WO2019224250A1

WO2019224250A1 - Medical handpiece for transmitting energy into biological tissue via an optical fiber

Info

Publication number: WO2019224250A1
Application number: PCT/EP2019/063219
Authority: WO
Inventors: Holger Wurm; Karl Stock; Christian Lingenfelder; Tilmann Trebst
Original assignee: Pharmpur Gmbh
Priority date: 2018-05-24
Filing date: 2019-05-22
Publication date: 2019-11-28
Also published as: DE102018112457A1

Abstract

The invention relates to a medical handpiece (1) for transmitting energy into biological tissue via an optical fiber (2), comprising a primary fiber (3) and a secondary fiber (4) which are coupled at a coupling point (5), the handpiece (1) further comprising a guide for the optical fiber (2), a coupling element (6) that surrounds the coupling point (5), and a suction channel (20). The aim of the invention is to provide a medical handpiece (1) which is used for transferring energy into biological tissue via an optical fiber (2), can be manufactured cost-effectively, allows individual components to be replaced in a simple fashion and prevents the handpiece (1) from heating up. Said aim is achieved by having the suction channel (20) surround the coupling element (6) at the coupling point (5).

Description

Medical handpiece for transmitting energy to biological tissue via an optical fiber

The invention relates to a medical handpiece for transmitting energy in biological tissue via an optical fiber, which is formed according to the preamble of claim 1.

In laser surgery on human or animal tissue, energy is transferred via optical fibers into the tissue to be treated. Especially in eye surgery, especially in cataract surgery, the protection of the surrounding, healthy tissue is required.

From the prior art, such as for example from the European patent EP 0 497 908 Bl, devices for laser surgery are known in which a target plate is excited by the radiation energy of a laser to oscillations. The shock waves generated thereby serve to fracture the surrounding tissue, which is subsequently removed via a suction passage. For a gentle and controlled removal of the tissue to be treated, the direct introduction of the radiation energy via an optical fiber into the tissue to be treated without the use of a target plate is advantageous.

US Pat. No. 6,120,498 discloses a handpiece for laser surgical applications for direct introduction of the radiation energy into the tissue to be treated, in which the optical fiber is guided within an integrated suction channel. By means of suction, tissue is guided in front of the optical fiber for efficient and safe removal and the ablated tissue is suctioned off.

It has been found that the optical fibers which are used in the known laser surgical devices and are usually made of sapphire or quartz, in particular the region of the fiber tip, already after a few Inserts have a high wear, whereby the entire optical fiber must be replaced. To solve this problem, European patent EP 1 024 760 B1 proposes a demountable handpiece comprising a first optical fiber via which the laser radiation from the laser source is guided to the handpiece and a second optical fiber, which is referred to as a light guide which is releasably coupled to the first optical fiber and for emitting the laser energy into the tissue to be treated. The light guide can be removed from the handpiece and replaced with an unused light guide. There are numerous adjustment surfaces for aligning the optical axis of the optical fiber with respect to a suction cannula, which serves for the extraction of crushed tissue, as well as with respect to the first optical fiber. The handpiece can be removed after an operation, cleaned and then reused. However, such handpieces, due to the narrow spaces and the numerous Justierflächen, often difficult, hygienic requirements, clean.

It has been shown that a warming of the handpiece must be prevented in order to ensure its functionality and stability, especially during an intervention, as well as the handling for the surgeon. In particular, at the coupling point of two fibers occur while thermal effects due to coupling losses and cladding modes, which can lead to heating and thereby affect the functionality and the handling of the handpiece. Coupling losses arise in particular due to a longitudinal or transverse offset or an angular offset of the fiber ends and due to surface reflections at these. Furthermore, thermal power dissipation may occur due to insertion losses, particularly reflection in the tissue to be treated and reincorporation into the fiber, as well as intrinsic losses in the fiber. The energy transfer via the fiber can also be done with a thermal power loss due to cladding modes. Optical fibers have a core-sheath structure wherein the light-guiding core is surrounded by a sheath having a lower refractive index than the core. Mantelmoden occur in particular by the coupling of two fibers or through the Reflection in the tissue to be treated and the re-coupling into the fiber, wherein the cladding modes, especially at the coupling point of two fibers lead to thermal losses and thus to a heating of the handpiece. The object of the invention is to provide a cost-manufacturable medical handpiece for transmitting energy in biological tissue via an optical fiber, which allows easy replacement of individual components and avoids heating of the handpiece. The invention solves the problem by a medical handpiece with the features of claim 1. Advantageous embodiments and advantageous developments of the invention are specified in the dependent claims.

The medical handpiece according to the invention for transmitting energy into biological tissue via an optical fiber, which has a primary fiber and a secondary fiber, which are optically coupled to one another via a coupling point, comprises a guide for the optical fiber, a coupling element which connects the coupling point of the primary and the secondary fiber encloses, and a suction channel, through which the treated and ablated tissue can be sucked. The medical handpiece according to the invention is characterized in that the suction channel surrounds the coupling element at the coupling point. The primary fiber serves to guide the emanating from a laser source radiation energy to the medical handpiece. Via the coupling point, the radiation energy is transferred from the primary fiber to the secondary fiber, the secondary fiber serving to radiate the radiation energy into the tissue to be treated. Through the suction of the aspirated liquid (which may be in particular an emulsion consisting of body water or an externally supplied rinsing liquid, such as a balanced salt solution, and ablated tissue material) via the suction creates a continuous suction in the suction. The aspirated liquid is used to cool the optical fiber. In addition, the aspirated liquid prevents the generation of cladding modes and resulting heat due to the coupling of cladding modes from the secondary fiber. To warm the handpiece too prevent at least a part of the optical fiber, in particular the secondary fiber, and at least a part of the coupling element, in particular the region of the coupling element at the coupling point, disposed within the suction channel.

In an advantageous embodiment of the medical handpiece, the coupling element is designed as a coupling sleeve. The primary fiber and the secondary fiber can be easily introduced into the coupling sleeve and optically and largely lossless coupled at the coupling point optically. This avoids high coupling losses and thereby a heating of the handpiece. Preferably, the coupling element consists of metal or a metal alloy, in particular of brass, an aluminum alloy, medical grade stainless steel or a nickel silver alloy in order to absorb and dissipate the heat occurring at the coupling point can. The thermal conductivity of the coupling element is preferably greater than 10 W / (m * K), preferably greater than 50 W / (m * K), particularly preferably greater than 80 W / (m * K). Due to a high thermal conductivity, the heat occurring at the coupling element, in particular at the coupling point, can be dissipated quickly, for example due to coupling losses or jacket modes, and excessive heating of the medical handpiece can be prevented.

In an advantageous embodiment of the medical handpiece, the secondary fiber is watertightly connected to the coupling element in order to protect the coupling point from moisture, which may affect the coupling between the primary fiber and the secondary fiber. Preferably, the secondary fiber for this purpose with the coupling element, in particular with the coupling sleeve glued. It is important to ensure that the proximal end of the secondary fiber, where the coupling with the distal end of the primary fiber takes place, is free of adhesives to prevent coupling losses. Under a proximal end are the ends facing away from the tissue to be treated and at a distal end to understand the tissue to be treated facing ends of an element of the handpiece. The medical handpiece in a preferred embodiment comprises a housing, a guide tube forming the optical fiber guide disposed within the housing, and a tip unit connected to the housing. Appropriately, the guide tube can be removed from the housing, so that the guide tube or the housing can be cleaned and replaced separately. The housing, the guide tube and the tip unit are preferably made of plastic, in particular a plastic for

Injection molding applications, for example, because of its high thermal stability, good chemical resistance and strength, of polyoxymethylene or of another plastic suitable for medical applications, e.g. Polyethylene or polypropylene. In the event that a reuse of the component is to be excluded, at least one of the components should not be autoclavable and make the handpiece unusable in the case of a preparation, in particular by the melting of one of the components.

In an advantageous embodiment, the coupling element is connected in a watertight manner to the guide tube and engages at least partially in the guide tube in order to prevent moisture from penetrating and impairing the coupling of the primary fiber to the secondary fiber. In particular, the coupling element can be glued to the guide tube. Preferably, the coupling point is within the tip unit, which is designed so that the coupling element is completely surrounded by the suction channel in the region of the coupling point. As a result, in particular the heat occurring at the coupling point can be dissipated via the aspirated liquid surrounding the coupling element and thus heating of the medical handpiece can be prevented.

In a preferred embodiment, the suction channel extends through the tip unit and at least partially through the housing. The tip unit preferably comprises a hollow needle, wherein the suction channel extends through the hollow needle, in particular to the distal end of the tip unit, which is guided to the tissue to be treated. The optical fiber, especially the secondary fiber, is guided through the hollow needle. In particular, the secondary fiber is central disposed within the hollow needle and completely surrounded by the suction channel. As a result, in particular cladding modes that occur due to reflections in the tissue to be treated and reincorporation into the fiber or the resulting thermal losses can be absorbed and removed.

In a production-technically advantageous embodiment, the guide tube has on its circumference a recess for the formation of the suction channel. The suction channel is thus formed by the guide tube, or by the recess of the guide tube and the housing. As a result, no additional holes or channels within the medical handpiece for the formation of the suction channel are necessary. By thus allowing removal of the guide tube from the housing a simple cleaning of the system is possible.

Preferably, the medical handpiece on a limiting element which engages in the recess of the guide tube. By the limiting element in particular a rotation of the guide tube within the housing, and thus also a rotation of the suction channel formed by the recess of the guide tube, prevented. In an advantageous embodiment of the medical handpiece, the housing has an opening connected to the suction channel, to which a suction adapter and / or a suction hose can be connected. About the suction adapter or the suction tube from the suction can be connected to a pump for generating a continuous suction. In an advantageous embodiment of the suction adapter or the suction hose engages in a groove of the guide tube, wherein the groove is preferably the recess forming the suction channel. The limiting element, which is intended to prevent a twisting of the guide tube within the housing, can thus be formed by the suction adapter or the suction hose, which promotes a simple and cost-effective production of the handpiece.

In a preferred embodiment, the suction adapter comprises a Luer lock connection. The use of the Luer system ensures high compatibility the connection of a medical suction hose with the medical handpiece.

In a preferred embodiment, the guide tube has a receptacle for a clamping piece, which serves for easy and releasable attachment of the primary fiber within the guide tube. The clamping piece expediently has a bore through which the primary fiber can be guided. By introducing the clamping piece in the receptacle of the guide tube, the primary fiber is fixed within the clamping piece and thus also within the guide tube. Preferably, the receptacle of the guide tube has a thread over which the clamping piece can be screwed in and out. However, it is also possible to fix the clamping piece via a clamping connection or a locking connection on the guide tube.

Preferably, the optical fiber is displaceable along a longitudinal axis of the medical handpiece. By the displaceability, the distance of the distal end of the optical fiber relative to the distal end of the medical handpiece or the distal end of the tip unit, which faces the tissue to be treated, can be changed. This is particularly advantageous in order to adjust the position of the optical fiber relative to the housing according to the particular circumstances, in particular due to different textures of the tissue to be treated.

In an advantageous embodiment, the guide tube comprises a thread which engages in a complementary thread of the tip unit. The detachable attachment of the guide tube within the medical handpiece takes place via the tip unit connected to the housing or via the intermeshing threads. Preferably, the tip unit is rotatably supported within the housing, wherein rotating the tip unit shifts the guide tube along the longitudinal axis of the medical handpiece relative to the housing. In particular, by rotating the tip unit connected to the housing, the optical fiber connected to the guide tube is moved along the longitudinal axis of the housing. This allows the position of the optical fiber relative to the housing via a rotation the top unit. The housing of the medical handpiece is not twisted and remains in its orientation, whereby no disturbing influence, for example by entanglement of possible connections, in particular a suction hose attached to the medical handpiece takes place. This also allows intraoperative adjustment of the position of the distal end of the optical fiber relative to the housing.

Preferably, the primary fiber is sapphire and the secondary fiber is quartz to provide an efficient and inexpensive design of the optical fiber of the handpiece, particularly due to the high wear and replacement of the secondary fiber required thereby. However, other materials, in particular a germanium (IV) oxide fiber, a ZBLAN fiber or a Hollo w-Core PCF (Photonic Crystal Fiber) or a mirror-coated capillary are also conceivable. In an advantageous embodiment, the medical handpiece, in particular the housing and / or the tip unit, at least partially transparent or translucent. This configuration allows the user to recognize and react to occurring blisters as well as deposits or blockages within the suction channel already during the surgical procedure, for example by changing the treatment parameters, e.g. suction vacuum, or by cleaning or replacing the medical handpiece.

The invention further relates to a medical treatment system for fiber surgery, in particular for eye surgery, comprising a medical handpiece according to the invention, wherein the handpiece with a fiber source, in particular an Erbium YAG fiber source, and a pump, preferably via a suction hose with the Suction channel is connected, is connected. The wavelength of the fiber radiation used is preferably in the range between 1.5 μm and 4 μm, preferably between 2.5 μm and 3.5 μm, in particular 2.94 μm. In this area, water, which is an essential component of the tissue to be treated, especially in ophthalmic surgery, has an absorption maximum. Since the fiber radiation in this wavelength range within a transmission path is absorbed by a few microns, a targeted energy input into the tissue to be treated is possible without the use of a target. The fiber radiation is preferably pulsed, whereby preferably a frequency of 1 Hz to 10 kHz, in particular 100-300 Hz, particularly preferably 200 Hz and pulse lengths in the millisecond range are used.

For the use of the medical handpiece according to the invention in the fiber and in particular in eye surgery, the primary fiber, which can be releasably inserted into the medical handpiece, is optically coupled to the secondary fiber at the coupling site via the coupling element. The medical handpiece makes it possible to deliver energy targeted, controlled and largely lossless in the tissue to be treated, the emitted energy can be read by a control unit and controlled. In this case, the optical fiber is cooled in particular in the region of the coupling point by the suctioned into the suction liquid, whereby a conditional by coupling losses heating of the handpiece can be minimized.

These and other advantages and features of the invention will become apparent from the following embodiment.

The invention will be described below in detail by means of an embodiment with reference to the accompanying drawings. These show:

1 is an illustration of a medical handpiece according to the invention;

Fig. 2 exploded view of the medical handpiece of Fig. 1;

Fig. 3 section of the front portion of the medical handpiece of FIG.

1 without primary fiber;

4 shows a detail of the front region of the medical handpiece from FIG.

1 with primary fiber inserted; FIG. 5 shows the guide tube of the medical handpiece from FIG. 1; FIG.

6 shows a detail of the front region of the medical handpiece from FIG.

1, wherein the guide tube is disposed in a first, rear position relative to the medical handpiece;

7 shows a detail of the front region of the medical handpiece from FIG.

1, wherein the guide tube is disposed in a second, middle position relative to the medical handpiece;

8 shows a detail of the front region of the medical handpiece from FIG.

1, wherein the guide tube is disposed in a third, forward position relative to the medical handpiece. An exemplary embodiment of the medical handpiece 1 according to the invention for transmitting energy into biological tissue via an optical fiber 2 is shown in FIG. 1 and in the exploded view of FIG. 2 corresponding thereto. The optical fiber 2 consists of a primary fiber 3 and a secondary fiber 4. The medical handpiece 1 comprises a housing 7, a tip unit 9 attached to the distal end of the housing 7 and a guide tube 15 arranged within the housing 7.

The tip unit 9, which comprises a hollow needle 10, is introduced into the housing 7, as can be seen in particular from FIGS. 3 and 4. About a circumferentially formed locking element 11 of the tip unit 9, which engages in a corresponding recess 8 of the housing 7, the introduced into the housing 7 tip unit 9 is locked to the housing 7. A stop element 12 and the detent element 11 latched in the recess 8 prevent a movement of the tip unit 9 relative to the housing 7 along the catch axis F of the medical handpiece 1. The sealing of the tip unit 9 with the housing 7 via sealing elements 13, in particular on the Tip unit 9 arranged O-rings. The Tip unit 9 can be rotated relative to the housing 7 about the longitudinal axis L, in particular via the stop element 12.

The guide tube 15, which serves to guide the optical fiber 2 and is arranged in the housing 7, forms a structural unit with a coupling element 6 and the

Secondary fiber 4. The coupling element 6, which has the shape of a coupling sleeve, is introduced into the distal end of the guide tube 15 and adhesively bonded thereto in a watertight manner. In the front, distal region of the coupling element 6, the secondary fiber 4 is inserted and connected via a peripherally applied adhesive waterproof with this. The secondary fiber 4 protrudes beyond the distal end of the

Coupling element 6 addition, whereby the secondary fiber 4, is at least partially disposed within the hollow needle 10 of the tip unit 9, when introduced in the medical handpiece 1 guide tube 15. About the proximal end of the housing 7, the guide tube 15 is introduced, which has at its distal end a thread, which is formed in the embodiment shown as external thread 16, and led to the tip unit 9, as shown in Fig. 3. The external thread 16 of the guide tube 15 engages in a complementary thread of the tip unit 9, which is designed here as an internal thread 14, a. Thereby, by rotating the tip unit 9, the guide tube 15 can be fixed to the tip unit 9.

The primary fiber 3 is, as shown in FIG. 1, guided by a proximal clamping piece 19, the guide tube 15 and the coupling element 6 connected thereto. As can be seen in particular from FIG. 4, the distal end of the primary fiber 3 is guided to a coupling point 5 which is defined by the proximal end of the secondary fiber 4. The position of the primary fiber 3 within the medical handpiece 1 is determined by fixing the clamping piece 19 in a receptacle 17 of the guide tube 15. The primary fiber 3 is clamped in the clamping piece 19. The receptacle 17 in this case preferably has a thread or a clamping or latching connection, via which the clamping piece 19 is detachably connected to the guide tube 15. For removing the tissue to be removed, the medical handpiece 1 comprises a suction channel 20. The suction channel 20 is, as shown in particular in FIGS. 3 and 4, in the distal region of the handpiece through the intermediate space between the hollow needle 10 and arranged therein Secondary fiber 4 is formed, wherein the suction channel 20, the secondary fiber 4 completely surrounds here. In the proximal direction, the suction passage 20 extends through the inside of the tip unit 9, a tip channel 21 formed between the guide tube 15 and the tip unit 9, and a guide channel 22 formed between the outer periphery of the guide tube 15 and the inner periphery of the housing 7 runs. The guide channel 22 is, as shown in Fig. 5, formed over a recess 18 of the guide tube 15 at its outer periphery. Via a lateral opening 23 of the housing 7, as shown in FIG. 1, a suction adapter 24 is introduced into the medical handpiece 1, which communicates fluidically with the suction channel 20. The suction adapter 24 contains in particular a Luer-lock connection, which can be connected to a pump via a suction hose, not shown here. In order to prevent rotation of the guide tube 15 within the housing 7 and thus to ensure the positioning of the suction channel 20 at the opening 23, the suction adapter 24 acts as a limiting element 25 which engages in the guide channel 22 forming recess 18.

The cooling of the medical handpiece 1, in particular of the coupling element 6 in the region of the coupling point 5 of the primary fiber 3 and the secondary fiber 4, takes place via the aspirated liquid, which is sucked through the suction channel 20. Via the coupling sleeve, which forms the coupling element 6 and consists of a metal or a metal alloy with a high thermal conductivity, the heat, which arises in particular at the coupling point 5, recorded and removed via the coupling element 6 at least at the coupling point 5 surrounding aspirated liquid become.

By rotating the tip unit 9, in particular via the stop element 12, the guide tube 15, via the external thread 16 with the internal thread 14th the tip unit 9 is positioned along the longitudinal axis L relative to the housing 7. 6 to 8 show by way of example a rear, a middle and a front positioning of the guide tube 15 and the associated optical fiber 2 relative to the housing 7. The rotation of the tip unit 9 thus enables the positioning of the optical fiber 2, in particular an intraoperative Adjusting the distal end of the optical fiber 2 with respect to the distal end of the medical handpiece 1, ie the tip of the hollow needle 10.

After use of the medical handpiece 1, individual components, in particular the housing 7 with the tip unit 9 attached thereto and / or the guide tube 15 with the associated secondary fiber 4, can be cleaned or replaced. For this purpose, the tip unit 9 is rotated until the external thread 16 of the guide tube 15 no longer engages in the internal thread 14 of the tip unit 9. Subsequently, the guide tube 15, including the introduced via the clamping piece 19 primary fiber 3, are removed from the housing 7. For cleaning or disposal of the housing 7, a suction hose connected to the suction adapter 24 must furthermore be removed. For cleaning or disposal of the guide tube 15, the introduced into the receptacle 17 of the guide tube 15 clamping piece 19 is to be solved and removed together with the imported primary fiber 3.

Due to the modular construction of the medical handpiece 1, in the case of wear of individual components, not the entire medical handpiece 1, in particular not the entire optical fiber 2, has to be replaced, but only the affected components. In addition, the structure of the medical handpiece 1 allows easy cleaning of the individual components, in particular sterilization in a steam sterilizer or by irradiation with gamma rays.

In the field of ophthalmic surgery, the medical handpiece 1 can be used in particular for vitrectomy and cataract surgery. reference numeral

1 medical handpiece

2 optical fiber

3 primary fiber

4 secondary fiber

5 coupling point

6 coupling element

7 housing

8 recess

9 point unit

10 hollow needle

11 locking element

12 stop element 13 sealing element

14 internal thread

15 guide tube

16 external thread

17 recording

18 recess

19 clamping piece

20 suction channel

21 lace channel

22 guide channel

23 opening

24 suction adapter

25 limiting element

Claims

claims

A medical handpiece (1) for transmitting energy to biological tissue via an optical fiber (2), comprising a primary fiber (3) and a secondary fiber (4) coupled via a coupling site (5), said

Handpiece (1) a guide for the optical fiber (2), a coupling element (6), which encloses the coupling point (5), and a suction channel (20), characterized in that the suction channel (20) the coupling element (6) surrounds at the coupling point (5).

2. Medical handpiece (1) according to claim 1, characterized in that the coupling element (6) is a coupling sleeve.

3. Medical handpiece (1) according to claim 1 or 2, characterized in that the coupling element (6) made of metal or a metal alloy, in particular of brass, an aluminum alloy, medical grade stainless steel or a nickel silver alloy, is.

4. Medical handpiece (1) according to any one of the preceding claims, characterized in that the thermal conductivity of the coupling element (6) is greater than 10 W / (m * K), preferably greater than 50 W / (m * K), particularly preferably greater than 80 W / (m * K).

5. Medical handpiece (1) according to one of the preceding claims, characterized in that the secondary fiber (4) with the coupling element

(6) is connected watertight.

6. Medical handpiece (1) according to one of the preceding claims, characterized by a housing (7), a guide forming A guide tube (15) disposed within the housing (7) and a tip unit (9) connected to the housing (7).

7. Medical handpiece (1) according to claim 6, characterized in that the coupling element (6) with the guide tube (15) is connected in a watertight manner and at least partially into the guide tube (15) engages.

8. medical handpiece (1) according to claim 6 or 7, characterized in that the coupling point (5) within the tip unit (9).

9. medical handpiece (1) according to one of claims 6 to 8, characterized in that the suction channel (20) through the tip unit (9) and at least partially through the housing (7).

10. Medical handpiece (1) according to any one of claims 6 to 9, characterized in that the tip unit (9) comprises a hollow needle (10), wherein the suction channel (20) through the hollow needle (10).

11. Medical handpiece (1) according to claim 10, characterized in that the optical fiber (2), in particular the secondary fiber (4), through the hollow needle

(10) is guided.

12. Medical handpiece (1) according to one of claims 6 to 11, characterized in that the guide tube (15) has at its periphery a recess (18) for forming the suction channel (20).

13. Medical handpiece (1) according to claim 12, characterized by a limiting element (25) which engages in the recess (18).

14. Medical handpiece (1) according to one of claims 6 to 13, characterized in that the housing (7) with the suction channel (20) having associated opening (23) to which a suction adapter (24) and / or from a suction hose is connectable.

15. Medical handpiece (1) according to claim 13 or 14, characterized in that the suction adapter (24) or the suction tube engages in a groove of the guide tube (15), wherein the groove is preferably the suction channel (20) forming recess (18) ,

16. Medical handpiece (1) according to any one of claims 13 to 15, characterized in that the suction adapter (24) comprises a Luer-lock connection.

17. A medical handpiece (1) according to any one of claims 6 to 16, characterized in that the guide tube (15) has a receptacle (17) for a clamping piece (19) for releasably securing the primary fiber (3) within the guide tube ( 15) is used.

18. Medical handpiece (1) according to claim 17, characterized in that the receptacle (17) comprises a thread.

19. A medical handpiece (1) according to any one of the preceding claims, characterized in that the optical fiber (2) along a longitudinal axis (L) of the handpiece (1) is displaceable.

20. A medical handpiece (1) according to any one of claims 6 to 19, characterized in that the guide tube (15) has a thread (16) which engages in a complementary thread (14) of the tip unit (9).

21. A medical handpiece (1) according to any one of claims 6 to 20, characterized in that the tip unit (9) within the housing (7) rotatably is mounted, wherein the rotation of the tip unit (9), the guide tube (15) along the longitudinal axis (L) of the housing (7) relative to the housing (7) shifts.

22. Medical handpiece (1) according to one of the preceding claims, characterized in that the primary fiber (3) made of sapphire and the secondary fiber (4) consists of quartz.

23. Medical handpiece (1) according to one of the preceding claims, characterized by an at least partially transparency or translucency of the handpiece (1), in particular of the housing (7) and / or the tip unit (9).

24. A medical treatment system for laser surgery, in particular for eye surgery, comprising a medical handpiece (1) which is connected to a laser source and a pump, characterized in that the medical handpiece (1) is designed according to one of the preceding claims.

25. Medical treatment system according to claim 24, characterized in that the wavelength of the laser radiation emitted by the laser source in

Range of 1.5 pm to 4 pm, preferably between 2.5 pm to 3.5 pm, particularly preferably 2.94 pm.

26. Use of a medical handpiece (1) according to any one of claims 1 to 23, characterized in that the primary fiber (3) releasably inserted in the handpiece (1) and with the secondary fiber (4) at the coupling point (5) via the coupling element (5). 6) is optically coupled.