Method and system for photoselective vaporization of the prostate, and other tissue

• US 6,986,764 B2
• Filed: 10/23/2002
• Issued: 01/17/2006
• Est. Priority Date: 12/15/2000
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Laserscope (Endo International PLC)
• Inventors: Davenport, Scott A., Arnold, Ken, Coleman, Tony D., Nahen, Kester, Garlich, Henry, Murray, Steven C.
• Primary Examiner(s): DAHBOUR, HENRY
• Application Number:
  US10/278,723
• Publication Number:
  US 20030135205A1
• Time in Patent Office: 1,182 Days
• Field of Search: 606/3, 606/2, 606/10, 606/11, 606/12, 606/16, 606/17, 606/7, 606/15, 606/27, 606/28, 606/29, 606/30, 606/31, 607/89, 607/90, 607/92, 607/100, 607/101, 607/102, 600/2, 600/3
• US Class Current: 606/3
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 18/22 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
• CPC Class Codes: A61B 2017/00274 Prostate operation, e.g. prostatectomy, turp, bhp treatment
• CPC Class Codes: A61B 2018/00547 Prostate
• CPC Class Codes: A61B 2018/00625 Vaporization
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/2015 Miscellaneous features
• CPC Class Codes: A61B 2018/2272 with reflective or refractive surfaces for deflecting the beam A61B2018/2261, A61B2018/2266 take precedence

Abstract

A method for photoselective vaporization of prostate tissue includes delivering laser radiation to the treatment area on the tissue, via an optical fiber for example, wherein the laser radiation has a wavelength and irradiance in the treatment area on the surface of the tissue sufficient because vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation. The laser radiation is generated using a neodymium doped solid-state laser, including optics producing a second or higher harmonic output with greater than 60 watts average output power. The delivered laser radiation has a wavelength for example in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than about 10 kilowatts/cm², in a spot size of at least 0.05 mm².

Claims

1. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on a surface the tissue, the laser radiation being absorbed substantially completely by the tissue within about 1 mm of the surface, and having average irradiance in the treatment area greater than 10 kiloWatts/cm² in a spot size at least about 0.05 mm².

2. The method of claim 1, wherein the spot size is between about 0.1 and 0.8 mm² in the treatment area.

3. The method of claim 1, wherein the irradiance is at least 30 kiloWatts/cm² in the treatment area.

4. The method of claim 1, wherein the laser radiation has a wavelength in a range from about 650 to about 200 nm.

5. The method of claim 1, wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm².

6. The method of claim 1, wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm².

7. The method of claim 1, including delivering a flow of irrigant to the treatment area.

8. The method of claim 1, wherein said tissue comprises prostate gland tissue.

9. The method of claim 1, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, with an optical fiber adapted to direct laser radiation from the fiber to the treatment area.

10. The method of claim 1, wherein said delivering comprises using a transurethral cystoscope, with an optical fiber having a side firing optical element directing laser radiation from the fiber to the treatment area, and placing said side firing optical element within about 1 mm, or less, of the treatment area.

11. The method of claim 1, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, and further including applying only local anesthetic during said delivering.

12. The method of claim 1, including generating said laser radiation using a solid state laser with greater than 60 Watts average output power.

13. The method of claim 1, including generating laser radiation using a macro-pulsed solid state laser with greater than 60 Watts average output power, and having output power greater than about 200 Watts during a macro-pulse.

14. The method of claim 1, wherein said delivering comprises delivering a macro-pulse consisting of a sequence of micro-pulses of laser radiation, and said irradiance is greater than 50 kiloWatts/cm² during the macro-pulse.

15. The method of claim 1, including generating said laser radiation using Neodymium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

16. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation and a flow of a transparent liquid irrigant to a treatment area on a surface the tissue, the laser radiation causing vaporization of a volume of tissue greater than a volume of residual coagulation of tissue, and having irradiance in the treatment area greater than 10 kiloWatts/cm² in a spot size at least 0.05 mm².

17. The method of claim 16, wherein the spot size is less than about 0.8 mm² in the treatment area.

18. The method of claim 16, wherein the irradiance is at least 30 kiloWatts/cm² in the treatment area.

19. The method of claim 16, wherein the laser radiation has a wavelength in a range from about 650 to about 200 nm.

20. The method of claim 16, wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm².

21. The method of claim 16, wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm².

22. The method of claim 16, wherein the irrigant comprises water.

23. The method of claim 16, wherein said tissue comprises prostate gland tissue.

24. The method of claim 16, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, with an optical fiber adapted to direct laser radiation from the fiber to the treatment area.

25. The method of claim 16, wherein said delivering comprises using a transurethral cystoscope, with an optical fiber having a side firing optical element directing laser radiation from the fiber to the treatment area, and placing said side firing optical element within about 1 mm, or less, of the treatment area.

26. The method of claim 16, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, and further including applying only local anesthetic during said delivering.

27. The method of claim 16, including generating said laser radiation using a solid state laser with greater than 60 Watts average output power.

28. The method of claim 16, including generating laser radiation using a macro-pulsed solid state laser with greater than 60 Watts average output power, and having output power greater than about 200 Watts during a macro-pulse.

29. The method of claim 16, wherein said delivering comprises delivering a macro-pulse consisting of a sequence of micro-pulses of laser radiation, and said irradiance is greater than 50 kiloWatts/cm² during the macro-pulse.

30. The method of claim 16, including generating said laser radiation using Neodymium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

31. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the delivered laser radiation has an average irradiance in the treatment area greater than 10 kiloWatts/cm² in a spot size at least 0.05 mm².

32. The method of claim 31, including delivering said laser radiation using an optical fiber, and wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

33. The method of claim 31, wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

34. The of claim 31, wherein the delivered laser radiation has a wavelength in a range of about 200 rim to about 650 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

35. The method of claim 31, wherein the spot size is less than about 0.8 mm² in the treatment area.

38. The method of claim 31, including delivering a flow of irrigant to the treatment area.

39. The method of claim 31, wherein said tissue comprises prostate gland tissue.

43. The method of claim 31, including generating said laser radiation using a solid state laser with greater than 60 Watts average output power.

36. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the average irradiance is at least 30 kiloWatts/cm² in the treatment area.

37. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser radiation has a wavelength in a range from about 650 to about 200 nm.

40. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, with an optical fiber adapted to direct laser radiation from the fiber to the treatment area.

41. The method of claim 40, wherein said optical fiber has a side firing optical element directing laser radiation from the fiber to the treatment area, and placing said side firing optical element within about 1 mm, or less, of the treatment area.

42. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, and further including applying only local anesthetic during said delivering.

44. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, including generating laser radiation using a macro-pulsed solid state laser with greater than 60 Watts average output power, and having output power greater than about 200 Watts during a macro-pulse.

45. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein said delivering comprises delivering a macro-pulse consisting of a sequence of micro-pulses of laser radiation, and said irradiance is greater than 50 kiloWatts/cm² during the macro-pulse.

46. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, including generating said laser radiation using Neodyrnium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

47. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, including generating said laser radiation using a diode-pumped, Neodymium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

48. A method for photoselective vaporization of prostate tissue, comprising:

generating laser radiation using a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 60 Watts average output power;

coupling said output to an optical fiber in a transurethral cystoscope, the optical fiber adapted to direct laser radiation from the fiber to a treatment area on a surface of the tissue;

delivering a flow of irrigant to the treatment area; and

delivering laser radiation to a treatment area on the tissue via the optical fiber, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation.

49. The method of claim 48, wherein the delivered laser radiation has an average irradiative in the treatment area greater than 10 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

50. The method of claim 48, wherein the delivered laser radiation has an average irradiance in the treatment area greater than 20 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

51. The method of claim 48, wherein the delivered laser radiation has an average irradiance in the treatment area greater than 30 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

52. The method of claim 48, wherein the delivered laser radiation has an average irradiance in the treatment area greater than 10 kiloWatts/cm², and the optical fiber is adapted to cause a spot size is less than about 0.8 mm² in the treatment area.

53. The method of claim 48, wherein the average irradiance is at least 30 kiloWatts/cm² in the treatment area.

54. The method of claim 48, wherein the optical fiber includes a side firing tip, and including placing said side firing tip within about 1 mm, or less, of the treatment area.

55. The method of claim 48, including applying only local anesthetic during said delivering.

56. The method of claim 48, including Q-switching said laser medium to produce micro-pulses during application of input power to the laser medium, and applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and wherein said output power is greater than about 200 Watts during said macro-pulses.

57. The method of claim 48, including Q-switching said laser medium to produce micro-pulses during application of input power to the laser medium, and applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and said irradiance is greater than 50 kiloWatts/cm² during the macro-pulse.

58. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue;

laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser comprises a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 60 Watts average output power.

59. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue;

laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 650 nm, and said irradiance has an average irradiance in the treatment area greater than 10 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

60. The apparatus of claim 59, wherein said irradiance has an average irradiance in the treatment area greater than 20 kiloWatts.

61. The apparatus of claim 59, wherein said irradiance has an average irradiance in the treatment area greater than 30 kiloWatts.

62. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue;

laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 10 kiloWatts/cm², and the optical fiber is adapted to cause a spot size is less than about 0.8 mm² in the treatment area.

63. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue;

laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser and optical fiber are adapted to deliver average irradiance of at least 30 kiloWatts/cm² in the treatment area.

64. The apparatus of claim 63, wherein the optical fiber includes a side firing tip, and is further adapted for placement of said side firing tip within about 1 mm, or less, of the treatment area.

65. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue;

laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and wherein said output power is greater than about 200 Watts during said macro-pulses.

66. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue;

laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium a sequence of pulses to generate macro-pulses of output radiation, and said irradiance is greater than 50 kiloWatts/cm² during the macro-pulse.

67. An apparatus for photoselective vaporization of prostate tissue, comprising:

a laser producing laser radiation having a wavelength in a range from about 200 nm to about 650 nm;

a transurethral cystoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the prostate tissue;

said laser and optical fiber being adapted to deliver the laser radiation with an average irradiance in the treatment area greater than 10 kiloWatts/cm² and the optical fiber is adapted to cause a spot size of at least about 0.05 mm² in the treatment area.

68. The apparatus of claim 67, wherein the laser comprises a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 60 Watts average output power.

69. The apparatus of claim 67, wherein the laser and optical fiber are adapted to deliver laser radiation having an average irradiance in the treatment area greater than 20 kiloWatts/cm².

70. The apparatus of claim 67, wherein the laser and optical fiber are adapted to deliver laser radiation having an average irradiance in the treatment area greater than 30 kiloWatts/cm².

71. The apparatus of claim 67, wherein the laser and optical fiber are adapted to deliver laser radiation having a spot size is less than about 0.8 mm² in the treatment area.

72. The apparatus of claim 67, wherein the optical fiber includes a side firing tip, and is further adapted for placement of said side firing tip within about 1 mm, or less, of the treatment area.

73. The apparatus of claim 67, wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and wherein said output power is greater than about 200 Watts during said macro-pulses.

74. The apparatus of claim 67, wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium a sequence of pulses to generate macro-pulses of output radiation, and said irradiance is greater than 50 kiloWatts/cm² during the macro-pulse.