JPS6092748A - Monitoring apparatus of laser knife - 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 [Field of Application of the Invention] The present invention relates to a laser scalpel device, particularly a laser scalpel device for surgical operations.

[Background of the invention]

Conventionally, steel scalpels have been used in surgical procedures, but recently, the usefulness of so-called laser scalpels that use lasers has been attracting attention. FIG. 1 shows the schematic configuration of the laser scalpel device.

Laser light is generated by a laser oscillator 1 such as a carbon dioxide laser, guided by a light guide path 2 composed of an articulated reflector type manipulator, an optical fiber, etc., and passed through a hand piece 3 connected to the tip of the light guide path 2. Emits light. The operator operates the handpiece 3 and irradiates a predetermined affected area 4 of the patient 8 on the operating table 7 with laser light in response to a signal from the foot switch 5 to perform surgery such as incision and blood coagulation. Normally, when the incision speed is medium (5 to 12 crn/88''), the incision depth of living tissue is said to be 2 to 3 IIO11 with a laser output of 30 W.

Incidentally, since the incision of a living body with a laser scalpel is performed using the thermal effect of the energy of the laser beam, there is no so-called "response" from the living body as in the case of a conventional steel scalpel. That is, when using a laser scalpel, it is difficult to know the depth of incision, and there is a problem that there is a high possibility that excessive incision will be made. For example, if there is a blood vessel below the affected tissue, excessive laser irradiation may damage the blood vessel and endanger the patient.

Conventionally, as a method for measuring the incision depth of living tissue using a laser scalpel device, a distance measurement method that detects reflected light, which was disclosed in the National Conference Papers of the ME Society (Journal of the ME Society, Vol. 19, 1981), has been used. There is an example where it was used. However, this method has the following serious drawbacks. That is, (1) The intensity of the reflected light changes due to smoke generated from the laser irradiation part, causing malfunction.

(2) If a carbonized layer is formed at the incision due to V-za irradiation, it is impossible to detect the incision boundary below the carbonized layer.

etc. In addition, although depth measurement using microwaves is theoretically conceivable, it is impractical because the resolution would be 20 m or more and the detector would be large. Although it is possible to use a small thermocouple or the like to detect the temperature rise in living tissue due to laser irradiation, this method is not necessarily satisfactory in terms of response speed and influence on living tissue.

Furthermore, the idea of detecting the incision depth of a laser scalpel using ultra-hepatic waves has been around for a long time, but this method produces a one-dimensional waveform, making it difficult to intuitively understand the image of the incision. It has the disadvantage of being expensive.

[Purpose of the invention]

The present invention has been made in view of the above circumstances, and its purpose is to provide a highly safe laser scalpel device that eliminates the above-mentioned drawbacks of conventional laser scalpel devices and prevents excessive incision. .

[Summary of the invention]

The above object of the present invention is achieved by a laser scalpel device characterized in that the laser scalpel device is provided with means for detecting a two-dimensional tomographic image including an incision using ultrasound.

[Embodiments of the invention]

Hereinafter, the present invention will be explained in detail based on the drawings.

FIG. 2 is a sectional view of the sawn bead of the laser scalpel device. The laser beam 21 guided by the light guide path 2 as substantially parallel light is focused on the affected area by the condensing lens 9 provided in the throat piece 3.

The handpiece 3 is provided with an attachment (pointer stick) 21E that indicates the focal position of the laser beam, and the operator makes an incision at the focal position of the laser beam by bringing the tip of the attachment 24 into contact with the living body. It is now possible to do this.

FIG. 3 shows the main part of the first embodiment of the present invention. In the figure, 21 is a laser beam, 22 is a living tissue, and 23 is a laser beam.
24 is a gap created by incision with a laser beam, 24 is the attachment, and 25 is a so-called ultrasonic probe (contact type ultrasonic transducer), which functions as an ultrasonic generator and detector.

In surgery using a laser scalpel, as shown in FIG.
The incision progresses while causing In the device of this embodiment, an ultrasonic probe 25 is attached to the side surface of the attachment 24 provided at the tip of the hand bead, and pulsed ultrasonic waves 26 are transmitted into the living tissue while the probe is brought into contact with the living body. Sink into it.

Therefore, reflected waves (hereinafter referred to as "echoes") generated within living tissues are
That's what it means. ) 27 is detected by the wave receiving circuit of the probe 25,
The cross-sectional shape is displayed using the sonic transmission time. In such a configuration, cross-sectional images can be captured at 25
-1. A portion 25-2 of the large number of piezoelectric elements is used to transmit and receive sound waves. By moving the position of the used element 25-2 from side to side, it becomes possible to extract a cross section including an incision as shown in FIG. 4 on the display section.

By the way, if the surgical site is a tumor (cancer) tissue, for example, it is necessary to know the size of the tumor in the depth direction from a tomographic image taken in a direction perpendicular to the plane of the paper. To achieve this, as shown in FIG. 5, the probe 25 may be rotated by 90 degrees and fixed to the handpiece.

However, on the other hand, since the angle at which the laser scalpel bandpiece bar is generally used is fixed, the embodiment shown in FIG. 5 is provided with a handpiece rotation mechanism 41. The rotation mechanism 41 is composed of a cap nut with a threaded inside.

Further, the outside of the light guide path 2 is provided with a screw that can be fitted with a cap nut. Furthermore, the hand piece 3 is provided with a protrusion 42 for coupling with a cap nut. Thereby, when adjusting the fixed position of the probe 25, by rotating the cap nut 41, the hand piece 3, the attachment 24 coupled thereto, and the probe 25 can be easily rotated. and,
By tightening the cap nut 41 again at any angle,
The position of the probe can be fixed freely.

FIG. 6 shows yet another embodiment. This embodiment differs from the third embodiment in that a rotary scanning type probe 25-3 is used as the probe. Other symbols indicate the same elements as in the embodiment shown in FIG.

In the embodiment shown in FIG. 6, the probe 25-3 is rotated many times by a motor to obtain
(indication) Perform imaging. FIG. 7 is a block diagram showing the overall configuration of this embodiment.

In the PPI imaging method, in order to rotate the probe 25-3'i, a flexible shaft 55 is coupled to the motor 5.
Drive with 4. Also, a transmitting/receiving circuit 5 for transmitting ultrasonic waves from the probe 25-3 and receiving reflected echoes inside the living body.
2 is connected to the signal line 57.

At this time, since the probe 25-3 is rotating, the signal line 57
Transmission and reception of signals is performed via the slip ring 51. The control circuit 53 is for synchronizing the rotation angle of the motor 54 and the time of wave transmission by the transmitting/receiving circuit 52. This synchronization signal converts the rotation angle into X and Y signals, and x-'
y control the display 56. On the other hand, probe 25-3
The reflected echo received by the transmitter/receiver circuit 52 converts the level of the reflected echo into two signals, which are used as a luminance modulation signal for the XY display 56. Accordingly, the reflected echoes obtained each time the probe rotates are converted into X-Y coordinates and can be imaged on the X-Y display 56. The ultrasonic probe 25-3 has a frequency of 10 MH using lead titanate ceramics, for example.
This is realized using a z oscillator. The space between the probe 25-3 and the container 58 is completely filled with the internal liquid 50 so that the probe 25-3 can rotate.

As a result, the container 58 can be realized in a cylindrical shape having a length of 15 mm and a diameter of 6 rran, for example, so that it can be sufficiently attached to a hand piece of a laser scalpel. Accordingly, when the probe 25-3 is attached to the attachment 24 as shown in FIG. 6, the obtained ultrasonic tomogram 1 includes the incision 23 made by the laser scalpel, as shown in FIG. . That is, when the living tissue is not incised, boundaries such as blood vessels within the living tissue where the acoustic impedance changes will be observed. However, when the laser beam is irradiated and the living tissue is incised, and the void 23 is created within the living tissue, an echo from the boundary surface is detected by the receiving eye of the probe 25, and the sixth It is depicted as shown in the figure. This makes it possible to monitor the progress of the incision of the living body by the laser scalpel in real time.

Next, in neurosurgery, for example, when tumor tissue is excised with a laser scalpel, a common surgical method is to proceed from the inside of the tissue to the outside (Laser Clinical, p. 333 (Medical Planning Co., Ltd.), 1972). Year). An example of obtaining effective image information using V in this case is shown in FIG. That is, the normal tissue 2 around the tumor tissue 290 shown in FIG.
It is necessary to know the boundaries between 2 and 2. With the radial scan type probe according to the present invention, the cross section A-A in the figure is
It is possible to obtain one ultrasonic tomographic image at '.

To implement the embodiment of FIG. 9 using a probe similar to that described in FIGS. 3 and 4, a rod 46, a disk 47,
, the spring 48 is constructed as shown in the figure. That is, when setting the mounting angle of the probe 25 perpendicular to the living body 22 as shown in FIG. 9, the rod 46 is pressed in the direction of the attachment 24 and rotated. Then, when the rod is released, the disk 47 is pressed against the attachment 24 by the spring 48, and the probe 25 and the case 4 are pressed together.
9 is configured to be fixed. Furthermore, in order to obtain tomographic images in various cross sections of the tumor tissue, the probe 25
It is necessary to move the position up and down. Therefore, the outside of the case 49 housing the probe 25 is screwed, and the inside of the support ring 45 is screwed. This results in case 4
By rotating 9, the case can be fixed at any position, and therefore the cross sections A and -A' of the probe 25 can be set arbitrarily. Also, in this case, probe 2
5 into the tissue 29, the incision includes:
It is necessary to inject 50% of physiological saline. In FIG.

〔Effect of the invention〕

As described above, according to the present invention, by using a radial scanning type probe attached to the handpiece of the laser scalpel in a laser scalpel device, it is possible to scan the X*Y, Z plane including the incision of the laser knife. Ultrasonic tomographic images can be obtained. Furthermore, compared to conventional ultrasonic probes, it can be realized in a smaller size, making it possible to provide a monitoring device with high practicality and operability.

[Brief explanation of drawings]

FIG. 1 is a diagram showing a schematic configuration of a conventional laser scalpel device, FIG. 2 is a sectional view of its handpiece, FIG. 3 is a diagram showing main parts of an embodiment of the device of the present invention, and FIG. FIGS. 5 to 9 are diagrams showing images obtained in this embodiment, and FIGS. 5 to 9 each illustrate other embodiments of the present invention. DESCRIPTION OF SYMBOLS 1... Laser oscillator, 2... Light guide path, 3... Handpiece, 4... Affected area, 24... Attachment,
25... Super Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 7 Figure q Figure IL

Claims (1)

[Claims] A laser scalpel device comprising a laser oscillator, a handpiece including an optical system for condensing laser light emitted from the laser oscillator, and a light guide path connecting the laser oscillator and the handpiece. A monitoring device for a laser scalpel, characterized in that it is provided with means for detecting a tomographic image.