JP6210682B2 - 低侵襲手術における組織の切開、切除およびアブレーションのためのレーザー・ステアリングおよびフォーカシングを提供する装置、システムおよび方法 - Google Patents
低侵襲手術における組織の切開、切除およびアブレーションのためのレーザー・ステアリングおよびフォーカシングを提供する装置、システムおよび方法 Download PDFInfo
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00577—Ablation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B2018/2035—Beam shaping or redirecting; Optical components therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B2018/2035—Beam shaping or redirecting; Optical components therefor
- A61B2018/20351—Scanning mechanisms
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B2018/2205—Characteristics of fibres
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B2018/2255—Optical elements at the distal end of probe tips
- A61B2018/2266—Optical elements at the distal end of probe tips with a lens, e.g. ball tipped
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B2018/2255—Optical elements at the distal end of probe tips
- A61B2018/2272—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam
- A61B2018/2277—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam with refractive surfaces
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B2018/2255—Optical elements at the distal end of probe tips
- A61B2018/2272—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam
- A61B2018/2283—Optical elements at the distal end of probe tips with reflective or refractive surfaces for deflecting the beam with pivotable mirrors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B2018/2255—Optical elements at the distal end of probe tips
- A61B2018/2294—Optical elements at the distal end of probe tips with a diffraction grating
Description
本出願は、2009年9月14日出願の米国特許出願第61/242,202号の優先権を主張し、その全ての開示は参照により本明細書に援用する。
本開示は、一般に、低侵襲手術における組織の切開、切除および/またはアブレーションのためのレーザー・ステアリングおよびフォーカシングを提供する装置、システムおよび方法に関する。
I.完全に使用されるスクリプトファイルは、パラメータをセットして、所望のレーザー・パスを定めて、各モータに必要なコマンドを送ることによって、システムを走らせる。以下のページにリストされるさまざまな機能を呼び出す。(ControlMotorMASTER.m):
clc; clear all; close all
% シリアルポートをリセットするmatlab関数
instrreset
s=serial(’com1’, ’Terminator’, ’CR’);
fopen(s);
% Stefan’s TMCM−310初期化ルーチン
Motorlnitialization(s)
% 休止は、シリアルポートに対してチョーキングを妨げる
pause(0.05)
% Stefan’s TMCM−310原点復帰ルーチン
MotorHome(s)
pause(0.05)
% % レーザーが辿る三角形パスを以下のように定める:
% % このより小さい三角形を使用するとき、ループにおいて121を下回るまで
% %「k」値を変化させる
% x(1:30)=[−3:0.1:−0.1]:
% x(31:60)=[0:0.1:2.9];
% x(61:121)=fliplr([−3:0.1:3]):
% y(1:30)=[−1.5:0.1:1.4]:
% y(31:60)=fliplr([−1.4:0.1:1.5]);
% y(61:121)=−1.5:
% % 参照のための三角形パスをプロットする
% % piot(x,y)
% このより大きい三角形を使用するとき、ループにおいて201を下回るまで「k」
%値を変化させる
x(1:50)=[−5:0.1:−0.1];
x(51:100)=[0:0.1:4.9];
x(101:201)=fliplr([−5:0.1:5]);
y(1:50)=[−2.5:0.1:2.4];
y(51 :100)=fliplr([−2.4:0.1 :2.5]);
y(101 :201 )=−2.5;
% 参照のための三角形パスをプロットする
% piot(x,y)
% 原点復帰スイッチが12時にセットされるように、我々がウェッジを中央点へ移動
%して、双方にとっての0度を呼び出す
MotorRotateRelative(s,−90,−90);
absth1 =(0.9*round((−90/0.9) .2857)/−4.2857)+90;
absth2=absth1;
% 各円の最大半径を定める(2*rは2つの組み合わせ円のための最大半径である)
%−注:これは、ウェッジから目標面までの距離の関数に変換するために後で必要にな
%る。
r=3;
% 今、我々がウェッジを所望の点まで動かす−注:上で定める三角形における点の数
%に合致するように最大k値を変える
for k=1 :201
if sqrt(x(k)A2+y(k)A2)<=2*r
% フィールドの内側を確認するためにチェックする
% テストする目的のために、x値およびy値を示す。
% X=x(k)
% Y=y(k)
% 点を我々自身の変換関数を有する角度に変換する
[th1 th2]=xy2th1 th2(x(k),y(k),r);
% 最短パスを採集する設定状況
rotth1=th1−absth1;
rotth2=th2−absth2;
if rotth1>180
rotth1=rotth1−360;
elseif rotth1<(− 80)
rotth1=rotth1+360;
end
if rotth2>180
rotth2=rottfi2−360;
elseif rotth2<(−180)
rotth2=rotth2+360;
end
% Stefan’sウェッジ移動関数
[relthl relth2]=MotorRotateRelative(s,rotth1 ,rotth2);
% 最新の現在角度位置
absth1=absth1+relth1;
absth2=absth2+relth2;
% 休止は、第1のモータが次の点に向けて回転を始める前に、第2のモータがその所
%望の点に達することを許容する
pause(0.1)
else
’out of range’
end
end
function []=Motorlnitia)ization(s)
% モータ設定関数
MC0=[’ASAP 6, 0, 400’ 13];
%モータ0および1への最大電流(0.8A)
MC1=[’ASAP 6.1, 400’ 13];
MPS0=[’ASAP 4, 0, 50’ 13];
%モータ0および1のための最大位置決め速度
MPS1=[’ASAP 4, 1, 50’ 13];
MSR0=[’ASAP 140.0, 1’ 13];
%モータ0および1のためのマイクロステップ分解能−ハーフステップ
MSR1=[’ASAP 140, 1, 1’ 13];
for a=1:length(MC0)
fwrite(s,int8(MC0(a)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
for b=1:length(MC1)
fwrite(s,int8(MC1(b)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
for c=1:length(MPS0)
fwrite(s,int8(MPS0(c)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
for d=1:length(MPS1)
fwrite(s,int8(MPS1(d)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
for e=1:length(MSR0)
fwrite(s,int8(MSR0(e)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
for f=1:length(MSR1)
fwrite(s,int8(MSR1 (f)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
function []=MotorHome(s)
% TMC−300のためのモータ原点復帰関数
% TMCM−310ボード上の「L」へのNC端子および「接地」への共通端子に接
%続されるリミットスイッチのために
% 参照検索開始文字列を作成する
RFS0a=[ARFS START, 0’ 13];
RFS1a=[’ARFS START, 1’ 13];
% 参照検索状況文字列を作成する
RFS0b=[’ARFS STATUS.0’ 13];
RFS1b=[’ARFS STATUS, 1’ 13];
% エンド条件文字列を作成する
endcondition=int8([’BA 008’ 13]);
% 参照検索開始コマンドを送って、リプライをクリアする
for a=1:length(RFS0a)
fwrite(s,int8(RFS0a(a)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
for a=1:length(RFS1a)
fwrite(s,int8(RFS1a(a)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
% 参照検索開始コマンドを送って、リプライをクリアする
for a=1:length(RFS0b)
fwrite(s,int8(RFS0b(a)))
end
outCOM0=int8(fscanf(s));
outRET0=int8(fscanf(s));
pause(0.05)
for a=1:length(RFS1b)
fwrite(s,int8(RFS1b(a)))
end
outCOM1=int8(fscanf(s));
outRET1=int8(fscanf(s));
pause(0.05)
% リプライをエンド条件と比較する
while outRET0(8)〜=48
for a=1:length(RFS0b)
fwrite(s,int8(RFS0b(a)))
end
outCOM0=int8(fscanf(s));
outRET0=int8(fscanf(s));
pause(0.05)
end
while outRET1 (8)〜=48
for a=1:length(RFS1b)
fwrite(s,int8(RFS1b(a)))
end
outCOM=int8(fscanf(s));
outRET1=int8(fscanf(s));
pause(0.05)
end
function [realthi , realth2]=MotorRotateRelative(s, thetal , theta2)
% シリアルポートオブジェクトであるθ1およびθ2の角度量によってモータを回転
%させる関数は角度である
% 角度をハーフステップ(0.9はハーフステップ)に変換するTMCM―310に
%送るコマンド文字列を定める
% 小数4.2857は、2つのプーリ間の比である
steps1=round((theta1/0.9)*(−60/14));
steps2=round((theta2/0.9)*(60/14));
outstr0=[’AMVP EL. 0, ’ int2str(steps1) 13];
outstr1=[’AMVP REL, 1, ’ int2str(steps2) 13];
realth1=steps1 *0.9/(−60/14);
realth2=steps2*0.9/(60714);
% 相対的な位置決め文字列をTMC―310に書き込む
for i=1:length(outstr0)
fwrite(s,int8(outstr0(i)))
end
% 以下のリターンは、原点復帰関数が適切に働くために必要である。なぜなら、送ら
%れたおよび返された文字列は、各コマンドに対応する戻り文字列を得るために蓄積し
%て各コマンドの後で走査しなければならないからである。
out=fscanf(s);
out=fscanf(s);
pause(0.05)
% この休止は、ボードがエラーのない両コマンドを扱うために必要である。
for j=1:length(outstr1)
fwrite(s,int8(outstr1(j)))
end
out=fscanf(s);
out=fscanf(s);
pause(0.05)
% この関数は、入力「x」、「y」座標を角度θl、θ2に変換する。このプログラム
%は、それがある位置、すなわち起源と考えられる点、から角度値を常に与える。
function [thetal, theta2]=xy2th1th2(x,y,r)
n=sqrt((xA2)+(yA2));
if n<=(2*r)
%% 変数bの値およびθl、θ2を求める式は、数学的に計算された
b=acosd(sqrt(xA2+yA2)/(2*r));
thetal=((atan2(y,x)*180)/pi)+b;
theta2=((atan2(y,x)*180)/pi)−b;
else
thetal=(’The values of x and y are out of the maneuvering limits’) (x,yの値は操縦限界の外である)
Theta2=(’The values of x and y are out of the maneuvering limits’) (x,yの値は操縦限界の外である)
end
Claims (7)
- 内視鏡レーザーメス・システムであって、
低侵襲手術における切開、切除およびアブレーションの少なくとも1つのレーザー光を供給する手術用レーザー源と、
目標組織に前記レーザー光を送出するために、体腔内部に挿入される先端部を有する喉頭鏡または内視鏡と、
前記喉頭鏡または内視鏡の前記先端部に取り付けられた内視鏡ヘッドとを含み、前記内視鏡ヘッドは、
前記手術用レーザー源からの前記レーザー光を拡大するために位置決めされた拡大レンズと、
前記拡大レンズからの前記レーザー光をコリメートするために位置決めされたコリメートレンズと、
前記内視鏡ヘッドを前記体腔と相互作用させる集束レンズと、
前記コリメートレンズと前記集束レンズとの間に位置決めされた少なくとも2つの回転可能な光学エレメントであって、それぞれが、光を屈折するように構成された光学ウェッジまたはプリズムまたは光を回折するように構成された回折格子を含む、回転可能な光学エレメントと、を含み、
前記少なくとも2つの回転可能な光学エレメントおよび前記各レンズは、その中心が共通の光軸上に軸合わせされ、
前記少なくとも2つの回転可能な光学エレメントは、それぞれ、前記光軸に対して第1の仰角で入射レーザー光を受けるように構造化され、そして前記光軸に対して前記第1の仰角とは異なる第2の仰角で屈折または回折したレーザー光を生成し、
前記屈折または回折したレーザー光は、前記光軸周りの前記各回転可能な光学エレメントの回転角に依存する前記光軸周りの方位角で生成される、システム。 - 前記手術用レーザー源は、光導波路を含む、請求項1に記載の内視鏡レーザーメス・システム。
- 前記少なくとも2つの回転可能な光学エレメントは、Risleyプリズム対を含む、請求項1に記載の内視鏡レーザーメス・システム。
- 前記回折格子は、(a)可変ピッチを有し、そして音響光学素子または液晶素子を含み、または(b)固定ピッチを有している、請求項1に記載の内視鏡レーザーメス・システム。
- 前記光導波路は、中空コアまたはフォトニック・バンドギャップ光ファイバーである、請求項2に記載の内視鏡レーザーメス・システム。
- それぞれが、前記屈折または回折したレーザー光の前記方位角を変更するために、前記各回転可能な光学エレメントを前記光軸周りに回転するように構成された少なくとも2つの発動装置をさらに含み、各発動装置は、各回転可能な光学エレメントが取り付けられる取り付けリングと、前記取り付けリングに取り付けられた磁気リングと、前記磁気リングの位置を測定するための少なくとも1つのセンサと、前記取り付けリングを回転するためのモータとを含む、請求項1に記載の内視鏡レーザーメス・システム。
- 固定ピッチの前記回折格子は、ホログラフィック透過型回折格子を含む、請求項4に記載の内視鏡レーザーメス・システム。
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JP2013504391A (ja) | 2013-02-07 |
EP2477569A4 (en) | 2013-10-16 |
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JP6673999B2 (ja) | 2020-04-01 |
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EA201270426A1 (ru) | 2012-12-28 |
EP3443922A3 (en) | 2019-06-12 |
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EP2477569A2 (en) | 2012-07-25 |
BR112012005490A2 (pt) | 2019-09-24 |
CN102770087A (zh) | 2012-11-07 |
CA3011108C (en) | 2020-04-28 |
US20170135766A1 (en) | 2017-05-18 |
CA3011108A1 (en) | 2011-03-17 |
EP2477569B1 (en) | 2018-10-24 |
JP2016165509A (ja) | 2016-09-15 |
JP6415477B2 (ja) | 2018-10-31 |
CA2773984A1 (en) | 2011-03-17 |
MX2012003156A (es) | 2012-09-28 |
CA2773984C (en) | 2018-08-21 |
WO2011032165A3 (en) | 2011-09-15 |
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US20200261153A1 (en) | 2020-08-20 |
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