Method and device for applying laser surgery

FIELD: medicine; medical engineering.

SUBSTANCE: method involves exposure to laser radiation by moving scanning laser beam over biological object surface under treatment. Spatial object position is varied concurrently with scanning laser beam radially and circumferentially moving over surface under treatment and changing inclination angle with respect to biological object surface. State of surface under treatment is controlled by recording its temperature, comparing the temperature to maximum permissible level. Radiation power is adjusted. Device has casing, laser, objective and guide. The objective is radially and circumferentially movable and inclination angle variable with respect to objective surface The objective is radially and circumferentially movable. Computer, control unit, power control unit and scanning device are also available.

EFFECT: accelerated surgical intervention procedure; save action of laser radiation beam.

2 cl, 1 dwg

 

The invention relates to medicine, in particular to laser surgery in terms of creating devices for laser surgery with correction power incident on biological tissue laser radiation, and can be used during surgical operations with the use of laser radiation, therapeutic effect is determined by the radiation dose absorbed by a living biological tissue.

Medical laser is a device for receiving high-intensity focused beam of monochromatic light emission. The laser was created in 1955, Soviet scientists A.M. Prokhorov and Basov N.G. There are different types of lasers - gas, liquid and solid. Laser radiation may be continuous and pulsed. In clinical medicine to use lasers of different capacities. The most powerful lasers are used in surgery. The action of laser radiation based on a sharp temperature rise in the irradiated spot that causes coagulation (clotting) or destruction of the biological tissue. Feature of laser radiation depends on the type of laser, its power, and the structure and biological properties of irradiated tissues. A narrow light beam of high power allows coagulation of a specific area of the affected organ in a split second. In addition to coagulation is biologicheskikh structures at high-power radiation and possibly explosive destruction from the effects of a kind of shock wave. It is the result of an instant jump tissue fluid in the gaseous state under the influence of high temperature. The laser beam can produce a bloodless dissection of tissue. Feedback depends on the type of tissue or organs, their color, thickness, density, etc. Such as a laser scalpel to remove the tumor. Laser radiation is used in the diagnosis and in the treatment of many diseases of the skin, tuberculosis, treatment of internal organs and many other purposes. The mechanism of action of the laser is not fully understood, in addition to thermal effects of the laser radiation causes a chemical transformation in the tissues and blood, wave impact on our energy bodies and even psychotherapeutic effect. In the last 5...10 years along with or independently of the application of laser in medicine widely used personal computers.

Diagnosis and treatment with the use of computers is harmless for the patient. The radiation level monitors modern computers meets the most stringent sanitary standards. Moreover, early prediction of diseases and their prevention is a completely new field of medicine, some progress which has been in the last decade in connection with the development of computer technology. Use wave therapy various emission is mi: laser, light, ultrasonic and radio waves are widely known. The main problem with therapy through wave radiation is the exact dosage of radiation. Under irradiation at minimum power the process of therapy is unreasonably prolonged and does not give the desired result and, on the contrary, when a powerful uncontrolled exposure possible negative effects, such as thermal burns.

Electromagnetic radiation are related rather to the very biological objects are penetrating ability in biological tissue. Each type of electromagnetic radiation has its penetrating ability. Revealed that the most deeply penetrating electromagnetic wave near infrared range 900-1000 nm. The energy of their photons is of the order of 1.5 eV, which is optimum for photostimulation. These properties allow you to apply non-invasive therapeutic effects.

Laser therapy is widely used in many areas of medicine as an effective therapeutic tool. The laser radiation is quite a wide range of effects. This radiation activates many processes in the body, increasing energy metabolism, anti-inflammatory, analgesic effect and other effects. Laser effects on the body is currently used not only for the ecene patients but for prevention of fatigue while reducing overall health due to vascular disorders, functional nature, as well as for recovery of functional status after intensive loads. Recent data have psychosomatic effects of laser radiation. One of the most important properties of laser radiation in accordance with quantum theory is that the emission and absorption of radiation occurs portions (quanta). Quanta laser radiation and light in General) are called photons. The emission and absorption of quanta associated with the transition of electrons of a substance at a higher (absorption) or low (radiation) orbit. Laser light differs from ordinary light four basic properties - monochromaticity, coherence, polarity and collimation. If you tell the agent (desktop laser body additional energy, then under certain conditions triggers the radiation quanta. All quanta are emitted with the same parameters (frequency, wave length, mass and energy). This uniformity of energy parameters of quanta called monochromaticity (same color). During this phase of the harmonic oscillations of the emitted quanta are the same (the maxima and minima of the oscillations of all quanta are one and the same time) is t is in is called the coherence of the laser radiation. As already mentioned, the laser light is an electromagnetic wave. Its electric and magnetic components are oriented to each other at an angle of 90° and perpendicular to the direction of wave propagation. When respectively the electric and magnetic components of all quanta of radiation are arranged in space relative to each other respectively in the same planes, the radiation is called polarized. The next difference of laser radiation from the usual light - collimation or narrow focus (divergence laser

beam), it usually does not exceed a fraction of a degree). This property allows you to reach a very large energy density per unit area and to transmit energy without significant losses. The energy flux of the laser radiation absorbed by the biological tissue for the whole cycle of medical procedures, can have both positive and negative effects. Therefore, the keeping of accurate dosage when conducting medical procedures is essential. However, in medical practice uses the value of the radiation power of the applied laser (dose is determined by multiplying the value of the power flux at the time of impact), i.e. it is set falling on biological tissue radiation dose. While absorbed in the biological tissue radiation dose is only part of PA is non doses that is, the incident beam is divided into two streams: not participating in the treatment process the reflected flux (corresponding to the reflection coefficient the reflection coefficient of the tissue) and used in the treatment process absorbed flux (corresponding to an absorption coefficient the absorption coefficient of biological tissue). For real biological tissues absorption coefficient varies in a rather wide range depending on a number of factors (the wavelength of the laser, color, and condition of the skin, the anatomical location of the zone of irradiation, atmospheric conditions, time of day, the psychological state of the patient, and the like), the combination of which is statistically impossible to account for each individual patient. Real practical result is the operational definition of the absorption coefficient in a particular zone of irradiation in the process of conducting medical procedures and the corresponding correction values falling on biological tissue laser radiation.

A device for laser therapy with correction power incident on biological tissue laser radiation, containing a working radiator in the form of a laser, at the entrance of which is located the control unit of its capacity, ensuring that the set value of the laser power constant during the irradiation procedures tissues (N is cointension laser therapy. Sat. works under the General editorship Swimskin, Vasoline, M., LLP “Company Technology”, 2000, s).

A disadvantage of the known device is that it serves to maintain the output power of laser radiation is not taken into account the absorption by biological tissue of the incident radiation that does not provide sufficient efficacy of therapeutic treatments.

From the same source, a device for laser therapy with correction power incident on biological tissue laser radiation, containing the laser, whose input is connected to the first output control unit, designed for power, trigger and control the radiation power of the laser during the laser radiation is input aperture photometric cavity, which also contains the main output aperture and an additional output aperture, while the main output aperture is equipped to provide photometric calibration cavity travelling plug opening of this aperture, the surface of the stopper has a diffuse reflectance of 100%, the additional output aperture installed photovoltaic Converter whose output is connected to the input of the correction unit of the laser power.

The advantage of this device compared to previously described is prob the possibility of manual adjustment of the laser power with regard to the absorption coefficient of the biological tissue of this radiation to ensure the installation of the specified absorbed by biological tissue dose radiation, what increases the effect of therapeutic procedures. The disadvantage of this device is the complexity and great length (about 2 minutes on each irradiated area) procedures manual correction of the radiation power of the laser for the installation of a given absorbed dose due to the need for re-installation of the new power value according to the testimony of the additional device, this may be offset previously selected zone of the tissue relative to the original, which actually determined the absorption coefficient, which reduces the accuracy of dosing, reduces the effectiveness of therapeutic procedure and thus does not allow to carry out the procedure for labile (moving on fabric) method.

The human body is a unique self-regulating system. Its normal state that determines health, maintains continuous operation, the functioning of internal organs and distributed systems of the body: blood, tissue bioenergetics, electrical excitation of nerves, muscles and other Physical fields and radiations of the body is actually operating noise of life support systems. This noise makes it possible to observe the whole body, any organ or system in its own light, and various kinds of fields and radiation make it possible to observe the functioning organism in various aspects, for Example, in the first embodiment, when observed in the infrared (thermal) emission spectrum shows the operation of capillary blood flow in the skin, i.e. the temperature of the body surface of the subject. In another, detected radio thermal bioenergy (metabolic rate) and the flow in the depth of the body, particularly in the cortex, which is more promising, but not yet available due to the high cost of the equipment. In the third, customerlevel is determined by the heat production of the muscles and internal organs. In the fourth, magnetic, body is the most transparent and show the status of the bioelectric excitation of the brain, heart, muscles and other

This approach, namely obtaining information on private signals of the object in Radiophysics and medicine called passive remote sensing. On the basis of the experience gained by practitioners of all countries of the world, as well as in a number of enterprises developing modern, high-tech medical equipment, created a new generation of medical devices and methods of functional diagnostics based on dynamic mapping of all physical fields and radiations of the human body: electric, magnetic, electromagnetic, infrared, radio thermal, acoustic and optical visible wave spectrum. These methods, called functional imaging, prob give the possibility to detect early functional harbingers of disease, i.e. to perform early diagnosis of diseases of internal organs, such as dynamics or the level of increase or decrease in temperature of the body. Modern equipment allows the physician to observe on the screen of the personal computer in the form of digital film functioning of these basic life-support systems in natural variability (dynamics), and statics in the form of a color picture. Functional mapping of the body according to his own signals is absolutely environmentally friendly, safe, no impact on the body, which opens up great prospects in our environmentally stressful time. Developed hardware and software make it possible to observe the image of your areas of the body in its own light in different wavelength ranges, build on them functional maps characterizing the functional state of the microcirculation and metabolism in biological tissues, including bioelectric activity of the heart, brain, muscles, blood supply, lymphatic system in different periods of time. In modern medicine is dominated by methods morphological structural diagnostics, the apex of which is a modern MRI scanner that allows to clearly identify the location of disfuncio body. However, long before the appearance of irregularities in Simoreg liloumace system must disrupt its functioning. To identify where and to what extent functional changes, the task of creating new instruments and methods for early functional diagnostics. In addition, modern equipment and methods allow an individual to monitor and adjust the course of medical procedures in order to restore sustainable functioning of the organism, i.e., effective treatment of a patient.

Thus, opening up entirely new possibilities of detecting diseases at an early stage through the creation of specialized banks functional images / precursors of pathology, i.e. a set of statistical data according to certain changes of wave radiation of the body from breaking its functions. We are talking about the new, most natural, effective and safe medical technology. Applications of this new equipment and technology covers virtually all medicine - from prenatal to gerontology. Natural functional monitoring on its own dynamic images of the body is indispensable: when resuscitation, rehabilitation clinics in geriatric clinics, during testing of pharmaceuticals, while optimizing the dosage of the pharmaceutical and physiotherapy.

In the course of diagnosis and treatment of almost all diseases most things the public interest to physicians is the temperature, its distribution and dynamics of changes on the surface of the body. One of the most common devices, allowing to visualize the temperature field is, for example, infrared imager (type AGA, rainbow, TV 03, irtis-200 are given ME and others). Such devices allow you to record, monitor and analyze on the monitor the distribution of the temperature field on the surface of the skin, they are based on the own thermal radiation of the human body in the infrared wavelength range. For example, the device irtis-200 are given Me, domestic developments in consumer qualities and characteristics are not inferior to Japanese TN 3106 ME the Japanese company NEC. The device comes bundled with your computer Pentium or Laptop and a Dewar vessel with a capacity of 25 liters for liquid nitrogen.

The main characteristics of the instrument:

The range of measured temperatures, °-10...+ 70

Temperature resolution °From 0.05

The type of cooler liquid nitrogen

The temperature measurement accuracy ° ±0,5

The horizontal resolution of 256 elements

The vertical resolution 256

The formation time frame, sec 2

Focusing, m from 0.1 to infinity

Dimensions, mm 200×140×100

Weight kg 1,8

Infrared thermography has already been applied in the diagnosis of various types of cancer, neurological, cardiovascular and other diseases for over 15 years and has been accumulated to date, considerable experience in other leading medical institutions. There is considerable experience in research and evaluation radiotomography images. It should be noted that usually used infrared thermography deals at best with a set of static images of a body surface or directly affected, or are heat zones or reflex projection internal pathologically altered organs. But due to the strong attenuation of the wave infrared range in the human body is not always reliable. All the underlying processes can be reflected in the temperature fields of the skin only as a result of the actions of those or other mechanisms of heat transfer. The use of thermal imaging technology for the treatment of diseases is unknown.

To study temperature distributions in the depth of the body must use devices, the host's own thermal radiation at longer wavelengths, for example in the radio.

The principle of the device for registration and visualization of deep thermal fields of the human body, radiotomography is based on the intrinsic thermal (Planck) radiation of a human body in the decimeter wavelength range. The basis of the device is highly sensitive multi-channel receiver radiometer on the input of which is connected a contact antenna applicators. Antenna-the APC is ictory are of interest to the researcher's area of the body or head of a person. For effective signal receiving antenna must have a good electrodynamic contact (low reflectance) and to be consistent across the impedance (impedance) with the human body. Since the characteristic impedance depends on the dielectric constant of the substance, and the human body has an average dielectric constant 40-60, the size of the antenna is significantly reduced relative to the size of free space. Accordingly improves and resolution. Thus, in particular, for a wavelength in free space of 40 cm wavelength in the human body is 5-8 see If you can get the resolution in 2,0-4,0 see

Multichannel radioterminal is a hardware-software complex, consisting of a high-sensitivity receiver UHF waves (radiometer), set of antenna applicators (number of channels) with fastening devices on the head and body of the personal computer type IBM and software package. The transfer of data from the radiometer to the computer in digital form via a standard RS-232 port. The device has led the quality control of installation of the antenna applicators on the body (the head) of a person. There are temperature sensors in the skin under the antennas and dates the IR room temperature. Instrument calibration is performed by setting all of the antennas in thermostat with saline. Two temperatures are calculated corresponding coefficients to calculate the temperature for each channel. Radiotomography significantly more difficult and expensive the imager, it is not yet widely used in clinics and requires highly qualified specialists for his service.

The known method and apparatus for examining the internal organs by the RF patent № 2071725. The disadvantage is the influence of harmful x-ray radiation.

A known method for the diagnosis of surfaces of biological objects using reflected radiant energy by the RF patent for the invention № 2086117, IPC 6 And 61 In 6/00, publ. 10.08.97, the Method implies that the effect on the surface of human access to laser radiation and recording the reflected radiation equipment containing the computer and the monitor. The disadvantages of this method: it applies only to study the surface of a biological object, for the study of internal organs is not adapted. The device is quite complicated and expensive, since it contains, besides the computer, the laser emitter and the photodetector.

The known method and apparatus for examining the internal organs and human tissue by RF patent for the invention № 2069063. The method enables the fast registration of laser radiation, passing through the examined body. The device comprises a laser emitter, a photodetector, a television camera and a video section (monitor).

The disadvantage of this method is the lack of control of radiation exposure to the patient body and the regulatory power of the laser emitter.

There is a method of treatment of destructive forms of tuberculosis by RF patent No. 2064801. This method is carried out short-term powerful irradiation of cavities of the patient easy to complete destruction of the microbial environment. The disadvantage is the lack of control and feedback.

The known method and device for laser treatment of the surface of the body by RF patent No. 1801362, IPC 5 And 61 In 6/00, publ. 15.03.93,

The method includes metered-dose irradiation of human body surface of the laser with simultaneous control of reflected laser beam. The device includes a laser light source and a device to control the state of the irradiated surface.

The disadvantage of this method and of the device: low quality control dispensing of therapeutic effects, due to the fact that is controlled by the reflectivity of the surface of the body, not the real state of this surface. For example, the reflectivity of the surface can dramatically increase when you sweat, this will be signaled to shut off the laser emitter. Another from the pile, the surface of the skin may be heated to a temperature of a thermal burn, while the reflected signal will be weakened, and the system control signal to increase the laser power, which will lead to tragic consequences.

The known method and device for holding wave therapy with a dosage of irradiation by the RF patent № 2101048, IPC 6 And 61 N5/10, publ. 10.01.98,

Method of forming a phase field radiation therapy according to this method is the visual representation of the options phase of the field on the storage media in the form of restricted isodisomy closed disjoint regions, input, information processing and management of the movement of the beam and irradiation dose software, according to a certain law, each area enclosed by isodata, assign a constant value of radiation dose and visually distinguish these areas. On the monitor screen each isodose match your color. The operator obtains a view only of the power of radiation exposure (and he knows, as he sets using controls computer from the keyboard, using the manipulator “mouse” or from a scanner). Asked irradiation dose depends on the experience of the operator and entered manually, the role of the computer and the use of its computing capabilities Nevel ' is A. A drawback of these methods and devices is that almost no control over the process of irradiation, but only for the dose level in each zone. The regulation process is not carried out. On the screen there is a stationary picture, preset program or a scanner. This can lead to overheating and thermal burns tissue irradiated surface of the biological object. If lead exposure on inherently low modes, the treatment is unreasonably delayed and will not give a positive result.

The known method and device for laser surgery (operations of the laser beam) on the website http://lasermed.ru Lancet-1”, the device includes a laser and a lens for submission of laser radiation on biological object, for example, to cut a benign (or cancer) tumors.

The disadvantage of this system is that surgical operation is performed manually, with all the ensuing negative consequences, namely the process of cutting out the tumor for a long time, there may be errors and inaccuracies, while conducting operations without anesthesia the patient for a long time experiencing painful feelings.

The known device and method for laser surgery, AS the USSR № 1785434, which contains the laser, the optical fiber and jectiv. The method consists in the movement of the laser beam. The disadvantages of the method and device are the lack of control of the laser power for security, control of the operation and the long duration of surgery

Objectives of the invention: quick surgery, with safe laser radiation by controlling the state of the irradiated surface.

The solution of the stated problem is achieved in the method of performing laser surgery, including laser radiation by moving the laser beam on the irradiated surface of the biological object, the fact that simultaneously with the movement of the scanning laser beam on the irradiated surface of the bioobject change the spatial position of the lens by circular and radial displacement and tilting angle of the lens to the surface of the biological object, in this control state of the irradiated surface by registering its temperature, comparing this temperature with a maximum permissible temperature value of the bio-object, regulate the power output.

These objectives are achieved in a device for laser surgery, including laser and the lens, due to the fact that it contains tsilindricheskimi toroidal housing, radial guide on which the hinge is installed lens with the possibility of radial and circular movements and change the angle of inclination to the surface of the biological object, a computer, a monitor, a device to control the state of the irradiated surface, made in the form of thermal or radiotomography connected to the computer, the laser contains a radiation power regulator and a scanning device with a drive of the longitudinal and transverse beam scanner connected to the computer.

The proposed solution has novelty, inventive step and industrial applicability. The proposed invert sweep of the scanning beam made it possible to reduce overheating of the Central part of the irradiated area of the biological object due to more uniform irradiation of the narrow concentrated beam of the laser.

The temperature field is highly sensitive even to very small (0,1...0,2 mg/min) changes of blood flow velocity. Local changes in blood flow in a certain volume of the body can be identified through the interpretation of the temperature fields measured by the imager (radiotomography), which is part of the proposed device.

Conducted patent research and analysis showed that the proposed solution has novelty, inventive step and industrial p is minimoto. Inventive step is ensured by the fact that the new set of essential features that are necessary and sufficient to implement the method, allows to obtain new properties: a significant increase in the efficiency of operations.

The invention is illustrated by the drawing which shows a schematic diagram of a system to implement the method using laser.

The device (see drawing) are intended for surgical exposure of laser radiation on biological object 1 to remove the tumor 2. It contains the laser 3 and lens 4.

Device for laser surgery has a cylindrical (toroidal) case 5, the axis 6, the radial guide 7, the video camera 8, a base 9. The laser 3 and the video camera 8 is connected to the computer 10. The laser 3 is also connected to the energy source 11. To the computer 10 connected to the control unit 12 (keyboard or mouse) and a monitor 13. Lens 4 laser 3 is mounted on a radial guide 7 can be moved and, in addition, the hinge. The hinge is not shown.

An EXAMPLE IMPLEMENTATION of the METHOD

For tumor removal 2 on the surface of the bio-object 1 rotate the cylindrical body 5 and simultaneously move the laser 3 and rejects the lens 4. When the laser beam cuts the tumor 2 cone, as shown in the drawing. The formation of the cone provides the design of the mouth of the STS, however, simultaneously with the movement of the scanning laser beam on the irradiated surface of the bioobject change the spatial position of the lens by circular and radial displacement and tilting angle of the lens to the surface of the biological object. In addition, control over the operation and regulation of the laser power ensures the safety, namely to prevent burnout tissues located near the border of the tumor.

The application of the invention allowed:

1. To fully automate the sessions of radiation surgery.

2. To control and safely adjust the exposure while surgery at the highest possible modes.

3. An extremely fast operation without anesthesia for people who does not perceive, for example, procaine and other painkillers.

4. To get a visual interpretation of the result of the operation on the screen of the monitor 13 of the computer 10. Modern cameras are equipped with the standard computer “Pentium” any configuration with the monitor and software, for example, irtis-200 are given Me, described above.

5. To ensure the safety impact of powerful laser radiation by minimizing the time of exposure to radiation and its power.

6. Use standard commercially available equipment: for example, the laser and the camera any which brand and personal computer type “Pentium” any configuration.

1. Method of performing laser surgery, including laser radiation by moving the laser beam on the irradiated surface of the bio-object, characterized in that simultaneously with the movement of the scanning laser beam on the irradiated surface of the bioobject change the spatial position of the lens by circular and radial displacement and tilting angle of the lens to the surface of the biological object, in this control state of the irradiated surface by registering its temperature, comparing this temperature with the maximum allowable value of the temperature of the bio-object, regulate the power output.

2. Device for laser surgery, including laser and the lens, characterized in that it comprises a cylindrical or toroidal case, the radial guide, on which the hinge is installed lens with the possibility of radial and circular movements and change the angle of inclination to the surface of the biological object, a computer, a monitor, a device to control the state of the irradiated surface, made in the form of thermal or radiotomography connected to the computer, the laser contains a radiation power regulator and a scanning device with a drive of the longitudinal and transverse beam sweep, the connection is established to the computer.



 

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