U.S. patent number 3,858,577 [Application Number 05/458,131] was granted by the patent office on 1975-01-07 for fiber optic laser light delivery system.
This patent grant is currently assigned to University of Southern California. Invention is credited to Michael Bass, Richard M. Dwyer, Bernard J. Haverback.
United States Patent |
3,858,577 |
Bass , et al. |
January 7, 1975 |
FIBER OPTIC LASER LIGHT DELIVERY SYSTEM
Abstract
A flexible endoscope with a laser connected thereto for
simultaneous viewing and performance of surgery on the interior
stomach wall. A low power laser operating in the visible light
range with the laser beam directed to one or more individual fiber
optic fibers carried on an endoscope for performing laser surgery
within a body cavity from an external position. A protective and
replaceable cap for the distal end of the laser fiber.
Inventors: |
Bass; Michael (Pacific
Palisades, CA), Dwyer; Richard M. (Glendale, CA),
Haverback; Bernard J. (North Hollywood, CA) |
Assignee: |
University of Southern
California (Los Angeles, CA)
|
Family
ID: |
23819489 |
Appl.
No.: |
05/458,131 |
Filed: |
April 5, 1974 |
Current U.S.
Class: |
600/108; 600/157;
600/176; 606/15 |
Current CPC
Class: |
A61B
1/12 (20130101); A61B 1/00165 (20130101); A61B
18/24 (20130101); H01S 3/0007 (20130101) |
Current International
Class: |
A61B
18/20 (20060101); A61B 18/24 (20060101); A61B
1/12 (20060101); A61B 1/00 (20060101); H01S
3/00 (20060101); A61b 001/06 () |
Field of
Search: |
;128/4,6,8,395,398,303.1,303.17,DIG.22 ;350/96 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Leon Goldman, "Lasers in Medicine", Gordon and Breach, Science
Publishers, Inc., page 197..
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Layton; Henry S.
Attorney, Agent or Firm: Harris, Kern, Wallen &
Tinsley
Claims
We claim:
1. In an instrument for simultaneously viewing an internal surface
of a body cavity and performing a surgical procedure on the surface
from an external position, the combination of:
a flexible endoscope having at least one bundle of fiber optic
fibers and a distal end and a proximal end;
another separate fiber optic fiber carried by said endoscope;
a laser for generating an output beam; and
coupling optics for coupling the laser output beam to the interior
of said other fiber adjacent the proximal end of said endoscope,
with said other fiber terminating at the distal end of said
endoscope.
2. An instrument as defined in claim 1 including a plurality of
separate fiber optic fibers carried by said endoscope, with said
coupling optics including means for coupling the laser output beam
to each of said separate fibers.
3. An instrument as defined in claim 1 including a plurality of
separate fiber optic fibers carried by said endoscope, with said
coupling optics including means for producing a plurality of
separate beams and simultaneously coupling separate beams to each
of said separate fibers.
4. An instrument as defined in claim 1 wherein said coupling optics
includes a shutter for controlling said laser output beam.
5. An instrument as defined in claim 1 wherein said coupling optics
includes an attenuator for controlling said laser output beam.
6. An instrument as defined in claim 1 wherein said laser provides
an output beam in the visible light range.
7. An instrument as defined in claim 1 wherein said laser provides
an output beam in the green range.
8. An instrument as defined in claim 1 wherein said laser provides
an output at the distal end of said separate fiber of not more than
a few watts.
9. An instrument as defined in claim 1 wherein said laser provides
an output at the distal end of said separate fiber in the order of
one-half watt.
10. An instrument as defined in claim 1 including a cap carried on
the distal end of said separate fiber and having a transparent
window overlying said distal end.
11. An instrument as defined in claim 10 with said cap having a
bend for bending said separate fiber for converging the lines of
sight through said endoscope and said separate fiber.
12. An instrument as defined in claim 1 including:
a sleeve slideable onto the distal end of said separate fiber;
and
a replaceable transparent window carried in said sleeve and
positionable at said distal end.
13. An instrument as defined in claim 1 including:
guide means carried on the distal end of said separate fiber
a flexible jacket about said separate fiber and terminating at said
guide means; and
a flexible transparent strip threaded from said proximal end
through said jacket and said guide means, and back through said
jacket to said proximal end;
with said guide means guiding said strip across the distal end of
said fiber, and with said strip movable in said sheath to present a
new strip surface at said distal end.
14. An instrument as defined in claim 1 including:
a cap carried on the distal end of said separate fiber and having a
transparent window overlying said distal end; and
means carried on said endoscope for delivering a fluid stream at
the exposed surface of said window.
15. An instrument as defined in claim 1 including:
a cap carried on the distal end of said separate fiber;
a transparent window rotatably mounted in said cap, with a portion
of said window overlying said distal end; and
means carried on said endoscope for rotating said window.
Description
This invention relates to endoscopes and in particular, to a new
and improved combination endoscope and surgical laser for
performing surgical procedures within body cavities, such as the
coagulation of a bleeding ulcer on a stomach wall.
Endoscopes and lasers are found in various configurations in the
prior art. U.S. Pat. No. 3,643,653 shows an endoscope with a
flexible line for introducing into the stomach. Within the line are
three sets of fiber optic bundles and a tube. Two fiber optic
bundles provide for light transmittal to the distal end of the
instrument and the third fiber optic bundle provides for viewing
the stomach interior illuminated by the first two bundles. The tube
provides for fluid flow into the stomach.
U.S. Pat. No. 3,327,712 shows a surgical device utilizing a
plurality of fiber optic bundles for transmitting low intensity
light to an eye, for viewing the eye, and for transmitting high
intensity light such as that from a mercury arc lamp. A lens is
provided at the distal end for focussing. A similar instrument
operating in the ultraviolet region is shown in U.S. Pat. Nos.
3,456,641 and 3,494,354.
U.S. Pat No. 3,471,215 shows an instrument utilizing a ruby laser
and one or more fiber optic fibers to form a flexible device for
directing energy to a body cavity or the like. A bundle of fibers
is preferred, with each fiber having a special makeup in the form
of a core of glass surrounded by a cladding of a lower refractive
index glass. The output end terminates in a tube for directing the
laser beam to the work surface. This patent also states that it
would appear that high intensity laser output energy could readily
be focussed and concentrated directly upon the end of a fiber optic
core or upon the ends of a plurality of such cores in a bundle, but
goes on to state that such an arrangement will not perform
satisfactorily because of hot spots and then discloses the claimed
subject matter as the solution for the problem.
U.S. Pat. No. 3,467,098 shows a laser type surgical instrument
wherein the laser beam is transmitted through a flexible tube with
the distal end hand held by the surgeon. U.S. Pat. No. 3,693,623
shows another hand held laser instrument utilizing a single glass
fiber as the conductor for energy from a gas laser, with the output
provided through a hollow tube. None of these flexible laser
instruments have any provision for viewing.
U.S. Pat. Nos. 3,417,754; 3,456,651; and 3,547,125 show
opthamological instruments which are hand held and self contained
providing for laser surgery on the eye.
These prior art devices have various disadvantages and it is an
object of the present invention to provide a new and improved
instrument which can be used for laser surgery and not have the
disadvantages of the prior art. It is desired to have a flexible
instrument which can be introduced into the stomach and which will
provide viewing and a high intensity laser beam at the same
time.
It has been found that high intensity laser energy can be
transmitted on a single flexible glass fiber and on a plurality of
such fibers operated in parallel. However, the fibers cannot be
maintained in the conventional bundle because the heat generated
will melt the cement and damage the instrument. Rather, the laser
beam in the instrument of the invention is focussed onto a single
fiber and the energy is transmitted through the individual fiber.
Instruments may be provided with a plurality of individual fibers
which may be used for additional energy transmission in parallel.
However the principle reason for providing a plurality of
individual fibers is to have a replacement available within the
instrument in the event of breakage of the fiber being used for
energy transmission.
It is also highly desirable to provide protection for the distal
end of the fiber which is susceptible to damage during the surgical
procedure. It is a further object of the invention to provide
several embodiments for the distal end of the laser conducting
fiber.
Other objects, advantages and results will more fully appear in the
course of the following description. The drawing merely shows and
the description merely describes preferred embodiments of the
present invention which are given by way of illustration or
example.
In the drawing:
FIG. 1 is a view of an endoscope with laser incorporating the
presently preferred embodiment of the invention;
FIG. 2 is an enlarged sectional view taken along the line 2--2 of
FIG. 1;
FIG. 3 is an enlarged sectional view taken along the line 3--3 of
FIG. 1;
FIGS. 4, 5, 6 and 7 are views similar to FIG. 3 showing alternative
embodiments of the invention;
FIG. 8 is a view similar to that of FIG. 1 showing an alternative
embodiment of the invention; and
FIGS. 9 and 10 are partial views similar to that of FIG. 1 showing
alternative embodiments of the invention.
The instrument of FIG. 1 includes an endoscope 15 which may be
conventional in design, such as that shown in the aforementioned
U.S. Pat. No. 3,643,653. The endoscope may include fiber optic
fiber bundles 16, 17 and 18 and a tube 19 in a sheath 20. The
bundles 16, 17 provide for light transmission from a light source
in a housing 22 to the distal end 23 of the instrument. The bundle
18 provides image transmission from the distal end to the eye piece
24 at the proximal end. The tube 19 provides for fluid transmission
from an inlet 25 to the distal end of the instrument. The bundles
16, 17, 18 may be conventional in construction, each comprising a
plurality of glass fibers bonded together to form the flexible
bundle.
Another fiber optic fiber is carried on the endoscope and, in the
embodiment of FIGS. 1 and 2, comprises a glass fiber 30 in a sheath
31 attached to the endoscope by straps 32. The separate fiber 30
provides for transmission of a laser beam from a laser 33 to the
distal end of the instrument. The output beam of the laser is
directed into the separate fiber 30 by coupling optics 34 which
typically may comprise a lens or lens system 35, a shutter 36 and
an attenuator 37.
A replaceable protective cap may be provided for the distal end of
the laser fiber 30 and in the embodiment of FIG. 3, comprises a
sleeve 40, typically of stainless steel, and a transparent window
41, typically of glass, quartz, sapphire or the like.
In use, the instrument is inserted into the body cavity, typically
the stomach, in the usual manner and the distal end is manipulated
to illuminate and provide viewing of the area of interest,
typically a bleeding site on the stomach wall. The surgeon sets the
attenuator for the desired power and opens the shutter permitting
transmission of the laser beam through the fiber 30 onto the tissue
to coagulate the blood or cauterize the wound.
In a typical instrument, the fiber 30 will have a diameter in the
order of 100 to 200 micrometers. The laser 33 may be a low power
unit, normally not more than a few watts and typically providing in
the order of one-half watt at the distal end of the instrument.
This is in contrast to prior art laser cauterizing instruments
which have operated in the 30 to 40 watts range.
In the instrument of the present invention, the laser beam is
directed into the individual fiber, and fiber optic bundles are not
utilized. When laser energy is directed into a bundle, the intense
beam heats and burns the adhesive used in adhering the fibers in
the bundle and produces irreparable damage to the fibers.
In the instrument of the invention, the laser output is in the
visible range, preferably in the green or blue-green light range,
which is readily transmitted by the flexible glass fiber. Further,
the green light is substantially fully absorbed by blood resulting
in maximum efficiency for coagulation. The flexible laser light
delivery system with endoscope provides simultaneous viewing of a
body cavity, such as the stomach wall, and delivers laser energy of
sufficient intensity to coagulate, cauterize or cut the
appropriately selected pathological area. The instrument can be
utilized in any body cavity, natural or man made, and is readily
controlled and guided from the outside by the physician.
Various conventional lasers may be used to produce modest power in
the blue-green part of the spectrum, including the argon ion laser,
the krypton ion laser, various dye lasers, and a frequency doubled
neodymium-YAG laser.
It has been found that interaction of the laser energy at the
distal end with organic or inorganic debris has a deleterious
effect on the fiber. By way of example, food in the stomach or
blood from a bleeding ulcer or debris created by the interaction of
the laser energy with the target will be heated by the beam and,
when present at or near the distal end of the fiber can produce
heating of the end of the fiber and a nontransparent coagulum of
material on the end of the fiber. Either of these events renders
the instrument inoperable and normally requires replacement of the
fiber.
In the present instrument, means are provided for protecting the
end of the fiber, and for easily replacing the protective end. In
the embodiment of FIG. 3, the transparent window 41 may be of a
very hard material such as sapphire or quartz which resist damage.
Also, the window is readily replaced by sliding off the sleeve 40,
removing the damaged or coated window and replacing it with a new
window. Other window constructions are shown in FIGS. 4-7 and will
be described hereinbelow.
While a disk is illustrated for the window 41, a lens may be used
as the window where desired.
The application of lasers for certain medical problems has become
increasingly important in the past 5 to 6 years. The clinical
application of lasers had pertained primarily to the field of
opthalmology, dentistry, otolaryngology, surgery, dermatology,
basic research for newer spectrophotometric measurements,
micro-surgery, and basic research problems. The use of laser energy
for gastrointestinal problems has been restricted to the use of
CO.sub.2 laser energy at 10.6.mu.m, delivered to the stomach of
animals through a rigid endoscope. This work was done at the
University of Minnesota Medical Center by Goodall and Wangensteen.
Their system suffers the following limitations: 1. The inability to
direct the laser beam with the rigid delivery system. 2. The
necessity to use a hollow scope since no convenient material to
transmit 10.6.mu.m light is available. 3. Of necessity by 1. and
2., the area of the gastrointestinal tract accessible to this
system is greatly limited. 4. The inability to deliver laser energy
to large areas of the gastronintestinal tract that are accessible
by the use of fiber optic endoscopes.
The present invention provides a new system whereby laser energy
can be transmitted along a flexible fiber optic of small dimensions
in sufficient intensity to produce a desired effect anywhere in the
gastrointestinal tract but can be applied to other body cavities
and body areas wherein a flexible fiber optic facilitates the
delivery of the laser energy.
Prior practice in laser cautery involved the use of the highest
attainable total power and thus researchers generally turned to the
10.6.mu.m CO.sub.2 laser. This light, in the infrared, cannot be
transmitted by any known flexible fiber optic delivery system
because there are no materials with which to make a 10.6.mu.m
transmitting fiber. There are however excellent fiber optic devices
for the transmission of visible light and it has been shown that a
modest total power of light in the blue green part of the spectrum
can, when concentrated to an area .about.2mm in diameter, produce
rapid hemostasis.
In the embodiment of FIG. 4 a sleeve 40' similar to the sleeve 40
of FIG. 3, is provided with a bend for converging the lines of
sight of the endoscope and laser fiber at a point 43.
In the embodiment of FIG. 5, a guide member 45 is positioned on the
sheath end of the fiber 30 and a sleeve or jacket 46 is positioned
over the sheath fiber. A strip 49 of a thin flexible transparent
material, such as a polyvinyl chloride or polyproplyene plastic, is
fed down the sleeve 46, through a slot 47 in the guide member 45,
across the end of the fiber 30, through another slot 48 in the
guide member 45, and up the sleeve. At any time the portion of the
strip 49 at the end of the fiber 30 becomes damaged or coated, the
strip is pulled through the guide member to bring a fresh portion
of the strip to the fiber end.
In the embodiment of FIG. 6, a tube 50 is carried along with the
sheathed fiber and terminates in a nozzle 51 which provides for
directing wash water or other fluid onto the exposed surface of the
window 41 to keep it free of debris, blood and the like.
In the embodiment of FIG. 7, a window 54 is rotatably mounted in an
end member 55. The window 54 is driven by a shaft 56 and a
protective sheath 57 may be provided about the sheathed fiber. When
the portion of the window 54 exposed at the end of the fiber
becomes damaged or coated, a new portion of the window is rotated
into working position by rotating the shaft 56 from the proximal
end of the instrument.
While the fiber 30 is shown carried on the side of the endoscope in
FIG. 1, the fiber may also be positioned within the endoscope, as
illustrated in FIG. 8. This may be accomplished in various
configurations within the endoscope, one typical approach being to
run the sheathed fiber down the tube 19.
While the embodiments disclosed so far have utilized a single
separate fiber for the laser beam, a plurality of separate fibers
may be utilized. The coupling optics 34 for one embodiment with a
plurality of fibers 30 is illustrated in FIG. 9. In this
embodiment, the lens system 35' functions to direct the laser beam
into one of the fibers. In the event the fiber is damaged or
broken, the lens system is manipulated to direct the laser beam
into another of the fibers, thereby increasing the life of the
instrument.
Another alternative embodiment for the coupling optics is shown in
FIG. 10, with the lens system 35" directing separate laser beam
into separate fibers. A fly-eye lens may be utilized for this
purpose. In the embodiments of FIGS. 9 and 10, the plurality of
fibers are not bundled, but rather are carried within the sheath
separate from each other, although they may be in physical contact.
In all instances, an individual laser beam is directed into a
separate fiber so that none of the laser energy is outside of the
fiber.
While a preferred fiber optic fiber of glass has been described,
fibers of other materials such as plastic or quartz may be
used.
* * * * *