Medical instrument and system comprising such an instrument

Abstract

The present invention relates to a medical instrument (1) comprising a free distal end for penetrating a tissue or organ and / or a blood vessel and a proximal end connectable to a light source (10), said instrument comprising a tubular support (3) in which is mounted at least one light guide (2), said support (3) having a beveled distal end comprising at least one orifice forming a first optical output, for substantially frontal emission of light by said guide (2) via said first optical output, said instrument being characterized in that it comprises at least one optical deflection means (210, 310, 312, 313) for the light forming a second optical output, for deflected light emission, comprising at least one machining on a distal portion of the instrument, with at least one reflective and / or concave polish for light convergence and / or convex polish for light divergence,said polishing being carried out on said light guide (2) and / or on said support (3). Figure to be published with the abbreviation: Fig. 11,

Description

Title of the invention: Medical instrument and system comprising such an instrument Technical field of the invention

[0001] The present invention relates generally to the field of light treatment instruments, in particular an endovenous laser that can be used for the treatment of varicose veins. This technology can be applied in an industrial environment, in particular food, dentistry, veterinary medicine. Furthermore, the present invention is not limited to endovenous treatment and can relate to various types of surgical procedures, such as conization or any other procedure requiring a tool allowing both debridement and / or destruction and photocoagulation. Similarly, the present invention provides a new solution for lasers and in particular CO2 lasers, but it is not limited to lasers and covers various types of light, at various wavelengths. state of the prior art

[0002] Surgical operations requiring debridement and / or destruction are often heavy and costly, in particular because they generally require general anesthesia. In addition, they generate scars, in particular because it is not always easy to coagulate the tissues. In this context, it is interesting to propose a tool facilitating debridement and / or destruction and improving the possibilities of photocoagulation.

[0003] More recent techniques for vascular sclerosis, in particular the treatment of varicose veins, for example the technique set out in document US 2003 / 0078569, although less burdensome for the patient, nevertheless require catheterization preparation, operator dressing, sterile fields, extensive disinfection and complex handling in the operating room. They also use long and expensive optical fibers. In addition, this technique requires the injection of anesthetic products which may cause undesirable effects, for example allergies. This is the case for conventional sclerosis in the office which uses chemical sclerosants.

[0004] Document US 2005 / 0131400 details a device for conducting a laser in an optical fiber, the end of the optical fiber passing through a catheter to be introduced into a blood vessel. The laser beam diffused at the end of the optical fiber inside a vein participates in the treatment of varicose veins by acting on the endothelial cells of the wall of the vein as well as its entire wall, the effect being thermomechanical. However, such a device does not allow the diffusion of light to be optimized during circumferential treatment of the wall of a vessel.

[0005] Application WO2007104836A1 teaches a tubular support such as a needle in which a light guide such as an optical fiber is present and discloses the use of side windows in the support or various arrangements of the distal end of the instrument for light diffusion. However, this type of instrument can be improved, in particular with regard to the deflection of the light, by convergence or divergence depending on the type of applications targeted.

[0006] The aim of the invention is to propose a simpler technique and a material, instrument and system, less expensive and easier to handle and / or improving the possibilities of detersion, tissue destruction and photocoagulation. Statement of the invention

[0007] The present invention therefore aims to propose a medical instrument and a system comprising such an instrument, making it possible to overcome at least some of the drawbacks of the prior art by proposing a simpler technique and equipment, instrument and system, which are less expensive and easier to handle and / or improve the possibilities of debridement, tissue destruction and photocoagulation. One of the advantages is thus to reduce the cost of the procedure outside the operating room and to be able to repeat the intervention at lower cost if necessary.

[0008] This object is achieved by a medical instrument comprising a free distal end intended to penetrate into a tissue or an organ and / or a blood vessel and a proximal end connectable to a light source, said instrument comprising a tubular support in which at least one light guide is mounted, said support comprising a beveled distal end comprising at least one orifice forming a first optical output, for a substantially frontal emission of the light by said guide via said first optical output, said instrument being characterized in that it comprises at least one means for optical deflection of the light forming a second optical output, for an emission of deflected light, comprising at least one machining on a distal portion of the instrument, with at least one reflective and / or concave polishing for a convergence of the light and / or convex for a divergence of the light,said polishing being carried out on said light guide and / or on said support.

[0009] According to another feature, the light guide comprises an optical fiber.

[0010] According to another feature, said optical fiber is hollow and associated with a source of CO2 laser light.

[0011] According to another feature, the light guide comprises a reflective coating on the internal wall of the tubular support.

[0012] According to another feature, said beveled distal end of said support is sharpened arrow-wise with a sharpening angle giving it cutting and pe- netr antes.

[0013] According to another feature, at least one distal portion is curved according to a radius of curvature, facilitating the manipulation of the instrument from outside the tissue or organ.

[0014] According to another feature, said light deflection means comprises at least one lateral orifice in the wall of said support, near the distal end, said lateral orifice comprising at least one chamfer in the thickness of the wall of the support, providing an optical deflection angle, either by flaring outwards to form a divergent deflection means, or by flaring inwards to form a convergent deflection means.

[0015] According to another feature, said light deflection means is a divergent deflection means comprising convex polishing carried out on a light-conducting ball deposited on the surface of the light guide.

[0016] According to another feature, the distal end of the light guide, for example a transversely sectioned or beveled bare-end optical fiber or a hollow fiber, is positioned set back from the beveled distal end of the holder, with a reflective polished internal surface within the beveled distal end of the holder then serving as a reflective tool forming an optical deflection means.

[0017] According to another feature, the beveled distal end of the support comprises a circumferential polishing area on the surface of the bevel at a beveling angle and comprises a second bevel, obtained by a second polishing of a portion of said polishing area.

[0018] According to another feature, said second polishing is carried out on a lateral portion of said polishing area, providing a lateral optical deviation angle.

[0019] According to another feature, said second polishing is circumferential over the entire said polishing area and provides a distal optical deflection angle.

[0020] According to another feature, said second polishing is carried out on a central and apical portion of said polishing area, providing an apical optical deviation angle.

[0021] According to another feature, said second polishing is carried out at a determined height to also obtain a polishing area of ​​the distal end of the light guide, resulting in two optical deviation angles and a deformed active surface of the light guide.

[0022] According to another feature, the beveled distal end of the support comprises a circumferential polishing area on the surface of the bevel at a beveling angle and comprises at least one semi-spherical and / or triangular notch forming at least one optical deflection means, either lateral or central and apical.

[0023] According to another feature, the distal end of the light guide is housed at inside the support, set back from the distal end of the support by a distance of at least 1 to 10 mm.

[0024] According to another feature, the instrument comprises two light guides, preferably two optical fibers, one of the guides carrying a divergent optical deflection means, for example a convex polishing while the other carries a convergent optical deflection means, for example a concave polishing.

[0025] According to another feature, said light guide comprises both a divergent optical deflection means and a convergent optical deflection means.

[0026] According to another feature, the support comprises both a divergent optical deflection means and a convergent optical deflection means.

[0027] According to another feature, the instrument comprises means for rotating and / or advancing the light guide and / or the support, in particular relative to each other.

[0028] According to another feature, the instrument comprises at least one marking to verify the correct positioning of the instrument.

[0029] According to another feature, at least one colored filter is arranged on the path of the light.

[0030] According to another feature, the support is made of biologically neutral material, preferably chosen from stainless steel or aluminum.

[0031] According to another feature, the support has a distal outer coating made of a material with increased thermal conduction.

[0032] According to another feature, the light guide is an optical fiber reflecting wavelengths between 200nm and 5pm.

[0033] According to another feature, the light guide is a coating of the internal surface of the support forming an internal reflective tube reflecting wavelengths between 200 nm and 1 Ipm, preferably 5 pm and 1 Ipm.

[0034] According to another feature, the light guide is a doped optical fiber with an external diameter of between 50 and 1000 pm, preferably between 50 and 150 pm, preferably between 75 and 125 pm.

[0035] According to another feature, the support has a length of between 10 and 120 mm, the external diameter of the guide is between 100 and 4,000 μm, preferably 50 and 1000 μm, the external diameter of the needle is between 200 and 5,000 μm, preferably between 450 μm and 1000 μm and the distal end of the support is beveled with a bevel angle of between 10 and 20°.

[0036] According to another feature, it comprises an electronic device for compatibility with the light vector and the source in order to calibrate the power of the beam at the needle outlet.

[0037] According to another feature, the opening of the guide, preferably the opening digital fiber, is between 15° and 40°, preferably 20 and 35°, even more preferably 23° and 32°.

[0038] According to another feature, the instrument comprises two channels, either by a double channel in the support, or by a channel of the support associated with another channel of another instrument, the assembly being coupled to a thermocouple measuring device for measuring the temperature at the distal end of the support.

[0039] According to another feature, the instrument further comprises an alarm system when the value of the measured temperature exceeds a predetermined threshold value.

[0040] According to another feature, the instrument further comprises a thermal reagent configured to react when it reaches a predetermined temperature, in order to visualize overheating.

[0041] According to another feature, the light guide comprises a plurality of different optical fibers, with different optical deflection means from one fiber to another, the instrument being coupled to a multiplexer at the level of the light source to carry out a photo-diagnosis thanks to the differential collection of the signals from the different fibers.

[0042] Another object of the invention is to propose a food control method which is easy and inexpensive to implement.

[0043] This aim is achieved by a method for screening for toxic products in food control by the use of a medical instrument according to the present application, by the detection of chromophores. Brief description of the figures

[0044] Other characteristics, details and advantages of the invention will emerge on reading the description which follows with reference to the appended figures, which illustrate: - [Fig.l] represents a schematic view of a system according to certain embodiments of the invention, in use; - [Fig.2] represents a schematic profile view of the connection means of the system according to certain embodiments; - [Fig.3] is a longitudinal sectional view of the connecting means of [Fig.2]; - [Fig.4] is a schematic side view of the connecting means and the tubular support according to certain embodiments; - [Fig.5] is a schematic view of the distal bevel of the tubular support, according to certain embodiments; - [Fig.6] is a schematic perspective view of the distal end of the support, according to certain embodiments comprising a second lateral distal bevel; - [Fig.7] is a schematic perspective view of the distal end of the support as shown in [Fig.6], and further representing the light guide and its numerical aperture according to certain embodiments; - [Fig.8] is a schematic perspective view of a tubular support and light guide of an instrument according to certain embodiments comprising a second circumferential distal bevel; - [Fig.9] is a schematic perspective and transparent view of the support and the light guide formed by a hollow tube for carrying a CO2 laser of an instrument according to certain embodiments; - [Fig. 10] is a schematic profile view of the support having a distal curvature according to certain embodiments; - [Fig.11], [Fig.12] and [Fig.13] represent details in schematic perspective view of the distal end of the support according to various embodiments comprising at least one lateral distal window with polishing; - [Fig. 14] is a schematic perspective view of a tubular support and light guide of an instrument according to certain embodiments comprising a second central and apical distal bevel; - [Fig. 15] is a schematic front view of the distal end of an instrument according to certain embodiments comprising a second central and apical distal bevel which projects onto the light guide and thus forms a polish of the distal end of the light guide; - [Fig. 16] is a schematic front view of the distal end of an instrument such as that of [Fig. 15], showing two different heights of the second central and apical distal bevel projecting onto the light guide, with the active surface of the light guide deformed by its distal polishing; - [Fig. 17] is a schematic perspective view of the distal end of an instrument such as that of [Fig. 16], showing the distal bevel angles on the light guide and tubular support and the deformation of the active surface of the light guide; - [Fig. 18] is a schematic perspective view of a tubular support and light guide of an instrument according to certain embodiments comprising at least one lateral, semi-spherical and / or triangular distal notch. detailed description of the invention

[0045] The present application relates to a surgical instrument for treatment by light, in particular by laser. Numerous combinations of the embodiments detailed in the present application can be envisaged without departing from the scope of the invention; the person skilled in the art will choose one or the other depending on the economic, ergonomic, dimensional or other constraints that he must respect for normative purposes. In addition, the various technical characteristics are described in functional terms and it is understood from reading this application that the same device can combine the functional characteristics of various embodiments.

[0046] Light treatment is known in the medical field, particularly laser treatment. As a reminder, the effects of this treatment can be thermal and mechanical. Thermal effects occur when the laser radiation is absorbed by the obstacle (the tissue). They then induce a tissue reaction which is linked to the change in the body's temperature and the duration of warming. Depending on the rise in tissue temperature, different types of reactions can occur. Hyperthermia corresponds to a moderate rise in tissue temperature, of the order of a few degrees. Thus, a tissue temperature of the order of 41°C for several tens of minutes can lead to cell death. Coagulation corresponds to irreversible necrosis without immediate tissue destruction. In this action, the tissue temperature can reach temperatures between 50°C and 100°C for approximately one second.This temperature then produces desiccation, whitening and shrinkage of the tissues by denaturing proteins and collagen. The tissues will then be eliminated (detersion) and then heal. Volatilization or vaporization corresponds to a loss of substance. Here, we are talking about a tissue temperature above 100°C. Under these conditions, the cellular constituents are evaporated during a relatively short period of time. A zone of coagulation necrosis is observed at the edges of the volatilized zone because the thermal transition between the volatilized zone and the healthy zone is gradual. The mechanical effects, for their part, are induced by the creation of a plasma, explosive vaporization, or by a cavitation phenomenon. These effects are mainly linked to the expansion of a shock wave (created from thermal effects) which will generate a destructive effect.Indeed, when material is ejected from the substrate by illumination, the latter will recoil. This recoil effect is linked to the conservation of energy and to the fact that light energy is transformed into kinetic energy. The present application proposes to take advantage of these effects to optimize processing possibilities.

[0047] According to a first objective of the invention, such an instrument comprises a light guide, for example an optical fiber, and a rigid tubular support receiving the guide, for example a needle forming a protective and guiding sheath around the light guide. The terms “tubular support” and “needle” are therefore used in the present application in a non-limiting and indistinct manner. Likewise, the terms “light guide”, “light vector”, “vector”, “optical fiber” or “fiber” are used in this application in a non-limiting and indistinct manner.

[0048] Such an optical needle is connected to a laser or white light source, for example filtered, of variable wavelength thanks to the light vector that it contains and which carries the light from the source to the distal end. The connection (4) with the light source can be made by a standard socket (SMA or other), re-sterilizable (in particular chemically) for use in a sterile surgical environment. Thus, unlike previous uses where the flexibility of an optical fiber is favored, for example in order to be able to travel (catheterize) a vein or even an artery over a long distance from an inlet of the fiber to an area to be treated, on the contrary, a certain rigidity is favored which is provided by the support. Of course, this rigidity is not absolute, but rather to be compared to the flexibility of an optical fiber as used, in particular in endovenous laser. This rigidity can be nuanced depending on the use.For example, in the case of a beveled needle, it can be rigid enough to allow it to penetrate a patient's skin, cut tissue such as a tumor lesion or cleanse tissue such as an ulcer, for example.

[0049] Advantageously, the instrument may comprise means for connection to a light source, in particular to a laser light source. The laser light source may have a wavelength of between 200 and 4000 nm, which is suitable for endovascular use. Other wavelengths are also possible depending on the applications. In particular, embodiments are provided in which a hollow fiber (or a reflective coating) is used in the hollow needle, with internal reflection, in particular for a CO2 laser (10.6 pm wavelength making the use of a solid optical fiber impossible).

[0050] In certain embodiments, the laser light source may have a wavelength advantageously between 800 and 1000 nm. Even more advantageously, this wavelength is 980 nm, due to its preferential absorption by oxygenated hemoglobin and by water.

[0051] The instrument comprises means for substantially frontal emission of the light and means for deflecting the light, in particular for lateral emission of the light or deflection not parallel to the frontal emission axis (corresponding to the generatrix of the cylinder formed by the needle and / or the fiber). Lateral diffusion can be achieved through one or more lateral windows and / or by means of a lateral bevel of the distal end of the instrument and / or by means of a polishing (or circumferential or apical bevel or flat, either on the support, or on the guide, or on both. Depending on the intended use, the windows can be distributed transversely or longitudinally along the light guide and / or the support. In some embodiments, the type of polishing used is a so-called "glossy" polishing. In other embodiments, the type of polishing used is a "matte" polishing. This type of polishing is more expensive but allows the light to be channeled in a desired direction.

[0052] Generally speaking, the present invention comprises a medical instrument (1) comprising a free, manipulable distal end intended to penetrate a tissue or an organ (6) and / or a blood vessel (V) and a proximal end connectable to a light source (10), said instrument comprising a tubular support (3) in which at least one light guide (2) is mounted. This support (3) comprises a beveled distal end (31) comprising at least one orifice forming a first optical output, for a substantially frontal emission of the light by said guide (2) via said first optical output. This beveled distal end is arranged to facilitate the penetration of the needle, as known from the prior art. The angle (A) of this distal bevel may vary depending on the size of the needle, in particular in diameter or in length, as for example shown in [Fig.5].The bevel angle of the needle is between 10-40°, preferably 20° and 30°, even more preferably 25°. The smaller the angle, the less painful the penetration through the skin; this angle therefore conditions the algogenic nature of the puncture. It also conditions the shape of the photon field: the optical surface and the active surface depending on the numerical aperture of the light guide (2), here of the fiber, are increased when the bevel angle is smaller. The bevel angle optically influences the shape of the photon field and therefore the biological effect.

[0053] According to various embodiments of the invention, the instrument comprises at least one optical deflection means (210, 310, 312, 313, 314, 315) of the light forming a second optical output, for an emission of deflected light. This deflection means, which can take various forms according to various embodiments, comprises at least one machining and / or polishing on a distal portion of the instrument. The polishing can be reflective for a straight deflection of the light and / or concave for a convergence of the light and / or convex for a divergence of the light. Advantageously, this polishing is carried out on said light guide (2) and / or on said support (3). It is understood that several different polishings can be provided at several locations on the distal portion of the instrument, to obtain several light deflection means, which make it possible to combine the effects produced by each.Indeed, concave polishing will allow a convergence of light and promote tissue cleansing, in particular sectioning, or even destruction. Conversely, convex polishing allows a divergence of light and will promote photocoagulation. Similarly, polishing forming a second bevel or a flat or a chamfer at the edge of an exit orifice will allow a divergence of light fa. favoring photocoagulation. Thus, rather than using convex polishing obtained by a ball deposited at the distal end (by the technique known as "ball fiber" in English) which is expensive and complex to implement, it is possible to machine the support and / or the guide to obtain a divergence of the light at a lower cost, while controlling the extent of the diffusion as a function of the angle (C, G, D, F) of the bevel, flat or chamfer and its polishing, as detailed below. Thus, instead of using a single distal bevel or polishing as in the prior art, various embodiments advantageously use a second polishing (or beveling), either of the support, or of the fiber, or of both. Other embodiments advantageously use a second polishing of a coating inside the support.The term "substantially frontal emission" means an emission of light at the distal end which occurs frontally at the optical output, but it is understood that, due to the presence of the distal bevel, this emission is not perfectly frontal and that the light is emitted in a direction not parallel to the generator of the cylinder formed by the support and / or the light guide.

[0054] Generally speaking, the instrument may comprise an optical fiber as a light guide (2), for example a fiber of a type commonly used for medical applications, for example made of silica, in particular simple silica. This fiber may be mounted in a tubular support (3) such as a needle. The term "needle" means a tubular structure or support, sufficiently rigid to allow precise manipulation of the light guide. Furthermore, in particular for endovenous treatment, this needle must be sufficiently rigid to pierce the skin, like a puncture needle. It is understood that the instrument has a first end, called distal in the present application, which is intended to penetrate the tissues and another end which is intended to be connected to a light source (in particular laser).The tubular support forms a cylinder between these two ends and defines a generator of the cylinder, which can be rectilinear, but sometimes curved as for example shown in [Fig. 10] amount that the radius (E) of curvature of the instrument can vary according to the applications (in particular according to the depth at which one wishes to intervene in the tissues) because it facilitates the manipulation of the instrument from outside the tissue or organ. The term "distal" therefore designates the free end of the instrument which penetrates into the tissues, organ (6) or blood vessels (V) and the term "apical" designates the apex, that is to say the point or the zone located furthest on this distal end. On the other hand, the instrument has another end, called proximal (because it is the closest to the user) which is connectable in particular to a light source to illuminate the light guide of the instrument.This proximal end is also connectable to other devices according to various embodiments detailed in the present application.

[0055] In certain embodiments, the diffusion orifices of the support and of the light guide, in particular the light deflection means, are located near a distal portion (31) of the instrument of the tubular support, either at their apical end and / or at least one lateral window allowing lateral or circumferential treatment if the instrument is rotated.

[0056] By the term "nearby" is meant that the diffusion orifice is closer to the apical end of the element than to its base, preferably is closer to the apical end of the element than to the middle of the element, for example at the apical end of the element. Thus, an orifice at the apical end of the support (and the guide) allows for straight treatment while an orifice forming a lateral window allows for circumferential treatment by rotating the tool.

[0057] In certain embodiments, the end of the support (3) is in a concave or convex semicircle, for example in the shape of a “sharp spatula” which allows tissue debridement or incision (e.g. conization of the cervix, ulcer debridement, tissue section). This allows an increased sectioning effect in particular if the polishing of the optical surface is concave with a focusing effect on the optical field thus concentrating the light energy or energy density. The precision of the incision can thus be increased.

[0058] Light deflection means

[0059] The instrument comprises at least one means for deflecting light, by means of at least one second bevel or flat or polishing, in addition to the beveled distal end (31) of the support (3). This polishing at the end of the needle may be convex or concave in order to diffuse or focus the output beam, the aim being to increase the optical diffusion field (in the case of convex polishing) for tissue destruction (for example for ulcerative debridement) or to focus it (in the case of concave polishing) for tissue section (for example for conization).

[0060] In some embodiments, said light deflecting means comprises at least one lateral orifice (312) in the wall of said support, near the distal end (31), said lateral orifice (312) comprising at least one chamfer (3121) in the thickness of the wall of the support (3), providing an angle (F) of optical deflection, either by flaring outwards to form a diverging deflection means, or by flaring inwards to form a converging deflection means. [Fig. 11], [Fig. 12] and [Fig. 13] show illustrative and non-limiting examples of such lateral orifices which may have various shapes and be in various numbers. The chamfer allows for a diffusion of light providing a different effect than that provided by the distal bevel of the instrument. For example, with a divergent angle as shown in these figures, the lateral holes promote photocoagulation.We therefore obtain a tool which cuts at its apex and coagulates in its distal portion, at . lower cost. In certain embodiments, as for example illustrated in a non-limiting manner in [Fig. 11], [Fig. 12], and [Fig. 13], the windowing of the support (3) (of the needle or the sectioning tool) may be circular, elliptical, square, rectangular depending on the applications. The number is variable depending on the applications, in particular for the thermal and thermomechanical effects in endovenous vascular applications. There is a chamfering angle (F) which may be variable depending on the machining of the device, and beyond that condition the shape of the photon field and therefore the biological effect. It may be added at a determined location judiciously posterior or lateral to the bevel in order to add a coagulation effect and to circumscribe the section above the bevel for example. The chamfering angle through the wall of the needle body is generally between 30-90°, preferably 50-70, preferably 60°.

[0061] Various embodiments of the present invention aim to provide an instrument with a first optical output, generally parallel to the generatrix of the cylinder formed by the support (3) and / or the guide (2) and a second deflected optical output, generally not parallel to the generatrix of the cylinder formed by the support (3) and / or the guide (2). At least two different optical surface angles (or active surfaces) are thus obtained for the same instrument, in particular with a reduced manufacturing cost and easier use.

[0062] In certain embodiments, said light deflection means is a divergent deflection means comprising convex polishing carried out on a light-conducting ball deposited on the surface of the light guide (3) (by the technique known as “bail fiber” in English).

[0063] In some embodiments, the end of the light guide, for example a transversely sectioned or beveled bare-end optical fiber or a hollow fiber, is positioned set back from the beveled distal end (31) of the holder (3), with a reflective polished internal surface (315) within the beveled distal end (31) of the holder (3) then serving as a reflective tool forming an optical deflection means. This advantageously allows a less expensive embodiment than when polishing is carried out. In other embodiments, a reflective device or coating is provided at the end of the needle, on the internal portion of the bevel not covered by the fiber. There are two solutions for conveying light onto the beveled distal portion which extends beyond the fiber (whether hollow, for example as in [Fig. 9] and [Fig.18], or not) A first consists of leaving the metal surface without cladding to allow the light to be reflected because the internal face of the end of the bevel is already metallic and polished (generally in biologically neutral stainless steel, as required for CE marking). This makes it possible to reduce the production cost of such a product. A second advantageously consists of limiting the . polishing of said end of the bevel to the sharpening of this area. This makes it possible to obtain a good quality / price ratio. In some of these embodiments, the distal end of the light guide (2) is housed inside the support (3), set back from the distal end (31) of the support by a distance, preferably a space of at least 1 to 10 mm. This distance may vary from one instrument to another or may be variable on the same given instrument, thanks to a translation of the fiber in the needle. This variation in distance varies the photon field at the distal end of the instrument and thus advantageously makes it possible to choose the physical effect obtained by the instrument (detersion, photo-coagulation, etc.). It will also be noted that, as an alternative to a hollow fiber, it is possible to use a reflective covering or coating inside the needle.This coating may stop at a distance from the distal end of the support (3) to obtain the same effects as for a hollow or solid fiber. Indeed, in certain embodiments, the light guide (2) is not an optical fiber independent of the needle, but a covering or a coating of the interior of the needle (3). This covering may be integral with the needle over the entire surface thus covered. Alternatively, the guide and the support remain independent. It may for example be made of silica and then have the same light guiding qualities as an optical fiber made of the same material, but it may also be made of a different material which can carry, for example, longer or shorter wavelengths. It also benefits from the protection of the sheath formed by the support or needle (3), particularly in terms of strength and shock protection.In addition, when the covering is integral with the needle, the precision of the instrument is increased. In certain embodiments, the light guide is an optical fiber reflecting wavelengths between 200nm and 5pm. In addition, in certain embodiments, the light guide is a hollow fiber or a coating of the internal surface of the support forming an internal reflective tube reflecting wavelengths between 200nm and 1 Ipm, preferably 5pm and 1 Ipm. It will also be noted that these embodiments with hollow fiber or coating can be combined with the various deflection means of the present application, whether it is a lateral window or lateral, circumferential or apical polishing or even notches, as detailed below.

[0064] In some embodiments, the beveled distal end (31) of the support (3) has a circumferential polishing area (310) on the surface of the bevel at a beveling angle (A) and has a second bevel, obtained by a second polishing (313) of a portion of said (310) polishing area. This second polishing thus forms a light deflecting means for a deflected light emission by the instrument. In some of these embodiments, said second polishing (313) is carried out on a lateral portion of said (310) polishing area, providing a angle (C) of lateral optical deviation. The lateral polishing angle of the bevel (C) conditions the penetrance due to the sectioning and cutting nature of the edge of the needle. In addition, it also conditions the overflow of the photon field, therefore its shape, therefore the biological effect. Preferably the lateral polishing angle of the bevel (C) is between 10-40, preferably 20° and 30°, more preferably 25°. Illustrative and non-limiting examples of such polishing or lateral beveling are shown in [Fig.6], [Fig.7], [Fig.11] and [Fig.12]. It should be noted that in the case where this second polishing is associated with a lateral orifice, the latter is aligned with respect to the second polishing, for example to obtain photocoagulation by the lateral orifice at the location of the section obtained by the lateral polishing.Generally speaking, the lateral orifices are generally aligned along the generatrix of the cylinder formed by the support, so as to provide their effect in the extension of the distal bevel or the deflection means located more towards the apex than this lateral orifice. Thus, when the instrument has two lateral orifices, they are generally aligned on said generatrix. Furthermore, in some of these embodiments, said second polishing (313) is circumferential over the entire said (310) polishing area and provides a distal optical deflection angle (D). The distal deflection angle (D) will condition the photon field at its lower overflow and therefore the biological effect of section reinforced by the quality of the machining of the edge of the device also conditioning the mechanical section capacity of the tool. An illustrative and non-limiting example of such polishing is shown in [Fig.8].On the other hand, in some of these embodiments, said second polishing (313) is carried out on a central and apical portion of said (310) polishing area, providing an apical optical deviation angle (G). Illustrative and non-limiting examples of such apical polishing or bevel (or flat) are shown in [Fig. 14], [Fig. 15], [Fig. 16] and [Fig. 17]. These embodiments make it possible, for example, to obtain photocoagulation by the second apical polishing at the edges of the section obtained by the distal bevel of the support. In addition, in the case where the second apical polishing (313) is carried out on both the support and the fiber, an advantageously deformed active surface (212) is obtained, for a multiple effect of the instrument on the tissues, organs (6) or vessels (V).Indeed, in some of these embodiments with apical polishing, said second polishing (313) is carried out at a height (H1, H2) determined to also obtain a polishing area (210) of the distal end of the light guide (2), resulting in two optical deflection angles (G) and a deformed active surface (212) of the light guide (2), for example as shown in [Fig. 16] and [Fig. 17]. Finally, in some embodiments, the beveled distal end (31) of the support (3) comprises a circumferential polishing area (310) on the surface of the bevel at a beveling angle (A) and said light deflection means comprises at least one . semi-spherical and / or triangular notch (314) forming at least one optical deflection means, either lateral or central and apical. An illustrative and non-limiting example of such notches is shown in [Fig. 18].

[0065] Holder / Needle

[0066] In general, the support (3) is made of a biologically neutral material, preferably chosen from stainless steel or aluminum. Biologically neutral materials are chosen, with variable thermal conductivity in order to limit undesirable effects such as burning at the puncture point, and preferably resistant to high temperatures. This results in an instrument which has biological neutrality. Furthermore, it will be noted that thanks to the use of the deflection means, the invention makes it possible to use powers such that the fiber is never damaged and therefore does not inoculate carcinogenic substances into the tissues, unlike certain devices of the prior art.Indeed, it is important to guarantee biological neutrality of the instrument at temperatures reached well above 150°C, beyond which we often observe in the prior art not only destruction of the core of a fiber, but also the combustion of its sheath (polymide or tefzel for example) thus generating its toxic combustion products (e.g. polycyclic aromatic hydrocarbons recognized as carcinogenic by the WHO). Furthermore, it is often still necessary for the moment to add a point of glue to the end of the needle, with regard to the manufacturing technique, but this glue is biologically neutral.

[0067] In some embodiments, it is possible to sharpen the distal end of the instrument in an arrow-shaped manner, for better penetration and cutting effect of the needle, for example as shown in [Fig.6], [Fig.7], [Fig.11], [Fig.12] and [Fig.13]. The angle (B) of the arrow may vary, for example as illustrated in [Fig.6]. The arrow angle (B) conditions the penetration through the skin: the higher it is, the less painful the puncture is. Preferably, the arrow angle of the needle (B) is between 10-40, preferably 20° and 30°, more preferably 25°. In other embodiments, the distal end is not sharpened in an arrow-shaped manner but remains circular or rather elliptical in shape because of its beveling allowing better penetration of the tissues. These embodiments also make it possible to make the medical instrument a detergent or cutting tool.Thus, certain embodiments relate to an instrument in which said beveled distal end (31) of said support (3) is sharpened arrow-wise with a sharpening angle (B) giving it cutting and penetrating properties.

[0068] In certain embodiments, the support, for example a needle, is curved. This advantageously makes it possible to limit the stresses at the origin of the needle and facilitate the vascular puncture procedure. As for example illustrated in a non- limiting on [Fig. 10], the support (3), here a needle, is curved. The production of a curved needle is entirely possible on a technical level in order to be able to reach anatomical elements in surgery in the operating room or in the office, particularly for phlebology in order to optimize the catheterization and its angle through the vessel. The radial angle (E) can be modified according to the applications. It is generally between 10 and 40°, preferably between 20 and 35° and ideally between 22 and 32° for medical practice.

[0069] The needle length, the diameter of the needle and the angulation of its bevel may be different depending on the application. Thus, they will be larger and longer for conization and (ulcer) tissue debridement. Preferably, in particular for the treatment of varicose veins, the needle may have an outer diameter in the range between 200 and 5000 pm, preferably between 450 pm and 1000 pm. The light guide may have an outer diameter of 100 to 4000 pm (4 mm), preferably between 50 and 1000 pm. In addition, the distal end (31) of the support (3) is preferably beveled with a bevel angle (A) of between 10 and 20°. On the other hand, the internal diameter of the support (3) may be greater than or equal to the external diameter of the fiber (2) to accommodate possible sheathing of the fiber and / or to form a channel around the fiber, in particular for the injection of substances and / or the control of blood reflux.The instrument may further comprise a channel, the reflux of blood in the channel attesting to the correct intravascular position of the needle; a channel may also be provided to inject an anesthetic or adapt a thermocouple or an optical tool for spectrophotometry, or inject a product allowing the fluorescence of the tissue to be studied. In addition, in certain embodiments, the needle comprises a double channel. The second channel may include a secondary fiber bringing another light allowing photodiagnosis, in particular in spectroscopy, but also a thermocouple measurement at the distal end of the instrument.Thus, in some embodiments, the instrument comprises two channels, either by a double channel in the support (3), or by a channel of the support (3) associated with another channel of another instrument, the assembly being coupled to a thermocouple measuring device for measuring the temperature at the distal end (31) of the support (3). In some of these embodiments, the instrument is connected or further comprises an alarm system when the value of the measured temperature exceeds a predetermined threshold value. On the other hand, in some of these embodiments, the instrument further comprises a thermal reagent configured to react when it reaches a predetermined temperature, in order to visualize overheating.In some embodiments, the support has a distal outer coating of increased thermal conductivity material, in order to facilitate obtaining a desired temperature for the treatment, in particular to amplify the thermal effect. within the tissue while preserving the proximal part of the needle with a lower thermal conductivity material, or even thermally insulating, in order to preserve the skin.

[0070] In certain embodiments, the support (3) has a length of between 10 and 120 mm, preferably with a spatula shape. The needles are generally shorter and smaller in diameter for vascular treatment, particularly in the absence of anesthesia, or laser lipolysis.

[0071] In certain embodiments, the instrument is connected to or comprises an electronic device for compatibility with the light vector and the source in order to calibrate the power of the beam at the needle output. This type of technique is known and makes it possible to check the output power, in particular advantageously in the context of the present invention thanks to the variation of the effects obtained by the light deflection means and / or by the possible movements of the fiber (2) in the support (3).

[0072] In certain embodiments, the support is made of a biologically neutral material, of variable thermal conductivity in order to limit undesirable effects or amplify the thermal effect such as burning at the puncture point, resistant to high temperatures. The material is preferably chosen from stainless steel, or aluminum.

[0073] Light guide / Fiber

[0074] The optical fiber used may be a fiber of a common type, for example made of silica and in particular of a type used for interventional fibroscopies, intravenous laser, surgery, etc. The light guide may be made of a material other than silica, depending on the wavelength of the light, in particular laser.

[0075] The cost of an instrument according to the invention can be divided by five or ten compared to an instrument currently used for the treatment of varicose veins by laser light if it is manufactured on a large scale, avoiding the high cost of the operating theatre if it is carried out in a surgery or treatment room and also allowing a repeated procedure in the event of an insufficient first result.

[0076] In some embodiments, the numerical aperture of the fiber is between 15° and 40°, preferably 20 and 35°, ideally 23° and 32°, for vascular applications. It can be increased by introducing several fibers into the same channel in order to modify the shape of the photon field. Thus, in some embodiments, the instrument comprises two light guides, preferably two optical fibers, one of the guides carrying a divergent optical deflection means, for example a convex polishing while the other carries a convergent optical deflection means, for example a concave polishing. In some embodiments, the same light guide (2) comprises both a divergent optical deflection means and a convergent optical deflection means. In certain embodiments, the light guide (2) comprises a plurality of different optical fibers, as in confocal microscopy for example, with different optical deflection means from one fiber to another, the instrument being coupled to a multiplexer at the light source to carry out a photo-diagnosis, in photofluorescence for example, thanks to the differential collection of the signals from the different fibers. Advantageously, the surface of the optical field determines the cutting or destructive effect on the tissue, particularly when the opening of the fiber is between 10° and 30°, preferably between 15 and 25°, or on the contrary enlarged for photo-diagnosis and tissue fluorescence revealing abnormal proteins in cancerology, particularly when the opening is between 20° and 40°, preferably 25-35°.

[0077] Indeed, the angle of the bevel conditions the surface which is that of the ellipse corresponding to the notion of “optical surface”. The numerical aperture conditions the “active surface” (212) within this optical surface. The angle of the bevel of the needle conditions the dimension of this active surface (212) which is increased resulting in an “optical amplification” or “optical amplification”. Illustrative and non-limiting examples of numerical aperture and active surface (212) are shown in [Fig. 7], [Fig. 16] and [Fig. 17]. We see in [Fig. 7] that the active surface will depend on the distal bevel and, in [Fig. 17], that the additional deflection means (313), by polishing both the support (3) and the fiber (2), will deform the active surface by widening it, which makes it possible to obtain a double effect at the distal end of the instrument.The first polishing surface (310) of the beveled distal end of the holder provides a first effect and the second polishing (313) at the apical end provides a second effect, due to the different angles of the two polishes providing different light field modifications.

[0078] Numerical aperture is understood to mean the sine of the maximum entry angle of the light into the light guide, for example the fiber, so that the light can be guided without loss, measured relative to the axis of the fiber.

[0079] In certain embodiments, the light guide is an optical fiber reflecting wavelengths between 200nm and 5pm. This makes it possible to broaden clinical applications by targeting new chromophores. The type of fiber can be chosen with a wavelength window wider than infrared (250nm, UV Silica), such as for example 3 or 4pm (Chalcogenides) for the needle and for its light vector. This makes it possible to broaden clinical applications by targeting new chromophores or fluorophores. Preferably, the fiber is made of silica.

[0080] Thus, the composition of the optical fiber will be chosen according to the wavelengths used. The table below summarizes the different compositions of the guide according to the wavelengths. Guide composition Wavelength (in pm) Standard silica 0.4-1.5 UV silica 0.23-1.5 IR silica 0.4-2.2 (Erbium, Holmium) Sapphire 0.4-3.3 Fluoride glasses 0.4-5.5 Chalcogenides 5.5-11 Texglass T.ox 1-11 and 3-13 AgCl and AgBr 0.4-11 Optical arms and hollow fibers 10.6 (CO2)

[0081] In some embodiments, the support is hollow and does not include a fiber. The light guide then consists of a coating of the internal surface of the support forming an internal reflective tube such as those used in CO2 laser handpieces.

[0082] Advantageously, the tube thus makes it possible to reflect long wavelengths, for example, 10600 nm (10.6 pm) when a CO2 laser is used, rather than a conventional laser light source. This wavelength being of low penetration (depth 20 pm), it is widely used for tissue cleansing, for example in the context of dermatological surgery or neurosurgery. In addition, this wavelength is not accessible to any other type of fiber and certain embodiments of the present application therefore allow the use of such lasers, by a hollow fiber or a coating inside the needle.

[0083] In certain embodiments, the CO2 laser may be carried by a hollow fiber which must stop just before the bevel. Indeed, polishing the bevel is likely to induce the production of powder residue which may make the secondary transmission of light incompatible. It will be noted that in [Fig. 9] showing an illustrative and non-limiting example of such a hollow fiber, no light deflection means is shown apart from the distal bevel, but it is of course possible to provide a deflection means such as one of those described in the present application, as for example illustrated in [Fig. 18], but also with any other embodiment having a deflection means.In the field of CO2 lasers, tissue debridement has a very important place in the operating room, whatever the specialties involved (neurosurgery, ophthalmology, dermatology, vascular surgery, tumor surgery, gynecological surgery, etc.). There are hollow fibers (2) that can be perfectly used and can be integrated into. upstream of the bevel of the needle whose correctly polished terminal part (metallic) is quite sufficient to transmit this light and even focus it in order to optimize its cutting and destructive character on the tissue concerned.

[0084] In certain embodiments, at least one colored filter is arranged in the path of the light. For example, the instrument comprises at least one filter and / or a colorization to allow the use of a filtered and / or colored white light, less expensive than a laser source. Thus, for example, at least a portion of the light guide (2) is filtered and / or colored. This advantageously makes it possible to filter the white light as a non-laser source (e.g.: PDT, tissue destruction, etc.), which is a source of savings, lasers being more expensive than a filtered white light source (flash lamp type) and facilitates the use of certain methods such as those of dynamic phototherapy for example.

[0085] In certain embodiments, the light guide comprises a doped optical fiber, preferably with an external diameter of between 50 and 1000 pm, preferably between 50 and 150 pm, preferably between 75 and 125 pm. Advantageously, the doped fiber makes it possible to work on small-caliber fibers of the order of 100 pm in diameter for aesthetic applications, in particular vascular photocoagulation and lipolysis, for example on the face. Preferably, the doping of the fiber is carried out with erbium, holmium, thulium, or praseodymium.

[0086] Connector

[0087] As already mentioned above, the instrument is preferably connected to the light source (10) by a connector (4) allowing the instrument to be changed, for example between two patients or two applications. This connector may be of the SMA type as known in the field and shown in [Fig.2], [Fig.3], [Fig.4] and [Fig.10], but it may be replaced by a locking clip connector, avoiding the use of a screw ferrule which risks causing poor positioning or breakage of the constituent elements of the instrument. The present application therefore uses the terms "connector" or "fitting" or "socket" indiscriminately with or without the term SMA, but they are not limiting.In some embodiments, the needle and the vector are connected within a hollow metal guide, the male socket of the needle being inserted into the female socket of the light vector, balls preferably being spring-loaded in order to maintain the connector in the correct position for optical guidance.

[0088] [Fig. 2] shows in a non-limiting manner certain embodiments, in which the connection or connecting means (4) comprises an SMA connector with a support and a screw ferrule. A fixing ring makes it possible to fix and stiffen the connection. A connecting tube (41) can be crimped into the connecting means (4), and a reinforcing support (42) can be provided to stiffen still the connection. The support (3) is inserted into the connection tube (before or after the connection). In certain embodiments, as for example illustrated in a non-limiting manner in [Fig.4], the support (3) is a needle crimped into the crimping tube (41) which comprises one or more crimping points (411). In these embodiments, the crimping is essential to ensure the rigidity of the needle and to avoid any mechanical twisting or angulation which could alter the fiber inside the body of the needle (3). It is integrated at the periphery of the latter in the part of the crimping body of the connection means (4). Advantageously, the crimping also allows a mass reserve which can contain excess heat produced from the needle in the tissue. Its composition, in particular its density, influences the parameters of thermal conductivity, heat transfer, thermal inertia, thermal resistance.It buffers excess heating which is a safety feature for using this material in vivo.

[0089] In some embodiments, the base of the support is crimped onto the connecting clip. This improves strength to prevent any fiber breakage at the origin of the needle which could be a source of breakage and therefore an accident. The clip is upstream of the crimping and may be metallic to increase strength. In some embodiments, the base of the needle and the connector has a marking of the bevel of the needle once it is fixed by screwing to maximum tightening or a clip with facing each other to ensure that the bevel is correctly positioned. Certain manipulations require rotation of the equipment, particularly in vascular applications.

[0090] In certain embodiments, the light guide has a diameter smaller than that of the support, at the connection between the support and the light guide. This advantageously makes it possible to avoid heating between the SMA connection of the needle and the safety factor light vector.

[0091] In some embodiments, a thermal reagent is included in the sheath of the light vector and the clip or SMA socket. This reagent may be non-metallic and single-use. Advantageously, this makes it possible to visualize abnormal overheating on the device.

[0092] In certain embodiments, the instrument comprises means for rotating and / or advancing the light guide (2) and / or the support (3), in particular relative to each other. In certain embodiments, the instrument comprises at least one marking for verifying the correct positioning of the instrument.

[0093] The present invention also relates to improving the ergonomics and use of a medical instrument. Although presented independently, and forming part of embodiments independent of the embodiments described above, those skilled in the art will easily understand that the characteristics described below can also be combined with what is described in the rest of this text.

[0094] Thus, in certain embodiments, the support (3), for example an optical needle, would be connected to a variable wavelength laser source by a light guide (light vector) connected on either side to the laser and to the support by a connecting clip instead of a standard socket (SMA or other). This advantageously saves time and improves ergonomics thanks to the easier handling. In addition, screwing in an SMA socket can sometimes cause destruction of the screw thread of the light guide (light vector) and of the support itself, for example the needle itself. In addition, the presence of a connecting clip allows the identification clip to be colored for each piece of equipment according to the applications, which further simplifies use.

[0095] In certain embodiments, the connection of the needle and the light vector is colorized. This makes it possible, depending on the applications, to facilitate the identification of each type of material according to the application for which it would be intended, preferably in the same color as the clip.

[0096] Applications

[0097] A laser light treatment method can advantageously use an instrument or system according to the invention. It can in particular be used for vascular applications, in particular for the treatment of varicose veins. For their treatment, the laser can be used for varicose vein sclerosis. It can also be used for arterial occlusion, thus replacing chemical embolization as well as fibro-calcareous arterial unblocking for the preparation of angioplasties. The same applies to ulcer debridement, tumor section or laser lipolysis.

[0098] For example, after local anesthesia, the instrument according to the invention is pricked directly at a varicose vein to be treated, through the skin, as for a puncture. The prick can be done under visual control or under ultrasound control. The instrument can itself be used to inject anesthetic through a channel provided for this purpose, thus avoiding an additional prick and the use of an additional syringe. A channel, possibly the same, can also be provided to check the blood flow. It is thus possible to check the correct positioning of the instrument in the vascular system. Anesthesia by peri-vascular or peri-tumoral intumescence can be performed. The location can be done under ultrasound. A photochemical substance can also be injected in order to potentiate the thermal or phototherapeutic effect if it is applied to the tumor pathology.

[0099] When the instrument is in position, a laser shot is performed. It is advantageous to rotate the end of the light guide to ensure a circumferential lesion of the wall of the varicose vein to be treated. This results in sclerosis of the varicose vein, which is then no longer irrigated. In endovenous laser, photocoagulation of the blood is observed with tissue retraction by contraction of the collagen in proportion more important in the varicose vein.

[0100] The instrument is then removed and can be decarbonized if necessary with a sterile compress. The instrument is then ready to treat another varicose vein. Direct puncture without a guide needle is also possible.

[0101] In some embodiments, the instrument comprises an electronic device (chip) for compatibility with the light guide and the source in order to calibrate the beam at the support output (needle output); this would make it possible to know exactly the power loss at the end of the needle compared to the data from the light source. In addition, it could be coupled to a device allowing spectrophotometry or optical cell biopsy.

[0102] In some embodiments, the instrument comprises a thermocouple device at the distal end of the support to measure the temperature at this point, in order to have an in vivo temperature measurement via an already patented double channel and a critical temperature alarm system which makes it possible to avoid burns and makes it possible to study in vivo and in vitro thermodynamic models with external thermography coupling for each application. The assembly would make it possible to design thermodynamic simulations. In addition, this would make it possible to detect chromophores for the screening of toxic products in food control from the moment they have a specific absorption spectrum; this would avoid slow and costly biological analyses and significantly increase screening on food chains.

[0103] The invention thus allows the screening of toxic products in food control by the use of a medical instrument according to the invention, by the detection of chromophores.

[0104] The study of temperature by thermocouple according to the abacus to be studied would make it possible to evaluate the percentage of fat and proteins in minced meat on a food chain for example or the study of a tumor in situ in human or veterinary pathology.

[0105] In certain embodiments, the use of a “multiplexer” type device makes it possible to emit at a certain wavelength and to recover a frequency shift, in particular for immunofluorescence by the injection of fluorophore, for example via the needle channel or even the use of chromophore. Thus, certain embodiments relate to the use of the instrument for the detection of chromophores. In addition, this type of tool allows spectrometric analysis, in particular in infrared, for example for the study of tissues in vivo. This makes it possible to develop this tool both in the fields of medical research but also in the veterinary and food fields in order to search for particular substances in spectrophotometric analysis. For fluorescence it It may be useful for calibration to use a tip whose end allows this fluorescence to be tested.

[0106] Wavelength division multiplexing or WDM (wavelength-division multiplexing) requires recruiting a small number of channels for the needle and therefore remains less expensive or "coarse WDM". It uses a dichroic filter deposited on the fiber itself. It allows the photon field to be divided into two, which allows bidirectional transmission in order to observe an absorption shift in spectrophotometry (immunofluorescence for example) for tumor photodiagnosis by revealing abnormal proteins.

[0107] It is conceivable to multiply the number of fibers in a needle, even in a caliber of only 2 mm, in order to exploit equivalent optical imaging of the “phased array” in ultrasound; we then speak of “dense WDM” or “ultra dense WDM”.

[0108] The present invention is therefore applicable to photodiagnosis When using a multiplexer at the light source, because with these multi-fiber systems, by modifying the optical field using the arrangements of the present application, it is possible to obtain particular images with various levels of specificity and sensitivity, in particular in immunofluorescence. A light is injected and its return is examined, but if a double-channel needle is used (with a channel for injecting immunofluorescent molecules) it is possible, for example, to discriminate between cell types (astrocytoma versus a glioma, for example) by recovering the frequency shift. Various double-channel embodiments (or 2 channels in 2 instruments) will therefore use one channel for injecting immunofluorescent molecules and the other for light, with the principles described in the present application.

[0109] Spectrometry (with an upstream multiplexer) can also be performed to detect particular molecules (with a specific absorption spectrum). In this case, it is not necessary to have two channels or an injection channel.

[0110] Among the applications, advantage can be taken of gradients or index steps, in particular to convey several different wavelengths. Indeed, there are essentially two types of optical fibers that exploit the principle of total internal reflection: step-index fiber and graded-index fiber. In step-index fiber, the refractive index drops abruptly from one value in the core to a lower value in the cladding. In graded-index fiber, this index change is much more gradual. A third type of optical fiber uses the principle of the band gap of photonic crystals to ensure light guidance, rather than total internal reflection. Such fibers are called photonic crystal fibers, or micro-structured fibers. These fibers usually have a much higher index contrast between the different materials (usually silica and air). Under these conditions, the physical properties of the guidance differ significantly from step-index and gradient-index fibers. The invention can therefore cover the use of these various types of fibers. Furthermore, the invention can also relate to single-mode and / or multi-mode fibers. Finally, the invention can also use dichroic filters.

[0111] In some embodiments, the wavelength of the light is between 200 and 5000 nm. For example, for arterial or venous unblocking, the wavelength may be about 308-310 nm.

[0112] As already mentioned above, the numerical aperture of the fiber determines the active surface of the device that can be used for these different applications such as optical imaging, called optical biopsy, medical applications in the thermal but also disruptive field, in particular in ophthalmology, in arterial unblocking (stenosis or occlusion), as well as for venous unblocking in the event of stenosis or occlusion. This makes it possible, for example, to prepare the vessels for the placement of a stent, either arterial or venous. Vascular unblocking uses wavelengths in the ultraviolet field as for industrial marking or the industrial section of materials.The mission times being much shorter the peak powers are very high which makes the thermal effect evolve at the biological level towards a thermo-mechanical effect and the tissue disruption which is a non-thermal effect therefore safe for medical applications. On the other hand, as mentioned above, the source can be a white light filtered by the fiber itself in order to determine the right wavelength for photodynamic therapy and photo-diagnosis (PDT = Photo Dynamic Therapy according to the Anglo-Saxon terminology) for example with long emission times, that is to say generally greater than one second.

[0113] As mentioned above, in certain embodiments, as for example illustrated in a non-limiting manner in [Fig.8], the optical needle which is not polished in the shape of an arrow, and does not have lateral polishing, which makes it possible to transform the needle into an optical sectioning tool. This concerns the areas of tissue or tumor debridement, whether on an operating field or office procedures such as laser conization on stages I and II which are not subject to operating room treatment due to the cost. The tool can therefore make it possible in this application to treat in the office with local anesthesia a long needle a small precancerous lesion is therefore statistically improved the prognosis. In the event of treatment deemed insufficient after the first histological biopsy, this treatment can be completed or repeated always at low cost outside the operating room.The same applies to dermatological surgery, for example (cleansing of ulcers, cleaning of small benign tumors under local anesthesia).

[0114] The laser light source requires modest power for this application, for example of the order of 10 to 15 W in the field of small portable lasers of low size.

[0115] Thus, in particular for greater precision, it may be advantageous for the light guide, for example an optical fiber, to extend beyond the support, for example a needle. It may be provided that the fiber protrudes by 0 to 1 cm, preferably by approximately 5 mm. To protect the optical fiber during a puncture, means may be provided for retracting the fiber into the needle and means for extending the optical fiber beyond the distal end of the needle, into a working position.

[0116] Means for rotating the light guide relative to other parts of the instrument may also be provided; for example relative to the support, in particular in the case of a needle containing an optical fiber, or relative to connecting means, in particular in the case of a needle internally coated with silica. These rotation means thus allow for easier circumferential treatment.

[0117] Also, an instrument according to the invention can be used for other vascular applications, for example the sclerosis of varicose veins not only on the lower limbs, but also of pelvic or esophageal varicose veins (intra-operatively), of hemorrhoids, or the occlusion of vascular sclerosis or vascular anastomosis during surgical operations. An instrument according to the invention can also be used to perform tissue perforation, or as an alternative to biological glues, of the cyanoa-crylates type, for any intravascular embolization, in particular for congenital or acquired fistulas, or venous embolization, in particular for malformations or angiomas, lymphatic occlusion which is a source of ulcers.

[0118] Other applications exist, in particular for tissue destruction, particularly if great precision is required. Thus, in dermatology, the use of a laser with a wavelength of 980nm, or wavelengths of Erbiums and Holmiums, 2.940 and 2.140 pm, absorbed by water, makes an instrument according to the invention particularly effective, in particular for the treatment of condylomas, warts and other skin lesions. The scars are of superior quality to those obtained by other techniques.

[0119] In the context of cell destruction, other applications may also be tissue debridement in contact mode, for example applied to ulcers. An instrument according to the invention may also be used for the destruction of tissue metastases, for example intrahepatic, more ergonomic and less expensive than by radiofrequency. Tissue destruction by laser involves a phenomenon of tissue absorption of photons with secondary conversion into heat. This absorption being targeted to certain molecular constituents specific to the tissue (chromophores), the effect Thermomechanical is more specific than other thermal tissue heating processes such as radiofrequency for example (thermal effect). This specificity allows new applications of lasers such as photodynamic therapy in cancerology for example.

[0120] The use of a rigid support for the light guide allows for more precise use and superior maneuverability. Thus, the lesions caused by the treatment are more precise. Biological stimulation improves healing. Hemorrhage is reduced, as is the risk of infection, carbonization involving temperatures close to or above 350°C or 400°C, up to tissue incandescence close to 600°C. Post-operative pain is also reduced, particularly in the case of ulcer debridements; there are fewer post-operative infections. There is a secondary inhibition of inflammation and pain-causing factors at the nerve endings.

[0121] In addition, parameters can be adjustable, for example the wavelength, the emission and exposure time between each shot, the fluence, the irradiance, the continuous or pulsed mode (single or multiple) or the destruction according to the optical diffusion at the end of the light guide.

[0122] It will be readily understood from a reading of the present application that the features of the present invention, as generally described and illustrated in the figures, may be arranged and designed in a wide variety of different configurations. Thus, the description of the present invention and the related figures are not intended to limit the scope of the invention but simply represent selected embodiments.

[0123] Those skilled in the art will understand that the technical features of a given embodiment may in fact be combined with features of another embodiment unless the opposite is explicitly mentioned or it is obvious that these features are incompatible. Furthermore, the technical features described in a given embodiment may be isolated from the other features of this embodiment unless the opposite is explicitly mentioned.

[0124] It should be obvious to those skilled in the art that the present invention allows embodiments in many other specific forms without departing from the field defined by the scope of the appended claims, they should be considered by way of illustration and the invention should not be limited to the details given above. List of reference signs

[0125] 1. Instrument 2. Light guide (optical fiber, hollow fiber or reflective coating) 21. Distal end of the light guide 210. Polishing area of ​​the distal end of the light guide 212. Active surface of the light guide 3. Tubular support (or needle) 31. Distal end of the beveled support 310. Polishing area of ​​the distal end of the support 311. Support orifice 312. Side orifice of the support 3121. Chamfering (or polishing) the side hole of the support 313. Second bevel or polishing of the support (either lateral or central) 314. Distal notches of the support orifice (lateral or central, semi-spherical or triangular) 315. Reflective polished internal surface of the support 4. Connection method 41. Connecting or crimping tube 411. Crimping points 42. Connecting tube support 43. Fixing ring 44. SMA lock (screw ferrule) 45. SMA connector holder 46. ​​SMA connector 6. Tissue or organ 7. Optical cable 8. Distal end of the instrument 10. Light source V. Blood vessel H. Height of distal polishing of the holder and guide B. Angle of deflection of the distal end of the support C. Polishing angle of the second lateral bevel of the distal end G. Polishing angle of the second central bevel of the distal end D. Bevel angle of the beveled distal end of the bracket E. Angle of curvature of the support F. Angle of the chamfer of the side hole of the support.

Claims

Claims

1. Medical instrument (1) comprising a free distal end intended to penetrate into a tissue or an organ (6) and / or a blood vessel (V) and a proximal end connectable to a light source (10), said instrument comprising a tubular support (3) in which at least one light guide (2) is mounted, said support (3) comprising a beveled distal end (31) comprising at least one orifice forming a first optical output, for a substantially frontal emission of the light by said guide (2) via said first optical output, said instrument being characterized in that it comprises at least one optical deflection means (210, 310, 312, 313, 314, 315) of the light forming a second optical output, for an emission of deflected light, comprising at least one machining on a distal portion of the instrument,with at least one reflective and / or concave polishing for light convergence and one convex polishing for light divergence, said polishing being carried out on said light guide (2) and / or on said support (3).,

2. A medical instrument (1) according to claim 1, wherein the light guide (2) comprises an optical fiber.

3. Medical instrument (1) according to claim 2, wherein said optical fiber is hollow and associated with a CO2 laser light source.

4. Medical instrument (1) according to claim 1, wherein the light guide (2) comprises a reflective coating on the inner wall of the tubular support (3).

5. Medical instrument (1) one of the preceding claims, wherein said beveled distal end (31) of said support (3) is sharpened arrow-shaped with a sharpening angle (B) giving it cutting and penetrating properties.

6. Medical instrument (1) one of the preceding claims, wherein at least one distal portion is curved according to a radius (E) of curvature, facilitating manipulation of the instrument from outside the tissue or organ (6).

7. Medical instrument (1) one of the preceding claims, wherein said light deflecting means comprises at least one lateral orifice (312) in the wall of said support, near the distal end (31), said lateral orifice (312) comprising at least one chamfer (3121) in the thickness of the wall of the support (3), providing an angle (F) of optical deflection, either by flaring outward to form a diverging deflection means, or by flaring inward to form a converging deflection means.

8. Medical instrument (1) one of the preceding claims, wherein said light deflecting means is a divergent deflecting means comprising convex polishing performed on a light-conducting ball deposited on the surface of the light guide (3).

9. Medical instrument (1) one of the preceding claims, wherein the distal end (21) of the light guide (2), for example a transversely sectioned or beveled bare-end optical fiber or a hollow fiber, is positioned recessed from the beveled distal end (31) of the holder (3), with a reflective polished internal surface (315) within the beveled distal end (31) of the holder (3) then serving as a reflective tool forming an optical deflection means.

10. Medical instrument (1) according to one of the preceding claims, wherein the beveled distal end (31) of the support (3) comprises a circumferential polishing area (310) on the surface of the bevel at a beveling angle (A) and comprises a second bevel, obtained by a second polishing (313) of a portion of said (310) polishing area.

11. A medical instrument (1) according to claim 10, wherein said second polishing (313) is performed on a lateral portion of said (310) polishing area, providing an angle (C) of lateral optical deflection.

12. A medical instrument (1) according to claim 10, wherein said second polishing (313) is circumferential over all of said (310) polishing area and provides a distal optical deflection angle (D).

13. A medical instrument (1) according to claim 10, wherein said second polishing (313) is performed on a central and apical portion of said (310) polishing area, providing an apical optical deflection angle (G).

14. Medical instrument (1) according to claim 13, wherein said second polishing (313) is carried out at a height (H1, H2) determined to also obtain a polishing area (210) of the distal end of the light guide (2), resulting in two optical deviation angles (G) and a deformed active surface (212) of the light guide (2).

15. A medical instrument (1) according to one of claims 1 to 9, wherein the beveled distal end (31) of the holder (3) has a circumferential polishing area (310) on the surface of the bevel at an angle (A) of beveling and comprises at least one semi-spherical and / or triangular notch (314) forming at least one optical deflection means, either lateral or central and apical.

16. Medical instrument (1) according to one of the preceding claims, wherein the distal end of the light guide (2) is housed inside the support (3), set back from the distal end (31) of the support by a distance of at least 1 to 10 mm.

17. Medical instrument (1) according to one of the preceding claims, in which the instrument comprises two light guides, preferably two optical fibers, one of the guides carrying a divergent optical deflection means, for example a convex polishing while the other carries a convergent optical deflection means, for example a concave polishing.

18. Medical instrument (1) according to one of claims 1 to 16, wherein said light guide (2) comprises both a diverging optical deflection means and a converging optical deflection means.

19. Medical instrument (1) according to one of the preceding, in which the support (3) comprises both a divergent optical deflection means and a convergent optical deflection means.

20. Instrument (1) according to one of claims 1 to 5, characterized in that it comprises means for rotating and / or advancing the light guide (2) and / or the support (3), in particular relative to each other.

21. Instrument according to one of the preceding claims, characterized in that it comprises at least one marking to verify the correct positioning of the instrument.

22. A medical instrument (1) according to any preceding claim, wherein at least one color filter is disposed in the path of light.

23. Medical instrument (1) according to any one of the preceding claims, wherein the support is made of biologically neutral material, preferably chosen from stainless steel or aluminum.

24. According to the preceding claim, in which the support has a distal outer coating made of material with increased thermal conduction.

25. A medical instrument (1) according to any preceding claim, wherein the light guide is a refractive optical fiber- using wavelengths between 200nm and 5pm.

26. A medical instrument (1) according to any preceding claim, wherein the light guide is a coating of the inner surface of the support forming an inner reflective tube reflecting wavelengths between 200 nm and 1 pm, preferably 5 pm and 1 pm.

27. ​​Medical instrument (1) according to any one of the preceding claims, wherein the light guide is a doped optical fiber with an outer diameter of between 50 and 1000 pm, preferably between 50 and 150 pm, preferably between 75 and 125 pm.

28. Medical instrument (1) according to any one of the preceding claims, wherein the support (3) has a length of between 10 and 120 mm, the outer diameter of the guide is between 100 and 4000 μm, preferably 50 and 1000 μm, the outer diameter of the needle is between 200 and 5000 μm, preferably between 450 μm and 1000 μm and the distal end (31) of the support (3) is beveled with a bevel angle (A) of between 10 and 20°.

29. Medical instrument (1) according to any one of the preceding claims, in which it comprises an electronic device for compatibility with the light vector and the source in order to calibrate the power of the beam at the needle outlet.

30. Medical instrument (1) according to any one of the preceding claims, wherein the aperture of the guide, preferably the numerical aperture of the fiber, is between 15° and 40°, preferably 20 and 35°, more preferably 23° and 32°.

31. A medical instrument (1) according to any preceding claim, wherein the instrument comprises two channels, either by a double channel in the holder (3), or by a channel of the holder (3) associated with another channel of another instrument, the assembly being coupled to a thermocouple measuring device for measuring the temperature at the distal end (31) of the holder (3).

32. Medical instrument (1) according to the preceding claim, which further comprises an alarm system when the measured temperature value exceeds a predetermined threshold value.

33. A medical instrument (1) according to any preceding claim, which further comprises a thermal reagent configured to react when it reaches a predetermined temperature, in order to visualize overheating.

34. Medical instrument (1) according to any one of the preceding claims, in which the light guide (2) comprises a plurality of different optical fibers, with different optical deflection means from one fiber to another, the instrument being coupled to a multiplexer at the light source to carry out photodiagnosis thanks to the differential collection of the signals from the different fibers.

35. Method for screening for toxic products in food control by using a medical instrument (1) according to the preceding claims, by detecting chromophores.

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