CN102038480A - 手术照明系统 - Google Patents

手术照明系统 Download PDF

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CN102038480A
CN102038480A CN2010105641795A CN201010564179A CN102038480A CN 102038480 A CN102038480 A CN 102038480A CN 2010105641795 A CN2010105641795 A CN 2010105641795A CN 201010564179 A CN201010564179 A CN 201010564179A CN 102038480 A CN102038480 A CN 102038480A
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optical waveguide
illumination
waveguide
optical
light
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CN102038480B (zh
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A·韦塞尔
K·特劳纳
J·加森
T·格雷
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Invuity Inc
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Spotlight Surgical Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
    • A61B1/07—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements using light-conductive means, e.g. optical fibres
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00103—Constructional details of the endoscope body designed for single use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
    • A61B1/0607—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements for annular illumination
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B23/00—Telescopes, e.g. binoculars; Periscopes; Instruments for viewing the inside of hollow bodies; Viewfinders; Optical aiming or sighting devices
    • G02B23/24—Instruments or systems for viewing the inside of hollow bodies, e.g. fibrescopes
    • G02B23/2407—Optical details
    • G02B23/2461—Illumination
    • G02B23/2469—Illumination using optical fibres
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Abstract

本发明涉及一种手术照明系统，包括：照明源；由未涂覆材料形成的大体圆柱形的光波导管，所述光波导管具有远端、近端和敞开的孔，所述孔的尺寸被设计成用于容纳从所述近端经过所述远端延伸的一个或多个器械或工具，所述波导管从所述近端向所述远端传导照明能并从一个或多个光学结构和所述远端发射照明能；以及用于从照明源向光波导管的近端传导照明能的照明管路。根据本发明的光波导管可以为围绕内窥镜或其他适宜器械以便将照明光传导至器械的远端的单次使用的一次性护套。光学波导护套也可以引导冲洗物和/或提供沿器械的抽吸。

Description

手术照明系统
本申请是申请号为200680019538.0、申请日为2006年4月4日、发明名称为“光学波导护套”的中国发明专利申请的分案申请。
相关申请
本申请要求2005年4月4日提交的未决美国临时专利申请序列号No.60/668,442和2005年10月7日提交的未决美国临时专利申请序列号No.60/724,717的优先权。
技术领域
本发明一般地涉及手术照明领域，特别是涉及光学波导内窥镜照明。
背景技术
如图1中所示的元件12的现有光纤照明元件被专门用于其中小包装很关键的医疗照明中。例如内窥镜10的器械是目前使用光纤照明的最常用器械。由于其紧凑的尺寸，光纤是刚性内窥镜照明的极佳选择。然而，在柔性内窥镜应用中使用光纤照明存在着许多复杂情况。
虽然毛玻璃或塑料纤维的成本相对便宜，但是将纤维组装到内窥镜管中的成本可能很高。一旦纤维被插入，其通常必须被粘结和抛光到特定角度。
光纤是非常脆和易碎的。在组装过程中或在多次杀菌循环之后的场合，光纤可能开始断裂和恶化。在多次杀菌循环后光纤产生色彩变化也是很常见的。由于纤维被整合到内窥镜中，光纤的任何损坏也会引起检查仪器的损坏，因此导致昂贵的检修。
在许多内窥镜检查过程中的重大挑战是线缆管理。在无菌领域通常可能存在许多线缆；摄像机线缆(电缆)、光纤线缆、冲洗和抽吸线缆等。由于光纤线缆具有最大的直径，其通常为最重的线缆。使用刚性内窥镜的外科医生面对的一个挑战是内窥镜的连续转动，以观察不同的方位角。当内窥镜转动时，迫使光纤线缆围绕着内窥镜一起转动，因此发生干涉。在关节镜手术中这些问题变得尤为重要。由于光纤线缆重，其事实上将转动内窥镜，因而经常迫使外科医生将其一只手保持在光纤线缆上，以防止内窥镜的不期望自转。
照明纤维还占据内窥镜或其他手术器械内部的空间。通过为光纤照明留置空间，光纤的直径可能被限制，以保持最小的总体内窥镜直径。
因此，需要一种多功能手术照明器具。
发明内容
如下所述的照明系统包括关节(内窥)镜、内窥镜或其它适宜的手术工具以及可连接的套管或护套，所述套管或护套包括能够从套管的近端向套管的远端传送光从而照亮手术区域的透明或半透明材料。因此，手术区域通过未占据否则将用于关节镜的光学器件的空间的元件照亮。关节镜照明系统进一步包括设置在套管的近端的一个或多个照明源。该照明源可在套节或其他适当位置处与套管光学耦合(连接)。该套管包括起到波导管作用的可杀菌聚合体。波导管为限制和引导光线的材料介质。在使用时，与套节相连的光源提供可被引导至套管的远端或任何其他适宜位置的光线。因此，护套提供导致手术部位照明的结构引导照明。
根据本发明的光波导管可以为围绕内窥镜或其他适宜器械以便将照明光传导至器械的远端的单次使用的一次性护套。光学波导护套也可以引导冲洗物和/或提供沿器械的抽吸。来自内窥镜的分离照明允许在不增大内窥镜的总体尺寸的情况下增大内窥镜的孔径。
根据本发明的光学波导护套或管子提供了一种适于医疗应用的柔性波导管。该光波导管可以是分离的，并独立于内窥镜或其他医疗器械，并且例如可与柔性或刚性内窥镜同轴地定向，以为内窥镜或其他手术器械提供光。光波导管可包括适宜的微结构或结构，以便独立于外部介质或波导管的弯曲部分将光回射保持在波导管的内部。波导管可以是一次性的，并且尺寸被设计成用于在孔中容纳内窥镜或其他器具，因此可以在内窥镜或其他照明器具的制造中省略光纤工作元件。
在一个方面，本发明提供一种手术照明系统，包括：照明源；由未涂覆材料形成的大体圆柱形的光波导管，所述光波导管具有远端、近端和敞开的孔，所述孔的尺寸被设计成用于容纳从所述近端经过所述远端延伸的一个或多个器械或工具，所述波导管从所述近端向所述远端传导照明能并从一个或多个光学结构和所述远端发射照明能；以及用于从照明源向光波导管的近端传导照明能的照明管路。
在另一个方面，本发明提供一种作为可模制为特定形状和/或制成一次性使用的单一部件(单元)的波导管。如果该波导管是一次性使用并且是无菌销售的，对于每次应用而言，其将是全新的，因此，如果在工作过程中发生任何损坏，该波导管可以很容易地被替换，并且可以在工作过程之后被丢弃。
在本发明的另一方面，提出一种也可用作提供冲洗和/或抽吸或用于医疗应用的其他适宜工作的套管的光波导管。
因为波导管可以被设计为具有转动环，其中光纤线缆可从光源连接至该转动环，先前提到的光纤转动问题可通过该光波导管解决。因此，波导管可相对于检查仪器独立地自转，而不需要转动栓系的光纤线缆。
在大多数内窥镜应用中，护套用于抽吸和冲洗。该护套安装在内窥镜上。如果护套为光波导管，其可以同时提供抽吸和/或冲洗以及照明。由于从内窥镜的孔中消除了光纤，光学器件可被制造成具有较大直径，从而显著提高仪器的分辨率(或清晰度)。因此，内窥镜的总直径将不会变化，并且分辨率提高。
光波导管可以提供照明，同时作为手术器械。除了刚性内窥镜外，例如套管针、闭塞器、牵引器的器具均可由波导材料制成。例如喉镜叶片的器具可由波导材料制成，且因此是自发光的，从而消除了对光纤的任何需要。
在本发明的另一方面，一个或多个耦合透镜可被用于将光耦合到光波导管。透镜或其他适宜的结构可采用任何适宜的几何形状，例如球形、圆柱形、非球面和/或非对称几何形状。如果使用具有宽输出角的光源，例如一个或多个发光二极管(LED)，可以使用例如非球面的更复杂透镜系统，以优化光耦合。
在另一方面，光波导管的一个或多个面可以包括预定的微结构图案。不同的光学光输出形状可通过产生特定的结构表面或图案来获得。
还可利用结构化技术来偏转光线以及将其聚焦为特定的形状。微结构可被应用到折射元件的背面和/或正面，以偏转光束以及使其成形。微结构表面还可以与一个或多个气隙和/或常见的表面形状相结合，以获得所需的光学性能。
在本发明的更进一步方面，光学波导护套或适配器(转接器)或连接器中的一个或多个表面可利用任何适宜的技术被偏振化(极化)，这些技术例如为微光学结构、薄膜涂层或其他技术。在手术环境下使用偏振光可以提供优良的照明，并且伴随着在例如摄像机或手术镜片的观察装置上使用辅助偏振涂层可以减少反射眩光，从而提供较小的视觉畸变和更精确的手术部位的彩色分辨率。
根据本发明的手术照明系统可包括大体圆柱形的光波导管、照明源、用于传导来自照明源的照明能的照明管路、以及用于接合照明管路并将来自照明管路的照明能耦合至光波导管的连接环(转接环)，其中该光波导管具有孔，所述孔的尺寸被设计成用于容纳一个或多个手术器械，该连接环允许照明管路和光波导管之间的相对运动。
根据本发明的可选照明系统可包括照明源、大体圆柱形的光波导管、以及用于从照明源向光波导管的近端传导照明能的照明管路，其中该光波导管具有远端、近端以及尺寸被设计成用于容纳从近端向远端延伸的一个或多个器械或工具的孔，该波导管从近端向远端传导照明能并从近端发射照明能。
这些和其他特征及优点将从以下详细说明和附图中变得更加明显。在附图和说明书中，数字表示本发明的不同特征，整个附图和说明书中相同的数字表示相同的特征。
附图说明
图1是一传统内窥镜的远端的透视图。
图2是根据本发明的带有光学波导护套的内窥镜的远端的透视图。
图3是根据本发明的光学波导护套的远端的透视图。
图4是根据本发明的光学波导护套的远端的端视图。
图5是耦合至光纤元件的光学波导护套的侧视图。
图6是图5所示的光纤耦合透镜阵列的端视图。
图7是根据本发明的带有光耦合适配器的光学波导护套的侧视图。
图8是带有位于其中的高分辨率关节镜的光学波导照明系统的侧视图。
图9是可选的光波导管光耦合技术的侧面透视图。
图10是图9所示的光波导管的端视图。
图11是带有另一可选光耦合件的光波导管的端视图。
图12是沿A-A截取的图11所示的光波导管的近端的局部剖视图。
图13是沿B-B截取的图11所示的光波导管的近端的局部剖视图。
图14是一可选光波导管的局部剖视图。
图14a-14d是图14所示的光波导管的可选远端的局部剖视图。
图15是带有一可选光耦合件的光波导管的透视图。
图16是图15所示的光波导管的近端的局部剖视图。
图17a-17c是图15所示的光耦合件的可选远端的正视图。
具体实施方式
下列公开内容总体上涉及用于传导光的光波导管和相关元件。以下讨论为示例性的，并且以下的公开内容也可适用于任何电磁辐射。图示的横截面为大体圆形，但也可采用任何适宜的几何形状。
现在参考图2，光学波导系统14可容纳任何适宜的手术器械，例如由光学波导护套16封装、包围或围绕的内窥镜18。根据本发明的光学波导护套为大体环形或圆柱(圆筒)形结构，并可以单独制造，而且可以为一次性使用的器具。在光波导管、例如光学波导护套16出现故障的情况下，可以立即进行替换。在内窥镜18和光学波导护套16之间形成流动路径26。流动路径26可以被用于任何适宜的工作，例如抽吸、冲洗或者引入其他工具或器具。
例如内窥镜18的手术器具可以被制成没有照明元件，因此与图1所示的器具的尺寸11相比，孔20可在不增加总体尺寸30的情况下被增大。内窥镜18的壁18A也可用作光波导管，以改善照明，并且提供可选的光路，以实现不同特性的照明。
现在参考图3，波导护套28可以为单个、大体均匀的元件，其可以由形成明显单一管路的两个或更多不同照明通路组成，或者可以由一个或多个平行光传导元件组成，所述光传导元件例如为光路元件24或图14所示的光路元件92。将照明元件从传统的内窥镜中移动到例如光管道(如波导护套28)的分离器具中使得允许照明表面22比许多传统照明元件大。由光波导管围绕例如内窥镜的器械可以为内窥镜或其他器械的任何取向提供大体均匀的照明。
现在参考图4，照明表面22可以采用任何适宜的构造，以提供照明。例如，诸如小平面30的小平面可以沿任何选定方向引导光能，并可以被涂敷或处理，以引入频率和/或偏振的过滤。例如微结构32的微结构可以被用于获得定向光能、过滤等。一个或多个透镜结构可以被耦合至照明表面22上，或者它们可形成在例如透镜34的照明表面之中或之上。可选地，这些元件也可以结合起来。
使用例如光路元件24的分离(独立)光传导元件使得允许通过波导护套进行选择性照明以及为具有不同特征如偏振、波长或强度的照明提供多个照明路径。每个光路元件可以包括微结构、小平面、透镜或在远端面24A上的其它适宜处理。
在图5和6中，设置耦合环38，以将来自光纤42的光耦合到光波导管36中。耦合环38允许光波导管36围绕孔的中心线37转动，而不转动光纤42。耦合环38可以包括例如耦合透镜(如透镜40)的任何适宜的光耦合结构，每个透镜将来自光纤42的光能39耦合至光波导管36中。根据光源，透镜或适宜的微结构可能是球形的、圆柱形的、非球面的或非对称的。就光纤而言，球面透镜可用于与光纤和光波导管的数值孔径(进入角)相匹配。因为离开光纤线缆的光的特定锥角，相匹配的进入角将被用于耦合环。
现在参考图7，光耦合适配器44可被用于通过表面46耦合光能并围绕进入通道48且经过连接环50将光能引导至光波导管36中。进入口49和入口通道48提供通向用于任何适宜的手术工具、器械或器具的孔35的通路。连接环50接合波导管36，同时允许波导管相对于光耦合适配器44的相对运动。可选地，耦合适配器44、连接环50和光波导管36可以毗连，并且不允许相对运动。连接环50也可以是波导管36的元件以及光耦合适配器44的元件。
图8图示了带有设置在其中的高分辨率关节镜54的关节镜照明系统52。该关节镜照明系统包括适于提供结构引导照明的套管护套55、套节56和照明源58。该套节可以包含一个或多个阀60并放置成与与真空和/或冲洗源62流体连通。该套管护套55包括起波导管作用的生物相容可杀菌(无菌)聚合体。该聚合体可以是透明或半透明的，并可以结合小平面、棱柱、微结构或其它适宜的特征。
照明源可操作地与套节56耦合并放置成与套管护套55光学连通。该照明源包括一个或多个LED 64(发光二极管)、电源66、电连接电源和LED的导体68、LED控制电路65和开关67。LED优选为提供明亮的白光的白光LED。可以以任何形式提供电源，例如电源出口或锂离子聚合物电池。当照明源进行照亮时，来自照明源的光以全内反射的方式通过套管护套传播，从而照亮套管护套的远端69。光没有从套管的外径表面泄漏出来。套筒的外表面可以设有金属或其它适宜的涂层，以帮助防止光泄漏，同时有助于全内反射。套筒的远端可以设有微结构、光学元件或扩散层。根据所需的光学输出，模制元件或定制涂层可应用到过滤器中或使离开护套的光成形。
可选地，照明源可以包括与套节可操作地相连的传统光纤线缆。该照明源可以被布置成通过设置在套节56内的套筒61的近端的光学耦合透镜与护套光学连通。
现在参考图9和10，来自LED阵列72的光能可以利用位于近端70p处的反射和/或折射的光学组件74耦合至光波导管70中，从而使得光能从远端70d上的照明表面71射出。
图11、12和13图解了耦合至光波导管76中的可选光。光75可以通过例如塑料杆78的任何适宜的管路提供。光管路78可在接合端79处形成、切割或成形，以便相对于光管道78以任何适宜的角度反射光75。表面80可以包括任何适宜的处理、涂层或微结构，以便相对于光管道78以适宜的角度反射适量的光75。
可以在光波导管的近端84中设置例如U形凹口82的凹口、凹槽或其它适宜的缺口，以便与例如塑料杆78的光管道接合。凹口82的形状可以被选择，以优化光管道和光波导管之间的光耦合。可在光波导管的任何适宜位置处包括例如小平面86的一个或多个结构，以便将光反射到孔88中或从光波导管中反射到围绕波导管的区域中。光通常通过照明表面89离开光波导管。
可选地，可以利用一个或多个例如光路元件或杆92的实心光引导件并将一个或多个杆形成为类似弹簧的螺旋而形成如图14和14a-14d中所示的光波导管90。输入93可以任何适宜的角度94(最佳角度在45°和90°之间)形成。远端95可被切割或成形为具有任何适宜的结构，以便例如如图14和14a-14d中所示沿任何适宜的方向反射或发射光。
手术照明系统100可以包括光波导管96和光适配器98。光适配器98的远端99具有如图17a-17c所示的任何适宜形状。例如透镜102、104、106和108的透镜或其它光学构件可以具有任何适宜的形状或取向，以便优化光耦合或输出。在图17a所示的光适配器上也可结合不同的透镜。可在光波导管96中形成互补的表面110，以获得选定的光传输或耦合。可选地，光适配器可穿过光波导管96延伸，从而使得例如透镜102、104、106和/或108的透镜直接照亮孔105和/或手术部位。
光波导管也可与接合光波导管的远端的任何适宜的端盖一起使用。端盖可用于或不被用于改变或反射照明能。类似地，可以在光波导管内使用垫片(补偿件)，以在波导管内定位任何工具，并且该垫片可以或不可以传导或改变照明能。
因此，虽然已经参照其研发环境描述了器械和方法的优选实施例，但是它们仅仅为本发明的原理的示例性描述。在不脱离本发明的精神和后附权利要求的范围的情况下，可以设计出其他实施例和构造。

Claims (7)

1.一种手术照明系统，包括：
照明源；
由未涂覆材料形成的大体圆柱形的光波导管，所述光波导管具有远端、近端和敞开的孔，所述孔的尺寸被设计成用于容纳从所述近端经过所述远端延伸的一个或多个器械或工具，所述波导管从所述近端向所述远端传导照明能并从一个或多个光学结构和所述远端发射照明能；以及
用于从照明源向光波导管的近端传导照明能的照明管路。
2.根据权利要求1所述的照明系统，其特征在于，所述光波导管是柔性的。
3.根据权利要求1所述的照明系统，其特征在于，所述光波导管是刚性的。
4.根据权利要求1所述的照明系统，其特征在于，所述照明源包括多个发光二极管。
5.根据权利要求1所述的照明系统，其特征在于，所述照明管路进一步包括用于将照明能引导至光波导管的反射表面。
6.根据权利要求1所述的照明系统，其特征在于，所述大体圆柱形的波导管通过将照明管路成形为围绕波导管的孔的螺旋而形成。
7.根据权利要求1所述的照明系统，其特征在于，进一步包括两个或更多照明管路。
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