NEUROSURGICAL SYSTEM FOR THE DETECTION AND REMOVAL OF TUMOR TISSUE

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to and all the advantages of U.S. Provisional Patent Application No. 63 / 160,099, filed on March 12, 2021.BACKGROUND

[0002] Glioma tumors may start in the glial cells of the brain or the spine. A surgical procedure, more specifically tumor resection, is often performed to resect the tumor. The goal of a surgical procedure for tumor resection is to achieve gross total resection (GTR). A very aggressive form of glioma is glioblastoma. In patients with glioblastoma, GTR has been shown to prolong the life of a patient by about 40% (e.g., from 10 months to 14 months). In patients with lower-grade gliomas, GTR increases the overall chances of survival.

[0003] 5-Aminolevulinic Acid (5-ALA) is often given to patients a couple hours before surgery. 5-ALA is a compound that occurs naturally in the hemoglobin synthesis pathway. In cancer cells, the hemoglobin synthesis is disrupted and the pathway stalls at an intermediate compound called Protoporphyrin IX (PPIX). During surgery, the healthcare professional may illuminate an area of brain tissue with excitation light (i.e., blue light) from a surgical microscope. The surgery may be carried out in a darkened or dimmed operating room environment. High-grade tumor cells containing PPIX absorb the excitation light and emit fluorescence (i.e., red fluorescence) having specific optical characteristics. The fluorescence may be observed by the healthcare professional from the surgical microscope.

[0004] Once the target tissue has been identified, the healthcare professional switches the surgical microscope back to standard white light illumination and continues to resect the target tissue. The healthcare professional switches back and forth between illuminating the tissue with white light and the excitation light throughout the surgical procedure to ensure the appropriate target tissue is being resected until the tumor resection is complete. Each time the target area is illuminated with the excitation light from the surgical microscope, the PPIX present at the tumor site may degrade due to photo-bleaching from being illuminated by the strong excitation light.

[0005] Fluorescence guided surgery increases the chances of GTR in high-grade tumors such as with glioblastoma tumors. At present, GTR of lower grade tumors is comparatively low because 5-ALA cannot be used to improve the outcome of lower-grade tumor resection as the tumor cells only emit a low level of fluorescence and the human eye is not sensitive enough to detect such low levels of fluorescence even with the use of the surgical microscope. A need exists for an improved system for fluorescence guided surgery that improves the chances of achieving GTR.

[0006] US 9 763 744 B2 discloses - as the closest prior art - an optical spectroscopy probe for providing optical spectroscopy guidance of a mechanical biopsy procedure, and a tissue biopsy device including an optical spectroscopy probe. The optical spectroscopy probe is positionable in a lumen of a mechanical biopsy device. The probe may enable optical spectroscopy guidance in biopsy procedures, include brain biopsy procedures.

[0007] US 2020 / 261170 A1 discloses systems and methods for performing minimally invasive surgical procedures, especially for removal of tumors, and especially for brain tumors, using a robotically inserted therapeutic probe, which first detects tumorous tissue on a pre-planned path through the patient's tissue, before performing therapeutic procedures on the tissue, such as ablation. This pre-treatment detection procedure is thus able to avoid the destruction of healthy tissue. This also ensures that the therapeutic process indicated in a preoperative surgical plan is only performed on tumorous tissue, without sole reliance on preoperative image indications. This is important for neurosurgical operations performed on the brain, since preoperative images may not be accurate due to brain shift occurring during the procedure. Detection can be performed optically or ultrasonically, and treatment by laser or RF ablation. The probe insertion can be performed at 90° to the insertion axis of the device, thus minimizing passage through healthy tissue.

[0008] Further approaches usable in the field of intraoperative navigation are known from RU 183 278 U1 and US 2021 / 052161 A1.

[0009] The background description provided here is for the purpose of generally presenting the context of the disclosure. Work of the presently named inventors, to the extent it is described in this background section, as well as aspects of the description that may not otherwise qualify as prior art at the time of filing, are neither expressly nor impliedly admitted as prior art against the present disclosure.SUMMARY

[0010] The invention is defined in the independent claim. Further developments are set forth in the dependent claims.

[0011] In a feature, a neurosurgery system for probing brain tissue of a patient for tumorous tissue is described. The neurosurgery system includes a suction tool configured to apply suction to tissue of the patient. The suction tool includes a suction cannula defining a lumen, an optical fiber, coupled to the suction cannula, the optical fiber being configured to transmit a fluorescence emitted by the brain tissue, and an indicator coupled to the suction cannula and configured to selectively emit visible light. The visible light being different from the fluorescence transmitted by the optical fiber. The neurosurgery system also includes an excitation source configured to emit an excitation light. The excitation light having a wavelength to induce the fluorescence in the tumorous tissue. The neurosurgery system also includes an optical instrument coupled to the optical fiber. The optical instrument is configured to convert the fluorescence emitted by the brain tissue and transmitted by the optical fiber into an electrical signal. The neurosurgery system also includes a controller that is coupled to the indicator and the optical instrument and configured to determine that the brain tissue is tumorous based on the electrical signal and activate the indicator based on the determination that the brain tissue is tumorous.

[0012] In a feature, a neurosurgical method for detecting whether brain tissue of a patient includes tumorous tissue is described. The neurosurgical method performed using a surgical system including a suction tool with an optical fiber and an indicator each coupled to the suction tool, an excitation source, an optical instrument coupled to the optical fiber, and a controller coupled to the excitation source, the optical instrument, and the indicator. The neurosurgical method comprising applying, with the suction tool, suction to the brain tissue of the patient. The neurosurgical method also includes emitting, with excitation light having a predetermined wavelength from the excitation source, to induce a fluorescence in the tumorous tissue. The neurosurgical method also includes collecting, with the optical fiber, the fluorescence emitted from brain tissue. The neurosurgical method also includes converting, with the optical instrument, the fluorescence into an electrical signal. The neurosurgical method also includes activating, with the controller, the indicator based on the electrical signal when the controller determines that the electrical signal indicates that the brain tissue is tumorous.

[0013] In a feature, a neurosurgical method for detecting whether target brain tissue is tumorous under ambient light conditions in an operating room using a surgical system is described. The surgical system includes a working tool including at least one optical fiber and an indicator, an optical instrument coupled to the at least one optical fiber, and an excitation source coupled to the at least one optical fiber, and a controller connected to the optical instrument and the indicator. The neurosurgical method for detecting target tissue including detecting fluorescence emitted from the target brain tissue during a surgical procedure. The step of detecting the fluorescence includes emitting blue light from the excitation source to induce fluorescence emission of the target brain tissue. The step of detecting the fluorescence also includes receiving, with the optical instrument, the fluorescence of the target brain tissue from the at least one optical fiber.. The step of detecting the fluorescence also includes converting, with the optical instrument, the fluorescence into an electrical signal. The neurosurgical method also includes determining, with the controller, that the target brain tissue is tumorous based on the electrical signal. The neurosurgical method also includes activating, with the controller, the indicator of the working tool in response to the determination that the target brain tissue is tumorous.

[0014] Further areas of applicability of the present disclosure will become apparent from the detailed description, the claims, and the drawings.BRIEF DESCRIPTION OF THE DRAWINGS

[0015] The present disclosure will become more fully understood from the detailed description and the accompanying drawings. FIG. 1 depicts a chart depicting the visibility of red fluorescence of tumor tissue when viewed from a surgical microscope according to the teachings of the prior art. FIG. 2 depicts a neurosurgical system according to the teaching of the present disclosure. FIG. 3 depicts a functional block diagram of a neurosurgical system according to the teachings of the present disclosure. FIG. 4 depicts an example suction tool of the neurosurgical system according to the teachings of the present disclosure. FIGS. 5A and 5B depict an example handle of a suction tool of the neurosurgical system according to the teachings of the present disclosure. FIG. 6 depicts an ultrasonic surgical system of a neurosurgical system according to the teachings of the present disclosure. FIG. 7 depicts a tissue detection system of a neurosurgical system according to the teachings of the present disclosure. FIG. 8 depicts a functional block diagram of a tissue detection system of a neurosurgical system according to the teachings of the present disclosure. FIGS. 9A and 9B depict an optical system of a tissue detection system according to the teachings of the present disclosure. FIGS. 10A and 10B depict an exploded view of some components of the optical system of a tissue detection system according to the teachings of the present disclosure. FIG. 11 depicts a view of an interior portion of a control console of a tissue detection system according to the teachings of the present disclosure. FIGS. 12A-E depict a sample element of a tissue detection system according to the teachings of the present disclosure. FIG. 13 depicts an excited spectral signal generated by a spectrometer of a tissue detection system according to the teachings of the present disclosure. FIGS. 14A and 14B depict a first modified spectral signal and a second modified signal generated by a controller of a tissue detection system according to the teachings of the present disclosure. FIG. 15 depicts gaussian curves fit to a second modified signal generated by a controller of a tissue detection system according to the teachings of the present disclosure. FIG. 16 depicts PPIX intensity generated by a controller of a tissue detection system according to the teachings of the present disclosure. FIG. 17 depicts a flowchart for a surgical resection procedure performed with a neurosurgical system according to the teachings of the present disclosure. FIGS. 18A and 18B depict a sample element of a tissue detection system coupled to an ultrasonic handpiece assembly according to the teachings of the present disclosure. FIGS. 19A and 19B depict a sample element and an indicator element of a tissue detection coupled to bipolar forceps of a surgical system according to the teachings of the present disclosure. FIG. 20 depicts a sample element coupled to a suction tool of a suction system with a jacket removed according to the teachings of the present disclosure. FIG. 21 depicts a sample element coupled to a suction tool of a suction system according to the teachings of the present disclosure. FIG. 22 depicts a sample element coupled to a suction tool of a suction system according to the teachings of the present disclosure.

[0016] In the drawings, reference numbers may be reused to identify similar and / or identical elements.DETAILED DESCRIPTION

[0017] The present inventors realized that there exists a need for a neurosurgical tumor resection system and / or method that is capable of detecting low levels of fluorescence in white light operating conditions (i.e., not requiring a darkened or dimmed operating room) while in the process of resecting the tumor. There also exists a need for a system that can reduce the amount of time that the target area is illuminated with excitation light to reduce the effects of photo-bleaching. Additionally, there exists a need for a system that can illuminate excitation light in deep cavities as surgical microscope fail to adequately illuminate excitation light in deep cavities. Lastly, there exists a need for a system that assists in intraoperative detection of the anaplastic focus of the tumor which is of importance because finding the anaplastic focus is imperative for precise histopathological diagnosis and optimal patient treatment.

[0018] While the disclosure specifically discusses a surgical procedure related to resection of target tissue of a brain tumor with the administration of 5-ALA to visualize fluorescence of PPIX, the teachings of the present disclosure may be extended to other types of surgical procedures, to detect other types of tissue, and to detect other types of fluorophores (Hypericin, Hexvix, Idocyanine Green "ICG", etc.). For example, ICG may be administered to help a healthcare professional visualize blood vessels during the surgical procedure. ICG may bond to plasma protein found in blood. ICG is excited by near infrared light and emits near infrared light having a slightly longer wavelength than the near infrared light that excited the ICG.

[0019] With respect to FIG. 1, chart 10 depicts the visibility of the red fluorescence of PPIX when viewed from a surgical microscope. During brain tumor resection surgery, target tissue (i.e., tumor tissue) including elevated concentrations of PPIX may inadvertently be missed when tumor resection surgery is performed according to the systems of the prior art (i.e., with a surgical microscope) which leads to less than GTR. Thus, a more accurate way of detecting elevated concentrations of PPIX would prove to be very beneficial in helping to achieve GTR. Hollow squares 40 indicate specimens that produce no visible fluorescence and solid squares 44 indicate specimens that produce visible fluorescence. The y-axis shows the accumulated levels of C PpIX above a threshold of 0.1 µg / mL. The x-axis indicates visible fluorescence (+F) and non-visible fluorescence (-F) for healthy tissue and for target tissue. Region 50 represents a false negative region in which PPIX was present in the specimen but did not produce visible light. In particular, a sub-region 54 within the region 50 includes specimens below a level 58 that when viewed from a surgical microscope but still considered to include elevated levels 62 of C PpIX . Thus, if the healthcare professional were to miss PPIX corresponding to the sub-region, GTR would not be achieved.

[0020] With reference to FIG. 2, the neurosurgical system 100 is provided that solves the shortcomings of the prior art. The neurosurgical system 100 may include a surgical navigation system 104, a surgical microscope 108, a surgical cart 114, and a suction system 113. The surgical navigation system 104 includes a cart assembly 106 that houses a navigation computer 110. The navigation computer 110 may also be referred to as the navigation controller. A navigation interface is in operative communication with the navigation computer 110. The navigation interface may include one or more input devices may be used to input information into the navigation computer 110 or otherwise to select / control certain aspects of the navigation computer 110. The navigation interface includes one or more displays 120. Such input devices may include interactive touchscreen displays / menus, a keyboard, a mouse, a microphone (voice-activation), gesture control devices, or the like.

[0021] The navigation computer 110 may be configured to store one or more pre-operative or intra-operative images of the brain. Any suitable imaging device may be used to provide the pre-operative or intra-operative images of the brain. For example, any 2D, 3D or 4D imaging device, such as isocentric fluoroscopy, bi-plane fluoroscopy, ultrasound, computed tomography (CT), multi-slice computed tomography (MSCT), magnetic resonance imaging (MRI), positron emission tomography (PET), optical coherence tomography (OCT). The images may also be obtained and displayed in two, three or four dimensions. In more advanced forms, four-dimensional surface rendering regions of the body may also be achieved by incorporating patient data or other data from an atlas or anatomical model map or from pre-operative image data captured by MRI, CT, or echocardiography modalities.

[0022] The navigation computer 110 may generate the one or more images of the brain on a display 120. The navigation computer 110 may also be connected with the surgical microscope 108. For example, the display 120 may show an image corresponding to the field of view of the surgical microscope 108. When the navigation computer 110 may include more than one display, with one such display showing the field of view of the surgical microscope 108 while the other such display may show a pre-operative or intra-operative image of the brain.

[0023] The tracking system 124 is coupled to the navigation computer 110 and is configured to sense the position of one or more tracking elements attached to a surgical tool or the patient. The tracking system 124 may be configured to track active or passive infrared tracking elements attached to the surgical tool or the patient. An example of a surgical navigation system 104 that may be used is Nav3i ™< that is commercially available from Stryker. A surgical navigation system 104 may have various functions and features as described in U.S. Pat. No. 7,725,162 B2 and U.S. Pat. Pub. No. 2020 / 0100849 A1.

[0024] The surgical microscope 108 includes one or more objectives configured to provide magnification in a range (e.g., from about 2 times to about 50 times). The surgical microscope 108 can have a field of view having an area of a predetermined range. The surgical microscope 108 is configured for fluorescence microscopy, for example, to detect PPIX. The surgical microscope 108 may include one or more excitation sources (e.g., an excitation source configured to emit light in the visible light spectrum or an excitation source configured to emit light in the infrared spectrum) for illuminating the brain tissue 111 with excitation light to cause the PPIX to fluorescence. The surgical microscope 108 may also include a camera capable of detecting radiation at the fluorescent wavelengths of PPIX or ICG.

[0025] The surgical cart 114 may include a surgical system 112, a suction system 113, a tissue detection system 116, and an ultrasonic surgical system 118. A display 121 may be coupled to the surgical cart and operatively connected to the surgical system 112, the tissue detection system 116, and / or the ultrasonic surgical system 118 to display information related with each respective system 112, 116, and 118. A healthcare professional may use the ultrasonic surgical system 118 and / or the surgical system 112 to ablate target tissue of the brain of the patient. The ultrasonic surgical system 118 may include an ultrasonic control console 128 and an ultrasonic handpiece assembly 130.

[0026] The suction system 113 may include a suction tool 156 and suction unit 117 to control various aspects of the suction tool 156. A suction tube may connect the suction tool 156 to the suction system 113. The suction system 113 may receive suction from a vacuum source, such as a vacuum outlet of a medical facility. The suction system 113 may include one or more regulators or one or more adjustment valves for controlling the suction pressure received from the vacuum source. The suction system 113 may also include one or more containers for storing the waste collected by the suction tool 156. In an example, the suction system 113 may correspond to a wall suction unit. In another example, the suction system 113 may correspond to a portable suction unit. The suction system 113 and the suction tool 156 may have various features, as described in U.S. Pat. No. 9,066,658 and U.S. Pat. Pub. No. 20180344993.

[0027] The surgical system 112 may include a surgical tool, such as bipolar forceps 160, and a surgical control console 115 to control various aspects of the surgical tool. The healthcare professional may also use the surgical tool to perform any surgical operation on the tissue. For example, to ablate the tissue or to cauterize the tissue. The bipolar forceps may have features, as described in U.S. Pat. No. 8,361,070 B2. While the disclosure discusses and illustrates that the surgical tool may include bipolar forceps 160, the surgical system 112 and surgical tool may include other tools, such as a neuro stimulator, a dissector, or an ablation device (e.g., an RF ablation device and / or a laser ablation device). For example, the surgical system and / or surgical tools may have various features as described in U.S. Pat. No. 8,267,934. Any number of surgical systems and any number of surgical tools may be employed by the healthcare professional in performing the surgical procedure.

[0028] T he tissue detection system 116 may include a control console 168 and a sample element 164 (illustrated as coupled to the ultrasonic handpiece assembly 130). The control console 168 may provide the healthcare professional with a real-time indication via the sample element 164 when brain tissue 111 corresponds to the target tissue. The sample element 164 may also be coupled to the bipolar forceps 160, the suction tool 156, or other surgical tools as will be described in greater detail below. The tissue detection system 116 determines when the brain tissue 111 corresponds to target tissue based on fluorescence emitted by the target tissue caused by the fluorophore. In an example, the fluorophore may correspond to PPIX. In another example, the fluorophore may correspond to ICG. As will be discussed in greater detail below, based on the intensity and the wavelengths of the fluorescence emitted by PPIX, the tissue detection system 116 may determine that the target tissue is present.

[0029] With reference to FIG. 3, a schematic of the neurosurgical system 100 is shown. The tissue detection system 116, although capable of performing a similar function (i.e., allowing the healthcare professional to detect the presence of PPIX) to the surgical microscope 108, may be used in conjunction with the surgical microscope 108 to improve the outcome of a tumor resection procedure and the chances of achieving GTR.

[0030] During the surgical procedure, the healthcare professional may initially view the brain tissue 111 of the patient with the surgical microscope 108 under excitation light (e.g., the blue light) to identify which portion of the brain tissue 111 corresponds to the target tissue evidenced by the red fluorescence. The healthcare professional may switch the surgical microscope 108 back to standard white light illumination for better visibility and begin resection of the target tissue. Since the sample element 164 is coupled to the suction tool 156, the healthcare professional does not have to account for any additional surgical tools (i.e., optical probes or the like) in the sterile field. The healthcare professional may perform the resection of the target tissue with the bipolar forceps 160 in the one hand and the suction tool 156 in the other hand.

[0031] As the healthcare professional is resecting the target tissue, the control console 168 may function to provide the healthcare professional with a real-time indication of the target tissue in the brain tissue 111 by activation of an indicator (discussed in greater detail below) of the sample element 164. The tissue detection system 116 according to the teachings of the present disclosure prevents the healthcare professional from having to switch back and forth between the various illumination settings of the surgical microscope 108 (i.e., illuminating the tissue with excitation light and white light) as the healthcare professional is performing resection of the target tissue. This becomes especially important as the healthcare professional approaches the margin of the target tissue because it is desirable for the healthcare professional to achieve GTR but to leave as much healthy tissue intact as possible.

[0032] With reference to FIG. 4, the suction tool includes a suction cannula 157 and a handle 159. The suction cannula 157 defines a lumen for suctioning fluid, debris, and tissue from a patient. The handle 159 is tubular shaped with a control portion 167 that may be square shaped. A distal end 162 may be tapered and is configured to receive a proximal end 161 of a suction cannula 157. A distal end 165 of the handle 159 includes a vacuum fitting which may be configured to receive a suction tube 169 which is connected to the vacuum source which generates the suction pressure. The vacuum fitting may be a standard barbed fitting, quick disconnect, or any other suitable fitting known in the art to allow the suction tube to be fluidly coupled to a vacuum source.

[0033] With additional reference to FIGS 5A and 5B, the control portion 167 may include a teardrop shaped control 170 for regulation of suction pressure. For example, when no portion of the teardrop shaped control 170 is covered by the healthcare professional, suction pressure may be minimal, and when the teardrop shaped control 170 is covered completely, suction pressure may be at its maximum. While the control portion 167 is described as including a teardrop shaped control, the control portion 167 may include another suitable input such as a button or different shaped control to allow the healthcare professional to vary the suction pressure. The control portion includes a through bore 171 for receiving the sample element 164, as will be discussed in greater detail below. The healthcare professional holds the suction tool 156 from its handle 159, manipulating the suction tool 156 so that the distal end 163 contacts the tissue of the patient during the surgical procedure in order to provide suction at the desired location. While the suction tool 156 is described as having a Fukushima configuration, other configurations are contemplated such as a Frazier or Poole configuration.

[0034] With reference to FIG. 6, the ultrasonic handpiece assembly 130 may comprise an ultrasonic handpiece 132 comprising a proximal end and distal end. The ultrasonic handpiece assembly 130 may further comprise sleeve 136 and an ultrasonic tip 140 that may be coupled to the distal end of the ultrasonic handpiece 132. The sleeve 136 may be configured to provide irrigation to the ultrasonic tip 140 and / or the surgical site. It is further contemplated that the sleeve 136 may also be configured to provide aspiration to the ultrasonic tip 140. The ultrasonic tip 140 may comprise a cutting feature that is configured to ablate, cut, shape, and / or remove biological tissue. The ultrasonic handpiece assembly 130 may have various features, as described in U.S. Pat. Nos. 6,497,715 B2; 6,955,680 B2; and 6,984,220 B2 and PCT Publication WO 2020 / 068756 A1.

[0035] The ultrasonic handpiece assembly 130 may also comprise a cable 144 or other power cord comprising a power connector 148 or adapter configured to couple the ultrasonic handpiece assembly 130 to a power supply, such as the ultrasonic control console 128 configured to regulate the various aspects of the ultrasonic handpiece assembly 130. The ultrasonic control console 128 may also be configured to provide irrigation and / or aspiration via one or more tubes (not shown) connected to the handpiece assembly 130 and regulate the irrigation and / or aspiration functions of the ultrasonic handpiece assembly 130 to optimize performance of the ultrasonic handpiece assembly 130. An example of ultrasonic surgical systems that may be used are commercially available from Stryker including Sonopet IQ Ultrasonic Aspirator. The ultrasonic control console 128 may control various operation parameters based on signals received from the tissue detection system 116.

[0036] With reference to FIGS. 7 and 8, the tissue detection system 116 includes a sample element 164 and a control console 168. The sample element 164 is connected to the control console 168 via connector 172. The sample element 164 may include a detection fiber 264, an indicator element 296, and an electrode 266 as discussed in greater detail below. The control console 168 may include a controller 204, a user interface 208, a power supply 212, an optical system 215, a microcontroller 220, and a mapping module 265. The optical system 215 may include an optics block 216, a spectrometer 224, an excitation source 228, and an optical connector 229. The function of each component will be discussed in greater detail below.

[0037] The user interface 208 may include a display for displaying output from the controller 204. The user interface 208 may also include one or more inputs (e.g., a push button, a touch button, a switch, etc.) configured for engagement by the healthcare professional. The power supply 212 may supply power to various components of the control console 168. The control console 168 may include a probe port 173 in which the connector 172 of the sample element 164 is connected. The detection fiber 264 may then be connected to the optics block 216 via the optical connector 229. The control console 168 may also include an electrical port 174 for establishing communication link to the surgical system 112 and the ultrasonic surgical system 118. The control console 168 may also include an indicator port 175 for connection to an indicator element 164, as will be discussed in greater detail below.

[0038] The mapping module 265 may include a device configured to generate stimulation signals for an electrode 266 that is configured to deliver the stimulation signals to the brain tissue 111. During surgical resection of the target tissue, the healthcare professional may need to map the brain tissue 111 in order to determine which areas of the brain tissue 111 correspond to functionally important areas. For example, functionally important areas of the brain that are responsible for speech or motor skills may be chosen to be avoided even when it is determined that these areas include target tissue if the target tissue cannot be removed without impacting the underlying function of the area. The device may be configured to generate an electric current which is then applied to the brain tissue 111 by the healthcare professional via an electrode. The electrode may be a standalone electrode disposed or coupled to an outer surface of the sample element 164 or the electrode may be integrated within the sample element 164, as discussed in greater detail below. The mapping module 265 and / or electrode 266 may have various functions and features as described in International Publication No. WO2021074265A1 and U.S. Pat. No. 7,150,737 B2. The controller 204 may be configured to generate an alert based on the results of the stimulation of the electrode 266 on the brain tissue 111. For example, the controller 204 may generate an alert to be displayed on the user interface 208, the display 120, or the display 121. The alert may indicate to the healthcare professional whether or not the brain tissue 111 corresponds to a functionally important area such as an area associated with motor function or speech function.

[0039] The excitation source 228 may illuminate the target tissue with excitation light via the detection fiber 264. The excitation source 228 may be configured to emit the excitation light (e.g., blue light at about 405 nm or blue light in the range of 400 nm to 500 nm). The excitation source 228 may also be configured to emit excitation light corresponding to other wavelengths such as wavelengths associated with the rest of the visible light spectrum other than blue light (e.g., greater than 500 nm but less than 700 nm), wavelengths associated with ultraviolet light spectrum (less than 400 nm) and / or infrared light spectrum (greater than 700 nm). The excitation source 228 may include any number of light sources such as a light emitting diode (LED), a pulsed laser, a continuous wave laser, a modulated laser, a filtered white light source, etc.

[0040] In certain instances, the excitation source may be further configured to emit excitation light corresponding to different wavelengths than described above. In this implementation, the excitation sources may be referred to as a first excitation source 228 and a second excitation source, with the first excitation source 228 being configured to emit a first excitation light at the predetermined wavelength of the visible light spectrum and the second excitation source configured to emit infrared light at a second wavelength range corresponding to the infrared light spectrum (e.g., 700 nm to 1 mm). When two excitation sources are present, the first excitation source 228 may be configured to emit light which would excite a first fluorophore such as PPIX, while the second excitation source is configured to emit light which would excite a second fluorophore such as ICG.

[0041] The controller 204 may control operation of the excitation source 228. The controller 204 may control operation of the excitation source 228 by varying operating parameters of the excitation source 228. The operating parameters may correspond to a time setting, a power setting, or another suitable setting. The time setting may include a pulse width. The pulse width may be based on the integration time of the spectrometer 224. The integration time of the spectrometer 224 is discussed in greater detail below.

[0042] The detection fiber 264 may be coupled to the optical connector 229. When the sample element 164 is coupled to the surgical tool (i.e., the ultrasonic handpiece assembly 130, the suction tool 156, or the bipolar forceps 160) the distal end 272 of the detection fiber 264 is adjacent to the working portion of the surgical tool and allows for the excitation light to be delivered to the target tissue.

[0043] With reference to FIGS. 9A and 9B, the optics block 216 is shown. The optical connector 229 may be coupled to the optics block 216. The optics block 216 may include an outer casing 274 constructed of metal or another suitable material and may fully enclose components 232 of the optics block 216. FIG. 7B shows the optics block 216 with the top of the casing removed such that the components 232 of the optics block 216 are visible. The optics block 216 may be L-shaped and include a first portion 280 and a second portion 284. The excitation source 228 may be coupled to the first portion 280 of the optics block 216. The spectrometer 224 may be coupled to the second portion 284 of the optics block 216.

[0044] With additional reference to FIGS. 10A and 10B, an exploded view of the components 232 of the optical system 215 is shown illustrating an optical path 285 for the excitation light and the optical path 287 for light collected from the brain tissue 111. The first portion 280 may include the optical path 285 for the excitation light to travel from the one or more excitation sources 228 to the brain tissue 111 via the detection fiber 264. The optical path 285 may be defined by the components 232 in the first portion 280 of the optical block. The second portion 284 may include the optical path 287 for the collected light to travel from the brain tissue 111 via the detection fiber 264 to the spectrometer 224. The optical path 287 may be defined by the components 232 in the second portion 284 of the optical block. The components 232 of the optical block may optical components such as one or more laser line filters and one or more long-pass filters. The optics block 216 may include other optical components such as one or more mirrors, lenses, optical connectors, optical fiber, and / or any other suitable optical components.

[0045] In FIG. 10A, the excitation source 228 emits the excitation light which travels through one or more components 232, such as a laser line filter and / or long pass filter. The laser line filter or bandpass filter may be configured to reject unwanted noise (e.g., lower level transitions, plasma, and glows) generated by the excitation source 228. Stated differently, the laser line filter may be configured to clean up the excitation light or make the excitation light more monochromatic. The long-pass filter may be configured to reflect the light down the detection fiber 264 and to the brain tissue 111. The excitation source 228 may be configured to deliver unfiltered excitation light (i.e., the filters may be omitted) via the detection fiber 264 to the target tissue. The detection fiber 264 may guide the excitation light to the brain tissue 111 via the sample element 164.

[0046] The detection fiber 264 may be configured to collect light (i.e., fluorescence and ambient light) from the brain tissue 111. The coupling of the sample element 164 to the surgical tool results in the distal end 272 being adjacent to the working portion of the surgical tool as to allow for the light to be collected from the target tissue.

[0047] Due to the presence of ambient light and / or background light caused by various sources in the operating room such as the surgical microscope 108, surgical lamps, or any other devices in the operating room, the light collected from the brain tissue 111 may include the ambient light and / or background light. With reference to FIG. 10B, the light collected by the detection fiber 264 passes through the components 232, such as the long pass filter, of the second portion 284 of the optics block 216. After the light passes through the components 232, the light may enter the spectrometer 224 which is coupled to the optics block 216.

[0048] The detection fiber 264 may be coupled to the optical connector 229. As discussed in greater detail below, the distal end 272 of the detection fiber 264 may include a lens or other transparent material such that when the sample element 164 is positioned on a surgical tool (i.e., the ultrasonic handpiece, the suction tool or the bipolar forceps) the coupling of the sample element 164 to the surgical tool results in the distal end 272 of the detection fiber 264 being adjacent to the working portion of the surgical tool as to allow for the excitation light to be delivered to the target tissue.

[0049] With reference to FIG. 11, a view of the control console 168 with the outer casing removed is shown. The optics block 216 may be fixed (e.g., via bolts) directly to a base 217 of the control console 168 to allow for heat dissipation for heat generated by one or more components of the optical system 215. The control console 168 may include enough void space such that more than one optics block 216 may be stacked inside the control console 168. For example, a second optics block with various optical components inside may be stacked on top of the optics block 216. The second excitation source may be coupled to the second optics block. The second optics block may include components that define an optical path for light generated by the second excitation source to reach the target tissue.

[0050] With reference to FIG. 12A, the sample element 164 shown. The sample element 164 may also include an indicator element 296. The indicator element 296 may include a transmission member 297 connected to an indicator 298. The indicator 298 may include one or more light emitting diodes or another suitable light source. The indicator 298 is configured to emit light in response to detection of tumorous or target tissue by the controller 204. The indicator 298 may be sphere shaped, dome shaped, cylinder shaped, or another suitable shape. A jacket 292 may enclose part of the detection fiber 264 and part of the indicator element 296, specifically the transmission member 297. Stated differently, the jacket 292 may terminate well in advance of the distal end 272 of the detection fiber 264 leaving the transmission element 297, the indicator 298 and the detection fiber 264 at least partially exposed. The jacket 292 may be made from any one of polyvinyl chloride, polyethylene, chlorinated polyethylene, and chlorosulfonated polyethylene / neoprene or another suitable material. The electrode 266 although not shown in FIG. 12A may be integrated with the sample element 164. For example, a distal end of the electrode may be positioned adjacent to a distal end of the detection fiber 264 so that the distal end of the electrode 266 may contact the brain tissue 111.

[0051] As previously discussed, the detection fiber 264 may carry the excitation light from the optical system 215 to the brain tissue 111 and the detection fiber 264 may also collect light from the brain tissue 111 and deliver the light to the optical system 215 which in turn provides filtered optical signals to the spectrometer 224.

[0052] The sample element 164 may be coupled to any surgical tool (i.e., the ultrasonic handpiece assembly 130, the suction tool 156 or the bipolar forceps 160) such that the distal end 272 of the detection fiber 264 is proximal to the working portion of the surgical tool. The distal end 272 of the detection fiber 264 may include a lens, a collimator, or another suitable optical component that allows the detection fiber 264 to deliver excitation light to the brain tissue 111 and the detection fiber 264 to collect light from the brain tissue 111.

[0053] While the example is provided that the detection fiber 264 functions to deliver excitation light to the tissue and also collect light from the tissue, the system may include two separate fibers such as a collection fiber and an excitation fiber instead. The collection fiber may collect light from the tissue and the excitation fiber may deliver excitation light to the tissue. While the detection fiber 264 and any other fibers discussed herewith are contemplated as single fibers for simplicity, it is understood that each of the fibers may include more than one fiber. For example, the detection fiber 264 may include a bundle of detection fibers all being connected in similar fashion to the single fiber connections discussed above. In another example, the detection fiber 264 may include any number of fibers connected in series.

[0054] With reference to FIG. 12B, a second alternative configuration of the sample element 164 is shown. The sample element 164' shown is functionally equivalent to the sample element 164 shown in FIG. 12A so a detailed discussion of the functionally of equivalent parts, is hereby omitted. The indicator 298' shown is cylinder shaped as opposed to the sphered shaped indicator 298 shown in FIG. 12A.

[0055] With reference to FIG. 12D, a third configuration for the sample element 164 is shown. The sample element 164" shown is functionally equivalent to the sample elements 164 and 164' shown in FIGS. 12A and 12B so a detailed discussion of the functionally of equivalent parts, is hereby omitted. In this configuration, the indicator element 296' is provided separate from the sample element 164' (i.e., the indicator element 296 is not integrated with the sample element 164'). The indicator element 296‴ may include a transmission member 297', such as a wire and / or a cable covered by a jacket, an indicator 298, and a connector 299 for connecting the transmission member 297 to the indicator port 175 of the control console 168. The indicator element 296 may include a connector 299 for connecting the indicator element 296 to the indicator port 175 of the control console 168.

[0056] With reference to FIG. 12D, a fourth configuration for the sample element 164 is shown. The sample element 164‴ shown is functionally equivalent to the sample elements 164, 164', and 164" shown in FIGS. 12A and 12B so a detailed discussion of the functionally of equivalent parts, is hereby omitted. Here, the transmission member 297‴ of the indicator element 296‴ and the indicator 298 may be replaced with an optical fiber hereinafter referred to as an indicator fiber. The indicator fiber serves to emit light in response to detection of target tissue by the controller 204. The sample element 264‴ may also include an indicator portion 291 which is illuminated by the indicator fiber as light travels down the sample element 264"'. The indicator portion 291 may be situated proximal to the distal portion of the sample element 164 to ensure that the healthcare professional is able to view the indicator portion 291 as the healthcare professional is resecting tissue. The indicator portion 291 may be transparent or may also correspond to a removed portion of the jacket 292 of the sample element 164. The indicator fiber may be coupled to the optics block 216 via the optical connector and receive light from the excitation source 228 or another excitation source at a different wavelength than the excitation light. For example, the excitation source may generate green light (e.g., wavelengths of about 520-564 nm) when instructed by the controller 204 to indicate the detection of the target tissue.

[0057] The sample element 164‴ may include a co-axial fiber with a central core and an outer channel covered by the jacket 292. The detection fiber 264‴ may be disposed within the central core while the indicator fiber is disposed within the outer channel. A portion of the jacket 292 of the sample element 164‴ may be removed such that the indicator fiber may illuminate light through the sidewalls of the outer channel to light up the indicator portion 291.

[0058] The controller 204 may transmit an activation signal to the indicator 298 in response to the detection of the target tissue. The indicator 298 may emit light in response to receiving the activating signal. The controller 204 may control the LED to emit various colors of light depending on whether the controller 204 detects PPIX or ICG (i.e., whether the brain tissue 111 corresponds to the target tissue or a blood vessel). For example, the controller 204 may control the LED to emit green light (e.g., wavelengths of about 520-564 nm) when PPIX above a threshold is detected or yellow light (e.g., wavelengths 565-590 nm) when ICG is detected.

[0059] The spectrometer 224 is configured to convert the filtered optical signals (i.e., filtered light) into spectral signals in the form of electrical signals. The microcontroller 220 is configured to control operation of the spectrometer 224. Examples of spectrometer systems that may be used are commercially available from Hamamatsu including Mini-spectrometer micro series C12880MA. Although a spectrometer 224 is contemplated throughout the disclosure, other optical instruments may be used instead of a spectrometer 224. The spectrometer 224 may include an entrance slit, a collimating lens / mirror, transmission grating element, a focusing mirror, and an image sensor. The entrance slit may receive the collected light from the optics block 216 which then passes through the collimating lens / mirror. The collimating lens / mirror collimates the collected light passed through the entrance slit and guides it onto the grating element. The grating element separates the incident light from the collimating lens into different wavelengths and lets the light at each wavelength pass through or reflect away at a different diffraction angle. The focusing lens or mirror forms an image of the light dispersed into wavelengths by the grating element onto linearly arranged pixels of the image sensor according to wavelength.

[0060] Each wavelength is photoelectrically converted into an electrical signal (i.e., a spectral signal). The image sensor outputs the signal of light incident on each pixel at a certain time interval (i.e., the image sensor converts the optical signals into electrical signals and outputs them). The time interval may be referred to as the integration timing. The microcontroller 220 may be configured to control operation of the spectrometer 224, for example, the integration timing based on instructions from the controller 204. The microcontroller 220 forwards the spectral signals via a communication interface (e.g., serial peripheral interface (SPI)) to the controller 204.

[0061] The controller 204 is configured to transform the spectral signals provided by the microcontroller 220 into simple / usable output variables via in real-time in order to provide the healthcare professional with an indication of presence of the target tissue within the sterile fields. The controller 204 may illuminate the indicator 298 of the sample element 164 in response to detecting the target tissue.

[0062] Since ambient light may be present in the optical signals collected at the target tissue and thus present in the spectral signals provided by spectrometer 224, the controller 204 is configured to perform one or more functions or methods of control to remove the ambient light from the spectral signals (i.e., the wavelengths associated with the ambient light) to accurately detect when the brain tissue 111 corresponds to the target tissue as evidence by the PPIX present in the target tissue.

[0063] The controller 204 may be configured to remove the ambient light from the spectral signals using any suitable method, function, or algorithm in in any suitable manner. In one example, the controller 204 may pulse the one or more excitation source 228. The controller 204 may be configured to pulse the excitation source 228 such that alternating spectral signals are collected. During a first period, the controller 204 may operate the excitation source 228 in a first illumination state (IS1) where the excitation source 228 is ON and illumining the target tissue via the detection fiber 264. During a second period of time, the controller 204 may be configured to operate the excitation source 228 in a second illumination state (IS2), where the excitation source 228 is OFF and not illuminating the target tissue via the detection fiber 264.

[0064] The spectral signals provided by the spectrometer 224 and generated as a result of the optical signals collected from the target tissue while the excitation source 228 is in the first illumination state (IS1) during the first period, should include the red fluorescence when the brain tissue 111 corresponds to the target tissue. The spectral signals received by the controller 204 during the first period of time while the excitation source 228 is in the first illumination state (IS1) may be referred to as excited spectral signals from this point forward. With reference to FIG. 13, an excited spectral signal 356 is shown corresponding to the red fluorescence collected during the first period of time. Due to the presence of ambient light and / or background light caused by various sources in the operating room such as the surgical microscope 108, surgical lamps, or any other devices in the operating room, the excited spectral signal 356 shows a wide range of wavelengths present in addition to the wavelengths associated with the red fluorescence. With reference to FIG. 8B, the light collected by the detection fiber 264 passes through the components 232, such as the long pass filter, of the second portion 284 of the optics block 216. After the light passes through the components 232, the light may enter the spectrometer 224 which is coupled to the optics block 216.

[0065] The spectral signals provided by the spectrometer 224 and generated as a result of the optical signals collected from the target tissue while the excitation source 228 is in the second illumination state (IS2), may contain ambient light and should not contain the red fluorescence generated by the target tissue even since the excitation light is required to be absorbed by the target in order for the tissue to emit the fluorescence. The spectral signals received by the controller 204 during the second period of time while the excitation source 228 is in the second illumination state (IS2) may be referred to as ambient spectral signals.

[0066] With reference to FIGS. 14A and 14B, a first modified spectral signal 360 and a second modified spectral signal 368 of the target tissue are shown. Fluorescence intensity is shown on one axis and emission wavelength is shown on the other axis. The controller 204 may be configured to generate the first modified spectral signal 360 in any suitable manner to remove ambient light (i.e., the ambient spectral signal) from consideration. For example, the controller 204 may be configured to subtract the ambient spectral signal from the excited spectral signal (i.e., subtract spectral signals provided over the second illumination state (IS2) from the spectral signals provided over the first illumination state (IS1)). After the first modified spectral signal 360 is generated, the controller 204 may be configured to further subtract any background signal still present from the first modified spectral signal 360.

[0067] The controller 204 may be configured to subtract any background signal still present in the first modified spectral signal to generate a second modified spectral signal. For example, the controller 204 may be configured to use an algorithm based on a polynomial, such as an automated polynomial fitting routine based on a modified version of least squares polynomial to obtain a baseline curve 364 representative of any background signal still present. The controller 204 using the algorithm may then subtract the baseline curve 364 from the first modified spectral signal 360 to obtain a second modified spectral signal 368 which is representative of the red fluorescence emitted from the target tissue with the ambient light and background light removed.

[0068] The controller 204 may be configured to fit at least one gaussian distribution / curve to the spectral signals. The controller 204 may fit the at least one gaussian distribution to raw spectral signal (i.e., the excited spectral signals and / or the ambient spectral signals), the first modified spectral signal, or to the second modified spectral signal. This may enable a level of confidence to be determined based on the results of the fitting. In FIG. 15, three gaussian curves (372, 376, 380) were fitted to the three remaining spectral bands of the second modified spectral signal 368 (i.e., the spectral signal remining after the ambient light and the background light were removed).

[0069] With reference to FIG. 16, the controller 204 may be configured to select the gaussian band that has been fitted to PPIX's emission band (i.e., a band including 635 nm) and generate the selected band 372 for display in real time such that the healthcare professional may view the PPIX intensity in real time as the sample element 164 collects the samples. The controller 204 may store a predetermined intensity threshold that has been associated with the target tissue.

[0070] The controller 204 may be configured to generate an activation signal based on a comparison of the PPIX intensity, for the PPIX emission band that was fitted to the gaussian band, to the predetermined intensity threshold. In response to the PPIX intensity exceeding the threshold, the controller 204 may generate an activation signal. Based on the activation signal, the indicator 298 of the sample element 164 may emit light thereby providing a real-time indication to the healthcare professional of the presence of target tissue.

[0071] The controller 204 may be configured to perform an error correction process prior to generating the activation signal. During the error correcting process, the controller 204 may be configured to determine a ratio of any of the spectral signals (raw spectral signal, the excited spectral signals, the ambient spectral signals, the first modified spectral signal, or the second modified spectral signal) to a gaussian band such as the gaussian band that has been fitted to the PPIX emission band. The controller 204 may be configured to calculate at least two full width at half maximum (FWHM) points for the gaussian band. The controller 204 may be configured to calculate how far the at least two FWHM points are from the any of the spectral signals (as a percentage of their intensity). When the ratio is above a threshold (e.g. 2 percent), the controller 204 may be configured to return that the PPIX intensity falls below the threshold and thus the controller 204 does not generate the activation signal even though the activation signal would have been generated prior to the error correction process being performed.

[0072] The controller 204 may communicate with the ultrasonic surgical console via a communication link established through the electrical port 174. For example, a cord may be plugged into the electrical port and also plugged into the ultrasonic control console 128 to establish the communication link. The communication link may also be established wirelessly. The controller 204 may inform the ultrasonic control console 128 based on a type of tissue detected. The controller 204 may inform the ultrasonic control console 128 when target tissue is present or absent. Based on the information provided from the controller 204, the ultrasonic control console 128 may adjust one or more operating parameters. For example, when target tissue is present, the resection rate may not be limited; however, when target tissue is not present, the resection rate may be limited such that the ultrasonic surgical handpiece is prevented from cutting the healthy tissue. In such an example, the ultrasonic console may control the drive signal, such as the voltage, current, or both supplied to the ultrasonic handpiece based on the whether the target tissue is detected. While the example is provided that the controller 204 may communicate with the ultrasonic control console 128, the controller 204 may alternatively communicate with the surgical control console 115 to control the various surgical tools (e.g., bipolar forceps 160, neuro stimulators, dissectors, ablation devices, etc.) based on the absence or presence of target tissue.

[0073] The controller 204 may be configured to perform one or more standardization routines and / or calibration routines. The controller 204 prompt the healthcare professional via the user interface 208 to perform the calibration routine at the beginning of the resection procedure to account for autofluorescence variations of brain tissue 111 from person to person. The controller 204 may instruct the healthcare professional to collect light from known healthy brain tissue 111 with the detection fiber 264 of the sample element 164 to use as a standard baseline. Based on the characteristics of the light collected, the controller 204 may adjust one or more parameters of an algorithm for determining whether brain tissue is tumorous or not such as the predetermined intensity threshold for PPIX.

[0074] In a standardization routine, during a first period of time, the controller 204 may instruct the healthcare professional to collect light from a light source (e.g., a nearby light) outputting light from a consistent spectral band with the detection fiber 264 of the sample element 164. After the optical system 215 has converted the light collected into an electrical signal (hereinafter, referred to as a first standardization electrical signal), the controller 204 may store the first standardization electrical signal representative of the characteristics of the light collected. During a second period of time occurring after the first period of time, the controller 204 may instruct the healthcare professional to collect light from the same light source. After the optical system 215 has converted the light collected into a second standardization signal, the controller 204 may compare the first standardization signal obtained during the first period of time to the second standardization signal obtained during the second period of time and use the results to account for any variations of the optical readings over time. For example, the controller 204 may adjust one or more parameters of an algorithm used to determine whether the brain tissue is tumorous or not or one or more settings of the spectrometer 224 to account for any variations of the optical readings over time.

[0075] FIG. 17 includes a flow chart 400 illustrating a surgical resection procedure in accordance with the teaching of the present disclosure. As will be appreciated from the subsequent description below, this flowchart merely represents an exemplary and non-limiting sequence of blocks to describe a typical resection procedure performed to resect target tissue and is in no way intended to serve as a complete functional block diagram of all of the steps of a resection procedure.

[0076] The resection procedure 400 begins at 404 where the healthcare professional may identify target tissue using the surgical microscope 108 under excitation light. At 408, after the target tissue has been identified, the healthcare professional may perform resection of the target tissue using one of the surgical tools described above. At 412, after resection of the target tissue identified via the surgical microscope, the healthcare professional determines whether there is any questionable brain tissue (e.g., tissue which does not emit visible light when viewed from the surgical microscope 108 under excitation but has characteristics associated with the target tissue) that may correspond to target tissue. If there is no questionable brain tissue, the resection procedure may end; otherwise, the resection procedure continues at 416.

[0077] At 416, the healthcare professional engages the sample element 164 with the questionable brain tissue (e.g., to excite the brain tissue and collect light from the brain tissue). At 420, the healthcare professional determines whether the tissue includes PPIX as evidenced by the indicator 298 of the sample element 164. If so, the resection procedure continues at 424; otherwise the resection procedure continues at back at 412. At 424, the healthcare professional applies electrical stimulation to the target tissue. At 428, the healthcare professional determines whether the electrical stimulation affected the patient. If so, the healthcare professional may choose not to perform resection of the target tissue; otherwise, the resection procedure continues back at 408.

[0078] With reference to FIGS. 18-21, the sample element 164 may be coupled to any surgical tool. The sample element 164 may be coupled to the ultrasonic handpiece assembly 130 as shown in FIGS. 18A and 18B, to the bipolar forceps 160 (or any surgical tool associated with the surgical system 112 such as dissector, etc.) as shown in FIG. 19A and 19B, and the suction tool 156 as shown in FIGS. 20-22. The sample elements 164 and 164' and / or the indicator element 296 may be coupled to the surgical tools in any suitable manner. For example, the sample element 164 (or the sample element 164" and indicator element 296") may be coupled to the surgical tools via an adhesive. The adhesive may be in the form of a sticker or substance such as glue. Additionally or alternatively, the sample element 164 (or sample element 164" and indicator element 296") may also be coupled to the surgical tools via a fixation element discussed in greater detail with respect to FIG. 22 or a jacket discussed in greater detail with respect to FIGS. 21 and 22.

[0079] As shown in FIG. 18B, the sample element 164‴ may be coupled to the ultrasonic handpiece assembly 130 in any manner as long as there is no direct contact between the tip 140 and distal portion of the sample element 164‴. For example, the sample element 164‴ may terminate at a portion of the sleeve 136 proximal to the tip 140. In another example, the sample element 164‴ may extend past the sleeve 136 but be arranged such that there is adequate empty space between the tip 140 and the sample element 164‴ to prevent contact between the tip 140 and the sample element 164‴.

[0080] In the configuration shown in FIGS. 19A and 19B, the sample element 164" is shown coupled to an outer portion of a first pincer 302 the bipolar forceps 160 and the indicator element 296" is shown coupled to an inner portion of a second pincer 304 of the bipolar forceps 160. As shown the indicator is disposed near the tip of the second pincer such that the healthcare professional can view the indicator 298" while performing resection of the target tissue without having to look at another screen or portion of the tool.

[0081] With reference to FIGS. 20 and 21, the sample element 164 is shown coupled to the suction tool 156. The detection fiber 164 and a portion of the indicator element 296, (i.e., the transmission element 297 and indicator 298) may be guided through the through bore 171 of the handle 159. A distal end 272 of the detection fiber 264 may be positioned proximally to a distal end of the suction cannula 257. The indicator 298 may be positioned near the distal end of the detection fiber 264 but more proximal to a distal end 162 of the control portion 167 of the handle 159 than the distal end 272 of the detention fiber is. In other words, the distal end 162 of the detention fiber 264 may be disposed more proximal to the distal end of the suction cannula 157 than the indicator 298 is. With additional reference to FIG. 21, after the detection fiber 264 and the portion of the indicator element 296 is fed through the through bore 171, a jacket 306 may be fitted overtop of the suction cannula 157, the detection fiber 164, and the transmission element 297. The jacket 306 may be mated to the distal end 162 of the handle 159 so that the distal end 162 and the through bore 171 are covered. The jacket 306 may terminate just before where in the indicator 298 is coupled to the suction cannula 157. The detection fiber 264 may protrude from beneath the jacket 306 so that the jacket 306 does not interfere with the delivery of excitation light or collection of fluorescence from the tissue. Also as shown, the indicator 298 is exposed fully but may be partially covered by the jacket 306. In some configurations, the jacket 306 may be omitted.

[0082] With reference to FIG. 22, a different configuration of a suction tube 156' is shown. Specifically, the suction tube 156' does not include a through bore in a handle 159' of the suction tube 156'. Instead, the sample element 164‴ is coupled to the suction tool 156' via fixation elements 308. Specifically, the sample element 164‴ is shown coupled to the suction cannula 157' by two fixation elements. Although only two fixation elements 308 are illustrated, more than two fixation elements 308 may be used to couple the sample element 164 to the suction cannula 157' or the handle 159'. The fixation elements 308 may include a clip, a band, or anything that may secure the sample element 164 to the suction tool 156'.

[0083] The foregoing description is merely illustrative in nature and is in no way intended to limit the disclosure, its application, or uses. The broad teachings of the disclosure can be implemented in a variety of forms. Therefore, while this disclosure includes particular examples, the true scope of the disclosure should not be so limited since other modifications will become apparent upon a study of the drawings, the specification, and the following claims. It should be understood that one or more steps within a method may be executed in different order (or concurrently) without altering the principles of the present disclosure. Further, although each of the examples is described above as having certain features, any one or more of those features described with respect to any example of the disclosure can be implemented in and / or combined with features of any of the other examples, even if that combination is not explicitly described. In other words, the described examples are not mutually exclusive, and permutations of one or more examples with one another remain within the scope of this disclosure.

[0084] Spatial and functional relationships between elements (for example, between controllers, circuit elements, semiconductor layers, etc.) are described using various terms, including "connected," "engaged," "coupled," "adjacent," "next to," "on top of," "above," "below," and "disposed." Unless explicitly described as being "direct," when a relationship between first and second elements is described in the above disclosure, that relationship can be a direct relationship where no other intervening elements are present between the first and second elements, but can also be an indirect relationship where one or more intervening elements are present (either spatially or functionally) between the first and second elements.

[0085] As used herein, the phrase at least one of A, B, and C should be construed to mean a logical (A OR B OR C), using a non-exclusive logical OR, and should not be construed to mean "at least one of A, at least one of B, and at least one of C." The term subset does not necessarily require a proper subset. In other words, a first subset of a first set may be coextensive with (equal to) the first set.

[0086] In the figures, the direction of an arrow, as indicated by the arrowhead, generally demonstrates the flow of information (such as data or instructions) that is of interest to the illustration. For example, when element A and element B exchange a variety of information but information transmitted from element A to element B is relevant to the illustration, the arrow may point from element A to element B. This unidirectional arrow does not imply that no other information is transmitted from element B to element A. Further, for information sent from element A to element B, element B may send requests for, or receipt acknowledgements of, the information to element A.

[0087] In this application, including the definitions below, the term "controller" or "module" may be replaced with the term "circuit." The term "controller" may refer to, be part of, or include: an Application Specific Integrated Circuit (ASIC); a programmable system on a chip (PSoC); a digital, analog, or mixed analog / digital discrete circuit; a digital, analog, or mixed analog / digital integrated circuit; a combinational logic circuit; a field programmable gate array (FPGA); a processor circuit (shared, dedicated, or group) that executes code; a memory circuit (shared, dedicated, or group) that stores code executed by the processor circuit; other suitable hardware components that provide the described functionality; or a combination of some or all of the above, such as in a system-on-chip.

[0088] The controller may include one or more interface circuits with one or more transceivers. In some examples, the interface circuit(s) may implement wired or wireless interfaces that connect to a local area network (LAN) or a wireless personal area network (WPAN). Examples of a LAN are Institute of Electrical and Electronics Engineers (IEEE) Standard 802.11-2016 (also known as the WIFI wireless networking standard) and IEEE Standard 802.3-2015 (also known as the ETHERNET wired networking standard). Examples of a WPAN are the BLUETOOTH wireless networking standard from the Bluetooth Special Interest Group and IEEE Standard 802.15.4.

[0089] The controller may communicate with other controllers using the interface circuit(s). Although the controller may be depicted in the present disclosure as logically communicating directly with other controllers, in various implementations the controller may actually communicate via a communications system. The communications system may include physical and / or virtual networking equipment such as hubs, switches, routers, gateways and transceivers. In some implementations, the communications system connects to or traverses a wide area network (WAN) such as the Internet. For example, the communications system may include multiple LANs connected to each other over the Internet or point-to-point leased lines using technologies including Multiprotocol Label Switching (MPLS) and virtual private networks (VPNs).

[0090] In various implementations, the functionality of the controller may be distributed among multiple controllers that are connected via the communications system. For example, multiple controllers may implement the same functionality distributed by a load balancing system. In a further example, the functionality of the controller may be split between a server (also known as remote, or cloud) controller and a client (or, user) controller.

[0091] Some or all hardware features of a controller may be defined using a language for hardware description, such as IEEE Standard 1364-2005 (commonly called "Verilog") and IEEE Standard 1076-2008 (commonly called "VHDL"). The hardware description language may be used to manufacture and / or program a hardware circuit. In some implementations, some or all features of a controller may be defined by a language, such as IEEE 1666-2005 (commonly called "SystemC"), that encompasses both code, as described below, and hardware description.

[0092] The term code, as used above, may include software, firmware, and / or microcode, and may refer to programs, routines, functions, classes, data structures, and / or objects. The term shared processor circuit encompasses a single processor circuit that executes some or all code from multiple controllers. The term group processor circuit encompasses a processor circuit that, in combination with additional processor circuits, executes some or all code from one or more controllers. References to multiple processor circuits encompass multiple processor circuits on discrete dies, multiple processor circuits on a single die, multiple cores of a single processor circuit, multiple threads of a single processor circuit, or a combination of the above. The term shared memory circuit encompasses a single memory circuit that stores some or all code from multiple controllers. The term group memory circuit encompasses a memory circuit that, in combination with additional memories, stores some or all code from one or more controllers.

[0093] The term memory circuit is a subset of the term computer-readable medium. The term computer-readable medium, as used herein, does not encompass transitory electrical or electromagnetic signals propagating through a medium (such as on a carrier wave); the term computer-readable medium may therefore be considered tangible and non-transitory. Non-limiting examples of a non-transitory computer-readable medium are nonvolatile memory circuits (such as a flash memory circuit, an erasable programmable read-only memory circuit, or a mask read-only memory circuit), volatile memory circuits (such as a static random access memory circuit or a dynamic random access memory circuit), magnetic storage media (such as an analog or digital magnetic tape or a hard disk drive), and optical storage media (such as a CD, a DVD, or a Blu-ray Disc).

[0094] The apparatuses and methods described in this application may be partially or fully implemented by a special purpose computer created by configuring a general purpose computer to execute one or more particular functions embodied in computer programs. The functional blocks and flowchart elements described above may serve as software specifications, which can be translated into the computer programs by the routine work of a skilled technician or programmer.

[0095] The computer programs include processor-executable instructions that are stored on at least one non-transitory computer-readable medium. The computer programs may also include or rely on stored data. The computer programs may encompass a basic input / output system (BIOS) that interacts with hardware of the special purpose computer, device drivers that interact with particular devices of the special purpose computer, one or more operating systems, user applications, background services, background applications, etc.

[0096] The computer programs may include: (i) descriptive text to be parsed, such as HTML (hypertext markup language), XML (extensible markup language), or JSON (JavaScript Object Notation), (ii) assembly code, (iii) object code generated from source code by a compiler, (iv) source code for execution by an interpreter, (v) source code for compilation and execution by a just-in-time compiler, etc. As examples only, source code may be written using syntax from languages including C, C++, C#, Objective-C, Swift, Haskell, Go, SQL, R, Lisp, Java ®< , Fortran, Perl, Pascal, Curl, OCaml, JavaScript ®< , HTML5 (Hypertext Markup Language 5th revision), Ada, ASP (Active Server Pages), PHP (PHP: Hypertext Preprocessor), Scala, Eiffel, Smalltalk, Erlang, Ruby, Flash ®< , Visual Basic ®< , Lua, MATLAB, SIMULINK, and Python ®< .

Claims

1. A surgical suction system (113) comprising: a suction tool (156) including a suction cannula (157) and a handle (159), the handle (159) being tubular shaped with a control portion (167) with a distal end (162) that is configured to receive a proximal end (161) of the suction cannula (157), wherein the suction tool (156) is configured to apply suction to brain tissue; a sample element (164) coupled to the suction tool (156) including at least one optical fiber (264) with a distal end (272) configured to collect a fluorescent light emitted from the brain tissue; an indicator (298) coupled to the suction tool (156) and configured to selectively emit light; and a controller (204) configured to: detect a type of brain tissue based on the fluorescent light; and activate the indicator (298) based on the detected type of brain tissue characterized in that the indicator (298) is positioned near the distal end (272) of the optical fiber (264) but more proximal to the distal end (162) of the control portion (167) of the handle (159) than the distal end (272) of the optical fiber (264) is.

2. The surgical suction system (113) of claim 1, wherein the at least one optical fiber (264) is coupled to an excitation source (228), the at least one fiber (264) configured to illuminate an excitation light from the excitation source (228) to induce the fluorescent light and collect the fluorescent light emitted from the brain tissue.

3. The surgical suction system (113) of claim 2, further comprising an optical system (215) coupled to the controller (204) and the sample element (164), the optical system (215) including the excitation source (228) and an optical detection system configured to convert the fluorescent light into a first electrical signal, wherein the controller (204) detects the type of brain tissue from the first electrical signal.

4. The surgical suction system (113) of claim 3, wherein the excitation source (228) is further defined as a first excitation source, wherein the fluorescent light is further defined as a first fluorescent light, wherein the electrical signal is further defined as a first electrical signal, wherein the optical system (215) further includes a second excitation source, wherein the at least one fiber (264) is configured to illuminate a second excitation light from the second excitation source to induce a second fluorescent light emitted from the brain tissue and collect the second fluorescent light, wherein the optical detection system is configured to convert the second fluorescent light into a second electrical signal, and wherein the controller (204) is configured to determine a second type of brain tissue from the second electrical signal.

5. The surgical suction system (113) of any one of the preceding claims, wherein the controller (204) is configured to detect the type of brain tissue based on an algorithm.

6. The surgical suction system (113) of claim 5, wherein the algorithm includes a calibration routine to be performed with respect to healthy tissue or a baseline parameter.

7. The surgical suction system (113) of claim 5 or 6, wherein the algorithm is configured to calculate a modified electrical signal by fitting a baseline polynomial curve to the electrical signal and subtract the baseline polynomial curve from the electrical signal to remove ambient light.

8. The surgical suction system (113) of claim 7, wherein the algorithm includes fitting at least one gaussian distribution to the modified electrical signal.

9. The surgical suction system (113) of any one of claims 5 to 8 when depending on claim 2, wherein the controller (204) is configured to cycle the excitation source (228) on and off, wherein the sample element (164) is configured to collect ambient light when the excitation source (228) is off and not illuminating the brain tissue with the fluorescent light, wherein the sample element (164) is configured to collect ambient light and the fluorescent light when the excitation source (228) is on and the sample element is illuminating the brain tissue with the fluorescent light, and wherein the algorithm includes subtracting the ambient light from the fluorescent light.

10. The surgical suction system (113) of any one of claims 1 to 9, further comprising an electrode (266) configured to apply electrical stimulation to the brain tissue, wherein the controller (204) generates an alert when the electrical stimulation produces a predefined response from a patient.

11. The surgical suction system (113) of any one of claims 1-10, wherein the suction tool (156) includes a handle portion (159) and an elongated portion, and wherein the sample element (164) is coupled to the elongated portion.

12. The surgical suction system (113) of any one of claims 1 to 11, wherein the indicator (298) is an indicator fiber.

13. The surgical suction system (113) of claim 12, wherein the indicator fiber is arranged to receive light at a different wavelength than the excitation light.

14. The surgical suction system (113) of any one of claims 1 to 13, wherein the controller (204) is configured to generate an activation signal based on a comparison of a Protoporphyrin IX (PPIX) intensity, for a PPIX emission band, which includes 635 nm, that was fitted to a gaussian band, to a predetermined intensity threshold.