JPS5946952A - Laser knife apparatus - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed Description of the Invention] Object of the Invention The present invention is a laser scalpel! ! - file, lr, J to surgical operation river σ - rusamess device fr (1 shout.

BACKGROUND TECHNOLOGY Conventionally, a steel scalpel has been used in the technique of cutting a row of trees, but recently, the usefulness of a so-called laser scalpel using a laser has been attracting attention. Figure 1 shows the laser scalpel device 1-4! '4 omitted (1' indicates formation).

Laser light is generated by a laser oscillator such as a carbon dioxide laser, and is generated by an articulated mirror manibule, an optical fiber, etc.
Guided by barrel light path 2 formed by i''4, R+<L'
f - Touching the tip of optical path 2^'・4. handpiece δ
Follow and emit. The operator operates the handpiece δ, and according to the signal from the hand switch 5, the robot 8 on the operating table 7
1S4- is irradiated with a laser beam to make an incision,
Performed 11 blood clotting surgeries. Normally, when the cutting speed is medium (5-12 crn/5cc), the laser output is 3
At 0W, the reno depth of the living assembly Mt't is said to be 2 to 3 mm.

Incidentally, since the incision of a living body with a laser scalpel is performed using the thermal effect of the energy of the laser beam, there is no so-called 1-response from the living body, unlike in the case of a conventional steel scalpel. That is, when using a laser scalpel, it is difficult to know the incision depth, and there is a problem that there is a high possibility that excessive resection will be performed for this purpose. For example, if there is a 1-+ tube beneath the affected tissue, excessive laser irradiation may damage the blood vessel and expose the patient to danger.

Conventionally, the incision depth of living tissue using a laser scalpel device was 61 mm.
As a method of constructing a fence, the Proceedings of the National Conference of the ME Society (+vI
Distance meter 6 that detects reflected light, disclosed in 1981) There is an example using this method. However, this method has the following more serious drawbacks. In other words, (1) The intensity of the reflected light changes due to the smoke generated from the laser irradiation part, resulting in the failure of Error 11.

(2) If a carbonized layer is formed at the incision due to laser irradiation, it is impossible to detect the incision boundary below the carbonized layer.

etc. In addition to this, is it possible in principle to use deep expansion measurement using microwaves? However, it is not practical because it requires more than 20 T resolution and the ejector is large. . In addition, the temperature m', l of the living tissue due to laser irradiation
Although a method of detecting the rise using a small thermocouple or the like is considered, this method is not satisfactory in terms of response speed and shadow 19 on living tissues.

[1] The present invention has been made in view of the above-mentioned circumstances, and its purpose is to eliminate the above-mentioned drawbacks of the conventional laser scalpel device 6, and to provide a highly safe system that prevents excessive incision. An object of the present invention is to provide a laser scalpel device.

The above-mentioned feature 1'' of the present invention is that in the laser scalpel device,
A means is provided for detecting or controlling the depth of the incision using ultrasound. This is achieved by a laser scalpel device with an f-shape.

Examples of the invention 1, the present invention will be explained in detail based on the drawings.

FIG. 2 is a sectional view of the throat piece of the laser scalpel device. The laser beam C21, which is guided as a substantially parallel beam by the bulge C path 2, is focused on the affected area by the condensing lens 9 provided in the throat piece 3.

At the handpiece 3, the focus position of the light 1/- is 1ij.
Attachment to indicate j,' (Instruction 4'□I4
) 24 is provided, and the operator uses the attachment 2
1. Incision can be made at the focal position of the laser beam by touching the tip of 4 to the living body. I'm doing x.

FIG. 3 shows the handling section of the first embodiment of the present invention. In the figure, 21 is a laser beam, 22 is a living tissue, and 23 is a laser beam.
24 is the gap created by the incision by the laser beam, and 24 is the gap created by the laser beam incision.
The i-attachment 25 is a so-called ultrasonic probe (contact-type ultrasonic transducer), which functions as a generator i6 and a detector of 11-3 sound waves.

In surgery using a laser scalpel, εIJ, as shown in Figure 3.

"To the converged laser beam 021": Su4 giant tissue 22 is cut 1
1 no 1 and the wall edge 23 is created and the opening continues. In the device of this embodiment, an ultrasonic probe 25 is attached to the it'11 surface of the attachment 24 provided at the tip of the throat piece, and the ultrasonic probe 25 is brought into contact with the living body and pulsed ultraback waves 20 are transmitted to the living body while rolling. A, ll Get into the carpet.

Then, the anti-rlJ '6'i (hereinafter referred to as "eco-1-") that occurs within the raw i'F' 411i P.

) 27 in the previous I+January i41'+'lj child 25's 1st wave):;,,,teinomi 11 effect l'ru'-Unishi-C.

S:1-, Laser beam 1+'-84i:iS, S/, c゛(-), Cutting of living tissue 1ii1 or Jltebe, c
-1, Δ) 1 (sound llU, It-j, Ih
14 <n; However, the laser 9'
1- is irradiated and the living body fl; II Makoto No. 1] begins, and when the narrow gap 23 is generated in the living tissue, the echo from the boundary direction of A is received by the probe 25. It will be detected at 11. At this time, between the sent pulse and the echo: +"'H', 9iH
;II;, By changing the rule between 1 and 1, the progress of the t1 eye drops is 1. I am able to make corrections. Zubu'
If the depth of the incision is shallow, only a delayed echo will be produced, or if the incision is shallow.
As the time progresses, the VCC delay time is longer than the echo is received) 1.
-J Rudo, the incision depth d of the lino opening is d-v'' rnaxCO3θ 10911.(1
) is said. Here, ■ is the speed of sound in a living body, and θ is the angle of intersection between the laser beam and the ultrasonic beam.

Therefore, when the above-mentioned τ1□tax reaches a predetermined value, there is a feedback system that stops the laser beam irradiation.
Is it possible to configure the system to control the incision and deep suction of the incision? li: Suriru.

FIG. 4 shows an example of the above-mentioned feedback system. Pulse generation [A pulsed ultrasonic wave is generated from the ultrasonic emitting circuit 32 of the probe using the stepper 31, and its echo is received by the wave receiving circuit 33.

Pulse generation time b'1s The pulse from 31 is time 0. ″j
The delay circuit 3 is set to a desired delay time τl11aX.
Sent to 4. The outputs of the wave receiving circuit 33 to and the delay circuit Sho 4 are input to the gate circuit 35, and are sent to the echo No. 18 having the -M delay time of τll1aX or to the comparator 36.
t is broken. The comparator 36 compares the signal with the noise level, and when it is recognized as a signal, turns the rate controller 37 to J・74 ii+υ to stop the laser beam irradiation2. − details of the probe used)
J type, inner diameter 4 tnrp, outer diameter 4.5 tnrp,
It is housed in a metal tube 41 with a height of 7 m+η. The interior uses chikunU\lead-based ceramics.
)-1z convex vibrator 4.2, back load old 43 and 1
A 1-tone matching +7 pad 144 is provided;
;l" 4-3 was taken out by one). As described above, the ultra-M wave probe 25 was
For example, the attachment l-ITI at the tip of the handpiece.
It is connected to I song by epoxy type) i'IJ, ljY, etc.

The ultrasonic pulse length obtained by this ultrasonic probe is about 4 wavelengths, and the distance resolution in the depth direction within the living tissue is reduced to 0.
．． I got about 5 minutes. Also, incision l50) lino opening t43
When one ship is 41, the value of τ1□laX is approximately 6 μs.
It was ec.

Figure 6 shows the actual parts of 81!2 of the present invention [Main parts of 11 examples]
It is something. In the figure, symbols 21 to 24 are δ('A
28 shows the same drying and clearing as shown in 1, and 28 is wary)
This is an ultrasonic transducer that functions as an ultrasonic generator and detector.

In the device of this embodiment, the tip of the handpiece J, ji4
A cylindrical ultrasonic transducer 28 is attached to the inside of a front attachment 24 provided in the front attachment 24, and the laser beam 21 is configured to pass through the cavity of the transducer 28. A portion 29 of the ultrasonic waves emitted from the transducer 28 to the gap 23 at the incision 1hj of the living tissue is reflected at the bottom of the incision!
j''] and is converted into an electrical signal through the vibrator 51. This electrical signal is vibrated in order to generate 9.% of the ultra-16 waves.
The phase is 2d from the input electrical signal applied to the child.

Mφ=□ω ・・・・・・ し) ■It is delayed by θ. Here, (Io is the distance from the transducer to the incision area σU, Vo is the sound speed of air “11,” and ω is the angular frequency of the ultrasound. Therefore, the phase delay Δφ can be measured. The progress of the incision can be monitored by .DELTA..phi.'61+1, for example, using a vector portometer.

The vibrations 28 and 7 are, for example, 20 KHz cylindrical vibrations using a zircon/chikun lead-based mix! Itl, you can use one child. The diameter of the cylindrical oscillator is approximately B mm. Also, city, (ii
l is provided on the inner and outer surfaces of the cylindrical vibrator, and each 11 (1) is extended from 1 to 4y. In the device of this embodiment, 4!i41(O) The distance from the child to the incision 1×1×1 point is 5 mm,
The phase delay φ is approximately 4 radians.

, Niru 7shi 1 is a collection of part 9 of the third embodiment of Mikudefu Akira. Is the ultrasonic probe 25A shown in Kino/Ai Seri Fir7 used as an ultrasonic detector? +71 is good. (The ultrasonic waves generated from the pressure incision during surgery (arrow 2g shows 7Je and 10) are used to measure the living body's λ, il.
K, ID 22 is traced, and the 4th I is outputted by the 112 probe 25A before 112° C. (11J opening position) to detect a deep opening.

Generally, when burning out living tissue with a laser beam, an incision is made.
Ultrasonic waves of various frequencies are generated when i≦I−. Therefore,
If the laser beam is subjected to amplitude modulation of one foot circumference Jl, lj, and the ultrasonic waves generated thereby are also modulated, the ultrasonic waves will be transmitted in the 21" gap 23 of the living tissue 220 and d. When generated, this ultrasonic wave is v cos O”' ”
(3) It reaches the probe 25A with a slight delay. Here, ■ is the travel speed in the living tissue, and θ is the angle formed by the direction of the laser beam probe. Therefore, the time difference τ between the modulated signal of the laser beam and the signal received by the probe 25A
It is possible to know the incision depth d of the incision by measuring d.

The probe 25A shown in Fig. 7 is similar to the probe shown in Fig. 5, and has a 2 MHz vibrator made of lead zirconium titanate ceramics with a back load and an acoustic matching layer. It has an outer diameter of 8 mm and is connected to the attachment 24. In the device of this embodiment, the laser beam is amplitude-modulated at 50 K to Iz (perimeter: 20 μ5 ec), and the time τ is δ μsec when the incision depth of the incision is dIJ″−4 fins. .

FIG. 8 shows a narrow portion of a fourth embodiment of the present invention. This embodiment uses an ultrasonic detector 28A to detect ultrasonic waves emitted from the incision into the gap 23 during surgery to detect the incision depth of the incision. .

Ultrasonic waves generated at the incision during surgery are radiated not only into the living tissue but also into the void as shown by arrow 29A in FIG. Here, as in the case of the embodiment shown in FIG. 7, the laser beam 21'& amplitude modulation is performed. This results in
The sound wave 29A radiated into the air gap 23 also has a vibration of 1.
There is a mono-intestinal disorder. This modulated ultrasonic wave reaches the front M ultrasonic wave detector 28A with a delay of τ knee... (4) ■0. Here, ■o is the publication speed in air. Therefore, by measuring the time difference τ between the modulation signal of the laser beam and the signal received by the detector 28A, the tilJ is opened.
It is possible to know the luJ open depth of fll.

In addition, in the (1-? configuration shown in FIG. 8), instead of the time difference τ, the phase notation (Equation (2) It goes without saying that the ultrasonic detector 28A shown in FIG. The light is l Q 1(tlz (period 100
μSeC). When the distance 14 (f) between the ultrasonic detector 28A and the bottom surface of the incision line is 5αm, the time interval τ is approximately 15μSec'''Ci'ii.

Incision depth 1u for each of the above embodiments: Even if each of the detection devices is used alone, it is of course effective, or in order to improve the safety of the medical device. , and use these in appropriate combination.2. You can do it like this.

Next, the incision depth detection device +i7 described above. A specific example of a method for controlling a laser scalpel device using the following will be described.

FIG. 9 is a timing chart showing a method for mining the 1111 tube below the diseased area from damage caused by the laser.

For example, the supersound iK J: i″2 /
'Pulse J! , L: Hit the leech wave 1゛ (Fig. 9), 51), and 1-X1 seat 1
[11. White is 1 year old, 1 year old, 4 i (Sonic wave-L-Ko (9th [
Mei (A)'s υ2) and +-, -C4 appear 7. ) Event 4) 1. Therefore, the clock pulse of the oscillator built into the laser controller (Figures 8i to 9 (13)
) σ) CL I\) is the same as the launch side of the super 1 E wave - Norz 5] - and the same Jllll as 7) i? From M'11 and kc, we can measure the clock pulse ζ when σ, ) echo 1 old 52 is obtained. In the 9th map of Ki 9 (1st RFF Sokunoku)
8'? # ['
Krokz Luss of l or something like this. Konoki i M
's K-chozu(・te,15'llet Coril i'
8. Before the 2nd pulse of the 11th clock pulse, set the mask at the position indicated by 53 of the 9th clock pulse (C). -, - (F・Ke0:,This mask V)If you can get Eco(+,i-go Rikigami I) during the period, you will be able to recognize this(,1,is η31fu's Shosen 5 by Leiri Mess, .

FIG. 10 shows the setting of the mask as described above, and the cut 15t'l car mask position 16. Implementation section 11 of the control circuit 11 which detects that the oscillation has been reached and stops the layer vibration.
That's 1, 1 and 4.
7 shows the same 1 Akane 2 Shigeru element as shown in Figure 4,
A pulse generating circuit 3] generates a pulse wave from the ultrasonic emitting circuit 32 of the probe, and its echo is received by the receiving circuit 33 and compared with the noise level by the comparator 36. . From the pulse generation circuit 31
The signal is simultaneously sent to the oscillation circuit 55. Oscillation circuit 55
This starts sending out clock pulses.

First, in order to set a mask corresponding to echoes from blood vessels in the affected area, the switch S1 is turned on and the pulse generation circuit 31 is operated. As a result, a pulse ultrasonic wave is transmitted from the ultrasonic wave emitting circuit 32, and a clock pulse is transmitted from the oscillation circuit 55. A preset counter (hereinafter simply referred to as "counter") 5G has data set to -2 in advance and counts pulses. The memory 57 uses the echo signal from the controller 36 to store the counter 5G.
The count value of is memorized. The digital calculator 58 compares the internal medicine in the memory 57 with the self-answer in the counter 56, and when they become equal,
9 operations to create the mask described above, and turn off the switch S1. As a result, during the period of the output (mask) of the pipe rake 59, the output (echo signal) of the comparator 3G is changed to i:i:I (, +11) by the gate aoK.For example, +U VS due to rake is C12 during mask period
When the laser controller 37 'i'
+1ilJ Ill dov −+)” 'd 4+
+4 can be stopped and blood vessel 4:It('!J can be prevented.

Hmm, 1. The excavation frequency of the oscillator F, ii 55 in this case can be found in the following way. As explained earlier, □1t, the ultrasonic launch frequency f7:1 of the ultraneck wave probe
0~ll-1y, and -4 is lr! 41'+! F min Wr
tfr=' is about 0.5 nm, and the propagation speed of prayer waves in the living body is 1-5 mm/it sec. Therefore, the time 71 white jhi becomes 300 n sec, and the oscillation frequency υ1=xr
is'/(2x 3oc) n5ec) =1,
C3M] lz is fine.

Next 1. +Incision method 1 according to the invention: 4-4-trimmed method (
・Another embodiment in which "di" control of the laser scalpel device is performed will be shown.

Figure 11 is a timing chart showing a method of controlling the incision method using a laser scalpel by setting a mask at a depth of 3 mm and opening 1 + 2 m inside the affected area.

In FIG. 11(A), 61 is the ultrasonic ejection pulse 6
2.63.64 are the depths of 1 and 2 on the inside of the affected area, respectively.
1, which shows the echo signal of
Moreover, FIG. 11 (1, 3), (C1, (D)) show the mask corresponding to the position of the above-mentioned depth l mm + 21mm + 3πm. In this way, multi-stage masks are set. Then, by the operator selecting an arbitrary mask,
If an ultrasonic echo occurs within the mask period, it can be determined that the incision depth by the laser scalpel has reached the mask depth.

FIG. 12 shows the mounting part of an embodiment of the control circuit for performing the above control, and in the figure, 31° 36.37 indicates the same component as shown in the fourth part. The Hals generating circuit 31 65 and 65', and mask 62' (first
(See Figure 1 (13)), and similarly use a multivibrator 66, 60' to create a mask 63' (See Figure 11 (See Q).
is masked 64 by multi-pipe lake 67.67'.
'(Fig. 111 1)) Reference++<1). Switches S2 and Sδ, 84 are provided for these masks (``Choose one of J's numbers, fire is 4''), and if you select 1, it will be an attack, or switch S2: will be selected as C4. ”Oh.

In this case, mask 02' is selected, and if an echo signal from the conoparator is received within the mask Jfij interval of mask 02', the laser controller 37! l
1l1 make 1, this will open the surface of the affected area ir+1 to a depth of 1.5. :, If Jffi (injury) is very small, select Jutsu 71 or Switch 82 and start laser irradiation.
The nth thing about a city is to make it a city.

In this case, the time corresponding to the incision depth can be found by placing it as follows.As mentioned above, 1↑
The speed at which waves travel in the living body is approximately 1.5 fights/μS.
ec, and the echo 'it4 ifr, -B wave goes around, so the echo from the elephant jW1 is 2/1.5 =
It will return in 1.3 μscc. If we follow the echo pulse 1lFi by 0.5 fi sec, then ε+'', and τ1, τ3, and τ4 shown in Figure 11 are τ, = 1.3-0.5/2''-, respectively. =1μSecτg =
2.7-α5/2=2. +μsecτ42-0.5/
The 2nd race will be 3.7μscc. Further, τ2 may be set to the pulse width of the echo so that hemorrhoids<0.5 μsec.

Detection or control circuits, etc. that are not included in each of the above embodiments can be implemented in various other configurations, and the present invention is to be understood as including such configurations. It is something.

Effects of the Invention As described above, according to the present invention, since the laser scalpel device is provided with a means for detecting or controlling the incision depth of the incision using ultrasonic waves, a highly safe laser scalpel device that prevents excessive incision can be achieved. This has the remarkable effect of realizing jfi f7'.

[Brief explanation of drawings]

FIG. 1 is an overview of a conventional laser scalpel device, and a schematic diagram showing its construction, FIG. 2 is a cross-sectional view of its handpiece, and FIG. Fig. 4 shows an example of the control circuit, Fig. 5 is a plan view of il without showing the details of the probe, and Figs.
i1j, Example device 1″1′, ]2 Fjll 'N:
',7Je ishi'(,n+q 9 E゛iI 11th
1! ? -1('', jlillii1i11 j, Risaku!
! 31', Kuf for Clarity], Nayat, i'1~
101, i1,! -1"I ]-2 figure is 1 by reducing the control fil+1 circuit. 1: l/-" big oscillator, 2: j4j bu(,1F"6
．． 3: handpiece, 4-:, ~1λ"il), 5 two-knot switch, 2] elm 9, 2,
'l, 25A: No blasphemy sound/
Wave j-role +rll -f, , 28,
28A Ni no call 11? No'-4k 1l11 children. 'II' +Tf Il, '+ II/, 11 people Stock association loss 1 stands () Sakunozu 1. 1: “Lipa Attorney Patent Attorney Masaru Iso 1 Nito 1
Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 4 Figure 6 Figure 1 Figure 7 Figure 8 Figure 9 Figure 11

Claims (1)

[Claims] (],) Laser emission] 1. a handpiece including an optical system for condensing laser light emitted from the laser oscillator; T: In a laser scalpel device for incising a biological tissue, which comprises a light guide path connecting a laser oscillator and a handpiece, and a control means for controlling the laser oscillator 't'+li, A laser scalpel device characterized in that it is provided with means for detecting or controlling the incision depth of an incision portion. (2) A contact device in which the detecting or controlling means functions as an ultrasonic generator and a detector. The incision depth of the incision is detected or controlled by monitoring the reflected waves from the side of the LA-type ultrasonic transducer. QIl'
, gi-Claim 1.1 Self-mounted laser scalpel device. (J) Self-detect rJ'll i' or il+1Ji
The means for transmitting the I111 includes a non-contact ultrasonic transducer having the functions of an ultrasonic generator and a detector, and emits ultrasonic waves to a gap in the incision (by emitting them and monitoring the reflected waves). The laser scalpel device according to claim 1, wherein the laser scalpel device is configured to detect or control the incision depth of the laser knife. VC (91711
The ultrasonic waves generated from the
Il! The laser scalpel device according to claim 1, characterized in that it is configured to detect or control the incision depth of the incision by detecting 492 in L. (5) The means for detecting or controlling r+iJ[11]
Contains a non-contact ultrasonic detector, which detects the incision generated from the incision during surgery.1. By detecting ultraframe waves emitted near the wall of the incision, the incision depth of the incision can be detected or fli'
The first thing to do is to control it! 1 feature TFL' 814 Requested IIIλ Section IJl-11 Self-mounted Laser Scalpel Device II.