INSTRUMENT FOR PERFORMING LASER MICRO-SURGERY AND DIAGNOSTIC TRANSILLUMINATION OF LIVING HUMAN TISSUE

• US 3,769,963 A
• Filed: 03/31/1972
• Issued: 11/06/1973
• Est. Priority Date: 03/31/1972
• Status: Expired due to Term

• Current Assignee: Leon Goldman, Rockwell R. James Jr
• Original Assignee: Leon Goldman, Rockwell R. James Jr
• Inventors: Goldman, Leon, Rockwell, R. James Jr.
• Primary Examiner(s): Trapp, Lawrence W.
• Application Number:
  US05/239,976
• Time in Patent Office: 585 Days
• Field of Search: 128/303.1,395,2R 350/35,36,91 331/94.5
• US Class Current: 600/476
• CPC Class Codes: A61B 2017/00061 spectrum
• CPC Class Codes: A61B 2017/00973 pedal-operated
• CPC Class Codes: A61B 2017/22085 light-absorbing A61B2017/22087 takes precedence
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 2090/395 with marking agent for marking skin or other tissue
• CPC Class Codes: A61F 2009/00863 Retina
• CPC Class Codes: A61F 9/008 using laser
• CPC Class Codes: A61F 9/00821 for coagulation
• CPC Class Codes: A61F 9/022 Use of special optical filters, e.g. multiple layers, filters for protection against laser light or light from nuclear explosions, screens with different filter properties on different parts of the screen; Rotating slit-discs optical filters per se G02B5/20

Abstract

An instrument for performing delicate surgery on man is provided with a continuous wave laser source specially associated with a binocular surgical microscope. The laser source emits electromagnetic radiation at wavelengths, preferably in the visible light range but also in the near visible infrared and ultraviolet ranges, which are absorbed selectively by different types of human tissue or tissue substructures. The source is mounted on a portable base remote from the operating area, and the radiation from the laser is communicated through a flexible fiber optic conductor to the binocular surgical operating microscope which is mounted on an articulating arm extending from the base so that the microscope may be freely positioned adjacent to the patient at the operating area. The laser beam is directed onto the tissue of the patient in a path coaxial with the viewing axis of the microscope to a point in the microscope'"'"''"'"'s field of view. Controls on the microscope give the surgeon complete control of the laser beam. These include a focusing telescope for control of the laser spot size and angle of convergence of the beam, a joy stick control for moving the fiber optic tip to cause a corresponding movement in the focused laser beam on the tissue within the field of view of the microscope to allow the surgeon to precisely prescribe an incision or effect localized irradiation on that area of the patient. Transillumination of the tissues in the area of interest on the patient is possible by the direct laser beam emitted at a low-nonhazardous power level or by a second laser system which may be operated independently of the main high power surgical laser and is delivered by a hand-held sterile probe.

Claims

1. A surgical instrument for making knife-like incisions on living human tissue or tissue substructures comprising:

a base positioned remote from an operating area;

a laser source mounted at said base;

said laser sOurce being operable to emit essentially continuous wave electromagnetic radiation having a wavelength within a spectral range including near ultraviolet visible and near infrared radiation;

a binocular microscope;

means for mounting said microscope for free movement adjacent said operating area;

laser beam focusing optics mounted on said microscope;

a flexible fiber optic conductor connected between said source and said focusing optics to transmit the output of said source to said focusing optics;

means for communicating said laser beam from said focusing optics along a path coaxial with the viewing axis of said microscope toward a patient at said operating area; and

controls positioned at the operating area for operation by a surgeon while viewing through said microscope, said controls including a. a first control for focusing said microscope on a portion of tissue of a patient at said operating area, b. a second control for focusing said focusing optics to control the size of the spot formed by said laser beam on said tissue, and c. a third control for moving said spot on said tissue in the field of view of said microscope.

2. The instrument of claim 1 wherein:

the spectral range of said laser emission includes only the visible range.

3. The instrument of claim 1 wherein:

said radiation has a wavelength within the spectral range of from 200 to 3,000 nanometers.

4. The instrument of claim 3 wherein:

said radiation has a wavelength within the spectral range of from 300 to 1,000 nanometers.

5. The instrument of claim 4 wherein:

said radiation has a wavelength within the spectral range of from 400 to 700 nanometers.

6. The instrument of claim 1 wherein:

said third control includes means on said microscope for moving the exit end of said fiber optic conductor in a plane which intersects the axis of said laser beam focusing optics.

7. The instrument of claim 6 wherein:

said third control includes a lever mounted on said microscope for moving said end of said fiber optic conductor.

8. The instrument of claim 1 wherein:

said laser source is operable to emit relatively low power level secondary emissions in the visible spectral range; and

said instrument further includes filter means for selectively blocking the primary emission from said source;

whereby said laser is capable of being aimed by said low power emission without causing a reaction on said tissue.

9. The instrument of claim 1 wherein:

said microscope mounting means includes an articulating arm connected to said base.

10. The instrument of claim 1 wherein:

said base is a portable wheeled floor standing base.

11. The instrument of claim 1 further comprising:

means for generating electromagnetic radiation for diagnostic transillumination including a laser source operable to emit electromagnetic radiation within a spectral range including visible radiation and radiation within the near ultraviolet and near infrared spectral ranges which can be rendered visible; and

means for directing said transilluminating radiation onto and through said tissue or tissue substructures for transillumination thereof.

12. The instrument of claim 11 wherein;

said transilluminating laser source includes a second laser source distinct from said first recited laser source.

13. The instrument of claim 11 further comprising:

means for communicating said transilluminating radiation through said focusing optics.

14. The instrument of claim 11 further comprising:

means, including a light probe, and a second fiber optic conductor distinct from said first recited fiber optic conductor for directing said visible light onto said tissue.

15. The instrument of claim 14 wherein:

said transilluminating laser source includes a second laser source distinct from said first recited laser source; and

said instrument further comprises means for comMunicating said transilluminating radiation through said focusing optics and means for alternatively directing said light from said second source through said second fiber optic conductor and said probe.

16. The instrument of claim 1 wherein:

said controls are mounted on said microscope.

17. The instrument of claim 1 where said controls further include:

a fourth control for regulating the power from said laser source; and

a fifth control for regulating the exposure time of said laser.

18. The instrument of claim 17 wherein:

said fourth and fifth controls are floor mount foot actuatable controls.

19. A surgical instrument for performing micro-surgery on living human tissue or tissue substructure comprising:

a laser source mounted remote from an operating area;

said laser source being operable to emit essentially continuous wave electromagnetic radiation having a wavelength within a spectral range in which it is differently absorbed by different tissue or tissue substructure;

a surgical microscope;

means for mounting said microscope for free movement adjacent said operating area;

laser beam focusing optics mounted on said microscope;

a conductor of said radiation connected between said source and said focusing optics to transmit the output of said source to said focusing optics;

means for communicating said laser beam from said focusing optics toward a patient at said operating area; and

controls mounted on said microscope including a. a first control for focusing said microscope on a portion of tissue of a patient at said operating area, b. a second control for focusing said focusing optics to control the size of the spot formed by said laser beam on said tissue, and c. a third control for moving said spot on said tissue in the field of view of said microscope.

20. A laser instrument comprising:

a laser operable to generate a beam of electromagnetic radiation at its output;

a focusing telescope for controlling the coherence of said beam, said telescope having an objective lens;

a flexible fiber optic conductor extending from said laser output to said telescope to transmit said beam from said laser to said telescope;

the exit end of said conductor being mounted for movement in a plane intersecting the optical axis of said telescope and within the focus of said objective lens; and

a control for moving said exit end in said plane.

21. The instrument of claim 20 wherein:

said control includes a universally pivoted lever.

22. A method of aiming and operating a laser instrument which comprises:

a. a laser operable to generate a beam of electromagnetic radiation at its output, said radiation including a principal emission at a first frequency and at least one secondary emission at a second frequency different from said first frequency, the power level of said principal emission being sufficient to cause a given effect on a target when directed thereon, and the power level of said secondary emission being insufficient to cause said effect but being capable of being rendered visible where directed upon said target b. means for controllably directing said beam from said laser output to said target, and c. a selectively actuable filter for blocking said principal emission, said filter being positioned between said laser output and said target, said method comprising the steps of;

operating said laser and actuating said filter to generate a beam toward said target containing said secondary emission but absent said principal emission; and

, concurrent therewith, controlling said directing means to direct said beam onto a desired spot on said target;

then deactuating said filter and operating said laser to generate a beam toward said target containing said principal emission to cause said given effect on said target.

23. A method of performing micro-surgery on living human tissues or tissue substructures comprising the stePs of:

viewing under magnification and along a given viewing axis an area on a patient which includes the tissue or tissue substructure upon which said micro-surgery is desired;

generating a laser beam of electromagnetic radiation at a selected frequency which is highly absorbed by said desired tissue of substructure and which is less highly absorbed by adjacent tissue, said frequency being within a spectral range including near ultraviolet, visible, and near infrared radiation;

directing said laser beam onto said area;

focusing said beam to a given spot size on said area;

while maintaining said viewing area fixed, moving said beam to a selected point on said desired tissue; and

then generating said laser beam at a power level sufficient to cause reaction in said desired tissue or tissue substructure.

24. The method of claim 24 further comprising the steps of:

generating a transilluminating laser beam of electromagnetic radiation within the spectral range of near ultraviolet, visible, and near infrared radiation and at a power density insufficient to cause reaction on said tissue or tissue substructure; and

passing said transilluminating laser beam through tissue at said viewed area to locate said desired tissue.

25. The method of claim 25 further comprising the step of:

varying the frequency of said transilluminating laser while observing the contrast of the area under magnification to determine said selected frequency.