Nerve sparing treatment systems and methods

Abstract

Treatment systems are provided, which comprise a treatment element applying a treatment to a tissue, a stimulation element optically stimulating nerves in the tissue, a sensing unit sensing an electrical signal produced by nerves in the tissue in response to the optical stimulation, and a control unit controlling the application of the treatment according to the sensed signal. The systems and methods are used to avoid damaging nerves by sensing them during operation and immediately before local treatment application and preventing energy emission when the treatment tool is too close to specified nerves. Additional electric stimulation may be provided to enable avoidance of nerve damages on a larger scale, the treatment may be applied by a cold laser, and the control unit may control the treatment in realtime and in a closed loop and immediate prevent further treatment upon sensing optically stimulated nerves.

1 . A treatment system comprising:
 a treatment unit comprising a treatment element arranged to apply a treatment to a tissue,   an optical stimulation unit comprising an optical stimulation element arranged to optically stimulate nerves in the tissue,   a sensing unit comprising at least one sensing electrode arranged to sense an electrical signal produced by nerves in the tissue in response to said optical stimulation, and   a control unit arranged to control the application of the treatment in realtime and in a closed loop according to the sensed electrical signal.   
     
     
         2 . The treatment system of  claim 1 , wherein the optical stimulation element is configured to stimulate nerves in a larger tissue volume than the treated tissue volume. 
     
     
         3 . The treatment system of  claim 1 , wherein the treatment is optical and the optical stimulation element is configured to operate at a wavelength or a wavelength range that has a higher penetration coefficient in the treated tissue than a wavelength or a wavelength range in which the optical treatment element operates. 
     
     
         4 . The treatment system of  claim 3 , wherein the wavelength or the wavelength range in which the optical stimulation element operates is adjustable. 
     
     
         5 . The treatment system of  claim 1 , wherein the treatment is optical and the optical stimulation element is configured to have a larger incidence spot size than the optical treatment element. 
     
     
         6 . The treatment system of  claim 1 , wherein the treatment element is an ablative cold laser. 
     
     
         7 . The treatment system of  claim 1 , wherein the optical stimulation element is a non-ablative laser. 
     
     
         8 . The treatment system of  claim 1  wherein at least one of the treatment element and the optical stimulation element is a laser in a wavelength range within at least one of: 1.35-1.55 μm, 1.85-2.5 μm and 9-11 μm. 
     
     
         9 . The treatment system of  claim 1 , wherein the treatment element and the optical stimulation element are lasers which are delivered through at least one of: a single fiber, different fiber cores in a single fiber and different fibers; and differ in at least one of: their respective wavelength or wavelength ranges, their respective incident spot sizes, their respective tissue penetration coefficient and their respective numerical apertures. 
     
     
         10 . The treatment system of  claim 1 , wherein the treatment element is an optical fiber or a waveguide, and the sensing electrode is attached to or integrated in the treatment element. 
     
     
         11 . The treatment system of  claim 1 , wherein the sensing electrode is a non-contact sensor arranged to sense at least one of: a radiofrequency signal, an electric field and a magnetic field. 
     
     
         12 . The treatment system of  claim 1 , wherein the control unit is arranged to immediately prevent treatment application upon sensing, by the sensing unit, of the electrical signal produced by nerves in the tissue in response to said optical stimulation. 
     
     
         13 . The treatment system of  claim 1 , wherein the control unit is arranged to control the optical stimulation to intersperse the optical nerve stimulation among pulses of treatment application and to immediately prevent a consequent pulse of treatment application upon detection of nerve response to the optical stimulation. 
     
     
         14 . The treatment system of  claim 1 , further comprising an electrical stimulation unit arranged to electrically stimulate nerves, wherein the sensing unit is further arranged to sense an electrical signal produced by nerves in the tissue in response to said electrical stimulation. 
     
     
         15 . The treatment system of  claim 14 , wherein the optical stimulation element is configured to stimulate nerves in a larger tissue volume than the treated tissue volume, and the electrical stimulation unit is arranged to stimulate nerves in a larger tissue volume than the optically stimulated tissue volume. 
     
     
         16 . A treatment system of  claim 14 , wherein the control unit is arranged to provide an alert upon the sensing of the electrical signal in response to the electrical stimulation. 
     
     
         17 . A treatment system of  claim 14 , wherein the control unit is arrange to reconfigure treatment parameters upon the sensing of the electrical signal in response to the electrical stimulation. 
     
     
         18 . The treatment system of  claim 14 , wherein the electrical stimulation unit comprises an electrical stimulation element which is associated with the treatment element. 
     
     
         19 . A treatment system comprising:
 a treatment unit comprising an optical fiber arranged to apply a cold laser ablative treatment to a tissue, an optical stimulation unit arranged to optically stimulate nerves in the tissue,   an electrical stimulation unit arranged to electrically stimulate nerves,   a sensing unit comprising at least one sensing electrode arranged to sense an electrical signal produced by nerves in the tissue in response to said optical stimulation, and to sense an electrical signal produced by nerves in the tissue in response to said electrical stimulation, and   a control unit arranged to control the optical stimulation and the electrical stimulation and control the application of the ablative treatment in realtime and in a closed loop according to the sensed electrical signal produced by nerves in the tissue in response to said optical stimulation.   
     
     
         20 . The treatment system of  claim 19 , wherein the control unit is arranged to immediately prevent treatment application upon sensing, by the sensing unit, of the electrical signal produced by nerves in the tissue in response to said optical stimulation, and to modulate treatment application upon sensing, by the sensing unit, of the electrical signal produced by nerves in the tissue in response to said electrical stimulation. 
     
     
         21 . A method comprising configuring a tissue treatment system to optically stimulate nerves in the tissue, sense an electrical signal produced by nerves in the tissue in response to said optical stimulation and control the treatment according to the sensed electrical signal. 
     
     
         22 . The method of  claim 21 , wherein a treated tissue volume is arranged to be enclosed within a stimulated tissue volume. 
     
     
         23 . The method of  claim 21 , wherein the treatment is light-based and further comprising configuring the optical stimulation and the light-based treatment to differ in at least one of: their respective wavelength ranges, their respective incident spot sizes, their respective tissue penetration coefficient and their respective numerical apertures. 
     
     
         24 . The method of  claim 21 , further comprising immediately preventing treatment application upon sensing the electrical signal produced by nerves in the tissue in response to said optical stimulation. 
     
     
         25 . The method of  claim 21 , further comprising interspersing the optical nerve stimulation among pulses of treatment application and immediately preventing a consequent pulse of treatment application upon detection of nerve response to the optical stimulation. 
     
     
         26 . The method of  claim 21 , further comprising electrically stimulating nerves and sensing an electrical signal produced by nerves in the tissue in response to said electrical stimulation. 
     
     
         27 . The method of  claim 26 , wherein a treated tissue volume is arranged to be enclosed within an optically stimulated tissue volume and the optically stimulated tissue volume is arranged to be enclosed within an electrically stimulated tissue volume. 
     
     
         28 . The method of  claim 26 , further comprising providing an alert upon the sensing of the electrical signal in response to the electrical stimulation. 
     
     
         29 . The method of  claim 26 , further comprising reconfiguring treatment parameters upon the sensing of the electrical signal in response to the electrical stimulation.