CA2194987A1 - Laser-assisted electrosurgery system - Google Patents
Laser-assisted electrosurgery systemInfo
- Publication number
- CA2194987A1 CA2194987A1 CA002194987A CA2194987A CA2194987A1 CA 2194987 A1 CA2194987 A1 CA 2194987A1 CA 002194987 A CA002194987 A CA 002194987A CA 2194987 A CA2194987 A CA 2194987A CA 2194987 A1 CA2194987 A1 CA 2194987A1
- Authority
- CA
- Canada
- Prior art keywords
- laser
- electrosurgical
- laser radiation
- energy
- distal end
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- 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
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- 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
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1402—Probes for open surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00452—Skin
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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
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00452—Skin
- A61B2018/00458—Deeper parts of the skin, e.g. treatment of vascular disorders or port wine stains
- A61B2018/00464—Subcutaneous fat, e.g. liposuction, lipolysis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
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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
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1213—Generators therefor creating an arc
Abstract
A laser and electrosurgical system (10) has a handpiece (12) with a proximal and distal end (13) and (14) from which laser radiation (17) and/or electrosurgical energy (18) is selectively or concurrently directed. The ends are along an axis; an electrode extends distally along the axis. Sources of laser and electrosurgical energy (18) are available and controlled. An initiation circuit (25) for the laser selectively delivers it before electrosurgery. Prior delivery to target tissue, the laser creates an ionized conductive pathway for electrosurgery. The combined concurrent application of laser and electrosurgery has a mechanism (27) to selectively distribute energy about the axis. A laser deflecting surface (28) or a beam deflector vibrate relative to the axis. A power switch (30) has levels for laser cut and ionization and/or a delay therebetween for electrosurgical coagulation. A wave guide (34) or an array thereof deliver radiation along the axis. A method has steps of directing selectively and concurrently laser and electrosurgery by aiming the axis, controlling laser and electrosurgical energy (18), delivering laser before electrosurgery, forming an ionized conductive pathway for the electrosurgery, distributing the laser about the axis in a predetermined pattern by deflecting the laser in a predetermined pattern generally along but slightly displaced from the axis to direct electrosurgical energy (18) in a predefined pattern on the patient's (11) target tissue. In another possible approach, there are additional steps of delivering the laser radition (17) as a beam and varying an ionized conductive pathway by refracting or diffracting the laser radiation (17) beam with the mechanism (27) having a beam pattern deflector.
Description
W096/04858 21 94 9 87 r~ r~
LASER-ASSISTED ELECTROSURGERY SYSTEM
1. Field of the Invention This invention relates to electrosurgery combined with laser radiation in a single surgical instnument, and more particularly the selective 5 and/or concurrent delivery from a surgical handpiece of laser energy and electrosurgery with superior benefits to those available separately.
LASER-ASSISTED ELECTROSURGERY SYSTEM
1. Field of the Invention This invention relates to electrosurgery combined with laser radiation in a single surgical instnument, and more particularly the selective 5 and/or concurrent delivery from a surgical handpiece of laser energy and electrosurgery with superior benefits to those available separately.
2. Background of the Disclosure Electrosurgery involves the application of radio frequency energy to achieve a tissue effect. The electrosurgical energy is generated by an electrosurgical generator which is applied to the tissue either by 10 monopolar or bipolar circuits. In monopolar, there is a small active electrode directed toward the tissue to be treated and to complete the circuit there is a large patient return electrode applied sv", ',~ to the patient's body. The power density through the patient return electrode is relatively small so that there is no tissue effect thereat. In bipolar, a pair of electrodes are spaced close together with tissue II,~,.L .,. In 15 certain circumstances the bipolar electrodes are moveable toward and away from one another.
Electrosurgery can be used for cutting, coagulating or a colllLJi,,aliv,, thereof called blend. Co~g~ ' n is often described as ~ ' : n of the tissue and fulguration of the tissue. Fulguration is the electrical arcing from the active electrode 20 toward various locations, on the patient's tissue, in the vicinity of the active electrode.
Typically when the arcs travel through air, they reach the tissue in a random, non-p,t.lk~ ,le manner. In many cases arcs leave the active electrode in a trajectory emanating generally along the axis of the active electrode, but b jefore they contact the tissue their paths may vary due to the impedance at the tissue near the active 25 electrode. The resulting fulguration is an uneven or randomly ~.vn~.. "t, ' or irregularly distributed delivery of the energy in each arc, thus producing an uneven or variable ~oPgl ' , of the tissue desiccated thereat. This is u"~ f~ ,, y from the point of view of producing a controlled and preferred level of eschar.
Ionized gases have been used to direct the electrosurgical energy in a more 30 controlled manner. U.S. Patent 4,781,175 deals particularly with that approach. A
diaacl~/~ Ikl! ~e of using ionized gas is the possibility of formation of embolisms within the blood of the patient being treated. In addition, there is the potential for the gas being ~ ~"i~di,~ d and fomming a plasma torch either through a leak in the electrosurgical W0 96/048s8 2 1 9 4 9 8 7 P~ ............................. 2~ ' handpiece or pencil or when delivered in a lc~,u...u~ OIJ;C procedure within the trocar which provides entry into the body cavity. Another problem with ionized gas is that the electrosurgery and the gas flow are essentially concurrent in the fonm of a plasma flame that is used to fulgurate and desiccate tissue at which it is aimed. The aiming or 5 positioning of the plasma flame on the desired target tissue is uncertain until activated.
Therefore, the pinpointing of the spot at which to initiate the eff~ct is not readily .It,l~:,,,,;,,aLIle until the electrosurgical energy is delivered.
U.S. Patent 5,011,483 discloses a device which is in the form of a handpiece housing from which electrosurgical and laser energy may be delivered . " _'y for10 selective use thereof. In connection with laycll ual,Opki procedures, an elongate hollow shaft is disclosed for a wave guide to conduct the laser energy. The wave guide may be flexible and one preferred form is a fiber optic. The disclosure of the reference is largely limited to the alternate use of laser or electrosurgery. There is no discussion or disclosure of concurrent delivery.
Japanese patent JP57-69853 relates to a laser device which radiates a laser beam to mark the position for subsequent application of laser surgery. No electrosurgery is disclosed and the use of a laser with electrosurgery even for pinpointing is not taught. Japanese patent JP57-69790 has a laser radiation apparatus wlth a laser oscillator including a light guide and a generator for radiating visible light 20 for positioning. These Japanese patents are used to direct the laser Qnergy and do not teach the concurrent use of laser energy and electrosurgery energy.
U.S. pntent 5,324,254 discloses a single Ic~ a~.O~ . instrument capable of supplying either laser radiation or electrosurgical energy. An electrosurgical electrode is provided at the distal end of the instrument for electrosurgical procedures. A side 25 port located near the proximate end of the instrument allows for the passage of a laser fiberoptic bundle, thereby allowing for laser surgery. The patent does not teach the concunrent use of laser energy and electrosurgical energy in a syncl,,u,,i~ed manner.
An article entitled How Lasers Miqht Control Uahtnina Strikes. appearing in Laser Focus ~vorld November 1993 pages 113 - 123 by Zhao Xin Miao and Daniels 30 Jean-Claude, discloses how lasers establish an ionized pathway for electric arc lloJI:~llli~ai~nl. Ordinary optical beams produce little ionkation in air or an essentially weak plasma which can be used to direct electrical discharges.
WO96104858 2 1 94987 1 "" 5 ~
'3-The application of any form of tmu ,pl lt ,i~, ionization to direct electrosurgical beams either statically or clJ"cl" 'Iy has not been disclosed in the prior l~,h, ,ùlùgy.
SUMMARY OF THE INVENTION
A laser and electrosurgical system allows a surgeon to provide cutbng, ~lA911' " 19, and/or a cc,r"bi" " ~ thereof on tissue of a paUent. The laser andelectrosurgical system preferably has a handpiece with a proximal end to be held _nd controlled by the surgeon. A distal end may be included on the handpiece from which laser radiation and/or electrosurgical energy may be selectively or concurrently directed 10 to the patient. The proximal and distal ends are most preferably along an axis. An electrosurgical electrode might extend from the distal end along the axis. A source energy for laser radiation most preferably is avaiiable at the proximal end and is controlled by the surgeon for delivery of laser radiation from the distal end toward the patient. A source of electrosurgical energy might also be available at the proximal end 15 and may be controlled by the surgeon for b~" lalll;s~iun of electrosurgical energy from the electrosurgical electrode toward the patient.
A retum path is provided for the electrosurgical energy. The return path is connected to receive at least a portion of the l,c." ""itb:d electrosurgical energy from the source of electrosurgical energy toward the patient. A retum input for the source 20 of electrosurgical energy is connected to the retum path for furnishing a complete circuit between the electrosurgical electrode, the patient, and the source of electrosurgical energy.
A control may be connected to the source energy for laser radiation and to the source of electrosurgical energy for the selective or concurrent application of laser 25 radiation and electrosurgical energy from the distal end.
The laser and electrosurgical system may have in the control an initiation circuit for the source energy for laser radiation, so laser radiation may be selectively delivered from the distal end slightly in advance of the delivery of the electrosurgical energy. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be 30 treated. The delivered laser radiation may also be used to create an ionized conductive pathway along which the electrosurgical energy will be guided.
The laser and electrosurgical system may be configured so the distal end and the electrosurgical electrode are preferably arranged ~eo."e,t,i~_l'y relative to the . , _, _ _, _,, _ _,, Wo961048~8 21 9 4 9 87 Ir~ r~l~
handpiece to provide laser radiation essentially alons the axis and from the distal end.
This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is formed by the laser radiation from the distal end to the patient substantially along the axis to direct the electrosurgical 5 energy.
The laser and electrosurgical system may provide a control which operates a Ille~,l.~lialll to selectively distribute, in a ple-let:~"i"ed pattem about the axis, the delivered laser radiation from the distal end.
The laser and electrosurgical system may include an ~ale~ ," ,c~".,'i~, radiation 10 deflecting surface arranged to vibrate relative to the axis. This preferably forms a pl edek~ ;ned pattem to achieve a varying ionlzed conductive pathway generally along but slightly displaced from the axis for thereby directing electrosurgical energy in the pl ~:delt~l l l lil led pattern to the patient.
The laser and electrosurgical system may be configured such that the laser 15 radiation is a beam ~nd the ",.~ lll includes a beam pattem deflector. The beam pattern deflector may be an acousto-optic modulator or ~, ~ l~el llel 1l of acousto-optic modulators to diffract, refract or reflect the beam.
The laser and electrosurgical system may include in the control for the source energy for laser radiation a power switch which may select between two levels of laser 20 r~diation energy delivery. The power switch may include a cutting laser radiation energy level and another level to provide for the ionized conductive pathway. The power switch may also include a time delay ",e-,l,al,i-", to interpose a preset time period between the initiation of cutting laser radiation and the subsequent delivery of electrosurgical energy for rO~31 ' " ~1 l. The time delay should be sufficient to provide 25 time for cutting with the Iwer radiation, followed by concurrent electrosurgical coagulation along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system may have the laser radiation energy within the visible, near-infrared and infrared light spectnum wavelengths. In one possible ~,OI "_ IrP~ the laser radiation source provides radiation of a ~ tl, in the range 30 of between 0.3 to 10.6 microns for eaLLI;.~ I;ng through air the ionized conductive pathway as substantially collimated.
A wave guide may be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis. An array of wave guides may Wo 96/048s8 2 1 9 4 9 8 7 ~ . c .
also be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis.
The laser and electrosurgical system may include a handpiece which is generally shaped like a pistol grip, where the pistol grip depends near the proximal end and is 5 therefore at an angle to the axis which extends from the distal end in the direction which the electrode is pointed.
The laser and electrosurgical system may have an electrosurgical electrode which is flexible and elongate for endoscùl,i., or l~p.~.u,cu,ui~, use within a cannula passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system may have its contro! located on the handpiece between the proximal and distal ends. The control may also be located on a foot pedal.
The laser and electrosurgic_l system may have a source of electrosurgical energy which includes an electrosurgical generator and a return path which is carried 15 on the handpiece for bipolar electrosurgery on the tissue ot the patient. Altematively, the return path may include a return pad connected to the patient for receiving electrosurgical energy during monopolar electrosurgery on the tissue of the patient.
A method for providing cutting, r~AD~' ,g, and/or a cu",L,i" n thereof on tissue of a patient with a laser and electrosurgical system may include the following 20 step of directing selectively and at least concurrently laser radiation and electrosurgical energy from a handpiece with its proximal and distal ends along an axis by aiming the distal end thereof along the axis from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling a source energy for laser radiation available at the proximal end of the handpiece by the 25 surgeon for first delivering laser radiation from the distal end. Controlling a source of electrosurgical energy available at the proximal end of the handpiece by the surgeon for 1, c., lall li~ >iui1 of electrosurgical energy from a electrosurgical electrode at the distal end may be yet another step of the method. Then the step of cur" leutil ,g a control to a source energy for laser radiation and to a source of electrosurgical energy so the 30 control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end.
The method oan also include the additional step of initiating the laser radiation delivered from the distal end concurrently or slightly in advance of the delivery of the W096/0485~ 2 1 9 4987 electrosurgical energy so that the laser radiation forms an ionized conductive pathway along which the electrosurgical energy will be guided for pinpointing the hrget tissue to be treated.
The method may include the additional step of guiding the electrosurgical 5 energy by arranging the distal end and the electrosurgical electrode geu~lletli~w!y relative to the handpiece for providing laser radiation essentially along the axis and from the distal end for the combined concurrent application of the laser radiation wnd the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end to the patient along the axis to direct the flow of 10 electrosurgical energy is preferably performed.
The method may include the additional step of distributing the laser radiation available at the proximal end for delivery about the axis in a ~., edete~ " ,i"ed pattern from the distal end with a " ,~ " ,. In one possible configuration, there is an added step in which the lln ~.h~lialll can deflect the laser radiation to create a varying ionized 15 conductive pathway with an ele~,bu"Itly"~ radiation deflecting suriace that vibrates in a p, edetel " ,i, led pattern generally along but slightly displaced from the axis to direct electrosurgical energy in a predefined pattern on the patient's target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or di~fracting the laser radiation 20 beam with the Illechwl;,.lll having a beam pattem deflector.
The method of initiating the laser radiation slightly in advanca of the delivery of the electrosurgical energy may be augmented with the additional steps of contrûlling the laser radiation initially with a switch having two levels of delivery. A first level of delivery may be a cutting level and a second level may be an ionizing conductive25 pathway level. This may provide for delaying the subsequent delivery of electrosurgical energy for co2gulation sufficiently for providing time for first cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method may also include the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectnJm . _!~.. Iytl ,:, provided by the source of laser radiation. There may also be the additional step of using a wave guide or an array of wave guides for delivery of the laser radiation from the proximal end to beyond the distal end and generally along the axis.
WO 96/04858 2 1 9 4 9 8 7 . ~
~
The method may include the additional step of using the handpiece, which is generally shaped like a pistol grip, by aiming along the axis extending from the distal end in the direction in which the electrode is pointed while having the pistol grip at an angle e:lyunulll 'Iy c~."lf~ clbl~ for surgery. The method may also include the 5 additional step of flexing into position an elongate electrosurgical electrode for dusGopiG or l_~_.u~ ,i.. use in a cannula placed through the patient's body walland into a cavity therein. There may be the additional step of using the control located on the handpiece between the proximal and distal ends, or using the control located on a foot pedal.
WO 96/04858 2 1 9 4 9 8 7 P~,ll~ _. 1~
EIRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a schematic drawing of the laser and electrosurgical system showing a monopol_r cu, ,9~, , of the elements.
Figure 2 is a schematic drawing of the laser and electrosurgical system showing 5 a bipolar cu, ,'il, ~ of the elements.
Figure 3 is a pulse timing graph which illustrates the timing between a laser pulse and successive electrosurgical pulses during a coAg~ ~' ) mode.
Figure 4 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an ele~,l,u,,,..~ radiation deflecting surface.
Figure 5 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an acousto-optic modulator.
Figure 6 is a schematic drawing of a portion of the l_ser and electrosurgical system which illustrates the use of a power switch.
Figure 7 is a pulse timing graph which illustrates the timing between a laser 15 pulse and successive electrosurgical pulses during a laser cut mode.
DETAILED DE aCH~ N OF THE INVENTION
A laser and electrosurgic_l system 10 is shown in ptl r -~e in Figure 1 and allows a surgeon to provide cutting, ~ o~' " ,g, and/or a ~,u"lLill ", thereof on 20 tissue of a patient 11. The laser and electrosurgical system 10 has a handpiece 12 with a proximal end 13 to be held and controlled by the surgeon. A distal end 14 on the handpiece 12 has a port 15 from which laser radiation and/or electrosurgical energy are selectively or concurrently directed to the patient 11 The proximaJ and distal ends 13 and 14 are along an axis "A". An electrosurgical electrode 16 extends from the distal 25 end 14 along the axis KA". A source energy for laser radiation 17 preferably manufactured by Coherent, Inc., located in Palo Alto, CA, and sold as model Infinity is connected to be available at the proximal end 13 and is controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11 A source of electrosurgical energy 18 preferably manufactured by Valleylab, located in Boulder, CO, 30 and sold as model Foroe 40, is connected electrically to be available at the proximal end 13andmaybecontrolledbythesurgeonlurl~c~,,a,,,;aaiunofelectrosUrgicalenergy from the electrosurgic~ll electrode 16 toward the patient 11.
Wo 96/048~8 2 1 9 4 9 8 7 1 - ' .
A retum path 19 is provided for the electrosurgical energy; the retum path 19 may be in a monopolar or bipolar circuit as s~.l ,t:" 'Iy shown in Figures 1 and 2, ,., ':ively. !~iF 'i 'Iy, in Figure 1 there is a return pad 20 and in hgure 2 there is a bipolar retum electrode 21 each to complete their respective circuits. The retum path 5 19 is connected to receive at least a portion of the ll c." ", lill~d electrosurgical energy from the source of electrosurgical energy 18 and then the patient 11. A retum input 22 for the source of electrosurgical energy 18 is connected to the retum path 19 for furnishing a complete circuit 23 between the electrosurgical electrode 16, the patient 11, and the source of electrosurgical energy 18.
A control 24 is connected to the source energy for laser radiation 17 and to thesource of electrosurgical energy 18 for the selective or concunrent application of laser radiation and electrosurgical energy from the distal end 14. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be treated when the laser radiation is within the visible spectrum. The delivered laser radiation is also used 15 to create an ionized conductive pathway along which the electrosurgicai energy will be guided .
The laser and electrosurgical system 10 has in the control 24 an initiation circuit 25 for the source energy for laser radiation 17, so laser radiation may be selectively delivered from the distal end 14 concurrently or slightly in advance of the delivery of the 20 electrosurgical energy. The laser energy will be modulated at a rate between 10 Hz.
and 31 kHz., and may be syn-.l"~,"i~d to deliver the pulse between zero and five" ,i~ .ul ~ ahead of the electrosurgical pulse. This allows the electrosurgical energy - to follow the ionized pathway created by the laser energy. In Figure 3, one possible pulse diagram is shown for the laser pulse and the electrosurgical pulse. The laser 25 pulse occurs at t, and the electrosurgical pulse occurs at t, + .000005 seconds.
When the laser is being used to create an ionized pathway, the laser energy must be controlled in order to avoid undesired tissue elfects. The duty cycle of the Iaser will be kept in the range of 10-5 to 105. Energy density delivered to any single area of tissue from the laser pulse should not exceed 26 J/cm2 for ~ ,.lyth:, 30 between 1.06 and 10.6 microns, and 17 J/cm2 for ~ .,ytll:. around and below .53 microns.
The laser and electrosurgical system 10 is configured so the distal end 14 and the electrosurgical electrode 15 are preferably anranged y~ ldd~ ly relative to the WO 96/04858 2 1 9 4 9 8 7 ~ s. ~
.
handpiece 12 to provide laser radiation essentially along the axis "A' and from the distal end 14. This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is fommed by the laser radiation from the distal end 14 to the patient 11 substantially along the axis "A~ to 5 direct the electrosurgical energy therealong.
The laser and electrosurgical system 10 provides a button 26 which operates a " le~.l IGI lial " 27, see Figure 4, to selectively distribute in a ,u, ed~ ,ed pattem about the axis "A~ the laser radiation from the distal end 14. The l"__hGi l;a"l 27 includes an e:__IIulllGyl,eli~i radiation deflecting surface 28 arranged to vibrate relative to the axis 10 "A". This forms a u,edele,,,,inad pattem to achieve a varying ionized conductive pathway generally along but slightly displaced from the axis "A~ for thereby directing electrosurgicalenergyintheluledetellllilledpattemtothepatient1l~ Thellle~hGlli~
27 may _" , I~'; . e,'~ include a beam pattem deflector 29. The beam pattern deflector 29 may be an acousto-optic modulator or GllGi lU_.I lel ~t of acousto-optic modulators to 15 diffract, refract or reflect the laser radiation.
In another alternate, the laser and electrosurgical system 10 includes in the control 24 for the source energy for laser radiation 17 a power switch 30 which may select between two levels of laser radiation energy delivery. This may be G~ VI 11~ led by changing the duty cycle of the laser. The power switch 30 includes a cutting laser 20 radiation energy level "C" and another level "I" to provide for the ionized conductive pathway. The power switch 30 also includes an electronic time delay Ille~,h GI li:~lll 31 to interpose a preset time period, shown in Fgure 7, between the initiation of cutting laser radiation 32 and the subsequent delivery of electrosurgical energy 33 for Pgl ' ~. The time delay should be sufficient to provide tima for cutting with the laser 25 radiation, followed by concurrent electrosurgical ~oPg~' ~ along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system 10 has the laser radiation energy within the range of visible, near-infrared and infrared light spectrum ~ llla. The laser radiation source 17 provides radiation of ~ tha in the range of between 0.3 to 30 10.6 microns for eaIGL,li~.l,i,lg through air the ionized conductive pathway GS
substantially collimated.
A wave guide 34, shown in Figure 1, is used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A". An W096/04858 2 1 9 4 9 8 7 P~ 'G
.
array of wave guides 35, shown in hgure 2 may " "_';/ ly be used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A".
The laser and electrosurgical system 10 includes on the handpiece 12 a pistol 5 grip 36 which depends near the proximal end 13 and is therefore at an angle 37 to the axis "A" which extends from the distal end 14 in the direction which the electrode 16 is pointed.
The laser and electrosurgical system 10 has ~ ly in Figure 2 an electrosurgical electrode support 38 which is flexible and eiongate for ~ "do,copic or 10 k~yc~ uscu~ ; use within a cannula (not shown) passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system 10 has its control located on the handpiecebetween the proximal and distal ends 13 and 14. The control may also be located on the pistol grip 36 or at a foot pedal 39.
A method for providing cutting, ~ 9~' " ,g, and/or a cv-,,L,i,-_~;o,, thereof ontissue of the patient 11 with a laser and electrosurgical system 10 includes the following step of directing selectively and at least concurrently laser radiation and electrosurgical energy from the handpiece 12 with its proximal and distal ends, 13 and 14, along an axis "A" by aiming the distal end 14 thereof along the axis "A" from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling the source energy for laser radiation 17 available at the proximal end 13 of the handpiece by the surgeon for first delivering laser radiation from the distal end 14. Controlling a source of electrosurgical energy available at the proximal end 13 of the handpiece 12 by the surgeon for llclllalllia~;vl, of electrosurgical energy from a electrosurgical electrode 16 at the distal end 14 may be yet another step of the method.
Then may follow the step of ccnnecting the control 24 to a source energy for laser radiation 17 and to a source of electrosurgical energy 18 so the control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end 14.
The method also includes the additional step of initiating the laser radiation delivered from the distal end 14 concurrently or slightly in advance of the delivery of the electrosurgical energy so that the laser radiation forms an ionized conductive pathway W0 96/W858 2 1 9 4 9 8 7 ~ 6 .
along which the electrosurgical energy will be guided for pinpointing the target tissue to be treated.
The method includes the additional step of guiding the electrosurgical energy by anranging the distal end 14 and the electrosurgical electrode 16 ge~ t~ lly relative 5 to the handpiece 12 for providing laser radiation essentially along the axis "A~ and from the distal end 14 for the combined concurrent application of the laser radiation and the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end 14 to the patient 11 along the axis ''A~ to direct the flow of electrosurgical energy is performed.
The method includes the additional step of distributing the laser radiation available at the proximal end for delivery about the axis ~A" in a p, t,.l~lt" " ,i"ed pattem from the distal end 14 with the l~ ,hmiall, 27. In one possible variation, there is an added step in which the l"e:ul,al,i~", 27 can deflect the laser radiation to create a varying ionized conductive pathway with an ~le-,l, u" ,..~u,, ,~ ti~, radiation deflecting surface 15 28 that vibrates in a ~n~:dtlt~:l",i"ed pattern generally along but slightly displaced from the axis "A" to direct electrosurgical energy in a predefined pattem on the patient's 11 target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or diffracting the laser radiation beam with the i"~.l,~li:.", 27 having a beam pattem 20 deflector 29.
The method of initiating the laser radiation slightly in advance of the delivery of the electrosurgical energy is augmented with the additional steps of controlling the laser radiation initially with the switch 30 having two levels of delivery. A first level of delivery IICn may be a cutting level and a second level 'l~ may be an ionizing conductive25 pathway level. This may provide for ds~ y il ,e subsequent delivery of electrosurgical energy for ~o~a~ , sufficiently for providing time for flrst cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method also includes the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectrum . '~ ~yth~ provided by the source of laser radiation 17. There may also be the additional step of using the wave guide 34 or the array of wave guides 35 for delivery of the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis ~A".
W0961048S8 ' ' 2 1 9 4 9 8 7 P~ '5 The method includes the additional step of using the handpiece, which is generally shaped like the pistol srip 36, by aiming along the axis ~Au extending from the distal end 14 in the direction in which the electrode 16 is pointed while having the pistol grip 16 at an angle 37 e:lyullullli~,~'j ~,u~ ull~iLle for surgery. The method also 6 includes the additional step of flexing into position the elongate electrosurgical electrode support 38 for c, ,.ius~.u~ui~ or lc,,uc.. u .cu,ui~. use in the cannula placed through the patient's body wall and into a cavity therein. There is the additional step of using the control 24 located on the handpiece 12 between the proximal and distal ends 13 and 14, or controlling with a foot pedal 39.
The claims which follow seek to cover the described ~",Lodi",~:";., and their eg~ ~: ' It~. The concept in its broadest scope covers the apparatus and methods for concurrent and simultaneous application of laser and electrosurgical energy. It is to be understood that the concept is subject to many ",- "' ,:. without departing fromthe spirit and scope of the claims as recited herein.
Electrosurgery can be used for cutting, coagulating or a colllLJi,,aliv,, thereof called blend. Co~g~ ' n is often described as ~ ' : n of the tissue and fulguration of the tissue. Fulguration is the electrical arcing from the active electrode 20 toward various locations, on the patient's tissue, in the vicinity of the active electrode.
Typically when the arcs travel through air, they reach the tissue in a random, non-p,t.lk~ ,le manner. In many cases arcs leave the active electrode in a trajectory emanating generally along the axis of the active electrode, but b jefore they contact the tissue their paths may vary due to the impedance at the tissue near the active 25 electrode. The resulting fulguration is an uneven or randomly ~.vn~.. "t, ' or irregularly distributed delivery of the energy in each arc, thus producing an uneven or variable ~oPgl ' , of the tissue desiccated thereat. This is u"~ f~ ,, y from the point of view of producing a controlled and preferred level of eschar.
Ionized gases have been used to direct the electrosurgical energy in a more 30 controlled manner. U.S. Patent 4,781,175 deals particularly with that approach. A
diaacl~/~ Ikl! ~e of using ionized gas is the possibility of formation of embolisms within the blood of the patient being treated. In addition, there is the potential for the gas being ~ ~"i~di,~ d and fomming a plasma torch either through a leak in the electrosurgical W0 96/048s8 2 1 9 4 9 8 7 P~ ............................. 2~ ' handpiece or pencil or when delivered in a lc~,u...u~ OIJ;C procedure within the trocar which provides entry into the body cavity. Another problem with ionized gas is that the electrosurgery and the gas flow are essentially concurrent in the fonm of a plasma flame that is used to fulgurate and desiccate tissue at which it is aimed. The aiming or 5 positioning of the plasma flame on the desired target tissue is uncertain until activated.
Therefore, the pinpointing of the spot at which to initiate the eff~ct is not readily .It,l~:,,,,;,,aLIle until the electrosurgical energy is delivered.
U.S. Patent 5,011,483 discloses a device which is in the form of a handpiece housing from which electrosurgical and laser energy may be delivered . " _'y for10 selective use thereof. In connection with laycll ual,Opki procedures, an elongate hollow shaft is disclosed for a wave guide to conduct the laser energy. The wave guide may be flexible and one preferred form is a fiber optic. The disclosure of the reference is largely limited to the alternate use of laser or electrosurgery. There is no discussion or disclosure of concurrent delivery.
Japanese patent JP57-69853 relates to a laser device which radiates a laser beam to mark the position for subsequent application of laser surgery. No electrosurgery is disclosed and the use of a laser with electrosurgery even for pinpointing is not taught. Japanese patent JP57-69790 has a laser radiation apparatus wlth a laser oscillator including a light guide and a generator for radiating visible light 20 for positioning. These Japanese patents are used to direct the laser Qnergy and do not teach the concurrent use of laser energy and electrosurgery energy.
U.S. pntent 5,324,254 discloses a single Ic~ a~.O~ . instrument capable of supplying either laser radiation or electrosurgical energy. An electrosurgical electrode is provided at the distal end of the instrument for electrosurgical procedures. A side 25 port located near the proximate end of the instrument allows for the passage of a laser fiberoptic bundle, thereby allowing for laser surgery. The patent does not teach the concunrent use of laser energy and electrosurgical energy in a syncl,,u,,i~ed manner.
An article entitled How Lasers Miqht Control Uahtnina Strikes. appearing in Laser Focus ~vorld November 1993 pages 113 - 123 by Zhao Xin Miao and Daniels 30 Jean-Claude, discloses how lasers establish an ionized pathway for electric arc lloJI:~llli~ai~nl. Ordinary optical beams produce little ionkation in air or an essentially weak plasma which can be used to direct electrical discharges.
WO96104858 2 1 94987 1 "" 5 ~
'3-The application of any form of tmu ,pl lt ,i~, ionization to direct electrosurgical beams either statically or clJ"cl" 'Iy has not been disclosed in the prior l~,h, ,ùlùgy.
SUMMARY OF THE INVENTION
A laser and electrosurgical system allows a surgeon to provide cutbng, ~lA911' " 19, and/or a cc,r"bi" " ~ thereof on tissue of a paUent. The laser andelectrosurgical system preferably has a handpiece with a proximal end to be held _nd controlled by the surgeon. A distal end may be included on the handpiece from which laser radiation and/or electrosurgical energy may be selectively or concurrently directed 10 to the patient. The proximal and distal ends are most preferably along an axis. An electrosurgical electrode might extend from the distal end along the axis. A source energy for laser radiation most preferably is avaiiable at the proximal end and is controlled by the surgeon for delivery of laser radiation from the distal end toward the patient. A source of electrosurgical energy might also be available at the proximal end 15 and may be controlled by the surgeon for b~" lalll;s~iun of electrosurgical energy from the electrosurgical electrode toward the patient.
A retum path is provided for the electrosurgical energy. The return path is connected to receive at least a portion of the l,c." ""itb:d electrosurgical energy from the source of electrosurgical energy toward the patient. A retum input for the source 20 of electrosurgical energy is connected to the retum path for furnishing a complete circuit between the electrosurgical electrode, the patient, and the source of electrosurgical energy.
A control may be connected to the source energy for laser radiation and to the source of electrosurgical energy for the selective or concurrent application of laser 25 radiation and electrosurgical energy from the distal end.
The laser and electrosurgical system may have in the control an initiation circuit for the source energy for laser radiation, so laser radiation may be selectively delivered from the distal end slightly in advance of the delivery of the electrosurgical energy. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be 30 treated. The delivered laser radiation may also be used to create an ionized conductive pathway along which the electrosurgical energy will be guided.
The laser and electrosurgical system may be configured so the distal end and the electrosurgical electrode are preferably arranged ~eo."e,t,i~_l'y relative to the . , _, _ _, _,, _ _,, Wo961048~8 21 9 4 9 87 Ir~ r~l~
handpiece to provide laser radiation essentially alons the axis and from the distal end.
This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is formed by the laser radiation from the distal end to the patient substantially along the axis to direct the electrosurgical 5 energy.
The laser and electrosurgical system may provide a control which operates a Ille~,l.~lialll to selectively distribute, in a ple-let:~"i"ed pattem about the axis, the delivered laser radiation from the distal end.
The laser and electrosurgical system may include an ~ale~ ," ,c~".,'i~, radiation 10 deflecting surface arranged to vibrate relative to the axis. This preferably forms a pl edek~ ;ned pattem to achieve a varying ionlzed conductive pathway generally along but slightly displaced from the axis for thereby directing electrosurgical energy in the pl ~:delt~l l l lil led pattern to the patient.
The laser and electrosurgical system may be configured such that the laser 15 radiation is a beam ~nd the ",.~ lll includes a beam pattem deflector. The beam pattern deflector may be an acousto-optic modulator or ~, ~ l~el llel 1l of acousto-optic modulators to diffract, refract or reflect the beam.
The laser and electrosurgical system may include in the control for the source energy for laser radiation a power switch which may select between two levels of laser 20 r~diation energy delivery. The power switch may include a cutting laser radiation energy level and another level to provide for the ionized conductive pathway. The power switch may also include a time delay ",e-,l,al,i-", to interpose a preset time period between the initiation of cutting laser radiation and the subsequent delivery of electrosurgical energy for rO~31 ' " ~1 l. The time delay should be sufficient to provide 25 time for cutting with the Iwer radiation, followed by concurrent electrosurgical coagulation along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system may have the laser radiation energy within the visible, near-infrared and infrared light spectnum wavelengths. In one possible ~,OI "_ IrP~ the laser radiation source provides radiation of a ~ tl, in the range 30 of between 0.3 to 10.6 microns for eaLLI;.~ I;ng through air the ionized conductive pathway as substantially collimated.
A wave guide may be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis. An array of wave guides may Wo 96/048s8 2 1 9 4 9 8 7 ~ . c .
also be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis.
The laser and electrosurgical system may include a handpiece which is generally shaped like a pistol grip, where the pistol grip depends near the proximal end and is 5 therefore at an angle to the axis which extends from the distal end in the direction which the electrode is pointed.
The laser and electrosurgical system may have an electrosurgical electrode which is flexible and elongate for endoscùl,i., or l~p.~.u,cu,ui~, use within a cannula passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system may have its contro! located on the handpiece between the proximal and distal ends. The control may also be located on a foot pedal.
The laser and electrosurgic_l system may have a source of electrosurgical energy which includes an electrosurgical generator and a return path which is carried 15 on the handpiece for bipolar electrosurgery on the tissue ot the patient. Altematively, the return path may include a return pad connected to the patient for receiving electrosurgical energy during monopolar electrosurgery on the tissue of the patient.
A method for providing cutting, r~AD~' ,g, and/or a cu",L,i" n thereof on tissue of a patient with a laser and electrosurgical system may include the following 20 step of directing selectively and at least concurrently laser radiation and electrosurgical energy from a handpiece with its proximal and distal ends along an axis by aiming the distal end thereof along the axis from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling a source energy for laser radiation available at the proximal end of the handpiece by the 25 surgeon for first delivering laser radiation from the distal end. Controlling a source of electrosurgical energy available at the proximal end of the handpiece by the surgeon for 1, c., lall li~ >iui1 of electrosurgical energy from a electrosurgical electrode at the distal end may be yet another step of the method. Then the step of cur" leutil ,g a control to a source energy for laser radiation and to a source of electrosurgical energy so the 30 control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end.
The method oan also include the additional step of initiating the laser radiation delivered from the distal end concurrently or slightly in advance of the delivery of the W096/0485~ 2 1 9 4987 electrosurgical energy so that the laser radiation forms an ionized conductive pathway along which the electrosurgical energy will be guided for pinpointing the hrget tissue to be treated.
The method may include the additional step of guiding the electrosurgical 5 energy by arranging the distal end and the electrosurgical electrode geu~lletli~w!y relative to the handpiece for providing laser radiation essentially along the axis and from the distal end for the combined concurrent application of the laser radiation wnd the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end to the patient along the axis to direct the flow of 10 electrosurgical energy is preferably performed.
The method may include the additional step of distributing the laser radiation available at the proximal end for delivery about the axis in a ~., edete~ " ,i"ed pattern from the distal end with a " ,~ " ,. In one possible configuration, there is an added step in which the lln ~.h~lialll can deflect the laser radiation to create a varying ionized 15 conductive pathway with an ele~,bu"Itly"~ radiation deflecting suriace that vibrates in a p, edetel " ,i, led pattern generally along but slightly displaced from the axis to direct electrosurgical energy in a predefined pattern on the patient's target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or di~fracting the laser radiation 20 beam with the Illechwl;,.lll having a beam pattem deflector.
The method of initiating the laser radiation slightly in advanca of the delivery of the electrosurgical energy may be augmented with the additional steps of contrûlling the laser radiation initially with a switch having two levels of delivery. A first level of delivery may be a cutting level and a second level may be an ionizing conductive25 pathway level. This may provide for delaying the subsequent delivery of electrosurgical energy for co2gulation sufficiently for providing time for first cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method may also include the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectnJm . _!~.. Iytl ,:, provided by the source of laser radiation. There may also be the additional step of using a wave guide or an array of wave guides for delivery of the laser radiation from the proximal end to beyond the distal end and generally along the axis.
WO 96/04858 2 1 9 4 9 8 7 . ~
~
The method may include the additional step of using the handpiece, which is generally shaped like a pistol grip, by aiming along the axis extending from the distal end in the direction in which the electrode is pointed while having the pistol grip at an angle e:lyunulll 'Iy c~."lf~ clbl~ for surgery. The method may also include the 5 additional step of flexing into position an elongate electrosurgical electrode for dusGopiG or l_~_.u~ ,i.. use in a cannula placed through the patient's body walland into a cavity therein. There may be the additional step of using the control located on the handpiece between the proximal and distal ends, or using the control located on a foot pedal.
WO 96/04858 2 1 9 4 9 8 7 P~,ll~ _. 1~
EIRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a schematic drawing of the laser and electrosurgical system showing a monopol_r cu, ,9~, , of the elements.
Figure 2 is a schematic drawing of the laser and electrosurgical system showing 5 a bipolar cu, ,'il, ~ of the elements.
Figure 3 is a pulse timing graph which illustrates the timing between a laser pulse and successive electrosurgical pulses during a coAg~ ~' ) mode.
Figure 4 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an ele~,l,u,,,..~ radiation deflecting surface.
Figure 5 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an acousto-optic modulator.
Figure 6 is a schematic drawing of a portion of the l_ser and electrosurgical system which illustrates the use of a power switch.
Figure 7 is a pulse timing graph which illustrates the timing between a laser 15 pulse and successive electrosurgical pulses during a laser cut mode.
DETAILED DE aCH~ N OF THE INVENTION
A laser and electrosurgic_l system 10 is shown in ptl r -~e in Figure 1 and allows a surgeon to provide cutting, ~ o~' " ,g, and/or a ~,u"lLill ", thereof on 20 tissue of a patient 11. The laser and electrosurgical system 10 has a handpiece 12 with a proximal end 13 to be held and controlled by the surgeon. A distal end 14 on the handpiece 12 has a port 15 from which laser radiation and/or electrosurgical energy are selectively or concurrently directed to the patient 11 The proximaJ and distal ends 13 and 14 are along an axis "A". An electrosurgical electrode 16 extends from the distal 25 end 14 along the axis KA". A source energy for laser radiation 17 preferably manufactured by Coherent, Inc., located in Palo Alto, CA, and sold as model Infinity is connected to be available at the proximal end 13 and is controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11 A source of electrosurgical energy 18 preferably manufactured by Valleylab, located in Boulder, CO, 30 and sold as model Foroe 40, is connected electrically to be available at the proximal end 13andmaybecontrolledbythesurgeonlurl~c~,,a,,,;aaiunofelectrosUrgicalenergy from the electrosurgic~ll electrode 16 toward the patient 11.
Wo 96/048~8 2 1 9 4 9 8 7 1 - ' .
A retum path 19 is provided for the electrosurgical energy; the retum path 19 may be in a monopolar or bipolar circuit as s~.l ,t:" 'Iy shown in Figures 1 and 2, ,., ':ively. !~iF 'i 'Iy, in Figure 1 there is a return pad 20 and in hgure 2 there is a bipolar retum electrode 21 each to complete their respective circuits. The retum path 5 19 is connected to receive at least a portion of the ll c." ", lill~d electrosurgical energy from the source of electrosurgical energy 18 and then the patient 11. A retum input 22 for the source of electrosurgical energy 18 is connected to the retum path 19 for furnishing a complete circuit 23 between the electrosurgical electrode 16, the patient 11, and the source of electrosurgical energy 18.
A control 24 is connected to the source energy for laser radiation 17 and to thesource of electrosurgical energy 18 for the selective or concunrent application of laser radiation and electrosurgical energy from the distal end 14. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be treated when the laser radiation is within the visible spectrum. The delivered laser radiation is also used 15 to create an ionized conductive pathway along which the electrosurgicai energy will be guided .
The laser and electrosurgical system 10 has in the control 24 an initiation circuit 25 for the source energy for laser radiation 17, so laser radiation may be selectively delivered from the distal end 14 concurrently or slightly in advance of the delivery of the 20 electrosurgical energy. The laser energy will be modulated at a rate between 10 Hz.
and 31 kHz., and may be syn-.l"~,"i~d to deliver the pulse between zero and five" ,i~ .ul ~ ahead of the electrosurgical pulse. This allows the electrosurgical energy - to follow the ionized pathway created by the laser energy. In Figure 3, one possible pulse diagram is shown for the laser pulse and the electrosurgical pulse. The laser 25 pulse occurs at t, and the electrosurgical pulse occurs at t, + .000005 seconds.
When the laser is being used to create an ionized pathway, the laser energy must be controlled in order to avoid undesired tissue elfects. The duty cycle of the Iaser will be kept in the range of 10-5 to 105. Energy density delivered to any single area of tissue from the laser pulse should not exceed 26 J/cm2 for ~ ,.lyth:, 30 between 1.06 and 10.6 microns, and 17 J/cm2 for ~ .,ytll:. around and below .53 microns.
The laser and electrosurgical system 10 is configured so the distal end 14 and the electrosurgical electrode 15 are preferably anranged y~ ldd~ ly relative to the WO 96/04858 2 1 9 4 9 8 7 ~ s. ~
.
handpiece 12 to provide laser radiation essentially along the axis "A' and from the distal end 14. This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is fommed by the laser radiation from the distal end 14 to the patient 11 substantially along the axis "A~ to 5 direct the electrosurgical energy therealong.
The laser and electrosurgical system 10 provides a button 26 which operates a " le~.l IGI lial " 27, see Figure 4, to selectively distribute in a ,u, ed~ ,ed pattem about the axis "A~ the laser radiation from the distal end 14. The l"__hGi l;a"l 27 includes an e:__IIulllGyl,eli~i radiation deflecting surface 28 arranged to vibrate relative to the axis 10 "A". This forms a u,edele,,,,inad pattem to achieve a varying ionized conductive pathway generally along but slightly displaced from the axis "A~ for thereby directing electrosurgicalenergyintheluledetellllilledpattemtothepatient1l~ Thellle~hGlli~
27 may _" , I~'; . e,'~ include a beam pattem deflector 29. The beam pattern deflector 29 may be an acousto-optic modulator or GllGi lU_.I lel ~t of acousto-optic modulators to 15 diffract, refract or reflect the laser radiation.
In another alternate, the laser and electrosurgical system 10 includes in the control 24 for the source energy for laser radiation 17 a power switch 30 which may select between two levels of laser radiation energy delivery. This may be G~ VI 11~ led by changing the duty cycle of the laser. The power switch 30 includes a cutting laser 20 radiation energy level "C" and another level "I" to provide for the ionized conductive pathway. The power switch 30 also includes an electronic time delay Ille~,h GI li:~lll 31 to interpose a preset time period, shown in Fgure 7, between the initiation of cutting laser radiation 32 and the subsequent delivery of electrosurgical energy 33 for Pgl ' ~. The time delay should be sufficient to provide tima for cutting with the laser 25 radiation, followed by concurrent electrosurgical ~oPg~' ~ along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system 10 has the laser radiation energy within the range of visible, near-infrared and infrared light spectrum ~ llla. The laser radiation source 17 provides radiation of ~ tha in the range of between 0.3 to 30 10.6 microns for eaIGL,li~.l,i,lg through air the ionized conductive pathway GS
substantially collimated.
A wave guide 34, shown in Figure 1, is used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A". An W096/04858 2 1 9 4 9 8 7 P~ 'G
.
array of wave guides 35, shown in hgure 2 may " "_';/ ly be used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A".
The laser and electrosurgical system 10 includes on the handpiece 12 a pistol 5 grip 36 which depends near the proximal end 13 and is therefore at an angle 37 to the axis "A" which extends from the distal end 14 in the direction which the electrode 16 is pointed.
The laser and electrosurgical system 10 has ~ ly in Figure 2 an electrosurgical electrode support 38 which is flexible and eiongate for ~ "do,copic or 10 k~yc~ uscu~ ; use within a cannula (not shown) passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system 10 has its control located on the handpiecebetween the proximal and distal ends 13 and 14. The control may also be located on the pistol grip 36 or at a foot pedal 39.
A method for providing cutting, ~ 9~' " ,g, and/or a cv-,,L,i,-_~;o,, thereof ontissue of the patient 11 with a laser and electrosurgical system 10 includes the following step of directing selectively and at least concurrently laser radiation and electrosurgical energy from the handpiece 12 with its proximal and distal ends, 13 and 14, along an axis "A" by aiming the distal end 14 thereof along the axis "A" from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling the source energy for laser radiation 17 available at the proximal end 13 of the handpiece by the surgeon for first delivering laser radiation from the distal end 14. Controlling a source of electrosurgical energy available at the proximal end 13 of the handpiece 12 by the surgeon for llclllalllia~;vl, of electrosurgical energy from a electrosurgical electrode 16 at the distal end 14 may be yet another step of the method.
Then may follow the step of ccnnecting the control 24 to a source energy for laser radiation 17 and to a source of electrosurgical energy 18 so the control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end 14.
The method also includes the additional step of initiating the laser radiation delivered from the distal end 14 concurrently or slightly in advance of the delivery of the electrosurgical energy so that the laser radiation forms an ionized conductive pathway W0 96/W858 2 1 9 4 9 8 7 ~ 6 .
along which the electrosurgical energy will be guided for pinpointing the target tissue to be treated.
The method includes the additional step of guiding the electrosurgical energy by anranging the distal end 14 and the electrosurgical electrode 16 ge~ t~ lly relative 5 to the handpiece 12 for providing laser radiation essentially along the axis "A~ and from the distal end 14 for the combined concurrent application of the laser radiation and the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end 14 to the patient 11 along the axis ''A~ to direct the flow of electrosurgical energy is performed.
The method includes the additional step of distributing the laser radiation available at the proximal end for delivery about the axis ~A" in a p, t,.l~lt" " ,i"ed pattem from the distal end 14 with the l~ ,hmiall, 27. In one possible variation, there is an added step in which the l"e:ul,al,i~", 27 can deflect the laser radiation to create a varying ionized conductive pathway with an ~le-,l, u" ,..~u,, ,~ ti~, radiation deflecting surface 15 28 that vibrates in a ~n~:dtlt~:l",i"ed pattern generally along but slightly displaced from the axis "A" to direct electrosurgical energy in a predefined pattem on the patient's 11 target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or diffracting the laser radiation beam with the i"~.l,~li:.", 27 having a beam pattem 20 deflector 29.
The method of initiating the laser radiation slightly in advance of the delivery of the electrosurgical energy is augmented with the additional steps of controlling the laser radiation initially with the switch 30 having two levels of delivery. A first level of delivery IICn may be a cutting level and a second level 'l~ may be an ionizing conductive25 pathway level. This may provide for ds~ y il ,e subsequent delivery of electrosurgical energy for ~o~a~ , sufficiently for providing time for flrst cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method also includes the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectrum . '~ ~yth~ provided by the source of laser radiation 17. There may also be the additional step of using the wave guide 34 or the array of wave guides 35 for delivery of the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis ~A".
W0961048S8 ' ' 2 1 9 4 9 8 7 P~ '5 The method includes the additional step of using the handpiece, which is generally shaped like the pistol srip 36, by aiming along the axis ~Au extending from the distal end 14 in the direction in which the electrode 16 is pointed while having the pistol grip 16 at an angle 37 e:lyullullli~,~'j ~,u~ ull~iLle for surgery. The method also 6 includes the additional step of flexing into position the elongate electrosurgical electrode support 38 for c, ,.ius~.u~ui~ or lc,,uc.. u .cu,ui~. use in the cannula placed through the patient's body wall and into a cavity therein. There is the additional step of using the control 24 located on the handpiece 12 between the proximal and distal ends 13 and 14, or controlling with a foot pedal 39.
The claims which follow seek to cover the described ~",Lodi",~:";., and their eg~ ~: ' It~. The concept in its broadest scope covers the apparatus and methods for concurrent and simultaneous application of laser and electrosurgical energy. It is to be understood that the concept is subject to many ",- "' ,:. without departing fromthe spirit and scope of the claims as recited herein.
Claims (6)
1. A laser and electrosurgical system 10 for a surgeon to use for cutting and coagulating tissue of a patient 11, the system 10 comprising:
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end 13 by a waveguide 34, and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable, and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12, and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11, and an initiation circuit 25 connected to the source of laser radiation 17 and connected to the source of electrosurgical energy 18, the initiation circuit 25 used for sequencing the delivery of laser radiation and electrosurgical energy to the patient 11, wherein the laser radiation has sufficient power to ionize a path between the distal end 14 and the tissue of the patient 11, and the electrode 16 is positioned near the path of the laser radiation such that the electrosurgical energy is conducted along the ionized path.
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end 13 by a waveguide 34, and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable, and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12, and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11, and an initiation circuit 25 connected to the source of laser radiation 17 and connected to the source of electrosurgical energy 18, the initiation circuit 25 used for sequencing the delivery of laser radiation and electrosurgical energy to the patient 11, wherein the laser radiation has sufficient power to ionize a path between the distal end 14 and the tissue of the patient 11, and the electrode 16 is positioned near the path of the laser radiation such that the electrosurgical energy is conducted along the ionized path.
2. The laser and electrosurgical system 10 of Claim 1 wherein the source of laser radiation 17 provides radiation of a wavelength in the range of between 0.3 to 10.6 microns for establishing the ionized conductive pathway.
3. The laser and electrosurgical system 10 of Claim 1 wherein a waveguide 34 within the handpiece 12 delivers the laser radiation from the proximal end 13 to the distal end 14.
4. The laser and electrosurgical system 10 of Claim 1 wherein an array of wave guides 35 within the handpiece 12 deliver the laser radiation from the proximal end 13 to the distal end 14.
5. A laser and electrosurgical system 10 for a surgeon to use for cutting and coagulating tissue of a patient 11, the system 10 comprising:
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end by a waveguide 34 and the laser radiation transmitted from the proximal end to the distal end through a waveguide in the handpiece and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient, the source of laser radiation 17 having sufficient power to ionize a conductive pathway from the distal end 14 to the tissue of the patient 11 and wherein the electrode 16 is positioned near the path of the laser radiation;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12 and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11;
a control 24 connected to the source of laser radiation 17 and to the source of electrosurgical energy 18 for the selective application of laser radiation and electrosurgical energy from the distal end 14 and a power switch 30 in the control 24 for selecting between two levels of laser radiation energy delivery the power switch 30 including a cutting laser radiation energy level and an ionized conductive pathway level of laser radiation energy.
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end by a waveguide 34 and the laser radiation transmitted from the proximal end to the distal end through a waveguide in the handpiece and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient, the source of laser radiation 17 having sufficient power to ionize a conductive pathway from the distal end 14 to the tissue of the patient 11 and wherein the electrode 16 is positioned near the path of the laser radiation;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12 and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11;
a control 24 connected to the source of laser radiation 17 and to the source of electrosurgical energy 18 for the selective application of laser radiation and electrosurgical energy from the distal end 14 and a power switch 30 in the control 24 for selecting between two levels of laser radiation energy delivery the power switch 30 including a cutting laser radiation energy level and an ionized conductive pathway level of laser radiation energy.
6. The laser and electrosurgical system 10 of Claim 5 wherein the power switch 30 includes a time delay mechanism 31 to interpose a preset time period between the initiation of cutting laser radiation 32 and the subsequent delivery of electrosurgical energy 33 for coagulation, the preset time sufficient to provide time for cutting with the laser radiation, the power switch 30 thereafter enables concurrent electrosurgical coagulation along the ionized conductive pathway to the laser cut tissue.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US08/289,958 US5509916A (en) | 1994-08-12 | 1994-08-12 | Laser-assisted electrosurgery system |
US08/289,958 | 1994-08-12 |
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CA2194987A1 true CA2194987A1 (en) | 1996-02-22 |
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Family Applications (1)
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CA002194987A Withdrawn CA2194987A1 (en) | 1994-08-12 | 1995-07-10 | Laser-assisted electrosurgery system |
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US (1) | US5509916A (en) |
EP (1) | EP0774925A1 (en) |
JP (1) | JPH09508556A (en) |
AU (1) | AU2750795A (en) |
CA (1) | CA2194987A1 (en) |
MX (1) | MX9701120A (en) |
WO (1) | WO1996004858A1 (en) |
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JPS5769853A (en) * | 1980-10-20 | 1982-04-28 | Tokyo Shibaura Electric Co | Lasre device |
JPS5769790A (en) * | 1980-10-20 | 1982-04-28 | Olympus Optical Co Ltd | Laser beam irradiator |
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US5267994A (en) * | 1992-02-10 | 1993-12-07 | Conmed Corporation | Electrosurgical probe |
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-
1994
- 1994-08-12 US US08/289,958 patent/US5509916A/en not_active Expired - Lifetime
-
1995
- 1995-07-10 EP EP95922694A patent/EP0774925A1/en not_active Withdrawn
- 1995-07-10 WO PCT/IB1995/000546 patent/WO1996004858A1/en not_active Application Discontinuation
- 1995-07-10 CA CA002194987A patent/CA2194987A1/en not_active Withdrawn
- 1995-07-10 MX MX9701120A patent/MX9701120A/en not_active Application Discontinuation
- 1995-07-10 AU AU27507/95A patent/AU2750795A/en not_active Abandoned
- 1995-07-10 JP JP8507152A patent/JPH09508556A/en active Pending
Also Published As
Publication number | Publication date |
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WO1996004858A1 (en) | 1996-02-22 |
AU2750795A (en) | 1996-03-07 |
MX9701120A (en) | 1997-05-31 |
JPH09508556A (en) | 1997-09-02 |
EP0774925A1 (en) | 1997-05-28 |
US5509916A (en) | 1996-04-23 |
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