JP5506702B2 - 流体流れ内を伝達される光学エネルギーによる組織切除および焼灼 - Google Patents
流体流れ内を伝達される光学エネルギーによる組織切除および焼灼 Download PDFInfo
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Description
本発明は、概して、医療の方法および装置に関する。具体的には、本発明は、軟質または硬質の組織を剥離、切断、穿孔または別様に修正するためのエネルギー適用のための方法および装置に関する。
切断または他の製造活動のためにレーザー光線を運ぶための導波管としての水または他の流体のジェットの使用が、特許文献1に記述され、カナダ国出願公報第2,330436Al号、特許文献2、特許文献3、特許文献4、および特許文献5に記載されている。特許文献6は、手の殺菌のためのレーザー流体ジェットの使用について記載している。生物組織を切断するためのレーザーの使用が、特許文献7に、前立腺組織の切除のためのレーザー使用が、特許文献8、特許文献9および特許文献10に記載されている。二極の高周波前立腺蒸発のための経尿道内視鏡の使用は、非特許文献1に記載されている。外科の切開をもたらすための圧力水流が、米国特許第7,122,017号と同第5,620,414号に記載され、そして、歯の穿孔のための圧力水流が、米国特許第7,326,054号に記載されている。米国特許第5,785,521号および同第6,607,524号は、硬い生体物質の熱弾性破損および破砕を引き起こすためのレーザーエネルギーの使用を記載し、それは、処置部位からすでに分裂した物質を冷却または除去(またはさらに破砕)する水/空気技術と組み合わされている。組織除去のプラズマを生じさせる食塩水内の高周波放電が、非特許文献2および非特許文献3に記載されている。組織切除のための空気/ウォータージェットが、非特許文献4に記載されている。米国特許出願公開第2005/0288639号は、膀胱内のバルーンによって尿道に固着され得るカテーテルベースのシステムの上の針注射器を記載している。米国特許第6,890,332号、同第6,821,275号、および同第6,413,256号は、組織剥離のためにRFプラズマを発生させるためのカテーテルを各々が記載している。重要な他の特許または出願公開は、7,015,253、6,953,461、6,890,332、6,821,275、6,451,017、6,413,256、6,378,525、6,296,639、6,231,591、6,217,860、6,200,573、6,179,831、6,142,991、6,022,860、5,994,362、5,872,150、5,861,002、5,817,649、5,770,603、5,753,641、5,672,171、5,630,794、5,562,703、5,322,503、5,116,615、4,760,071、4,636,505、4,461,283、4,386,080、4,377,584、4,239,776、4,220,735、4,097,578、3,875,229、3,847,988、US2002/0040220、US2001/0048942、WO93/15664、およびWO92/10142を含んでいる。
例えば、本発明は以下の項目を提供する。
(項目1)
組織を修正する方法であって、該方法は、
光伝送液体媒体の流れを生成することと、
該光が全反射によって該流れを介して伝送されるように、干渉性光の供給源を該光伝送液体媒体に連結することと、
該流れを組織に向けることと
を含む、方法。
(項目2)
上記液体流れは、上記液体媒体を圧力下において0.01mmから1mmまでの範囲にある直径を有するノズルを通過させることによって生成される、項目1に記載の方法。
(項目3)
上記圧力は、6.8948×10 3 Paから6.8948×10 6 Paまでの範囲にある、項目2に記載の方法。
(項目4)
上記干渉性光は、10mWから40Wの範囲にある出力レベルを有している、項目3に記載の方法。
(項目5)
上記組織は、発光組織であり、上記流れは、管腔から放射方向外側に向けられる、項目1に記載の方法。
(項目6)
上記管腔内にプローブを設置することと、上記光伝送液体媒体の加圧された流れを該プローブから放射方向外側に向けることと、該流れが該組織に向けられたときに該干渉性光を該液体媒体内に集束させることとをさらに含む、項目5に記載の方法。
(項目7)
上記ノズルは、0.01mmから1mmの範囲にある直径を有し、上記圧力は、6.8948×10 3 Paから6.8948×10 6 Paまでの範囲にあり、上記干渉性光は、10mWから40Wまでの出力を有している、項目6に記載の方法。
(項目8)
上記組織は、軟組織であり、上記流れは、該組織を切断するために1つの直線に向けられる、項目1に記載の方法。
(項目9)
上記ノズルは、0.01mmから1mmの範囲にある直径を有し、上記圧力は、6.8948×10 3 Paから6.8948×10 6 Paまでの範囲にあり、上記干渉性光は、10mWから40Wまでの出力を有している、項目8に記載の方法。
(項目10)
上記組織は、歯または骨を含み、上記流れは、歯を穿孔するか、または骨および軟骨を切り通すように向けられる、項目1に記載の方法。
(項目11)
上記ノズルは、0.01mmから1mmの範囲の領域を有し、上記圧力は、6.8948×10 3 Paから6.8948×10 6 Paまでの範囲にあり、上記干渉性光は、10mWから40Wの出力を有している、項目10に記載の方法。
(項目12)
組織にレーザーエネルギーを送達するシステムであって、該システムは、
プローブと、
光伝送流体の流れを噴出するノズルと、
干渉性光を伝送するための導波管と
を備えており、
該導波管および該ノズルは、該導波管からの干渉性光が、全反射によって該光伝送流体の流れの中に集束させられ、該光伝送流体の流れを通して伝送されるように、構成されている、システム。
(項目13)
上記光伝送流体を上記ノズルまで6.8948×10 3 Paから6.8948×10 6 Paまでの圧力において送達するためのポンプをさらに備えている、項目12に記載のシステム。
(項目14)
上記ノズルは、0.01mmから1mmまでの範囲にある直径を有している、項目13に記載のシステム。
(項目15)
干渉光を上記導波管まで10mWから40Wまでの範囲にある出力レベルで送達するためのレーザー供給源をさらに備えている、項目12に記載のシステム。
(項目16)
上記プローブは、管腔の表面または管腔を通して前進させられるように適合されている、項目12に記載のシステム。
(項目17)
上記プローブは、上記光伝送流体を上記ノズルまで送達するための少なくとも1つの中央軸方向通路を有している、項目13に記載のシステム。
(項目18)
上記プローブは、軸方向管腔を有する外側チューブと、該軸方向管腔内に往復運動可能に据え付けられた内側流体送達チューブとを備えており、上記中央軸方向通路は、該内側流体送達チューブ内に配置され、上記導波管は、該中央軸方向通路内に配置されている、項目14に記載のシステム。
(項目19)
上記ノズルは、上記外側チューブ内の窓を通して横方向に上記光伝送流体の流れを噴出するように配置されている、項目15に記載のシステム。
(項目20)
上記ノズルは、上記光伝送流体の流れを6.8948×10 3 Paから6.8948×10 6 Paまでの範囲の圧力および0.01mmから1mmまでの流れの直径で噴出し、上記干渉光は、10mWから40Wまでの範囲にある出力レベルで送達される、項目16に記載のシステム。
(項目21)
上記プローブは、手で持たれ、軟組織を切断するためのエネルギーを送達するように適合されている、項目12に記載のシステム
(項目22)
上記プローブは、軸を有するシャフトを備えている、項目21に記載のシステム。
(項目23)
上記ノズルは、上記シャフトに対して軸方向に上記流れを送達するように配向されている、項目22に記載のシステム。
(項目24)
上記ノズルは、上記シャフトに対して横方向に上記流れを送達するように配向されている、項目22に記載のシステム。
(項目25)
上記ノズルは、上記光伝送流体の流れを6.8948×10 3 Paから6.8948×10 6 Paまでの範囲の圧力、および0.01mmから1mmまでの流れの直径で噴出し、上記干渉光は、10mWから40Wまでの範囲にある出力レベルで送達される、項目21に記載のシステム。
(項目26)
上記プローブは、手で持たれ、歯を穿孔するか、または骨および軟骨を切り通すためのエネルギーを送達するように適合されている、項目12に記載のシステム。
(項目27)
上記プローブは、軸を有するシャフトを備えている、項目26に記載のシステム。
(項目28)
上記ノズルは、上記シャフトに対して横方向に上記流れを送達するように配向されている、項目27に記載のシステム。
(項目29)
上記ノズルは、上記光伝送流体の流れを6.8948×10 3 Paから6.8948×10 6 Paまでの範囲の圧力、および0.01mmから1mmまでの流れの直径で噴出し、上記干渉光は、10mWから40Wまでの範囲にある出力レベルで送達される、項目26に記載のシステム。
(項目30)
上記プローブの上に同軸に配置されたアンカーフレームをさらに備えており、該アンカーフレームは、該プローブが身体管腔の中に導入されるときに組織表面を係合するように適合されている遠位端を有している、項目12に記載のシステム。
ハイポチューブ66は、以下でさらに詳述されるように、レーザーファイバー72を担持し、水または他の流体ジェットを受け取ることと送達することとが可能である管腔74を含む。中央のシャフト62は、剥離された組織の吸込除去のために、バルーン膨張管腔76と管腔78とをさらに備えている。
前述の実施形態と同様に、集束レンズ154は、レーザーファイバー144からウォータージェットまたは他の加圧流体流れFSの中に干渉性光を送達するために任意に提供される。図8の装置は、図11に示されるような歯穿孔等の様々な処置に使用され得る。横方向流れの携帯装置140は、従来の歯のドリルと類似の方法で、歯科医によって保持され、操作され得る。シャフトの遠位端148は、流れFSが治療される歯の表面に向けられるように、口内に保持される。シャフト142、レーザーファイバー144および流れ管腔152は、接続ケーブル166によって、水または他の流体供給源160、適切なレーザー光源162、および制御回路164に接続される。
Claims (19)
- 組織にレーザーエネルギーを送達するシステムであって、該システムは、
管腔と遠位端とを有するシャフトを備えるプローブと、
該プローブの該遠位端付近に設置されたノズルであって、該ノズルは、該プローブから外側に光伝送流体の流れを噴出し、該管腔は、該ノズルまで延び、該ノズルは、該遠位端付近に設置された該管腔よりも小さいサイズの制限部を備える、ノズルと、
干渉性光を伝送するための、該管腔内に設置された光導波管であって、該光導波管は、光噴出端を備える、光導波管と
を備えており、
該光導波管の該光噴出端および該制限部は、該流体の流れが該制限部から放射されるときに該制限部内に干渉性光を集光させ、全反射によって該光伝送流体の流れを通して該干渉性光を伝送するように、該遠位端付近に構成されている、システム。 - 前記光伝送流体を前記ノズルまで6.8948×10 3 Paから6.8948×10 6 Paまでの圧力において送達するためのポンプをさらに備えている、請求項1に記載のシステム。
- 前記ノズルは、0.01mmから1mmまでの範囲にある直径を有している、請求項2に記載のシステム。
- 干渉性光を前記導波管まで10mWから40Wまでの範囲にある出力レベルで送達するためのレーザー供給源をさらに備えている、請求項1に記載のシステム。
- 前記プローブは、管腔の表面または管腔を通して前進させられるように適合されている、請求項1に記載のシステム。
- 前記プローブは、前記光伝送流体を前記ノズルまで送達するための少なくとも1つの中央軸方向通路を有している、請求項2に記載のシステム。
- 前記プローブは、軸方向管腔を有する外側チューブと、該軸方向管腔内に往復運動可能に据え付けられた内側流体送達チューブとを備えており、前記中央軸方向通路は、該内側流体送達チューブ内に配置され、前記導波管は、該中央軸方向通路内に配置されている、請求項6に記載のシステム。
- 前記ノズルは、前記外側チューブ内の窓を通して横方向に前記光伝送流体の流れを噴出するように配置されている、請求項7に記載のシステム。
- 前記ノズルは、前記光伝送流体の流れを6.8948×10 3 Paから6.8948×10 6 Paまでの範囲の圧力および0.01mmから1mmまでの流れの直径で噴出し、前記干渉性光は、10mWから40Wまでの範囲にある出力レベルで伝送される、請求項5に記載のシステム。
- 前記プローブは、手で持たれ、軟組織を切断するためのエネルギーを送達するように適合されている、請求項1に記載のシステム。
- 前記プローブは、軸を有するシャフトを備えている、請求項10に記載のシステム。
- 前記ノズルは、前記シャフトに対して軸方向に前記流れを送達するように配向されている、請求項11に記載のシステム。
- 前記ノズルは、前記シャフトに対して横方向に前記流れを送達するように配向されている、請求項11に記載のシステム。
- 前記ノズルは、前記光伝送流体の流れを6.8948×10 3 Paから6.8948×10 6 Paまでの範囲の圧力、および0.01mmから1mmまでの流れの直径で噴出し、前記干渉性光は、10mWから40Wまでの範囲にある出力レベルで伝送される、請求項10に記載のシステム。
- 前記プローブは、手で持たれ、歯を穿孔するか、または骨および軟骨を切り通すためのエネルギーを送達するように適合されている、請求項1に記載のシステム。
- 前記プローブは、軸を有するシャフトを備えている、請求項15に記載のシステム。
- 前記ノズルは、前記シャフトに対して横方向に前記流れを送達するように配向されている、請求項16に記載のシステム。
- 前記ノズルは、前記光伝送流体の流れを6.8948×10 3 Paから6.8948×10 6 Paまでの範囲の圧力、および0.01mmから1mmまでの流れの直径で噴出し、前記干渉性光は、10mWから40Wまでの範囲にある出力レベルで伝送される、請求項15に記載のシステム。
- 前記プローブの上に同軸に配置されたアンカーフレームをさらに備えており、該アンカーフレームは、該プローブが身体管腔の中に導入されるときに組織表面を係合するように適合されている遠位端を有している、請求項1に記載のシステム。
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