Novel Fiber Optic Tip Designs and Devices For Laser Surgery
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Abstract
Fiber optic delivery of laser energy has been used for years in various types of surgical procedures in the human body. Optical energy provides several benefits over electrical or mechanical surgery, including the ability to selectively target specific tissue types while preserving others. Specialty fiber optic tips have also been introduced to further customize delivery of laser energy to the tissue. Recent evolution in lasers and miniaturization has opened up opportunities for many novel surgical techniques.Currently, ophthalmic surgeons use relatively invasive mechanical tools to dissect retinal deposits which occur in proliferative diabetic retinopathy. By using the tight focusing properties of microspheres combined with the short optical penetration depth of the Erbium:YAG laser and mid-IR fiber delivery, a precise laser scalpel can be constructed as an alternative, less invasive and more precise approach to this surgery. Chains of microspheres may allow for a self limiting ablation depth of approximately 10 µm based on the defocusing of paraxial rays. The microsphere laser scalpel may also be integrated with other surgical instruments to reduce the total number of handpieces for the surgeon.In current clinical laser lithotripsy procedures, poor input coupling of the Holmium:YAG laser energy frequently damages and requires discarding of the optical fiber. However, recent stone ablation studies with the Thulium fiber laser have provided comparable results to the Ho:YAG laser. The improved spatial beam profile of the Thulium fiber laser can also be efficiently coupled into a fiber approximately one third the diameter and reduces the risk of damaging the fiber input. For this reason, the trunk optical fiber minus the distal fiber tip can be preserved between procedures. The distal fiber tip, which degrades during stone ablation, could be made detachable and disposable. A novel, low-profile, twist-locking, detachable distal fiber tip interface was designed, assembled, and tested for use in Thulium fiber laser lithotripsy. A 1.00-mm-outer-diameter detachable fiber tip interface was designed, constructed, and tested ex vivo on urinary stones in the laboratory. Similar stone ablation rates between the previously studied tapered distal fiber tip and the detachable fiber tip were measured. For urologists desiring faster TFL lithotripsy procedures, the incorporation of detachable distal fiber tips allows for rapid replacement of damaged fiber tips without concern about the laser to trunk fiber connection. This method for preserving the trunk fiber could be a motivation for integrating a dedicated laser fiber into the ureteroscope, with detachable distal tips, thus freeing the working channel for the use of other surgical instruments.During laser lithotripsy, distal fiber tip degradation increases as the fiber core diameter decreases. However, smaller fiber diameters ( ≤ 200 µm ) are more desirable because of increased saline irrigation rates in the single working channel of the ureteroscope and less impact on ureteroscope deflection. A hollow fiber cap is proposed to reduced fiber tip degradation in small diameter fibers, without compromising stone ablation rates. The disadvantage of the hollow fiber tip observed in the study is the increase in stone retropulsion. However, integrating the hollow fiber tip with a clinically used stone basket may allow for a robust stone ablation instrument that also minimizes retropulsion. These surgical approaches involving novel specialty fiber optic tip designs are discussed in this thesis.