Method and system for photoselective vaporization for gynecological treatments

Abstract

A method for photoselective vaporization of uterine 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/cm 2 , in a spot size of at least 0.05 mm 2 .

1 . An apparatus for photoselective vaporization of tissue of a female reproductive organ, comprising: 
 a laser producing laser radiation;    a hysteroscope, 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;    an 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 optical fiber includes one of a side firing tip and an end firing tip, and is further adapted for placement of said one of a side firing tip and an end firing tip within about 1 mm, or less, of the treatment area.    
   
   
       2 . The apparatus of  claim 1 , wherein the laser comprises a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 40 Watts average output power.  
   
   
       3 . The apparatus of  claim 1 , 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.  
   
   
       4 . The apparatus of  claim 1 , wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 700 nm, and has an average irradiance in the treatment area greater than 10 kiloWatts/cm 2  and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2  in the treatment area.  
   
   
       5 . The apparatus of  claim 1 , wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 700 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm 2  and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2  in the treatment area.  
   
   
       6 . The apparatus of  claim 1 , wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 700 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm 2  and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2  in the treatment area.  
   
   
       7 . The apparatus of  claim 1 , wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 700 nm, and has an average irradiance in the treatment area greater than 10 kiloWatts/cm 2 , and the optical fiber is adapted to cause a spot size is less than about 0.8 mm 2  in the treatment area.  
   
   
       8 . The apparatus of  claim 1 , wherein the laser and optical fiber are adapted to deliver average irradiance of at least 30 kiloWatts/cm 2  in the treatment area.  
   
   
       9 . The apparatus of  claim 1 , wherein the optical fiber includes a side firing tip.  
   
   
       10 . The apparatus of  claim 1 , wherein the optical fiber includes an end firing tip.  
   
   
       11 . The apparatus of  claim 1 , 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.  
   
   
       12 . The apparatus of  claim 1 , 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/cm 2  during the macro-pulse.  
   
   
       13 . An apparatus for photoselective vaporization of tissue of a female reproductive organ, comprising: 
 a laser producing laser radiation;    a hysteroscope, 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;    an 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 radiation has a beam quality (M 2 ) that is less than or equal to 100.    
   
   
       14 . The apparatus of  claim 1 , including a control system coupled to the laser, and controlling output of the laser so that the laser radiation has characteristics suitable to cause a treatment of wherein said tissue comprises uterine tissue, and said treatment is for a gynecological condition selected from leiomyoma uteri, rhabdomyoma, endometriosis, endometrial hyperplasia, endometrial cysts, endometrial polyps, menorrhagia, uterine septa, intrauterine adhesions, or cervical intraepithelial neoplasia.  
   
   
       15 . An apparatus for photoselective vaporization of tissue of a female reproductive organ, comprising: 
 a laser producing laser radiation having a wavelength in a range from about 200 nm to about 700 nm;    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;    the laser and optical fiber being adapted to deliver the laser radiation with an average irradiance in the treatment area greater than 10 kiloWatts/cm 2  and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2  in the treatment area; wherein the optical fiber includes one of a side firing tip and an end firing tip, and is further adapted for placement of said one of a side firing tip and an end firing tip within about 1 mm, or less, of the treatment area.    
   
   
       16 . The apparatus of  claim 15 , wherein the laser comprises a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 40 Watts average output power.  
   
   
       17 . The apparatus of  claim 15 , 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.  
   
   
       18 . The apparatus of  claim 15 , wherein the laser and optical fiber are adapted to deliver laser radiation having an average irradiance in the treatment area greater than 20 kiloWatts/cm 2 .  
   
   
       19 . The apparatus of  claim 15 , wherein the laser and optical fiber are adapted to deliver laser radiation having an average irradiance in the treatment area greater than 30 kiloWatts/cm 2 .  
   
   
       20 . The apparatus of  claim 15 , wherein the laser and optical fiber are adapted to deliver laser radiation having a spot size is less than about 0.8 mm 2  in the treatment area.  
   
   
       21 . The apparatus of  claim 15 , wherein the optical fiber includes a side firing tip.  
   
   
       22 . The apparatus of  claim 15 , wherein the optical fiber includes an end firing tip.  
   
   
       23 . The apparatus of  claim 15 , 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.  
   
   
       24 . The apparatus of  claim 15 , 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/cm 2  during the macro-pulse.  
   
   
       25 . The apparatus of  claim 15 , wherein the laser radiation has a beam quality (M 2 ) that is less than or equal to 100.  
   
   
       26 . The apparatus of  claim 15 , including a control system coupled to the laser, and controlling output of the laser so that the laser radiation has characteristics suitable to cause a treatment of uterine tissue, and said treatment is for a gynecological condition selected from leiomyoma uteri, rhabdomyoma, endometriosis, endometrial hyperplasia, endometrial cysts, endometrial polyps, menorrhagia, uterine septa, intrauterine adhesions, or cervical intraepithelial neoplasia.