the apparatus of Figure 6 did not vary over the 30 mm range. The apparatus of Figure 2 was twice as sensitive of the prior art devices.
• the light from the endoscope has the IR removed and the camera is sensitive to both IR light and visible light energy.
• pulsing is not essential but is preferred and also a polarizing filter may be used to reduce glare.
• infrared light energy can, but not readily, be removed from the overhead lights and pulsing of at least the infrared light energy is strongly preferred.
• the polarizing filter may also be used.
• the signals from the CCD may be processed in a variety of ways to enhance the visibility of the infrared image.
• Such enhancement may include contrast enhancement, additional gain, digital edge detection, addition of pseudo-color, use of the full 1 watt of the laser diode and the like.
• FIG. 7 of the accompanying drawings there is illustrated the use of the second diode laser of Figure 6.
• surgery is to be performed on a bladder designated by reference numeral 100.
• Ureter 102 is illuminated by light fiber 104 from a light source 106.
• the bladder 100 is transilluminated by a second light probe 108 energized by a second laser from a source 110.
• the two sources are those illustrated in Figure 6 and would usually be enclosed within a single case. Except for the second source, the system will be that illustrated in Figures 2 and 6 combined.
• the second IR source permits the surgeon to clearly see the site of the operation and the interior of the organ to be treated. In such a situation the full 1 watt of energy of the laser supplying probe 100 may be employed.
• FIG. 8 there is illustrated another example of use of the present invention to transilluminate tissue to be inspected or operated upon.
• An IR emitting light probe 112 is inserted into the body and the probe 112 is to be positioned in a specific location behind tissue 114.
• An IR detector probe 116 is also inserted into the body on the opposite side of the tissue 114 from the probe 112. The emitting probe 112 is maneuvered into the desired position with the help of detector probe 116
• the site of the operation is viewed on monitor 118 by use of endoscope 120 and associated members including visible light source 122.
• the use of the IR emitting probe 112 and detector probe permits the position of probe 112 to be determined at all times particularly during a scanning procedure.
• a particularly useful approach to arthriscopic surgery employing the apparatus of the present invention is illustrated in Figure 9 of the accompanying drawings.
• a knee joint 124 to be repaired is viewed by an endoscope 126 inserted into leg 128 in alignment with the joint 124 to be repaired.
• the joint is flooded with infrared light by a light probe 130 positioned preferably against the skin of the leg 128 opposite the joint 124 and thus on the opposite side of the joint from the endoscope 126.
• the emitting probe 130 is finished with a flat end placed against the skin outside the body. Because the articular cartilage and surrounding tissues are generally "white and translucent" with less color contrast when compared to laparoscopy, the back transillumination yields improve overall illumination of the viewed surgical site while providing back transillumination of structures between the emitting probe and the endoscope. Applying the infrared light through the skin, diffuses the light and produces good overall illumination of the area.
• FIG. 10 there is illustrated a procedure for protecting nerves from damage during invasive procedures. It has been found that if an IR light emitting probe is brought into contact with a nerve, IR energy is transmitted along the nerve and it becomes an IR emitter.
• nerve fibers are grouped in bundles to form the nerves. Nerves have a translucent and whitish appearance because of their myelin content. It is imperative that they are not inadvertently damaged during surgery.
• the inferior alveolar nerve 130 enters the lower jaw or mandible 132 posteriorly through the mandibular foramen 134. It gives sensory nerve supply or innervation to the gums and teeth of the mandible.
• the inferior alveolar nerve 130 exits the mental foramen of the mandible anteriorly as the mental nerve 136 giving sensory innervation to the skin over the chin and the lower lip.
• the apparatus of Figure 10 illuminates the inferior alveolar nerve 130 using an infrared emitting probe 138 with a spherical end.
• the infrared emitting probe is placed against the mental nerve 136 as it exists the mental foramen 140.
• the inferior alveolar nerve 130 is transilluminated posteriorly.
• the illumination of a length of the nerve permits it to be viewed and preserved.
• the procedure is applicable to protection of important nerve structure wherever located.
• the device disclosed herein will often be sold as an article of commercial in kit form in which the various of the elements may be sold as a package.
• Such could include the light source, the fiber for insertion into an organ, vessel or the like, a catheter which may or may not be used with the aforesaid light fiber, a camera, camera microprocessor, sync generator light source, light sensor, pulse generator and/or audible or visual proximity sensor with ancillary equipment as required.
• the article may be that illustrated in Figure 1, or Figure 2 , the sleeve of Figure 3 or additional equipment of Figures 4 to 10.

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• 1995
  • 1995-09-14 IL IL11529195A patent/IL115291A0/xx unknown
  • 1995-09-15 EP EP95934484A patent/EP0781111A4/de not_active Withdrawn
  • 1995-09-15 JP JP8511079A patent/JPH10508222A/ja active Pending
  • 1995-09-15 WO PCT/US1995/012044 patent/WO1996009001A1/en not_active Application Discontinuation
  • 1995-09-15 CA CA002200063A patent/CA2200063C/en not_active Expired - Lifetime
  • 1995-09-15 AU AU36807/95A patent/AU3680795A/en not_active Abandoned
  • 1995-11-06 TW TW084111742A patent/TW313516B/zh active

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