Laser treatment devices

Abstract

A surgical tool is provided that includes a handle at a proximal region of the surgical tool. A shaft assembly extends in a distal direction from the handle, and has a proximal portion and a distal portion, which is sized and shaped to be insertable into a subject during a surgical procedure. The shaft assembly includes a burr, an optical fiber, and at least one motor configured to rotate the burr. The burr is disposed at a distal end of the shaft assembly, and is shaped so as to define an opaque external diamond-coated cutting surface. The optical fiber is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy that heats the opaque external diamond-coated cutting surface from within the surgical tool. Other embodiments are also described.

Description

[0001] LASER TREATMENT DEVICES

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS

[0003] The present application claims priority from US Provisional Application 63 / 558,803, filed February 28, 2024, which is assigned to the assignee of the present application and incorporated herein by reference.

[0004] FIELD OF THE APPLICATION

[0005] The present invention relates generally to surgical tools, and more particularly to minimally invasive surgical tools.

[0006] BACKGROUND OF THE APPLICATION

[0007] US Patent 5,342,358 to Daikuzono describes apparatus that performs operations such as incision, coagulation and evaporation of the tissue of a living body such as human body with laser lights. An apparatus is described for performing a surgical operation of the tissue of a living body with laser lights while contacting a blade with the tissue of the living body has a holding portion which is held by an operator, a blade which is integral with the holding portion and is made of a material which generates heat on exposure to laser lights and cannot transmit the laser lights therethrough, and an optical fiber which receives laser lights for emitting the laser lights from the front end thereof, the blade being positioned in such a manner that a part of the blade is located in the irradiation area of the laser lights from the optical fiber and the optical fiber is movable toward and away from the blade while the optical fiber is held by the holding portion.

[0008] US Patent 11,369,398 to Perets et al. describes a tool having a handle and an elongate shaft that extends distally from the handle. A distal portion of the shaft is inserted into a subject during a surgical procedure. An optical fiber delivers laser energy to a tip at the distal portion of the shaft. The tip includes a mechanical cutting mechanism including a moving part that absorbs the laser energy, thermally conducts the absorbed energy to tissue that is disposed between the moving part and another part, and moves with respect to the other part in order to cut tissue that is disposed between the parts using a mechanical force that is lower than a mechanical force that would be required to cut the tissue in the absence of the laser energy. Other embodiments are also described. US Patent 4,994,060 to Rink et al. describes a laser heated cautery cap assembly including a catheter assembly adapted to be introduced into a lumen, such as an arterial opening. The catheter assembly includes at least one optical fiber connected to a laser light source adapted to produce short output bursts. A cautery cap at the catheter distal end includes a transparent substrate member disposed to receive the laser energy from the optical fiber(s). The substrate member preferably is formed of a crystalline solid having a smooth, curved outer surface, with a central guidewire bore extending therethrough. One end of the bore is provided with a tapering counterbore, and the opposite end of the substrate member is an input surface disposed to receive laser energy from the optical fiber. A nose piece includes a central guidewire bore coaxial with the substrate member bore, the nose piece including a tapered proximal end dimensioned to fit within the counterbore of the substrate. The substrate counterbore and bore surfaces, and major portions of the curved outer surface are coated with a highly reflective material, and another portion of the outer surface is coated with a material which absorbs the laser energy and is heated thereby. The input surface of the substrate receives laser illumination from the optical fiber(s) and conducts it to the counterbore surface, which reflects the light internally to the absorptive coating portion. Thus a portion of the cap structure is heated, while the nose piece and the remainder of the substrate surface remains relatively cool.

[0009] SUMMARY OF THE APPLICATION

[0010] In accordance with some applications of the present invention, a minimally invasive surgical tool is provided that comprises a tissue-treatment tip that absorbs laser energy (e.g., from an optical fiber), photothermally converts the laser energy into absorbed thermal energy, and uses the absorbed energy to treat tissue of a subject by conducting the absorbed energy from a tissue-treatment tip surface to the tissue, while the tissue-treatment tip surface is at an elevated temperature due to the absorbed energy.

[0011] In some applications of the present invention, the tissue-treatment tip comprises a burr, which is disposed at a distal end of a shaft assembly. The burr is shaped so as to define a cutting wall, which is shaped so as to define an opaque external cutting surface and an internal surface. A distal portion of the shaft assembly is shaped so as to define a distally- facing surface. The internal surface and the distally-facing surface together at least partially define a cavity. The optical fiber is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the opaque external cutting surface.

[0012] In some applications of the present invention, the opaque external cutting surface is diamond-coated.

[0013] The following is a non-limiting list of examples of target tissues of the subject and different types of surgeries in which the surgical tools described herein may be used:

[0014] • a meniscus of a knee of the subject, e.g., in a meniscectomy or partial meniscectomy

[0015] • a cartilage debridement procedure,

[0016] • a microfracture procedure,

[0017] • bone drilling,

[0018] • tissue of the hip, e.g., in a hamstring repair, or gluteus medius repair,

[0019] • spine decompression,

[0020] • disc replacement,

[0021] • tissue of the shoulder, e.g., in a shoulder synovectomy, frozen shoulder surgery,

[0022] • arthroscopic capsular release, rotator cuff repair,

[0023] • a tendon or ligament, e.g., for use in arthrolysis,

[0024] • tissue of the bicep, e.g., in a biceps tenotomy, or

[0025] • tissue of the hand, e.g., in carpal tunnel surgery.

[0026] Additional examples of types of surgeries in which the surgical tools described herein may be used include hemorrhoid removal, removal of fecal impaction, adenoidectomy, hysteroscopic surgery (e.g., removal of pedunculated submucosal fibroids), laparoscopic surgery (e.g., removal of subserosal fibroids), abdominal surgery (e.g., performed laparoscopically), cyst cutting, and endoscopic stomach polyp removal.

[0027] For some applications, the tissue-treatment tip uses the absorbed laser energy and a mechanical force to treat the tissue. The tissue-treatment tip treats the tissue by thermally conducting the absorbed energy to the tissue while a motor induces motion of the tissuetreatment tip. For some such applications, the absorbed laser energy elevates the temperature of the tissue-treatment tip, reducing an amount of mechanical force that is required to treat the tissue.

[0028] There is therefore provided, in accordance with an application of the present invention, a surgical tool for performing a surgical procedure on a subject, the surgical tool including: a handle at a proximal region of the surgical tool; a shaft assembly extending in a distal direction from the handle, the shaft assembly having proximal and distal portions, the distal portion of the shaft assembly sized and shaped to be insertable into the subject during the surgical procedure, the shaft assembly including: a burr, which is disposed at a distal end of the shaft assembly, and which is shaped so as to define an opaque external diamond-coated cutting surface; and an optical fiber, which is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy that heats the opaque external diamond-coated cutting surface from within the surgical tool; and at least one motor configured to rotate the burr.

[0029] For some applications, the optical fiber passes through at least a portion of the shaft assembly.

[0030] For some applications, the surgical tool shields the optical fiber from emitting light outside the surgical tool.

[0031] For some applications, the at least one motor is configured to rotate the burr with respect to the optical fiber.

[0032] For some applications: the burr is shaped so as to define a cutting wall, which is shaped so as to define the opaque external diamond-coated cutting surface and an internal surface, the distal portion of the shaft assembly is shaped so as to define a distally-facing surface, the internal surface and the distally-facing surface together at least partially define a cavity, and the optical fiber is positioned to emit the laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the opaque external diamond-coated cutting surface.

[0033] For some applications, at least a portion of the internal surface is curved.

[0034] For some applications, the distally-facing surface is more reflective than the internal surface.

[0035] For some applications, the optical fiber is positioned to emit the laser energy directly to at least 5% of a surface area of the internal surface, such as at least 20%, e.g., at least 30% of the surface area.

[0036] For some applications, an average thickness of the wall is 0.1 - 1.3 mm, such as 0.1 - 0.25 mm or 1 - 1.3 mm.

[0037] For some applications, a distal end of the optical fiber is positioned within the cavity.

[0038] For some applications, a distal end of the optical fiber is flush with the distally- facing surface.

[0039] There is further provided, in accordance with an application of the present invention, a surgical tool for performing a surgical procedure on a subject, the surgical tool including: a handle at a proximal region of the surgical tool; a shaft assembly extending in a distal direction from the handle, the shaft assembly having proximal and distal portions, the distal portion of the shaft assembly (a) sized and shaped to be insertable into the subject during the surgical procedure, and (b) shaped so as to define a distally-facing surface, the shaft assembly including: a burr, which is disposed at a distal end of the shaft assembly, and which is shaped so as to define a cutting wall, which is shaped so as to define (i) an opaque external cutting surface, and (ii) an internal surface, the internal surface and the distally-facing surface together at least partially define a cavity; and an optical fiber, which is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the opaque external cutting surface; and at least one motor configured to rotate the burr. For some applications, the optical fiber passes through at least a portion of the shaft assembly.

[0040] For some applications, the surgical tool shields the optical fiber from emitting light outside the surgical tool.

[0041] For some applications, at least a portion of the internal surface is curved.

[0042] For some applications, an average thickness of the wall is 0.1 - 1.3 mm.

[0043] For some applications, a distal end of the optical fiber is positioned within the cavity.

[0044] For some applications, a distal end of the optical fiber is flush with the distally- facing surface.

[0045] For some applications, the at least one motor is configured to rotate the burr with respect to the optical fiber.

[0046] For some applications, the external cutting surface is diamond-coated.

[0047] For some applications, the distally-facing surface is reflective.

[0048] For some applications, the optical fiber is positioned to emit the laser energy directly to at least 5% of a surface area of the internal surface, such as at least 20%, e.g., at least 30%, of the surface area.

[0049] There is still further provided, in accordance with an application of the present invention, a surgical tool for performing a surgical procedure on a subject, the surgical tool including: a handle at a proximal region of the surgical tool; a shaft assembly extending in a distal direction from the handle, the shaft assembly having proximal and distal portions, the distal portion of the shaft assembly (a) sized and shaped to be insertable into the subject during the surgical procedure, and (b) shaped so as to define a lateral window, the shaft assembly including: a burr, which is disposed at a distal end of the shaft assembly, and which is shaped so as to define an external cutting surface; at least one shaver blade, which is disposed within the distal portion of the shaft assembly; and an optical fiber, which is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy to the burr; and at least one motor configured to: rotate the burr about a central longitudinal axis of the shaft assembly, and rotate the at least one shaver blade about the central longitudinal axis of the shaft assembly, such that the at least one shaver blade cuts tissue alongside the distal portion of the shaft assembly when the at least one shaver blade is axially aligned with and exposed through the lateral window.

[0050] For some applications, the optical fiber passes through at least a portion of the shaft assembly.

[0051] For some applications, the surgical tool shields the optical fiber from emitting light outside the surgical tool.

[0052] For some applications, the surgical tool shields the optical fiber from emitting light that heats the shaver blades.

[0053] For some applications, the at least one shaver blade is shaped as a plurality of teeth.

[0054] For some applications, the at least one motor is configured to rotate the burr with respect to the optical fiber.

[0055] For some applications, the external cutting surface is opaque.

[0056] For some applications, the optical fiber is positioned to emit the laser energy to heat the external cutting surface.

[0057] For some applications, the external cutting surface is diamond-coated.

[0058] For some applications, the at least one motor is configured to separately rotate the burr and the at least one shaver blade about the central longitudinal axis of the shaft assembly.

[0059] For some applications, the at least one motor is configured to rotate the at least one shaver blade with reciprocating rotary motion.

[0060] For some applications, the at least one motor is configured to rotate the burr in one rotational direction.

[0061] For some applications: the shaft assembly further includes (a) an elongate shaft, and (b) a shaver cannula defining a lateral opening having a perimeter that defines the at least one shaver blade, and at least a longitudinal portion of the shaver cannula is disposed within the elongate shaft.

[0062] For some applications, a distal portion of the elongate shaft is shaped so as to define the lateral window.

[0063] For some applications, the shaver cannula is rotationally fixed with respect to the burr.

[0064] For some applications: the surgical tool further includes an inner optical-fiber cannula, which is rotationally fixed with respect to the burr, and disposed within at least a longitudinal portion of the shaver cannula so as to define a space radially between an external surface of the inner optical-fiber cannula and an internal surface of the shaver cannula, the optical fiber passes through the inner optical-fiber cannula.

[0065] For some applications, a distal portion of the elongate shaft is shaped so as to define the lateral window.

[0066] For some applications, the shaver cannula and the elongate shaft are axially slidable with respect to each another such that the surgical tool assumes at least: a shaver-enablement state, in which (a) the burr is proximally retracted within the elongate shaft proximal to a distal end opening of the elongate shaft, and (b) the lateral opening of the shaver cannula at least partially longitudinally overlaps the lateral window of the elongate shaft, and a burr-enablement state, in which (a) the burr is distally exposed from the distal end opening of the elongate shaft, and (b) the lateral opening of the shaver cannula at least partially does not longitudinally overlap the lateral window of the elongate shaft.

[0067] For some applications: the shaft assembly further includes (a) an inner optical-fiber cannula, through which the optical fiber passes; and (b) a burr cannula, which is rotationally fixed with respect to the burr, at least a longitudinal portion of the burr cannula is disposed within the elongate shaft, at least a longitudinal portion of the shaver cannula is disposed within the burr cannula, and the at least one motor is configured to separately rotate the burr and the at least one shaver blade about the central longitudinal axis of the shaft assembly.

[0068] For some applications, the inner optical-fiber cannula is rotationally fixed with respect to the shaver cannula.

[0069] For some applications: the burr is shaped so as to define a cutting wall, which is shaped so as to define the external cutting surface and an internal surface, the distal portion of the shaft assembly is shaped so as to define a distally-facing surface, the internal surface and the distally-facing surface together at least partially define a cavity, and the optical fiber is positioned to emit the laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the external cutting surface.

[0070] For some applications, a distal end of the optical fiber is positioned within the cavity.

[0071] For some applications, a distal end of the optical fiber is flush with the distally- facing surface.

[0072] For some applications, the surgical tool is configured such that the distally-facing surface is rotatable with respect to the cutting wall.

[0073] The present invention will be more fully understood from the following detailed description of embodiments thereof, taken together with the drawings, in which:

[0074] BRIEF DESCRIPTION OF THE DRAWINGS

[0075] Fig. 1 is a schematic illustration of a surgical tool, in accordance with an application of the present invention;

[0076] Figs. 2A and 2B are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip of the surgical tool of Fig. 1, in accordance with an application of the present invention;

[0077] Figs. 3A and 3B are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip of another surgical tool, in accordance with an application of the present invention; Fig. 4 is a schematic illustration of yet another surgical tool, in accordance with an application of the present invention;

[0078] Figs. 5A and 5B are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip of the surgical tool of Fig. 4, in accordance with an application of the present invention;

[0079] Fig. 6 is a schematic illustration of still another surgical tool, in accordance with an application of the present invention;

[0080] Figs. 7A and 7B are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip of the surgical tool of Fig. 6 in a shaver-enablement state, in accordance with an application of the present invention; and

[0081] Figs. 8A and 8B are schematic isometric and cross-sectional illustrations, respectively, of the tissue-treatment tip of the surgical tool of Fig. 6 in a burr-enablement state, in accordance with an application of the present invention.

[0082] DETAILED DESCRIPTION OF APPLICATIONS

[0083] Reference is made to Fig. 1, which is a schematic illustration of a surgical tool 20, in accordance with an application of the present invention. Surgical tool 20 comprises a shaft assembly 28, which comprises an elongate shaft 30 and a tissue-treatment tip 40 that is disposed at a distal portion 60 of shaft assembly 28.

[0084] Reference is further made to Figs. 2A and 2B, which are schematic isometric and cross-sectional illustrations, respectively, of tissue-treatment tip 40 of surgical tool 20, in accordance with an application of the present invention.

[0085] Typically, surgical tool 20 is used with or comprises a laser energy source (not shown). Fig. 1 shows surgical tool 20 comprising a laser energy interface 24 that delivers laser energy from the laser energy source, by an optical fiber 26, toward tissue-treatment tip 40. Distal portion 60 of shaft assembly 28 is sized and shaped to be insertable into the subject during a surgical procedure.

[0086] For some applications, optical fiber 26 passes through at least a portion of shaft assembly 28 (optionally including at least a portion of elongate shaft 30), such as shown; alternatively or additionally, optical fiber 26 passes alongside at least a portion of shaft assembly 28 (optionally including at least a portion of elongate shaft 30) (configuration not shown). Surgical tool 20 is typically used by a healthcare worker (e.g., a surgeon) to treat tissue of a subject, and therefore comprise a handle 22 at a proximal portion 62 of shaft assembly 28 (and typically at a proximal portion of elongate shaft 30). Handle 22 is typically used to advance tissue-treatment tip 40 to tissue that is desired to be treated (i.e., a target tissue). At least a portion of tissue-treatment tip 40 is brought into contact with target tissue and heated (not necessarily in that order), as described below. For some applications, contacting the target tissue with tissue-treatment tip 40 results in vaporization of at least some of the target tissue. Alternatively or in addition, contacting the target tissue with tissue-treatment tip 40 results in coagulation of at least some of the target tissue. Target tissues may include, but are not limited to, tissue of a joint (e.g., a knee, shoulder, hip or spine), such as a bone, a tendon, or cartilaginous tissue, such as a meniscus.

[0087] For some applications, an angular orientation of tissue-treatment tip 40 is fixed with respect to an angular orientation of handle 22. For some such applications, a distance from handle 22 to tissue-treatment tip 40 is fixed.

[0088] Tissue-treatment tip 40 both (i) conducts heat to the target tissue, and (ii) is operatively coupled to one or more motors 32 that transfer a mechanical force to the tissuetreatment tip, thereby inducing motion of the tissue-treatment tip. In this way, surgical tool 20 makes use of both thermal energy and mechanical force to treat tissue.

[0089] Surgical tool 20 (tissue-treatment tip 40 thereof) comprises a burr 70, which is disposed at a distal end 72 of shaft assembly 28, optionally also at a distal end of elongate shaft 30, as in the configuration shown in Figs. 1 and 2A-B. Burr 70 is shaped so as to define an opaque external cutting surface 74. Typically, at least a portion of opaque external cutting surface 74 faces at least partially in a distal direction, and may also face at least partially radially outward. Alternatively, an entirety of opaque external cutting surface 74 faces radially outward without also facing distally.

[0090] For some applications, cutting surface 74 is diamond-coated.

[0091] For example, external cutting surface 74 may comprise a hard material (e.g., comprising metal) to which diamond particles are adhered.

[0092] Optical fiber 26 is operatively connected to distal portion 60 of shaft assembly 28 and is positioned to emit laser energy that heats opaque external cutting surface 74 from within surgical tool 20. Typically, surgical tool 20 shields optical fiber 26 from emitting light outside the surgical tool.

[0093] Surgical tool 20 further comprises one or more motors 32 configured to rotate burr 70, as described above. For example, the one or more motors 32 may be disposed at least partially (e.g., entirely) within handle 22 and / or partially (e.g., entirely) disposed outside handle 22, e.g., mounted on an external surface of handle 22 or on shaft assembly 28.

[0094] Reference is made to Fig. 2B. For some applications, burr 70 is shaped so as to define a cutting wall 76, which is shaped so as to define opaque external cutting surface 74 and an internal surface 78. Distal portion 60 of shaft assembly 28 is shaped so as to define a distally-facing surface 80. Internal surface 78 and distally-facing surface 80 together at least partially define a cavity 82. (Optionally, cavity 82 is additionally partially defined by another internal surface of surgical tool 20, such as a longitudinal portion of the surgical tool longitudinally between distally-facing surface 80 and the proximal end of cutting wall 76.)

[0095] Optical fiber 26 is positioned to emit the laser energy into cavity 82, such that internal surface 78 of cutting wall 76 absorbs the laser energy and thermally conducts the absorbed energy to opaque external cutting surface 74, thereby elevating the temperature of opaque external cutting surface 74. Opaque external cutting surface 74 in turn thermally conducts the absorbed energy to the tissue when opaque external cutting surface 74 is placed in contact with the target tissue. Typically, the laser energy that is absorbed by cutting wall 76 undergoes photothermal conversion and is thermally conducted to opaque external cutting surface 74. It is therefore typically desirable that cutting wall 76 conduct heat efficiently. Suitable materials for cutting wall 76 include, for example, metals such as tungsten, molybdenum, stainless steel, cobalt, chrome and / or alloys thereof.

[0096] For some applications, the use of both absorbed thermal energy and mechanical force reduces an amount of mechanical force that is required for surgical tool 20 to treat (e.g., to trim a portion of) the tissue. For example, even in the absence of the thermal energy, treatment tip 40 may trim the tissue to a certain extent if opaque external cutting surface 74 rotates while contacting the tissue. However, surgical tool 20 may require a greater mechanical force to trim the tissue without the thermal energy. Thus, the thermal energy facilitates trimming the tissue using a lower mechanical force. Distally-facing surface 80 may be flat (as shown), curved (configuration not shown), or partially flat and partially curved (configuration not shown).

[0097] For some applications, at least a portion of internal surface 78 of cutting wall 76 is curved, such as shown.

[0098] For some applications, distally-facing surface 80 is rotationally fixed with respect to cutting wall 76, such as shown in Fig. 2B (and Figs. 3B, 7B, and 8B, described hereinbelow).

[0099] For some applications, distally-facing surface 80 is more reflective than internal surface 78 of cutting wall 76. For example, distally-facing surface 80 may comprise a reflective coating, e.g., comprising gold and / or silver. This reflectivity may help concentrate the laser energy on internal surface 78 of cutting wall 76.

[0100] Reference is made to Fig. 2B. For some applications, optical fiber 26 is configured to emit the laser energy to generally evenly illuminate and heat a large portion of internal surface 78. For example, optical fiber 26 may be configured to emit the laser energy as described by configuring:

[0101] • a position of optical fiber 26 (e.g., of a distal end 84 of optical fiber 26) with respect to internal surface 78, such as a greatest distance and / or an average distance, and / or

[0102] • a shape and / or optical properties of distal end 84 of optical fiber 26, such the fiber aperture size and / or Numerical Aperture (NA); for example, fiber end lensing may be used during manufacture of distal end 84 of optical fiber 26.

[0103] For some applications, optical fiber 26 is configured optical fiber 26 is configured to emit the laser energy to directly illuminate at least 5% of a surface area of internal surface 78, no more than 80% of the surface area, and / or 5% - 80% of the surface area.

[0104] For some applications, optical fiber 26 is configured optical fiber 26 is configured to emit the laser energy to directly illuminate at least 5% of the surface area, no more than 30% of the surface area, and / or 5% - 30% of the surface area. For example, optical fiber 26 may comprise a standard cleaved fiber in these applications.

[0105] For some applications, optical fiber 26 is configured optical fiber 26 is configured to emit the laser energy to directly illuminate at least 20% (e.g., at least 30%) of the surface area, no more than 80% (e.g., no more than 70%) of the surface area, and / or 20% - 80%, e.g., 30% - 70%, of the surface area. For example, distal end 84 of optical fiber 26 may be shaped as a ball lens in these applications.

[0106] For some applications, an average thickness of cutting wall 76 is at least 0.1 mm, no more than 1.3 mm, and / or 0.1 - 1.3 mm. For example, the average thickness of cutting wall 76 may be:

[0107] • at least 0.1 mm, no more than 0.25 mm, and / or 0.1 - 0.25 mm, such as in configurations in which cavity 82 is relatively large, or

[0108] • at least 1 mm, no more than 1.3 mm, and / or 1 - 1.3 mm, such as in configurations in which cavity 82 is relatively small.

[0109] One benefit of providing cavity 82, particularly with a relatively thin cutting wall 76, is that the resulting relatively small thermal mass of burr 70 enables rapid temperature change of burr 70 by the laser energy. Rapid temperature change increases the likelihood of tissue vaporization or coagulation, while reducing the likelihood of tissue carbonization.

[0110] Reference is still made to Fig. 2B. For some applications, distal end 84 of optical fiber 26 is positioned within cavity 82, such as shown. For other applications, distal end 84 of optical fiber 26 is flush with distally-facing surface 80 (configuration not shown).

[0111] For some applications, the one or more motors 32 are configured to rotate burr 70 with respect to optical fiber 26, such as shown. In these applications, optical fiber 26 is typically rotationally static during use of surgical tool 20.

[0112] For some applications, shaft assembly 28 further comprises an inner optical-fiber cannula 34, which is rotationally fixed with respect to burr 70. Optical fiber 26 passes through inner optical-fiber cannula 34.

[0113] Reference is now made to Figs. 3A and 3B, which are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip 140 of a surgical tool 120, in accordance with an application of the present invention. Other than as described hereinbelow, surgical tool 120 and tissue-treatment tip 140 are similar to surgical tool 20 and tissue-treatment tip 40, described hereinabove with reference to Figs. 1 and 2A-B, and like reference numerals refer to like parts.

[0114] Surgical tool 120 comprises a shaft assembly 128, which comprises an elongate shaft 130 and tissue-treatment tip 140. Shaft assembly 128 extends in a distal direction from handle 22. Shaft assembly 128 has proximal portion 62 and a distal portion 160, which is sized and shaped to be insertable into the subject during the surgical procedure. Surgical tool 120 comprises burr 70 and optical fiber 26, described hereinabove with reference to Figs. 1 and 2A-B.

[0115] Distal portion 160 of shaft assembly 128 is shaped so as to define a lateral window 166. For example, a distal portion of elongate shaft 130 may be shaped so as to define lateral window 166, such as shown in Figs. 3A-B. Shaft assembly 128 comprises one or more shaver blades 186, which are disposed within distal portion 60 of shaft assembly 128.

[0116] The one or more motors 32 of surgical tool 120 are configured to:

[0117] • rotate burr 70 about a central longitudinal axis 188 of shaft assembly 128, and

[0118] • rotate the one or more shaver blades 186 about central longitudinal axis 188 of shaft assembly 128, such that the one or more shaver blades 186 cut tissue alongside distal portion 60 of shaft assembly 128 when the one or more shaver blades 186 are axially aligned with and exposed through lateral window 166, such as shown in Figs. 3A- B.

[0119] Surgical tool 120 is advanced toward target tissue such that the target tissue enters lateral window 166, and movement of the one or more shaver blades 186 trims the target tissue. For some applications, surgical tool 120 is configured to be connected to an external source of suction, and couples the external source of suction in fluid communication with lateral window 166, typically via an interior of shaft assembly 128. The applied suction sucks the trimmed target tissue into shaft assembly 128. To this end, surgical tool 120 may comprise a suction port 168 (labeled in Fig. 1).

[0120] For some applications, the one or more shaver blades 186 are shaped as a plurality of teeth 190, such as shown in Figs. 3A-B. Alternatively, the one or more shaver blades 186 have a different cutting shape.

[0121] For some applications, the one or more motors 32 are configured to simultaneously rotate burr 70 and the one or more shaver blades 186 about central longitudinal axis 188 of shaft assembly 128.

[0122] Typically, the one or more motors 32 are configured to rotate burr 70 and the one or more shaver blades 186 in one rotational direction. Alternatively, the one or more motors 32 are configured to rotate burr 70 and the one or more shaver blades 186 with reciprocating rotary motion. For some applications, shaft assembly 128 further comprises a shaver cannula 192 defining a lateral opening 194 having a perimeter 196 that defines the one or more shaver blades 186 (e.g., the plurality of teeth 190). At least a longitudinal portion of shaver cannula 192 is disposed within elongate shaft 130.

[0123] For some of these applications, shaver cannula 192 is rotationally fixed with respect to burr 70, such as shown in Figs. 3A-B.

[0124] For some applications, shaft assembly 128 further comprises inner optical-fiber cannula 34, which is rotationally fixed with respect to burr 70, and disposed within at least a longitudinal portion of shaver cannula 192 so as to define a space 206 radially between an external surface 208 of inner optical-fiber cannula 34 and an internal surface 210 of shaver cannula 192 (labeled in Fig. 3B). Optical fiber 26 passes through inner optical-fiber cannula 34.

[0125] Reference is now made to Fig. 4, which is a schematic illustration of a surgical tool 320, in accordance with an application of the present invention.

[0126] Reference is further made to Figs. 5 A and 5B, which are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip 340 of surgical tool 320, in accordance with an application of the present invention.

[0127] Other than as described hereinbelow, surgical tool 320 and tissue-treatment tip 340 are similar to surgical tool 120 and tissue-treatment tip 140, described hereinabove with reference to Figs. 3A-B, and / or surgical tool 20 and tissue-treatment tip 40, described hereinabove with reference to Figs. 1 and 2A-B; surgical tool 320 may implement features of one or both of these other surgical tools, mutatis mutandis. Like reference numerals refer to like parts.

[0128] Surgical tool 320 comprises a shaft assembly 328, which comprises an elongate shaft 330 and tissue-treatment tip 340. Shaft assembly 328 extends in a distal direction from a handle 322. Shaft assembly 328 has proximal portion 62 and a distal portion 360, which is sized and shaped to be insertable into the subject during the surgical procedure. Shaft assembly 328 comprises burr 70 and optical fiber 26, described hereinabove with reference to Figs. 1 and 2A-B. Surgical tool 320 further comprises one or more motors 332 configured to rotate burr 70 and the one or more shaver blades 186 about a central longitudinal axis 388 of shaft assembly 328. For some applications, shaft assembly 328 further comprises a shaver cannula 392 defining lateral opening 194 having perimeter 196 that defines the one or more shaver blades 186. At least a longitudinal portion of shaver cannula 392 is disposed within elongate shaft 330.

[0129] For some applications, shaft assembly 328 further comprises inner optical-fiber cannula 34, through which optical fiber 26 passes; and a burr cannula 346, which is rotationally fixed with respect to burr 70. At least a longitudinal portion of burr cannula 346 is disposed within elongate shaft 330. At least a longitudinal portion of shaver cannula 392 is disposed within burr cannula 346.

[0130] For some of these applications, the one or more motors 332 are configured to separately rotate burr 70 and the one or more shaver blades 186 about central longitudinal axis 388 of shaft assembly 328. This separate control of rotation allows the healthcare worker to choose whether to operate the burr or the shaver. Typically, the shaver is operated at a lower rotational speed than that of the burr, in order to enable tissue to be efficiently sucked in between lateral window 166 and shaver cannula 392.

[0131] Burr 70 is rotated by rotating burr cannula 346. Typically, during rotation of burr cannula 346, shaver cannula 392 is rotated at the same speed and in the same direction as burr cannula 346, to inhibit or prevent lateral shaving during rotation of the burr.

[0132] The one or more shaver blades 186 are rotated by rotating shaver cannula 392.

[0133] For some of these applications, surgical tool 320 comprises exactly one motor 332, and further comprises two gears 334 that enable separate rotation to burr 70 and the one or more shaver blades 186, by selectively being engaged by the single motor 332.

[0134] For some of these applications, inner optical-fiber cannula 34 is rotationally fixed with respect to shaver cannula 392.

[0135] In this configuration, the one or more motors 332 are typically configured to rotate burr 70 with respect to optical fiber 26.

[0136] For some applications, the one or more motors 332 are configured to rotate the one or more shaver blades 186 with reciprocating rotary motion.

[0137] For some applications, the one or more motors 332 are configured to rotate burr 70 in one rotational direction. Alternatively, the one or more motors 332 are configured to rotate burr 70 with reciprocating rotary motion. Reference is made to Fig. 5B. For some applications, distal portion 360 of shaft assembly 328 is shaped so as to define a distally-facing surface 380. For example, a distal end of shaver cannula 392 may be shaped so as to define distally-facing surface 380; alternatively, another distal portion of the shaft assembly is shaped so as to define the distally-facing surface. Internal surface 78 of cutting wall 76 of burr 70 and distally-facing surface 380 together at least partially define a cavity 382. (Optionally, cavity 382 is additionally partially defined by another internal surface of surgical tool 320, such as a longitudinal portion of the surgical tool longitudinally between distally-facing surface 380 and the proximal end of cutting wall 76.)

[0138] For some applications, surgical tool 320 is configured such that distally-facing surface 380 is rotatable with respect to cutting wall 76, such as shown in Fig. 5B.

[0139] Reference is now made to Fig. 6, which is a schematic illustration of a surgical tool 420, in accordance with an application of the present invention.

[0140] Reference is further made to Figs. 7A and 7B, which are schematic isometric and cross-sectional illustrations, respectively, of a tissue-treatment tip 440 of surgical tool 420 in a shaver-enablement state, in accordance with an application of the present invention.

[0141] Reference is still further made to Figs. 8 A and 8B, which are schematic isometric and cross-sectional illustrations, respectively, of tissue-treatment tip 440 of surgical tool 420 in a burr-enablement state, in accordance with an application of the present invention.

[0142] Other than as described hereinbelow, surgical tool 420 and tissue-treatment tip 440 are similar to surgical tool 120 and tissue-treatment tip 140, described hereinabove with reference to Figs. 3A-B, and / or surgical tool 20 and tissue-treatment tip 40, described hereinabove with reference to Figs. 1 and 2A-B; surgical tool 420 may implement features of one or both of these other surgical tools, and / or of surgical tool 320 described hereinabove with reference to Figs. 4 and 5A-B, mutatis mutandis. Like reference numerals refer to like parts.

[0143] Surgical tool 420 comprises a shaft assembly 428, which comprises an elongate shaft 430 and tissue-treatment tip 440. Shaft assembly 428 extends in a distal direction from a handle 422. Shaft assembly 428 has a proximal portion 462 and a distal portion 460, which is sized and shaped to be insertable into the subject during the surgical procedure. Shaft assembly 428 comprises burr 70 and optical fiber 26, described hereinabove with reference to Figs. 1 and 2A-B. Surgical tool 420 further comprises one or more motors 32 configured to rotate burr 70 and the one or more shaver blades 186 about a central longitudinal axis 488 of shaft assembly 428.

[0144] For some applications, shaft assembly 428 further comprises a shaver cannula 492 defining lateral opening 494 having a perimeter 496 that defines the one or more shaver blades 186 (e.g., the plurality of teeth 190). At least a longitudinal portion of shaver cannula 492 is disposed within elongate shaft 430.

[0145] For some applications, a distal portion 412 of elongate shaft 430 is shaped so as to define a lateral window 466.

[0146] For some of these applications, shaver cannula 492 and elongate shaft 430 are axially slidable with respect to each another such that surgical tool 420 (including tissuetreatment tip 440 thereof) assumes at least:

[0147] • a shaver-enablement state, such as shown in Figs. 7A-B, in which (a) burr 70 is proximally retracted within elongate shaft 430 proximal to a distal end opening 436 of elongate shaft 430, and (b) lateral opening 494 of shaver cannula 492 at least partially longitudinally overlaps lateral window 466 of elongate shaft 430, and

[0148] • a burr-enablement state, such as shown in Figs. 7A-B, in which (a) burr 70 is distally exposed from distal end opening 436 of elongate shaft 430, and (b) lateral opening 494 of shaver cannula 492 at least partially does not longitudinally overlap lateral window 466 of elongate shaft 430, such as shown in Figs. 7A-B, e.g., entirely does not longitudinal overlap lateral window 466 (configuration not shown).

[0149] Typically, surgical tool 420 comprises a user control 498 that transitions surgical tool 420 (including tissue-treatment tip 440 thereof) between shaver-enablement state and burr-enablement state.

[0150] In an embodiment, techniques and apparatus described in one or more of the following applications are combined with techniques and apparatus described herein:

[0151] • US Provisional Application 63 / 067,368, fled August 19, 2020

[0152] • US Patent 11,369,398 to Perets et al.

[0153] • US Provisional Application 63 / 252,276, filed October 5, 2021

[0154] • International Application PCT / IL2022 / 050211, filed February 23, 2022, which published as PCT Publication WO 2023 / 021497 to Perets et al. • US Provisional Application 63 / 390,067, filed July 18, 2022

[0155] It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.

Claims

CLAIMS1. A surgical tool for performing a surgical procedure on a subject, the surgical tool comprising: a handle at a proximal region of the surgical tool; a shaft assembly extending in a distal direction from the handle, the shaft assembly having proximal and distal portions, the distal portion of the shaft assembly sized and shaped to be insertable into the subject during the surgical procedure, the shaft assembly comprising: a burr, which is disposed at a distal end of the shaft assembly, and which is shaped so as to define an opaque external diamond-coated cutting surface; and an optical fiber, which is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy that heats the opaque external diamond-coated cutting surface from within the surgical tool; and at least one motor configured to rotate the burr.

2. The surgical tool according to claim 1, wherein the optical fiber passes through at least a portion of the shaft assembly.

3. The surgical tool according to claim 1, wherein the surgical tool shields the optical fiber from emitting light outside the surgical tool.

4. The surgical tool according to claim 1, wherein the at least one motor is configured to rotate the burr with respect to the optical fiber.

5. The surgical tool according to any one of claims 1-4, wherein the burr is shaped so as to define a cutting wall, which is shaped so as to define the opaque external diamond-coated cutting surface and an internal surface, wherein the distal portion of the shaft assembly is shaped so as to define a distally- facing surface, wherein the internal surface and the distally-facing surface together at least partially define a cavity, and wherein the optical fiber is positioned to emit the laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the opaque external diamond-coated cutting surface.

6. The surgical tool according to claim 5, wherein at least a portion of the internal surface is curved.

7. The surgical tool according to claim 5, wherein the distally-facing surface is more reflective than the internal surface.

8. The surgical tool according to claim 5, wherein the optical fiber is positioned to emit the laser energy directly to at least 5% of a surface area of the internal surface.

9. The surgical tool according to claim 8, wherein the optical fiber is positioned to emit the laser energy directly to at least 20% of the surface area of the internal surface.

10. The surgical tool according to claim 9, wherein the optical fiber is positioned to emit the laser energy directly to at least 30% of the surface area of the internal surface.

11. The surgical tool according to claim 5, wherein an average thickness of the wall is 0.1 - 1.3 mm.

12. The surgical tool according to claim 11, wherein the average thickness of the wall is 0.1 - 0.25 mm.

13. The surgical tool according to claim 5, wherein a distal end of the optical fiber is positioned within the cavity.

14. The surgical tool according to claim 5, wherein a distal end of the optical fiber is flush with the distally-facing surface.

15. A surgical tool for performing a surgical procedure on a subject, the surgical tool comprising: a handle at a proximal region of the surgical tool; a shaft assembly extending in a distal direction from the handle, the shaft assembly having proximal and distal portions, the distal portion of the shaft assembly (a) sized and shaped to be insertable into the subject during the surgical procedure, and (b) shaped so as to define a distally-facing surface, the shaft assembly comprising: a burr, which is disposed at a distal end of the shaft assembly, and which is shaped so as to define a cutting wall, which is shaped so as to define (i) an opaque external cutting surface, and (ii) an internal surface, wherein the internal surface and the distally-facing surface together at least partially define a cavity; and an optical fiber, which is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the opaque external cutting surface; andat least one motor configured to rotate the burr.

16. The surgical tool according to claim 15, wherein the optical fiber passes through at least a portion of the shaft assembly.

17. The surgical tool according to claim 15, wherein the surgical tool shields the optical fiber from emitting light outside the surgical tool.

18. The surgical tool according to claim 15, wherein at least a portion of the internal surface is curved.

19. The surgical tool according to claim 15, wherein an average thickness of the wall is 0.1 - 1.3 mm.

20. The surgical tool according to claim 15, wherein a distal end of the optical fiber is positioned within the cavity.

21. The surgical tool according to claim 15, wherein a distal end of the optical fiber is flush with the distally-facing surface.

22. The surgical tool according to claim 15, wherein the at least one motor is configured to rotate the burr with respect to the optical fiber.

23. The surgical tool according to any one of claims 15-22, wherein the external cutting surface is diamond-coated.

24. The surgical tool according to any one of claims 15-22, wherein the distally-facing surface is reflective.

25. The surgical tool according to any one of claims 15-22, wherein the optical fiber is positioned to emit the laser energy directly to at least 5% of a surface area of the internal surface.

26. The surgical tool according to claim 25, wherein the optical fiber is positioned to emit the laser energy directly to at least 20% of the surface area of the internal surface.

27. The surgical tool according to claim 26, wherein the optical fiber is positioned to emit the laser energy directly to at least 30% of the surface area of the internal surface.

28. A surgical tool for performing a surgical procedure on a subject, the surgical tool comprising: a handle at a proximal region of the surgical tool;a shaft assembly extending in a distal direction from the handle, the shaft assembly having proximal and distal portions, the distal portion of the shaft assembly (a) sized and shaped to be insertable into the subject during the surgical procedure, and (b) shaped so as to define a lateral window, the shaft assembly comprising: a burr, which is disposed at a distal end of the shaft assembly, and which is shaped so as to define an external cutting surface; at least one shaver blade, which is disposed within the distal portion of the shaft assembly; and an optical fiber, which is operatively connected to the distal portion of the shaft assembly and is positioned to emit laser energy to the burr; and at least one motor configured to: rotate the burr about a central longitudinal axis of the shaft assembly, and rotate the at least one shaver blade about the central longitudinal axis of the shaft assembly, such that the at least one shaver blade cuts tissue alongside the distal portion of the shaft assembly when the at least one shaver blade is axially aligned with and exposed through the lateral window.

29. The surgical tool according to claim 28, wherein the optical fiber passes through at least a portion of the shaft assembly.

30. The surgical tool according to claim 28, wherein the surgical tool shields the optical fiber from emitting light outside the surgical tool.

31. The surgical tool according to claim 28, wherein the surgical tool shields the optical fiber from emitting light that heats the shaver blades.

32. The surgical tool according to claim 28, wherein the at least one shaver blade is shaped as a plurality of teeth.

33. The surgical tool according to claim 28, wherein the at least one motor is configured to rotate the burr with respect to the optical fiber.

34. The surgical tool according to any one of claims 28-33, wherein the external cutting surface is opaque.

35. The surgical tool according to claim 34, wherein the optical fiber is positioned to emit the laser energy to heat the external cutting surface.

36. The surgical tool according to claim 34, wherein the external cutting surface is diamond-coated.

37. The surgical tool according to any one of claims 28-33, wherein the at least one motor is configured to separately rotate the burr and the at least one shaver blade about the central longitudinal axis of the shaft assembly.

38. The surgical tool according to claim 37, wherein the at least one motor is configured to rotate the at least one shaver blade with reciprocating rotary motion.

39. The surgical tool according to claim 38, wherein the at least one motor is configured to rotate the burr in one rotational direction.

40. The surgical tool according to any one of claims 28-33, wherein the shaft assembly further comprises (a) an elongate shaft, and (b) a shaver cannula defining a lateral opening having a perimeter that defines the at least one shaver blade, and wherein at least a longitudinal portion of the shaver cannula is disposed within the elongate shaft.

41. The surgical tool according to claim 40, wherein a distal portion of the elongate shaft is shaped so as to define the lateral window.

42. The surgical tool according to claim 40, wherein the shaver cannula is rotationally fixed with respect to the burr.

43. The surgical tool according to claim 42, further comprising an inner optical-fiber cannula, which is rotationally fixed with respect to the burr, and disposed within at least a longitudinal portion of the shaver cannula so as to define a space radially between an external surface of the inner optical-fiber cannula and an internal surface of the shaver cannula, wherein the optical fiber passes through the inner optical-fiber cannula.

44. The surgical tool according to claim 42, wherein a distal portion of the elongate shaft is shaped so as to define the lateral window.

45. The surgical tool according to claim 44, wherein the shaver cannula and the elongate shaft are axially slidable with respect to each another such that the surgical tool assumes at least:a shaver-enablement state, in which (a) the burr is proximally retracted within the elongate shaft proximal to a distal end opening of the elongate shaft, and (b) the lateral opening of the shaver cannula at least partially longitudinally overlaps the lateral window of the elongate shaft, and a burr-enablement state, in which (a) the burr is distally exposed from the distal end opening of the elongate shaft, and (b) the lateral opening of the shaver cannula at least partially does not longitudinally overlap the lateral window of the elongate shaft.

46. The surgical tool according to claim 40, wherein the shaft assembly further comprises (a) an inner optical-fiber cannula, through which the optical fiber passes; and (b) a burr cannula, which is rotationally fixed with respect to the burr, wherein at least a longitudinal portion of the burr cannula is disposed within the elongate shaft, wherein at least a longitudinal portion of the shaver cannula is disposed within the burr cannula, and wherein the at least one motor is configured to separately rotate the burr and the at least one shaver blade about the central longitudinal axis of the shaft assembly.

47. The surgical tool according to claim 46, wherein the inner optical-fiber cannula is rotationally fixed with respect to the shaver cannula.

48. The surgical tool according to any one of claims 28-33, wherein the burr is shaped so as to define a cutting wall, which is shaped so as to define the external cutting surface and an internal surface, wherein the distal portion of the shaft assembly is shaped so as to define a distally- facing surface, wherein the internal surface and the distally-facing surface together at least partially define a cavity, and wherein the optical fiber is positioned to emit the laser energy into the cavity, such that the internal surface of the cutting wall thermally conducts the energy to the external cutting surface.

49. The surgical tool according to claim 48, wherein a distal end of the optical fiber is positioned within the cavity.

50. The surgical tool according to claim 48, wherein a distal end of the optical fiber is flush with the distally-facing surface.

51. The surgical tool according to claim 48, wherein the surgical tool is configured such that the distally-facing surface is rotatable with respect to the cutting wall.

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