Endoscopic laser scalpel for head and neck cancer surgery
Endoscopic laser scalpel for head and neck cancer surgery
复制标题
用于头颈癌手术的内窥镜激光手术刀
DOI：
10.1117/12.909172
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发表时间：
2012
影响因子：
2.6
通讯作者：
R. Toledo
中科院分区：
文献类型：
--
作者：
S. Patel;M. Rajadhyaksha;S. Kirov;Yongbiao Li;R. Toledo
微创外科技术，如腹腔镜手术和内窥镜检查，提供了可靠的疾病控制，减少了对患病器官功能的影响。外科激光可以消融、切割和切除组织，同时封闭小血管，将出血和肿瘤淋巴转移的风险降至最低。红外波长的激光很容易被水吸收，对邻近组织造成的热损害最小，是关键解剖结构附近手术的理想选择。管理信息系统技术在很大程度上无法采用激光的使用，部分原因是将激光带入内窥镜腔的困难。中空波导光纤已被改装为将外科激光引入内窥镜检查。然而，它们提供的光束发散迅速，需要小心地操纵光纤尖端相对于目标。因此，外科激光在管理信息系统手术中的主要障碍是缺乏有效的控制仪器来操纵体腔内的激光并将其准确地输送到目标组织。为了克服这一限制，我们设计并建造了一套内窥镜激光系统，其中包括微型双楔形光束转向装置、摄像机和用于远程和/或机器人操作的控制系统。双楔形Risley装置为内窥镜检查提供了最小的外形。临床规格和设计考虑将与设备的描述和其控制系统的发展一起提出。
Minimally invasive surgical (MIS) techniques, such as laparoscopic surgery and endoscopy, provide reliable disease control with reduced impact on the function of the diseased organ. Surgical lasers can ablate, cut and excise tissue while sealing small blood vessels minimizing bleeding and risk of lymphatic metastases from tumors. Lasers with wavelengths in the IR are readily absorbed by water causing minimal thermal damage to adjacent tissue, ideal for surgery near critical anatomical structures. MIS techniques have largely been unable to adopt the use of lasers partly due to the difficulty in bringing the laser into the endoscopic cavity. Hollow waveguide fibers have been adapted to bring surgical lasers to endoscopy. However, they deliver a beam that diverges rapidly and requires careful manipulation of the fiber tip relative to the target. Thus, the principal obstacle for surgical lasers in MIS procedures has been a lack of effective control instruments to manipulate the laser in the body cavity and accurately deliver it to the targeted tissue. To overcome this limitation, we have designed and built an endoscopic laser system that incorporates a miniature dual wedge beam steering device, a video camera, and the control system for remote and /or robotic operation. The dual wedge Risley device offers the smallest profile possible for endoscopic use. Clinical specifications and design considerations will be presented together with descriptions of the device and the development of its control system.