JPH06507328A - A device that performs surgical incisions using a combination of thermal laser beam and ionizing laser beam - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] A device that performs surgical incisions using a combination of thermal laser beam and ionizing laser beam Technical field The present invention provides a method for treating materials, particularly human or animal tissue, with a focused light beam. The present invention relates to an incision device.

Background technology Particularly because of their sharp focusing and high power, laser beams today are used to cut through materials. It is used to That is, the laser beam on the one hand It is used in manufacturing, especially in the manufacture of integrated circuits. In medicine, especially ophthalmology, heat is used to treat the retina. A laser beam is used to coagulate or destroy the abdominal skin for the treatment of cataracts. has been done.

When using a laser with a long pulsation time laser beam (e.g. thermal laser), the target point The energy converted as heat acts on the adjacent areas and improves the desired area of the incision wall. Achieve thermal coagulation or undergo undesirable material changes outside the incision.

Using lasers with very high power laser beams (e.g. solid-state lasers) Although it is possible to create an incision wall quickly, the incision wall may be very unstable, especially when using soft materials. It may become. This is because the incision wall is not stabilized by heat. be.

Particularly for materials containing fluids such as implants, human tissue, or animal tissue. In some cases, when making an incision with a high-power laser beam, fluid such as blood may be present at the incision. to invade. Therefore, the incisions do not clot, thus interfering with the use of lasers. cause problems.

A thermal mode laser (ion laser) generates its energy through random molecular motion. converts energy into heat. However, in a small space, heat is the fourth power law (pressure is temperature It rises to the 4th power. That is, the pressure becomes P-K'). Light in a small space It is caused by the energy conversion of an ionizing laser. The ensuing heat explosion Provides the force that acts to disrupt tissue and remove tissue layers. This effect Regarding the factor of the intensity generated and the factor of the magnitude of random molecular motion, which is heat, Given the entropy of the process, heating the adjacent tissue and preventing bleeding The key is to provide sufficient heat. Proceed to form the anastomosis in the depth direction. However, it is necessary to ensure that the condition is suitable for further resection. Ru. This is the object of the present invention.

Disclosure of invention The purpose of the present invention is to focus on sharp cutting that can cut fluid-containing materials with high efficiency. The purpose of the present invention is to obtain a method for making an incision by a laser beam that is aligned with the laser beam.

The method of the present invention includes a first optical rupture sensor and a second generating a laser beam from a laser source consisting of a first thermal laser; and a second laser beam simultaneously directed within a common optical axis to make an incision in the material. The increase in temperature in the area of this incision caused by the thermal laser The pressure within the incision was increased by 4%, and the first laser beam and the second laser beam were The optical axis of the beam coincides with the focus, and the thermal laser beam is relatively continuous. and the photorupting laser beam is a laser beam added to the continuous exposure of the thermal laser. It is characterized by its pulsating nature.

A method of incising human or animal tissue uses a laser beam from a photorupting laser; These two laser beams can be combined with another laser beam from a thermal (ion) laser. The beams may be passed coaxially or through different paths to a common focal point. This continuous wave Layer this photorupting nolus on top of a thermal laser or a pulsating thermal laser at the appropriate time.

Particularly when cutting human or animal tissue containing blood, different types of laser It is advantageous to add the laser at the same time. Combining the energy of the laser beam of a thermal laser It is converted into heat inside the fabric.

In the case of low power, tissue coagulation occurs and this coagulation causes tissue force to coagulate at the incision area. and prevent further loss of fluid (i.e. blood). Photo-rupturing laser energy – Due to the high power output, the simultaneous pulsating beams of photodisruptive lasers create ionization within the tissue. This, in turn, destroys molecules and atoms. Physical sensation of plasma incision to occur. This plasma uses the optical energy of the laser beam as a medium. Once stored, this energy is rapidly released in the form of effective vaporization. This causes an explosion. It generates energy, ie converts energy into mechanical force, and ablate tissue at the incision. child This conversion to mechanical energy is very effective when There is almost no need to heat the tissue.

The laser beam of a thermal laser cuts the coagulation caused by heat; This stabilizes the incision wall and prevents other fluid forces from entering the incision.

The energy of the thermal laser beam is deposited along with the energy (increased in a small space). This causes the tissue to divide and coagulate.

In a more particular embodiment of the invention, the thermal laser is an argon laser, the ionizing laser is Alternatively, the optical rupture laser may be a Nd:YAG laser. Nd:YAG laser is 1 1 millijoule of heat in a short time of 0 nanoseconds (1 nanosecond is 10-9 times 1 second) , it generates 100 kilowatts, and this energy is 100 kilowatts. The fracture pressure of the skull is converted into stress. This effect is localized within a small space. This creates high pressure, which causes tissue to split. Argon laser comparison After a long exposure, it produces only 1 Watt and 1 Pascal of pressure. dew A force is applied continuously over a period of time, causing a gradient from solid to gas and from high temperature to low temperature. Carnot's principle is an action to acquire the necessary momentum for the tissue and eliminate tissue debris. This is achieved by

To express this for a particular example, 1 millijoule produced in 10 seconds By using Nd:YAG laser energy, pressure generation is achieved. Here is an example.

1 millijoule/10 nanoseconds, 10-3 millijoules/10-” seconds, which is 5 This corresponds to 10 quarts, which is an output of 100 kilowatts. newton's mae If converted to data, it corresponds to 5, which is 1ONxrn/sec. N is Pascal's pressure ( If adjusted to N/m"=Pa), a high pressure of 100 kilopascals Xm/sec will be generated. .

This must be accepted primarily as a stress acting as a destructive force.

A 1 watt argon laser energy with an exposure time of 0.1 seconds yields the following values: It will be done.

1 watt Xl0-' sec = 10-' joule, io-' joule/10-1 sec = 1 Watts = lNxm/sec By adjusting the pressure (Pa=N/m2), the equation IPaXm/sec=PaXv can get. The pressure is significantly reduced compared to the Nd:YAG laser, and the speed is It increases proportionally in this product, which is determined by a constant.

At the end of this exposure time, the energy from the argon laser governs the molecular motion. It generates a velocity of kinetic energy to remove tissue debris from the open end of the formed trough. Remove. This action energy is Valid only if there is an entry.

The pressure is not only generated by the Nd:YAG laser, but also by a small energy If confined in space, even an argon laser will generate pressure (Pa=J/m' ). However, in the open space of the trough, energy flows along the existing gradient. It flows.

Confining energy for a short period of time or in a small space creates pressure. narrow space When confined, the light completely converts into energy and destroys the confined space. This creates pressure that causes it to expand. Pressure and heat work together in a confined space. do.

One degree of temperature increases pressure by 4%.

This is expressed as follows. 4P=dP/dKXK, if you integrate this, P = c, becomes ', which is twice equal to N/m", '. Now, the speed m7 seconds = 1 If so, N/m2. ’Xm/sec 20 and double, C is Sigma (Sigma) The mechanical energy Returning to Lugie, N, m/sec, m2. ni' = Pa, v/ni'.

This double laser creates a trough. High wattage Nd:YAG laser generates destructive pressure. The closed bottom of the trough-like section prevents confinement in a narrow space. The heated argon laser generates high temperatures and therefore pressures. But open Towards the edge, it becomes kinetic energy, along the solid-to-gas gradient. move matter. This ejects tissue debris, much like a projectile in the barrel of a gun. do.

Therefore, this dual laser, Nd:YAG laser component, Along with deepening the dissection trough, the argon laser component also increases the removal energy of tissue debris. supplying energy and cleaning a relatively wide internal bore in the presence of a transition path. Ocula (o (ccular) or other tissue dissection purposes, do not touch the probe. This laser application is achieved by focusing the beam from a remote location. . By combining fracture pressure and kinetic energy in the appropriate ratio, the surgeon To provide a laser device that can be widely cultivated, inexpensive, and generally usable. .

This dual laser cuts deeply into the suture line (in eye surgery) and later Astigmatism does not occur. In addition, anterior chamber hemorrhage and pus that were draining through the self-disinfecting opening were detected. It is possible to accomplish a trepanation procedure.

By applying this dual laser several times, even if the medium is not clear, various colors can be obtained. A large iridotomy can also be performed on the iris. Asians and blacks have dark irises This dual laser can also be applied to colored tissues and their hard mesenchymal tissues. Its effect The rate is determined by the cavitation hub which provides the gradient that carries out the action. Always significantly enhanced.

This is also evidenced by the backflow of blood from the Julen canal in the trabecular column into the anterior chamber. It is also applicable to wide inner postholes. The extent is related to the size of the anastomosis achieved. It is possible to draw a conclusion. Even for short, temporary successes, or on average a few months A repeatable discharge point is sufficient even for long sides.

This dual laser method has the effect of Scheie's It is similar to the ophthalmology method known as ophthalmology.

This known method eliminates laser transducer surgery or laser surgery. ing.

Brief description of the drawing The attached diagram shows typical equipment used to carry out the dual laser method described above. This is illustrated on the screen and described below.

FIG. 1 is a diagram diagrammatically illustrating an apparatus of a thermal laser and a photorupture laser according to the present invention. .

Mode of carrying out the invention This device is placed in a housing l, and a gas laser 2 and a solid-state laser 3 are connected to this device. The device is configured so that the laser beam 4.5 of the solid-state laser 3 is reflected by the mirror device 6 and shared. Direct it to the light passing axis 7.

For this purpose, the laser beam 4 of the gas laser 2 is polarized to a common optical axis 7 by the first mirror 6a. The mirror 6b disposed on the shaft 7 further reflects the light toward the optical axis toward the outlet 8. . The laser beam 5 of the solid-state laser 3 is similarly deflected to the optical axis 7 by the first mirror 6c, and further The mirror 6d reflects the light toward the optical axis toward the outlet 8. In this way, the solid-state laser The beam penetrates a mirror 6b, or for this purpose this mirror 6b is located on the optical axis, Transparent silver plated.

In order to adjust the laser beam 4.5, mirrors 6a to 6d are properly installed in an adjustable manner. Ru. Therefore, the output beam 9 of the device of the present invention becomes the laser beam 4 of the gas laser 2. It can also serve as the laser beam 5 of the solid-state laser 3.

In the illustrated embodiment, the gas laser 2 is an argon laser, filled with argon. It consists of a slightly rectangular torus tube. This torus is arranged into three parts. rock Two end tubes 11 with loose Brewster windows and a tube surrounded by a coil 12 An actual laser tube 10 is placed between the part 13 and the part 13. Energy required for discharge is supplied to this coil 12. In this case, the diameter of the tube section 13 supplying energy is significantly larger than the actual diameter of the laser tube 1o.

Coil I4 exerts a magnetic effect on the ion current, thereby narrowing the ions. Forcibly enter the flight path inside the pipe to avoid colliding with the wall. Like this In this way, the thermal load on the tube wall of this laser can be kept low.

A selection prism 15 is placed opposite the Brewster window of one end tube 11. The selection prism 15 sets the limit of the wavelength of the laser beam 4 emitted from the output mirror 16. Adjust within.

Coil 12 acts as a high frequency concentrator supplied with energy from amplifier 17. do. In this case, by sending an appropriate signal from the controller 2o to the control line 21, Radio frequency energy is sent only to radio frequency concentrator 12.

For gas lasers 2, mostly continuous output beams 4 with power between 2W and 100W is obtained. In this example, the duration of this laser is in the range of 0.1 seconds. .

Solid-state laser 3 has neodymium in the yttrium aluminum oxide crystal lattice. Consists of 18 solids. This type of YAG laser has a solid on one axis. It consists of an elongated ellipsoid 19 arranged and plated with silver on the inside. The switching device 23 A flash bulb 22, which is supplied with energy, is provided on the other axis of this oblong body 19. system When an appropriate signal is applied to the controller 20 or the control line 24, the flash light is activated by the switching device 23. Turn on ball 22.

When performing a flash discharge, a cylindrical solid with mirrors 25 and 26 installed at the tip of each axial image. Bumping light into 18. The mirror 26 is coated with semi-transparent coating. The laser beam 5 reflected between the mirrors 25 and 26 has enough energy to pass through the mirror 26. - level, the laser beam 5 is immediately passed through the mirror 26.

In the case of solid-state lasers, output energy of IWs - 100Ws (watt seconds) is generated. can do. of very short pulses of duration in the range of Ims (milliseconds). As a pulsed laser, basically a solid can only be used, resulting in The output is between 1 kW and 100 kW. In the illustrated embodiment, a solid-state laser laser The laser beam 5 has pulses with a duration of tons (nanoseconds).

The device of the invention is activated by the controller 20. In this case, the control light 30.3 1 indicates that laser 2.3 is ready, respectively. to the controller 20 Thus, the desired pulse duration of the laser beam can be set. this In this case, the controller 34 is used to set the two lasers 2.3 into operation at the same time. do. Finally, the controller 35 inserts a pulse between the two successive sequences. You can enter it. Control lights 36 and 37 indicate failure of one or the other laser. Display obstacles.

The employment of these different types of lasers makes it possible to It is particularly advantageous when dissecting tissue including the body. Applying the device of the present invention to eye surgery Emphasis should be placed on the advantages and disadvantages. In the device of the present invention, the solid laser The tool allows you to perform complex incisions with minimal bleeding, which can significantly interfere with repeated incisions. It is possible to implement it. In this case, the incision wall will harden due to the solidification of the incision wall due to slight heat. intensity has already been obtained and therefore does not cause irritation in the process of treating the damaged tissue. 1°Nd: Use the YAG laser at least twice and observe at this time. The implosion that follows the explosion can be used to advantage.

It is possible to separate an organization from a single bombing space and increase the explosive space advantageously. If the power should be set for the laser beam (well, blood. Also, on the contrary, pull away (If there is too little tissue, it will coagulate and cause scars. Coagulation caused by heat may cause scars.) A YAG laser that uses electrical power to enlarge the blast cavity (thus, Furthermore, it is truly ideal for forming passages.

International search report DrT/rA Q7/nn714 front page continuation (81) Designated countries EP (AT, BE, CH, DE.

DK, ES, FR, GB, GR, IT, LU, MC, NL, SE), 0A (BF , BJ, CF, CG, CI, CM, GA, GN, ML, MR, SN, TD, TG. ), AT, AU, BB, BG, BR, CA, CH, C5, DE.

DK, ES, FI, GB, HU, JP, KP, KR, LK, LU, M G, MN, MW, NL, No, PL, RO, RU, SD, SE, US

Claims (1)

[Claims] 1. A first photodisruptive laser and a second thermal laser are used to cut the fluid-containing material. generating a laser beam from a laser source consisting of a first and a second laser; Laser beams are simultaneously directed within a common optical axis to form an incision in the material and heat the material. This created incision is caused by an increase in temperature in the area of this incision caused by the laser. The first laser beam and the second laser beam are the thermal laser beam is relatively continuous with coincident optical axes and a consistent focus; The photo-rupturing laser beam is a laser beam added to the continuous exposure of the thermal laser. A method for cutting a fluid-containing material, characterized in that the material has a pulsating property.