WO2019130465A1 - Dispositif de traitement chirurgical - Google Patents

Dispositif de traitement chirurgical Download PDF

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Publication number
WO2019130465A1
WO2019130465A1 PCT/JP2017/046871 JP2017046871W WO2019130465A1 WO 2019130465 A1 WO2019130465 A1 WO 2019130465A1 JP 2017046871 W JP2017046871 W JP 2017046871W WO 2019130465 A1 WO2019130465 A1 WO 2019130465A1
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WO
WIPO (PCT)
Prior art keywords
laser light
detection
unit
irradiation
energy
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Application number
PCT/JP2017/046871
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English (en)
Japanese (ja)
Inventor
賢 藤沼
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オリンパス株式会社
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Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2017/046871 priority Critical patent/WO2019130465A1/fr
Publication of WO2019130465A1 publication Critical patent/WO2019130465A1/fr

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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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A61B5/0285—Measuring or recording phase velocity of blood waves

Definitions

  • the present invention relates to a surgical device.
  • Patent Document 1 In surgical treatment of living tissue, there is known a surgical treatment apparatus which uses laser doppler to determine the presence or absence of a blood vessel hidden in fat or the like inside living tissue and informs the operator (for example, Patent Document 1) reference.).
  • the laser Doppler method detects blood flow in living tissue, although the presence or absence of blood vessels can be determined by determining the presence or absence of blood flow, the blood vessel wall present outside the blood flow is detected. You can not do it. For this reason, even if the surgical procedure is performed while avoiding the detected blood flow portion, when the surgical procedure is performed on the living tissue very near the blood flow portion, the surgical procedure is performed on the blood vessel wall existing outside the blood flow. There is a possibility that the treatment will be applied unintentionally.
  • the present invention has been made in view of the above-described circumstances, and an object thereof is to provide a surgical treatment apparatus capable of preventing an unintended surgical treatment from being performed on a blood vessel wall.
  • the detection laser beam is applied to a living tissue by an energy emitting unit for emitting therapeutic energy, a detection laser beam irradiation unit for emitting a detection laser beam, and the detection laser beam irradiation unit.
  • a blood flow detection unit for detecting a blood flow in the surgical operation apparatus, wherein the irradiation range of the detection laser light is set larger than the incident range of the therapeutic energy emitted from the energy emission unit. It is.
  • the detection laser light emitted from the detection laser light irradiation unit is irradiated to the living tissue
  • the return light returning from the inside of the living tissue is detected by the light detection unit, and the detected return light is used.
  • the blood flow detection unit detects a blood flow in the irradiation range of the detection laser light in the living tissue.
  • the therapeutic energy is ejected from the energy ejection unit, whereby the treatment can be performed on the incident range of the therapeutic energy in the living tissue.
  • the irradiation range of the detection laser beam is set larger than the incident range of the therapeutic energy, it is positioned around the blood flow when the blood flow is detected by the irradiation of the detection laser beam.
  • the vessel wall can be prevented from overlapping the incident range of the therapeutic energy to prevent an unintentional surgical operation on the vessel wall.
  • the irradiation range of the detection laser beam may be set larger than the influence range of the therapeutic energy emitted from the energy emission unit by a predetermined size.
  • the irradiation range of the detection laser light is set larger than the influence range of the therapeutic energy. Therefore, when the blood flow is detected by the irradiation of the detection laser light, the periphery of the blood flow is detected.
  • the vessel wall can be prevented from being unintentionally influenced by the surgical procedure by preventing the vessel wall located in the vessel from overlapping the range of influence of the therapeutic energy.
  • the irradiation range of the detection laser beam may be set larger by a predetermined dimension over all directions outside the incident range of the therapeutic energy. By doing this, it is possible to obtain a difference which is always separated by a predetermined dimension between the incident range of the therapeutic energy and the blood flow when the blood flow is detected by the irradiation of the detection laser light. By setting this difference to be larger than the thickness dimension of the blood vessel wall, the blood vessel wall does not overlap with the incident range of the therapeutic energy, thereby preventing an unintentional surgical operation on the blood vessel wall. be able to.
  • the irradiation range of the detection laser beam may be set larger by a predetermined dimension over all directions outside the influence range of the therapeutic energy.
  • the predetermined dimension may be 1 mm or more.
  • the blood vessel wall of a thick blood vessel which may cause serious bleeding if cut, has a thickness of about 0.5 mm.
  • the above-mentioned mode it may have an energy injection prohibition part which forbids injection of the above-mentioned therapeutic energy by the above-mentioned energy ejection part, when blood flow is detected by the above-mentioned blood flow detection part.
  • the energy injection prohibiting unit prohibits the injection of the therapeutic energy, so the operator does not intend and the incident range of the therapeutic energy is Even if the blood vessel wall is brought close to the blood vessel wall, the emission of therapeutic energy is prohibited before the incident area overlaps the blood vessel wall, and it is possible to more reliably prevent an unintended surgical operation on the blood vessel wall.
  • the energy injection prohibition unit prohibits the injection of the therapeutic energy by the energy injection unit when the blood flow detected by the blood flow detection unit is equal to or more than a predetermined threshold.
  • a predetermined threshold There are large blood flows in thick blood vessels where serious bleeding may be a concern when cut.
  • the treatment of the thick blood vessel is unintentionally performed because the injection of therapeutic energy by the energy ejection unit is prohibited. What is done can be prevented more reliably.
  • the energy emitting unit may emit a therapeutic laser beam.
  • the detection laser light may have a wavelength smaller in absorption coefficient with respect to the living tissue than the treatment laser light. By doing this, the detection laser beam can be made to reach a deeper part of the living tissue than the treatment laser beam, and the detection laser beam can be irradiated to a wider range including the irradiation range of the treatment laser beam. Can.
  • the irradiation range on the living tissue surface of the detection laser beam includes a circle having a diameter of 3.5 mm or more centered on the irradiation range on the living tissue surface of the therapeutic laser beam. It may have a shape.
  • the laser light emitting unit for guiding is provided for irradiating the guide laser light having a predetermined focal distance, and the laser light emitting unit for guiding is for the detection laser light emitting unit.
  • the relative position in the irradiation direction of the guide laser beam may be determined in advance. In this way, the living body tissue can be irradiated with the detection laser beam in a predetermined irradiation range simply by aiming the guide laser beam at the site where the operator wants to treat.
  • FIG. 1 It is a whole block diagram which shows the surgical treatment apparatus which concerns on one Embodiment of this invention. It is a longitudinal cross-sectional view explaining the internal structure of the front-end
  • FIG. 8 shows the injection end of the surgical treatment apparatus of FIG. 7; It is a figure which shows an example of the irradiation range of the therapeutic laser beam and the detection laser beam which are inject
  • the surgical treatment apparatus 1 is, as shown in FIG. 1, a treatment laser beam (therapy energy), a detection laser beam, and a treatment laser beam from the tip that is held by the operator and made to face the living tissue X. It comprises a treatment probe 2 capable of emitting a guide laser beam, and an apparatus main body 3 connected to the treatment probe 2.
  • a treatment laser beam therapy energy
  • a detection laser beam detection laser beam
  • a treatment laser beam from the tip that is held by the operator and made to face the living tissue X.
  • It comprises a treatment probe 2 capable of emitting a guide laser beam, and an apparatus main body 3 connected to the treatment probe 2.
  • the device body 3 includes a therapeutic laser light source 4 for generating therapeutic laser light, a detection laser light source 5 for generating detection laser light, a guiding laser light source 6 for generating guiding laser light, and a treatment probe. 2.
  • a light detection unit 7 for detecting return light from the living tissue X collected by 2; a blood flow detection unit 8 for detecting the presence or absence of blood flow based on the return light detected by the light detection unit 7;
  • the laser light source 4 for treatment, the laser light source 5 for detection, and the light source control part (energy injection prohibition part) 9 which controls the laser light source 6 for guidance based on the operation in the probe 2 and the detection result by the blood flow detection part 8 ing.
  • the therapeutic laser light source 4 is adapted to generate therapeutic laser light having a wavelength of, for example, 2000 nm, which is selected from 400 to 600 nm, for example, 500 nm, or 1350 to 2000 nm.
  • the detection laser light source 5 is configured to generate a detection laser beam having a wavelength selected from 650 to 1300 nm.
  • the guide laser light source 6 is configured to generate guide laser light having a wavelength different from that of the treatment laser light and the detection laser light and in a visible light range that is easily visible to the naked eye.
  • the treatment laser light generated in the treatment laser light source 4, the detection laser light generated in the detection laser light source 5, and the guide laser light generated in the guide laser light source 6 are connected to the light sources 4, 5 and 6, respectively.
  • the light is output to the outside via an optical fiber (energy emitting unit, laser light irradiation unit for guiding, laser light irradiation unit for detection) 10 and 11.
  • the optical fibers 10 and 11 are coupled by an optical coupler 12 and guided to the treatment probe 2.
  • the light detection unit 7 is a photodetector that detects return light from the living tissue X guided by the light receiving optical fiber 18 having the incident end disposed forward on the tip of the treatment probe 2.
  • the blood flow detection unit 8 is configured to measure a blood flow value on the basis of the return light detected by the light detection unit 7 through a known judgment algorithm by the laser Doppler method.
  • the blood flow detection unit 8 is configured to output detection information when the blood flow value is equal to or more than a predetermined threshold.
  • the detection information may include information on the presence or absence of the blood vessel (see FIG. 4) Y and information indicating the thickness of the blood vessel Y, or may include identification information as to whether it is an artery or a vein. .
  • the light source control unit 9 will be described later.
  • the treatment probe 2 is provided with an objective lens 14 disposed at the tip of a cylindrical casing 13, and the emitting ends 10a of the optical fibers 10, 11 at positions spaced from the objective lens 14 11a is placed.
  • the therapeutic laser light generated in the therapeutic laser light source 4 and the guiding laser light generated in the guiding laser light source 6 are guided by the same first optical fiber 10.
  • the detection laser light generated in the detection laser light source 5 is guided by the second optical fiber 11 different from the first optical fiber 10.
  • the emission end 10a is disposed at a position closer to the objective lens 14 than the second optical fiber 11.
  • the treatment laser light and the guide laser light emitted from the emission end 10 a of the first optical fiber 10 are collected by the objective lens 14 at a predetermined focal length and are predetermined with respect to the tip of the treatment probe 2
  • a very small light spot A is focused and imaged on the surface of the living tissue X opposite to the spaced position.
  • the detection laser beam emitted from the emission end 11a of the second optical fiber 11 is collected by the objective lens 14 and a living body in a wider irradiation range B surrounding the position of the light spot A of the treatment laser beam.
  • the tissue X is irradiated.
  • the light spot (incidence range) A on the surface of the living tissue X of the treatment laser light varies depending on the type of living tissue X to be treated and the type of surgery, but a circle with a diameter of 0.1 to 0.5 mm It is set to.
  • the irradiation range B on the surface of the living tissue X of the detection laser beam is set to a circle having a diameter of 3.5 mm or more, centering on the center of the light spot A of the treatment laser beam.
  • the treatment probe 2 is provided with a grip 15 held by the operator, for example, for turning on and off the guide laser beam near a position where the operator's thumb will be placed when the grip 15 is held.
  • a first switch 16 and a second switch 17 for turning on and off the treatment laser beam and the detection laser beam are provided.
  • the light source control unit 9 operates the guide laser light source 6 to emit a guide laser beam.
  • the light source control unit 9 operates the detection laser light source 5 to emit detection laser light, and the blood flow detection unit 8.
  • the laser light for treatment is emitted by controlling the operation of the laser light source 4 for treatment according to the presence or absence of the detection information from.
  • the light source control unit 9 causes only the detection laser beam to be emitted, and when the detection information is output from the blood flow detection unit 8, the second switch 17 is turned on. Even in the state, by continuing to stop the operation of the therapeutic laser light source 4, the therapeutic laser light is prohibited from being emitted from the tip of the therapeutic probe 2. Further, the light source control unit 9 emits the treatment laser beam when the detection information is not output from the blood flow detection unit 8 in the state where the detection laser beam is emitted.
  • the operator holds the grip 15 of the treatment probe 2 and performs the surgical treatment.
  • the first switch 16 provided on the grip 15 is switched on.
  • the light source control unit 9 operates the guide laser light source 6 to emit the guide laser light from the tip of the treatment probe 2.
  • a light spot of the guide laser light is formed on the surface of the living tissue X.
  • the operator moves the treatment probe 2 to move the light spot of the guide laser light on the surface of the living tissue X so as to coincide with the portion to be treated.
  • the operator switches the second switch 17 to the on state.
  • the light source control unit 9 operates the detection laser light source 5 to emit the detection laser light from the tip of the treatment probe 2. And thereby, the living body tissue X is irradiated with the detection laser light in the irradiation range B surrounding the position where the light spot of the guide laser light is formed.
  • the detection laser light is irradiated onto the living tissue X in the set irradiation range B.
  • the detection laser light has a wavelength selected from 650 to 1300 nm, and this wavelength has a smaller light absorption coefficient with respect to the living tissue X than the therapeutic laser light, and thus reaches the deep part of the living tissue X be able to. That is, while the treatment laser beam is limitedly irradiated to the surface of the living tissue X, the detection laser beam is extended to a wide range in which the influence range C of the treatment laser beam is expanded outward in all directions.
  • the detection laser beam When the detection laser beam is irradiated to the living tissue X, the detection laser beam is incident on the living tissue X and scattered, and a part thereof is returned light and disposed at the tip of the treatment probe 2 The light is incident on the incident end of the light receiving optical fiber 18. The incident return light is guided to the light detection unit 7 through the light receiving optical fiber 18 and detected by the light detection unit 7.
  • the intensity information of the return light detected by the light detection unit 7 is sent to the blood flow detection unit 8, and the blood flow detection unit 8 measures a blood flow value through a determination algorithm by the laser Doppler method.
  • the blood flow detection unit 8 outputs detection information when the blood flow value is equal to or more than a predetermined threshold.
  • the emission of detection laser light to the detection of detection information is performed instantaneously.
  • the blood flow detection unit 8 When the measured blood flow rate is lower than the threshold, the blood flow detection unit 8 does not output anything, and the light source control unit 9 operates the therapeutic laser light source 4 to perform treatment. Laser light is emitted from the tip of the treatment probe 2 toward the living tissue X. At this time, as shown in FIG. 3, the light spot A of the therapeutic laser light is formed on the surface of the living tissue X, and the detecting laser light is applied to the living tissue X in an irradiation range B surrounding the periphery thereof.
  • the light source control unit 9 stops the operation of the therapeutic laser light source 4 and Laser light is prohibited from being emitted from the tip of the treatment probe 2 toward the living tissue X.
  • the blood vessel wall Y1 of the thick blood vessel Y and the irradiation range B of the detection laser light overlap, but a large blood flow value larger than the threshold is not measured, and the irradiation of the therapeutic laser light Not prohibited.
  • the region Y2 inside the blood vessel Y overlaps the irradiation range B of the detection laser light as shown in FIG. 5 by moving the treatment probe 2
  • the blood flow value is measured, and the blood flow value is a threshold When it becomes above, irradiation of the therapeutic laser beam is prohibited.
  • the irradiation range B of the detection laser beam is formed in a circular shape having a diameter of 3.5 mm or more. Even if the influence range C of the therapeutic laser light when the diameter is about 0.5 mm is a circle having a diameter of 2.5 mm, the irradiation range B is larger by a predetermined dimension (1.0 mm).
  • the irradiation range B of the detection laser beam having a width of 0.5 mm or more exists outside the influence range C.
  • the thick blood vessel wall has a thickness of about 0.5 mm, which may cause serious bleeding if it is cut
  • the blood vessel wall Y1 with a thickness of about 0.5 mm Before overlapping with the influence range C, the blood flow can be detected to prohibit the irradiation of the therapeutic laser light.
  • the influence range C of the therapeutic laser light is not a range to which the therapeutic laser light is directly irradiated, but a range in which thermal effects or tissue degeneration or the like may occur due to the irradiation of the therapeutic laser light.
  • the irradiation range B is set larger than the incident range A or the affected range C by a predetermined dimension, It is possible to prevent surgical treatment of the blood vessel wall Y1.
  • the blood vessel wall Y1 located around the blood flow is a therapeutic laser light when the blood flow value above the threshold value is measured by the irradiation of the detection laser light.
  • the blood vessel Y can be prevented from being affected by the irradiation of the therapeutic laser light before overlapping with the influence range C of the therapeutic laser light. That is, even if the blood vessels Y cross each other or have branches, none of the plurality of blood vessels Y traveling in different directions is affected by the irradiation of the therapeutic laser light. It has the advantage of being able to
  • the irradiation range B of the detection laser light may include a shape including a circle having a diameter of 3.5 mm or more, for example, another shape such as an ellipse or a polygon. it can. It may change suitably according to the thickness and the kind of blood vessel Y which want to detect instead of the shape and size of these irradiation ranges.
  • Efficiency can also be improved.
  • two switches 16 and 17 are provided on the treatment probe 2 and the first switch 16 is turned on to emit a guide laser beam, and the second switch 17 is turned on to emit a detection laser beam and a treatment laser beam.
  • the treatment laser light may be emitted by the first switch 16, and the guide laser light and the detection laser light may be emitted by the second switch 17.
  • a third switch (not shown) may be provided on the treatment probe 2 and irradiation of detection laser light may be performed by turning on the second switch 17, and treatment laser light may be irradiated by the third switch.
  • the light source control unit 9 does not emit the treatment laser light by itself, and the treatment laser according to the presence or absence of the detection information from the blood flow detection unit 8 The operation of the light source 4 is controlled.
  • the irradiation of the treatment laser light and the detection laser light is performed. It was decided to make the ranges A and B different.
  • the second optical fiber 11 may be disposed to guide a plurality of (for example, five) detection laser beams at intervals.
  • the laser light and the guide laser light are condensed on the surface of the living tissue X to form a small light spot A, and the detection laser light is diffused to surround the light spot A of the therapeutic laser light. Irradiation may be performed over a wide range (irradiation range) D.
  • the detection laser beams emitted from the five second optical fibers 11 are irradiated to five circular irradiation areas D overlapping each other as shown in FIG. As described above, it is preferable to be configured to include a circular irradiation range B having a diameter of 3.5 mm.
  • the distances of the emission ends 10a and 11a of the optical fibers 10 and 11 with respect to the objective lens 14 are made substantially equal to guide the treatment laser light.
  • a GRIN lens 22 may be disposed at the end of the light emitting first optical fiber 10 so that a small diameter light beam is emitted.
  • an optical element 23 such as a prism is disposed so that the center position of the detection laser light approaches the center position of the treatment laser light. It is also good. Also in this case, the same irradiation range B as in the case of adopting the configuration of FIG. 2 can be achieved.
  • the detection is performed by arranging the first optical fiber 10 for guiding the treatment laser light and the second optical fiber 11 for guiding the detection laser light as close as possible.
  • the central position of the laser light may be brought close to the central position of the therapeutic laser light.
  • the two optical fibers 10 and 11 are built in the housing 13 of the treatment probe 2 has been described, the two may be separately attachable and detachable.
  • the optical fiber for guiding the guiding laser light with the optical fiber 10 for guiding the therapeutic laser light, the guiding laser light irradiation part and the energy emitting part which is the therapeutic laser light irradiation part
  • the optical fiber 11 for guiding the detection laser light it may be common with the detection laser light irradiation unit, or another fiber may be used.
  • the guide laser light irradiation unit is visible light having a predetermined focal length, and at least the relative position in the irradiation direction of the laser light with respect to the detection laser light irradiation unit is It is preferable to be determined in advance.
  • the size is set so that the influence range C by the irradiation of the therapeutic laser light does not overlap the blood vessel wall Y1 when the blood flow is detected.
  • the size may be set so that the blood vessel wall Y1 does not overlap with the influence range C of the therapeutic laser light.
  • the probe which comprises an electrode is provided and the electric scalpel which performs a surgical procedure by electric energy is employ

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  • Health & Medical Sciences (AREA)
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  • Physics & Mathematics (AREA)
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  • Heart & Thoracic Surgery (AREA)
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Abstract

La présente invention concerne un dispositif de traitement chirurgical (1) pour protéger les parois de vaisseaux sanguins contre un traitement chirurgical non intentionnel, qui comprend : une unité d'émission d'énergie (10) servant à émettre de l'énergie thérapeutique ; une unité de rayonnement de lumière laser de détection (11) servant à émettre une lumière laser de détection ; une unité de détection de lumière (7) servant à détecter une lumière de retour revenant de l'intérieur d'un tissu biologique (X) provenant du rayonnement du tissu biologique (X) au moyen de la lumière laser de détection par l'unité de rayonnement de lumière laser de détection (11) ; et une unité de détection de flux sanguin (8) servant à détecter un flux sanguin dans la région soumise au rayonnement de lumière laser de détection dans le tissu biologique (X) à l'aide de la lumière de retour détectée par l'unité de détection de lumière (7). La région soumise au rayonnement de lumière laser de détection est définie pour être supérieure à une région exposée à l'énergie thérapeutique émise par l'unité d'émission d'énergie (10).
PCT/JP2017/046871 2017-12-27 2017-12-27 Dispositif de traitement chirurgical WO2019130465A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH01238853A (ja) * 1988-03-22 1989-09-25 Matsushita Electric Ind Co Ltd 医用レーザ装置
WO1991010473A1 (fr) * 1990-01-12 1991-07-25 Israel Barken Actionnement d'un laser commande par ordinateur a l'aide de la debitmetrie doppler
JP2015516182A (ja) * 2012-03-06 2015-06-11 ブライトシード・エルエルシーＢｒｉｔｅｓｅｅｄ，Ｌｌｃ 一体型センサーを有する外科器具

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH01238853A (ja) * 1988-03-22 1989-09-25 Matsushita Electric Ind Co Ltd 医用レーザ装置
WO1991010473A1 (fr) * 1990-01-12 1991-07-25 Israel Barken Actionnement d'un laser commande par ordinateur a l'aide de la debitmetrie doppler
JP2015516182A (ja) * 2012-03-06 2015-06-11 ブライトシード・エルエルシーＢｒｉｔｅｓｅｅｄ，Ｌｌｃ 一体型センサーを有する外科器具

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