Method of laser-assisted prostatectomy and apparatus for carrying out the method
First Claim
1. A method of laser-assisted prostatectomy comprising the steps of:
- providing an apparatus which comprises an elongated tubular sheath which has a distal end and a proximal end and contains a first tube for guiding an axially moveable laser fiber that has at its distal end lateral laser-beam emitting openings, and that can be turned around its longitudinal axis;
a second guide tube for guiding a fiber-optic lens system for observation of the operation site; and
a third guide tube for guiding one of an auxiliary instrument selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue, and a rotating cleaning brush;
each said auxiliary instrument can be inserted into said third guide tube and removed therefrom during the operation of said apparatus;
said first, second, and third tubes being arranged parallel to each other in said sheath, the space between the inner surface of said tubular sheath and the outer surface of said guide tubes forming at least two longitudinal channels isolated from each other, one said channel being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another to a reservoir for the removal of said cooling and flushing liquid after its use;
inserting said apparatus into the urethra of a patent suffering from the obstruction of the prostatic part of the urethra to the position in which said distal end of said sheath is in said prostatic part of the urethra;
inserting said balloon catheter through said third guide tube to the position of the inflatable tip of said catheter inside the bladder;
inflating said inflatable tip so as to fix the balloon catheter and to isolate an area between said inflated tip and the operation area within said prostatic urethra from the urinary bladder;
initiating an inflow of said washing and cooling liquid to said prostatic part of the urethra through said first guide tube and outflow of said liquid through said spaces, thus maintaining constant circulation of said liquid through the operation area and said distal end of said laser fiber;
inserting said laser fiber into said first guide tube to the position of said distal end of said laser fiber in said prostatic part; and
firing said laser fiber and directing a laser beam laterally from said laser fiber onto said prostatic part of said urethra and rotating said laser fiber during the operation for directing said laser beam to a required area.
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Abstract
A method of laser-assisted prostatectomy which is based on the use of special laseroscope with continuous flow of the flushing and cooling liquid is provided. The method consists of inserting the above laseroscope into the patient'"'"'s urethra with the laser fiber tip positioned at the prostate gland area, inserting a balloon catheter through the laseroscope to the urinary bladder neck, inflating the balloon of the catheter, initiating an inflow of washing and cooling liquid to the operating area, which is isolated from the urinary bladder by the balloon catheter, inserting a laser fiber into the laseroscope, firing the laser fiber and directing a laser beam laterally from the laser fiber onto the prostatic gland for directing the laser beam to the required area. The method is carried out by means of an apparatus comprising a tubular sheath (10) with three guide tubes, i.e., a guide tube (13) for an optical lens system (12), a second guide tube (14) for a laser fiber (16), and a third or auxiliary guide tube (18) for interchangeably inserting: a cleaning brush (19), which may rotate and reciprocate in the guide tube (18) for cleaning the operating tip of the laser fiber (16); an ultrasonic probe (40) for measuring the degree and depth of ablation of the prostatic tissue; and a balloon catheter (42) for the occlusion of the bladder neck. Spaces (15a) and (15b) between the inner surface of the sheath (10) and the outer surfaces of the guide tubes form mutually isolated channels for the continuous supply and removal of the flushing and cooling liquid.
164 Citations
15 Claims
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1. A method of laser-assisted prostatectomy comprising the steps of:
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providing an apparatus which comprises an elongated tubular sheath which has a distal end and a proximal end and contains a first tube for guiding an axially moveable laser fiber that has at its distal end lateral laser-beam emitting openings, and that can be turned around its longitudinal axis;
a second guide tube for guiding a fiber-optic lens system for observation of the operation site; and
a third guide tube for guiding one of an auxiliary instrument selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue, and a rotating cleaning brush;
each said auxiliary instrument can be inserted into said third guide tube and removed therefrom during the operation of said apparatus;
said first, second, and third tubes being arranged parallel to each other in said sheath, the space between the inner surface of said tubular sheath and the outer surface of said guide tubes forming at least two longitudinal channels isolated from each other, one said channel being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another to a reservoir for the removal of said cooling and flushing liquid after its use;inserting said apparatus into the urethra of a patent suffering from the obstruction of the prostatic part of the urethra to the position in which said distal end of said sheath is in said prostatic part of the urethra; inserting said balloon catheter through said third guide tube to the position of the inflatable tip of said catheter inside the bladder; inflating said inflatable tip so as to fix the balloon catheter and to isolate an area between said inflated tip and the operation area within said prostatic urethra from the urinary bladder; initiating an inflow of said washing and cooling liquid to said prostatic part of the urethra through said first guide tube and outflow of said liquid through said spaces, thus maintaining constant circulation of said liquid through the operation area and said distal end of said laser fiber; inserting said laser fiber into said first guide tube to the position of said distal end of said laser fiber in said prostatic part; and firing said laser fiber and directing a laser beam laterally from said laser fiber onto said prostatic part of said urethra and rotating said laser fiber during the operation for directing said laser beam to a required area. - View Dependent Claims (2, 3)
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4. A method of laser-assisted prostatectomy comprising the steps of:
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providing an apparatus which comprises an elongated tubular sheath which has a distal end and a proximal end and contains a first tube for guiding an axially moveable laser fiber that has at its distal end lateral laser-beam emitting openings, and that can be turned around its longitudinal axis;
a second guide tube for guiding a fiber-optic lens system for observation of the operation site; and
a third guide tube for guiding one of an auxiliary instrument selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue, and a rotating cleaning brush;
each said auxiliary instrument can be inserted into said third guide tube and removed therefrom during the operation of said apparatus;
said first, second, and third tubes being arranged parallel to each other in said sheath, the space between the inner surface of said tubular sheath and the outer surface of said guide tubes forming at least two longitudinal channels isolated from each other, one said channel being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another to a reservoir for the removal of said cooling and flushing liquid after its use;inserting said apparatus into the urethra of a patent suffering from the obstruction of the prostatic part of the urethra to the position in which said distal end of said sheath is in said prostatic part of the urethra; initiating an inflow of said washing and cooling liquid to said prostatic part of the urethra through said first guide tube and outflow of said liquid through said spaces, thus maintaining constant circulation of said liquid through the operation area and said distal end of said laser fiber; inserting said laser fiber into said first guide tube to the position of said distal end of said laser fiber in said prostatic part; firing said laser fiber and directing a laser beam laterally from said laser fiber onto said prostatic part of said urethra and rotating said laser fiber during the operation for directing said laser beam to a required area. - View Dependent Claims (5, 6)
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7. An apparatus for continuous laser-assisted prostatectomy comprising:
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an elongated hollow tubular sheath having an outer surface and an inner surface, said tubular sheath having has a distal end and a proximal end; a first tube which has an outer surface and an inner surface and is arranged axially movably in said hollow tubular sheath for guiding an insertable and axially moveable laser fiber, said laser fiber having a distal end and lateral laser-beam emitting openings at said distal end; a second guide tube which has an outer surface and an inner surface and contains an optical lens system for observation of the operation site in a prostatic part of the urethra; a third guide tube which has an outer surface and an inner surface and contains for guiding one of an auxiliary instrument, said first guide tube, said second guide tube, and said third guide tube being parallel to each other; at least two axial mutually isolated spaces formed between said inner surface of said sheath and said outer surfaces of said first guide tube, said second guide tube, and said third guide tube, one said space being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another said space being connected to a reservoir for the removal of said cooling and washing liquid. - View Dependent Claims (8)
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9. A method of laser-assisted prostatectomy comprising the steps of:
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providing an apparatus which comprises an elongated tubular sheath which has a distal end and a proximal end and contains a first tube for guiding an axially moveable laser fiber that has at its distal end lateral laser-beam emitting openings, and that can be turned around its longitudinal axis;
a second guide tube for guiding a fiber-optic lens system for observation of the operation site; and
a third guide tube for guiding one of an auxiliary instrument selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue, and a rotating cleaning brush;
each said auxiliary instrument can be inserted into said third guide tube and removed therefrom during the operation of said apparatus;
said first, second, and third tubes being arranged parallel to each other in said sheath, the space between the inner surface of said tubular sheath and the outer surface of said guide tubes forming at least two longitudinal channels isolated from each other, one said channel being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another to a reservoir for the removal of said cooling and flushing liquid after its use;inserting said apparatus into the urethra of a patent suffering from the obstruction of the prostatic part of the urethra to the position in which said distal end of said sheath is in said prostatic part of the urethra; inserting said balloon catheter through said third guide tube to the position of the inflatable tip of said catheter inside the bladder; inflating said inflatable tip so as to fix the balloon catheter and to isolate an area between said inflated tip and the operation area within said prostatic urethra from the urinary bladder; initiating an inflow of said washing and cooling liquid to said prostatic part of the urethra through said first guide tube and outflow of said liquid through said spaces, thus maintaining constant circulation of said liquid through the operation area and said distal end of said laser fiber; inserting said laser fiber into said first guide tube to the position of said distal end of said laser fiber in said prostatic part; firing said laser fiber and directing a laser beam laterally from said laser fiber onto said prostatic part of said urethra and rotating said laser fiber during the operation for directing said laser beam to a required area. removing said balloon catheter from said third guide tube; inserting into said third guide tube said cleaning brush to the sidewise position with respect to said distal end of said laser fiber; reciprocating said cleaning brush while causing its rotation thus cleaning said distal end of said laser fiber; removing said cleaning brush from said third guide tube; reinserting said balloon catheter and reinflating said inflatable tip; and continuing the operation.
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10. A method of laser-assisted prostatectomy comprising the steps of:
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providing an apparatus which comprises an elongated tubular sheath which has a distal end and a proximal end and contains a first tube for guiding an axially moveable laser fiber that has at its distal end lateral laser-beam emitting openings, and that can be turned around its longitudinal axis;
a second guide tube for guiding a fiber-optic lens system for observation of the operation site; and
a third guide tube for guiding one of an auxiliary instrument selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue, and a rotating cleaning brush;
each said auxiliary instrument can be inserted into said third guide tube and removed therefrom during the operation of said apparatus;
said first, second, and third tubes being arranged parallel to each other in said sheath, the space between the inner surface of said tubular sheath and the outer surface of said guide tubes forming at least two longitudinal channels isolated from each other, one said channel being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another to a reservoir for the removal of said cooling and flushing liquid after its use;inserting said apparatus into the urethra of a patent suffering from the obstruction of the prostatic part of the urethra to the position in which said distal end of said sheath is in said prostatic part of the urethra; inserting said balloon catheter through said third guide tube to the position of the inflatable tip of said catheter inside the bladder; inflating said inflatable tip so as to fix the balloon catheter and to isolate an area between said inflated tip and the operation area within said prostatic urethra from the urinary bladder; initiating an inflow of said washing and cooling liquid to said prostatic part of the urethra through said first guide tube and outflow of said liquid through said spaces, thus maintaining constant circulation of said liquid through the operation area and said distal end of said laser fiber; inserting said laser fiber into said first guide tube to the position of said distal end of said laser fiber in said prostatic part; firing said laser fiber and directing a laser beam laterally from said laser fiber onto said prostatic part of said urethra and rotating said laser fiber during the operation for directing said laser beam to a required area; deflating said inflatable tip; removing said balloon catheter from said third guide tube; inserting into said third guide tube said cleaning brush to the sidewise position with respect to said distal end of said laser fiber; reciprocating said cleaning brush while causing its rotation thus cleaning said distal end of said laser fiber; removing said cleaning brush from said third guide tube; retracting said laser fiber into said first guide tube; inserting said ultrasonic sound into said third guide tube to the position of said prostatic part; measuring the depth and degree of ablation of the tissue; removing said ultrasonic sound from said third guide tube; reinserting said balloon catheter and reinflating said inflatable tip; and continuing the operation.
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11. A method of laser-assisted prostatectomy comprising the steps of:
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providing an apparatus which comprises an elongated tubular sheath which has a distal end and a proximal end and contains a first tube for guiding an axially moveable laser fiber that has at its distal end lateral laser-beam emitting openings, and that can be turned around its longitudinal axis;
a second guide tube for guiding a fiber-optic lens system for observation of the operation site; and
a third guide tube for guiding one of an auxiliary instrument selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue, and a rotating cleaning brush;
each said auxiliary instrument can be inserted into said third guide tube and removed therefrom during the operation of said apparatus;
said first, second, and third tubes being arranged parallel to each other in said sheath, the space between the inner surface of said tubular sheath and the outer surface of said guide tubes forming at least two longitudinal channels isolated from each other, one said channel being connected at its proximal end through a shut-off valve to a source of the supply of a flushing and cooling liquid, and another to a reservoir for the removal of said cooling and flushing liquid after its use;inserting said apparatus into the urethra of a patent suffering from the obstruction of the prostatic part of the urethra to the position in which said distal end of said sheath is in said prostatic part of the urethra; initiating an inflow of said washing and cooling liquid to said prostatic part of the urethra through said first guide tube and outflow of said liquid through said spaces, thus maintaining constant circulation of said liquid through the operation area and said distal end of said laser fiber; inserting said laser fiber into said first guide tube to the position of said distal end of said laser fiber in said prostatic part; inserting said ultrasonic sound into said third guide tube; firing said laser fiber and directing a laser beam laterally from said laser fiber onto said prostatic part of said urethra and rotating said laser fiber during the operation for directing said laser beam to a required area; periodically deenergizing said laser fiber, withdrawing said laser fiber into said first guide tube, pushing forward said ultrasonic sound to the area of said prostatic part, measuring the depth and degree of ablation of the tissue, withdrawing said ultrasonic sound into said third guide tube, returning said laser fiber into said position in said prostatic part; and initiating said firing step.
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12. An apparatus for continuous laser-assisted prostatectomy comprising:
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an elongated hollow tubular sheath having an outer surface and an inner surface, said tubular sheath having a distal end and a proximal end; a first tube which has an outer surface and an inner surface and is arranged axially movably in said hollow tubular sheath for guiding an insertable and axially moveable laser fiber, said laser fiber having a distal end and lateral laser-beam emitting openings at said distal end; a second guide tube which has an outer surface and an inner surface and contains an optical lens system for observation of the operation site in a prostatic part of the urethra; a third guide tube which has an outer surface and an inner surface for guiding one of an auxiliary instrument, said first guide tube, said second guide tube, and said third guide tube being parallel to each other; at least two axial mutually isolated spaces formed between said inner surface of said sheath and said outer surfaces of said first guide tube, said second guide tube, and said third guide tube, one said space being connected at its proximal end through a first shut-off valve to a source of the supply of a flushing and cooling liquid, and another said space being connected to a reservoir for the removal of said cooling and washing liquid, said auxiliary instruments are selected from a group consisting of a balloon catheter, an ultrasonic sound for measuring the depth and degree of ablation of the tissue in the area of said operation site, and a rotating cleaning brush. - View Dependent Claims (13, 14, 15)
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Specification