IT201600113567A1 - DEVICE FOR LASER THERMOHOLING AND EQUIPMENT INCLUDING THE DEVICE - Google Patents

Description

DEVICE FOR LASER THERMOABLATION AND EQUIPMENT INCLUDING THIS DEVICE

DESCRIPTION

TECHNICAL FIELD

The present invention relates to medical devices and equipment for thermal ablation treatments. Embodiments described herein relate to laser thermal ablation systems.

ANTERIOR ART

Thermal ablation is frequently used in medicine for the removal of tissues, such as solid tumor tissues, through a minimally invasive approach. Different forms of energy have already been used in this field, including radiofrequency, microwaves and lasers. Other techniques use cryoablation, that is, the destruction of parts of pathological tissue through cooling cycles, or irreversible electroporation that applies electrical impulses to irreversibly damage the cell membrane.

In the field of laser thermal ablation, devices are used comprising a catheter which constitutes an introducer needle through which a fiber is inserted into the place to be treated.

Basically, electromagnetic radiation, typically laser radiation, is channeled into the tumor mass to destroy cancer cells. To reach the tumor mass, a device is provided which has a catheter or a patent needle within which an optical fiber is guided. In some cases the optical fiber is brought to the place where the laser radiation is to be applied and the catheter is retracted. The bare fiber is in direct contact with the tissues which are irradiated with electromagnetic radiation. In other known embodiments, the fiber is guided in a catheter and remains inside it, said catheter being the material which allows the passage of the laser radiation. A refrigerant fluid circulates in the catheter to remove heat and avoid tissue carbonization phenomena.

A plurality of optical fibers are used to process larger volumes of tissue, each guided in situ through an introducer needle. Currently, the ablation standard with a flat-tip fiber provides for the use of 5 W and a dose of 1200-1800J. To increase the volume in a transverse direction with respect to the axis of the fiber, we use the insertion of more optical fibers while if we want to increase the volume of ablation also in the axial direction we resort to a maneuver of retraction of the fiber and release of a plurality of doses of energy in sequence.

One of the main limitations to obtaining large volumes of ablation with a bare fiber applicator is the formation of a carbonization layer that is created in the wall of the cavity left by the sublimation of the tissue in the area proximal to the fiber and a strong dehydration in the first portion. of tissue behind the char. These phenomena hinder the diffusion of laser light to the distal portions of the tumor, limiting the effectiveness of the device. The obstacle to the diffusion of light and heat developed in the fabrics closest to the fiber causes temperatures to rise in these portions close to the tip of the fiber with consequent sublimation of the fabrics. This phase change consumes laser energy which could otherwise contribute to the denaturation of tissues in the distal areas. Consequently, with the same total energy delivered, the volume that undergoes the desired treatment is less. A further administration of energy essentially contributes to increasing the sublimation of the tissues closest to the tip of the fiber which rise to higher temperatures, without helping to increase the volume treated.

Carbonization occurs due to a high power density at the tip of the fiber and in the space closest to it, where dehydration occurs drying and sublimation of the tissue which produces a charred cavity and a ring of surrounding coagulated tissue. This creates a barrier to thermal diffusion towards fabrics distant from the tip of the fiber. In order to deliver thermal energy beyond the charred and coagulated area, it is not possible to increase the power delivered, since by using a frontal emission of the optical fiber, narrow and long lesions are obtained that are incompatible with the rounded shape that tumorous masses generally have. Furthermore, an increase in the laser power beyond the optimal values leads to a worsening of the irreversible damage process of the cells that we try to obtain with thermal ablation. In fact, at higher powers a rapid increase in temperature is caused in the areas closest to the fiber, which quickly dehydrate drying out because they are not supplied with liquids from the more distant areas. Areas of highly dehydrated tissue become opaque to the transmission of laser light and hinder the propagation of heat in the surrounding volume.

To solve these problems, cooled thermal ablation devices have been created, in which a coolant circulates in the catheter in which the fiber is inserted and removes heat. More particularly, cooled devices of the known type comprise an external catheter having a closed distal end, inside which a conduit is arranged which receives a light guide, typically an optical fiber. A gap is defined between the internal duct and the external catheter, in fluid communication with a second gap defined between the internal duct and the optical fiber. The coolant circulates in the two cavities. The coolant removes heat from the treatment area avoiding overheating and carbonization of the tissues surrounding the fiber.

US-A-7,270,656 describes a laser thermoablation device comprising: an external tubular structure having a closed terminal end and an internal longitudinal cavity; and an internal tubular structure having a side wall defining an internal longitudinal volume terminating with a terminal end. A light guide is inserted inside the internal tubular structure to convey laser radiation to the terminal end. The internal tubular structure extends longitudinally into the internal longitudinal cavity of the external tubular structure. A first cavity is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid. The terminal end of the internal tubular structure is open to place the interspace and the internal volume of the internal tubular structure in fluid communication, to remove heat from the treatment area. In this way, an improvement in the effectiveness of the device is achieved.

The results obtained with this solution, however, are susceptible of further improvements.

SUMMARY OF THE INVENTION

According to a first aspect, a laser thermoablation device is provided comprising an external tubular structure, for example a catheter, having a closed terminal end, and an internal tubular structure, positioned in the external tubular structure. The inner tubular structure comprises a side wall with a terminal end and defining an inner volume, configured to receive a light guide. A first cavity is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid. To favor and improve the circulation of the cooling fluid, the side wall of the internal tubular structure comprises at least one lateral opening which places the first cavity, formed between the internal tubular structure and the external tubular structure, in fluid connection, with the internal volume of the structure. internal tubular. The presence of the light or side opening made in the wall of the internal tubular structure favors a laminar flow and with low losses of the refrigerant fluid resulting in better efficiency in the removal of heat and better effectiveness of the treatment performed with the device.

In practice, the device can have a handle and optical and hydraulic connection members to an equipment that includes a laser source and a refrigeration circuit. The internal tubular structure and the external tubular structure constitute the terminal or distal part of the device. The external tubular structure can be formed by a patent needle, a catheter or other tubular element.

Preferably, to obtain a more effective circulation of the cooling fluid, the side wall of the internal tubular structure comprises more than a single opening or port for the passage of the cooling fluid. In advantageous embodiments, a plurality of lateral ports are provided, which place the first interspace in fluid connection with the internal volume of the internal tubular structure.

To obtain a more uniform flow, the ports or openings formed in the wall of the inner tubular structure are preferably arranged staggered from each other around a longitudinal axis of the inner tubular structure.

In advantageous embodiments, the side ports are arranged staggered from each other, i.e. spaced apart, along the longitudinal development of the internal tubular structure.

The terminal end of the internal tubular structure can be open so that the flow of refrigerant fluid can pass both through the side ports, formed in the wall of the internal tubular structure, and through the open end of the latter. However, in preferred and embodiments, a better circulation of the refrigerant fluid is obtained if the terminal end of the internal tubular structure is closed. In this way, the cooling fluid flows only through the side openings formed in the side wall of the internal tubular structure.

In order to obtain uniform cooling and uniform irradiation of the tissues surrounding the device during its use, it is advantageous for the internal tubular structure and the external tubular structure to be substantially coaxial to each other, at least in the electromagnetic radiation emission zone. For this purpose, spacers placed in the gap between the external tubular structure and the internal tubular structure can be used. In devices of the current art, these spacers are made by extrusion together with the wall that forms the external tubular structure or the internal tubular structure. These spacers substantially reduce the section useful for the passage of the refrigerant fluid flow. To avoid this drawback, in particularly advantageous embodiments of the device according to the invention, between the external tubular structure and the internal tubular structure a first spacer can be placed having a helical shape extending around the longitudinal axis of the internal tubular structure and of the external tubular structure. For example, the spacer can be formed by a filiform element produced as a mechanically separate component with respect to the internal tubular structure and with respect to the external tubular structure. This spacer reduces in a much smaller way, compared to traditional spacers, the section useful for the passage of the refrigerant fluid. Preferably, a single spacer element is provided.

Preferably, it is also advisable to keep the light guide in a substantially coaxial position with respect to the internal tubular structure. For this purpose it is appropriate to use a second spacer placed in a gap formed between the internal tubular structure and the light guide placed in the internal tubular structure. The second spacer can also be configured as a linear or filiform element arranged helically around the axis of the internal tubular structure, between this and the light guide.

In some embodiments, the light guide can comprise an optical fiber, which can extend up to the terminal end of the internal tubular structure. In other embodiments, the optical fiber may have a distal end placed within the internal tubular structure at a certain distance from the terminal end of the internal tubular structure. The tip of the optical fiber and / or a portion of its lateral surface adjacent to the tip can be machined to obtain the diffusion of the electromagnetic radiation, typically a laser radiation, conveyed along the optical fiber.

In other embodiments, it can be envisaged that the optical fiber is combined with a diffuser positioned between the terminal end or tip of the optical fiber and the terminal end of the internal tubular structure. The diffuser has a shape and / or a surface finish and / or a material containing diffusing particles, to promote the diffusion of electromagnetic radiation from the inside of the diffuser to the outside of the diffuser.

In some embodiments, the diffuser includes a central core and an outer sheath surrounding the core. The sheath, or the core, or both the sheath and the core, can be diffusing at a wavelength of an electromagnetic radiation propagating in the light guide.

In advantageous embodiments, the core is made of a transparent material at the wavelength of the electromagnetic radiation propagating in the light guide, while the sheath is made of a diffusing material. This simplifies the construction of the diffuser. In order to increase the quality of the diffusion of the electromagnetic radiation, obtaining a more uniform irradiation, according to advantageous embodiments the diffuser has a curved shape, in particular a shape with an approximately helical shape, in at least a portion of its longitudinal extension. For example, the diffuser can have a proximal rectilinear section (i.e. closer to the optical fiber) and a distal section (i.e. further from the optical fiber) of helical shape, forming one or more coils around a geometric axis substantially corresponding to the longitudinal axis of the internal tubular structure.

When the device has an optical fiber configured to diffuse the electromagnetic radiation laterally and / or comprises a diffuser configured to diffuse the electromagnetic radiation laterally, the internal tubular structure and the external tubular structure can be made of a material which is simply transparent to the electromagnetic radiation conveyed along the light guide housed in the internal tubular structure.

In some embodiments, however, it can be envisaged that one, the other or both of the aforementioned external and internal tubular structures are made in such a way as to diffuse the electromagnetic radiation propagating in the light guide.

For example, it is possible to create a light guide comprising an optical fiber which ends at a certain distance from the terminal end of the internal tubular structure, and which emits a beam of electromagnetic radiation, typically a beam of laser radiation, from its tip. The beam can be divergent and affect the internal surface of the internal tubular structure which, if made of diffusing material, promotes the uniform diffusion of the electromagnetic radiation towards the external tubular structure. The latter can be transparent or also diffuse to electromagnetic radiation. In other embodiments, the internal tubular structure can be transparent to the electromagnetic radiation used, while the external tubular structure is diffusing.

The internal tubular structure and / or the external tubular structure can be made diffusing with an appropriate mechanical or even chemical surface processing. In some embodiments, the external tubular structure and / or the internal tubular structure can be made diffusing by adding suitable particles or powders diffusing into the base material of which the internal tubular structure and / or the external tubular structure is made. The base material can be a quartz, glass, resin or other polymeric material.

In some embodiments, the terminal end of the external tubular structure is closed by a closure element made of a material diffusing at the wavelength of the electromagnetic radiation propagating in the light guide. In this way the propagation of the electromagnetic radiation is obtained also from the front. In other embodiments, the closure element may be opaque to the electromagnetic radiation used, in which case the electromagnetic radiation diffuses into the surrounding tissues only radially with respect to the axis of the external tubular structure. In still further embodiments, the closing element of the terminal end of the external tubular structure can have a reflective surface facing the interior of the tubular structure itself. In this way, the electromagnetic radiation incident on the closing element is reflected backwards and can spread into the tissues through the side wall of the external tubular structure.

As previously noted, the temperature reached in the treatment area can be a critical parameter, since in order to obtain the denaturation of the tumor cells it is necessary to reach a sufficiently high temperature. However, high temperatures lead to carbonization of the tissues and thus to the generation of an obstacle to the further propagation of electromagnetic radiation. To obtain a better control during the treatment phase, some embodiments of the device provide a temperature sensor associated with the external tubular structure. The temperature sensor can be a thermocouple, a thermistor, or any other suitable sensor. The temperature sensor is preferably housed inside the external tubular structure, to be mechanically protected.

According to a further aspect, an apparatus for laser thermoablation is described herein comprising: a device as described above; a laser source; a refrigeration circuit; a control unit.

The equipment may also include one or more of the following elements, components, or devices: a circulation pump for the refrigerant fluid; a flowmeter, configured to detect the flow rate of refrigerant fluid; a pressure sensor configured to detect the pressure of the refrigerant fluid in at least one point of the refrigeration circuit; a tank for feeding the refrigerant fluid towards the device; a tank for collecting the refrigerant fluid from the device; a storage and recycling tank for the refrigerant fluid; a member for removing heat from the refrigerant fluid.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be better understood by following the description and the accompanying drawings, which show practical non-limiting embodiments of the invention. In particular, in the drawings they show:

Fig.1 an overall view of a device according to an embodiment;

Fig.2 is a section on the line II-II of Fig.1;

Fig.3 a section on a plane containing the longitudinal axis of the catheter constituting the distal element of the device of Fig.1;

Fig.4 in the cross section along the line IV-IV of Fig.1;

Fig. 5 a section according to a plane containing the longitudinal axis of a catheter in a different embodiment;

Fig. 6 is a diagram illustrating the trend of the coolant flow rate as a function of the supply pressure;

Fig. 7 a section according to a plane containing the longitudinal axis of a catheter in a further embodiment;

Fig.8 a second floor section containing the longitudinal axis of a catheter in yet another embodiment;

Figs. 9, 10, 11, embodiments of the terminal part of the catheter and of the components contained therein;

Figs.12A-12H embodiments of a terminal closure element of the catheter;

Fig. 13 an embodiment of a catheter with a dilatable member;

Figs. 14 and 15 diagrams of a refrigerant circuit of an appliance using the device described here;

Figs. 16 and 17 diagrams of equipment according to the invention in two embodiments;

Fig. 18 is an isometric view of an end portion of a light guide inserted in an internal tubular structure in a variant embodiment;

Figs. 19, 20, 21 alternative embodiments of the light guide and in particular of the terminal diffuser thereof;

Figs. 22A-22I light guide diffuser emission diagrams in various embodiments;

Figs. 23A-23C embodiments of the terminal element of the light guide.

DETAILED DESCRIPTION OF FORMS OF IMPLEMENTATION

The following detailed description of exemplary embodiments refers to the accompanying drawings. The same reference numerals in different drawings identify the same or similar elements. Also, the drawings are not necessarily to scale. Furthermore, the detailed description that follows does not limit the invention. Rather, the scope of the invention is defined by the attached claims.

Reference throughout the description to "an embodiment" or "the embodiment" or "some embodiment" means that a particular feature, structure or element described in connection with an embodiment is included in at least one embodiment of realization of the described object. Therefore the phrase "in an embodiment" or "in the embodiment" or "in some embodiment" at various points along the description does not necessarily refer to the same or the same embodiments. Furthermore, the particular features, structures or elements can be combined in any suitable way in one or more embodiments.

With initial reference to Fig. 1, 1 indicates a device according to the invention, in a first embodiment. The device 1 comprises a distal part 3 and an optical-hydraulic connection 5 to an apparatus, described below, containing a laser source. The optical-hydraulic connection 5 can comprise three channels, better illustrated in the section of Fig.2. A first channel 7 and a second channel 9 serve to circulate a cooling fluid inside a catheter, described below, which is part of the distal portion 3 of the device 1. A third channel 11 serves for the passage of a light guide, for example an optical fiber 13. In some embodiments, as described in more detail below, a connection to a temperature sensor, which is located at the distal end of the catheter of the device 1, can also pass through the channel 11.

In the embodiment illustrated in Figs. 1 and 2 the channels 7, 9 and 11 are substantially coplanar, and the channel 11 is interposed between the channels 7 and 9. In this way the channels 7 and 9 are spaced apart, to limit mutual heat exchange. The channels 7, 9 and 11 are enclosed in a flexible pipe 10, forming a common sheath that holds together the channels 7, 9 and 11 up to a terminal element 12 from which the channels 7, 9 and 11 branch off separately, ending with respective fittings 15, 17 and 19. These fittings serve to connect the device 1 to the apparatus containing a laser source, to inject a laser radiation into the optical fiber 13, and a refrigeration circuit which circulates a refrigerant fluid through the channels 7 and 9.

Fig. 3 illustrates, in a section according to a plane containing the longitudinal axis, the distal portion 3 of the device 1, and Fig.4 shows a cross section along the line IV-IV of Fig.3 of this distal portion.

The distal portion of the device 1 comprises an external tubular structure 21, consisting for example of a catheter or a needle. The terminal end of the external tubular structure 21 is closed by a closing element 22. In the following, the external tubular structure 21 will also be referred to briefly as a catheter.

An internal tubular structure 23 is arranged inside the external tubular structure 21. In the embodiment illustrated in Fig. 3, the internal tubular structure 23 is essentially constituted by a side wall of a small diameter tube, ending with one end terminal closed by a closing element 24.

In some embodiments, the external tubular structure or catheter 21 and the internal tubular structure 23 can have a circular cross section, as shown in particular in the cross section of Fig.4.

The outer tubular structure or catheter 21 comprises a tubular wall with an outer surface 21.1 and an inner surface 21.2. Similarly, the internal tubular structure 23 comprises a side wall with an external surface 23.1 and an internal surface 23.2. The internal surface 23.2 defines an internal volume of the internal tubular structure 21. Between the internal surface 21.2 of the external tubular structure 21 and the internal surface 23.1 of the internal tubular structure 23 a gap of annular section is defined 25.

When assembled, a light guide or optical guide 27 is inserted in the internal tubular structure 23 which constitutes an element conveying electromagnetic radiation towards the terminal end of the external tubular structure 21. As can be seen in particular in the section of Fig. 4, the light guide 27 is approximately coaxial to the internal tubular structure 23 and a gap 29 is formed between the internal surface 23.2 and the light guide 27. The light guide 27 is optically coupled to a laser source (described below), which generates a laser beam of suitable wavelength and power, for the thermal ablation treatment. Embodiments of the light guide 27 will be described in greater detail below.

In the embodiment illustrated in Figs. 3 and 4, the tubular wall of the internal tubular structure 23 comprises a plurality of lateral openings or openings 31, made in the lateral wall of the internal tubular structure 23. The lateral openings or openings 31 place in fluid communication the interspace 25 with the internal volume of the internal tubular structure 23 and more precisely with the interspace 29. In this way a refrigerant fluid which enters the interspace 25 can reach the terminal area of the external tubular structure 21 and of the internal tubular structure 23 and enter inside the internal tubular structure 23 to return towards the apparatus to which the device 1 is interfaced. The circulation of the refrigerant fluid can also be reverse, with supply through the interspace 29 and return through the interspace 25.

Although theoretically it is possible to provide a single side port 31, for a better flow of the cooling fluid it is advantageous to provide two or preferably at least three side ports or openings 31. Advantageously in some embodiments the side ports 31 are arranged angularly offset from each other around a longitudinal axis A-A of the internal 23 and external 21 tubular structures, which are substantially coaxial to each other. In some embodiments the angular pitch can be constant. For example, if three side lights 31 are provided, they can be arranged staggered by 120 ° from each other. Furthermore, in advantageous embodiments the side ports 31 are distributed along the axis A-A of the external tubular structure 21 and of the internal tubular structure 23, i.e. they are spaced apart along the longitudinal development of the device 1.

The side openings or ports 31 can have any suitable shape, for example circular or elliptical.

It turned out that, through the side ports 31, a better flow of the coolant fluid, in particular a coolant liquid, is obtained between the interspace 25 and the interspace 29 or vice versa. The flow obtained through the side ports 31 tends to be laminar, thus preventing or limiting the formation of vortices in the tip of the device. The pressure drops are lower, thanks to the laminarity of the flow, compared to what is obtained in the devices of the current art, in which the fluid connection between the external cavity and the internal cavity occurs through the open end of the internal tubular structure . By providing openings or side ports 31, a better circulation of the refrigerant fluid is obtained and therefore a greater flow with the same thrust, that is, the pressure of the refrigerant fluid.

This improvement in the flow of refrigerant fluid is obtained both with a configuration of the type illustrated in Fig. 3, where the terminal end of the internal tubular structure 23 is closed by the closing element 24, and, albeit to a lesser extent, with a structure of the type shown in Fig. 5. This figure shows a device substantially the same as that of Fig. 3, but which differs from the latter substantially only in that the internal tubular structure 23 is open at the front, rather than closed by the closing element 24. To improve the flow conditions, the terminal end of the internal tubular structure 23 is cut in the shape of a flute, ie with an oblique cut with respect to the longitudinal axis A-A. The increase in the flow of refrigerant fluid allows the device to deliver greater power and obtain a larger ablation volume, allowing the treatment of larger tumors even in an advanced state. Fig.6 shows a diagram showing the flow rate in ml / min of a refrigerant liquid as a function of the pressure applied to obtain its circulation inside the device 1. The diagram in Fig.6 shows 3 curves indicated with C1, C2 , C3 obtained experimentally. The curve C1 is obtained with a device of the type illustrated in Fig. 3, while the curve C3 and the curve C2 represent the capacities for devices of the current art, without any lights or side openings made on the wall of the internal tubular structure and in which the connection between the interspace 25 and the interspace 29 is obtained only in correspondence with the front opening, ie the terminal of the internal tubular structure 23. The curves C2 and C3 have been obtained with an internal tubular structure ending with an inclined edge, made with an oblique cut, and with an edge orthogonal to the longitudinal axis, respectively.

A substantial increase of about 15-20% of the flow rate with the same pressure is observed in favor of the solution according to the invention compared to the configurations of the current art.

In order to obtain effective cooling, the flow of the refrigerant fluid should be as homogeneous as possible inside the cavities formed by the external tubular structure 21, the internal tubular structure 23 and the light guide 27. It is also advisable not to have flow reduction zones in the distal part of the device, i.e. in the vicinity of the lateral ports or openings 31. On the other hand, to obtain uniform irradiation of the surrounding tissues, within which the catheter 21 is inserted, it is appropriate that the light guide 27, the internal tubular structure 23 and the external tubular structure 21 are as concentric to each other as possible. The presence of spacers traditionally obtained by extrusion, inside the cavities 25 and 29, reduces the cross section useful for the flow, consequently increasing the pressure drops and reducing the flow rate. In addition, the spacers of the current art make the flow of the refrigerant fluid uneven, resulting in unevenness of the refrigeration effect.

According to advantageous embodiments described here, in order to solve or alleviate these problems, spacers of innovative shape are used. With reference to Figs. 3 and 4, a first spacer 33 is arranged in the interspace 25 between the external tubular structure 21 and the internal tubular structure 23. This spacer has the shape of a linear element, that is, thread-like, which winds helically around the longitudinal axis A-A of the internal tubular structure 23 and of the external tubular structure 21. The helical shape of the first spacer 33 can be seen in particular in Fig. 3. The helical spacer 33 can have a circular section, as shown in Fig. 4. In other embodiments the first spacer 33 can have a cross section of a different shape, for example elliptical. Regular or irregular polygonal shapes of the cross section of this spacer 33 are not excluded, which may be dictated by the need to improve flow conditions. In practical embodiments, the first spacer 33 is constructed as a physically separate component with respect to both the internal tubular structure 23 and the external tubular structure 21, rather than being obtained by extrusion of a piece with one or the other of these tubular structures. . This allows the first spacer 33 to be arranged helically with the desired pitch around the longitudinal axis A-A.

The first spacer 33, with helical development, allows the external tubular structure 21 and the internal tubular structure 23 to be kept coaxial with each other, without representing an excessive obstacle to the circulation of the refrigerant fluid inside the interspace 25. useful section for the flow of the refrigerant fluid corresponds to the cross-sectional area of the single spacer 33. The helical arrangement allows the internal tubular structure 23 and the external tubular structure 21 to be kept coaxial with a single spacer, while the solutions of the current art , with spacers made integrally by extrusion with the external or internal tubular structure, would require the use of at least three spacers angularly offset by 120 ° with respect to the longitudinal axis of the external tubular structure and of the internal tubular structure.

The first spacer 33 allows the internal tubular structures 23 and external 21 to be kept concentric with each other. For a better efficiency of the device, it is appropriate to keep the internal tubular structure 23 and the light guide 27 concentric as well. In advantageous embodiments, a for this purpose, again with reference to Figs. 3 and 4, a second spacer 35 can be arranged in the interspace 29. The second spacer 35 can have substantially the same shape as the first spacer 33, i.e. it can be constituted by an elongated linear element, i.e. thread-like, for example with a circular cross-section . The second spacer 35 can be arranged helically around the longitudinal axis A-A, as shown in the longitudinal section of Fig.3. The spacer 35 allows to keep the light guide 27 substantially coaxial to the internal tubular structure 23, without significantly hindering the flow of refrigerant fluid in the interspace 29.

By using linear elements with helical winding as spacers, instead of extruded straight spacers together with the tubular structure, there is also the advantage of being able to arrange these spacers only in the terminal area of the external tubular structure 21 and of the internal tubular structure 23, leaving the section of passage defined by the interspaces 25 and 29 in the proximal area of the tubular structures 21, 23, as can be seen in particular in the section of Fig.3.

In the embodiment of Figs. 3 and 5 the terminal end of the internal tubular structure 21 is closed by a closing element 22, of ogival shape, that is, with a rounded external end. As will be clarified in greater detail below, the closing element 22 can be made with different optical properties, for example it can be transparent, diffusing or reflecting at the wavelength of the electromagnetic radiation conveyed by the light guide 27. In variants of embodiment the closing end 22 of the external tubular structure 21 can have a different shape, for example conical or pyramidal, as shown by way of example in the embodiments of Figs. 7 and 8. The embodiments of Figs. 7 and 8 are otherwise substantially similar to the embodiments of Figs. 3 and 5 and are therefore not described in greater detail. The same reference numerals are used to mark corresponding elements in the various embodiments. The embodiment of Fig. 7 has an internal tubular structure 23 with an open distal or terminal end, while the embodiment of Fig.8 provides an internal tubular structure 23 with a terminal end closed by a closing element 24.

In the embodiments illustrated Figs. 3 and 5 the light guide 27 comprises an optical fiber 28 which extends inside the internal tubular structure 23 up to close proximity to its distal end. The end part of the optical fiber 28 can be machined in such a way as to be diffusing, that is, to allow the escape of the optical radiation conveyed by the light guide 27 through the side wall of the optical fiber. The optical radiation that diffuses from the side wall of the terminal portion of the optical fiber 28 can pass through the internal tubular structure 23 and the external tubular structure 21 to then diffuse into the tissue inside which the catheter formed by the external tubular structure 21 has been inserted. For this purpose, at least a part of the internal tubular structure 23 and of the external tubular structure 21 are made of a transparent or diffusing material at the wavelength of the electromagnetic radiation conveyed along the light guide 27.

In other embodiments, the optical fiber 28 can have a lower longitudinal development and terminate at a certain distance from the distal or terminal end of the internal tubular structure 23. In the embodiments of Figs. 7 and 8, the light guide 27 comprises an optical fiber 28 and a diffuser 30, which extends from the tip 28P of the optical fiber 28 towards the terminal end of the internal tubular structure 23. The diffuser 30 is made in such a way that the electromagnetic radiation conveyed by the light guide 27 escapes from the lateral surface of the diffuser 30 itself. Also in this case, at least part of the internal tubular structure 23 and of the external tubular structure 21 are made of materials that are transparent or diffuse to the electromagnetic radiation conveyed by the light guide 27.

Particular embodiments of the diffuser 28 will be described later with reference to Figs. 19, 20, 21.

In other embodiments, the light guide 27 may terminate at a certain distance from the terminal end of the internal tubular structure 23. For example, the light guide 27 may comprise the optical fiber 28 and be devoid of diffuser 30, with a terminal end of the optical fiber 28 placed at a distance from the terminal end of the internal tubular structure 23 equal to a multiple of the diameter of the internal tubular structure 23. Examples of embodiment of a device 1 of this type are illustrated in Figs. 9, 10, 11. In these embodiments, the electromagnetic radiation R mainly emerges from the tip of the optical fiber 28 which remains integrally housed in the internal tubular structure 23. The tip of the optical fiber 28 can be suitably shaped, to emit a radiation beam electromagnetic, and more precisely a beam of laser radiation, of suitable shape, for example diverging. The materials of which the internal tubular structure 23 and the external tubular structure 21 are made are chosen in such a way as to obtain the diffusion of the electromagnetic radiation towards the outside of the external tubular structure 21 to irradiate the surrounding tissue, within which the catheter is inserted. formed by the external tubular structure 21.

For this purpose, in some embodiments at least the terminal part of the internal tubular structure 23 can be made of a material transparent to the electromagnetic radiation used, while at least the terminal portion of the external tubular structure 21 is made of material diffusing at this wavelength. . In other embodiments, also the terminal portion of the internal tubular structure 23 can be made of a diffusing material, rather than transparent to the wavelength used. In still other embodiments, the internal tubular structure 23 can be made, at least in its terminal portion, of a material diffusing the electromagnetic radiation used, while at least the terminal portion of the external tubular structure 21 can be made of a material transparent to this radiation. electromagnetic. In general terms, at least of the external 21 and internal 23 tubular structures are made of a diffusing material, while the other can be made of a material transparent to the electromagnetic radiation used, or both are made of diffusing material.

In Fig. 9 the terminal part of the internal tubular structure 23 is made of diffusing material and the electromagnetic radiation beam, for example a laser beam, which emerges from the distal end of the optical fiber 28 diffuses through the internal tubular structure 23 towards the tubular structure 21 and passes through the latter, which is made of transparent material. In the embodiment illustrated in Fig. 9, the terminal element 22 for closing the external tubular structure 21 is made of transparent or diffusing material for the electromagnetic radiation used, so that this radiation can also spread frontally.

In the embodiment of Fig. 10 the terminal portion of the internal tubular structure 23 is tapered, so as to increase the portion of electromagnetic radiation incident on the internal surface of the internal tubular structure 23 and facilitate its diffusion towards the outside, i.e. towards the structure external tubular 21. The latter can be made transparent or diffusing. In the embodiment of Fig. 10 the closing element 22 of the terminal end of the external tubular structure 21 is reflective, and has a surface 22.1 facing towards the inside of the external tubular structure 21, so that the electromagnetic radiation which exits frontally from the internal tubular structure 23 is reflected by the surface 22.1 towards the interior of the external tubular structure 21. In the embodiment of Fig. 10, the possibility of making a transparent or preferably diffusing terminal element 22 as provided in the form of realization of Fig. 9.

In Fig. 11 a still further embodiment is shown, in which the internal tubular structure 23 can be opaque to the radiation conveyed through the light guide 27. The electromagnetic radiation beam exits from the distal or terminal end of the internal tubular structure 23 and is diffused through the diffusing material of which at least the distal part of the external tubular structure 21 is made. The terminal element 22 for closing the external tubular structure 21 is reflective, as in the embodiment of Fig.10. However, it is not excluded to make this closure element 22 in transparent or preferably diffusing material, as provided in the embodiment of Fig.9.

In the various embodiments, the beam which emerges from the tip 28P of the optical fiber is normally divergent. This occurs in particular when the tip 28P of the optical fiber 28 is flat. The divergence is defined by the numerical aperture NA of the optical fiber 28. Typical values of the divergence are 0.22mRad, 0.27mRad, 0.37mRad. Moreover, the possibility of achieving different values in the construction phase by varying the refractive index of the cladding and the core of the optical fiber 28 is not excluded.

The divergence of the laser beam exiting the optical fiber 28 can be used to strike a diffusing structure in the immediate vicinity of the tip and obtain a strong lateral emission, typically the internal tubular structure 23 or the external tubular structure 21

The tip 28P of the optical fiber 28 can also be machined to increase the divergence of the beam. In particular, for example, a conical geometry of the tip with a polished or rough surface can act on the outgoing optical beam, obtaining an emission with increased divergence. The divergence obtained as a function of the angle at the vertex of the tip can be calculated by applying Snell's law to the fiber-air or fiber-liquid interface when the optical fiber is immersed in a liquid and the direction of the refracted light component is evaluated.

To obtain a material diffusing at the wavelength of the electromagnetic radiation conveyed through the light guide 27, different solutions can be used.

In some embodiments, the diffusion of electromagnetic radiation is obtained by adding suitable dyes or powders in the base material with which the external tubular structure 21 and / or the internal tubular structure 23 is formed by extrusion. embodiments, the material that makes the internal tubular structure 23 external 21 diffuser can be applied on the surface after the extrusion. The diffusing properties can be provided only in the distal part of the relative tubular structure (internal 23 and external 21) or can affect the entire tubular structure.

To obtain the diffusive capacity of the internal 23 and / or external 21 tubular structure, other techniques can also be used, for example mechanical processing of abrasion or chemical attack. With these techniques, roughness of the surface of the tubular structure 21 and / or 23 is obtained which locally changes the light guide conditions according to Snell's law.

In still further embodiments, in order to obtain diffusive capacities, the internal tubular structure 23 can be made with undulations on one plane or on two planes orthogonal to each other to essentially give rise to a helical course of the internal tubular structure 23. The undulations of the structure internal tubular 23 serve to cause the electromagnetic radiation to strike the walls of the internal tubular structure 23 causing diffusion and / or refraction-reflection effects. In some embodiments, even the external tubular structure 21 can be provided with a wavy shape, if this is not an obstacle to the introduction of the device inside the fabric to be treated.

In combination or as an alternative to the solutions described above to obtain the diffusion of the electromagnetic radiation towards the outside of the external tubular structure 21, it is possible to use a refrigerant fluid circulating in the cavities 25 and 29, in which a suspension of scattering particles or powders is contained. . These powders can be of dimensions comprised for example between about 10 nm and about 100 micrometers. The scattering particles or powders can be chosen so as to have a reduced absorption of the electromagnetic radiation used. For example, hydroxyapatite, TiO, TiO2, Al2O3 particles can be used. In addition to these, for example, Barium sulphate (BaSO4) can be used which also has radio-opacity properties and allows the device to be viewed under X-ray imaging techniques. The possibility of using other diffusing and radioactive substances is not excluded. opaque. The possible addition of iodine in the liquid, allows to obtain a diffusing and radiopaque liquid for the detection of the device in radiographic or tomographic (CT) images.

In other embodiments, liquid diffusing particles can be used instead of solid diffusing powders. For example, a coolant liquid can be used in which a certain quantity of a second liquid is mixed, immiscible with the coolant and having diffusing properties.

The various technical solutions described above to obtain the diffusion of the electromagnetic radiation outside the external tubular structure 21 can be combined with each other and / or with the use of optical fibers processed to be themselves diffusive at least in the distal portion, or combined with optical diffusers placed axially in front of the optical fiber itself.

In the embodiments illustrated in Figs. 9, 10 and 11 the closing element 22 placed at the terminal end of the external tubular structure 21 has a partially cylindrical and partially conical or pyramidal shape. However, different shapes of this closure element 22 are also possible. Fig. 12 illustrates four different possible geometric shapes of the closure element 22. Each of these geometric shapes can be used to create a diffusing or reflecting closure element 22. In Figs. 12A, 12C, 12E, 12G the closing element 22 is made of diffusing material, so that the electromagnetic radiation that escapes from the light guide 27 is also diffused frontally into the tissue in which the catheter formed by the external tubular structure 21 is inserted. embodiments of Figs. 12B, 12D, 12F, 12H the closing element 22 has a reflective internal surface 21.1, so that the electromagnetic radiation that affects it is reflected backwards.

The various conformations of the closing element 22 differ from each other both as regards the portion of surface facing inwards of the external tubular structure 21, and as regards the surface facing outwards of the external tubular structure 21. For example , in Figs. 12A, 12B the internal surface 22.1 is conical or convex pyramidal, while in Figs. 12C, 12D this internal surface is flat. The external surface is vice versa truncated pyramidal or truncated cone in Figs. 12A, 12B and hemispherical in Figs 12C, 12D. In the following figures the internal surface is concave, and the external surface is partially cylindrical and partially spherical, conical or pyramidal. It is to be understood that the different shapes of the inner and outer surfaces illustrated in Fig. 12 may be combined differently than illustrated.

In some embodiments, the external tubular structure 21 can be provided with a flexible portion, made for example by an elastic membrane. This material allows expansion under the effect of the pressure of the cooling fluid. The elastically deformable wall portion of the external tubular structure 21 causes, by dilating, the compression of the surrounding tissues and therefore the increase of the surface radiated by the electromagnetic radiation propagated through the light guide 27.

An embodiment in which the external tubular structure 21 is partially formed by an elastically deformable material schematically represented in Fig. 13. Near the distal end the external tubular structure 21 has a portion formed by an elastically deformable membrane 20 which in Fig. 13 is shown in an expanded position due to the pressure of a refrigerant fluid which circulates in the interspace 29 and in the interspace 25. In this embodiment, the flow of the refrigerant fluid is from the inside of the internal tubular structure 23 towards the interior of the external tubular structure 21. The side ports 31 which place the interspace 29 in fluid connection with the interspace 25 are advantageously located in correspondence with the portion of the external tubular structure 21 formed by the elastically deformable material 20, so that by pumping the refrigerant fluid in the interspace 29 this protrudes from the side lights 33 and inflates the membrane 20 forming a dilated balloon, before flowing into and along the interspace 25. By way of example, in the embodiment illustrated in Fig. 13 the light guide 27 is shown in a helical shape, for the purposes that More detail will be clarified below with reference to further examples of embodiments. In other embodiments, the light guide 27 can be straight. The internal tubular structure 23 can be transparent or diffusing at the wavelength of the electromagnetic radiation used, so as to allow the electromagnetic radiation to escape through the volume of the balloon formed by the membrane 20, which in turn can be diffusing or transparent at length. waveform of the electromagnetic radiation used. Any suspended particles in the coolant can facilitate or make the diffusion of electromagnetic radiation more uniform.

The refrigerant fluid which is circulated in the device 1 can be a disposable fluid, or it can be circulated in a closed circuit. Fig.14 schematically shows a refrigeration circuit connected to the device 1, with a configuration in which the refrigerant fluid is disposable. The refrigerant fluid can be, for example, a saline solution or any other biocompatible fluid, so that any dispersion from the device 1 towards the treated tissues does not cause harm to the patient. In the solution schematically illustrated in Fig. 14, the refrigerant circuit, indicated as a whole with 41, comprises a first tank 43 containing a fresh refrigerant fluid and a second tank 45 containing exhausted refrigerant fluid. Through a duct 47 the first tank 43 is connected to the channel 7 or to the channel 9 of the connection element 5 of the device 1 (see Fig. 1 and 2). Reference 49 indicates a pump, for example a peristaltic pump, which circulates the refrigerant fluid in the refrigeration circuit 41. The exhausted refrigerant fluid coming from the device 1 is conveyed into the tank 45 through a duct 51.

The volume of refrigerant fluid contained in the first tank 43 may be sufficient to ensure refrigeration throughout the entire treatment cycle, so as to avoid the need to replace the tank 43 during the intervention.

In the embodiment schematically represented in Fig. 15, the refrigeration circuit, again indicated with 41, is a closed circuit, so that the refrigerant fluid which circulates by means of the pump 49 is taken from the tank 44 and returned to it. The tank 44 can be suitably cooled, so as to keep the cooling fluid at a temperature suitable for carrying out its function of removing heat from the treatment zone. The tank 44 can also actually consist of the internal volume of a duct forming part of a heat exchanger.

Fig. 16 schematically shows an apparatus 60 which uses the device 1 in one of the embodiments described above. In the diagram of Fig. 16 the refrigeration circuit 41 is a closed circuit. The reference 53 indicates a laser source which emits a laser radiation which is conveyed through an optical fiber 55 towards the device 1. The optical fiber 55 can be connected to the light guide 27 of the device 1 by means of the connection element 5, through connector 19 (Fig. 1). The optical fiber 55 can optionally constitute an extension of the optical fiber 28 described above.

Reference 57 indicates a control unit, which can be connected to the laser source 53 to control the emission of laser radiation, to the pump 49 of the refrigeration circuit 41, and to a refrigeration device 59 to remove heat from the refrigerant fluid from the circuit. 41. The control unit 57 can also be functionally connected to further sensors of the apparatus 60. For example, a pressure sensor 61 can be provided, which detects the pressure in the delivery branch of the refrigeration circuit 41, i.e. in the duct 47, downstream of the pump 49. A temperature sensor 63 can be arranged at the distal end of the device 1, i.e. preferably inside the external tubular structure 21 and adjacent to its terminal end, to keep the temperature under control of the catheter formed by the external tubular structure 21 and therefore indirectly of the surrounding tissue, into which the cat has been inserted tere. In some embodiments, a flow meter 65 may also be provided which measures the flow rate of refrigerant fluid which circulates in the refrigeration circuit 41.

The sensors 61, 63, 65 allow a control of the operation of all the equipment 60 and of the device 1 interfaced with it. The electrical connection between the central unit 57 and the temperature sensor 63 can be obtained through a cable 67 which passes through the channel 11 of the connection element 5 (Fig. 2).

In Fig. 17 an apparatus 60 similar to that described with reference to Fig. 16 is shown. Same numbers indicate parts that are the same or corresponding to those already described with reference to Fig. 16. In the embodiment of Fig. 17, instead of a tank for the refrigerant liquid, a duct indicated with 71 is provided, forming a heat exchanger and whose overall internal volume is sufficient to contain an adequate quantity of refrigerant liquid. The duct 71 can be placed at least partially inside a refrigeration system 73, for example comprising a Peltier cell, for cooling the coolant circulating in the refrigeration circuit.

The use of a temperature sensor associated with the device 1 can allow the monitoring of the treatment carried out through this device. The temperature sensor can provide information to the control unit 57, in particular information on the temperature of the coolant and therefore, indirectly, on the temperature that develops in the surrounding tissues during the treatment. This temperature depends on the tissue and is a function of its absorption coefficient, scattering, the wavelength of the radiation used, the power emitted, and the flow rate of the cooling fluid, as well as its temperature.

The control unit 57 can act on the power delivered by the source 53, on the flow rate of the refrigerant fluid and on its temperature, to control the temperature of the surrounding tissues.

The temperature sensor 63 can also be used to directly measure the temperature of the tissues. For this purpose it is sufficient to interrupt the emission of laser radiation by the source 53 and the circulation of the refrigerant fluid by the pump 49. In a few seconds (4-5 seconds) the temperature of the refrigerant fluid inside the external tubular structure 21 reaches the temperature of the surrounding tissues and is measured directly by the temperature sensor 63.

By controlling the parameters described above, it is also possible to interrupt the delivery of power by the laser source 53, keeping the circulation of the refrigerant fluid active through the pump 49, when a critical temperature is reached.

The flow meter 65 on the return branch of the refrigeration circuit 41 and the pressure sensor 61 on the delivery branch of the relationship circuit 41 identify any flow anomalies incompatible with the correct operation of the device. For example, it is possible to detect any leaks of refrigerant fluid. It is also possible to provide two flow meters, one on the delivery branch and one on the return branch.

In some embodiments, the control unit 57 can act on the refrigeration system 59,73, which regulates the temperature of the refrigerant fluid, for example to obtain a thermostating of the refrigerant fluid, increasing the efficiency of the cooling of the tissues.

The refrigerant fluid used can be liquid or gaseous. As mentioned above, in the case of liquid refrigerant fluid, a saline solution can be used, consisting of water and 0.9% NaCl or other suitable concentrations. Nitrogen, carbon dioxide or other suitable gas can be used as the gaseous refrigerant.

As indicated above, the light guide 27 can comprise an optical fiber 28 which extends to the terminal end of the internal tubular structure 23. The optical fiber 28 can have a surface treatment in its terminal area, that is, close to the terminal end of the structure. internal tubular 23 and external tubular structure 21, which facilitates the lateral emission by diffusion of the electromagnetic radiation conveyed by the optical fiber 28 itself. In other embodiments, an optical diffuser 30 can be associated with the optical fiber 28 (see Figs. 7 and 8). The optical diffuser 30 can have a shape or a surface finish, or it can be made of a suitable material, to facilitate the lateral diffusion of the electromagnetic radiation.

In particularly advantageous embodiments, the optical diffuser 30 has an undulated shape, on one plane or on two orthogonal planes, for example assuming a helical shape, as schematically represented in Fig. 18. In this figure, only the internal tubular structure 23, the terminal portion of the optical fiber 28 and the diffuser 30 are shown. This has a helical course around a longitudinal geometric axis of the internal tubular structure 23. The wavy shape of the diffuser 30 facilitates propagation towards the outside of the electromagnetic radiation.

In order to obtain a better distribution of the optical diffusion, it is possible to act on the various components of which the diffuser 30 can be constituted. Figs. 19, 20, 21 schematically show three embodiments of a light guide 27 comprising an optical fiber 28 and a diffuser 30. In the three illustrated embodiments the diffuser 30 comprises a core 30A and a sheath 30 surrounding the core 30A. The two elements that form the diffuser 30 can both be diffusing, or one diffusing and the other transparent to the electromagnetic radiation propagating in the optical guide 27. In the embodiment of Fig. 19 both the core 30A and the sheath 30B are formed in diffusing material. In the embodiment of Fig. 20 the core 30A is formed of the diffusing material and the sheath 30B is made of transparent material. In the embodiment of Fig. 21 the core 30A is transparent and the sheath 30B is diffusing. Figs. 22A-22I show the electromagnetic radiation diffusion patterns in different embodiments of the diffuser 30. Figs. 22A-22D show the diffusion diagrams for a diffuser 30 made as in Fig. 20, ie with a diffusing core and a transparent, rectilinear shaped outer sheath. The four diagrams are obtained for different lengths of the diffuser 30, equal to 15 mm, 20 mm, 25 mm and 30 mm, respectively. By increasing the length of the diffuser 30 it is noted that the loss of directive mission is more pronounced, while there is no particular effect on the radial and rear emission. To change the radial emission, a different concentration or a different granulometry of the diffusing powder contained in the core 30A is then used. The diagram of Fig.22E shows the emission of a diffuser 30 made with a diffusing core and a diffusing sheath and with a helical shape, with a single coil. The diagram of Fig. 22F illustrates the result obtained with the same diffuser but of rectilinear shape.

The diagrams of Figs. 22G, 22H and 22I show the emission of a diffuser 30 made with a transparent core and a diffusing sheath with the following geometric characteristics: as regards Fig. 22G the diffuser 30 is straight, in the case of Fig. 22H the diffuser has a helical development (Fig.18) with two coils and finally the diagram of Fig.22I relates to the emission of a diffuser with a straight section and a helical section forming a single coil.

It can be observed that the radiation diagram of Figs 22G, 22H and 22I relating to a diffuser 30 with a helical portion are similar to the emission diagrams obtained with a diffusing sheath and a diffusing core (diagrams of Figs.

22E, 22F), which however present constructive difficulties. The transparent core and diffusing sheath embodiment with a diffuser having an at least partially helical shape (diagram of Fig. 22I) provides the most uniform lateral emission.

The diffuser 30 can have a tip of various shapes, as schematically illustrated in Figs. 23A, 23B and 23C. In Fig. 23A the diffuser 30 ends with a truncated conical or truncated pyramidal terminal element, in Fig.23B a terminal element with a convex hemispherical shape is provided, in Fig.23C the terminal element has a concave hemispherical shape. The shape of the tip of the diffuser 30 can be chosen according to the applications of the device 1, for example to obtain greater or lesser penetration of the radiation into the treated tissues.

The diffuser, both as regards the core and as regards the sheath, can be made of polymeric material or quartz, for example. In the material of which the diffuser is made, radiopaque powders can be introduced or a punctual marker can be inserted for applications with radioscopic monitoring.

Particularly advantageous aspects of embodiments of the invention are defined by the following clauses.

Clause 1. A laser thermal ablation device comprising:

- an external tubular structure having a closed terminal end;

- an internal tubular structure, positioned in the external tubular structure, and having a side wall with a terminal end and defining an internal volume, configured to receive a light guide;

in which a first interspace is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid; and in which the lateral wall of the internal tubular structure comprises at least one lateral opening which places the first interspace in fluid connection with the internal volume of the internal tubular structure.

Clause 2. Device according to clause 1, in which the lateral wall of the internal tubular structure comprises a plurality of lateral openings, which place the first interspace in fluid connection with the internal volume of the internal tubular structure.

Clause 3. Device as per clause 2, in which the side lights are arranged staggered from each other around a longitudinal axis of the internal tubular structure.

Clause 4. Device as per clause 2 or 3, in which the side lights are arranged staggered from each other along the longitudinal development of the internal tubular structure.

Clause 5. Device as per one or more of the preceding clauses, in which the terminal end of the internal tubular structure is closed.

Clause 6. Device as per one or more of the preceding clauses, in which the internal tubular structure and the external tubular structure are approximately coaxial; and in which at least one first spacer is arranged between the external tubular structure and the internal tubular structure.

Clause 7. Device as per clause 6, in which the first spacer has a helical shape developing around the longitudinal axis of the internal tubular structure and of the external tubular structure.

Clause 8. Device as per one or more of the preceding clauses, in which a light guide is housed in the internal volume of the internal tubular structure.

Clause 9. Device as per clause 8, in which the light guide includes an optical fiber and possibly a diffuser positioned between one end of the fiber and the terminal end of the internal tubular structure.

Clause 10. Device according to clause 8 or 9, in which a second gap is formed between the internal tubular structure and the light guide for the circulation of a refrigerant fluid.

Clause 11. Device according to one or more of clauses 8 to 10, in which the light guide and the internal tubular structure are substantially coaxial at least in one end portion, and in which between the light guide and the side wall of the tubular structure at least a second spacer is placed inside.

Clause 12. Device as per clause 11, in which the second spacer has a helical shape developing around the axis of the internal tubular structure.

Clause 13. Device as per clauses 7 and 12, in which the first spacer and the second spacer develop around the longitudinal axis of the internal tubular structure with opposite helical windings.

Clause 14. A device as in one or more of clauses 8 to 13, wherein the light guide comprises a diffuser, which comprises a core and a sheath surrounding the core; and in which at least one of said core and sheath is diffusing at a wavelength of an electromagnetic radiation propagating in the light guide.

Clause 15. Device as per clause 14, in which the core is made of a material diffusing at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 16. Device as per clause 14, in which the core is made of a material transparent to the wavelength of the electromagnetic radiation prepaid in the light guide.

Clause 17. Device as per one or more of clauses 14 to 16, in which the sheath is made of a material diffusing at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 18. Device as per clause 14 or 15, in which the sheath is made of a transparent material at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 19. Device according to one or more of clauses 8 to 18, wherein at least a portion of the light guide is curved so as to form a side surface inclined with respect to a direction of propagation of the electromagnetic radiation in the light guide.

Clause 20. Device as per one or more of the previous clauses, in which the external tubular structure includes at least a portion made of material diffusing at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 21. Device as per one or more of the previous clauses, in which the internal tubular structure includes at least a portion made of diffusing or transparent material at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 22. Device as per one or more of the previous clauses, in which the terminal end of the external tubular structure is closed by a closure element in a material diffusing at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 23. Device according to one or more of clauses 1 to 21, in which the terminal end of the external tubular structure is closed by a reflecting element, to reflect towards the interior of the external tubular structure the electromagnetic radiation propagating in the light guide .

Clause 24. Device as per one or more of the preceding clauses, comprising a temperature sensor associated with the external tubular structure; and preferably housed inside said external tubular structure.

Clause 25. Device according to one or more of the preceding clauses, comprising an optical-hydraulic connection comprising a multiple flexible piping, forming a first refrigeration channel for the supply of a refrigerant fluid, a second refrigeration channel for the removal of fluid coolant from the device, and an optical channel, in which a light guide is housed.

Clause 26. Device as per clause 24, in which the first refrigeration channel, the second refrigeration channel and the optical channel are approximately coplanar, the optical channel preferably being interposed between the first refrigeration channel and the second refrigeration channel.

Clause 27. A laser thermal ablation device comprising: - an external tubular structure having a closed terminal end;

- an internal tubular structure, positioned in the external tubular structure, and having a side wall with a terminal end and defining an internal volume, configured to receive a light guide;

in which a first interspace is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid; characterized in that between the external tubular structure and the internal tubular structure there is a first spacer having which develops helically around the longitudinal axis of the external tubular structure.

Clause 28. Device as per clause 1, in which a light guide is housed in the volume of the internal tubular structure, and in which a second spacer is arranged between the light guide and the internal tubular structure, which develops helically around the axis of the internal tubular structure.

Clause 29. Device as per clause 27 or 28 including, in addition, one or more of the characteristics of clauses 1 to 26.

Clause 30. A laser thermal ablation device comprising:

- an external tubular structure having a closed terminal end;

- an internal tubular structure, positioned in the external tubular structure, and having a side wall with a terminal end and defining an internal volume, configured to receive a light guide;

in which a first interspace is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid; and wherein at least a portion of one of said external tubular structure and said internal tubular structure is diffusing to the electromagnetic radiation propagating in the light guide and the other of said external tubular structure and said internal tubular structure is transparent or diffusing to said electromagnetic radiation .

Clause 31. Device as per clause 30, further comprising one or more of the characteristics of clauses 2 to 26.

Clause 32. A laser thermal ablation device comprising:

- an external tubular structure having a closed terminal end;

- an internal tubular structure, positioned in the external tubular structure, and having a side wall with a terminal end and defining an internal volume;

- a light guide housed in the internal volume of the internal tubular structure, comprising an optical fiber and a diffuser optically coupled to a distal end of the optical fiber;

in which a first interspace is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid; and in which the diffuser is at least partially made of a diffusing material and has a curved shape.

Clause 33. Device as per clause 32, in which the diffuser has at least a helical portion that wraps around the longitudinal axis of the internal tubular structure.

Clause 34. A device as per clause 32 or 33, wherein the diffuser comprises a core and a sheath surrounding said core.

Clause 35. Device as per clause 34, in which the core is transparent and the sheath is diffusing at the wavelength of the electromagnetic radiation propagating in the light guide.

Clause 36. Device as per one or more of clauses 31 to 35, further comprising one or more features of clauses 1 to 26.

Clause 37. A laser thermo ablation equipment comprising: a device as per one or more of the preceding clauses;

a laser source;

a refrigeration circuit;

a control unit.

Clause 38. Equipment pursuant to clause 27, comprising one or more of the following components:

- a circulation pump for the refrigerant fluid;

- a flow meter, configured to detect the flow rate of the refrigerant fluid; - a pressure sensor configured to detect the pressure of the refrigerant fluid in at least one point of the refrigeration circuit;

- a tank for feeding the refrigerant fluid towards the device; - a tank for collecting the coolant from the device;

- a storage and recycling tank for the refrigerant fluid;

- an organ for removing heat from the refrigerant fluid.

Claims (14)

DEVICE FOR LASER THERMAL ABLATION AND EQUIPMENT INCLUDING THIS DEVICE Claims 1. A laser thermal ablation device comprising: - an external tubular structure having a closed terminal end; - an internal tubular structure, positioned in the external tubular structure and having a side wall with a terminal end and defining an internal volume, configured to receive a light guide; in which a first interspace is formed between the external tubular structure and the internal tubular structure for the circulation of a refrigerant fluid; characterized in that the lateral wall of the internal tubular structure comprises at least one lateral opening which places the first interspace in fluid connection with the internal volume of the internal tubular structure. 2. Device according to claim 1, wherein the side wall of the internal tubular structure comprises a plurality of lateral openings, which place the first interspace in fluid connection with the internal volume of the internal tubular structure. 3. Device according to claim 2, in which the side ports are arranged offset from each other around a longitudinal axis of the internal tubular structure. 4. Device as per claim 2 or 3, in which the side ports are arranged in sequence along the longitudinal development of the internal tubular structure. 5. Device according to one or more of the preceding claims, in which the terminal end of the internal tubular structure is closed. 6. Device according to one or more of the preceding claims, in which the internal tubular structure and the external tubular structure are approximately coaxial; and in which at least one first spacer is arranged between the external tubular structure and the internal tubular structure. 7. Device as per claim 6, in which the first spacer has a helical shape developing around the longitudinal axis of the internal tubular structure and of the external tubular structure. 8. Device according to one or more of the preceding claims, in which a light guide is housed in the internal volume of the internal tubular structure and in which a second cavity is formed between the internal tubular structure and the light guide for the circulation of a refrigerant fluid. 9. Device as per claim 8, in which the light guide comprises an optical fiber and possibly a diffuser positioned between one end of the fiber and the terminal end of the internal tubular structure. 10. Device according to claim 8 or 9, in which the light guide and the internal tubular structure are substantially coaxial at least in one end portion, and in which at least one second spacer; in which the second spacer preferably has a helical shape developing around the axis of the internal tubular structure; and in which preferably the first spacer and the second spacer develop around the longitudinal axis of the internal tubular structure with opposite helical windings. 11. Device according to one or more of the preceding claims, comprising an optical-hydraulic connection comprising a multiple flexible pipe, forming a first refrigeration channel for the supply of a refrigerant fluid, a second refrigeration channel for the removal of refrigerant fluid from the device, and an optical channel, in which a light guide is housed. 12. Device as per claim 11, in which the first refrigeration channel, the second refrigeration channel and the optical channel are approximately coplanar, the optical channel preferably being interposed between the first refrigeration channel and the second refrigeration channel. 13. A laser thermal ablation equipment including: - a device according to one or more of the preceding claims; - a laser source; - a refrigeration circuit; - a control unit. 14. Apparatus according to claim 12, comprising one or more of the following components: - a circulation pump for the refrigerant fluid; - a flow meter, configured to detect the flow rate of the refrigerant fluid; - a pressure sensor configured to detect the pressure of the refrigerant fluid in at least one point of the refrigeration circuit; - a tank for feeding the refrigerant fluid towards the device; - a tank for collecting the coolant from the device; - a storage and recycling tank for the refrigerant fluid; - an organ for removing heat from the refrigerant fluid.