LASER INCISIONAL DEVICE

Abstract: The invention contemplates an elongate pencil-like tool (12) having flexible fiber-optical connection at one end to the output of a laser emitting in the ultra-violet region of the spectrum. The fiber-optic transmission (11) is expanded within the tool (12) and converted to a collimated-light re­ gion which is adapted to serve a selected one of a plurality of different optical-projection configurations, each such con­ figuration being unique to a different one of a plurality of projection fittings (18), detachably securable to the other end of the tool (12).

Description: LASER INCISIONAL DEVICE BACKGROUND OF THE INVENTION The invention relates to laser surgery and in particular to a tool which is sufficiently portable to enable manual manipulation of laser radiation in the performance of a surgical operation. Laser surgery to date has involved relatively bulky YAG apparatus wherein relatively great outputpower density dictates short exposure, and wherein the part of a body to be operated upon must be precisely positioned for the particular desired operation. Radiation wavelengths are in the nearinfrared and therefore local burning is a necessary consequence of the exposure. As far as I am aware, there is no possibility of enabling a surgeon to manually manipulate the orientation of conventional laser apparatus for surgical purposes. There exists therefore a substantial limitation on surgical use of such apparatus. In my copending European Patent Application No. 84307972.4 filed 16th Noventer 1984, I disclose laser apparatus and techniques for ophthalmological surgery wherein seaecti -e ablation of body cells is aokieyed by pI.o-c- decomposition, without burning, using radiation limited essentially to the ultraviolet end of the spectrum, and reference is made to said application for a more complete discussion. BRIEF STATEMENT OF THE INVENTION It is an object of the invention to provide a readily manipulable surgical tool, as in the manipulable nature of a scalpel, whereby laser radiation may be selectively applied for surgical purposes. Another object of the invention is to provide such a tool with the feature of delivering laser energy to a selected part of the body at a wavelength and energy density such that tissue ablation is by photodecomposition, unaccompanied by charring of tissue cells. A still further object is to provide such a tool with provision of selectively interchangeable fittings whereby the tool may perform a selected one of several different kinds of surgical operation upon selected body tissue. A specific object is to meet the above objects with a tool having the ability to surgically noninvasively dispose of a cataracted natural lens, without danger to the retina. The invention achieves the above objects with an elongate pencil-like tool having flexible fiberoptical connection at one end to the output of a laser emitting in the ultraviolet region of the spectrum. The fiber-optic transmission is expanded within the tool and converted to a collimated-light region which is adapted to serve a selected one of a plurality of different optical-projection configurations, each such configuration being unique to a different one of a plurality of projection fittings, detachably securable to the other end of the tool. DETAILED DESCRIPTION The invention will be described in detail in conjunction with the accompanying drawings, in which: Fig. 1 is a simplified view in perspective, showing a surgical tool of the invention, and an associated laser device flexibly connected for supply of laser-output energy to the tool; Fig. 2 is an enlarged longitudinal sectional view of the tool of Fig. 1; Figs. 3, 4, and 5 are simplified diagrams to illustrate alternative projection fittings selectively available for use in connection with the tool of Fig. 2; and Fig. 6 is a simplified diagram to illustrate use of the tool of Fig. 2, with a projection fitting usable in effecting surgical photodecomposition of a cataracted natural lens, without physical damage to the cornea or to the retina of the involved eye. In Fig. 1, the invention is shown in conjunction with laser apparatus 10 producing an output beam via an optical-fiber cable 11 which provides flexible connection to the tail end of a hand-held manipulable tool 12. Tool 12 contains optical elements whereby the laser output delivered to tool 12 is converted at the fo°sard or head end 13 of tool 12 for discharge as a ray bundle of configuration desired for particular surgical purposes. More specifically, in Fig. 2 the tool 12 is seen to comprise an elongate generally tubular body 14 which is essentially closed at its tail end except for a reduced central bore via which the discharge end 15 of cable 11 is securely positioned. The radiation preferred in use of tool 12 is limited to the ultraviolet region of the spectrum, as for example the range wherein wavelength of the beam output of laser 10 is not more than substantially 400 nanometers (nm), illustratively in the range 150 nm to 400 nm. Such emissions for gas lasers are characteristically at 351 rim for xenon-fluoride lasers, 337 nm for nitrogen lasers, 308 nm for xenon-chloride lasers, 208 nm for krypton-fluoride lasers, 193 nm for argon-fluoride lasers, and 157 nm for fluorine lasers; and within this range, frequency-doubling techniques applied to other lasers, including crystal lasers, provide further alternative sources. One of the existing commercial excimer-laser products of Lambda Physik GmbH, Gottingen, Germany, for example their Model EMG 103 operating with argonfluoride, is satisfactory for use as laser 10. And in view of the short wavelength involved in the output of this laser, it is recommended that the optical fiber of cable 11 be of quartz, selected for optimum ultraviolet-transmission characteristics. This optical fiber will he understood to be suitably clad, and at the discharge end 15, the transversely truncated end of the optical fiber faces directly toward the head end of the tool and on the axis of the tubular cavity of body 14. Characteristically, the laser-emission discharge at 15 is divergent, and a first spherical lens 16 retained in body 14 receives the opticalfiber discharge (over a relatively large area, of diameter D1) and converges the same to a smaller area (of diameter D2) at a second spherical lens 17 which is also retained in body 14. The lens 17 is selected and positioned to establish projection of a collimated region of ultraviolet radiation on the tool axis and toward the head end. For purposes of selective shaping of ultraviolet discharge from tool 12, provision is made for removable attachment of a final-lens mount or fitting 18 which is shown to be a generally frusto-conical tube having threaded engagement at 19 to the head end of body 14. A lens 20 retained at the reduced end of tube 17 is of a diameter to accept the full collimated bundle projected by lens 17; as shown, lens 20 is spherical and is of focal length selected to project a convergent conical ray bundle to a focal point at desired projected offset S1 from lens 20. In view of the short wavelengths involved, it is preferred that all optical elements, such as lenses 16-17-20 be of quartz. In use, the surgeon's traversal of the focal point 21, along a body surface region of surgical operation, will be understood to achieve photodecomposition which results in a groove having sidewalls which diverse outwardly from a depth depending upon energy density and time of exposure. It is to be understood that the described arrangement whereby lenses 16-17 are selected to achieve a reduced-diameter collimated bundle are merely illustrative and that upon suitable selection of focal lengths for lenses 16-17, the size of the collimated bundle issuing-from lens 17 may be even smaller than shown, or larger than diameter D1. The use fullness of smaller or larger diameter collimated regions will appear from discussion of other lens fittings, as shown for example in Figs. 3 to 6. The lens fitting 22 of Fig. 3 will be understood to be another one of the plurality selectively available as a replacement for lens fitting 18 of Fig. 2. The difference in Fig. 3 is that its lens 23 is cylindrical, being shown as plano-cylindrical, wherein the cylindrical axis extends perpendicular to the plane of the section of Fig. 3. The collimated bundle projected by lens 17 to lens 23 thus enables lens 23 to project with convergence to a focal line 24, which is shown in Fig. 3 as a point because the focal line (of length D2) extends perpendicular to the plane of Fig. 3. It will be seen that, upon suitable choice of lens (17) focal length and positioning in body 14, the collimatedbundle diameter D2 may be greater or less than implied by Fig. 3, so that the length of the line focus at 24 (and hence its energy density per unit length of the focal line) can be selected accordingly. The fitting of Fig. 3 will be seen to provide the surgeon with an effective chisel which produces no offal or chips, enabling the surgeon to achieve a degree of smoothness in his manipulated sculpting of a given region of body tissue, such as the surface of a cornea. The lens fitting 25 of Fig. 4 represents another alternative in place of the fitting 18 in Fig. 2. As indicated by legend, the optical contents of fitting 25 comprise a spherical lens 26 and a cylindrical lens 27, whereby the incoming collimated bundle projected by lens 17 is converted to focus at 28 and wherein the shape of the focal spot is elliptical rather than circular (Fig. 2) or a line (Fig. 3). Fig. 5 shows another selectively available replacement lens fitting 30, whereby two spherical lenses 31-32 contained therein are selected to perform a further diameter reduction, from the D2 diameter projected by lens 17 to a much reduced diameter D3 for surgical projection to body tissue. Of course, by providing the reduced diamter D3 of projected collimated laser emissions, projected energy density is enhanced. It will be understood that by coursing the projected bundle of Fig. 5 along a desired region of body tissue, the resulting photodecomposition will be to a depth dependent upon length of exposure, and the ablated region will be characterized by sidewalls which are parallel. The fitting of Fig. 5 is illustratively useful to the ophthalmological surgeon who desires to manually achieve plural radial incisions in the external surface of the cornea, as in performing a radial keratotomy. Fig. 6 is a fragmentary showing of another replacement lens fitting 35 wherein it will be understood that the configuration of lenses within tool body 14 is such as to project a larger-area bundle of collimated ultraviolet radiation, as of diameter D4, to a short-focus spherical lens 36. Due to the short focal length of lens 36, the angle of conical convergence of its projected ray bundle is relatively large; the projected bundle is shown coming to focus at the cataracted natural lens 37 of an eye 38. Thus, energy density is greatest at the natural lens, and laser 10 will be understood to be adjusted to assure that the energy density at natural lens 37 is sufficient to achieve photodecomposition of lens 37, while also being insufficient (due to diffusion, i.e., lack of focus) to have any appreciable effect upon the corneal and/or retinal regions of the involved eye. Removal of the cataracted lens is thus possible without surgical invasion of the eye. It will be seen that the described tool and its uses meet all stated objects. The surgeon is provided with an instrument which enables selective ablation of body tissue without charring any body cells, and the ablation may be performed either upon a region of the outer surface of the body or beneath the outer surface, as in the case of removal of a cataracted natural lens. While the invention has been describeed in detail for preferred embodiments, it will be understood that modifications may be made without departing from the scope of the invention.

Claims: CLAIMS: 1. In combination, laser means having a radiation-beam output, means including an elongate flexible optical-fiber cable coupled at one end to said output, and a manipulable tool having a body with a cavity bore open at one end and with the other end of said cable retained by said body and positioned within and on the axis of said bore for conically divergent laser-output discharge in the direction of the open end of the bore, optical-element means in said bore and within said divergent discharge for establishing a collimated beam of laser radiation in the direction of the open end of the bore, and a lens mount selectively attachable to the open end of said body, said lens mount including a lens element positioned in the collimated beam when said mount is attached to said body. 2. The combination of claim 1, in which the lens element of said mount is a spherical lens, whereby the collimated laser radiation may be focused to a point-like spot at longitudinal offset from the lens element 3. The combination of claim 1, in which the lens element of said mount is a cylindrical lens, whereby the collimateu laser radiation mas be focused to a line transverse to said axis and at longitudinal offset from the lens element. 4. The combination of claim 1, in which the lens element of said mount comprises at least two components, namely, a spherical lens for converting the collimated radiation to a conically convergent beam, and a cylindrical lens positioned at axial offset from the focal point of the convergent beam for converting convergent-beam radiation to a line of length substantially proportional to the diametrical extent of the convergent beam at the location of cylindrical-lens placement in the convergent beam. 5. The combination of claim 1, in which the lens element of said mount comprises at least two components, namely a first spherical lens for converting the collimated radiation to a conically convergent beam, and a second spherical lens positioned beyond the focal point of the convergent beam and of shorter focal length, than that of said first spherical lens for converting laser radiation from said spherical lens to a collimated beam of reduced section as compared with that of the first-mentioned collimated beam. 6. The combination of claim 1, in which said laser is of ultraviolet variety, characterized by a beam output of not more than substantially 400 nm wavelength. 7. The combination of claim 6, in which the coupling of said cable to said laser output includes a beam splitter, and in which a source of visible light is also coupled to said cable via said beam splitter 8. The combination of claim 1, in which optical fiber of said cable is of quartz, and in which said laser is of ultraviolet variety, characterized by beam output in the range 150nm to 400nm. 9. A portable tool adapted for laser excitation via a flexible optical-fiber cable, comprising a body having a cavity bore open at one end, said body including means for supporting and positioning the downstream end of an optical-fiber cable on the axis of the bore for conically divergent laser-output discharge in the direction of the open end of the bore, optical-element means in said bore and within said divergent discharge for establishing a collimated beam of laser radiation in the direction of the open end of the bore, and a lens mount removably attached to the open end of said body, said lens mount including a lens element positioned in the collimated beam. 10. The tool of claim 9, in which said lens mount is one of a plurality of mounts selectively mountable to said body, said mounts being equipped with lenses having different optical properties. 11. The tool of claim 10, in which said lenses having different optical properties include at least two selected from the group comprising (a) a spherical lens component, (b) a cylindrical lens component, (c) two spherical-lens components having different focal lengths, and (d) a spherical-lens component and a cylindrical-lens component. 12. The method of surgically non-invasively removing a cataracted natural lens from an afflicted eye, which comprises selecting an exciner laser from among the ultraviolet group which includes xenon-chloride lasers, krypton-fluoride lasers, argon-fluoride lasers, and fluorine lasers, optically treating the beam output of the selected laser such that beam output is translated into a conically convergent ray bundle to a focal spot of relatively great power density, orienting the convergent bundle to focus on the cataracted natural lens via transmission through the cornea of the afflicted eye, whereby relatively great power density is focused at the cataracted lens and relatively diffused and only greatly reduced power density characterizes energy exposure levels at the cornea and/or the retina of the eye, exciting the laser to induce photodeconposition via said relatively great power density but at a level such that the diffused power-density level does not induce photodecomposition of body cells and/or tissue other than at the cataracted lens, and manipulating the direction and local position of the focal spot within the cataracted lens until its photodecomposition is substantially complete. 13. The method of surgically non-invasively removing a cataracted natural lens from an afflicted eye, which comprises selecting a laser which emits a beam of radiation at an ultraviolet wavelength in the range 150 nm to 400 nm, optically treating the beam output of the selected laser such that beam 0output is translated into a conically convergent ray bundle to a focal spot of relatively great power density, orienting the convergent bundle to focus on the cataracted natural lens via transmission through the cornea of the afflicted eye, whereby relatively great power density is focused at the cataracted lens and relatively diffused and only greatly reduced power density characterizes energy exposure levels at the cornea and/or the retina of the eye, exciting the laser to induce photodecomposition via said relatively great power density but at a level such that the diffused power-density level does not induce photodecomposition of body cells and/or tissue other than at the cataracted lens, and manipulating the direction and local position of the focal spot within the cataracted lens until its photodecomposition is substantially complete.

Inventors: L'ESPERANCE, FRANCIS A.
Applicants: L'ESPERANCE, FRANCIS A.
Application year: 1984
Main classification: A61B17
IPC codes: A61B18