Method of surgery making use of laser emission and an apparatus for accomplishing same

A method whereby a hollow organ is compressed from two sides along an intended line of section after which simultaneous dissection and welding of the edges of the cavities formed is carried out by moving a focused laser beam along said line. The degree of compressing the organ's walls is within the range from 1/5 to 1/2 of the initial thickness of said walls. A device for accomplishing said method has a pair of clamping jaws drawn together or apart by means of clamps. One of the jaws serves as a guide path for a carriage, mounted on which is the exit portion of a light guide with a focusing lens. The light guide is connected with a laser. A through slot is made in one of the jaws along the line of intended section and a groove is provided on the other jaw opposite said slot. The walls of the slot and the groove have a surface reflecting the laser beam.

The present invention relates to medicine, and more particularly, to a 
method of surgery making use of laser emission and an apparatus for 
accomplishing the same. The invention can be most successfully used for 
conducting surgery on hollow organs, for example, the resection and 
formation of a stump of the urinary bladder; the formation of a tubular 
flap from the urinary bladder in order to form an artificial ureter; the 
resection of the small and large intestines; the resection and formation 
of a stump of the stomach; the formation of a tubular flap from a part of 
the greater curvature of the stomach in cases of complete and partial 
plastic surgery on the esophagus, and also in any other case when 
bloodless aseptic laser-beam dissection of an organ must be accompanied by 
simultaneous aspetic laser-beam welding of that organ's walls with the 
formation of new cavities. 
As is known, the use of laser beam surgery is finding of late ever broader 
applications. 
Usually, in prior art apparatus, a focused laser beam with power densities 
from 10.sup.4 to 10.sup.5 W/cm.sup.2, transmitted from a laser via a light 
guide and focused at the light guide exit, is directed at the area to be 
dissected. In this case, the surgeon holds the exit portion of the light 
guide in his hand and moves it in a manner for the focusing point to 
coincide with the visually traced line of section, while visually 
controlling the focusing depth and travelling speed of the focusing point 
according to the thermophysical properties of the tissues being dissected. 
The depth of section in the prior art apparatus is determined by the depth 
of laser beam focusing (depending on the distance between the exit portion 
of the light guide and the surface of the organ being operated upon), the 
speed of the focusing point of the laser beam travelling along the 
intended line of section and the thermophysical properties of the tissues 
being dissected, whereupon the dissected tissues are joined together, for 
example, by means of a silk suture. 
However progressive, this method of surgery making use of laser emission 
has a number of disadvantages. 
A disadvantage of the prior art apparatus is that it provides for the 
dissection of tissues only, without simultaneous aseptic laser-beam 
welding of the organ's walls. During surgical operations on hollow organs, 
this results in the infection of the initially aseptic surface of the 
laser-beam section with the contents of the hollow organ undergoing 
surgery (intestine, stomach, urinary bladder, etc.) and preventing fullest 
utilization of the aseptic effect of laser emission. This is particularly 
dangerous in cases where surgery is carried out on the tissues of an organ 
containing large blood vessels, more than 1-1.5 mm in diameter, since the 
resection of the organ produces profuse hemorrhage from these vessels, and 
in cases when the vessels are more than 3 mm in diameter, blood may even 
spurt in a fountain. 
Moreover, when carrying out surgery by the prior art method, healthy organs 
situated beneath the organ subjected to surgery may be injured, since the 
operating surgeon is unable to accurately control the section depth 
because it is impossible to correlate the depth of laser beam focusing and 
the travelling speed of the laser beam focusing point according to the 
thermophysical properties of the tissues being dissected. 
At the same time, when using the prior art apparatus and method there is 
the danger of the laser beam damaging healthy organs situated beside the 
organ that is operated upon because of the natural tremor of or an 
accidental push to the surgeon's hand. The natural tremor of the surgeon's 
hand results in a wider than necessary section and the charring of its 
walls. 
There is also the hazard of the operating medical personnel being exposed 
to reflected and diffuse laser emission from the auxiliary metal surgical 
instruments present in the operational field and from the surfaces of the 
tissues of the organ being operated upon. 
The use of the prior art apparatus also involves the hazard of injuring the 
operating surgeon's eyesight by the highly intensive light radiation 
formed in the laser beam focusing zone as a result of the gaseous products 
evolving during the interaction of the laser beam with the dissected 
tissues when they are heated to a high temperature. 
It is an object of the present invention to provide a method of surgery 
with use being made of laser emission that would make possible bloodless 
aseptic dissection of the two opposite walls of a hollow organ and 
simultaneous aspetic welding of the opposite dissected walls with the 
formation of two new cavities. 
Other objects of the present invention are to considerably increase the 
tissue section speed in comparison with the prior art method, and also to 
prevent the charring of the walls of the organ being operated upon along 
the line of section, to guarantee the healthy organs adjacent to the 
operated organ against damage and to reliably protect the medical 
personnel against exposure both to reflected and scattered laser emission, 
as well as to the highly intensive light irradiation of high-temperature 
gaseous products evolving from the interaction of the focused powerful 
laser beam with the tissue being dissected. 
Still another object of the present invention is to ensure the good 
accretion of the tissues of the resected hollow organ. 
Among further objects is the provision of a surgical laser that would make 
it possible to effect bloodless aseptic dissection of two opposite walls 
of a hollow organ and simultaneous aseptic laser-beam welding of the 
dissected opposite walls, while increasing considerably the speed of 
cutting the organ's tissues in comparison to other, prior art devices, 
preventing the charring of the dissected walls of the organ being operated 
upon, and to guarantee against injury to healthy organs adjacent to the 
organ operated upon, and that would reliably protect medical personnel 
both from exposure to reflected and scattered laser radiation and exposure 
to the highly intensive light radiation of the high-temperature gaseous 
products evolving during the interaction of the focused powerful laser 
beam with the dissected tissue. 
These and other objects are attained by that in a method of surgery on 
hollow organs using a focused laser beam moved along the line of intended 
section of a hollow organ, according to the invention, the hollow organ is 
preliminarily clamped on two sides so that the oppsite walls of said 
hollow organ touch each other along the line of intented section, after 
which simultaneous dissection along the compressed line and welding of the 
edges of the newly formed cavities is effected by moving the focused laser 
beam along the intended line of treatment, with the degree of compressing 
the walls of said hollow organ along said line being within the range of 
1/5 to 1/2 of the initial thickness of said walls. 
The proposed method makes it possible to carry out bloodless aseptic 
dissection of a hollow organ to be operated upon with the aid of a laser 
beam simultaneously with laser-beam welding of the opposite walls 
comprising blood vessels up to 5 mm and more in diameter. 
Depending on the individual features of the hollow organs, the power of the 
laser beam may be within the range from 20 to 200 W, and the range of 
laser emission wavelengths used may vary from 0.4 to 10.6.mu.. 
An apparatus for the implementation of the proposed method comprises a 
laser mounted at the entry point of a light guide at whose exit portion a 
focusing lens is set in accordance with the invention, clamping jaws made 
of a material impermeable to laser radiation and mounted with the 
possibility of drawing them together or apart for clamping the walls of a 
hollow organ on two sides along an intended line of section, and a 
carriage made of a material impermeable to laser radiation and mounted on 
a guide path, and fastened in the aforementioned carriage is the exit part 
of the light guide with the focusing lens, and a through-slot is made in 
the guide path along the line of intended section for the passage of a 
laser beam to the portion of the hollow organ clamped in the jaws, said 
slot having mirror surface walls with a high reflection coefficient 
reflecting the laser beam, and one of the jaws being provided with a 
groove in the area where the hollow organ is clamped, situated opposite 
the aforementioned through-slot, its surface having a high-reflection 
coefficient providing for diffuse scattering of laser emission, the walls 
of the through-slot, the groove and carriage, when the hollow organ is 
clamped in the jaws, forming a closed channel for the laser beam to pass 
there through to the secured section of the hollow organ only. 
The proposed apparatus provides for the creation of a strip of compression 
along the intended line of section and welding of the hollow organ. The 
carriage, movably linked to the guide path of one of the jaws, serves to 
bring the focused laser beam up to the hollow organ to be operated along 
an accurately fixed line of section and welding, prevents the laser beam 
focusing point's crosswise oscillations which lead to the charring of the 
section's surfaces. The mirror-reflection walls of the slot in the guide 
path direct the laser beam to the clamped portion of the organ under 
surgery in case the laser beam axis does not quite coincide with the 
middle of the slot. The surface of the groove in one of the jaws provides 
for diffuse scattering of the laser emission incident thereupon, ensuring 
a beam power density and laser emission distribution necessary for 
welding. At the same time, the design of the apparatus reliably guarantees 
against inadvertent dissection of the patient's healthy organs and tissues 
adjacent to the operated organ, while excluding the exposure of medical 
personnel to the highly intensive light radiation from gaseous products 
evolving during the interaction of the powerful focused laser beam with 
the operated organ's tissues. On the whole, the proposed apparatus 
provides for rapid bloodless aseptic dissection and simultaneous welding 
of the two opposite walls of a hollow organ being operated upon with the 
formation of two new cavities on both sides of the section, at a speed 3-5 
times higher than the speed of tissue section by means of prior art 
devices. Moreover, the welded sutures joining the newly formed cavities on 
both sides of the section are continuous all along their length. 
It is advisable for the walls of the slot and the surface of the groove to 
be gold-plated. 
The proposed embodiment of the apparatus can be used most effectively for 
the section of organs several centimaters long. 
In another embodiment of the invention, the guide path has through-slots on 
both sides of the aforementioned through-slot, situated perpendicularly to 
the travelling direction of the carriage, mounted in which are tappets 
with metal staples, while one of the jaws opposite said tappets has 
grooves for clinching the staples when said tappets with staples move 
towards them, and the carriage is provided with a slide block for 
consecutively moving the tappets with the staples towards the hollow 
organ's clamped area. 
Such a design of the apparatus ensures a two-row suture in each cavity of 
the dissected organ. One of the sutures is formed by the laser beam, while 
the second suture, passing in the immediate proximity to the first, is 
formed by the metal staples. Here, the height of the welded suprastaple 
tissue elevation is minimal, no more than 0.5 mm, while the distance 
between adjacent staples in the row of staples is so selected as to ensure 
normal blood supply in the suprastaple elevation. 
The low height of the suprastaple elevation and the sufficiently large 
distance between adjacent staples in the row ensures speedy regeneration 
of the resected organ in aspetic conditions with the formation of a 
minimal scar without any post-operative complications. This embodiment is 
advisable for effecting the section of an organ longer than 10 centimeters 
for reinforcing the newly-made suture. 
It is advisable for the apparatus to be provided with a means for measuring 
the compression to which the hollow organ's walls are subjected, embodied 
as rods with scales graduated in compression units, while one end of each 
rod is press-fitted into one of the clamping jaws while the rest of the 
rod is slide-fitted for passage through the other jaw.

The proposed apparatus 1 (FIGS. 1 and 2) comprises a pair of clamping jaws 
2 and 3 for clamping the walls of a hollow organ 4. The jaws 2 and 3 are 
drawn together or apart by means of removable U-shaped clamps 5, mounted 
on the end portions of the jaws 2 and 3. Each clamp 5 is provided at the 
ends with a pin 6 and a stopper screw 7 with a handle 8, threaded through 
the clamp 5. The pin 6 and the end of the screw 7 are slide-fitted into 
respective depressions on the outer sides of the jaws 2 and 3. 
Other mechanisms of similar action may be used instead of the clamps 5, for 
example, mechanisms with a step-by-step registration of the degree of 
compression. 
The apparatus 1 has a means for measuring the compression of the walls of 
the operated organ 4. Said means is made in the form of rods 9 with scales 
graduated in compression units. The rods 9 are mounted at the end portions 
of the jaws 2 and 3, one end of each rod 9 being press-fitted into the jaw 
2, while the rest of the rod 9 is slide-fitted and enters a respective 
opening in the jaw 3. The rods 9 also ensure that the jaws 2 and 3 move in 
parallel during the compression of the organ's walls. 
The means for measuring the compression of the walls of the hollow organ 4 
may be embodied, for example, as a piezoelectric transducer, mounted into 
either of the jaws 2 and 3 in the area where the hollow organ 4 is clamped 
and connected to a remote recording instrument. 
The jaw 3 is T-shaped in section with outer lugs 10 slide-fitted into the 
internal slots of a carriage 11, mounted in which is the exit portion of a 
light guide 12 with a focusing lens 13. The entry portion of the light 
guide 12 is connected with a laser 14. 
The jaw 2 (FIG. 2) is rectangular in cross section. However, any other 
cross-sectional shape of the jaws 2 and 3 is possible, for example, the 
jaw 3 may be of rectangular cross-section with internal guiding slots 
slide-fitted to external guiding lugs of the carriage 11. 
An aperture 15 is made in the carriage 11 for the passage of the laser beam 
to the portion of the hollow organ 4 clamped between the jaws 2 and 3, 
opposite which the through-slot 16 is made in the jaw 3 along the line of 
intended section. There is a groove 17 opposite the slot 16 in the jaw 2. 
The walls of the slot 16 and the groove 17 have surfaces with a high 
reflection coefficient, mirror-reflecting and diffuse-scattering the laser 
beam respectively. 
The walls of the slot 16 are polished, while those of the groove 17 are 
matted by sand blasting. When operating with carbon dioxide, garnet lasers 
and a laser based on neodymium glass, the walls of the slot 16 and groove 
17 have a gold plating providing for the effective reflection of the 
radiation incident thereupon. Here the walls of the slot 16, in the case 
where the laser beam axis fails to coincide with said slot's center, 
mirror-reflecting the laser radiation incident thereupon, perform the 
function of a light guide for the laser beam at the end portion of the 
laser beam immediately before the operated organ 4, while the walls of the 
groove 17 in each case perform the function of a diffuser of laser 
radiation. 
The groove 17 is rectangular in cross-section. A semi-circular or 
trapezoidal, or any other cross-section of said groove ensuring diffuse 
scattering of laser radiation can be used. 
The apparatus 1 is provided with a system for removing the gaseous products 
evolving during the interaction of the laser beam with the tissue of the 
organ 4 being operated upon. 
This system comprises an annular chamber 18 mounted on the carriage 11 and 
linked through a sleeve 19 with a means (not shown) for the aspiration of 
gaseous products and also tubes 20, connected with the chamber 18, passing 
through the slot 16 in a manner ensuring that their inlet openings are in 
the immediate vicinity of the laser beam's focusing point. 
The tubes 20, in addition to their immediate purpose, also play the role of 
screens preventing the propagation of scattered laser radiation along the 
slot 16. 
Used in our investigations were pulsed and continuous argon, carbon dioxide 
and neodymium garnet lasers, lasers operating on neodymium glass, as well 
as other lasers with laser beam powers in the range from 20 to 200 W over 
wave-length intervals from 0.4 to 10.6.mu.. However, other lasers can also 
be used, whose selection is a matter of routine for those skilled in the 
art. 
The light guide 12 is made as a hinged mirror system in the form of a 
flexible cord made of light fibers so as not to hinder the movement of the 
carriage 11 together with the light guide's exit portion along the jaw 3 
while preserving the axis of the focused laser beam passing through the 
carriage 11 approximately along the center of the slot 16. 
The focusing lens 13 is made of germanium when intended for operation with 
a carbon dioxide laser, and of optical glass when intended for operation 
with an argon or garnet laser and lasers with neodymium glass. In each 
case, the lens 13 is bloomed. 
The carriage 11 and the jaws 2 and 3 are made of titanium alloys. They can 
also be made of stainless steel or other material impermeable to laser 
radiation. 
Operation with the proposed apparatus proceeds as follows. 
The clamping jaws 2 and 3 are set on both sides of the organ 4 to be 
operated, along the line intended for section, after which, by rotating 
the screws 7 of the clamp 5 the walls of the organ 4 are compressed. The 
degree of compression of the clamped walls of the organ 4, depending on 
the specific features of the hollow organs concerned, lies within the 
range of 1/5 to 1/2 of the initial wall thickness and is controlled by the 
scale on the rod 9. 
This brings about a strictly dosed increase in pressure of the interstitial 
biological fluid in the organ 4 in the zone of the intended section. 
The carriage 11 is moved into one of its extreme positions and the system 
for aspirating the gaseous products evolving during the interaction of the 
laser beam with the tissue of the operated organ 4, is switched on. Then, 
the laser 14 is switched on and the carriage 11 is smoothly moved along 
the jaw 3. Therewith the focused laser beam passes strictly along the 
intended line of dissecting the tissue of the hollow organ 4. Half of the 
supplied laser beam power is spent mostly for dissecting the tissue of the 
hollow organ 4, while the rest of the emission passes towards the jaw 2 to 
be scattered by the diffuse reflection surface of the groove 17 and ensure 
mainly, simultaneous welding of the walls of said organ 4. In the process 
of dissecting and welding the walls of the hollow organ 4, there takes 
place a strictly dosed displacement and intermixing of the interstitial 
biological fluid of the organ 4 in the zone affected by laser emission. 
This is accompanied by coagulation and results in the formation of a 
continuous suture on both sides of the section, mechanically joining the 
opposite edges of the dissected organ 4 at the moment of laser beam 
action. Thus, two new enclosed cavities of the operated organ 4 are 
formed. 
The walls of the slot 16, the groove 17 and the carriage 11, as the hollow 
organ 4 is compressed between the jaws 2 and 3, form an enclosed channel, 
completely isolating the surrounding space from any effect of laser 
radiation and gaseous products evolving during the interaction of the 
laser beam with the organ's tissues. 
The operation over, the laser 14 is switched off together with the system 
for aspirating the gaseous products evolving during the operation, and the 
affected resected part of the hollow organ 4 is removed. 
FIG. 3 shows another embodiment of the invention. 
The clamping jaw 3 has additional through-slots 21 on both sides of the 
through slot 16 normal to the direction of travel of the carriage 11. Set 
in the slots 21 are tappets 22 carrying metal staples 23. Grooves 24 are 
made in the clamping jaw 2 opposite the tappets 22 intended for clinching 
the staples 23 in the clamping zone of the hollow organ 4. The carriage 11 
is fitted with a slide block 25 for moving the tappets 22 with the staples 
23 and carrying a shaft 26 with gears 27 which engage with teeth 28 
fastened along the length of the outer surface of the jaw 3. Knobs 29 are 
provided with the gears 27 on the ends of the shaft 26 for rotating said 
shaft and moving said carriage. 
When using this embodiment of the apparatus 1, the hollow organ 4 is 
clamped between the jaws 2 and 3 with the aid of the clamps 5 along the 
intended line of section. Then the system for aspirating the gaseous 
products and the laser 14 are switched on. By rotating knob 29 the 
carriage 11 is moved along the jaw 3. Herewith, the block 25 presses in 
succession all the tappets 22 which eject the staples 23 from the slots 
21. The staples 23 pierce the walls of the operated organ 4 and are 
clinched against the grooves 24 of the jaw 2. The suturing of the walls of 
the organ 4 with the staples 23 is accompanied by the aseptic bloodless 
dissection and simultaneous aseptic welding of said organ's walls by the 
laser beam, whereby two new cavities of the organ 4 are formed, each of 
them with a welded suture at the side of dissecting the organ 4, 
reinforced by a row of the metal staples 23.