WO2003007833A1 - System for controlling the tissue temperature induced by a surgical laser - Google Patents

System for controlling the tissue temperature induced by a surgical laser Download PDF

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Publication number
WO2003007833A1
WO2003007833A1 PCT/FR2002/002308 FR0202308W WO03007833A1 WO 2003007833 A1 WO2003007833 A1 WO 2003007833A1 FR 0202308 W FR0202308 W FR 0202308W WO 03007833 A1 WO03007833 A1 WO 03007833A1
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Prior art keywords
laser
tissue
fiber
wavelengths
laser according
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PCT/FR2002/002308
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French (fr)
Inventor
Jérome KECK
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European Surgical Systems, Sarl
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Publication of WO2003007833A1 publication Critical patent/WO2003007833A1/en

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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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00057—Light
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00714—Temperature
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature

Definitions

  • the invention relates to the technical field of surgical lasers. It has long been desired, during the surgical use of lasers, to control the induced tissue effect, a function of the rise in tissue temperature caused by the laser.
  • the Applicant has noted that there is a need in hepatic surgery for instruments controlling thermal diffusion in the indications of destruction of inoperable liver tumors, in first intention or after one or more courses of chemotherapy. Surgeons would like to have a safe technique, allowing rapid intervention endoscopically, avoiding already weak patients heavy operating times and convalescence; - The Applicant has noted that there is also a need, in neurosurgery, for a laser technique making it possible to effectively treat vascular or deep lesions. In fact, coagulation with an electric scalpel induces tissue necrosis each time the current flows through the treated tissues and access to deep or intravascular tumors is not made much easier by the surgical instruments currently available.
  • Surgical lasers are already known in the prior art for which the tissue effect of the laser beam is quantified by a temperature, the control of the power delivered to the measured tissue temperature having to allow the control of the tissue effect produced .
  • Coagulation, evaporation and carbonization indeed correspond to precise temperatures, for a given tissue.
  • European patent application EP-A-0 212 786 thus describes the recovery of infrared wavelengths on the return of an optical fiber for surgical laser, these infrared reaching a photo-detector connected to a comparator, a cut-off threshold enabling the laser source to be stopped when a predetermined threshold value is reached.
  • American patent US-A-4 316 467 describes an electronic assembly making it possible to adjust the power transmitted by optical fiber from a laser beam to the skin of a patient, for the treatment of angiomas or other pigmentation disorders of the epidermis.
  • the device described in document US-A-4 316 467 comprises a second optical fiber making it possible to send to a photo-detector a signal corresponding to the variations in absorption of light energy, between the light and dark areas of the epidermis.
  • the invention aims to provide a device for real-time control of the tissue effect induced by a fiber optic surgical laser, this device being compact, safe and easy to use for different types of tissue, this device should convince a greater number of specialist surgeons to overcome certain prejudices against surgical lasers.
  • the invention relates, according to a first aspect, to a method for controlling the tissue temperature induced by a surgical laser, this method comprising a step of sampling at least two wavelengths from the tissue. during treatment and greater than the wavelength emitted by the laser and a step of calculating the ratio between these two sampled wavelengths, the value of the tissue temperature being correlated with the values of this ratio.
  • the sampled wavelengths are predetermined in a range of wavelengths between 1000 and 2500 nanometers.
  • the invention relates, according to a second aspect, to a device for implementing the method as presented above, this device comprising an analyzer separator capable of separating the therapeutic laser and the light emitted by the tissue being treatment.
  • the analyzer separator comprises single-line mirrors housed in a closed black enclosure.
  • the invention relates, according to a third aspect, to a surgical laser comprising a device as presented above, this laser comprising an optical fiber conducting the laser beam for processing the tissues and conducting in return the tissue radiation, the lengths of which of waves to be sampled.
  • the laser has the following characters, possibly combined:
  • - It is chosen from the group comprising Nd / Yag lasers, Holmium / Yag lasers, diode lasers; - It includes a diode laser cavity of the GalnAs type;
  • Its power is between approximately 1 watt and approximately 100 watts, preferably between 30 and 100 watts;
  • the fiber core diameter is between 200 and 800 micrometers
  • the fiber comprises a silica core coated with a cladding made of HCS polymer, or a silica core coated with a cladding
  • This analyzer separator is housed in a closed black enclosure 1.
  • a laser cavity 2 emits a therapeutic laser beam 3.
  • this laser cavity is of the GalnAs diode type emitting on a wavelength of 960 nanometers, with a maximum power of 100 watts.
  • a connector 4 allows power limitation depending on the diameter of the fiber. This connector also ensures a correction of the size of the power injection point in the fiber.
  • this connector comprises a conical diaphragm gilded under vacuum over a thickness of 5 micrometers.
  • Such a connector allows the use of fibers with a core diameter of between 200 and 800 micrometers, these fibers comprising a silica coated with a hard polymer cladding (HCS type) having a low cost but an average transmission index.
  • HCS type hard polymer cladding
  • these fibers comprise a silica core coated with a cladding of doped silica having a maximum transmission index but a high cost.
  • the supply of the laser cavity 2 is of the switching type.
  • the cooling of the laser cavity 2 is carried out, in one embodiment, by PELTIER elements.
  • the analyzer separator includes:
  • separating means such as single-line mirrors capable of separating the therapeutic laser, the aiming beam 11 emitted by a aiming laser 12, the light reflected by the tissue being treated and infrared light from the fabric.
  • the exposure of tissues to the therapeutic laser leads to emission of infrared light by the tissue, infrared light which is recovered in the fiber, transmitted in the cavity 1, filtered by single-line mirrors 10 and analyzed by at least two measurement cells.
  • the infrared return signal is separated into two parts, the two signals obtained then being compared, their mean value being validated if the values of the two signals are not different by more than This average value is transmitted to a microprocessor for comparison with a standard value selected by the surgeon according to the chosen effect.
  • the Applicant has in fact found that the temperature threshold values corresponding respectively to the denaturation, to the coagulation, to the evaporation and to the carbonization of the tissues do not vary appreciably from one tissue to another, for most of the tissues affected by the surgical use of lasers.
  • tissue coagulation takes place between 62 ° and 90 ° C.
  • direct coagulation is linked to absorption by hemoglobin and oxyhemoglobin.
  • the device according to the invention makes it possible to control, almost in real time, the tissue temperature in the area being treated by laser, this temperature control, allowing the power of the treatment laser to be controlled so as to maintain a tissue temperature substantially constant.
  • a correction of the power value delivered may be carried out so that the average value of the detected infrared signals does not deviate by more than 5% from the standard reference value selected by the surgeon according to the chosen effect.
  • Such a device allows laser access to any type of surgeon and surgery, since the critical temperature thresholds are determined in advance, thus allowing safe use.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Electromagnetism (AREA)
  • Optics & Photonics (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Otolaryngology (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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Abstract

The invention relates to a method of controlling the tissue temperature induced by a surgical laser. The inventive method is characterised in that it comprises: a step involving the sampling of at least two wavelengths which originate from the tissue during treatment and which are greater than the wavelength emitted by the laser; and a step in which a ratio is calculated between said two sampled wavelengths, the value of the tissue temperature being correlated with the values of said ratio.

Description

DISPOSITIF DE CONTROLE DE LA TEMPERATURE TISSULAIRE INDUITE PAR UN LASER CHIRURGICALD I SPOSI TI F FOR TISSUE TEMPERATURE CONTROL INDUCED BY A SURGICAL LASER
L'invention se rapporte au domaine technique des lasers chirurgicaux. Il est souhaité depuis longtemps, lors de l'utilisation chirurgicale des lasers, de contrôler l'effet tissulaire induit, fonction de l'élévation de température tissulaire provoquée par le laser.The invention relates to the technical field of surgical lasers. It has long been desired, during the surgical use of lasers, to control the induced tissue effect, a function of the rise in tissue temperature caused by the laser.
Les applications chirurgicales des lasers sont à ce jour très variées, et certaines de ces applications illustrent la pertinence d'un contrôle thermique qui, s'il était correctement effectué, permettrait de réduire à la fois les risques traumatiques et la durée des interventions. Ainsi par exemple :Surgical applications of lasers are currently very varied, and some of these applications illustrate the relevance of a thermal control which, if correctly carried out, would reduce both traumatic risks and the duration of interventions. So for example:
- la diffusion thermique du faisceau laser lors des actes relevant des pathologies de l'oreille interne, par exemple sur les cholestéatomes, peut entraîner des lésions du nerf facial ; - la diffusion thermique lors d'interventions exploratrices et curatives en gastro-entérologie peut entraîner des lésions sur des membranes voisines de la zone de tir, par exemple sur le colon. Pour éviter de telles lésions, les techniques actuelles sont complexes et impliquent des temps d'interventions élevés, entraînant des délais d'attente des patients, d'autant plus regrettables que certaines des affections à traiter sont à évolution rapide et pronostic sévère.- the thermal diffusion of the laser beam during acts relating to pathologies of the inner ear, for example on cholesteatomas, can lead to lesions of the facial nerve; - thermal diffusion during exploratory and curative interventions in gastroenterology can lead to lesions on membranes close to the firing zone, for example on the colon. To avoid such lesions, current techniques are complex and involve long intervention times, resulting in patient waiting times, which are all the more regrettable since some of the conditions to be treated are rapidly evolving and have a severe prognosis.
Certaines interventions nécessitent un contrôle tout particulier de la diffusion thermique provoquée par les tirs lasers :Certain interventions require a very particular control of the thermal diffusion caused by the laser shots:
- la demanderesse a constaté qu'il existe un besoin en chirurgie hépatique pour des instruments contrôlant la diffusion thermique dans les indications de destruction des tumeurs du foie inopérables, en première intention ou après une ou plusieurs cures de chimiothérapie. Les chirurgiens aimeraient disposer d'une technique sûre, permettant une intervention rapide par voie endoscopique, évitant à des patients déjà faibles des temps opératoires et de convalescence lourds ; - la demanderesse a constaté qu'il existe également un besoin, en neurochirurgie, d'une technique laser permettant de traiter efficacement des lésions vasculaires ou profondes. En effet, la coagulation au bistouri électrique induit une nécrose tissulaire à chaque passage du courant dans les tissus traités et l'accès aux tumeurs profondes ou intra- vasculaires est peu facilité par les instruments chirurgicaux actuellement disponibles.- The Applicant has noted that there is a need in hepatic surgery for instruments controlling thermal diffusion in the indications of destruction of inoperable liver tumors, in first intention or after one or more courses of chemotherapy. Surgeons would like to have a safe technique, allowing rapid intervention endoscopically, avoiding already weak patients heavy operating times and convalescence; - The Applicant has noted that there is also a need, in neurosurgery, for a laser technique making it possible to effectively treat vascular or deep lesions. In fact, coagulation with an electric scalpel induces tissue necrosis each time the current flows through the treated tissues and access to deep or intravascular tumors is not made much easier by the surgical instruments currently available.
On connaît déjà, dans l'art antérieur, des lasers chirurgicaux pour lesquels l'effet tissulaire du faisceau laser est quantifié par une température, l'asservissement de la puissance délivrée à la température tissulaire mesurée devant permettre le contrôle de l'effet tissulaire produit.Surgical lasers are already known in the prior art for which the tissue effect of the laser beam is quantified by a temperature, the control of the power delivered to the measured tissue temperature having to allow the control of the tissue effect produced .
La coagulation, l'évaporation et la carbonisation correspondent en effet à des températures précises, pour un tissu donné.Coagulation, evaporation and carbonization indeed correspond to precise temperatures, for a given tissue.
La demande de brevet européen EP-A-0 212 786 décrit ainsi la récupération des longueurs d'onde de l'infrarouge au retour d'une fibre optique pour laser chirurgical, ces infrarouges parvenant à un photo-détecteur relié à un comparateur, un seuil de coupure permettant l'arrêt de la source laser lorsque une valeur seuil prédéterminée est atteinte.European patent application EP-A-0 212 786 thus describes the recovery of infrared wavelengths on the return of an optical fiber for surgical laser, these infrared reaching a photo-detector connected to a comparator, a cut-off threshold enabling the laser source to be stopped when a predetermined threshold value is reached.
Le brevet américain US-A-4 316 467 décrit un montage électronique permettant d'ajuster la puissance transmise par fibre optique depuis un faisceau laser vers la peau d'un patient, pour le traitement d'angiomes ou autres troubles de pigmentation de l'épiderme. Le dispositif décrit dans le document US-A-4 316 467 comprend une deuxième fibre optique permettant d'envoyer vers un photo-détecteur un signal correspondant aux variations d'absorption de l'énergie lumineuse, entre les zones claires et sombres de l'épiderme.American patent US-A-4 316 467 describes an electronic assembly making it possible to adjust the power transmitted by optical fiber from a laser beam to the skin of a patient, for the treatment of angiomas or other pigmentation disorders of the epidermis. The device described in document US-A-4 316 467 comprises a second optical fiber making it possible to send to a photo-detector a signal corresponding to the variations in absorption of light energy, between the light and dark areas of the epidermis.
Les brevets américains US-A-5 057 099 et US-A-5 334 191 décrivent le contrôle de la puissance laser envoyée dans une fibre optique en fonction du rayonnement infrarouge détecté en retour.American patents US-A-5,057,099 and US-A-5,334,191 describe the control of the laser power sent into an optical fiber as a function of the infrared radiation detected in return.
L'invention vise à fournir un dispositif permettant le contrôle en temps réel de l'effet tissulaire induit par un laser chirurgical à fibre optique, ce dispositif étant compact, d'utilisation sûre et aisée pour différents types de tissus, ce dispositif devant permettre de convaincre un plus grand nombre de chirurgiens spécialistes de passer outre certains préjugés à rencontre des lasers chirurgicaux.The invention aims to provide a device for real-time control of the tissue effect induced by a fiber optic surgical laser, this device being compact, safe and easy to use for different types of tissue, this device should convince a greater number of specialist surgeons to overcome certain prejudices against surgical lasers.
A cette fin, l'invention se rapporte, selon un premier aspect, à un procédé de contrôle de la température tissulaire induite par un laser chirurgical, ce procédé comprenant une étape d'échantillonnage d'au moins deux longueurs d'onde issues du tissu en cours de traitement et supérieures à la longueur d'onde émise par le laser et une étape de calcul du rapport entre ces deux longueurs d'onde échantillonnées, la valeur de la température tissulaire étant corrélée aux valeurs de ce rapport.To this end, the invention relates, according to a first aspect, to a method for controlling the tissue temperature induced by a surgical laser, this method comprising a step of sampling at least two wavelengths from the tissue. during treatment and greater than the wavelength emitted by the laser and a step of calculating the ratio between these two sampled wavelengths, the value of the tissue temperature being correlated with the values of this ratio.
Selon une caractéristique, les longueurs d'onde échantillonnées sont prédéterminées dans une gamme de longueurs d'onde comprises entre 1000 et 2500 nanomètres.According to one characteristic, the sampled wavelengths are predetermined in a range of wavelengths between 1000 and 2500 nanometers.
L'invention se rapporte, selon un deuxième aspect, à un dispositif pour la mise en œuvre du procédé tel que présenté ci-dessus, ce dispositif comprenant un séparateur analyseur apte à séparer le laser thérapeutique et la lumière émise par le tissu en cours de traitement.The invention relates, according to a second aspect, to a device for implementing the method as presented above, this device comprising an analyzer separator capable of separating the therapeutic laser and the light emitted by the tissue being treatment.
Selon une caractéristique, le séparateur analyseur comprend des miroirs mono-raie logés dans une enceinte noire fermée. L'invention se rapporte, selon un troisième aspect, à un laser chirurgical comprenant un dispositif tel que présenté ci-dessus, ce laser comprenant une fibre optique conduisant le faisceau laser de traitement des tissus et conduisant en retour le rayonnement tissulaire, dont les longueurs d'ondes à échantillonner. Selon diverses réalisations, le laser présente les caractères suivants, éventuellement combinés :According to one characteristic, the analyzer separator comprises single-line mirrors housed in a closed black enclosure. The invention relates, according to a third aspect, to a surgical laser comprising a device as presented above, this laser comprising an optical fiber conducting the laser beam for processing the tissues and conducting in return the tissue radiation, the lengths of which of waves to be sampled. According to various embodiments, the laser has the following characters, possibly combined:
- un faisceau de visée est transmis par la fibre ;- an aiming beam is transmitted by the fiber;
- il est choisi parmi le groupe comprenant les lasers Nd/Yag, les lasers Holmium/Yag, les lasers diodes ; - il comprend une cavité laser diode de type GalnAs ;- It is chosen from the group comprising Nd / Yag lasers, Holmium / Yag lasers, diode lasers; - It includes a diode laser cavity of the GalnAs type;
- il émet sur une longueur d'onde de 960 nanomètres ; - sa puissance est comprise entre environ 1 watt et environ 100 watts, de préférence entre 30 et 100 watts ;- it emits on a wavelength of 960 nanometers; - Its power is between approximately 1 watt and approximately 100 watts, preferably between 30 and 100 watts;
- le diamètre de cœur de fibre est compris entre 200 et 800 micromètres ;- the fiber core diameter is between 200 and 800 micrometers;
- la fibre comprend un cœur en silice revêtu d'une gaine (cladding) en polymère de type HCS, ou un cœur en silice revêtu d'une gainethe fiber comprises a silica core coated with a cladding made of HCS polymer, or a silica core coated with a cladding
(cladding) en silice dopée.(cladding) in doped silica.
D'autres objets et avantages de l'invention apparaîtront au cours de la description suivante de modes de réalisation, description qui va être effectuée en se référant à la figure unique annexée représentant schématiquement un séparateur analyseur mis en œuvre dans l'invention.Other objects and advantages of the invention will appear during the following description of embodiments, which description will be made with reference to the single appended figure schematically representing an analyzer separator implemented in the invention.
Le schéma optique du séparateur analyseur est donné sur la figure annexée.The optical diagram of the analyzer separator is given in the appended figure.
Ce séparateur analyseur est logé dans une enceinte noir fermée 1.This analyzer separator is housed in a closed black enclosure 1.
Dans cette enceinte 1, une cavité laser 2 émet un faisceau laser thérapeutique 3.In this enclosure 1, a laser cavity 2 emits a therapeutic laser beam 3.
Dans un mode de mise en œuvre, cette cavité laser est de type diode GalnAs émettant sur une longueur d'onde de 960 nanomètres, de puissance maximum de 100 watts.In one embodiment, this laser cavity is of the GalnAs diode type emitting on a wavelength of 960 nanometers, with a maximum power of 100 watts.
Pour obtenir cette puissance dans une mise en œuvre, 50 diodes de 2,5 watts maximum chacune sont utilisées, soit 2 barrettes de 25 ou 3 barrettes de 17 diodes.To obtain this power in an implementation, 50 diodes of 2.5 watts maximum each are used, either 2 strips of 25 or 3 strips of 17 diodes.
Une puissance maximum de 100 watts ne permettant pas l'utilisation de petits diamètres de fibres, un connecteur 4 permet la limitation de puissance en fonction du diamètre de la fibre. Ce connecteur assure également une correction de la taille du point d'injection de la puissance dans la fibre.A maximum power of 100 watts does not allow the use of small fiber diameters, a connector 4 allows power limitation depending on the diameter of the fiber. This connector also ensures a correction of the size of the power injection point in the fiber.
Dans un mode de mise en œuvre, ce connecteur comprend un diaphragme conique doré sous vide sur une épaisseur de 5 micromètres.In one embodiment, this connector comprises a conical diaphragm gilded under vacuum over a thickness of 5 micrometers.
L'utilisation d'un tel connecteur permet l'emploi de fibres de diamètre de cœur compris entre 200 et 800 micromètres, ces fibres comprenant un cœur en silice revêtu d'un cladding en polymère dur (de type HCS) ayant un faible coût mais un indice de transmission moyen.The use of such a connector allows the use of fibers with a core diameter of between 200 and 800 micrometers, these fibers comprising a silica coated with a hard polymer cladding (HCS type) having a low cost but an average transmission index.
Dans un autre mode de mise en œuvre, ces fibres comprennent un cœur en silice revêtu d'une gaine (cladding) en silice dopée présentant un indice de transmission maximum mais un coût important.In another embodiment, these fibers comprise a silica core coated with a cladding of doped silica having a maximum transmission index but a high cost.
L'alimentation de la cavité laser 2 est de type à découpage.The supply of the laser cavity 2 is of the switching type.
Le refroidissement de la cavité laser 2 est effectué, dans un mode de mise en œuvre, par des éléments PELTIER.The cooling of the laser cavity 2 is carried out, in one embodiment, by PELTIER elements.
Le nombre d'élément nécessaire sera calculé, par un homme du métier, en fonction de la quantité de chaleur à dissiper.The number of elements required will be calculated by a person skilled in the art, according to the amount of heat to be dissipated.
Afin de permettre l'utilisation du laser dans de parfaites conditions de sécurité, le séparateur analyseur comprend :In order to allow the use of the laser under perfect safety conditions, the analyzer separator includes:
- 2 cellules de mesure de puissance 5, 6 associées à des miroirs de renvoi 7,8 placés sur le trajet du faisceau laser thérapeutique en sortie de cavité 2 ;- 2 power measurement cells 5, 6 associated with deflection mirrors 7,8 placed on the path of the therapeutic laser beam at the outlet of cavity 2;
- au moins deux cellules de mesure infrarouge 9 associée à des moyens séparateurs tels que miroirs mono-raie aptes à séparer le laser thérapeutique, le faisceau de visée 11 émis par un laser de visée 12, la lumière réfléchie par le tissu en cours de traitement et la lumière infrarouge émise par le tissu.- at least two infrared measurement cells 9 associated with separating means such as single-line mirrors capable of separating the therapeutic laser, the aiming beam 11 emitted by a aiming laser 12, the light reflected by the tissue being treated and infrared light from the fabric.
L'exposition des tissus au laser thérapeutique conduit à émission de lumière infrarouge par le tissu, lumière infrarouge qui est récupérée dans la fibre, transmise dans la cavité 1, filtrée par les miroirs mono-raie 10 et analysée par au moins deux cellules de mesure 9. Dans un mode de mise en œuvre, afin d'éviter toute dérive liée à la pollution d'un des filtres, le signal de retour infrarouge est séparé en deux parties, les deux signaux obtenus étant alors comparés, leur valeur moyenne étant validée si les valeurs des deux signaux ne sont pas différents de plus de Cette valeur moyenne est transmise à un microprocesseur pour comparaison avec une valeur étalon sélectionnée par le chirurgien en fonction de l'effet choisi.The exposure of tissues to the therapeutic laser leads to emission of infrared light by the tissue, infrared light which is recovered in the fiber, transmitted in the cavity 1, filtered by single-line mirrors 10 and analyzed by at least two measurement cells. 9. In one mode of implementation, in order to avoid any drift linked to the pollution of one of the filters, the infrared return signal is separated into two parts, the two signals obtained then being compared, their mean value being validated if the values of the two signals are not different by more than This average value is transmitted to a microprocessor for comparison with a standard value selected by the surgeon according to the chosen effect.
La demanderesse a en effet constaté que les valeurs de seuil de température correspondant respectivement à la denaturation, à la coagulation, à l'évaporation et à la carbonisation des tissus ne varient pas sensiblement d'un tissu à l'autre, pour la plupart des tissus concernés par l'emploi chirurgical des laser.The Applicant has in fact found that the temperature threshold values corresponding respectively to the denaturation, to the coagulation, to the evaporation and to the carbonization of the tissues do not vary appreciably from one tissue to another, for most of the tissues affected by the surgical use of lasers.
Par exemple, la coagulation tissulaire s'effectue entre 62° et 90°C. Ainsi, la coagulation directe est liée à l'absorption par l'hémoglobine et l'oxyhémoglobine .For example, tissue coagulation takes place between 62 ° and 90 ° C. Thus, direct coagulation is linked to absorption by hemoglobin and oxyhemoglobin.
Pour une longueur d'onde de 960 nanomètres, également absorbée fortement par l'eau, il est ainsi possible de coaguler sans couper, de coaguler et couper, ou de couper sans coaguler. Le dispositif selon l'invention permet de contrôler, quasi en temps réel, la température tissulaire dans la zone en cours de traitement par laser, ce contrôle de température, permettant un asservissement de la puissance du laser de traitement de sorte à maintenir une température tissulaire sensiblement constante. Ainsi, par exemple, une correction de la valeur de puissance délivrée pourra être effectuée afin que la valeur moyenne des signaux infrarouges détectés ne s'écartent pas de plus de 5% de la valeur de référence étalon sélectionnée par le chirurgien en fonction de l'effet choisi.For a wavelength of 960 nanometers, also strongly absorbed by water, it is thus possible to coagulate without cutting, to coagulate and cut, or to cut without coagulating. The device according to the invention makes it possible to control, almost in real time, the tissue temperature in the area being treated by laser, this temperature control, allowing the power of the treatment laser to be controlled so as to maintain a tissue temperature substantially constant. Thus, for example, a correction of the power value delivered may be carried out so that the average value of the detected infrared signals does not deviate by more than 5% from the standard reference value selected by the surgeon according to the chosen effect.
Un tel dispositif permet l'accès au laser à tout type de chirurgien et de chirurgie, puisque les seuils de température critique sont déterminés par avance, permettant ainsi une utilisation en toute sécurité. Such a device allows laser access to any type of surgeon and surgery, since the critical temperature thresholds are determined in advance, thus allowing safe use.

Claims

REVENDICATIONS
1. Dispositif de contrôle de la température tissulaire induite par un laser chirurgical, caractérisé en ce qu'il comprend des moyens d'échantillonnage d'au moins deux longueurs d'onde issues du tissu en cours de traitement et supérieures à la longueur d'onde émise par le laser, et des moyens de calcul du rapport entre ces deux longueurs d'onde échantillonnées, et des moyens de corrélation entre la valeur de la température tissulaire et les valeurs de ce rapport.1. Device for controlling the tissue temperature induced by a surgical laser, characterized in that it comprises means for sampling at least two wavelengths originating from the tissue being treated and greater than the length of wave emitted by the laser, and means for calculating the ratio between these two sampled wavelengths, and means for correlation between the value of the tissue temperature and the values of this ratio.
2. Dispositif selon la revendication 1 caractérisé en ce que les longueurs d'onde échantillonnées sont prédéterminées dans une gamme de longueurs d'onde comprises entre 1000 et 2500 nanomètres.2. Device according to claim 1 characterized in that the sampled wavelengths are predetermined in a range of wavelengths between 1000 and 2500 nanometers.
3. Dispositif selon la revendication 1 ou 2, caractérisé en ce qu'il comprend un séparateur analyseur apte à séparer le laser thérapeutique et la lumière émise par le tissu en cours de traitement.3. Device according to claim 1 or 2, characterized in that it comprises an analyzer separator capable of separating the therapeutic laser and the light emitted by the tissue during treatment.
4. Dispositif selon la revendication 3, caractérisé en ce que le séparateur analyseur comprend des miroirs mono-raie (10) logés dans une enceinte noire fermée (1).4. Device according to claim 3, characterized in that the analyzer separator comprises single-line mirrors (10) housed in a closed black enclosure (1).
5. Laser chirurgical comprenant un dispositif tel que présenté dans l'une quelconque des revendications 1 à 4, caractérisé en ce qu'il comprend une fibre optique conduisant le faisceau laser de traitement des tissus et conduisant en retour le rayonnement tissulaire, dont les longueurs d'ondes à échantillonner.5. Surgical laser comprising a device as presented in any one of claims 1 to 4, characterized in that it comprises an optical fiber conducting the laser beam for processing the tissues and conducting in return the tissue radiation, the lengths of which of waves to be sampled.
6. Laser selon la revendication 5, caractérisé en ce qu'un faisceau de visée (11) est transmis par la fibre. 6. Laser according to claim 5, characterized in that an aiming beam (11) is transmitted by the fiber.
7. Laser selon l'une quelconque des revendications 5 ou 6, caractérisé en ce qu'il est choisi parmi le groupe comprenant les lasers Nd/Yag, les lasers Holmium/Yag, les lasers diodes.7. Laser according to any one of claims 5 or 6, characterized in that it is chosen from the group comprising Nd / Yag lasers, Holmium / Yag lasers, diode lasers.
8. Laser selon la revendication 7, caractérisé en ce qu'il comprend une cavité laser diode de type GalnAs.8. Laser according to claim 7, characterized in that it comprises a diode laser cavity of the GalnAs type.
9. Laser selon l'une quelconque des revendications 5 à 8, caractérisé en ce qu'il émet sur une longueur d'onde de 960nanomètres.9. Laser according to any one of claims 5 to 8, characterized in that it emits on a wavelength of 960 nanometers.
10. Laser selon l'une quelconque des revendications 5 à 9, caractérisé en ce que sa puissance est comprise entre environ 1 watt et environ 100 watts, de préférence entre 30 et 100 watts.10. Laser according to any one of claims 5 to 9, characterized in that its power is between approximately 1 watt and approximately 100 watts, preferably between 30 and 100 watts.
11. Laser selon l'une quelconque des revendications 5 à 10, caractérisé en ce que le diamètre de cœur de fibre est compris entre 200 et 800 micromètres.11. Laser according to any one of claims 5 to 10, characterized in that the fiber core diameter is between 200 and 800 micrometers.
12. Laser selon la revendication 11, caractérisé en ce que la fibre comprend un cœur en silice revêtu d'une gaine en polymère de type HCS.12. Laser according to claim 11, characterized in that the fiber comprises a silica core coated with a sheath made of HCS type polymer.
13. Laser selon la revendication 11, caractérisé en ce que la fibre comprend un cœur en silice revêtu d'une gaine en silice dopée. 13. Laser according to claim 11, characterized in that the fiber comprises a silica core coated with a doped silica sheath.
PCT/FR2002/002308 2001-07-11 2002-07-02 System for controlling the tissue temperature induced by a surgical laser WO2003007833A1 (en)

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FR0109243A FR2827151B1 (en) 2001-07-11 2001-07-11 METHOD FOR CONTROLLING TISSUE TEMPERATURE INDUCED BY A SURGICAL LASER
FR01/09243 2001-07-11

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Publication number Priority date Publication date Assignee Title
EP1626778B1 (en) * 2003-05-05 2010-03-17 Trion-Swiss Limited Laser apparatus for heat treatment

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EP0212786A1 (en) 1985-08-02 1987-03-04 C.R. Bard, Inc. Laser/optical fiber safety apparatus and method
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US5057099A (en) 1987-02-27 1991-10-15 Xintec Corporation Method for laser surgery
US5334191A (en) 1992-05-21 1994-08-02 Dix Phillip Poppas Laser tissue welding control system
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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4316467A (en) 1980-06-23 1982-02-23 Lorenzo P. Maun Control for laser hemangioma treatment system
US4718417A (en) * 1985-03-22 1988-01-12 Massachusetts Institute Of Technology Visible fluorescence spectral diagnostic for laser angiosurgery
EP0212786A1 (en) 1985-08-02 1987-03-04 C.R. Bard, Inc. Laser/optical fiber safety apparatus and method
US5057099A (en) 1987-02-27 1991-10-15 Xintec Corporation Method for laser surgery
EP0311295A2 (en) * 1987-10-07 1989-04-12 University College London Improvements in surgical apparatus
US5569239A (en) * 1990-06-15 1996-10-29 Rare Earth Medical, Inc. Photoreactive suturing of biological materials
US5334191A (en) 1992-05-21 1994-08-02 Dix Phillip Poppas Laser tissue welding control system
EP0709941A1 (en) * 1994-07-27 1996-05-01 Laser Industries Limited Method and apparatus for generating bright light sources
US5976175A (en) * 1995-06-26 1999-11-02 Lederle (Japan), Ltd. Fiber optic laser conducting probe for photodynamic therapy

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FR2827151A1 (en) 2003-01-17

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