EP0998232A1 - Dispositif d'ablation par laser et systeme de commande - Google Patents

Dispositif d'ablation par laser et systeme de commande

Info

Publication number
EP0998232A1
EP0998232A1 EP98939108A EP98939108A EP0998232A1 EP 0998232 A1 EP0998232 A1 EP 0998232A1 EP 98939108 A EP98939108 A EP 98939108A EP 98939108 A EP98939108 A EP 98939108A EP 0998232 A1 EP0998232 A1 EP 0998232A1
Authority
EP
European Patent Office
Prior art keywords
laser
ablation member
laser ablation
laser energy
providing
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP98939108A
Other languages
German (de)
English (en)
Inventor
Thomas J. Pacala
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
United States Surgical Corp
Original Assignee
United States Surgical Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by United States Surgical Corp filed Critical United States Surgical Corp
Publication of EP0998232A1 publication Critical patent/EP0998232A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • 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
    • A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A61B2017/22074—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy

Definitions

  • the present disclosure relates generally to laser ablation devices for surgical use. More specifically, the present disclosure relates to a laser ablation device having a control system for automatically controlling a longitudinally advancing laser energy transmission mechanism and/or a laser generator to facilitate ablation of body tissue.
  • the laser ablation device is particularly suited for use in performing transmyocardial revascularization (TMR) and angioplasty.
  • TMR transmyocardial revascularization
  • TMR transmyocardial revascularization
  • a CO2 laser was used to produce holes in the heart wall by transmitting laser energy from the laser to the heart wall.
  • Typical CO2 lasers used for transmyocardial revascularization (TMR) are externally located and have an articulated support arm for aiming and directing laser energy through a series of mirrors that reflect the energy onto the heart wall.
  • TMR transmyocardial revascularization
  • the entrance wound in the heart can be closed by relatively brief external pressure while the endocardial and myocardial layers remain open to permit blood flow from the ventricle to the heart muscle.
  • the intravascular method involves the direction of laser energy from inside the heart to form a bore in the heart wall while the other method involves introduction of the lasing apparatus through a relatively small incision in the patient's chest to access the outer wall of the heart.
  • the optical fiber conveying the laser energy and the laser generating source are typically manually advanced and controlled, respectively, to form a bore.
  • This manual advancement and control presents problems in that depth and rate of penetration are difficult to accurately reproduce for the multiple bores at the different areas of the heart which are necessary in myocardial revascularization procedures. For example, if the advancement rate of the laser is too slow and/or the laser generating source is left on for a long period of time, tissue damage from thermal and acoustic shock can result .
  • U.S. Patent No. 5,607,421 (Jeevanandam, et al . ) discloses the use of a motor to move a laser fiber to a preset stop position, thereby limiting fiber penetration to a preset depth.
  • the actual depth needed to form a proper channel can be hard to measure, such as when creating a channel from the epicardium (exterior) of the heart in the left ventricle.
  • a laser ablation device having a control system for controlling an advancement mechanism provided in engagement with a laser energy transmission mechanism, such as, e.g. an optical fiber device.
  • the control system can further control a laser energy generator optically connected to the laser energy transmission mechanism.
  • Controlled advancement mechanisms include constant and/or variable rate springs, motors, and other mechanisms which can be coordinated with the laser energy generator to advance the laser energy transmission mechanism during ablation.
  • the control system preferably includes a detector responsive to sound generated by laser energy as targeted material is ablated.
  • the detector transmits at least one signal to a control module associated with the laser energy generator and/or the advancement mechanism.
  • the control system operates using the principle that there exists an acoustical difference between the sound generated by the lasing process while in a first material being ablated (such as the heart wall or plaque) , and the sound generated in a second material after the laser fiber passes through the first material (such as into a ventricle or artery filled with blood) .
  • the acoustical change such as, for example, a change in decibel level or pitch, as the end of a laser fiber passes from one medium to another can be detected and allowed to cause an event to occur, such as termination of fiber advancement and/or laser energy transmission and/or activation of a signal, such as an audible sound, to alert the laser operator of the change.
  • FIG. 1 is a perspective view of one embodiment of the laser ablation device having a control system in accordance with the present disclosure
  • FIG. 2 is a perspective view of a laser generator and control module
  • FIG. 3 is a perspective view of a hand piece having an acoustic transducer connected thereto;
  • FIG. 4 is an enlarged side view of the distal end of the hand piece of FIG. 3;
  • FIG. 5 is an exploded view showing the various components of the hand piece;
  • FIG. 6 is a side view illustrating ablation of tissue with the laser ablation device of FIG. 1;
  • FIG. 7 is a side view illustrating the laser fiber entering the heart ventricle
  • FIG. 8 is a side view showing ablation of tissue with the acoustic transducer mounted on the patient.
  • FIG. 9 is a side view showing ablation of tissue with the acoustic transducer mounted on the surgeon's finger.
  • FIG. 10 is a side cross sectional view showing a laser fiber ablating plaque in a blood vessel.
  • a laser ablation device having an audio feedback control system is designated generally as 10.
  • Lasing device 10 is similar to lasing devices disclosed in copending, commonly assigned U.S. Patent Application Serial No. 08/720,934 to Kolesa et al . , filed October 4, 1996.
  • Device 10 is capable of advancing a laser ablation member 11 through a material, such as tissue, while concomitantly outputting laser energy, where the advancement rate is coordinated with the magnitude of laser energy generated and/or with the pulsing frequency of the laser source.
  • the advancement rate, the magnitude of laser energy generated, and the pulsing frequency of the laser source can be automatically controlled by the control system.
  • This coordination and control enables precise channels to be created.
  • the feedback control is achieved by sensing variations of the sound generated by the laser ablation member as it advances through the targeted material, such as heart tissue or plaque.
  • laser ablation device 10 includes a hand piece 12, an optical fiber advancing mechanism 13, a laser generator 14, a foot operated actuator 16, a control module 17, and at least one transducer 18.
  • the optical fiber advancing mechanism 13 is of the type capable of precisely transmitting longitudinal motion to laser ablation member 11, e.g., an optical fiber, optical fiber bundle or other laser energy transmission mechanism including, but not limited to, wave guides.
  • the controlled longitudinal motion can be provided by one or more motors and preferably by one or more stepper motors .
  • the laser generator 14 may be either a continuous wave laser or a pulsed, high energy laser, such as, for example, an excimer, CO2 , Yag or an alexandrite laser.
  • the optical fiber advancing mechanism 13 and the laser generator 14 are operably connected to foot actuator 16.
  • foot actuator 16 By depressing foot actuator 16, laser energy is transmitted through the optical fiber 11 by laser generator 14 while fiber advancing mechanism 13 contemporaneously advances optical fiber 11 relative to hand piece 12.
  • An electrical signal from foot actuator 16 actuates control module 17 which communicates with fiber advancing mechanism 13.
  • Control module 17 is programmable via keypad 62 to control the motors or other suitable advancing structure in advancing mechanism 13 upon actuation of foot actuator 16.
  • the control module 17 is further programmable to respond to signals received from a feedback circuit housed within control module 17 and electrically connected to transducer 18 for suspending operation of advancing mechanism 13 and/or laser generator 14 as described below.
  • the control module 17 includes a display 64 for displaying information to the operator.
  • the control module 17 can further include an audible analyzer to determine the depth of the optical fiber 11 within the heart and to map the depth of the various layers throughout the heart using the signals received by the feedback circuit . Mapping information can be displayed
  • Control module 17 is shown with a receptacle 19 adapted to engage a terminal of a programmable computer to interface control module 17 with the computer. As such, instructions required to operate advancing mechanism 13 can then be stored in memory within control module 17.
  • a toggle switch 15 can be provided to switch from an operation mode to a test mode. In a particular test mode, when the foot actuator 16 is acted upon, the flexible optical fiber 11 is moved sequentially from a retracted position, to a predetermined extended position, and back to the retracted position.
  • Fiber advancing mechanism 13 is preferably equipped with two internal limit switches (not shown) which are manually set to control optical fiber 11.
  • the first limit switch is activated when the optical fiber 11 is at a desired retracted position (i.e., a "home" position), wherein the mechanism that is retracting the fiber is caused to stop.
  • Optical fiber 11 is preferably in the retracted position unless foot actuator 16 is depressed or the test mode is activated.
  • the exact retracted position is selected by means of selector 21, e.g., a rotatable knob.
  • the second limit switch within unit 13 limits/controls the maximum distance that the optical fiber can extend from hand piece 12. External selector 23 is provided so that the operator can select the desired maximum extension of the distal end of the optical fiber from the handpiece .
  • selector 23 can be in the form of a rotatable knob that can be set at selectable positions, wherein each position corresponds to a predetermined maximum longitudinal position of the optical fiber.
  • the fiber reaches the selected maximum position, the fiber's advancement is automatically terminated and laser generation is suspended.
  • the operator can select maximum fiber extension positions so that the distal end of the fiber extends from the distal end of hand piece 12 from between about 0.5 cm and about 5.0 cm, with the ability to select in increments of about 0.25 cm to about 0.5 cm.
  • the maximum extension position can be chosen to be slightly longer than the heart wall thickness for the particular patient such that fiber 11 will penetrate into the patient's ventricle. This thickness can be estimated by echocardiogram measurements, for example.
  • transduce 18 serves to send accoustical signals to control module 17.
  • control module can terminate fiber advancement and laser generation. This control is similar to the activation of the second limit switch (described above) but is caused by accoustical change as opposed to a pre-set value.
  • FIG. 3 illustrates a perspective view of the hand piece 12 of laser ablation device 10.
  • hand piece 12 includes housing 20 formed from molded housing half-sections 20a and 20b. Housing 20 has an elongated body 22 with a conically tapered section 24.
  • Optional locator ring 26 is provided at the distal end of conically tapered section 24.
  • the front surface 29 is positioned in abutting relation with the epicardium of a patient directly following the piercing of the epicardium with the tip of fiber 11 during a TMR procedure.
  • Locator ring 26 facilitates proper orientation of the hand piece 12 with respect to the heart tissue.
  • locator ring 26 can be formed integrally with housing half-sections 20a and 20b or can be removably fastened to tapered section 24.
  • a ridged surface 27 is formed on an outer wall of housing half-sections 20a and 20b to facilitate grasping of the hand piece 12.
  • the hand piece 12 further includes a mounting assembly 66 for mounting the acoustic transducer 18 in proximity to the tip of fiber 11.
  • FIG. 4 illustrates the transducer 18 mounted to the hand piece 12.
  • the transducer 18 includes a stopper 68 which prevents the transducer 18 from moving while mounted to the hand piece 12.
  • transducer 18 can be mounted within hand piece 12, as discussed in greater detail, below.
  • FIG. 5 illustrates hand piece 12 with housing half- sections 20a and 20b and the internal components separated.
  • Housing half-sections 20a and 20b define a central bore 30, a proximal recess 32, and a distal recess 34.
  • the proximal recess 32 is configured to receive a swivel connector 36 which is fastened to the optical fiber casing 38.
  • the swivel connector 36 has an annular flange 40 dimensioned to be received within an increased diameter section 42 of proximal recess 32 to permit rotation of housing 20 with respect to optical fiber casing 38.
  • the locator ring 26 has a cylindrical body portion 44 having an annular flange 46 formed at its proximal end.
  • the cylindrical body portion 44 includes a central bore 50 and is configured to be received within the distal recess 34 defined by housing half-sections 20a and 20b. Central bore 50 of cylindrical body portion 44 is aligned with a central opening 48 formed in the distal end of the housing 20 and the central bore 50 of housing 20. Locator ring 26 can either swivel, to allow independent rotation of the hand piece 12 relative thereto, or be fixed in place.
  • the optical fiber 11 is slidably positioned within central bores 30 and 50 such that it can be advanced through opening 48 in housing 20. Pins or screws 49 can be used to fasten the housing half -sections 20a and 20b together to secure the locator ring 26 and the swivel connector 36 to the housing 20. If locator ring 26 is eliminated, front surface 28 of tapered portion 24 can act as the stop which contacts the patient's outer epicardial surface .
  • FIGS. 1, 3 and 4 illustrate perspective views of transducer 18 of laser ablation device 10.
  • Transducer 18 and the control circuit within control module 17 are the main components of the feedback control system of the present disclosure.
  • Transducer 18 includes a housing 70 having a microphone therein for receiving sound waves emanating from the tip of fiber 11 during firing. The microphone transforms the sound waves into electrical signals which are transmitted to control module 17 via cable 72 for controlling ablation of heart tissue.
  • Transducer 18 and cable 72 can also be incorporated into handpiece 12, wherein cable 72 passes through casing 38 to communicate with control module 17.
  • the operation of the feedback control system will become more apparent from a detailed discussion of a TMR procedure using the presently disclosed laser ablation device.
  • the optical fiber 11 Prior to entry into the epicardium 52, the optical fiber 11 is in the retracted position as shown in Fig. 6.
  • the tip of fiber 11 can protrude slightly from the locator ring 26 by distance D-j_ in the range of about 1 to about 5mm
  • the fiber tip With fiber 11 initially protruding and without depressing the foot actuator to output laser energy, the fiber tip is brought into contact with epicardium 52 so as to mechanically press on and tents the epicardial outer surface (not shown) .
  • the pressure initially causes the fiber tip to advance through tissue faster than the rate of fiber advancement. As such, the tissue in the range of D_ will receive less laser energy compared to the remaining tissue to be ablated which can reduce bleeding from the channel.
  • the fiber tip can start flush with the distal end of locator ring 26.
  • depression of foot actuator 16 also causes activation of acoustic transducer 18.
  • the fiber tip is advanced through the myocardium 50 and endocardium 54 until: 1) it reaches its maximum extended position (FIG. 7) corresponding to the distance D2 measured from surface 11a of fiber tip and surface 29 of locator ring 26 as preset by selector switch 23 or 2) until its advancement is suspended by the control module 17 in response to signals transmitted by transducer 18.
  • the acoustic transducer 18 prefferably be in an activated state at all times during advancement of the optical fiber 11 for continuous monitoring of sound emanating from the fiber tip as the laser fires. This permits continuous feedback to control the advancement of the optical fiber and the laser energy generator.
  • the feedback control system is programmed to advance fiber 11 at a rate that is coordinated with the power level and the frequency of pulsing of the laser generator.
  • optical fiber 11 can be advanced at a rate of between about 0.125 mm/sec (0.005 in/sec) to about 12.7 mm/sec (0.5 in/sec) with a laser power level of about 10 mJ/mm 2 to about 60 mJ/mm 2 and a pulsing frequency of about 5 Hz to about 400Hz.
  • the optical fiber is advanced at a rate of about 0.75 mm/sec to about 2.0 mm/sec with a laser power level of between about 20 mJ/mm 2 to about 40 mJ/mm 2 and a pulse frequency of about 30 to about 50 Hz.
  • the rate of advancement of the optical fiber is no greater than the rate of ablation of tissue in order to minimize mechanical tearing by the fiber.
  • the advancing mechanism can be set to advance the fiber at a rate greater than the ablation rate. Studies have shown that a Xenon chloride excimer laser operating at a power level of about 35mJ/mm 2 can ablate about 30-35 microns of animal heart tissue per pulse.
  • the fiber 11 can be moved to another location on the epicardium to begin forming another channel.
  • the overall procedure wherein dozens of channels 60 are typically formed can thus be performed much faster as compared to prior art methods.
  • FIGS. 8 and 9 illustrate two alternative methods for utilizing laser ablation device 10.
  • acoustic transducer 18 is mounted on the patient and in FIG. 9, acoustic transducer 18 is mounted on the surgeon's hand 74.
  • transducer 18 can be located almost anywhere as long as it can properly detect the desired acoustics during operation and communicate with the control module.
  • the controller can provide a signal to the laser operator that the emitted laser energy has moved from one medium to another.
  • This can be in the form of an audible or visual signal such as a beeper, buzzer or light.
  • the laser operator can remove pressure from foot pedal 16 to terminate the lasing process .
  • FIG. 10 shows the distal end 11' of laser fiber 11 passing through plaque 100 in blood vessel 200. Similar to that described above, an acoustical change can be detected as the fiber transmits a pulse of energy past the plaque, as compared to that while ablating the plaque. This change can be used to terminate the laser energy and to stop and/or withdraw the fiber. It will be understood that various modifications be made to the embodiments disclosed herein. For example, other types of materials could be ablated and the control system and method of the present disclosure be used to control various processes as an acoustical change is detected. For example, in other surgical applications, acoustical change as the laser energy moves from cartilage to bone or from bone to tissue can be detected.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Electromagnetism (AREA)
  • Optics & Photonics (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Otolaryngology (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)

Abstract

La présente invention concerne un appareil et un procédé permettant de pratiquer une ablation par laser, particulièrement la revascularisation transmyocardique (TMR). Pour la TMR, le procédé consiste à fournir d'abord un dispositif laser (10) pourvu d'un élément d'ablation à laser (11) (par exemple, une ou plusieurs fibres optiques), à avancer ensuite ledit élément (11) vers l'épicarde (52) d'un patient, à décharger l'énergie laser depuis l'élément précité (11) de manière à pratiquer une ablation du tissu cardiaque et créer une voie s'étendant à l'intérieur du ventricule (56) du patient, puis à émettre au moins un signal de commande depuis un capteur (18) sensible à l'ablation pour commander l'élément d'ablation à laser (11) et/ou l'énergie laser produite. L'appareil comprend un dispositif à action laser (10), pourvu d'un élément d'ablation à laser, et un capteur (18) pour capter les sons produits par l'énergie laser produite. Le capteur (18) est configuré de manière à générer et émettre au moins un signal en réaction au son détecté en direction d'un module de commande (17) associé au générateur d'énergie laser. Le module de commande (17) peut ensuite provoquer un événement en rapport avec le procédé à action laser ou signaler à l'opérateur laser qu'un événement s'est produit.
EP98939108A 1997-07-22 1998-07-20 Dispositif d'ablation par laser et systeme de commande Withdrawn EP0998232A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US5330997P 1997-07-22 1997-07-22
US53309P 1997-07-22
PCT/US1998/015709 WO1999004709A1 (fr) 1997-07-22 1998-07-20 Dispositif d'ablation par laser et systeme de commande

Publications (1)

Publication Number Publication Date
EP0998232A1 true EP0998232A1 (fr) 2000-05-10

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP98939108A Withdrawn EP0998232A1 (fr) 1997-07-22 1998-07-20 Dispositif d'ablation par laser et systeme de commande

Country Status (5)

Country Link
EP (1) EP0998232A1 (fr)
JP (1) JP2001512039A (fr)
AU (1) AU8760098A (fr)
CA (1) CA2296372A1 (fr)
WO (1) WO1999004709A1 (fr)

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Publication number Priority date Publication date Assignee Title
US6217575B1 (en) 1999-02-24 2001-04-17 Scimed Life Systems, Inc. PMR catheter
US6468271B1 (en) 1999-02-24 2002-10-22 Scimed Life Systems, Inc. Device and method for percutaneous myocardial revascularization
US6464693B1 (en) 2000-03-06 2002-10-15 Plc Medical Systems, Inc. Myocardial revascularization
DE10021529A1 (de) 2000-05-03 2001-11-15 Celon Ag Medical Instruments Von Hand betätigbarer Ultraschallzertrümmerer zum Zerkleinern oder Entfernen von menschlichem oder tierischem Gewebe
US6533779B2 (en) 2001-01-16 2003-03-18 Scimed Life Systems, Inc. PMR catheter and associated methods
US6544220B2 (en) 2001-02-14 2003-04-08 Scimed Life Systems, Inc. Fluid jet PMR
US6709432B2 (en) * 2002-04-26 2004-03-23 Medtronic, Inc. Ablation methods and medical apparatus using same
IL264133B (en) 2010-03-03 2022-09-01 Lumenis Ltd Equipment and methods for tissue microbibilization using fractional treatment patterns

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US4504727A (en) * 1982-12-30 1985-03-12 International Business Machines Corporation Laser drilling system utilizing photoacoustic feedback
US5196006A (en) * 1989-04-25 1993-03-23 Summit Technology, Inc. Method and apparatus for excision endpoint control
NZ242509A (en) * 1991-05-01 1996-03-26 Univ Columbia Myocardial revascularisation using laser
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Title
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Also Published As

Publication number Publication date
AU8760098A (en) 1999-02-16
WO1999004709A1 (fr) 1999-02-04
CA2296372A1 (fr) 1999-02-04
JP2001512039A (ja) 2001-08-21

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