Tissue treatment apparatus and methods

Abstract

Disclosed are apparatus, method, devices and instruments, including an apparatus that includes a flexible waveguide coupled to a supporting structure, and further coupled to a treatment tip. The apparatus also includes a beam controller to control application of a radiation beam emitted from the flexible waveguide to distribute the beam over an area different than an area covered by direct application of the beam to a single location on a target tissue. Further disclosed is an apparatus that includes a waveguide, coupleable to a laser source, and a thermal protection instrument. The thermal protection instrument includes a tissue contacting member to contact a part of an area of a tissue irradiated by laser radiation, and a beam blocking element to absorb at least some of radiation not absorbed by the area of the tissue, the beam blocking element being thermally isolated from the area of the tissue.

1 . An apparatus comprising:
 a flexible waveguide coupled to a supporting structure, and further coupled to a treatment tip, the flexible waveguide being coupleable to a laser source generating laser radiation and configured to deliver the laser radiation and to emit a beam of the generated laser radiation from a distal end of the flexible waveguide to irradiate a target tissue of a patient; and   a beam controller to control application of the radiation beam emitted from the flexible waveguide to distribute the beam over an area different than an area covered by direct application of the beam to a single location on the target tissue.   
     
     
         2 . The apparatus of  claim 1 , wherein the beam controller configured to control application of the radiation beam is configured to cause spatial movement of the distal end of the waveguide. 
     
     
         3 . The apparatus of  claim 1 , wherein the waveguide is integrated into the treatment tip. 
     
     
         4 . The apparatus of  claim 1 , wherein the flexible waveguide includes:
 a flexible waveguide configured to direct laser radiation generated by a CO2 laser system.   
     
     
         5 . The apparatus of  claim 1 , wherein the treatment tip comprises:
 one or more grasping jaws to grasp at least part of the tissue of the patient.   
     
     
         6 . The apparatus of  claim 5 , wherein the one or more grasping jaws include:
 a fixed grasping jaw; and   a moving grasping jaw configured to controllably move relative to the fixed grasping jaw.   
     
     
         7 . The apparatus of  claim 1 , wherein the radiation emitted from the distal end of the flexible waveguide is passed through a dedicated opening defined in the treatment tip before the radiation is applied to the target tissue. 
     
     
         8 . The apparatus of  claim 1 , wherein the beam controller comprises:
 a reflector to direct the radiation, emitted from the distal end of the flexible waveguide, to the target tissue.   
     
     
         9 . The apparatus of  claim 8 , further comprising:
 a housing containing the reflector, wherein the flexible waveguide is fixedly secured to the housing such that the distal end of the flexible waveguide is maintained in a fixed position relative to the housing.   
     
     
         10 . The apparatus of  claim 8 , wherein the reflector defines a substantially concave surface in one direction and further defines a convex surface in another direction, the surfaces of the reflector causing the radiation to be reflected from the surfaces to be distributed substantially uniformly to form a shape of a line on the cut tissue. 
     
     
         11 . The apparatus of  claim 8 , wherein the reflector comprises:
 a scanning reflector configured to spatially move to direct the radiation emitted from the distal end of the flexible waveguide to different locations on the target tissue.   
     
     
         12 . The apparatus of  claim 11 , wherein the scanning reflector is configured to converge the reflected beam to a shape of a small spot. 
     
     
         13 . The apparatus of  claim 1 , wherein the beam controller comprises:
 a curved spatial reflector having pre-determined geometry and configured to direct the radiation emitted from the distal end of the flexible waveguide so that the directed radiation is substantially distributed over a section in the target tissue according to a pre-determined cutting geometry resulting from the pre-determined geometry of the curved spatial reflector.   
     
     
         14 . The apparatus of  claim 13 , wherein the resulting shape is similar to one of an ellipse and a rectangle, with one axis of the one of the ellipse and the rectangle having narrow dimensions such that a resulting cut in the tissue is substantially a thin line. 
     
     
         15 . The apparatus of  claim 1 , wherein the beam controller comprises:
 an actuator to actuate at least the distal end of the flexible waveguide to cause the distal end of the flexible waveguide to spatially move.   
     
     
         16 . The apparatus of  claim 15 , wherein the actuator configured to actuate the at least the distal end of the flexible waveguide is configured to:
 actuate the at least distal end of the flexible waveguide to cause the radiation emitted from the distal end of the flexible waveguide to be applied to different locations of the target tissue in a scanning pattern.   
     
     
         17 . The apparatus of  claim 1 , wherein the beam controller is further configured to:
 control the power density of the laser radiation by varying the distance between the distal end of the flexible waveguide and the target tissue.   
     
     
         18 . The apparatus of  claim 1 , wherein the beam controller comprises:
 a controllably displaceable scanning tip coupled to the waveguide; and   an actuator to actuate the scanning tip, the actuation of the scanning tip causing the scanning tip to be controllably displaced to apply the radiation energy delivered via the waveguide to different locations of the target tissue in a scanning pattern.   
     
     
         19 . The apparatus of  claim 18 , wherein the waveguide further comprises the scanning tip. 
     
     
         20 . The apparatus of  claim 18 , wherein the actuation of the scanning tip causing the tip to be controllably displaced causes one or more of: controllable linear displacement, and controllable radial displacement of the scanning tip over an angular range. 
     
     
         21 . The apparatus of  claim 18 , wherein the scanning tip coupled to the waveguide is secured to the treatment tip. 
     
     
         22 . The apparatus of  claim 21 , wherein the treatment tip includes an inner channel extending to an opening defined on an external surface of the treatment tip, the inner channel structured to receive at least a portion of the waveguide. 
     
     
         23 . The apparatus of  claim 1 , further comprising:
 a moveable radiation protector to, when actuated to a blocking position, prevent radiation emitted from the distal end of the flexible waveguide from propagating beyond the target tissue of the patient.   
     
     
         24 . The apparatus of  claim 1 , wherein the supporting structure includes one of: a hollow tube, a shaft, and a scope-based device. 
     
     
         25 . The apparatus of  claim 1 , wherein the treatment tip is pivotably coupled to the supporting structure at a hinged location. 
     
     
         26 . A method comprising:
 coupling a flexible waveguide configured to deliver laser radiation to a treatment tip coupled to a supporting structure;   coupling the laser radiation generated by a laser source to the flexible waveguide; and   controlling application of a radiation energy beam emitted from a distal end of the flexible waveguide to distribute the beam over an area different than an area covered by direct application of the beam to a single location on a target tissue of a patient.   
     
     
         27 . An apparatus comprising:
 a waveguide coupleable to a laser source generating laser radiation; and   a thermal protection instrument including:
 a tissue contacting member to contact a part of an area of a tissue irradiated by laser radiation emitted from an emitting end of the waveguide, and 
 a beam blocking element to absorb at least some of radiation not absorbed by the area of the tissue, the beam blocking element being thermally isolated from the area of the tissue. 
   
     
     
         28 . The apparatus of  claim 27 , wherein the tissue contacting member includes an opening to enable the at least some of the radiation not absorbed by the area of the tissue to reach the beam blocking element. 
     
     
         29 . The apparatus of  claim 27 , wherein the thermal protection instrument further comprises:
 a thermal insulation layer positioned between the tissue contacting member and the beam blocking element.   
     
     
         30 . The apparatus of  claim 29 , wherein the tissue contacting member and the thermal insulation layer include at least partly overlapping respective openings to enable the at least some of the radiation not absorbed by the area of the tissue to reach the beam blocking element. 
     
     
         31 . The apparatus of  claim 27 , wherein the tissue contacting member is a thermally insulation layer. 
     
     
         32 . The apparatus of  claim 27 , wherein the thermal protection instrument is a backstop coupleable to a supporting structure. 
     
     
         33 . The apparatus of  claim 27 , wherein the thermal protection instrument further comprises:
 an external thermal insulation layer coupled to an external-facing surface of the beam blocking element, the external thermal insulation layer configured to prevent thermal damage to neighboring tissue areas.   
     
     
         34 . The apparatus of  claim 27 , further comprising:
 a grasping device including:
 an energy emitting member coupled to the emitting end of the waveguide, the energy emitting member configured to grasp another part of the area of the tissue being treated; and 
 the thermal protection instrument, wherein the tissue contacting member of the thermal protection instrument is positioned opposite the energy emitting member. 
   
     
     
         35 . The apparatus of  claim 34 , wherein the radiation emitted from the emitting end of the waveguide is passed through an opening defined in the energy emitting member before the radiation is applied to the area of the tissue being irradiated, and wherein the at least some of the radiation not absorbed by the area of the tissue is passed through another opening defined in the tissue contacting member such that the at least some of the radiation not absorbed by the area of the tissue is received by the beam blocking element. 
     
     
         36 . The apparatus of  claim 27  further comprising:
 a beam controller to control direction of the radiation emitted by the waveguide to apply the radiation to different locations of the area of the tissue, the beam controller including one or more of: 
 a reflector to direct the radiation emitted from the emitting end of the waveguide to the area of the tissue, 
 an actuator to actuate at least the emitting end of the waveguide to cause the emitting end of the waveguide to spatially move, and 
 a controllably displaceable scanning tip coupled to the waveguide, and an actuator to actuate the scanning tip, the actuation of the scanning tip causing the scanning tip to be controllably displaced to apply the radiation energy delivered via the waveguide to different locations of the area of the tissue in a scanning pattern. 
 
     
     
         37 . The apparatus of  claim 27 , further comprising:
 a heat removal mechanism to remove heat resulting from at least some of the absorbed radiation from the beam blocking element.   
     
     
         38 . The apparatus of  claim 27 , further comprising:
 a thermal sensor to measure the temperature of the beam blocking element.   
     
     
         39 . The apparatus of  claim 38 , further comprising a controller to control the radiation emitted from the emitting end of the waveguide based on the measured temperature of the beam blocking element. 
     
     
         40 . A method comprising:
 contacting a part of an area of a tissue with a tissue contacting member coupled to a beam blocking element, the beam blocking element being thermally isolated from the area of the tissue; and   applying laser radiation to the area of the tissue, wherein at least some of the radiation not absorbed by the area of the tissue is absorbed by the beam blocking element, the thermal isolation of the beam blocking element from the area of the tissue substantially preventing heat resulting from the at least some of the radiation absorbed by the beam blocking element from being directed to any part of the area of the tissue.   
     
     
         41 . The method of  claim 40 , wherein contacting part of the area of the tissue with the tissue contacting member comprises:
 contacting part of the area of the tissue with the tissue contacting member coupled to a thermal insulation layer positioned between the tissue contacting member and the beam blocking element.   
     
     
         42 . The method of  claim 40 , wherein applying laser radiation comprises:
 applying the radiation based on temperature measured at the beam blocking element.   
     
     
         43 . A thermal protection instrument comprising:
 a tissue contacting member to contact a part of an area of a tissue irradiated by laser radiation emitted from an emitting end of a waveguide, the waveguide being coupleable to a laser source to generate the laser radiation; and   a beam blocking element to absorb at least some of radiation not absorbed by the area of the tissue, the beam blocking element being thermally isolated from the area of the tissue.