DE10219297A1 - Medical instrument for generation of scar tissue to stiffen soft tissue, combines an ultrasound generator with a laser so that electromagnetic and or ultrasound energy can be coupled into the tissue via an opto-acoustic coupler - Google Patents
Medical instrument for generation of scar tissue to stiffen soft tissue, combines an ultrasound generator with a laser so that electromagnetic and or ultrasound energy can be coupled into the tissue via an opto-acoustic couplerInfo
- Publication number
- DE10219297A1 DE10219297A1 DE10219297A DE10219297A DE10219297A1 DE 10219297 A1 DE10219297 A1 DE 10219297A1 DE 10219297 A DE10219297 A DE 10219297A DE 10219297 A DE10219297 A DE 10219297A DE 10219297 A1 DE10219297 A1 DE 10219297A1
- Authority
- DE
- Germany
- Prior art keywords
- tissue
- laser
- ultrasound
- generation
- electromagnetic
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N7/00—Ultrasound therapy
- A61N7/02—Localised ultrasound hyperthermia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
Abstract
Description
In vielen Bereichen der Veterinär- und Humanmedizin ist es im Bereich rekonstruktiver bzw. plastischer und/oder kosmetischer chirurgischer Interventionen gewünscht, weichgewebliche Anteile in ihrer Flexibilität und Mobilität zu verändern. Daher ist es gewünscht, mit einem möglichst minimal belastenden Verfahren eben eine solche Versteifung herbeizuführen. In many areas of veterinary and human medicine, it is in the field reconstructive or plastic and / or cosmetic surgical Interventions desired, soft tissue parts in their flexibility and To change mobility. Therefore, it is desired with as minimal as possible burdening procedure just to bring about such a stiffening.
Stand der TechnikState of the art
Es ist beispielsweise bekannt, dass einige Hunderassen, wie Englische Bulldogge, Chow-Chow, etc. dazu neigen, im Schlaflaute Schnarchgeräusche von sich zu geben. Hier wäre es wünschenswert, mit einem möglichst wenig belastenden Eingriff die Schnarchneigung zu mindern, bzw. zu unterdrücken. Zur Zeit erfolgt dies durch direkte chirurgische Maßnahmen, die in der Regel das Gaumensegel ganz oder teilweise entfernen und durch die anschließend entstehende Narbe eine Straffung herbeiführen. Ähnliche Vorgehensweisen sind auch im Bereich der Humanmedizin zur chirurgischen Behandlung von Schnarchern bekannt. Es ist auch bekannt, derartige Resektionen des Gaumensegels, bzw. der Uvula lasertechnisch mit entweder CO2- oder Nd : YAG-Lasern vorzunehmen, oder aber direkt die Uvula und die seitlichen Segelfenster mittels Hochfrequenz-Applikation so weit thermisch zu veröden, dass es ebenfalls wieder zur Narbenbildung und damit Straffung kommt. Eine ähnlich liegende Problemstellung liegt im Bereich der Entfernung, bzw. Reduktion von Falten in der Gesichtshaut vor. Hier wird entweder wiederum durch Lasertechnik und großflächige Bestrahlung versucht, subdermale Narbenplatten zu erzeugen, die zu einer Straffung und Immobilisierung des Gewebes führen. Gleichermaßen wird versucht, durch Injektion nerventoxischer Gifte, wie beispielweise Botulinumextrakt, das Gewebe in eine Krampfstarre zu überführen. Ebenfalls sind Techniken bekannt, die durch eine oberflächliche Abtragung des Gewebes eine Neubildung der oberen Hautschichten stimulieren und damit zumindest solche Faltenanteile, die sich ausschließlich in der Oberhaut ausgebildet haben, auch entfernen können. Andere Anwendungsgebiete einer derartigen Technik liegen ggf. in der Versteifung des Halteapparates von venösen Herzklappen. For example, it is known that some dog breeds, such as English Bulldog, Chow, etc, tend to snore in the sleep sounds. Here it would be desirable to reduce the snoring with a least stressful intervention, or to suppress. At present, this is done by direct surgical measures, which usually remove the soft palate completely or partially and bring about the resulting scar a tightening. Similar approaches are also known in the field of human medicine for the surgical treatment of snorers. It is also known to carry out such resections of the soft palate, or the uvula laser technically with either CO 2 - or Nd: YAG lasers, or directly thermally flush the uvula and the side sail windows by means of high-frequency application, that it also again scarring and thus tightening comes. A similar problem lies in the area of removal, or reduction of wrinkles in the facial skin. Here, either by laser technology and large-scale irradiation, attempts are made to produce subdermal scar plates, which lead to a tightening and immobilization of the tissue. Likewise, an attempt is made by injecting nerve toxic toxins, such as botulinum extract, the tissue into a convulsive rigidity. Techniques are also known which stimulate the formation of a new formation of the upper layers of the skin by superficial removal of the tissue and thus also remove at least those parts of the fold which have formed exclusively in the epidermis. Other fields of application of such a technique may be the stiffening of the holding apparatus of venous heart valves.
Erfindungsgemäße LösungInventive solution
Ein auch in den möglichen Anwendungen in der Veterinär- und Humanmedizin unterschiedlichen Einsatzgebieten gemeinsam ist der erfindungswesentliche und auch für den medizinischen Fachmann überraschende Befund, dass es anstatt großflächiger Induktion von Narbenplatten oder teilchirurgischer Gewebeentfernung mit anschließender großer Vernarbung völlig ausreicht, röhrenförmige Narbentunnel in dem Zielgewebe zu induzieren. Dabei wirken diese röhrenförmigen Narbentunnel, nachdem sich innerhalb der Röhre durch einsprossendes Granulationsgewebe eine strangförmige Narbe gebildet hat, wie die Stangen eines Gatters oder das Maschenwerk eines stabilen Netzes, das je nach Geometrie und Anlage völlig ausreicht, die weichgeweblichen Zielstrukturen gezielt zu versteifen. One also in the possible applications in veterinary and human medicine different fields of application is common to the invention and also for the medical professional surprising finding that it instead of large-scale induction of scar plates or partial surgical Tissue removal with subsequent large scarring is sufficient induce tubular scar tunnels in the target tissue. Act These tubular graining tunnels, after passing through the tube sprouting granulation tissue has formed a rope-shaped scar, such as the bars of a gate or the mesh of a sturdy net that ever completely sufficient according to geometry and design, the soft tissue Purposefully stiffen target structures.
Neben diesem verfahrenstechnischen Grundgedanken ist erfindungsgemäß auch die technische Lösung, um eben solche röhrenförmigen Primärstrukturen im Zielgewebe zu schaffen. Hierzu werden erfindungswesentlich und vorzugsweise optische Lichtleitfasern verwendet, die gleichzeitig, wie - unsere eigene Patentschrift zur Simultanübertragung von Laser und Ultraschall zitierend - beschrieben, in der Lage sind, chirurgischen Ultraschall und Laserstrahlung simultan und/oder alternierend zu übertragen. Dabei kommt der Möglichkeit der alternierenden Applikation von chirurgischem Ultraschall und Laserlicht besondere Bedeutung zu, um in Abhängigkeit der biologischen Reaktion das Zielgewebe perforieren zu können, ohne dass die Faser vom vorher geplanten Weg auswandern kann, da insbesondere mit Ultraschallfrequenzen zwischen 20 und 50 kHz normales Weichgewebe oder Muskelzellen sehr gut perforiert werden können, hingegen collagen- und elastinhaltige Strukturen besonders gut mit gepulster Laserstrahlung, wahlweise eines Excimer-Lasers oder eines Erbium-dotierten Festkörper- Lasers Anwendung finden. Prozesswesentlich ist dabei das Zusammenwirken aus ultrakurzer Pulsdauer und sehr hoher Absorption der Lichtstrahlung im Zielgewebe. Typischerweise kommen Pulsbreiten von 300 Mikrosekunden und weniger in Betracht. In dem bevorzugten Ausführungsbeispiel typischerweise von ca. 200 Nanosekunden und weniger. In addition to this procedural principle is according to the invention also the technical solution, just such tubular primary structures in the target tissue. For this purpose, essential to the invention and preferably optical fibers used at the same time as - ours own patent for the simultaneous transmission of laser and ultrasound citing - described, are capable of surgical ultrasound and To transmit laser radiation simultaneously and / or alternately. Here comes the Possibility of alternating application of surgical ultrasound and Laser light has special importance in order to be dependent on the biological Reaction to be able to perforate the target tissue without the fiber from previously planned route can emigrate, especially with Ultrasonic frequencies between 20 and 50 kHz normal soft tissue or Muscle cells can be very well perforated, whereas collagen and Elastin-containing structures particularly well with pulsed laser radiation, either an excimer laser or an erbium-doped solid state Find Lasers application. Process essential is the interaction from ultra-short pulse duration and very high absorption of light radiation in the Target tissue. Typically, pulse widths of 300 microseconds and less in consideration. Typically in the preferred embodiment of about 200 nanoseconds and less.
In Weiterführung des Erfindungsgedankens besteht das lichtleitende System dabei aus einer Hohlkapillare, vorzugsweise aus Saphir, welche bevorzugt die Ultraschallenergie appliziert, bei Bedarf jedoch auch als Wellenleiter für die in einem besonderen Ausführungsbeispiel bevorzugte Erbium : YAG- Laserstrahlung genutzt werden kann. Gleichzeitig kann das innere Lumen einer solchen Kapillare, die mechanisch außerordentlich stabil ist und zur Erhöhung der Stabilität noch mit einem biokompatiblen Metallüberzug, typischerweise Gold, beschichtet ist, einen Außendurchmesser von weniger als einem Millimeter und dem inneren Lumen kann das durch die Ultraschallschwingung, bzw. Laserstrahlung fragmentierte Gewebe abgesaugt werden. Gleichzeitig kann aber auch das innere Lumen durch Einbringung einer weiteren Lichtleitfaser im Sinne eines Mandrins benutzt werden, um mit dieser inneren Faser beispielsweise ebenfalls wiederum Laserstrahlung zum Vorbohren des gewünschten Zielkanals übertragen werden oder aber höherfrequenter Ultraschall zur Erlangung eines A-Scan-Signals zur ständigen Messung der Restgewebedicke am Ende des Zielkanals, was insbesondere bei der Behandlung des Gaumensegels und der Uvola notwendig sein wird. In continuation of the inventive concept, the light-conducting system in this case from a hollow capillary, preferably made of sapphire, which preferably the Ultrasonic energy applied, if necessary, however, as a waveguide for in In one particular embodiment, erbium: YAG Laser radiation can be used. At the same time, the inner lumen of a Such capillary, which is mechanically extremely stable and to increase stability even with a biocompatible metal coating, typically Gold, coated, has an outside diameter of less than one Millimeter and the inner lumen can do this through the ultrasonic vibration, or laser radiation fragmented tissue are sucked off. simultaneously but can also the inner lumen by introducing another Optical fiber in the sense of a mandrin used to interact with this inner Fiber, for example, also in turn laser radiation for pre-drilling the desired target channels are transmitted or higher frequency Ultrasound for obtaining an A-scan signal for continuous measurement of Residual tissue thickness at the end of the target channel, which is particularly in the Treatment of the soft palate and the uvola will be necessary.
In Weiterführung des Erfindungsgedankens kann das innere Lumen aber auch zur Injektion beispielsweise von Fibrinkleber oder anderer vernarbungsfördernder Substanzen genutzt werden. Die erfindungsgemäßen Vorrichtungen sind in den Abb. 1 bis 2 näher erläutert: In continuation of the inventive concept, the inner lumen can also be used for injection, for example of fibrin glue or other scarring-promoting substances. The devices according to the invention are explained in more detail in FIGS. 1 to 2:
Dargestellt ist das Prinzip einer möglichen technischen Ausführungsform der Erfindung. In einem Handstück (1) wird zur gewünschten Gewebeschädigung geeigneter Ultraschall und oder entsprechende Laserstrahlung in einen optoakustischen Applikator (2) eingekoppelt. Der optoakustische Applikator (2) kann je nach Anforderung mehr oder weniger flexibel ausgelegt sein und wird in der gewünschten Position in das Weichgewebe (3) eingestochen, wobei durch die am distalen Ende des Applikators abgegebene Ultraschall- und oder Laserenergie die gewünschte röhrenförmige Gewebeschädigung erzeugt wird. Zur Erzeugung der Laser- und Ultraschallenergie dient ein Ultraschallgenerator (4), der einen im Handstück (1) befindlichen Ultraschallwandler versorgt, sowie der Laser (5). Außerdem befinden sich am Handstück (1) die Anschlüsse für eine gegebenenfalls in den Applikator (2) integrierten Spülung (6) und Absaugung (7), die das Entfernen der erzeugten Gewebefragmente erlaubt. Shown is the principle of a possible technical embodiment of the invention. In a handpiece ( 1 ) suitable ultrasound and / or corresponding laser radiation is coupled into an optoacoustic applicator ( 2 ) for the desired tissue damage. The optoacoustic applicator ( 2 ) can be designed more or less flexible as required and is inserted in the desired position in the soft tissue ( 3 ), wherein the desired tubular tissue damage is generated by the ultrasound and / or laser energy delivered to the distal end of the applicator , To generate the laser and ultrasound energy, an ultrasound generator ( 4 ), which supplies an ultrasonic transducer located in the handpiece ( 1 ), and the laser ( 5 ) are used. In addition, located on the handpiece ( 1 ) the connections for an optionally in the applicator ( 2 ) integrated flushing ( 6 ) and suction ( 7 ), which allows the removal of tissue fragments generated.
Diese Abbildung zeigt das Prinzip einer möglichen technischen
Ausführungsform des optoakustischen Applikators. Dieser besteht aus einem
Wellenleiter (8), zum Beispiel einer Saphir-Kapillare, deren proximales Ende
in einer Ultraschallsonotrode (9) derart befestigt ist, das über die Mantelfläche
tangential Ultraschallenergie eingekoppelt werden kann. Diese regt den
Wellenleiter (8) zu longitudinalen Schwingungen an. Über die vom Laser
kommende akustische entkoppelte Glasfaser (10) wird die Laserstrahlung in
die proximale Stirnfläche des Wellenleiters (8) eingekoppelt. Das Lumen (11)
des Wellenleiters (8) kann bei entsprechender konstruktiver Gestaltung zur
Absaugung, Spülung und oder als Arbeitskanal genutzt werden.
Bezugszeichenliste
1 Handstück
2 optoakustischer Applikator
3 Weichgewebe
4 Ultraschallgenerator
5 Laser
6 Spülung
7 Absaugung
8 Wellenleiter
9 Ultraschallsonotrode
10 Glasfaser
11 Wellenleiterlumen
This figure shows the principle of a possible technical embodiment of the optoacoustic applicator. This consists of a waveguide ( 8 ), for example a sapphire capillary, whose proximal end is fixed in an ultrasonic sonotrode ( 9 ) in such a way that ultrasonic energy can be coupled tangentially over the lateral surface. This excites the waveguide ( 8 ) to longitudinal vibrations. The laser radiation is coupled into the proximal end face of the waveguide ( 8 ) via the acoustic decoupled glass fiber ( 10 ) coming from the laser. The lumen ( 11 ) of the waveguide ( 8 ) can be used with appropriate structural design for suction, flushing and or as a working channel. LIST OF REFERENCES 1 handpiece
2 optoacoustic applicator
3 soft tissue
4 ultrasonic generator
5 lasers
6 rinse
7 suction
8 waveguides
9 ultrasonic sonotrode
10 glass fiber
11 waveguide lumens
Claims (8)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE10219297A DE10219297A1 (en) | 2002-04-25 | 2002-04-25 | Medical instrument for generation of scar tissue to stiffen soft tissue, combines an ultrasound generator with a laser so that electromagnetic and or ultrasound energy can be coupled into the tissue via an opto-acoustic coupler |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE10219297A DE10219297A1 (en) | 2002-04-25 | 2002-04-25 | Medical instrument for generation of scar tissue to stiffen soft tissue, combines an ultrasound generator with a laser so that electromagnetic and or ultrasound energy can be coupled into the tissue via an opto-acoustic coupler |
Publications (1)
Publication Number | Publication Date |
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DE10219297A1 true DE10219297A1 (en) | 2003-11-06 |
Family
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DE10219297A Withdrawn DE10219297A1 (en) | 2002-04-25 | 2002-04-25 | Medical instrument for generation of scar tissue to stiffen soft tissue, combines an ultrasound generator with a laser so that electromagnetic and or ultrasound energy can be coupled into the tissue via an opto-acoustic coupler |
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Cited By (43)
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DE10347079A1 (en) * | 2003-10-10 | 2005-05-19 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Ultrasound coupler for ultrasonic device, e.g. for bone examination, has electroacoustic transducers coupled to side of elongate waveguide for generating and detecting ultrasound waves |
WO2006042201A1 (en) | 2004-10-06 | 2006-04-20 | Guided Therapy Systems, L.L.C. | Method and system for ultrasound tissue treatment |
US8128618B2 (en) | 2005-08-03 | 2012-03-06 | Massachusetts Eye & Ear Infirmary | Targeted muscle ablation for reducing signs of aging |
US8282554B2 (en) | 2004-10-06 | 2012-10-09 | Guided Therapy Systems, Llc | Methods for treatment of sweat glands |
US8298144B2 (en) | 2006-06-23 | 2012-10-30 | Koninklijke Philips Electronics N.V. | Timing controller for combined photoacoustic and ultrasound imager |
US8409097B2 (en) | 2000-12-28 | 2013-04-02 | Ardent Sound, Inc | Visual imaging system for ultrasonic probe |
US8444562B2 (en) | 2004-10-06 | 2013-05-21 | Guided Therapy Systems, Llc | System and method for treating muscle, tendon, ligament and cartilage tissue |
US8460193B2 (en) | 2004-10-06 | 2013-06-11 | Guided Therapy Systems Llc | System and method for ultra-high frequency ultrasound treatment |
US8480585B2 (en) | 1997-10-14 | 2013-07-09 | Guided Therapy Systems, Llc | Imaging, therapy and temperature monitoring ultrasonic system and method |
US8636665B2 (en) | 2004-10-06 | 2014-01-28 | Guided Therapy Systems, Llc | Method and system for ultrasound treatment of fat |
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US8690779B2 (en) | 2004-10-06 | 2014-04-08 | Guided Therapy Systems, Llc | Noninvasive aesthetic treatment for tightening tissue |
US8708935B2 (en) | 2004-09-16 | 2014-04-29 | Guided Therapy Systems, Llc | System and method for variable depth ultrasound treatment |
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US8764687B2 (en) | 2007-05-07 | 2014-07-01 | Guided Therapy Systems, Llc | Methods and systems for coupling and focusing acoustic energy using a coupler member |
US8858471B2 (en) | 2011-07-10 | 2014-10-14 | Guided Therapy Systems, Llc | Methods and systems for ultrasound treatment |
US8857438B2 (en) | 2010-11-08 | 2014-10-14 | Ulthera, Inc. | Devices and methods for acoustic shielding |
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-
2002
- 2002-04-25 DE DE10219297A patent/DE10219297A1/en not_active Withdrawn
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