Surgical equipment.

p0001The present invention relates to a surgical equipment to incise, severing, cutting, resecting and treating human or animal living tissue by use of a concept called surgery "non-tactile", that is ie without direct contact between a blunt object work like: scalpel, scissors or other, and the patient's tissue structures.

p0002The-tactile surgery practice since the introduction of laser beams in medicine and especially the CO₂ laser. Indeed, the carbon dioxide laser, the most appropriate surgery, allows remote work without mechanically touching the tissue. He proved his experimental and clinical efficacy compared to the use of conventional scalpel:<ul><li>hémostasiant its effect on small vessels reduces blood suffusions in the operative field, facilitating the vision of the surgeon,</li><li>cancellation of traumatic manipulation of tissues, because it acts without any metal contact in the operative field, capital advantage in oncology,</li><li>obtaining greater assurance of sterility due to work remotely associated with the immediate destruction of germs in the impact point of the beam,</li><li>reduction of post-operative pain scar.</li></ul>

p0003As against the laser as a scalpel remains superficial in its action, developed more or less expanded beam focusing. This laser-CO₂ does not control the bleeding of large vascular trunks, as found in important parenchymal organs of the body.

p0004The second example-tactile surgery is now a reality with the introduction of new surgical equipment emitting a jet of water more or less fine as well as more or less high pressure (see "Resection of the liver with a water jet," Br . J. Surg. Vol 69 (1982) 93-94 printed in Great Britain).

p0005This surgical technique per share remote pressure water jet is particularly interesting for the preparation - parenchymal tissue resection offering less resistance to the water jet with respect to support tissue structures such as large vascular trunks.

p0006These two-tactile surgery techniques thus become complementary, so the goal of this invention is the realization of a non-tactile surgery equipment balancing the two effects: CO₂ laser and water jet pressure at the discretion in a single item in the surgeon's hand and allow more pharmacological treatment of surgical and a simultaneous thermographic viewing field of the effect so that the laser of the water jet on the operated tissues.

p0007Surgical equipment according to the present invention has the characteristics described and claimed in the following.

p0008The drawing illustrates very schematically and by way of example one embodiment of the surgical equipment of the invention.

p0009FIG 1 is a general perspective view.

p00102 schematically illustrates the devices for producing the laser beam, the water jet and thermographic providing information about the operative field.

p00113 schematically and partially illustrates a handpiece according to the invention.

p0012Figure 1 illustrates very schematically the surgical equipment according to the invention which consists of a housing 1 containing the visualization laser (12), the working laser (13), the water jet-forming device and the thermography of electronic equipment. This housing 1 in which the various elements will be described in more detail hereinafter, is equipped on the one hand connections (2) for connecting it to a power source of 220 volts supplied to the two lasers 12,13, to a source of pressure medium 4, usually air, to a water supply 5, to a pipe for admixtures 6, to a current source 7 and a TV output 8. Furthermore the housing is equipped a multiple connector 9 for connecting it to an articulated arm or a flexible cable 10 whose end is provided with a handpiece 11. the flexible arms or flexible cable 10 is used to route the housing 1 at the output of the handpiece the laser beams visualization and working, that the water jet and the binding of the probe to its thermographic electronic equipment for supplying and analysis.

p0013Referring more particularly to Figure 2 now, it is seen that the housing contains a first laser visualization HeNe laser 12 and a second working CO₂ at 13 which beams are directed using lenses 14,15 and a mirror 16 of a lens 17 respectively on a common mirror 18. Thus the outlet of the housing 1 visible laser beams 12 and invisible from the working laser 13 are strictly combined or superimposed and can be focused on the same point which allows the operator to see the point of impact and the degree of focussing of the working laser beam 13 by visually observing the display of the laser 12. the combined beam 19 is conducted by mirrors through the articulated arm 10 or by an optical fiber (not shown) through a flexible cable to the end face 20 of the handpiece 11 from which it emerges through an opening 21.

p0014The two lasers 12 and 13 are of the sealed type, working CO₂ laser 13 to provide a significant energy has a power that it is necessary to provide this laser cooling system. This cooling circuit comprises a circuit schematic 22 surrounding the laser tube 13 connected in a closed circuit on the primary of a heat exchanger 23 whose secondary is connected to a circulation pump 24 driven by a compressed air motor 24a, and via a three-way valve 25 to a reservoir 26 of coolant, supplied with liquid by a conduit 5, and a discharge outlet 27 can be reconnected closed recharge circuit to the tank 26. Thus when the three-way valve 25 connects the ducts 28 and 29 the heat generated by the operation of the work laser 13 can be removed.

p0015Alternatively the CO₂ laser may be air-cooled, in this case the circuit 22 would be directly connected to the compressed air circuit 4.

p0016The pump 24 driven by an air motor 24a fed by the compressed air line 4 via a three-way valve would be fed directly into the water conduit 30.

p0017Thanks to this clever arrangement it is possible using the same pump 24, when the three-way valve is in its other position connecting the conduit 28 to a conduit 30, to supply pressurized water to the nozzle 31 located the end of the handpiece 11, the conduit 30 circulating inside the articulated arm 10 or the flexible cable replacement. Thus using the same elements, valve 25 and water reservoir 26, it is possible either to cool the working laser 13 when at work, or forming the water jet using non-tactile scalpel.

p0018When the fountain is on, it is planned to embed through line 6 adjuvants, drug of sorts, that allow for not only a mechanical action of the jet on fabrics but also pharmacological and therapeutic.

p0019Commands for controlling the operation of the lasers 12,13 of the pump 24 and the valve 25 can either be grouped on the handpiece 11 to be accessible on the operator pedals. The handpiece 11 is again provided with a thermographic sensor 32 connected by an electric cable 33 passing through the articulated arm 10 to an electronic equipment 34 located in the housing and the outlet 8 can be connected to a TV screen to give Direct thermographic image of the tissues in which the surgeon works.

p0020This is very important for normal tissue and pathological ones, including a cancerous tumor, do not have the same calorific value and can thus be distinguished from each other by their heating reaction is caused by the impact of laser beam working or by the impact of the water jet.

p0021This surgical equipment is unique in that it allows you to group in a single device and a single handpiece a CO₂ laser scalpel, pharmacological scalpel jet of water under pressure and display equipment thermographic the operating area .

p0022É This equipment is also remarkable in that the working laser cooling system 13 is combined with the production system of the water jet which simplifies the equipment and makes it very handy, easy to use, and economical to realize that separate devices.

p0023The great advantage of this combined surgical equipment is that the surgeon can at any time during operation work with the scalpel laser or water jet scalpel and thus adapt the-tactile surgical technique based on the quality of the fabrics cut or treat. It may also by modulating the pressure of the water jet use it to wash the surgical field and make specific pharmacological agents, such as: anesthetics, chemotherapy, sanitizers, hémostasiants, etc., which is an extremely useful contribution and important in most surgical interventions today.