Multifunction laser-powered surgical tool with optical electrocautery capability

An endoscopic tool has an elongate cylindrical cannula with an open hooked end insertable into the body of a patient with a trocar element providing a laser powered flux of energy for precise incision and optional cauterization of tissue. A conventional pointed trocar may be used with the hooked cannula to permit forcible insertion of the hooked cannula end to the selected surgical site. In the alternative, a laser energy conveying trocar may be used with the hooked cannula or homeostatic insertion into the patient's body. The active distal end portion of the trocar may be provided with a selectively shaped energy-delivering tip element. The energy-delivering tip element may be provided with a subsurface heating region in which a selected implanted material converts received laser energy into heat for application to tissue held in the hooked open end portion of the cannula. Once the selected tissue is hooked, the surgeon may forcibly apply the heated or laser-energy emitting surface of the tip element to the tissue to be vaporized and incised. A cauterizing surface may be provided on the tip element of the trocar or, in the alternative to the hooked portion of the cannula.

FIELD OF THE INVENTION 
This invention relates to apparatus for performing surgical incisions and 
body-fluid coagulations at precisely selected locations through a cannula 
inserted into a patient's body, and more particularly to a durable, 
multi-function, laser energy powered, small-bore, precision surgical tool 
insertable through conventional cannulae for internal surgery. 
BACKGROUND OF THE PRIOR ART 
There are many circumstances in which it is undesirable for a surgeon to 
make a relatively large incision in a patient's body in order to perform 
surgical procedures at internal locations. With wide availability of 
fiber-optic techniques, surgeons can now avoid making large abdominal 
incisions by using endoscopic surgical techniques. This typically requires 
the surgeon to forcibly introduce, under local anesthetic, one or more 
cannulae through the outer skin into the patient's body. Such cannulae 
typically have outer diameters in the range 5-10 mm. 
As best understood with reference to FIG. 1, a sharp-pointed rod, known as 
a "trocar", is provided inside the cannula and facilitates forcible 
intromission of the cannula into the patient's body. The trocar with its 
point projecting at the front of the cannula is thus used to perforate the 
outer skin and enables pushing in of the elongate cannula (with the 
elongate body of the trocar within) through a succession of skin, muscle 
and fat layers, e.g., for laparoscopic surgery in the abdomen of a 
patient. Following such an insertion of the trocar and its surrounding 
cannula, the trocar is removed and the cannula left in place. The surgeon 
can thereafter insert through the cannula a variety of small bore 
instrumentation as necessary to perform various surgical functions. It is 
quite common to employ a number of cannulae suitably placed, as determined 
by x-ray or ultrasonic scanning of the patient's body, so that the 
innermost ends of the various cannulae are disposed close to the selected 
surgical site. 
The variety of instruments which may thus be deployed through one or more 
cannulae include an optic fiber connected to finely-controlled camera 
equipment to view and externally display the surgical field on a monitor 
for study by the surgical team, instruments for specifically grasping 
and/or manipulating tissue, or a multi-function device by which the 
surgeon can perform cutting and body-fluid coagulating functions 
simultaneously. The active end portion of such a device may be a laser 
energy heated element or a laser-energy emitting tip element. 
Through endoscopy surgeons can perform very precise surgery by remote 
control of the surgical tools. The key to success is precisely adjustable 
placement of the cannulae at suitable locations and in specific 
orientation with respect to the surgical site, so that instruments may be 
introduced through the cannulae selectively. Thus, for example, the 
surgeon most likely will place a cannula which is to be used to obtain a 
view of the surgical field via fiber optics above the surgical site rather 
than to a side thereof. As indicated earlier, during a complex surgical 
procedure the surgical team may remove an instrument from a particular 
cannula and replace it with another instrument and/or move the removed 
instrument into another cannula. If this technique is to be practiced, 
depending on how more than one instrument is to be used, there may be 
difficulties associated with the location of the available cannulae. This 
is particularly serious when very precise surgical operations are to be 
performed and particularly where it is essential to minimize internal 
trauma to the patient in the course of performing the surgery. 
The present invention is intended to afford a surgeon greater latitude and 
efficiency in precisely performing a variety of surgical functions through 
one or more cannulae. 
SUMMARY OF THE INVENTION 
It is a principal object of the present invention to provide a 
multi-function surgical tool that may be precisely deployed and utilized 
through a hook-ended cannula positioned to engage selected tissue in a 
patient's body. 
Another object of this invention is to facilitate endoscopic surgery by 
provision of laser energy through a hook-ended cannula positioned 
selectively about a surgical site in a patient's body. 
A further object of this invention is to provide a sturdy and reusable 
surgical tool for utilizing laser energy to perform multiple functions, 
such as incision, coagulation and electrocautery, in endoscopic surgery. 
An even further object of this invention is to provide a laser-energy 
powered surgical tool that may be used in conjunction with cooperating 
devices deployed via conventional cannulae to perform a variety of 
surgical functions by applying a laser energy heated element at precisely 
selected locations inside a patient's body, with an optional 
electrocautery function. 
Yet another related object of this invention is to provide a method of 
incising precisely held selected tissue, located in a confined region, by 
applying laser-powered energy at a high temperature to vaporize, and 
optionally cauterize, the tissue. 
These and other related objects are realized by providing a multifunction 
surgical tool for applying a flow of laser-powered energy to selected 
tissue precisely held in a patient's body, the tool including a cannula 
and a trocar. In the preferred embodiment, the cannula includes an 
elongate hollow cylindrical body and has a first connector part at a first 
end, and a hollow, open, hooked element at a second end. Upon placement of 
the cannula with its second end inside the patient's body, the surgeon can 
hook selected tissue with the open hooked element. The trocar includes an 
elongate element slidably inserted inside the hollow body of the cannula, 
and has a second connector part at a connectable end for connection with 
the first connector part of the cannula in a manner which permits slidable 
motion between the first and second connector parts as well as between the 
trocar and the cannula. The elongate element of the trocar has a distal 
end for delivery of a flow of laser-powered energy therethrough to the 
tissue hooked by the hooked element. 
In a related aspect of this invention, there is provided a method for 
performing surgical operations on selected tissue at a confined internal 
site in a patient's body, including the steps of: 
providing an elongate tubular cannula having a first connector part at an 
outside end and an open, hollow, hooked portion at a distal end with the 
hooked portion engaging the selected tissue; 
providing an elongate laser-energy transmitting trocar through the tubular 
cannula, with the trocar having a second connector at an outside end 
slidably connected with the first connector and with an energy-delivering 
tip element at a distal end of the trocar located in the open hooked 
portion of the cannula; 
slidably moving the tip element relative to the hooked portion, by slidably 
moving the first and second connector parts relative to each other outside 
the patient's body, until an energy-delivering surface of the tip element 
contacts the engaged tissue; and 
providing a controlled flow of energy to the tip element to heat said 
engaged tissue contacted thereby.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Surgical instruments comprising a thin-walled cylindrical cannula and an 
elongate rod-like trocar inserted therethrough are well know. As indicated 
in FIG. 1, such a known endoscopic surgical instrument 100 typically has 
an elongate cannula 102 with a user-graspable head element 104 at an outer 
end, and a square-cut smooth-edged, circular opening at a distal end 106 
which is disposed inside the patient's body during use. The trocar has an 
elongate, generally solid body 108 having an external diameter such as to 
permit a closed sliding fit inside the hollow body of cannula 102, and a 
length which exceeds that of the cannula 102. At an outside end of trocar 
108 is a user-contactable head 110, and at a distal end of the elongate 
portion of trocar 108, extending past opening 106 of cannula 102, is a 
pointed end 112. Head 104 of such a conventional surgical instrument may 
be provided with a mechanism for securely locking-onto trocar 108 with 
point 112 of the trocar located just outside of opening 106 of cannula 
102. In this disposition, by the application of a force to head 110 of 
trocar 108, the surgeon can penetrate through, for example, the abdominal 
wall of the patient to locate the cannula opening 106 at a desired 
location. This is one preliminary aspect of what is generally known as 
"laparoscopic" surgery, but the same general principle applies in any kind 
of endoscopic surgical procedure. 
Following the above-described insertion of the cooperating combination of 
cannula 102 and trocar 108, following release of any connection 
therebetween by operation of any securing means (not shown) in cannula 
head 104, a pulling force may be applied to trocar head 110 to extract it 
totally out of cannula 102. The surgeon now has access through the very 
small puncture 116 in the patient's body to the tissues immediately in 
front of and/or around cannula opening 106. 
The surgeon may, thereafter, insert a conventional optic fiber element to 
enable visual inspection of the tissue in front of and around cannula 
opening 106, and may then follow it up by inserting a biopsy-obtaining 
element through cannula 102 or insert any known conventional small-bored, 
surgical tool to perform a specific surgical operation on such tissue. 
As persons of ordinary skill in the surgical arts will appreciate, when 
working at a confined site, e.g., at a knee joint or within the cranial 
cavity of a patient, uncontrolled application of energy, e.g., by a 
conventional laser-energy applying tool inserted through cannula 102, does 
not permit the making of precise incisions at a controlled rate. It is 
this precision which is provided by the preferred embodiment of the 
present invention as illustrated in FIG. 2. 
Referring to FIG. 2, a laser-powered surgical tool 200 according to a 
preferred embodiment of this invention includes an elongate tubular 
cannula body 202 provided at one end with a front handle section 204 and 
at a distal end 206 with a hollow, open, hooked element 208. This hooked 
element 208 has a generally cylindrical body open at a distal end 210 and 
a cutout 212 formed to leave a hook lip 214 very close to the open end 
thereof. 
Through the hollow front handle section 204 and the tubular body of cannula 
202 there is inserted a laser member body having a specifically shaped 
distal end 216 and a second end at which is provided a back handle section 
218 comprising a cylindrical connector portion 220 shaped and sized to be 
slidably insertable into a corresponding opening 222 of front handle 
section 204 for engagement therein as described more fully hereinbelow. 
Back handle section 218 is formed to receive a stress-relief member 224 by 
which, for example, a conventional optic fiber/cable 226 receives laser 
energy flux from a laser source (not shown) for conveyance through the 
length of the trocar for transmission therethrough to tip 216. Cable 226, 
in known manner, may be formed to include electrical wires to convey a 
cauterizing current to distal end 216, as described below. 
As generally indicated in FIG. 3, the combination of cannula 202 and laser 
member 228 extending therethrough can be used as a trocar to puncture 
through an outer body wall or tissue, for example, the abdominal wall 114 
of a patient through the same type of puncture 116 as discussed with 
reference to the known surgical tool 100 per FIG. 1. Thus, the 
intromission of the hollow, open, hooked element 208 at the distal end of 
cannula 202 very close to the tissue to be surgically operated upon is 
readily accomplished in known manner. 
The surgeon may use a conventional fiber-optic viewing element of a length 
and diameter comparable to trocar 228, inserted through hook-ended cannula 
202. 
Laser member 228, as best seen in FIG. 4, has a lower cylindrical portion 
222 which serves as a connector element. This cylindrical portion 222 has 
a plurality of cutouts which define a corresponding plurality of 
resiliently flexible but relatively stiff connector legs 230 each having 
an outward lip 232 at a distal edge. 
As best seen in the longitudinal cross-sectional view per FIG. 5, at the 
inside center of front handle section 204 there is provided a conical 
recess 234 communicating with a central bore 236 which is coaxial with a 
tubular body of cannula 202. This recess 234 prevents damage to the tip 
when the laser member 228 is introduced into cannula 202. Front handle 
section 204 is attached to this tubular body at a second recess 238 by 
adhesion with a suitable adhesive or by any other suitable known means. 
As will be appreciated, the provision of conical recess 234 also 
facilitates centering of the laser member 228 inserted through central 
bore 236 of front handle section 204. Front handle section 204 also has a 
distal central cylindrical connector portion 240 which is generally 
similar to the trocar connector portion 222 but has a somewhat larger 
diameter to receive legs 230 thereof as shown in FIG. 5. The cannula 
connector portion 240 is cylindrical, i.e., lacks the types of cutouts 
which define legs 230 in trocar connector portion 222, and has a radially 
inward lip 242. Also, at the inside cylindrical surface of cannula 
connector portion 240 there is provided a radially inward annular ridge 
244 which holds the back handle section in place forward extending the 
laser tip beyond the hook (FIG. 9) for use as a standard laser tip. 
In the preferred embodiment, there is provided a compressible resilient 
helical spring 246 which is sized to be in predetermined compression 
within the limits of slidable movement permitted between cannula 202 and 
laser member 228 at all times when the aforementioned elements are 
assembled as illustrated in FIG. 5. Spring 246 thus ensures that there is 
a continual biasing force tending to drive back handle section 218 axially 
away from front handle section 204 and, comensurately, to drive the distal 
end 216 of trocar 228 into a non-exposed position within either the 
unrelieved cylindrical portion of the open, hooked end element 208 or end 
206 of cannula 202. 
Between corresponding cannula shoulders 248 and 250, respectively defined 
in front handle section 204 and back handle section 218, there is provided 
an accordion-type, resilient, generally cylindrical sealing element 252 
which prevents the ingress of ambient dirt and body fluids into the space 
immediately surrounding laser member 228 and in the annular cylindrical 
space defined between the outer cylindrical surface of laser member 228 
and the inner cylindrical surface of cannula 202. This sealing element 252 
also serves to retain within the assembled elements any body fluids that 
may seep through cannula 202 as laser member 228 is moved into, along, and 
out of the interior of cannula 202. Note that the above-described 
elements, as assembled per FIGS. 1-5, permit not only relative sliding 
movement between cannula 202 and laser member 228 but also allow relative 
rotational motion between them and between them respective front and back 
handle sections 204 and 218. 
Stress-relief element 224 at the end of optic fiber 226 fits into a central 
bore 254 defined within back handle section 218. Near the inner end of 
stress-relief element 224 there may be provided one or more recesses 256 
within which extend corresponding protrusions 258 formed within bore 254. 
Coaction between recesses 256 and corresponding positioned protrusions 258 
ensures detachable attachment between stress-relief element 224 and back 
handle section 218. Such releasable attachment facilitates physical 
separation and cleansing/sterilization of the various elements, as most 
appropriate in light of the materials from which the various elements are 
made. Sealing element 252 may be adhered to either one or both of front 
handle section 204 or back handle section 218 at their corresponding 
shoulders 248 or 250, respectively, with any suitable known adhesive. 
As best seen in FIG. 6, hooked element 208 is affixed concentrically and 
coaxially with respect to a longitudinal X--X of cannula 202, and has an 
open and preferably circular open end 210. A side cutout 212 is shaped to 
generate a hooked lip 214 very close to the open end 210. In addition, an 
elongate longitudinal second cutout 213 is provided in a longitudinal 
direction inwardly of open end 210 for visualization of the laser tip. 
Care is taken to ensure that there are no sharp or ragged edges which 
could unintentionally snag any tissue in the patient. 
As will be readily appreciated, a user handling the device during use will 
grasp the front and back handle sections 204 and 218, respectively, 
together and will manipulate them, either together or relative to each 
other, as necessary to hook selected tissue and to operate thereon. The 
structure internal to the front and back handle sections 204 and 218 
serves as a releasable connector between them. Obvious modifications can 
no doubt be made to the exemplary preferred embodiment for performing this 
function. 
As best seen in FIG. 7 in a somewhat enlarged view of the distal end of the 
assembly per FIG. 2, a shaped point 216 of a laser member 228 can be 
located within and very close to the hooked lip 214, controlled by the 
amount of pressure applied by the user/surgeon to back handle section 218 
with respect to front handle section 205 (see FIG. 5). If a small element 
of the patient's tissue 800 has been hooked by manipulation of lip 214, 
application of tip distal end 216 of laser member 228 allows extremely 
precise contact with the tissue 800. Then, if tip 216 is of a type heated 
by laser energy or otherwise, a very precise controlled application of 
laser-powered energy to a selected portion of the grasped tissue 800 
becomes possible. Since the tissue 800 is stretched across the hollow 
inside of hooked element 208, and tip 216 physically presses thereon, in 
addition to heating provided by energy delivered through tip 216, there 
can also be provided an optional application of mechanical force to the 
tissue 800. See FIG. 8. In other words, the incision, cauterization, or 
other surgical operation performed on hooked tissue 800 can involve either 
or both of a mechanical force and a high temperature application of 
energy. Thus, multiple functions can be performed with the surgical tool 
in a very precise manner, e.g., a leaking blood vessel can be compressed 
mechanically, and then sealed when the laser tip is activated. 
It is likely that the surgeon may place another, perhaps conventional, 
cannula with an optic fiber system hooked to a camera or other viewing 
apparatus above or to the side but very close to the surgical site. This 
would allow the surgeon to observe which elements of tissue are being 
hooked for precise surgery. 
As best understood with reference to FIG. 9, which may be considered a 
somewhat enlarged view of the distal end portion per FIG. 3, shaped tip 
216 of laser element 228 can be projected through opening 210 of hook 
element 208. Such a laser element 228 may be of a known type which 
facilitates optical lighting and/or viewing of tissue not yet approached 
by opening 210. Thus, in a simple step-by-step, relatively quick and very 
flexible technique, a surgeon can selectively view, hook, and by the 
application of high temperature heat incise relatively small amounts of 
tissue. Note that if the external diameter of cannula 202 is selected to 
be about 0.5 cm, an external diameter of trocar 218 may be of the order of 
3 mm less if it is inserted through a sleeve or if just the shaped tip 216 
is selectively formed to be of relatively small diameter. Such small 
dimensions, and the inherent strength of a tubular metal structure such as 
the elongate body of cannula 202, provide very small dimensioned but 
relatively strong and durable guides by which a relatively fragile laser 
energy transmitting element can be precisely manipulated for access to 
very confined sites in the patient's body. 
In the preferred embodiment, in order to apply a high temperature energy 
flux to selected tissue hooked by hook element 208 as described above, the 
elongate laser element 228 is provided an elongate cylindrical, laser 
light transmitting, body. This body receives a flux of laser energy 
through an optic fiber 226, through a strain relief element 224, and 
conveys it to shaped tip portion 216 to deliver the energy to selected 
tissue. 
Tip portion 216 may be made as a discrete element, of a material different 
from that used to form the elongate main body portion of the laser element 
228. Such a tip element can be manufactured in a wide range of shapes and 
sizes, particularly for the energy-delivering surfaces. The other end of 
such a tip element may be connected to an energy-delivering end of an 
optic fiber. 
To reduce Fresnel losses at such a junction between an optic fiber and a 
tip element, the tip element can be provided with a non-abruptly varying 
reflective index material at its energy-receiving end, as taught in U.S. 
Pat. No. 5,164,945 to Long et al. Relevant portions of this reference, 
describing the manner in which such a non-abruptly varying reflective 
index material distribution may be generated in a tip element are 
expressly incorporated herein by reference. 
The energy-delivering surface of such a tip element may have a small 
energy-emitting end surface through which laser energy conveyed through 
the optic fiber may be emitted frontally to cause vaporization of tissue 
receiving the same. An exemplary tip element of this type is discussed in 
U.S. Pat. No. 5,164,945, and relevant description thereof is incorporated 
herein by reference. 
Another alternative is to provide a portion of the energy-delivering 
surface of a tip element as discussed above with a material selected to 
substantially totally absorb all laser energy received thereat for 
immediate conversion thereof into thermal energy applicable to tissue by 
direct contact with an external surface. U.S. Pat. No. 5,164,945 teaches 
how such a laser energy absorbing material may be ballistically-alloyed to 
the tip element itself to form a very secure, non-delaminating region in 
which received laser energy is converted to thermal energy. The manner in 
which this can be accomplished is also described in this patent and is 
also expressly incorporated by reference herein. 
As noted, the tip element may have a variety of shapes and sizes to suit 
particular needs. Referring to FIGS. 10(a) and 10(B), there is seen an 
exemplary rounded chisel-like tip element for receiving laser energy 
through a laser energy transmitting element 218. As illustrated in FIGS. 
10(A) and 10(B), such a laser energy transmitting laser element 228 has a 
body with an end face 260 to which is adhered a thin layer 262 of a known 
laser-light transmitting adhesive 262. The illustrated exemplary tip 
element 1000 has a cylindrical body portion with an end surface 1002 
adhered by adhesive 262 to end surface 260 of laser member element 218. 
The energy-delivering end portion of tip element 1000 is provided with two 
angled flat surfaces 1004,1004, which need not be necessarily symmetric 
with respect to longitudinal axis Y--Y. In the preferred embodiment, the 
forwardmost end of tip element 1000 is rounded at a surface 1006, although 
this also is not mandatory. 
FIG. 11 illustrates another example of a shape for tip element 1100, of 
which an energy-delivering portion 1102 is conically shaped. The extreme 
distal end face 1104 of such a tip element may be used to emit a flux of 
laser energy forwardly for vaporization of tissue receiving the same, as 
described above. 
With either of the shapes, namely the one illustrated in FIGS. 10(A) and 
10(B) or the one illustrated in FIG. 11, the portion of the forwardmost 
end of the respective tip elements 1000 and 1100 may be provided with the 
laser energy absorbing material as fully described in U.S. Pat. No. 
5,164,945 incorporated herein by reference for its relevant teaching of 
how such a material may be selected, ballistically-alloyed into the tip 
element material, and used. 
Very briefly, laser light energy received from, for example, the elongate 
body of laser element 228, per FIG. 10(A), is conveyed through tip element 
1000 until it reaches the material 1200, upon which the laser energy 
received thereat is substantially converted into thermal energy. This 
results in a very high temperature at the external surface where the laser 
energy absorbing material 1200 is provided. With the structure according 
to FIG. 11, a certain portion of laser light energy may be emitted from 
forward surface 1104, as indicated by the short arrows 1106, while another 
portion of the laser energy received at the material 1200 would be 
converted to thermal energy to heat the exposed surface thereof. Such a 
tip element could thus be used to incise tissue by forward projection of 
an emitted flux of laser energy, while enabling the application of thermal 
energy by contacting tissue with the conical portion which contains laser 
energy absorbing material 1200. 
As described in U.S. Pat. 5,164,945, a suitable laser energy absorbing 
material 1200 is tungsten which absorbs not only the visible portion of 
the electromagnetic spectrum but also the infrared portion, and has a very 
high temperature melting point. Other suitable high temperature melting 
point materials include gold, copper, manganese, beryllium, silicon, iron, 
platinum, vanadium, rhodium, iridium, niobium, osmium, cobalt, uranium, 
titanium, chromium, nickel, zirconium, molybdenum, tantalum, yttria, 
zirconia and alumina. The melting point temperatures of these materials 
are all greater than 1000.degree. C. Persons of ordinary skill in the art, 
upon understanding the teaching of U.S. Pat. No. 5,164,945, should be able 
to select the material, tip element shape, and other structural features 
to suit specific needs. Accordingly, details of this nature are omitted 
herein for conciseness. 
The present invention is intended to provide a multifunction surgical tool, 
and one such function is the provision of a cauterization current by the 
surgeon to immediately cauterize incised blood vessels to prevent 
continued bleeding therefrom. 
Since the hooked element 208 and the cylindrical body of cannula 202 may 
both be made of an electrically conducting metal, provision of a 
cauterizing electric current to hooked element may be used to effect 
cauterizing contact by the external surface thereof pressed to tissue to 
be cauterized. 
FIG. 11 illustrates another exemplary shape for a tip element, in which is 
included a cylindrical portion 1100 contiguous with a conical portion 
1102. A laser energy absorbing material 1200 is provided, as described 
earlier, at a distal end portion of the conical surface. In the embodiment 
per FIG. 11, the extreme end face 1104 is not provided the laser energy 
absorbing material, hence a portion of the laser energy that reaches the 
tip element is emitted as indicated by arrows 1106. Another portion of the 
laser energy reaching the conical portion 1102 is absorbed by the material 
1200 and converted to heat available at a high temperature for use as 
described above. With the use of such a tip element, the surgeon can 
perform very fine incisions on hooked tissue with the forwardly emitted 
laser energy flux and may thereafter further project and apply the conical 
heated surface to cauterize the incised tissue. 
In yet another embodiment, per FIG. 12, there is provided a built-in 
facility for also applying what is commonly known as 
"electrocauterization" with this invention. In this structure an 
electrical current-carrying element 1204 is attached to the hook 208 to 
convey a cauterizing electrical current thereto. A second end of 
electrical conductor 1204 may be passed through the cylindrical wall of 
cannula 202 at, for example, a junction 1206, as best seen in FIG. 12, and 
connected to a source of direct electric current/voltage. A small amount 
of play may be provided to the length of conductor 1204 to avoid 
restricting the surgeon in his or her activity. 
A thin electrically insulating layer 1208 is provided at the outside 
surface of cannula 202, preferably all the way to and just past the 
junction thereof with hooked element 208, to avoid any stray or 
uncontrolled electrical currents leaking to the tissue of the patient 
during use of the device. This insulating layer 1208 ensures the 
non-insulated hooked element 208 receives the current only via insulated 
body 202 of the cannula. 
FIG. 13 illustrates a simple, exemplary system for providing the needed 
electrical cauterizing current. In this system, a battery or other direct 
electrical current source of suitable voltage 1300 has one terminal, e.g., 
the positive terminal, connected to a foot-operated switch 1302 which is 
connected to electrical conductor 1204, and thus to hooked element 208 or 
to electrically conductive layer 1202 on tip element 1100. The patient 
1500 lies in electrical contact with an electrically conductive pad 1304 
on a surgical table 1306. Electrically conductive pad 1304 is connected to 
the second terminal of direct current source 1300. To the surgical tool 
1600 is attached via optical fiber 226 a source 1600 of laser energy. 
Laser source 1600 may be operable by a user-actuated switch or control 
which may be mounted to the laser element 228 (in known manner, not 
shown). In the alternative, the surgeon could be seated upon a comfortable 
seat and be able to access electrical foot switch 1302 with one foot and a 
second foot-operated switch 1400 connected to actuate laser source 1600 
with his or her other foot to deliver laser energy to the tip element 
1100. 
As will be readily appreciated, the system described above can be used for 
homeostatic insertion into the patient's body. By heating of the external 
tissue, by laser-powered energy applied via the trocar tip element and by 
cauterization to seal off any vessels incised thereby, the surgeon can 
easily penetrate the device to the surgical site in place of a standard 
trocar. 
By the structures described in the immediately preceding paragraphs, a 
surgeon familiar with devices including cannulas and cooperating trocars 
may, with the benefits of the present invention, very precisely hook, i.e, 
deliberately hold in one place, a small amount of a patient's tissue, then 
emit laser energy directly thereat to incise it, or apply a heated surface 
powered by laser energy to vaporize the contacted tissue. He or she may 
then selectively apply a cauterizing current to stanch any undesirable 
bleeding thereat. The cannula portion of the present invention may be left 
in place after such a multifunction operational use of the device, and a 
known type of optical-observation facilitating trocar may be inserted 
through the same cannula to optically review in detail the results of the 
surgical operations just performed. The device may also be inserted 
through a standard cannula. In the alternative, a second viewing cannula 
may be used cooperatively. 
The present invention has the advantage that all the major mechanical 
structural elements are of generally well-known geometry and basic 
structure. The modifications thereto, according to the present invention, 
need not add significantly add to the cost of such elements, need not 
affect the general surgical techniques with which most surgeons are 
familiar, and do not significantly alter the geometries, sizes or costs of 
the basic elements. U.S. Pat. No. 5,164,945, incorporated herein for its 
teaching of various specifically-identified aspects, provides the basis 
for enabling persons of ordinary skill in the art to modify the well-known 
basic elements to generate the laser energy absorbing surfaces, the 
electrically-conductive cauterizing layer, and the like. Finally, the hook 
element 208, in cooperation with the cannula and tip element as taught 
herein, facilitates precise multifunction surgical operations in highly 
confined sites in a patient's body without the requirement for major 
cutting through outer layers of body tissue. The benefits to the patient 
are obvious: relatively minor external incisions and hence significantly 
reduced likelihood of infection and complications, fast healing of the 
outside wound where the device penetrates into the patient's body, clean 
and antiseptic multiple surgical functions performed quickly and with 
immediate cauterization of any incidentally severed blood vessels, the 
consequential reduction in time taken to recover, and lower costs and lost 
income. 
In this disclosure, there are shown and described only the preferred 
embodiments of the invention, but, as aforementioned, it is to be 
understood that the invention is capable of use in various other 
combinations and environments and is capable of changes or modifications 
within the scope of the inventive concept as expressed herein.