Apparatus for operation by laser energy

An apparatus performs operations such as incision, coagulation and evaporation of the tissue of a living body such as human body with laser lights. An apparatus for performing a surgical operation of the tissue of a living body with laser lights while contacting a blade with the tissue of the living body comprising a holding portion which is held by an operator, a blade which is integral with the holding portion and is made of a material which generates heat on exposure to laser lights and can not transmit the laser lights therethrough, and an optical fiber which receives laser lights for emitting the laser lights from the front end thereof, said blade being positioned in such a manner that a part of said blade is located in the irradiation area of the laser lights from said optical fiber and said optical fiber being movable toward and away from said blade while said optical fiber is held by said holding portion.

DETAILED DESCRIPTION OF THE INVENTION 
Field of the Invention 
The present invention relates to an apparatus for performing operations 
such as incision, coagulation and vaporization of the tissue of a living 
body such as human body by using laser lights. The apparatus can be also 
used for internal treatment using an endoscope as well as surgical 
operation. 
Recently, surgical operations or internal operations for incision, 
coagulation and vaporization of the tissue of a human body have been often 
conducted by using laser energy. Operation with laser lights has an 
advantage over operations with a mechanical knife in that bleeding is 
less. Operation of an organ in the vicinity of the heart with laser lights 
has an advantage over operations with an electric knife in that shock to 
the heart is less. The term "laser lights", as used herein, is intended to 
comprehend laser energy fluxes as available from conventional laser energy 
sources. Further it has an great advantage in that the curing speed of the 
operated tissue is fast. 
Traditional laser knives typically have been of a non-contact type. The 
present inventor has proposed a contact type laser knife which makes it 
easy to perform an operation by bringing a contact probe into the tissue 
in U.S. Pat. 4,736,743. The laser knife has a contact chip or a contact 
probe at the front end of an optical fiber. Laser lights are emitted from 
the front end of the optical fiber and are transmitted through the contact 
probe and are emitted from the front end of the contact probe. 
Since the contact probe is made of sapphire or quartz, it is easily broken 
or damaged if an excessive external force is erroneously applied thereto 
or it is brought into contact with the other instruments in an operation 
room. In this case, it is necessary to exchange the damaged contact probe 
with a new contact probe and to mount the new contact probe on a holder. 
If there is not enough time, it is necessary to exchange the older holder 
having a spare holder with a new contact probe. 
In any case, damages to the contact probe during emergent operation should 
be avoided. 
Since it takes an extended period of time to fabricate the contact probe 
into a given configuration depending upon the use, the manufacturing cost 
becomes higher, and the material per se is expensive. 
Since the contact probe for incision is fabricated into a configuration 
which is exclusively used therefor, it is necessary to exchange the 
contact probe for incision with a contact probe for coagulation or 
vaporization if coagulation or vaporization of the peripheral tissue is 
wanted to be performed. 
SUMMARY OF THE INVENTION 
It is therefore an object of the present invention to provide an apparatus 
for performing an operation with laser lights, which has a high durability 
and is economical. 
It is another object of the present invention to provide an apparatus for 
performing an operation with laser lights, which may be used for incision, 
coagulation and vaporization. 
The above mentioned objects are accomplished by providing an apparatus for 
performing a surgical operation of the tissue of a living body with laser 
lights while contacting a blade with the tissue of the living body 
comprising a holding portion which is held by an operator, a blade which 
is integral with the holding portion and is made of a material which 
generates heat on exposure to laser lights and can not transmit the laser 
lights therethrough, and an optical fiber which receives laser lights for 
emitting the laser lights from the front end thereof, said blade being 
positioned in such a manner that a part of said blade is located in the 
irradiation area of the laser lights from said optical fiber and said 
optical fiber being movable toward and away from said blade while said 
optical fiber is held by said holding portion. 
The blade is made of a non-exothermic metallic material which will not 
generate heat on exposure to laser lights as well as exothermic metallic 
material which generates heat on exposure to laser lights. In any case, 
the metallic material may be coated on the surface thereof with an 
exothermic material which generates heat on exposure to laser lights. In 
other words, if a non-exothermic material is used, inherent ability for 
incision is exhibited. If an exothermic material is used, the exothermic 
degree is advantageously enhanced. However, a material which will not be 
melt on exposure to laser lights is selected for the blade. 
The material which forms the blade is preferably selected from the group of 
stainless steel, titanium, tantalum and nichrome. The exothermic material 
is one which is selected from the group of graphite, ion oxides and 
magnesium oxides and the mixture thereof. A coating layer of the 
exothermic material may be formed by depositing the exothermic material on 
the surface of a main body of the blade while the blade surface is melt at 
high temperature, or by applying the exothermic material on the surface of 
the blade main body after preliminarily dispersing the exothermic material 
in a heat resistant bonding material. 
The holding portion is made of a metallic pipe. The blade is held on the 
metallic pipe without any interposing adiabatic member therebetween. The 
metallic pipe has a length of 10 cm or more. The heat which is generated 
when the blade is irradiated with laser lights is conducted to the 
metallic pipe so that the heat is diverged into air. 
A guide pipe is held on the holding portion and optical fiber is provided 
so that they are movable forward and rearward within and along the guide 
pipe and the position of the optical fiber in a longitudinal direction 
within the guide pipe can be fixed. 
In the present invention, the optical fiber is movable toward and away from 
the blade. 
In this case, the optical fiber is designed so that the irradiation area of 
the laser lights from the front end of the optical fiber has a projection 
area which is larger than that of the blade upon the tissue of a living 
body. Coagulation or vaporization of the tissue can be made by directly 
irradiating the tissue with laser lights from the front end of the optical 
fiber while the optical fiber is remote from the blade. Incision can be 
made by using the energy possessed by the laser lights as an exothermic 
energy of the blade by approaching the optical fiber to the blade for 
converging the laser lights from the front end of the optical fiber on the 
blade. Therefore two mode operations such as incision and coagulation or 
vaporization is possible with a single instrument. 
The blade is formed in such a manner that it is bent in on direction at the 
front end thereof, the bent portion of the blade will contact with the 
tissue of the living body on the front side thereof and is irradiated with 
laser lights on the rear side of said bent portion. The blade may be used 
for cauterization of a projected tumor, for example. 
The blade may be open-looped in such a manner that it extends forward from 
the holding portions, the base ends of the blade being held by respective 
holding portions, irradiation area of the laser light from the front end 
of the optical fiber is preset toward the front end of the loop. 
The loop may be slanted at the front end thereof so that the irradiation 
axis of the laser lights intersects with a plane on which the front end 
portion of the loop is placed. 
The holding portions may be in the form of scissors and an optical fiber is 
held on said holding portion so that the laser lights are incident upon 
the blade edge of the scissor. 
The holding portions may be in the form of scissors and two bundle of 
optical fibers are held by said holding portions so that the laser lights 
are incident upon the respective blade edge. This apparatus may be 
effectively used for incision of the tissue. 
The holding portions may be in the form of tweezers and optical fibers may 
be held on said holding portions so that the laser lights are incident 
upon the pressure contact surface of each of the front end of the holding 
portion. This apparatus is capable of performing an operation such as 
coagulation while the tissue is tweezed and picked up. 
A radio frequency oscillator may be connected to the blade so that the 
blade can be used as an electric knife.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
The present invention will become more apparent from the description of 
preferred embodiments shown in the drawings. 
FIGS. 1 and 2 show a first embodiment of an apparatus of the present 
invention. A reference numeral 10 denotes a holder pipe which is held by 
an operator and is made of a stainless pipe for example. A mounting pipe 
12 is integrally secured to the front end of the holder tube 10 by means 
such as welding. A J-shaped hook blade 14 is integrally secured to the 
mounting pipe 12 by means such as welding. The hook blade 14 is circular 
in cross-section along the length thereof from the base end to an 
intermediate position and is flat in cross-section from along the length 
the position to the front end and is sharp on the front side (left side as 
viewed in FIG. 1) as shown in FIGS. 4 and 5. A guide pipe 16 is provided 
within the holder pipe 10. The guide pipe 16 is integrally secured to the 
above-mentioned pipe 12 by means such as welding so that it is also 
integral with the holder pipe 10. 
Optical fiber 18 are inserted in the guide pipe 16 in spaced manner 
therewith. The optical fiber 18 is optically coupled to a laser generator 
20 so that it transmits the laser lights from the laser generator 20 for 
emitting the laser lights from the front end of the fiber 18. A sleeve 22 
is mounted on the base end of the guide pipe 16 as means for positioning 
the optical fiber 18. A pressure contact member 26 which is made of 
rubber, for example, is compressed by leftward movement as viewed in FIG. 
1 of a plug 24 which is threadably fitted into the sleeve 22. Compression 
of the pressure contact member 26 causes the member 26 to pressure contact 
with the outer periphery of the optical fiber 18 so that the optical fiber 
18 is firmly secured to the guide pipe 16. The optical fiber 18 can be 
freely moved by drawing the optical fiber 18 rightward or forcing the 
fiber leftward while the holder pipe 10 is held with a left hand after 
compression of the pressure contact member 26 is released by rotating the 
plug 26 in an opposite direction. If the optical fiber 18 is forced 
leftward, it is moved toward the hook blade 14 as represented by a phantom 
line in FIG. 1 and is moved away from the hook blade 14 if it is 
withdrawn. The illustrated optical fiber 18 has a main body 18A which is 
coated with a protection tube 18B. 
Laser lights are emitted from the front end of the optical fiber 18 in such 
a manner that they diverge at a small divergence angle. When the optical 
fiber 18 is moved toward the hook blade 14 as shown by the phantom line of 
FIG. 1, the irradiation area Z with the laser lights has a width equal to 
that of the hook blade 14 so that the laser lights are incident upon the 
rear side of the hook blade 14. In contrast to this, when the optical 
fiber 18 is moved remote from the hook blade 14 the width of the 
irradiator area Z becomes larger than that of the hook blade 14 as shown 
in FIG. 5. Accordingly, although some of the laser lights are incident 
upon the rear side of the hook blade 14, the other laser lights are 
directly incident upon the tissue. 
Such an apparatus can be used for incision as shown in FIG. 2. Irradiation 
with laser lights is conducted while the holder pipe 10 is held with a 
hand and the front side of the hook blade 14 is abutted upon the tissue M. 
The laser light are incident upon the rear side of the hook blade 14 and 
the light incident area intensively generates heat. The heat is 
transmitted to the front side of the hook blade 14 so that the 
cauterization of the tissue is performed with this heat. In this process, 
incision can be made by moving the hook blade 14 in one direction as shown 
in the drawing. 
In this case, prior to incision the tissue around an object to be incised 
can be coagulated by moving the hook optical fiber 18 from the hook blade 
14. This method exhibits hemostatic capability by coagulation of the 
tissue. 
The apparatus having the hook blade 14 is applicable in a manner shown in 
FIG. 3. While a part of the tissue for example veins or muscle is hooked 
up on the rear side of the hook blade 14 at the front end thereof, the 
hooked up tissue is irradiated with the laser lights. In this case, the 
hooked up tissue per se is directly irradiated with laser lights and after 
the laser lights have transmitted through the tissue, the laser lights are 
incident upon the hook blade 14. The hook blade 14 is heated and incision 
is also conducted with the heat from the blade 14. 
If the front end of the optical fiber 18 is damaged due to contact of the 
front end of the optical fiber 18 with the tissue and the like, the 
optical fiber 18 can be reused by advancing the optical fiber by the 
length of the damaged fiber. If necessary, the damaged optical fiber 18 
may be replaced with a new optical fiber. Since the optical fiber 18 is a 
universal article, it is very economical in comparison with the above 
mentioned contact probe or contact chip. The cost of the whole apparatus 
is economical. 
FIG. 6 shows the structure of a second apparatus. The apparatus has a flat 
plate like blade 14A in lieu of the hook blade 14 at the front end 
thereof. The preferred utilization of the blade 14 is to cauterize the 
tumors or soared tissue by applying the front side of the flat plate like 
blade 14A thereon and irradiating the rear side of the blade 14 with laser 
lights. 
FIGS. 7 to 10 shows an embodiment of an apparatus having an open-looped 
blade. The looped blade 14A shown in FIGS. 7 and 8 is secured relative to 
the holder pipe 10 so that it is secured to the mounting pipes 12 at the 
open ends thereof and extends forward in a parallel relationship and 
obliquely slanted downward at the front end thereof. 
The optical fiber 18 is positioned in such a manner that the front end of 
the looped blade 14B is located in the irradiation area Z of the laser 
lights Z. The looped blade 14B in this embodiment can adopt various 
operations such as wide incision by pulling the holder pipe 10 rearward 
while the front end of the loop is pressed upon the object tissue, 
removing of a projected tissue by moving the holder pipe 10 on a plane 
while applying the whole of the front side 14a upon the tissue, and 
removing of a projected tissue and vaporazation of the tissue by 
positioning the projected tissue between the rear side 14b and the front 
end of the optical fiber 18. 
FIG. 9 shows an embodiment in which the whole looped blade 14C is on the 
same plane. FIG. 10 shows an embodiment of a looped blade 4D having a 
substantially rhombi shape which is common to the electric surgical 
knifes. 
FIGS. 11 and 12 show an embodiment in which a tweezers-shaped holder is 
integral with a blade. A tweezers-like holder 30 is integrally provided 
with pressure contact blades 32a, 32b at the front end thereof. A guide 
pipe 12 is mounted on the holder 30 so that it extends along one side of 
the holder 30. The optical fiber 18 1s movable forward and rearward within 
the guide pipe 12. In this ease, the optical fiber 18 is designed in such 
a manner that the pressure contact portions 32a, 32b are also irradiated 
with laser lights when the tissue is tweezed between the pressure contact 
portion 32a, 32b. 
Such an apparatus like tweezers can be used for irradiation of the tissue M 
at an object position with laser lights while it is tweezed and lifted up 
with pressure contact portions 32a, 32b as shown in FIG. 11. 
FIGS. 13 to 15 show an embodiment in which a scissors like holder is 
integral with an incision blades. A tweezers-like holders 34 are 
integrally provided with incision blade 36 at the front end thereof. A 
guide pipe 12 is held between holders 34 so that left spring members 38 
are disposed between each of the holders 34 and the guide pipe 12. Optical 
fiber 18 is movable forward and rearward with the guide pipe 12. The 
optical fiber 19 are positioned so that they emit laser lights toward the 
edge of the incision blades 36. 
This apparatus conducts incision of the tissue by emitting laser lights 
from the front end of the optical fiber 18 while tweezing the tissue 
between the incision blades 36. In this case, when the incision blades 36 
are moved toward each other, the leaf springs 38 will flex. Release of 
tweezing of the tissue returns the guide pipe 12 and the optical fiber 18 
to a home center position. 
Although the incision blades 36 are irradiated with laser lights emitted 
from a optical fiber, an optical fiber 18 may be mounted on each of the 
holders 40 so that it emits laser lights toward each of the biasing blades 
42 of the tweezers-like holder 40 as shown in FIGS. 16 and 17. Each of the 
illustrated blade 42 is formed with a recess 42a. 
This apparatus is mainly preferable for hemostasis by tweezing veins 
between the biasing blades 42. 
An embodiment shown in FIGS. 19 and 19 is effective for mainly piercing. A 
sharp pyramid shaped piercing blade 46 is integral with the front end of a 
thin plate-like holder 44. A guide pipe 12 and optical fiber 18 are 
secured in a space within the holder 44. The piercing blade 46 is formed 
with a notch window 46a so that the laser light are directly incident upon 
the tissue via the window when the optical fiber 18 is retracted. 
This apparatus can be used for piercing the tissue by irradiating the rear 
side of the piercing blade 46 with laser light by pressing the front end 
of the piercing blade 46 into the tissue. 
At least the above mentioned blade in the present invention is made of a 
material which can not transmit the laser lights. The typical material is 
a metal which may be selected from the group of stainless steel, titanium, 
tantalum, nichrome and the like. If the blade is electrically conductive, 
the blade which is connected with a radio frequency oscillator may be used 
as a surgical electric knife. In use of the electric knife, an opposite 
polar plate for the blade is preliminarily attached to a patient. 
If the blade of the present invention is used as an electrical knife 
terminal in such a manner, incision of the tissue can be made without 
laser light irradiation. In the course of the incision, the laser lights 
can be radiated from the front end of the optical fiber when vaporization 
and/or coagulation of the tissue is necessary. Incision speed or incision 
capability can be enhanced by radiating the laser lights while applying 
radio frequency waves to the blade. 
Use of the apparatus with the electric knife will be further described. If 
the apparatus is used as an electric knife, the incision ability is 
generally higher than the case in which laser lights are used. However, 
the electric knife has little hemostatic capability in comparison with the 
case in which laser lights are also used and has a coagulation ability 
which is not so high and gives large damages to the tissue. Therefore, the 
blade is used as an electric knife for making an incision operation at a 
high incision ability and it is preferable that the tissue be irradiated 
with laser lights for enhancing the hemostatic ability in the course of 
the incision operation or if the tissue is bleedable coagulation ability 
can be enhanced and an increase in damage to the tissue can be prevented 
by irradiating the tissue with laser lights while the electric knife is 
used in a coagulation mode. Use of an electric knife with irradiation of 
the tissue with laser lights provides distinct advantages which have not 
been found in the prior art. 
Although it is not essential to coat a blade with an exothermic material, 
the exothermic efficiency is enhanced if a coating layer of the exothermic 
material is formed. Examples of the exothermic material may be one which 
is selected from the group of carbon, graphite, iron oxides, magnesium 
oxides or the mixture thereof. 
The blade of the present invention may be attached to an endoscope. In this 
case, the above mentioned apparatus may be inserted into an introducing 
bore of the endoscope or may be in such manner that a blade is mounted on 
the front end of an insertion sheath or catheter and an optical fiber or a 
guide pipe is inserted into the sheath or disposed within the sheath. 
The apparatus may be mounted on a Zelektscope. If the blade is mounted on 
the sheath or the catheter for internal treatment, these component 
constitute "a holding portion" used herein. It is preferable that the 
holder or guide pipe be flexible for internal treatment.