GB2504933A - A surgical laser having multiple optical fibres - Google Patents

Abstract

A surgical device has multiple optical fibres (20) for transmitting laser light. The laser fibres are surrounded by a sleeve16 and may terminate into a multi-channel fibre connector (30). At least a part of the outer sleeve 16 may be rigid. The fibres maybe formed within inner sleeves that are surrounded by the outer sleeve. The distal ends of the fibres may be arranged in a staggered configuration or as two separate groups. If the ends are arranged in two separate groups (28) the distal ends may face each other in an opposing configuration.

Description

SURGICAL lASER DEVICES LIFT D OF TI-il I'PvLNTlON b The present invuntion relates to medical laser devices far perfoniiing surgical tediniques, and in particular to devices which may be used for perforiniug tissue i-eseetion or ablation dunng laser surgerv

BACKGROUND TO THE LNVENTION

The resection of tissue is eurrqti. pertorrne4 using a process called diathermy, whereby metal eleeubdes in thefl sh*ap of loop, a ball, 4 point or a bar are employed to remove excess tissue. One of the downsides to such a technique is that an electrical curitnt is passed through the pahenl during the coin-sc of the procedure which can 1 5 sometimes gi'e ii se to electrical burns it the circuit v not earthed safely and corre2tl An additional pioblem is that the use of metal electrodes does not generate sufficient heat to allow deep heating of' the surrounding tissue As a result, blood sussels ate sornettmes.no sealed properly and inteital hlcØcjIng can OcCur.

An alttuiative niuhod nolves the ue of surgical laseis, such thai laser tissue ablation is pertormcd using a. single medical grade optical. fibre, mote commonly ref rred to as a laser fibre. These Laser fibres have either a fIat tip, a shaped ip, a eurnd tip o.r.a polished angled sidefte tip The laser fibre is passed as a flexible cable through a hand piece or the working channel of a surgical operating instrument often called a eystoscope or resectoseope. Guiding. and directing a single laser fhre in the working channel is not easy, and is impossible to coordinate the movement and control of two or more laser fibres using traditional iquipment. Moreover laser fibre ablation takes more time to complete, and remo es les tissue from an aftected area More tissue can he removed using a technique referred to as laser enucleation.

However, large pieces of tissue can rcniain withfri the operation site and must he i moved subsequently by a technique cal red tissue morcellanon Tin is in effect a separate and quite different surgical proccdi.tre waich adds more time to the. surgical operation.

US UI' surgical 1srs as an aiteuiauvd metho4 to trachtional diathcny t4chmques is becoming more common. In recent years. surgc.ai procedures empioyih. lasers have gained status as a preferred sut'gicri procedure from the. perspective of both aurgeons and patients, as a result of shorter surgical operations, quicker recovery tmes or patient itid reduced postsurgicai complications (e.g. infection, internal bleeding etc.). For example prostate laser surgery is a procedure to ease urinary iC symptoms caased by an tlargd prostate, a ondhion kna'n as hepign prostatic hyporplasia (BPH). Using a surgical laser, a surgeon is.abic to removç prostate tissue that. may be squeezing the urethra and/or blocking the passage of urine, This ereaçs larger tube, allowing the urine to pass through, This may he clone in one of several ways.

Lasers of all types rise coneetratcd light to gçperaie precise and intense heat.. Flow that intense beat is applied. in this case to the human body during]aser surerv, determhes the type of surgical technique which may be titi]ise4. For exampie the processes referred. as Hoi..AP. the holmium laser ablation, of the prostate; ThL.AP, thulium laser ablation of the prostate; V14.AP., visual laser ablation of the prostale; and [VP, photosele.ctive vaporisation. of the prostate, involve the sculpting of the prostatie urcthra'to create an unobstructed uretht'a by melting, away tissue in the urinary' tract.

The process involves the photosensitive vapori's'3tion ab1ation) of tissue which is often carried out with the use of a.holniium, thulium, diode,, KTP (qtas$ipn titanyl ? Phosphate) or a green laser.

\n altcrnatie method inolves a hoinmini. laser enuckation ot the prosate (or I IoLET) xhei c large p.eccs of prostate traue are rcsected nd subsequentl removed Since this is a forth of laser enuek.ation a secohd step of tissue moreelTation is required after first cutting away the excess.prostatiC tissue Thp inctease in surgical operahn.g time is of particular i11)oa11ce.when a patient has alresdy been Undr a general.anaesffieue for several hours.

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Regardless of the t'pe of surgical technique performed. the standard procedure for prostate laser surgery is to insert.a combined. visual scope and laser through the tip of the penis inte the urethra thrøugli a reseetoscope. Additional c.quipme.nt also uicorpw rted nun ii e rc'LLto'eopc raiv include a saline irrigation sy siecu with separate inflow atid outflow components, and/ut a LissuC morceliaton Part of the problem with having so much equipment for a surgical procedure, apart froni the restric Lion' on the uo ot equipment whiLli may he usee in the IiisL place is the increaed demanth placed on the surgton in lcrms of multi-task'ng A surgeon wnl often executC numerous movements simultaneously, including the activation and deactivation of the la$er, manipulation of the tesectpscnpe with one hand to position the tip of the laser fibre to vithin few ntiilimetrs of the target tissue, and th sweep of the laser fibre back and forth over the surgical site diring the operalion. In addition, a surgeon will be monitoring other factors such as the patien.trs vital signS, the video feed display from the v;sual scope at the surgical site, the adjustment. of the hiflnw arid outflow of the irrigation fluid to/from the surgical site, as well, as the laser *pocr commanded from the lacr spurcc.

A need ists in the art for a surgical.lascr device which enables a sUrgcon to perform 2} a variety of techniques in £3 shortei opei ationul tune toi the clear benefits of the pattent and suigeon ft would therefoic he uselul on such occasions Lu employ a stnble ouigieai lasci device ha\ ing the ahi1it to peifon a wide range of surgical techniques ueh that eparate equipment for perfoming morcellation was not required.

It. would he advantageous if that surgical laser device was sized so that it Was suitably small and compact to comfortably fit within the confines of a standard or slightly modified resectoscope itwould be further advantageous if the surgical laser device had a plurality of 1ase fibres which. could be employed during a srugical process allowing a variety of surgical tcchniqucs (resection, ablation, coagulation or vaporisatiun c/c,) to he employed. It would he highly athantagepus if a surgepn had the ibilily to uou'rol tile OiO ement of the vlurahty of laser fi ores in the surgical laser device to effect the surgical procedures to a high degree ofprecision. In addition, it would he achuintageou.s if the siirgeon could fiirti.er control the power of the laser source. directed to the individual laser fibres of the surgiea]. laser device to the extent that individual lscr fibres could be controlled according to the dethads of tl* surgical tecimique employed.

SUMMARY OF THE INVENTION

Accordingly, the presçflt invention provides a surgical laser device comprising a Ic' plurality of Optical fibres, each optic.cl fibre:eing adapted to carry a beam of light and having an upstream end connectable t.o a laser assembly that provids a respective number of light beams, the optical fibres being suhstantialiy surrounde4 by. sleeve assembly sthi.ci. defines a part of the device. thai can he manipulated by a user, wherein a downs-trearn cud of each optical fibre extends. through (and typically projects beyond) a distal end part of the slenc assunbh The surgical laser device eomrises a plurality of optical fibres., with each optal fibre being configured to receive and carry a beam Of light In particular, a beam o' light haying a high. degree of spatial and tempora] coherence erg. a lasef beam. In an emhodment of the invention it is envisaged that a mLnimuin otT two optical 6hrc may be employed, although a skilled person will be aware that any contenient number of optical fibres niay he employed subject to. cerlaiii pruetical restraints such as the availability of space within the sleeve assembly or the heat that. generated by the optical fibres in use, For example, four, fite, six or more ptic.ai fibres may he employed to. increase the amount of tissue that can be removed by the laser device or to enable a particular sirgical technique to he employed. The optical fibres may comiric 200-440 jun core fibres capable of transmitting about TOW to about. 3.0W pr fibre at variety of wavolengths e.g. .52 nm, 920 nm, 1470 urn, 1980 nfl) and 2010 tim, when operating in puLsed or continuots wave mode.

Tn use, each of the optical fibres receivcs a light beam from a laser assenihly and transmits the light beam. along its interior length until it emerges 11cm the downstreath

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end Although it is anticipated that. the light beams received by, and transmitted a'ong, me optical fibres nil be of a stngle and contlnuou wa\elength working at a pie-set power 1e\el it tS eqUdll\ possiblc that inchidual optical fibrc1⁄4 or groups ot optcal fibres may.rccci:yc and trarisnhit light bçarris of d.iffetent wavelengths and/or poWer levels if. this is desirable, The wavelergtli and/or pv!evi of the light beams. can be controlled by the laser assembly, which will typically include a laser source and a laser beam splitter which separates a. siugh. beam of light into the respective number of light beams flw the surgical laser device. For example, the power output of the laser source earl he selectively controlled and optional filters or absothers can he positioned at the output of the laser beam splitter to vary the power level for individual optkal fibres or groups of opti4al fibres. It tyjll he understood that other means of controlling the wavelength ard/or the power level can be used, inducing additional computer software or control equipment.

In an Cmhodimcnt of the inventiofl the downstream c.nd.s of a plurality of optical fibres n arianged m ctiffeient lateral planes an an opposing contiguration (ic so that the arc angled towards each other) to define what can hO tetmed a jaw' configuratioa More particularly, the optical fibres arc configured such that a first group of optical fibres is arranged in a first lateral plane and a second group of optical fibres is arranged iii aseeoncl.lateral plane. Each.group can include one or more optical fibres and in. the latter case they are typically arranged side by side in the: respective lateral plane. The downstream ends of the optical fibres frt the first group are angle. towards the downstream ends of the optical f htes h the second grol.4p and spaced apart by a gap so that the light beams thaI emerge from fhejr downstream ends are similarly angled tosards each other to allo für reecting of tu,sue in an aitemat{ve embodiment of the: invention the downstream ends of a plurality of optical fibres arc arranged side by skie in the same lateral plan.e to define what can he termed a paw' confi.guration Such a configuration may he more suitable for tissue iibhttion.

in either of the jaw' or 4pa.w' cot figurations, any opucrd fibres arranged side by side in the same latral plane can he ananged in a staggered configmaLon his embodiment of the invention., at 1ei:t patt ofthesTeeve assembly is formed from 5. a substantially rigid material suc]t as, for earnpie, a skii.tahk.. medical grade metal or soirer This perriits a surgeon to use a pres*et or pre-defined shape or o.rieTitati.oii of thu downsticain euth of the optical tiNes fbi perfotming a particulai sutglca1 technique 1 ot exnmple a uhsumtially ngid slcc%c ass mhly haz positi)flR and hOldS the plurality of optical fibres securely so that their downstream ends are mgled towards each other in two tpposiitg groups. e.g. the jaw' configuration described above, may he used to resect a chatinel of tissue. Suitable construction Itatenals for the sleeve assembly may inc.Nde, bUt are not limited to, heat tësistaqt polymers such as p.olyetheretherketon.es, pol.yetherimides. phenol forinaidehyde or polytetrafluoroethylenes. Other materials whidh may be considered include metals such as stainless steel, aluminum, titanium and alloys thereof In an embodiment of the inwjitjon. it i envisaged that the device has a longitudinal axis that i.s typically deEmed by a wbular: part 01 the sleeve a.seni.bly. Th downstream end p14 least one optical fibre (and preftrdhly each oixica.1 fibre) can he angled away from the longitudinal axis suh that the light bean. wbibh emerges from the downstream end of the optical fibre is similarly migled away I om the longitudinal axis. Any light beam which emerges from the downstream end of an angLed optical fibre runs substantially aiohg or parallel tt, the axis of the downstream end of the fibre. in a typical co.nfiguration the dowUstream end of çch optical, fibre might he bent away from the longitudinal axis at an angle of from about 20 to about 30 degrees It is anticipated that smaller angles are possible hut the n'a'clmum angle will be determined by the nature of the fibre. itself, such that total internal reflection of the light beam is naitttai.neçL In an. embodiment of the invetitiOn, the distal end part of the eeve assembly ls fixed relative to the longitudinal axis. In other words, the angle ht which the downstream end of each optical fibre is angled with respect to the longitudinal axis is substantially fixed and cannot he altered by the user. However, in an alteniative embodiment, the distal end pail of the sleete assembly is se eite1y rno\able relative to the iongitudmai ixts by the user The distal end part can be constructed in any cintable vay to _tllo\\ thi SLICCUVC movement to be carried out The dutal end part can oc selectively moved by any auitthi.e control. theap, eg. guide wirCs which are.

coriliected to the distal end part and can, be manipulated by the user, A surgeon is able to select a surgical laser device having an arrangement ol optical fibres that is specifically suiled to a patienfs surgical requirements. i a use, the surgeon can rotate or insert/retract the surgical laser device so that the distal end pad of the sleeve assembly, and hence the downstream, end of the optical fibres, is posti.oned next to a surgical. site within a patieht.. By manipulating the surgical. la.set dzicc within the patient, the surgeon can perform the necessaly surgety.

in an eni}x5djnleqt of the invention, the distal end part of the sleeve assembly may define a plurality of happcls, cath channel receiving an optical fibre.. For example, if there. are. n fibres then the distal end lat ohj&e sleeve assethhly may define n separate channels. The channels may be formed by brilnpiflg a end of the sleeve assembly, which can then lie bent so that the donslieam ends ot the optical fibres are angLed away G am the longitudinal axis olthe cLeice E he ellanne1 s allow optical fihies to he StLuiel\ held and positioned in a side by sick confluration, without the netd for separate sleeve parts.

The sleeve assembly may comprise a plurality of individual parts.

in the case of a paw' configuration, the sleeve assembly may include a single inner sleeve part. the distal end part of which defines a plurahtv of channels as described ahdve, This met sleete.pwt nlay then be optionally surrounded by an outer sleeve..

In the ease of a jaw' configuttion, the sleeVe usernhly may include a flrst. inner 33 sleeve part and a second inner sleet e part the distal end portions of sihid define a piumhiy of channels as described above.. The optical 5.brcs of a. first group are posntioned n the ebanuds of the first inner sleeve part anc-the optieal fibres of a second group are positioned in the channels of the. second inner s]eeve part The first and second inner sleeve parts are then positioned relative to each other so that the; downstream ends of the optical fibres in the first group are angled towards the downstem ends of the opflcal tibres in the seond gruup and ate spaced duiwt by a gap. I he First 4hd second inner sleeve pw-ts ma he optionally.surro mded by an otrtcr sicev.c, in an alternative ethhodiinent of the invention. the. sleeve assembly conipriss a plurally of inner sleeve parts each surrounding a respective one of the optical fi.bres The inner siee parts are then held and positioned relative to each ocher to defihe either the jaw' or paw' configurations. The inner sleeve parts may he optionally surrounded by an outer sleeve.

Each toner slee e part may be provided in the form of a tubular member that 1.5 surrounds and protects either a group of optical fibres or an individual optical fibre depending upon ti..eibodim.ent of the invention. The outer sleeve may also he provided in the form of a tubular memhçr that typically is sufficiently rgid to group together and position the iruiet sleeve part(s).

the optical iThres may he doped with any suitable range of cornpotmds suitdble for their use as medical grade optical fibres, In an embodiment of the invention the optical fibres may typie4]ly he doped with silicon dioxide, or they may he doped with.

one of the rare earth metals, such as erbium, ytterbium. neodymium, dysprosium, praseodymium or thulium. it will he appaent t the skilled person that the range of dopants employed may include any suitable elements or cc pounds. which permit the optical fibres to operate at the required poe' te\els suitable for suigical procedures In an embodiment of the tnentiun, it is anticipated tha the surgical laser de' ice miw he connected in iso to a laser assembi) which includes a laser source and laser beam splitter. The present invention therefolç further provides a]awi assembly c(nnprising: a laser source; a laser beam splitter; and a. sutgical aser device aS doscribed hereizi conreetcd to the laser beam splitter.

The laser source and laser beam splitter may be separate coñponents., although it will be apprecialed that the laser source and laser beam splitter could be integrally conihined due to thL consiramts of size when considering laser surger de'iign ai a modem opiatmg theatLe lJsuig a separate lusei beam splittu allows the surgical laser device to be retro-.fltted For uSe wtfli existing inser sources. itgardiess pf wheLher the laser source and laser beam splitter are integrally contbind or not, it will he apparent to the skilled person that t:he laser beam phfler scparat a single light beam (A e laser beam) that is ioidtd by the laei SOWLe into a plurality ul ugh! beams Each light beam is then piovided to a respectu e optical fibre Muhiri the surgical laer device so that it can he directed to the strgical site For example, the laser beam splitter is able to separate the single light beam into n light beams sach that each light, beam tony he ptovided to a respective, one of n optical fibrcs in tbe surgical laser device, where a 2. Any suitable laser beam splitter can he used and can be connected to the laser source hyany suitable cable or connector The surgicul iasCr dbv±e is preferabTy connected to the laser beam splitter via a suitable inkrrnechate cable v..hich mchdcs a pluruity of optical ribres (t e TI optical fibres). A first connector allows the interntedi4e cable to hc conn ted to the laser beam splitter so that the upstream end of each optical fibre is connected to a respective Omptt of the.: laser hean splitter, while a second connectot allows the cable to ic connected o the surgical laser device preferably h) means of a coopetating connector that forms part of the s'trgie& laser desiec The upstream ends of thc optical fibres of the surgical laser dviee are Onnected to the cooperating connector 2.5 so thai they can be connected to the aownstreahis end of the optical fibres of the intermediate cable. It is antieipated.ihat the various connectors can comprise standard.

connection fit means. e.g. male and fomale parts, if will he apparent that the type of laser source which may he employed may be selected from hut not lnmtcd to a vuret of suitable lasci sources for example a medical grade thrilium laser. A typied stitgical laser operating in continuous wave mode has a powei output of anywhere in the region from about 7O\ to about I 8OVv This allows a surgeon to perform. a virtually bloodless surgica.i procedure due to the deep heat. which may he generated by the lighu beams that emerge from the dovQnstreain ends o.r tips ef tile optical fibres of the surgical laser device. In an alternative emboditnent of the invention, a skilled person will ?iPPrCci4t that it will he possible to operate t1Wl, pt the separate optical fibres independently *acording to the teciunque employed. Each of the opiftal fibres rhu.y he conflgured, to operat4± independently at a, power output from about 1.0W to about 30W.

In an embodiment of the invention, the sleeve assembly is suitably sized and ip dimensioned to pennit it to he inserted into a standard or slightly modified resectoseop.e or other surgical tool for the purposes of using the plurality of opricc], fibres to perform a variety of surgical techniques. Preferably the surgical laser deyicie may he sized and dimensioned such that it may he deployed, alongside, existing surgical tools, or may be integrally combined with. such tools, for example, a saline IS irrigatiOn systepi..

Specific embodithePts of the my tion are now ds,eribed by way of:ex.amplc and with reference to the accompanying drawings in, which, likç numerals are used to 1J1(lCcttC like parts.

DRAWINGS

Pgure I is a schematic drawing showing C $iggical laser.de'ice of the present invention connected to a laser assembly where the laseT source tttid laser be.ant splitter are'.separate components; Figure.2 i.s a schematic drawing showing a. surgical laser device of the present invention. eonrtected to a laser assembly where the laser source and laser beam splitter re intcgally combined; Figure 3 is a plan view of a surgical laser device of the present invention. witha jaw' configuration; Figure 4 is a side view of the surgical laser device of Figure 3 -Ii Figure 5 is a side view of a surgical laserdevice of the present invention wIth a configuration;.

Figure. 6 i.s a plan view of the surgical laser device of Figure 5; rigure 7 is a side vjew of a surgic1 laser device of the present inveution.witb a kpa.w configuratiOn and whcrc the: optical fibres are arranged. in a st4ggere,d configuration; Figure. 8 is a side view ol a surgical laser device of the p.rsent invention where a distal end part of the sleeve assembly defines three channek Figure 9 is a perspective view showing a cable comiector for connecting a surgical laser devIce of the present invention to an intermediate cable; and 1.0 Figure 10 s, a perspective view showing an intermediate cable for connecting the sutgicai laser device to the laser beam splitter.

Retkrring now to the drawings. Figures 1 and 2 show how a urgica1 laset deice 2 is connected in use to a laser assembly comprising a laser source $ and a laser beam 1 splitter 6. The laser source 4 is a thulium medical grade laser configured to operate at a:PQWcr output of hetwoen 7O1 PW. The laser source 4 produces a single laser beam S which is tra,nsrriitted to the last beam splitter 6. The laser beam splitter 6 converts the single laser beam 8 into a plurality of laser beatn 1 Q. which ae the t4ansniitted to the surgical laser device 2 via an intermediate cable. 12.

In the embodnent shown in Figure 1 the laser source -1-and the laser beuni splrttei 6 ar separate components connected together by cable 14. lEn the enihodhnent shown in Figure 2 the laser source 4 and the laser beam splitter & are integrally combined and the cable 14 1.5 not required. insteç1 th singie laser beam S from the. laser source 4 is fed directly into the laser beam splitter 6.

Figures 3 and 4 are. plan and side views, respectively, of a surgic.di laser device 2 with jaw' configuration. A sübsfanti&ly rigid sleeve assen.ib].y 16 includes an outef sleeve 18. that svatound$ a plurality of inner sleeve parts. 2O As shown in. Figures 3 and 4, the inner sleeve parts 2.0 are $iyided into first group 22a and a second group 22h with four inner sleeve. parts 20 in eath got. 11 -

Th&nner sleeve parts 2Oproject beyond a dIstal end 24 of:The outer sleeve $ Where and. sçeond groups 22a 22h divurgo té define tht 5aws' f the surgical laser ckvtcc: Z B!Ph iflPCr:sICtV pm $ bac a distal eM 26 thPDsitDfls and secues thns*aneid2$.ofaopt1iabte4 A pthaJ e36ectei* *pnh eadt: b the but slev pai; O *ith 3ts. èbc4st fld 28 xtSág ingJi the distal end. 26 of the respecS latter slewo.part2O1-and typkatty:pEoj ing tigIny beyon4 it s shwn. In Figure 3-and I supstteitm end being connected to*cthrnetor * R.. tbe surg3cMi laser 4evi*: 2 spwnin flguros) and 4 a total of cightoptieal ft $ are, ie4 ap4' Sit it accornda, t,. its own ümer sleeve part.20. A Ia The dii,fend6 ofthe:innersleeflpSs 20 htths fiStgtnJp22 ae positioned side Wskle ins:tIr$ latent piantan4the'dista[ ends::26 of The inner sleevopatts 20 A *&scon4 group Z hac posiie4, side by Se bi a secondlateril plant The distal hnskeve pfl$ate sp*ed apatygapi8a84arebeitqr angled iüW I Zo*átt ek 4ther as shown lnPigxe. S the open on$ of inner sleeve part 20 is i,sitasvay Mtaiot# IS axis of the 4'4tc 2) so that th:e Jer bwirn 10 that emerge from the downstSS ends 28 cau bó. ud:WrettSsi*.

titeouteK ad jnnøt sleeves is. z4 en. bepØç faw suit*lo nt*tcEJal eg. medical grnde metaL Tht3: Q, flkcs 36 flpii$: 2QQ ip coie rib, cupabje of stit6$ 1040W er tTht& tthe ttq4 teleAgti for pa,Sgth vfint surgiealieôlmique.

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£igure% and 6 are side and plan vIews, r pedtively *1 a sutgi*aI 1St devi 41) wi:paw configuratiqn. The overall coSnactionof the urgic4 laserdevice40 is tce:shownin Pirnes 3 ats! At and like tomponen s have been given the ij*,Stec nza1s4 A substantially rigidsictit asstbly 16 thdUde ozttetslgcvc iS that strtpiin4sa pairtflnnerilceve parts42. TheJnicrslSWp&ts 42 project beyond a dis't4 end 24 -13-ci the outer sleeve I 8 and, are positioned side by side in the same lateral plane. Each inner sleeve part 42 has a distal end 44 which positiohs the downstream end 2.8 of an optical fibre 36. An optical fibre 36 extendsthrough each. of the. inner sleeve parts 42 w nh it' do wnsut am end 28 e'tendinn through the distal end 44 of Thu re'-pect\ e tnnei slce\ e pail 42 -sun typica1 ly proj ect9ig slightly b( sand it as shovn in I ignc 5 and its @psUeain end being conneotcd:to aconnecto 30.

The distal end 44 of each inner Sletve part 42 is bent away from a longitudinal axis oF the device 40 as shown in Figure 5, Figure tis a side view ala surgical laser device.50 with a paw' configuration. The overall conStru.cton of the surgical laser de4ee 50 is similar to the devices shown in Figures 3 to 6 and like, components have. been. given the same reference nutnerls.

is In this embodiment the surgieffi laser device 50 has three:inner sleeve parts 52 and thy are rn-ranged in.a staggered configuration in the same lateral plane-In other words the downstream end 28 of each optical. fibre 36 is positioned at a different distance from the distal end 24 of' the outer sleeve 1. A similar staggered configuration could be applied to one r both of the inner sleeve parts 20 in the firsf and second groups 23a, 22h of the surgical laser dvice 2.showti in Figures 3 artd 4 with the jaw conflguration.

Figtire.8 is a ide view of a surgical laser device 60 with a paw' configuration. The overall construction of the surgie& laser device 60 simiigr to the: deyiees shown in Figures 3 to 7 and like componehts ha been given the sanie refernee nwncrals.

In this embodiment a single inner cTee'e part 62 is posifloneo wathin the outer sleeve I 8 and. its dIstal end 64 deL9nes three separate channels 66a, 66h and 66c. The channeLs 66a, 66b, 66c can be formed by crimping the open end. of the inner sleeve part 6.2 with a snitable tool. The crimped end of the inner sleeve part 62 can then. he hen or angled away frorr a longituLlu al axis of the device 60 1 hree optical fibres 3h will extend through the maci ideeve part 62 sitn each optical fibri 6 being received -14-inn respective one of the.channel.s 66a, 66h and 66c in the distal end 64. The outer s ecvc 1 8 an be urn tIed completel v It v ill be on derstoocl that to tonn 0 configuration. a second inkier sleeve part 62 (ilot shown) can he positioned within the nnter Sleeve 18, In Lils ease the inner sleeve arts.62 can he c nfigurcd so that the parts that project beyond the distal end 24 of the outer sleeVe 18 diverge to define the jaws' ofT the surgical laser device 60.

Fignra 9 slows an alternative connector 70 which Can be used in place of the connector 30 hown in Figures 3 to S.. The connector 30 has inputs arranged in a circular array whereas the coithector 70 has inpuls arrangd in ii linear array. The optical fibres 3.6 have their ustreani ends cninected to the inputs and they extend through the inner sleeve parts 20 with their downstream ends 28 projecting slightly beyond the distal ends 26.. It will. he readily appreciated that any suitable connector can he tsed, .cipUonallywit some soil of male/female configuration, so that it can he 1.5 connected to a cQopcra:ung connector or socket.

The connector 70 of the surgical laser device can be used to connect the.deviec directly to the laser beam splitter 6, However, it is generally preferred that an ititerniediate cable 12 is i',ed Figure 10 shows an tnteuileduttb cable 12 i,utli a fist connector I 2a tiit c.onn.ets to a cooperating connector or socket on the laser beam splitter 6 and *a second connector fTh that connects to the connector 70 shown in Figure 9. It will be readily understood that the intermediate cable 12 includes a plurality of optical fibres 36 (not shown). An upstream end of each cptical fibre 36 will he connected to an input.of the first connector 12a and a downstream cofirietor 26 will be connected toan output of the second. connector I 2h. The intermediate cable 12 &lws the surgical laser device to he conveniently used at a distance from the laser beam splitter 6.

A surgical laser device as described above oan bc operated as as discussed by 0 sa of example n relation to proatcie laser surgery Prior to surgery taking place, tn appwpnate surgical laser device ill tic %lcctcd accoiding to the type of surgical procedure that is due to he performed in tins case the i csection of a channel of tissue within the prostate. The choice of surgical. laser device will he. reflected in the.

number of optical fibres 36 and the position or arrangement of the downstream end 28 of thc fibres 36 ( g a law' or p.iw' coufiguratien, optional!) with stiggeted downsti'cam ends) that are reqi.iired to complete the Su.reiccl technique. The 5airgic.ai laser deVice wil.l then be cqnneçed to the laser. beam splitet 6 so that it receives a respeefive nuniherof laser beams 10 via the intermediat.e eah]e 12.

The surgical laser device is inserted into a standard or modified hand-held rectoseope, together with any additional surgical equipment that might be required.

The surgical laser device is noW ready f2r performing the surgic.altechnique.

The resectoscope incorporating the surgical laser device is inserted up thtpugb. a patient's enis so that the downstream ends 28 of the optical tibte 36 are located at tnc sui aical s,tte ready to resect a chunnel of cxces prostate tissue vithn the urchra The laser source 4 15 -wttehcd on and controlled an I the surgical laser des ice is operated by a surgeon to cut awa-or resect a channel of prostate tissue, While incorporakd ith the resectescope, the surgicel lase, deviL.e can hc krthcr inserted into, or retracted from, the surgical site so that a surgeon is able to position the dosnstreant end.28 c,f the optical fibres 36 ecactiy at the point ira. space that they arO 2.0 requ.red In perthtm the surgical. ceeh.nlquc. In.addhion, it is possible to sweep out an wea Thi the laser beanb 10 engmg from the down1rcarn ends 28 of the ophc4l fibres 36 by iolatang the surgical lasei device about ts longitudinal axis This Lnahks the surgeon to manipulate the downstream ends 28 of the optical fibres 36 to the exact positions that are required so that a ehamiel of tissue can be resec.ied. Upon completion of the surgery, the laser source 1 can be switched off and the surgical laser d e ice can be remo ed trom the patient by ret, act' ng the resectoscope The surgicttl Thscr dcv: ice can also he used to ablate tissue as well as for reseeting. 3D