CA2304477A1

CA2304477A1 - Handpiece with coolant reservoir

Info

Publication number: CA2304477A1
Application number: CA002304477A
Authority: CA
Inventors: Jonathan M. Baumgardner; David R. Hennings; Bruce J. Sand; Gerald Elsbach
Original assignee: Individual
Current assignee: New Star Lasers Inc
Priority date: 1997-09-26
Filing date: 1997-09-30
Publication date: 1999-04-08
Also published as: WO1999016369A1; EP1030611B1; EP1030611A1; ES2227733T3; US5976123A; DE69730538D1; AU8655398A; DE69730538T2; EP1030611A4; AU743307B2

Abstract

A cooling handpiece (100), and method for use in therapeutic, cosmetic or aesthetic, diagnostic, exploratory, intervention or other medical procedures;
and the handpiece for use in conjunction with a controllable energy source such as coherent light, non-coherent light or laser light, ultrasound energy, radio frequency energy, other types of electromagnetic, and mechanical energy;
the hand piece (100) comprising a main body portion adapted for directing the energy to target tissue, the main body portion further adapted for receiving a removable reservoir containing coolant fluid, the reservoir (101) having an attachment means (98) for releasable attachment of the reservoir (101) to the handpiece (100), and the handpiece (100) having a controllable valve (208) for delivery of a portion of the coolant fluid to the target tissue.

Description

HANDPIECE WITH COOLANT RESERVOIR
RELATED APPLICATIONS
This is a c~~ntinuation-in-part of U.S. Patent Application Serial No.
081692,929 filed Jul. 30, 1996.
FIELD OF THE INVENTION
IO This inven~ ion relates to cryogenic cooling in conjunction with laser or other energy delivery devices, in;,luding laser, radio frequency, ultrasound and other sonic energy, electromagnetic, cl emical, mechanical and other types of energy, for use in medical and other applications, and n ..ore particularly, to a handpiece with a removable coolant fluid reservoir for use in surgical, aes hetic, den~natoiogy, intervention, diagnostic and other medical methods and techniques utilizing flushing and/or cooling.
BA~:KGROUND AND ADVANTAGES OF Tl-IE INVENTION
In medical and other types of laser applications, laser delivery handpieces are widely used. With the development of optical fibers and solid-state lasers, complex arrangements of collimating lenses, mirrors and filters have been replaced with small, efficient laser deliven~
devices utilizing fit er optics.
U.S. Paten t No. 5,020,995 issued Jun. 4, 1991 to Levy teaches a surgical treatment and method for cut ing tooth tissue. A handpiece for cutting dentin and enamel is disclosed which contains a h. allow tube connected to an external source of cooling fluid. The apparatus has a number of dr iwbacks, however, including the need for peripheral tubing and other connections to cont rol and laser source. In practice, these plurality of external connections make the device av kward to use. Furthermore, if the coolant source is located farther than about 0.5 to about 1.0 meter from the outlet end positioned to direct coolant onto the tissue being cooled, either ~ significart insulation is rcquired or a considerable purge time will be necessary to deiive ~ coolant fluid at a low temperature to the desired location on demand.
U.S. Patent No. 5,344,418 issued Sep. 6, 1994 to Ghaffari teaches an optical system for treatment of va icular lesions. In addition to the drawbacks noted above, principally the need for external connec lions and complicated piping, insulation and purging requirements, the cooling system in c itended to cool the sapphire lens of the system. The patent also refers to a system for the cont rol of skin temperature.
Recently, :. great deal of attention has been given to selective cooling of biological tissue during them ally mediated therapeutic procedures. B. Anvari et al., Selective Cooling of Biological Tissues: Application for Thermally Mediated Therapeutic Procedures, Phys. Med.
Biol. 40 (1995) 24 f-252. Methods and systems have been proposed based on models of heat conduction in varic us types of tissue at various levels beneath the skin. In certain dermatological apx lications the objective has been to produce a photo and/or thermal effect primarily to subsurface tissue, without destroying or altering superficial structures. Examples of such procedures include laser treatment of port wine stains and the clinical treatment of other dermatoses, l aions and tattoos. Experiments have been performed that use, for example, infrared radiometn ~ to measure the thermal response of in vivo human skin to cooling by a cryogen spurt.
While a innmiation has been gained from these studies and others about the effect of such cooling on bic logical tissue during such operations, very little effective or e~cient equipment is coma ercially available. Often, applying spurts of cryogenic materials to a site of laser delivery resin s in splashing of the cryogenic liquid and/or unconfined and uncontrollable cooling.
Therefore, it is an advantage of the present invention to provide an improved handpiece for performing they many mediated medical, therapeutic, cosmetic and other procedures with selective cooling of surface tissue.
It is a furtl per advantage of the present invention to provide a light, unrestricted handpiece for such procedures.
It is a further advantage of the present invention to provide an apparatus with an on-board cryogen or o:her coolant fluid reservoir.
It is a further advantage of the present invention to provide such apparatus which allows visualization ~ of the remaining amount of coolant fluid and which is refillable.
It is a furtl ~er advantage of the present invention to provide such apparatus in which both coolant and la ser energy are both delivered in a controlled, confined manner to avoid delivery of both ia: er energy and coolant to undesired locations.
It is a iurti per advantage of the present invention to provide such apparatus with a refillable cryogen f luid reservoir.
It is a furtl per advantage of the present invention to provide such apparatus with a removable cryogen fluid reservoir.
! 5 It is a furtl per advantage of the present invention to provide a handpiece for delivering energy such as froi n a laser or other therapeutic device to target tissue, the handpiece having an on-board cooling s stem comprising individual disposable or re-usable cylinders or cartridges of cryogen or other cooling fluid which couple to the handpiece and can be replaced conveniently and e' 1'tciently as needed.
It is a further advantage of the present invention to provide a handpiece with coolant for delivering enerl y, including laser, radio frequency, ultrasound and other sonic energy, electromagnetic, cl.emical, mechanical and other types of energy.
It is a furtl per advantage of the present invention to provide methods of using such apparatus, in medi~;al and aesthetic procedures including but not limited in any way to wrinkle removal, hair remc val, tattoo removal, part-wine and other pigmentation adjustment, etc.

It is a furtl per advantage of the present invention to provide apparatus and methods for reformation of coil igen.
SUMMARY OF THE INVENTION
The invent ion is a handpiece for use in therapeutic procedures employing selective cooling. The appar ~tus is intended for use in conjunction with a controllable laser source or other type of energ I delivery device, including radio frequency devices, ultrasound devices, etc.
The apparatus con prises a handpiece portion for physically manipulating and controlling the apparatus, an ever, y delivery means for controllably delivering a predetermined amount of energy to a presele ;ted surface area, coolant reservoir means having a predetermined volume, cryogen fluid conti fined in the reservoir means, releasable attachment means for securely and releasably couplinf; the reservoir to a valve means, the valve means for controllably delivering a portion of the cn ogen fluid to the preselected surface area.
A preferre i embodiment comprises delivery tube means having a proximal and a distal end, the laser deliv ;ry means and the valve means coupled to the delivery tube such that both the laser energy an i the portion of the predetermined volume of cryogen are controllably delivered to the prc selected surface area. In a preferred embodiment, the reservoir comprises a transparent tube, tl ms providing a visual indication of the volume or cryogen fluid remaining in the reservoir. 1n a 1 preferred embodiment, the valve means comprises a controllable solenoid valve. A preferred :mbodiment, comprises a laser delivery means focusing means.
The preser t invention is an improved method and device for reformation of collagen. In a preferred embodi;nent, collagen connective tissue in skin can be contracted or shrunk instantaneously, th rs tightening the overlying tissue without the superficial damage or destruction associa ted with other techniques of superficial skin resurfacing.
In another preferred embodim ant, the method and device is highly beneficial in therapeutic contraction of the collagen connu;tive tissue within the musculo-skeletal system. Superficial heat exchange by means of a dynami ; cooling process enhance these modalities by eliminating pain or discomfort and reducing any r sk of superficial destruction of the skin tissue.
The preser t invention is a method for reformation of collagen tissue comprising the step of irradiating r he tissue with laser energy having a wavelength in the range of about 1 to about 12 microns. tn a preferred embodiment, the temperature of the collagen is raised to between about 58 ~ nd about 62 degrees Celsius. In a preferred embodiment, the energy has a wavelength in the z ange of about 1.2 to about 1.8 microns. In a preferred embodiment, the energy has a wavel ength of about 1.3-1.4 microns. In a preferred embodiment, the energy is delivered in a continuous wave. In a preferred embodiment, the energy is delivered in a pulsed mode. In a preferre d embodiment, the pulse rate of delivery of the laser energy is such that the pulses of energy ar: delivered within the thermal relaxation time period for the given volume of tissue being therma lly treated. In a preferred embodiment, the total energy delivered is in the range of about 4 tc about 50 joules per square centimeter.
Skin which is subjected to long-term sun exposure exhibits a variety of clinical changes which have been attributed to aging. The major histopathological finding in photoaging is the accumulation of m iterial in the papillary dermis which has staining characteristics similar to elastin and, therefc re, the condition is termed "solar elastosis".
Solar Blast Isis replaces the nomtal collagen in the papillary dermis which results in the clinical changes observed in photoaged skin such as wrinkles. Increased collagen degradation occurs from the U'I exposure which has been shown to stimulate collagenase production by human fibroblasts and to upregulate collagenase gene expression.
Collagen p roduction, however, remains unchanged in this condition. The net result is, therefore, a relative; decrease in the steady-state collagen levels in photoaged skin, predominately in tl .e papillary dermis.

Although 1 here is no established histological finding which directly correlates with the appearance of writ kung in photodamaged skin, it has been accepted that a net reduction in collagen levels is tl ~e etiologic component. This is based upon the hypothesis that collagen provides the cutanc:ous strength and resiliency.
In addition to these anatomical factors, clinical improvement in wrinkles has been histologically corn fated with collagen synthesis in various cutaneous treatment modalities.
These include chenucal cutaneous peels, dermabrasion, use of topical tretinoin and laser assisted skin resurfacing.
The mech~ nism of wrinkle reduction is, therefore, based upon the reversal of the net collagen reduction stimulated by solar exposure. The net gain of collagen in the papillary dermis results fron. a biological response to iatrogenic injury, whether by chemical, mechanical or laser-induced tr: puma. The biological response is in the form of the complex sequence of events incorporates t in the wound repair process culminating in, among other factors, histological, immmohistological and in situ hybridization evidence of new collagen synthesis in IS the papillary dermis.
The preset t invention is, therefore, a method for the reduction of the fine wrinkles which result from 1 rhotodamage to the skin.
Since the s uperficial skin layer, the epidermis, plays no role in the reduction of wrinkles by the ref ~rmation of collagen in the papillary dermal layer of the skin, there would be a distinct advantag ~ gained by protecting this outer layer during the process of inciting a wound healing response in the dermal layer.
It is an ad~ ~antage of the present invention, therefore, to provide a controllable dynamic cooling process to prevent said epidermal damage by means of the disclosed handpiece with coolant reservoir.
Numerous other advantages and features of the present invention will become readily apparent from the ~ bllowing detailed description of the invention and the embodiments thereof, from the claims an, i from the accompanying drawings in which the details of the invention are fully and complete: y disclosed as a part of this specification.
HRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a representative section view of a preferred embodiment of a cooling handpiece with refillable coolant reservoir of the present invention.
FIG. 2 is a representative detail section view of the distal end of a preferred embodiment of a a poling handpiece with removable coolant reservoir of the present invention.
FIG. 3 is a representative section view of a preferred embodiment of a coolant reservoir of the prE sent invention.
FIG. 4 is 2 representative section view of a preferred embodiment of a fluid level indicator accessory of the present invention.
FIG. 5 is a representative perspective view of a preferred embodiment of a cooling handpiece with refi liable coolant reservoir of the present invention.
FIG. b is a representative section view of another preferred embodiment of a coolant reservoir of the pre sent invention.
FIG. 7 is a graph demonstrating the temperature gradient through a portion of the skin withoutgrecooiing, as a function of both the wavelength of incident laser energy and the depth of laser radiation p ~netration.
FIG. 8 is a graph demonstrating the temperature gradient through a portion of the skin with rep cooling as a function of both the wavelength of incident laser energy and the depth of laser radiation pen~;tration.

DETAILED DESCRIPTION OF THE INVENTION
The feasib.lity of selectively cooling biological tissues has been explored experimentally. Ini cared radiometry can be used to measwe the thermal response of in vivo human skin to cooling by a cryogen spwt. One model assumes a two-layered semi-infinite medium consisting of skin in contact with a cold film whose thiclrness may change with time.
The term "boundar y layer" refers to a film of cryogenic material in contact with both air and skin. When cryoge i is spurted onto the skin surface, skin temperature is reduced as a result of supplying the laten t heat of vaporization. As the skin surface temperature approaches the boiling point of the cryogen, the rate at which cryogen droplets evaporate becomes less than the accumulation rate ~ ~r cryogen on the surface.
FIG. 1 is a representative section view of a preferred embodiment of a cooling ha,ndpiece with refi liable coolant reservoir of the present invention. FIG. 2 is a representative detail section view of the distal end of a preferred embodiment of a cooling handpiece with removable coolant reservoir of the present invention. The handpiece 100 has a housing 101 with a proximal en i 100a and a distal end 100b.
A laser or ether functional or interventional energy source (not shown) is connected to an energy delivery means 102. Energy delivery means 102 typically comprises a single optical fiber, e.g. 400 mice on diameter, a fiber optic cable, a fiber bundle or other fiber optic laser delivery device. W file the present invention may be fully operable and efficacious utilizing a C02 laser, it will t c understood that the present invention is especially suited for use with those energy sources capable of being transmitted conveniently via optical fibers.
These include white light, infrared energy, Q-switched ruby lasers, flashlamp-pumped type pulsed dye lasers, Nd:YAG, Holmiur i-type and other solid-state lasers in use and known currently or in the future.
Moreover, the handpiece may optionally utilize any other operative energy sowce or functional device, i ncluding infrared or ultraviolet, x-ray or radio frequency delivery means, coherent or non-co ierent energy, ultrasound delivery means, mechanical cutting tools, drilling apparatus, etc., or ybmbination of the above, Applications which induce a thermal effect in the tissue can be contr gilled using the handpiece of the presern invention, and applications which utilize tissue caolir g in their performance are all included within the scope of this invention.
A distal ecd 104 of the energy delivery device 102 is fixed within the distal end 100b of the handpiece b~ ~ SMA connector 98. The SMA connector is threaded onto a nipple 96 which itself is thre; ~ded into housing 101. An optional lens or other energy focusing device 106 is disposed adjacer t the distal end 104 of the energy delivery device 102, and threaded nipple 96 allows for mam.al adjustment and precise orientation of distal end 104 of energy delivery device 102 and foc ising means 106. It will be understood that a great variety of design factors must be considerec and will be included in the scope of the present invention.
Providing focusing means eit ier integral with or separate from the laser or other energy delivery means allows flexibility a . treatment or coverage, allows creation of different spot sizes and other parameter optimize xion depending upon the application, e.g. wrinkle removal, collagen shrinking, collages stimulation or synthesis, blanching of port wine stains, photoablation in a cutting or tissue re noval application, etc. It will be understood that in other preferred embodiments the focusing lens 106 is optionally located elsewhere within the apparatus 100, and in other prefer ~ed embodiments a plurality of focusing means are located at different positions within th~: apparatus 100.
A transpaZ rnt delivery tube I08 is mounted adjacent the distal end 100b of the handpiece 100 in o aerative relationship with the distal end 104 of the energy delivery device 102 and the option ~1 Iens or other focusing device 106. Thus, laser or other energy which enters the delivery tube 108 radiates therefrom at distal end 110. The length of the delivery tube may vary dependin g upon the desired spot size, the need to provide an extending tip and the type of laser delive y means used. The focusing means is also adjustable in preferred anbodiments. Typical laser delivery device delivery tubes such as those known as d iece Extenders, Part Nos. RD-1100 and RD-1200 made by Spectrum Medical Technologies, Inc. in Natick Mass. are c ~mmercially available.
The deIive y tube 108 is preferably transparent and tubular, but can have a plurality of different cross sect.onal geometries. A preferred embodiment is about 4-5 centimeters is length, but can be longer c r shorter, depending upon desired spot size, etc. Adjacent the distal end 110 of the delivery tubs 108 there is a coolant port l lZ which directs coolant toward the distal end 110 and target tiss~ ie, as desired. The design of delivery tubs 108 will prevent possible "fly-away" of ablated ti asue, cells or blood, providing protection from cross contamination for other inhabitants and eqi ipment in the operating room. The tube will also direct the fluid cryogen to specific areas conv:niently. Waste of cryogen and loss of containment thereof as well as the risk for unintended contact with the cryogen is also minimized thereby.
An additio gal advantage of the delivery tube 108 of the present invention is to provide a means for markir $ the surface of the tissue which has been treated or visualized, etc. Small pressure marks, indentations, or other markings, dyes, etc. can be formed or released by the distal end 110 of tt a delivery tube I08. Thus, in the example of wrinkle removal using laser energy, the surface of skin which is irradiated and cooled using cryogen or other coolant bears no immediate visu~ 1 indication of having just been treated, and the operator is thus aided by the visual indications i .jade by the distal end 110 of the delivery tube 108.
Adjacent t)ie proximal end 11Z of the delivery tube 108, air vent 114 allows air or other fluid or gas t« be flushed across outer surface 107 of tens means 106.
In the absence of the vent 114 and fl swing gas, other means may be used to prevent accumulation and consequential fogg ng or other distortion of focusing means I06 by condensation of water or other vapor on the cuter surface 107 of focusing means i06. Such means could include means for heating the lens and preventing condensation of vapor theueon.
Providing , ~ transparent delivery tube I08 also provides the physician or technician with an unobstruct ;d view of the treatment in progress. Preferred embodiments have enhanced transmitting featun;s, including anti-reflection coatings to protect the internal optical system and eliminate the p ~tential for energy backlash, and perpendicular positioning means which reduce the risk of r ~flected light which could otherwise create a vision hazard in the operating room.
A thermal feedback system comprises a lens 120 for focusing a detected infrared output from the tre ited and/or cooled target tissue onto a thermal sensor 122. Such thermal sensor 122 can be , u~y operative thermal sensor such as a thermopile, etc. A
typical sensed output from cooled target tissue is radiation at about 10 microns, or more or less, and will be a function of the type : of thermal sensor 122 selected. A feedback signal is transmitted via sensor output 124 to the c ~ntral processing unit of the energy delivery device, such as an on-board controller for a las~.r system. As mentioned above, various control schemes, protocols and other methods are l gown to those skilled in the art and will additional and new ones will be apparent. The nrP~ ;. ; uwention is intended to provide a novel apparatus for effecting these protocols. Such prntocol might call for i~~~;"" ~~ps including laser operatic.. ~~u c;ontroller tests, delivery mee, ~s integrity and connection tests, and thermally sensing the status of the target tissue. Durir g operation, the temperature of the target tissue can be sensed continuously or at discrete time points. Excessive pre-cooling, simultaneous cooling and post-cooling of the target tissue can be avoided, thereby preventing tissue damage due to excessive cooling, and other thermal medi ition of surface strata of the target tissue during thermal treatment of sub-surface strata, etc.
FIG. 3 is a representative section view of a preferred embodiment of a coolant reservoir 200 of th ; present invention. Reservoir 200 consists of a cylindrical tubular outer wall 202, an integr ally fonned sealed portion 204 at a proximal end 206 and a valve assembly 208 at a distal end 210. The proximal end 206 can also be capped or closed with a removable portion so as to all ~w filling from either end. The valve assembly 208 comprises a valve actuator 212 and n gale threaded portion 214, and is coupled to a plug portion 216 mounted within the distal eni 210 of the reservoir 200. Sealing o-rings 218 are used between the tube 202 and the plug 216, between the plug 216 and the valve assembly 208, and adjacent the valve actuator 212. Rese rvoir chamber 220 contains a certain volume of cryogenic fluid or other coolam. In a prefer red embodiment, the reservoir 200 consists of a tube 202 between about 0.25 and 1.0 inches. in diameter, or narrower or wider, and between about 4.0 and 8.0 inches long, or shorter or longer, manufactured out of plastic, glass or other suitable material.
In preferrej embodiments, the reservoir 200 can be either refillable or replaceable. In the refillable embodiment, suitable nozzle cap or other fill means is provided on the reservoir 200. In the replace able embodiment, the reservoir is a disposable canister which can be purchased in advat .ce and stocked at the hospital or clinic. A suitable attachment or mounting IS ~ means is provided :o conveniently, efficiently and safely remove an empty reservoir when empty and replace it with a full canister. The reservoirs have either threaded end fittings or bayonet-type locku ~g means for providing a leak-proof, secure attachment between the reservoir 200 and ~ est of the handpiece 100. It will be apparent to those skilled in the art that the disposable and replaceable coolant reservoirs 200 can be manufactured with a wide range of variation in atta~;hment means, volume, shape and materials, all of which are included in the scope of this inven ion.
In a preferred embodiment, the reservoir chamber 220 has a volume of between about 10 and 500 milliliL;rs, or more or less as may be desired or necessary for particular applications. Freor and liquid C02 have been widely used cryogens and are well known in the field of cryosurgery. Another appropriate cryogen spray would be 1, 1, 1, 2 -tetrafluoroethane, CiH2F,, an enviror. mentally compatible, non-toxic, non-flammable freon substitute. Other cryogens, such as 34R (also a freon substitute), may also be used, and based upon this description will be apparent to those skilled in the art.
FIG. 4 is a representative section view of a preferred embodiment of a fluid level indicator adapter 2 50 of the present invention. As shown, reservoir 200 threads into female threaded portion w uch results in valve assembly 208 opening and allowing coolant to flow from reservoir chap nber 220 through valve assembly 208 and through coolant channel 254 in body 256 of adapter 250. Channel 254 empties into sight glass chamber 260 which is visible through window 2~.2 in body 256 of the adapter 250 and through window 117 of handpiece housing 102. Addis tonal sealing o-rings 264 are shown. At the distal end 280 of the adapter 250, optional valve assembly 270 comprising insert portion 272 and valve actuator 274 serves to seal the adapter at that end in the situation where the adapter 250 is removed from the handpiece 100 whi .e a reservoir 200' containing coolant is coupled thereto.
At the proximal end 282 of the adapter 250, adapter vent holes 122 allows venting of any coolant remaining in the sight glass chambe r 260 during disassembly of the apparatus.
A safe, rec undant, security locking system between the coolant reservoir 200 and adapter 250 comps ises a threaded portion 252 and corresponding threaded portion on reservoir 200' and set screw 292. It will be understood that the reservoir 200 can be mounted onto the adapter 250 either oefore or after the adapter 250 is coupled to the handpiece 100. In either case, the adapter 2 ~0 slides into recess 103 in handpiece 100 such that insert portion 272 is disposed within rec eiving base 105, and bayonet pin 290 engages pin slot 207 at the proximal end IQOa of the ha idpiece 100. It will be understood that the receiving recess 103 can be any operative mounting opening, slot, flange, area, pad, surface etc.
Additionally, set screw 292 can be threaded tlu ough the proximal end 282 of the adapter 250 so as to prevent release of the reservoir 200 from the bayonet mount of the adapter 250.

Coolant is delivered from the reservoir 200 through controllable cryogen valve 307.
Valve 307 can be F low-temperature solenoid-type valve which delivers spurts of cryogen as desired. Common :.utomotive or other industrial liquid fuel injectors can also be used. Delivery of spurts between ; .bout 10 milliseconds and about 500 milliseconds in length are possible with various types of va lves. Typically, the solenoid-type valve 307 is able to withstand pressures of up to about 80 to 100 PSI and temperatures as low as about -30 to -40 degrees Celsius.
After pass ng through the valve 307, the cryogen is directed through channel 109 and into the delivery to ~e 108 at channel port 112. Controller wires i 16 will actuate the valve means, as desired, allowing cryogen to flow into the delivery tube 108. In a preferred embodiment, a spr, Dying nozzle means is employed such that the cryogen is sprayed onto a preselected surface area in a predetemuned pattern or at a predetermined flowrate, velocity, etc.
As describ ~d above, various dynamic cooling protocols, methods and systems are well known for use witt thermally mediated treatment of biological tissue and other materials.
Simultaneously or alternatingly, predetermined amounts of laser energy as well as cryogenic coolant can be deli rered to the operating site precisely according to temperature and position sensors and on-boy rd computing means associated with the laser source.
Controllers based upon theoretically-ierived or actually measured operating parameter data will allow the physician or techni ~ian to maintain a predetermined thermal gradient or temperature profile throughout certain preselected tissue. These control schemes will be possible with the apparatus of the pr esent invention and particular or individual control schemes for specific applications will b~: apparent to those skilled in the art. A preferred embodiment of the present invention includes s timing circuit to control according to predetermined operating parameters time and rate of la: er energy delivery, time and rate of cryogen delivery, sequencing and overlap of those e~ ants with ablation, cooling periods, etc.
la Other pref ;rred embodiments of the present invention comprise temperature sensors located at various 1 positions, such as at a distal end of the delivery tube.
The temperature sensor will sense the temp ~rature of either the tip of the delivery tube, the skin upon which the laser energy and the coo ant are directed, or both. Temperature probes and methods are well known in the art. Such ten vperature sensors operate in a variety of different ways, including black-body type radiatioi . sensors, themwcouples, thermometers, etc. The temperature sensor provides inforn~ati~ m to a controller with feedback control of the laser, coolant delivery switch, etc.
A preferre~ i embodiment of the present invention comprises a laser and/or cryogen interlock system. v ~ the event the handpiece is held such that vapors in the reservoir are delivered before lic uid, a substantial decrease in cooling effect is observable. Venting of cryogen fumes is v ;ry inefficient relative to the degree of cooling which can be achieved using liquid cryogen. Un ess the surgeon is careful, during operation the handpiece can be manipulated in suc i a way as to tilt or tum the handpiece so that the liquid cryogen flows away from the solenoid c r other flow valve. To prevent discharge of vapors, and sometimes more importantly, to pre rent delivery of laser energy in the absence of sufficient coolant an interlock system is used. Th: s system can be configured in a number of different ways, as will be apparent to those s gilled in the art. Mercury switches to prevent switch actuation at certain orientations are wi~ iely used. Integrated circuits and other types of microprocessors or nucro-devices are.also av iilable for such level control. Such a device ensures adequate orientation, such as a vertical I osition, of the handpiece prior to delivery of laser energy. Additionally, the interlock can be tie d into a temperature sensor/control circuit. Such a circuit ensures a suitably low temperature at the skin surface or at a distal point on the valve or delivery tube prior to permitting delivery of laser energy. Another embodiment of the preferred embodiment measures fluid flow through the valve. Such apparatus prevents delivery of laser energy until and unless WO 99!16369 PGT/US97/18115 fluid cryogen is flo wing at a predetermined minimum rate.
FIG. 5 is a representative perspective view of a preferred embodiment of a cooling handpiece with refs !!able coolant reservoir of the present invention. At the proximal end IOOa of the handpiece 11 t0 there is a strain relief assembly 115 which encloses any or all of the following: the ener ry delivery means 102, the output 124 from thermal sensor 122, and controller lines l It ~ for actuating coolant flow.
FIG. 6 is a representative section view of another preferred embodiment of a coolant reservoir 200' of tt.e present invention. This reservoir 200' has a built-in sight glass 262' for determining remain ing coolant volume. Reservoir 200' consists of a cylindrical tubular outer wall 202', an seale i portion 204' at a proximal end 206' and a valve assembly 208' at a distal end 210'. The prow imal end 206' can also be capped or closed with a removable portion so as to allow filling from either end. The valve assembly 208' comprises a valve actuator 212' and is coupled to a plug portion 216' mounted within the distal end 210' of the reservoir 200'.
Sealing o-rings 211i' are used between the tube 202' and the plug 216', between the plug 216' and the valve riser ably 208', and adjacent the valve actuator 212'. Remaining fluid volume can be determined by the operator or technician by looking through the sight glass window 262' and through windo,v 117 of handpiece body 102.
FIG. 7 is a graph demonstrating the experimentally obtained temperature gradient through a portion c f the skin without precoolina as a function of both the wavelength of incident laser enerF y and the depth of laser radiation penetration. The graph demonstrates a change in temperas ure (~T) of about 60 degrees Celsius and ail curves are shown for the time point 1 millisecond following exposure to the laser energy. The graph shows three lines corresponding to li ser wavelengths of 10.6 microns, 1.3-1.4 microns and 1.06 microns.
FIG. 8 is ~ graph demonstrating the temperature gradient through a portion of the skin with precooling as a function of both the wavelength of incident laser energy and the depth of laser radiation pen~,ration. The graph demo~trates a change in temperature (~'I~ of about 60 degrees Celsius. In these experiments, precooling of the skin surface tissue for a period of 20 milliseconds was c inducted immediately prior to exposure to laser energy. All curves are shown for a time p pint 1 millisecond following exposure to the laser energy.
The graph shows three lines correspc coding to Laser wavelengths of 10.6 microns, 1.3-1.4 microns and 1.06 microns. It will be understood that the paran~ters of time, cooling and exposure to laser energy may be varied man ually or automatically, as desired.
Studies ha re shown that irradiating tissue with a midinfrared laser source through a surface thermal ab sorption element or heat sink permits an optimum thermal profile within the target tissue with near physiologic temperature at the surface of the irradiated surface thus minimizing surface thermal damage. In the case of desired thermal collagen shrinkage, this is clearly the desired ;ondition. Others have shown that attenuating the surface temperature before laser irradia lion and therefore creating a boundary layer on the skin surface can result in selective cooling oa'the target tissue thus preserving the normal overlying epidermis.
During a t rpical dynamic cooling process, the surface of the skin is pre-cooled to as low as 0 degrees C ~lsius or lower, at a rate fast enough to cool the surface only but not dissipate heat from below about 400-500 microns below the surface. In a preferred embodiment, Burin ~ the cooling step the target tissue remains at body temperature and is not cooled at all.
For examF le, in laser-induced shrinkage of collagen tissue, by applying cooling to the surface of the skin for a short period of time, typically between about 5 and 100 milliseconds, and then delivering laser energy, the surface is initially cooled but the target tissue never is.
Generally, the surf ice layer of skin is rapidly cooled. A high rate of cooling will prevent proximal hypothen nia and will also tend to have a numbing, anesthetic or analgesic erect.
Therefore, upon de livery of laser energy onto the surface and therethrough, the target tissue WO 99/16369 PCT/US97Ji811~
will be raised to th~; optimal thermal shrinkage temperature and generally not any higher, in an adequately rapid p: ~ocess.
In a preferred embodiment of the method of the present invention, cooling and heating are performed in a predetermined timing sequence, optionally with the use of timer circuits andlor other contrc Iler means.
With respc ct to studies performed removing sub-dermal skin lesions, such as port wine stains and other re, l or brown marks, an optimum cooling strategy might be one that uses a short spurt of cryo. ;en (e.g., 5-20 ms) to reduce the local temperature in the pigmented epidermis, while m inimizing attenuation of the laser light by the boundary layer, followed by post-irradiation ca ding spurt that provides a heat sink for dissipation of the epidermal heat generated by mela~ in absorption. The present invention includes and encompasses all of the above.
Unless def ned otherwise, all technical and scientific terms used herein have the same meaning as commc nly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described can be used in the practice: or testing of the present invention, the preferred methods and materials are now described. All publications and patent documents referenced in this application are incorporated herein. by reference.
The Nd;Y, \G, Nd:YAP and Nd:YALO-type lasers are such sources of coherent energy. This wavelength of 1.3-1.4 microns is absorbed relatively well by water, and as a result is attractive for tis; ,ue interaction. It is also easily transmitted through a fiber optic delivery system as opposed to the rigid articulated arm required for the COz laser.
Very precise methods of controlling laser systems and optically filtering produced light currently exist. By selecting the appropriate coy nbination of resonance optics and/or anti-reflection coatings, wavelengths in the range of 1.3-1.~1 microns and even 1.32-1.34 microns can be produced.

Light trap: port in skin and other tissues is dominated by primary and secondary scattering events, r ather than by optical absorption alone. Lask G, et al.
Nonablative Laser Treatment of Facie I Rhytides; SPIE Proc. 1997; 2970 :xxx.
The conce,~t of an "effective attenuation coefficient" pd (in an exponential attenuation relation similar to : Jeer's Iaw for absorption alone) has bin used traditionally to approximate the light fluence ~ (units: J/cmz) within a tissue in which scattering is important:
~(z) = Aexp(p,~) [ 1 ]
I~~g'= (3 pa[!aa + l~s(I-g)]~'n [2]
where A is a con:.tant, z is the del ~th (units: cm) within the tissue, ua is the absorption coefficient (units: cxn -'), pf is the scattering coefficient (units: cm'), and g is the sc:.ttering anisotropy (units: dimensionless). Welch A.J., van Gemert M.I.C.
(editors), Introduct ion to medical applications: Optical-Thermal Response of Laser-Irradiated Tissue. (Plenum P~ ess, New York, 1995), pp. 609-618.
Light fluei.ce ~ is the energy (units: J) passing through a cross-sectional area (units:
cm2) from all direc sons. It differs from the radiant exposure F (units:
3/cm2) which we use in describing treatment parameters since F is the energy density directed onto the tissue surface from the light sour ;e. The fluence ~ can be much larger than the radiant exposure F due to multiple scattering events - see Figure 1 of Welch et al. When the tissue is highly scattering, on the average many 1 photon scattering events occur before the photon is ultimately absorbed.
If the real fight fluence distribution were represented by Equation [ 1 ], the "effective optical absorption' as a function of depth z would mimic this exponential function and the "effective optical a osorption coefficient" would be given by Equation [2].
However, the real light fluence distril ~ution is more complicated than Equation [ 1 ] indicates and is best represented by a N orate Carlo modeling calculation which includes the effects of initial light distribution strikin;; the tissue (e.g., collimated light at normal incidence, diffuse light at non-normal incidence, a tc.), the changes of index of refraction at the airltissue interface (and at any other interfaces wi hin the tissue), absorption and scattering events within the tissue, and remittance from th~: tissue (by reflection at the air/tissue interface and by backscattering from within the tissue). . acques SL, Wang L. Monte Carlo modeling of light transport in tissues:
Optical-Thermal R esponse of Laser-Irradiated Tissue. (Plenum Press, New York, 1995), pp.
73-100.
For the pu poses of the present invention, it will be understood that the term "non-homogeneous colla gen" will refer to that collagen typically found in human or other animal skin, as described in the preceding paragraph. Non-homogeneous collagen is also anisotropic by nature, in that ii does not exhibit identical properties (such as light transmission, birefringence, conc uctivity of heat or electricity) when measured along axes in different directions. It is wel l known that skin tissue is composed of such non-homogeneous collagen, as I S compared to other zansparent, isotropic and homogeneous collagen-containing tissue, such as that of the cornea.
While the minciples of the invention have been made clear in illustrative embodiments, there will be imme~ liately obvious to those skilled in the art many modifications of structure, arrangement, prop. ~ttions, the elements, materials, and components used in the practice of the invention, and othe rwise, which are particularly adapted to specific environments and operative requirements withc ut departing from those principles. The appended claims are intended to cover and embrace any and all such modifications, with the limits only of the true purview, spirit and scope of the invention.
III

Claims

We claim:

1. A cooling handpiece comprising:
a main body portion having a proximal end and a distal end;
controllable energy delivery means for controllably delivering energy from the distal end of the main body portion to target tissue;
a reservoir receiving recess integral with the main body portion;
removable coolant reservoir shaped to operatively fit within the reservoir receiving recess of the handpiece and having contained therein coolant fluid, the coolant reservoir and the main body portion each having attachment means for releasable attachment of the reservoir to the handpiece; and a controllable valve for controllably delivering a portion of the coolant fluid to the target tissue.

2. The a handpiece of Claim 1 further comprising a delivery tube for directing the energy from the energy delivery means as well as the coolant fluid onto the target tissue, the delivery tube having a proximal end and a distal end.

3. The handpiece of Claim 1 in which the reservoir comprises a tubular portion with an at least partially transparent sidewall for providing visual indication of the volume of coolant fluid remaining in the reservoir.

4. The handpiece of Claim 1 in which the valve means comprises a controllable solenoid valve.
III

5. The handpiece of Claim 1 further comprising means for focusing the energy being delivered to the target tissue.

6. The handpiece of Claim 1 in which the reservoir is refillable.

7. The handpiece of Claim 1 in which the attachment means comprises matching threaded end fittings on both the reservoir and the main body portion.

8. The handpiece of Claim 1 in which the attachment means is a locking, bayonet-type attachment means comprising a locking pin and mating slot.

9. The handpiece of Claim 1 further comprising a thermal sensor and feedback control means for preventing undesirable delivery of energy to the target tissue.

10. The handpiece of Claim 1 further comprising an energy delivery interlock means for preventing undesirable delivery of energy to the target tissue.

11. The handpiece of Claim 10 in which the energy delivery interlock means includes a fluid level switch.

12. The handpiece of Claim 10 in which the energy delivery interlock means includes a thermal sensor.

13. The handpiece of Claim 10 in which the energy delivery interlock means includes a fluid flo N sensor.

14. A cooling handpiece comprising:
a main bo~y portion having a proximal end and a distal end, the main body portion adapted for directing energy from a controllable energy delivery device to target tissue, the main body portion further adapted for receiving a removable coolant reservoir, the main body portion having an attachment means for releasable attachment of the reservoir to the handpiece, the reservoir containing coolant fluid; and a controllable valve for controlled delivery of a portion of the coolant fluid to the target tissue.

15. The handpiece of Claim 14 further comprising an energy delivery device having a distal end and a proximal end, the device for receiving energy at its proximal end and transmitting the energy to its distal end for delivery to the target tissue.

16. The handpiece of Claim 14 further comprising a removable coolant reservoir, the reservoir having an attachment means for releasable attachment of the reservoir to the handpiece, the reservoir containing coolant fluid for controlled delivery through the valve to the target tissue.

17. The handpiece of Claim 14 further comprising a thermal sensor, the thermal sensor mounted to he handpiece to sense the temperature of the target tissue.

18. The handpiece of Claim 14 further comprising a delivery tube for positioning the handpiece adjacent target tissue and for directing energy from an energy delivery means as well as coolant fluid onto the target tissue, the delivery tube having a proximal end and a distal end.

19. The handpiece of Claim 16 in which the reservoir comprises a tubular portion with an at least partially transparent sidewall for providing visual indication of the volume of coolant fluid remaining in the reservoir.

20. The handpiece of Claim 14 further comprising an adapter for coupling a coolant fluid reservoir to the main body portion for controllable delivery of coolant fluid to target tissue.

21. The handpiece of Claim 20 in which the adapter further comprises a coolant chamber and a sight glass for providing a visual indication of remaining coolant.

22. The handpiece of Claim 14 in which the controllable valve comprises a controllable solenoid valve.

23. The handpiece of Claim 14 further comprising means for focusing the energy being delivered to the target tissue.

24. The handpiece of Claim 16 in which the reservoir is refillable.

25. The handpiece of Claim 14 in which the attachment means on the reservoir comprises a set of helical threads and the handpiece further comprises an operative set of mating helical threads, the two sets of helical threads operative to engage the reservoir and the handpiece.

26. The handpiece of Claim 14 in which the attachment means on the reservoir comprises a bayonet-type mounting locking pin and the handpiece further comprises an operatively positioned mating slot for the locking pin.

27. The handpiece of Claim 14 further comprising a thermal sensor and feedback control means for preventing undesirable delivery of energy to the target tissue.

28. The handpiece of Claim 14 further comprising an energy delivery interlock means for preventing undesirable delivery of energy to the target tissue.

29. The handpiece of Claim 28 in which the energy delivery interlock means includes a fluid level switch.

30. The handpiece of Claim 28 in which the energy delivery interlock means includes a thermal sensor.

31. The handpiece of Claim 28 in which the energy delivery interlock means includes a fluid flo N sensor.

32. A method of performing a thermally mediated procedure using a cooling handpiece with (1) a main body portion having a proximal end and a distal end, the main body portion adapted for directing energy from a controllable energy delivery device to target tissue, the main body portion further adapted for receiving a removable coolant reservoir, the reservoir having an attachment means for releasable attachment of the reservoir to the handpiece, and (2) a controllable valve for controllable delivery of a portion of the coolant fluid to the target tissue, the method comprising the following steps:
(a) operatively coupling a coolant fluid reservoir containing coolant fluid to the handpiece;
(b) controllably delivering a coolant fluid to the target tissue;
(c) controllably delivering energy to the target tissue;
(d) interrupting delivery of energy when the cryogen liquid reservoir is empty or is nearly empty; and (e) removing empty or nearly empty reservoir.

33. The method of Claim 32 further comprising the following step:
(f) refilling the reservoir with coolant fluid.

34. The method of Claim 32 further comprising the following step:
(g) visually monitoring the volume of coolant fluid remaining in the handpiece.

35. A handpiece for controllable delivery of functional energy and surface coolant fluid to target tissue comprising:
a main body portion having a proximal end and a distal end, the main body portion adapted for receiving functional energy and for directing functional energy from the distal end to target tissue, the main body portion further adapted for receiving a removable reservoir containing coolant fluid, the main body portion having an attachment means for releasable attachment of the reservoir to the handpiece; and a controllable valve disposed between the attachment means and the distal end for controlled delivery of a portion of the coolant fluid to the target tissue.

36. The handpiece of Claim 35 further comprising a reservoir containing coolant fluid.

37. A method for treating skin using a handpiece for controlled delivery of interventional energy and surface coolant fluid to target tissue, the handpiece having a main body portion with a proximal end and a distal end, the main body portion adapted for receiving interventional energy and for transmitting the interventional energy from the distal end to target tissue, the main body portion further adapted for receiving a removable reservoir containing coolant fluid, the main body portion further having an attachment means for releasable attachment of the reservoir to the handpiece, the handpiece also having a controllable valve for controlled delivery of a portion of the coolant fluid to the target tissue, the method comprising the steps of placing the distal end of the handpiece adjacent the target tissue, delivering coolant fluid from the distal end of the handpiece to the surface of the target tissue, and transmitting interventional energy from the distal end of the handpiece to the target tissue.

38. The method of claim 37 in which the handpiece is adapted to receive interventional energy having a wavelength between about 1 micron and about 12 microns and in which the step of transmitting interventional energy includes transmitting the interventional energy having a wavelength between about 1 and about 12 microns.

39. The method of claim 37 in which the handpiece is adapted to receive interventional energy having a wavelength between about 1.3 micron and about 1.4 microns and in which the step of transmitting interventional energy includes transmitting the interventional energy having a wavelength between about 1.3 and about 1.4 microns.

40. The method of claim 37 in which the handpiece is adapted to receive laser energy and in which the step of transmitting interventional energy includes transmitting the laser energy.

41. The method of claim 37 in which the handpiece is adapted to receive non-coherent interventional energy and in which the step of transmitting interventional energy includes transmitting the non-coherent interventional energy.

42. The method of claim 37 in which the skin treatment includes wrinkle removal.

43. A method for treating tissue using a handpiece adapted for receiving and transmitting electromagnetic energy, the handpiece further adapted for receiving a reservoir containing coolant fluid and releasably coupling the reservoir to the handpiece, the handpiece also having a controllable valve for controlled delivery of a portion of the coolant fluid to the target tissue, the method comprising the following steps: (1) delivering coolant fluid from the handpiece to the surface of the target tissue, and (2) transmitting electromagnetic energy from the handpiece to the target tissue.

44. The method of Claim 43 further including the following step: (3) optically detecting the remaining volume of coolant fluid remaining in the reservoir.

45. A laser handpiece apparatus for use in therapeutic and other procedures employing selective cooling, the apparatus for use in conjunction with a controllable laser source, the apparatus comprising:
laser delivery means for controllably delivering a predetermined amount of laser energy to a preselected surface area;
removable reservoir means integral with the laser delivery means having contained therein a predetermined volume of cryogenic liquid;
valve means for controllably delivering a portion of the cryogen liquid to the preselected surface area; and releasable attachment means for securely and releasably coupling the reservoir to the valve means.

46. The apparatus of Claim 45 further comprising delivery tube means having a proximal and a dis~al end, the laser delivery means and the valve means coupled to the delivery tube such that both the laser energy and the portion of the predetermined volume of cryogen are controllably delivered to the preselected surface area.

47. The apparatus of Claim 45 in which the reservoir comprises a transparent tube, thus providing a visual indication of the volume of cryogen liquid remaining in the reservoir.

48. The apparatus of Claim 45 in which the valve means comprises a controllable solenoid valve.

49. The apparatus of Claim 45 further comprising means for focusing the laser energy.

50. The apparatus of Claim 45 in which the reservoir is refillable, the apparatus further comprising a refill valve means.

51. The apparatus of Claim 45 in which the reservoir is removable, the apparatus further comprising an attachment means for securely coupling the reservoir to the valve means.

52. The apparatus of Claim 45 in which the attachment means comprises matching threaded end fitting on both the reservoir and the valve means.

53. The apparatus of Claim 45 in which the attachment means comprises a locking bayonet-type mourting.

54. The apparatus of Claim 45 further comprising temperature sensor and feedback control means for preventing undesirable delivery of laser energy.

55. The apparatus of Claim 45 further comprising a laser delivery interlock means for preventing undesirable delivery of laser energy.

56. The apparatus of Claim 55 in which the laser delivery interlock means includes a level switch.

57. The apparatus of Claim 55 in which the laser delivery interlock means includes a temperature sensor.

58. The apparatus of Claim 55 in which the laser delivery interlock means includes a liquid flow sensor.

59. A method of performing a therapeutic procedure involving delivery of laser energy to preselected surface areas, the method comprising the following steps:
(a) providing a laser handpiece apparatus, the apparatus comprising laser delivery means, removable reservoir means integral with the laser delivery means having a predetermined volume of cryogenic liquid contained therein, valve means for controllably delivering a portion of the cryogen liquid, and releasable attachment means for securely and releasably coupling the reservoir to the valve means;
(b) controllably delivering a predetermined amount of cryogen liquid to the preselected surface areas;
(c) controllably delivering a predetermined amount of laser energy to the preselected surface areas;
(d) interrupting delivery of laser energy when the cryogen liquid reservoir means is empty;
(e) releasing attachment means and removing empty cryogen liquid reservoir means;
and (f) replacing the empty cryogen liquid reservoir means with a full one for continued delivery of both cryogen liquid and laser energy from the handpiece, as desired.

60. The method of Claim 59 wherein step (f) is replaced with the following step:
(g)-refilling the reservoir with cryogen liquid coolant.

61. The method of Claim 59 further comprising the following step:
(h) visually monitoring the volume of cryogen liquid retained in the reservoir means.