WO2003063696A1 - Appareil et procede permettant de differencier des types de tissu - Google Patents

Appareil et procede permettant de differencier des types de tissu Download PDF

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Publication number
WO2003063696A1
WO2003063696A1 PCT/GB2003/000227 GB0300227W WO03063696A1 WO 2003063696 A1 WO2003063696 A1 WO 2003063696A1 GB 0300227 W GB0300227 W GB 0300227W WO 03063696 A1 WO03063696 A1 WO 03063696A1
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WIPO (PCT)
Prior art keywords
signal
output
characteristic
region
laser
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PCT/GB2003/000227
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English (en)
Inventor
Norman James Geddes
Kevin Roy Welford
David Vedmore Willetts
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Qinetiq Limited
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Publication of WO2003063696A1 publication Critical patent/WO2003063696A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0093—Detecting, measuring or recording by applying one single type of energy and measuring its conversion into another type of energy
    • A61B5/0097—Detecting, measuring or recording by applying one single type of energy and measuring its conversion into another type of energy by applying acoustic waves and detecting light, i.e. acoustooptic measurements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
    • 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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4504—Bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0875—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of bone

Definitions

  • This invention relates to an apparatus and a method for distinguishing tissue types within a human or animal body, particularly, although not exclusively, for distinguishing bone tissue from adjacent nerve tissue, and to endoscopic laser ablation apparatus.
  • an endoscope or fibrescope
  • a user of an endoscope observes images of a region under investigation directly by means of an eyepiece, or alternatively images displayed on a visual display unit.
  • an endoscope is a generally useful tool for internal examination it has the disadvantage that in certain circumstances the images provided are inadequate to clearly distinguish different tissue types.
  • some types of endoscope have fibre bundles which contain very few individual optical fibres; such low-diameter endoscopes are useful for accessing restricted spaces (for example within the human spine) but generate images of poorer quality than those generated by endoscopes having a larger number of individual optical fibres within a fibre bundle.
  • a practitioner using an endoscope to carry out internal examination can encounter difficulty in clearly distinguishing tissue types (for example bone tissue and nerve tissue within a spinal region) when using an endoscope. If the practitioner intends to carry out a surgical procedure in the region on the basis of images produced by. an endoscope, there is a risk of surgical error.
  • tissue types for example bone tissue and nerve tissue within a spinal region
  • an endoscope there is a risk of surgical error.
  • spinal laser ablation surgery in which bone tissue causing pressure on nerve tissue is ablated, accidental damage to nerve tissue can have catastrophic consequences, for example paralysis.
  • an electrical or optical signal generated which signal is characteristic of a tissue type under examination.
  • a signal may for example be used in automated procedures for mapping a region under investigation on the basis of tissue type.
  • this object is achieved by apparatus for distinguishing tissue types in a region internal to a human or animal body, the apparatus comprising a source of at least partially coherent radiation, an optical fibre for delivering a portion of the at least partially coherent radiation to the region and means for positioning the optical fibre's distal end, characterised in that the apparatus further comprises means for imparting mechanical vibration to at least one of the tissue types, a radiation detector, and interfering means for interfering radiation delivered by the optical fibre to the region and subsequently reflected by tissue therein into the optical fibre's distal end with radiation from the source at the detector to generate a characteristic signal at an output thereof, the characteristic signal being characteristic of a tissue type at which the optical fibre's distal end is positioned.
  • the means for imparting mechanical vibration comprises an oscillator and a probe for contacting a tissue type, the probe incorporating a transducer for converting electrical signals from the oscillator into mechanical vibration.
  • the apparatus further comprises a frequency demodulator arranged to receive a characteristic signal generated at the output of the detector and generate a demodulated signal in response thereto, and a phase-locked loop arranged to receive the demodulated signal and a signal from the oscillator and produce a characteristic signal with reduced noise at an output of the phase-locked loop in response to input of the demodulated signal and the signal from the oscillator.
  • a frequency demodulator arranged to receive a characteristic signal generated at the output of the detector and generate a demodulated signal in response thereto
  • a phase-locked loop arranged to receive the demodulated signal and a signal from the oscillator and produce a characteristic signal with reduced noise at an output of the phase-locked loop in response to input of the demodulated signal and the signal from the oscillator.
  • This provides a characteristic signal having a greater signal-to-noise ratio than a corresponding signal generated at the output of the detector.
  • the oscillator may be arranged to generate a signal comprising two or more frequencies each suitable for inducing mechanical vibration in a corresponding tissue type, and to pass the signal to the probe.
  • the apparatus may further comprise an output device arranged to receive characteristic signals from the output of the detector, or as the case may be the output of the phase-locked loop, and output a visible or audible signal characteristic of a tissue type at which the optical fibre's distal end is located.
  • an output device arranged to receive characteristic signals from the output of the detector, or as the case may be the output of the phase-locked loop, and output a visible or audible signal characteristic of a tissue type at which the optical fibre's distal end is located.
  • the source of at least partially coherent radiation is laser, as a laser's highly coherent output results in an easily detected interference signal at the detector.
  • the laser is a semiconductor laser as such a laser is compact, robust and susceptible of control by simple electronic means.
  • endoscopic laser ablation apparatus for performing laser ablation surgery in a region internal to the human or animal body, the apparatus comprising an ablation laser and an optical fibre for delivering radiation output by the ablation laser to the region, characterised in that the apparatus further comprises apparatus according to any one of claims 1 to 4 for distinguishing tissue types within the region, the distal ends of the optical fibres being co-located.
  • Prior art endoscopic laser ablation apparatus is typically positioned within a human or animal body using real-time X-ray imaging apparatus.
  • Real-time X-ray imaging allows positioning of the apparatus to an accuracy within 1 mm.
  • much greater positioning accuracy is required.
  • the distal end of a laser ablation apparatus has to be positioned to within 500 ⁇ m in order to avoid causing damage to nerve tissue when ablation is carried out. Such damage may have catastrophic consequences, e.g. paralysis.
  • Endoscopic laser ablation apparatus of the invention has the advantage that it may be positioned more accurately than prior art endoscopic laser ablation apparatus, and hence reduces incidence of surgical error when carrying out ablation surgery.
  • Endoscopic laser ablation apparatus of the invention preferably further comprises an output device arranged to receive characteristic signals from the output of the detector, or as the case may be from the output of the phase-locked loop, and output a visible or audible signal characteristic of a tissue type at which the distal ends of the optical fibres are located.
  • the apparatus may further comprise an endoscope so that a user is additionally provided with an image of the internal region in which ablation surgery is to be carried out.
  • the endoscope incorporates a visual display unit
  • the visual display unit may be arranged to receive characteristic signals from the output of the detector, or as the case may be, from the phase-locked loop, and display a visible signal characteristic of a tissue type at which the distal ends of the optical fibres are located.
  • the visual display unit may be arranged to display both an image of an internal region and simultaneously a visible signal indicating tissue type at which the distal ends of fibres are located.
  • the visual display unit may be arranged to display a false colour image which corresponds to a particular tissue type.
  • the optical fibres delivering the at least partially coherent radiation and radiation from the ablation laser may be one and same fibre, the proximal end of which is coupled both to the source of at least partially coherent radiation and to the ablation laser. This results in an apparatus which is less invasive in use.
  • the source of at least partially coherent radiation ideally a laser, preferably a semiconductor laser, for reasons explained above.
  • the optical fibres delivering the at least partially coherent radiation and radiation from the ablation laser may be one and same fibre, with the ablation laser acting as the source of at least partially coherent radiation; in this case the apparatus further comprises means for controlling the output power of the ablation laser.
  • the ablation laser serving to provide both radiation for distinguishing tissue types and radiation for ablation.
  • a method of distinguishing tissue types in a. region internal to a human or animal body comprising the step of delivering at least partially coherent radiation from a source thereof to the region, characterised in that the method further comprises the steps of imparting mechanical vibrations to at least one tissue type within the region and interfering a portion of the at least partially coherent radiation which is reflected by a tissue type with radiation from the source at a detector to generate a characteristic signal at an output thereof, the characteristic signal being characteristic of the tissue type from which radiation is reflected.
  • the mechanical vibrations are imparted by the steps of applying an oscillating signal to a transducer and placing the transducer in contact with a tissue type in the region.
  • a characteristic signal with reduced noise may be obtained by the steps of frequency demodulating the characteristic signal to produce a demodulated signal and inputting the demodulated signal and the oscillating signal to a phase-locked loop.
  • the characteristic signal or as the case may be the characteristic signal with reduced noise, readily comprehensible, it may be input to an output device to generate a characteristic visible or audible signal.
  • Figure 1 shows apparatus known in the prior art, viz, an endoscope or fibrescope;
  • Figure 2 shows apparatus of the invention;
  • Figure 3 shows prior art endoscopic laser ablation apparatus;
  • Figure 4 shows endoscopic laser ablation apparatus of the invention.
  • the endoscope 10 comprises a flexible bundle 12 of individual optical fibres (not shown) contained within a flexible sheath 14. Each of the fibres terminates at proximal and distal ends 13, 11 of the bundle 12, except for one fibre 24 which is coupled to a light source 32, for example a light-emitting diode or an incandescent lamp.
  • the endoscope further comprises an optical detector 18, such as an array of light-sensitive pixels, and a monitor 30.
  • the distal end 11 of the bundle 12 is inserted into a patient's body to view an internal region thereof.
  • Light from the source 32 is delivered to the internal region via the fibre 24, reflected by the internal region under investigation and received by remaining fibres in the bundle 12. .
  • Received light is conveyed to the proximal end 13 of the bundle 12.
  • An image of the proximal end 13 of the bundle 12 is formed on the detector 18 by a lens 16, and an image of the internal region under investigation is displayed on a monitor 30.
  • An alternative prior art endoscope is like to the endoscope 10, except that the lens 16 is an eyepiece allowing direct viewing of the region at the distal end 11 of the bundle 12.
  • This alternative endoscope does not require an optical detector or a monitor.
  • Another prior art endoscope is like to the endoscope 10, except that the bundle 12 has a large enough diameter to allow an image to be formed on the distal end thereof by a lens which is comprised in the endoscope.
  • the lens provides improved image quality.
  • the apparatus 50 comprises a laser 52 (for example a laser diode), optical fibres 53, 55, an optical interference unit (OIU) 54, a signal conditioning unit (SOU) 59 comprising a frequency-demodulator 58A and a phase- locked loop 58B, and an ultra-sonic oscillator 56 having a probe 57 which incorporates a transducer (not shown).
  • the SCU 59 is electrically connected to an electrical output 75 of the OIU 54 and to the oscillator 56 by electrical connections 51 A, 51 B.
  • the apparatus 50 further comprises mechanical means (not shown) for manipulation of the end 55A of the fibre 55 by a user (i.e. a practitioner).
  • the apparatus 50 has an electrical output 60.
  • the OIU 54 comprises lenses 61 , 70, 73, a beam-splitter 62, a half-wave plate 64 and a quarter-wave plate 68 each having its optic axis at 45° to the plane of the paper, a Brewster plate 66, a mirror 71 , a beam-recombiner 72 and an optical detector 74 (e.g. a photodiode) having an output 75.
  • lenses 61 , 70, 73 a beam-splitter 62, a half-wave plate 64 and a quarter-wave plate 68 each having its optic axis at 45° to the plane of the paper, a Brewster plate 66, a mirror 71 , a beam-recombiner 72 and an optical detector 74 (e.g. a photodiode) having an output 75.
  • an optical detector 74 e.g. a photodiode
  • the apparatus 50 is shown arranged for investigation of an internal region 80 of a patient.
  • the region 80 comprises a bone region 84 surrounded by a nerve tissue region 82.
  • the nerve tissue region 82 meets the bone region 84 at an interface 83.
  • a practitioner desiring to accurately locate the position of the interface 83, moves the end 55A of the fibre 55 in the vicinity of the interface 83 whilst the probe 57 is maintained in contact with the bone region 84.
  • a characteristic electrical signal is generated at the output 60.
  • a variety of output devices may be connected to the output 60.
  • devices such as a moving coil voltmeter or a loudspeaker may be employed to give a visual or an audible indication to the practitioner when the distal end 55A of the fibre 55 is located over a particular type of tissue.
  • a chart recorder may be connected to the output 60 via suitable circuits to provide mapping of the interface region 83 if the distal end 55A of the fibre 55 is moved across the interface 83 in a systematic way.
  • the apparatus 50 operates as follows. " Radiation from the laser 52 is coupled into the optical fibre 53 and passed to the OIU 54. Radiation exiting the fibre 53 is linearly polarised in the plane perpendicular to the plane of the paper and is collimated by the lens 61 and directed towards the beamsplitter 62. The beamsplitter 62 divides the radiation into two beams of approximately equal power. One beam passes through the half-wave plate 64 (after which it is polarised in the plane of the paper), through the Brewster plate 66 and quarter- wave plate 68 and is coupled ' by the lens 70 into the fibre 55. The other beam is directed to the detector 74 via the beam-recombiner 72 and the lens 73.
  • Radiation coupled into the fibre 55 passes to the distal end 55A thereof and illuminates the internal region 80 under investigation; a portion of this radiation exits the distal end 55A and is reflected by matter in the vicinity thereof back into the fibre 55.
  • the reflected radiation passes back to the OIU 54 along the fibre 55.
  • the reflected radiation is collimated by the lens 70 and passes through the quarter-wave plate 68, after which a non-depolarised component thereof is linearly polarised in the plane perpendicular to the plane of the paper in Figure 2.
  • the reflected, non-depolarised radiation is reflected by the Brewster plate 66 and the mirror 71 and passes to the beam-recombiner 72 and thence to the detector 74 via the lens 73.
  • the reflected, non-depolarised radiation is thus interfered with radiation directly received by the detector 74 from the laser 52.
  • Ultra-sonic energy is applied to the bone region 84 by means of the ultra-sonic oscillator 56 and probe 57.
  • the oscillator 56 generates a signal of ultra-sonic frequency which is received by the probe 57.
  • the probe 57 comprises a transducer (not shown) which is placed in contact with the bone region 54 when the apparatus 50 is used.
  • the bone region 84 therefore undergoes ultra-sonic vibration, however the adjacent nerve tissue region 82 does not as it lacks sufficient mechanical rigidity.
  • Signals generated at the output 75 of the OIU 54 are passed to the SOU 59 together with a signal from the oscillator 56.
  • a signal with an improved signal-to noise ratio is generated at the output 60, compared to a corresponding signal generated at the output 75.
  • bone tissue 84 may be distinguished from nerve tissue 82 by monitoring the status of an output device connected to the output 60 as the distal end 55A of the fibre 55 is moved in the vicinity of the interface 83.
  • Some vibration may occur in the nerve tissue 82, depending on its exact mechanical properties. The magnitude of any such vibration will be less than that of vibrations induced in the bone tissue 84 and such vibration may have phase shift with respect to vibration induced in the bone tissue 84.
  • a signal having an ac component is generated at the output 60 both when the distal end 55A of the fibre 55 is located at bone tissue 84 and when it is locate at nerve tissue 82.
  • tissue types may still be distinguished on the basis of the amplitudes and relative phases of signals generated at the output 60.
  • the frequency of the signal output by the oscillator 56 may be adjusted to optimise acoustic resonance in the bone region 84.
  • the ultra-sonic oscillator 56 may be arranged to generate an ultra-sonic signal consisting of two frequencies, one of which is selected for optimal acoustic coupling to bone tissue 84 and the other being selected for optimal acoustic coupling to adjacent nerve tissue 82.
  • a modulated signal is produced at the outputs 60, 75 the frequency of which corresponds to the tissue type over which the fibre end 55A is located. Positive identification of both bone and nerve tissue may thus be achieved.
  • Each frequency may be adjusted to optimise acoustic resonance in a corresponding tissue type. Frequencies other than ultra-sonic frequencies may be used depending on the mechanical properties of one or more of the tissues types under investigation.
  • the apparatus 50 may be used to distinguish n different tissue types, provided at least n-1 are capable, by virtue of their mechanical properties, of supporting vibrations. If the different tissue types are connected such that vibrations may be transmitted to each from one of the tissue types, only a single probe is required. If this is not the case, more than one probe may be required to set up vibrations in various tissue types. Positive identification of the n tissue types may be achieved using one or more signals having n different frequencies, provided all n tissue types are capable of supporting vibrations.
  • An alternative apparatus of the invention is like to the apparatus 50 except that it has no SOU, the output of the OIU being connected directly to an output device.
  • the alternative apparatus has a simpler construction and may be employed in circumstances where a relatively poor sign-to-noise ratio is tolerable in the output of the OIU.
  • the laser 52 could alternatively be a source of partially coherent radiation (for example an LED), although a laser provides a larger interference signal at the detector 74 because a laser's output is highly coherent.
  • a semiconductor laser is preferred as such a laser is compact, robust and susceptible of control by simple electronic means.
  • the apparatus 100 comprises an aim laser or LED 102 (for example a He-Ne laser) having visible output, an ablating laser 104 (for example a Ho:YAG laser), a saline system 106 for delivery of saline solution, a vacuum system 108 for removing debris from a point of surgery, a white light source 132 (for example an incandescent lamp) and a monitor system 130.
  • an aim laser or LED 102 for example a He-Ne laser
  • an ablating laser 104 for example a Ho:YAG laser
  • a saline system 106 for delivery of saline solution
  • a vacuum system 108 for removing debris from a point of surgery
  • a white light source 132 for example an incandescent lamp
  • the laser or LED 102 and the laser 104 are coupled to a single optical fibre 116.
  • the saline system 106 and the vacuum system 108 are coupled to flexible tubes 118, 120.
  • the white light source 132 is coupled to an optical fibre 124.
  • the monitor system 130 comprises a lens, an optical detector and a visual display unit (VDU, not shown), and is coupled to a fibre bundle 122.
  • the white light source 132, the monitor system 130, the fibre 124 and the fibre bundle 122 together form an endoscope 1 10, or fibrescope, like to that shown in Figure 1.
  • the fibres 116, 124 are held together with the tubes 118, 120 and the fibre bundle 122 within a flexible sheath 114.
  • Distal ends of the fibres 116, 124, the tubes 118, 120 and the fibre bundle 122 are delivered to an internal region 180 of a human or animal body, for example a spinal region.
  • the apparatus 100 further comprises mechanical means (not shown) allowing a practitioner to manoevre the distal tip 125 of the apparatus 100.
  • a practitioner observes that part of the internal region 180 located near the tip 125 of the apparatus 100 by means of the monitor system 130, and moves the tip 125 adjacent a region of bone to be ablated using the mechanical means.
  • the practitioner operates the aim laser 102 to ensure that the tip 125 is in a position such that, when the ablation laser 104 is operated, bone tissue 184 is ablated rather than adjacent nerve tissue 182.
  • the ablation laser 104 is operated to ablate offending bone tissue.
  • the saline and vacuum systems 106, 108 may be operated to clean a point at which surgery is carried out.
  • FIG. 4 there is shown an endoscopic laser abalation apparatus of the invention, indicated generally by 200.
  • the apparatus 200 has a construction like to that of the apparatus 100; parts of the apparatus 100, 200 which are equivalent are labelled by reference numerals which differ by a value of 100.
  • the apparatus 200 comprises an aim laser 202 coupled to an optical interference unit (OIU) 254 via an optical fibre 253, a signal conditioning unit (SCU) 259 incorporating a frequency de-modulator and a phase-locked loop (not shown) and having an output 260, an ultra-sonic oscillator 256 having a probe 257 which incorporates a transducer (not shown), and an optical fibre 255 for coupling a portion of the radiation output by the aim laser 202, via the OIU 254, to a region 280 within a human or animal body in which laser ablation surgery is to be carried out.
  • the apparatus 200 further comprises an ablation laser 204 coupled to the fibre 255 by an optical fibre 216.
  • Parts 202, 253, 254, 255, 256, 257, 258 and 260 constitute apparatus for distinguishing bone tissue 284 from nerve tissue 282, this apparatus being like to that shown in Figure 2.-
  • the fibre 216 may extend to the distal end 225 of the apparatus 200.
  • the use of a single fibre 255 for delivery of both ablating radiation and radiation from the aim laser 202 keeps the diameter of the sheath 214 to a minimum.
  • the apparatus 200 further comprises a light source 232 coupled to an optical fibre 224, a monitor system 230 (comprising a lens, a detector and a visual display unit (VDU) which are not shown) coupled to a fibre bundle 222.
  • a monitor system 230 comprising a lens, a detector and a visual display unit (VDU) which are not shown
  • VDU visual display unit
  • a practitioner positions the distal end 225 of the apparatus 200 approximately over a region of bone to be ablated using the mechanical means and the endoscope 210.
  • the practitioner may position the distal end 225 of the apparatus 200 very accurately over a region of bone to be ablated, and much more accurately than is possible merely by use of the endoscope 210 alone.
  • this laser may be used for aiming the apparatus 200 as well as for effecting ablation.
  • the ablation laser 204 is coupled to the OIU 254 via the fibre 253.
  • the aim laser 202 and the fibre 216 may then be dispensed with.
  • An alternative endoscopic laser ablation apparatus of the invention is like to the apparatus 200, except that signals from the output 260 are passed to the monitor system 230 and are used to give a visual indication on the VDU of the monitor system corresponding to a tissue type over which the distal end of the apparatus is positioned.
  • a further alternative endoscopic laser ablation apparatus of the invention is like to the apparatus 200, except that signals from an OIU are passed directly to an output device, or as the case may be to a monitor system, and a SCU is not employed. This provides a simpler apparatus in circumstances where a reduced signal-to-noise ratio is tolerable in the output of the OIU.
  • Another alternative endoscopic laser ablation apparatus of the invention comprises an ablation laser coupled to an optical fibre (for delivery of ablating radiation) and the apparatus of Figure 2, but does not comprise an endoscope or fibrescope.
  • apparatus of the invention for distinguishing different tissue types, e.g. bone tissue and nerve tissue
  • the apparatus may also be used to distinguish regions of the same biological tissue type, provided such regions have mechanical or other properties such that these regions respond differently to an applied vibration.
  • a diseased region of nerve tissue has a different density and/or different elasticity compared to a healthy region of nerve tissue. Therefore, when a mechanical vibration is applied to bone tissue adjoining nerve tissue, signals generated at points 75, 60 of the apparatus 50 when the end 55A is positioned over healthy nerve tissue will differ from signals at those points generated when the end 55A is positioned over diseased nerve tissue.
  • apparatus of the invention is in distinguishing regions consisting of the same biological material, all of which are healthy but which are in different biological states such that the regions have different responses to an applied vibration, due to differing mechanical or other properties within the regions.
  • regions consisting of the same biological material, all of which are healthy but which are in different biological states such that the regions have different responses to an applied vibration, due to differing mechanical or other properties within the regions.
  • human or animal fertility treatment it is necessary to identify eggs in the female which are in a sufficiently high state of fertility to allow their use in fertility treatments.
  • the fertility of an egg is related to the viscosity of its surrounding follicular fluid, and therefore a mechanical vibration applied to a female ovary produces different vibrational responses within follicular fluid surrounding eggs in differing states of fertility.
  • Signals generated at points 60, 75 of the apparatus 50 when the distal end 55A of the apparatus 50 is positioned over follicular fluid are therefore indicative of the fertility of an egg within that fluid.

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  • Laser Surgery Devices (AREA)

Abstract

L'invention a trait à un appareil (50) permettant de différencier des types de tissu dans une zone (80) située à l'intérieur du corps d'un être humain ou d'un animal. Ledit appareil comprend une source (52, 53) de rayonnement au moins partiellement cohérent, une fibre optique (55) fournissant une partie du rayonnement au moins partiellement cohérent à ladite zone, et des moyens de positionnement de l'extrémité distale (55A) de la fibre. L'appareil est caractérisé en ce qu'il comprend également des moyens (56, 57) permettant d'imprimer une vibration mécanique à au moins l'un des types de tissu, un détecteur de rayonnement (74), et des moyens de brouillage (61, 62, 64, 66, 68, 70, 71, 72, 73) destinés à brouiller le rayonnement qui est fourni par la fibre optique à la zone et qui est ensuite réfléchi par le tissu situé à cet endroit avec un rayonnement émanant de la source au niveau du détecteur, afin de générer un signal caractéristique à une sortie de ce dernier, le signal caractéristique étant caractéristique du type de tissu au niveau duquel l'extrémité distale de la fibre est positionnée. L'appareil peut faire partie d'un appareil d'ablation par laser endoscopique.
PCT/GB2003/000227 2002-01-30 2003-01-21 Appareil et procede permettant de differencier des types de tissu WO2003063696A1 (fr)

Applications Claiming Priority (2)

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GB0202066.7 2002-01-30
GB0202066A GB2384851A (en) 2002-01-30 2002-01-30 Apparatus and method for distinguishing tissue types

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WO2003063696A1 true WO2003063696A1 (fr) 2003-08-07

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112932627A (zh) * 2021-03-08 2021-06-11 河南省中医院（河南中医药大学第二附属医院） 一种基于超声引导穿刺装置及方法
US11202674B2 (en) 2018-04-03 2021-12-21 Convergent Dental, Inc. Laser system for surgical applications

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1995029737A1 (fr) * 1994-05-03 1995-11-09 Board Of Regents, The University Of Texas System Appareil et procede a guidage doppler par ultrasons permettant la maitrise en temps reel selon une technique non invasive des lesions tissulaires induites par un traitement thermique
US5582171A (en) * 1994-07-08 1996-12-10 Insight Medical Systems, Inc. Apparatus for doppler interferometric imaging and imaging guidewire
WO1998038907A1 (fr) * 1997-03-06 1998-09-11 Massachusetts Institute Of Technology Instrument d'analyse a balayage optique de tissu vivant
US6016440A (en) * 1996-07-29 2000-01-18 Bruker Analytik Gmbh Device for infrared (IR) spectroscopic investigations of internal surfaces of a body
EP1090582A1 (fr) * 1999-10-01 2001-04-11 Karl Storz GmbH & Co. KG Procédé d'imagerie pour déterminer l'état de tissus
US20010027316A1 (en) * 2000-01-21 2001-10-04 Gregory Kenton W. Myocardial revascularization-optical reflectance catheter and method
WO2001074251A2 (fr) * 2000-03-31 2001-10-11 Rita Medical Systems Inc. Appareil et procede de biopsie et traitement tissulaire

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5371588A (en) * 1993-11-10 1994-12-06 University Of Maryland, College Park Surface profile and material mapper using a driver to displace the sample in X-Y-Z directions

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1995029737A1 (fr) * 1994-05-03 1995-11-09 Board Of Regents, The University Of Texas System Appareil et procede a guidage doppler par ultrasons permettant la maitrise en temps reel selon une technique non invasive des lesions tissulaires induites par un traitement thermique
US5582171A (en) * 1994-07-08 1996-12-10 Insight Medical Systems, Inc. Apparatus for doppler interferometric imaging and imaging guidewire
US6016440A (en) * 1996-07-29 2000-01-18 Bruker Analytik Gmbh Device for infrared (IR) spectroscopic investigations of internal surfaces of a body
WO1998038907A1 (fr) * 1997-03-06 1998-09-11 Massachusetts Institute Of Technology Instrument d'analyse a balayage optique de tissu vivant
EP1090582A1 (fr) * 1999-10-01 2001-04-11 Karl Storz GmbH & Co. KG Procédé d'imagerie pour déterminer l'état de tissus
US20010027316A1 (en) * 2000-01-21 2001-10-04 Gregory Kenton W. Myocardial revascularization-optical reflectance catheter and method
WO2001074251A2 (fr) * 2000-03-31 2001-10-11 Rita Medical Systems Inc. Appareil et procede de biopsie et traitement tissulaire

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11202674B2 (en) 2018-04-03 2021-12-21 Convergent Dental, Inc. Laser system for surgical applications
CN112932627A (zh) * 2021-03-08 2021-06-11 河南省中医院（河南中医药大学第二附属医院） 一种基于超声引导穿刺装置及方法

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GB2384851A (en) 2003-08-06
GB0202066D0 (en) 2002-03-13

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