DE10249674A1 - Surgical instrument for cutting, tissue removal or suction of material from an operation area, has an illumination light source and a detector for non-imaging analysis of the tissue type to assist in instrument positioning - Google Patents

Abstract

Surgical instrument for cutting, removal or suction of material from an operation area (1), has a head part (7) for said cutting, removal or suction and a light source (5) for generation of illuminating light. Back-scattered and reflected light is detected by a detector (6). The detector is not an imaging detector, rather it is used to detect the light intensity and generate a signal that can be used to classify the tissue based on its specific properties.

Description

The present invention relates on a surgical instrument for cutting, ablation or suction of material in an operation area, with a head part, with cutting, ablating or on the material in the surgical area can be suctioned

Surgical instruments of the generic type are known from the prior art and are, for example in retinal surgery as an instrument for ultra-fine cutting and removing tissue. Surgical instruments for suction of material in a surgical field are, for example, for removal of degenerated tissue parts used in brain surgery, whereby the surrounding, non-degenerate tissue is intact during the suction process should stay. With material in this context is first Line means any human or animal tissue material, this can also be bone or Tooth material.

From the US 5,449,357 a surgical suction instrument is known with which material from an operating field can be suctioned off. To initiate the suction process, the operator manually actuates corresponding control elements. Such suction instruments are used, for example, to remove a tumor in a brain. Then the surgeon uses the visual impression and his tactile sensation to decide which areas of the tissue are degenerate and must therefore be removed.

From the JP 01104333 an operating system with a manipulator, an image recording unit and a control unit is known, which can be used for remote operation or to support an immediate operation. Here, similar to known endoscopes, an imaging sensor system is provided, which serves to improve the positioning of the manipulator.

A surgical instrument for ultra-fine cutting tissue is an electrosurgical electrode, such as an electron Avalance Knife is known from WO 00/54683 A1. This electrode system comprises a headboard with a central electrode and one for this purpose, another electrode arranged coaxially, via the sub-microsecond pulses high performance to the material of the surgical field can. The surgical field is in liquid medium and so is the cutting of the material on the one hand through plasma formation at the tip of the Pulse Electron Avalance Knife and on the other hand due to a shock wave of the sub-microsecond pulses. The intensity with which the cutting process can be done by the pulse energy and pulse duration to be controlled. The control options the cutting process is very limited.

The present invention lies hence the task of a surgical instrument of the generic Specify and refine the way that improved control and control options across from has the surgical instruments known from the prior art, so in particular precise and more reproducible operations are possible.

This task is done with an operational tool solved of the type mentioned at the beginning, in which a non-imaging analysis system is provided, the a light source, an illumination beam path, a detector and has a detection beam path, the illumination beam path from the light source over the head part to the operating area and the detection beam path from the area of operation the head part runs to the detector, so that this Operation area can be illuminated with light from the light source and at the operation area reflected, scattered, excited or induced light in not imaging the detection beam path can be coupled in, and the detector light intensity in the detection beam path detected and one dependent on it Detection signal generated.

The invention is based on the knowledge based on the fact that a improved control and control options for the surgical instrument then possible is when the surgical instrument is used to assess the Detection means required for the material to be processed become. Then the material to be processed can be very special advantageously analyzed immediately and the result for control of the surgical instrument can be used, so that now, for example, the material of the operation area or field selectively with regard to its specific Properties can be edited or removed.

The invention advances a non-imaging Focus on optical analysis of the material as it's not about the visual positioning of the surgical instrument, but an assessment of the material or the changes made to it goes. Taking a non-imaging optical analysis according to the here The present invention is therefore not an imaging optic in mind understand by endoscopes.

For this evaluation, the surgical instrument therefore has detection means that work essentially on an optical basis. For example, a light source is provided, with the light of which the operating area can be illuminated. For this purpose, this light passes through an illumination beam path that runs from the light source to the head part of the surgical instrument. The light source or the light from the light source is expediently selected so that a specific detection method can be carried out with the light, for example fluorescence detection. Basically, the relevant light here include not only the visible wavelength range, but also the infrared and / or the ultraviolet wavelength range.

The light used for lighting is reflected in the area of operation or the material and / or scattered. Depending on the detection method, the lighting can of the operating area also stimulate or induce light, e.g. Luminescent or Raman light.

That reflected, scattered, excited or induced light goes through the detection beam path to a detector that has a detection signal generated. How much of the reflected, scattered, excited or induced light enters the detection beam path depends on the effective numerical aperture of the operating area Part of the detection beam path.

The detector detects the light in the detection beam path and generates a detection signal. This Detection signal hangs on the detected light intensity, for example a direct proportionality or a binary Context can be used. Depending on this detection signal the surgical instrument can now be controlled, it being conceivable is that the Control automatically in all Operating and operating modes of the surgical instrument intervenes. It could also control according to the invention in addition or as an alternative to manual control initiated by the operator respectively.

The light source and the detector are not placed around the head part of the surgical instrument to keep the surgical instrument small. Just make sure that the Illumination beam path and the detection beam path to the head part of the surgical instrument. Conveniently, the illumination and detection beam path extends at least partly along a supply line for the headboard.

The head part of the surgical instrument can advantageously run small, so that it is particularly for one Brain surgery is suitable. In this case, the headboard of the Surgical instrument elongated and especially thin be so that if possible little intact material is damaged by the surgical instrument.

It may be required during surgery be that the currently underway Suction or cutting process must be abruptly interrupted to make it intact To protect tissue material. This can be achieved with the surgical instrument according to the invention by a control unit evaluating the detection signal and based on this evaluation, cutting, ablation or suction of material is automatically interrupted, switched off or changed in intensity. If the operator repositioned the headboard and thus on another If you want to continue the operation, you can re-evaluate it of the detection signal indicate that material at this point is to be edited or removed. In this case, the control unit the cutting, removal or suction process of the surgical instrument turn back on.

This can increase the duration of the operation can be minimized in a particularly advantageous manner since the surgical instrument then with increased Performance works when this is in the current surgical situation is not critical. Both switching on and off as well as reducing or increase the cutting or suction process of material can be automated according to the invention become. In this respect there are also wrong decisions in an operation, through which the tissue is damaged is reduced in a particularly advantageous manner.

Basically all are optical Detection method for the surgical device according to the invention is suitable, which is an assessment or classification of the material to be processed or the machining process. Are particularly preferred optical detection methods, such as optical coherence tomography or spectroscopic Detection methods. Furthermore, a combination of optical and acoustic detection methods provided, namely in particular acousto-optical spectroscopy. A complete waiver of image acquisition at the operation area enables a very small operating instrument; this will make the size of endoscopes clearly undercut.

Optical coherence tomography enables morphological information about the material to be processed or processed and information about it Gain scattering and absorption properties and in principle realized with an optical structure, essentially a Michelson interferometer equivalent. Light from a light source has a short coherence length, and one of the two partial beam paths of the Michelson interferometer is used as a measuring arm used. The other partial beam path serves as a reference arm. by virtue of the short coherence length of the used light, an interference signal only occurs when the partial beam path serving as reference arm and the partial beam path serving as measuring arm Partial beam path have the same effective optical length. With the optical coherence tomography you can measure distances to an object with accuracy, which is essentially due to the coherence length of the light used limited is.

It is therefore advantageous to equip the surgical instrument according to the invention with an analysis system that uses optical coherence tomography in the form of a Michelson interferometer. The Michelson interferometer has a reference arm and a measuring arm, the measuring arm running from a beam splitter to the operating area and back to the beam splitter and the beam splitter being arranged in the illumination and detection beam path. The measuring arm of the Michelson interferometer is therefore a part of the illumination and De tektionsstrahlengangs. For this purpose, the light from the light source has a coherence length suitable for optical coherence tomography. On the one hand, this can be achieved by using a light source whose coherence length is correspondingly short, for example a mercury vapor lamp. Of course, it is also possible to use a light source which has a high coherence length, for example a laser, if an optical component is introduced in the illuminating beam path that reduces the coherence length, for example a scattered light plate.

In particular to determine the depth of cut when Cutting the material requires the morphological Deep structure of the material, i.e. essentially perpendicular to its surface to detect. In the embodiment, this is done with the Michelson interferometer Scanning the operation area along the optical axis of the illumination beam path. The scanning is going through a change of the relationship the effective lengths from measuring arm to reference arm with simultaneous detection of the light of the detection beam path causes. This mode of operation of an optical coherence tomograph is also referred to as an A-scan in analogy to the ultrasound examination. The change the effective length of the measuring arm can by varying the focal length of the illumination and detection beam path at the surgical site or

field, for example via a corresponding, along the optical axis of the illumination beam path movably arranged lens system. Alternatively or additionally a change of the relationship the effective lengths from measuring arm to the reference arm by adjusting the length of the reference arm. With that no one has to Focusing optics are provided on the head part of the surgical instrument his.

In a particularly preferred embodiment it is envisaged that with the Michelson interferometer scanning the operating field transverse to the optical axis of the illumination beam path he follows. This mode of operation of an optical coherence tomograph is also known as B-scan. A simultaneous one is also conceivable Scanning along the optical axis of the illumination beam path and a direction orthogonal to it. The scanning is preferably carried out transverse to the optical axis of the illumination beam path, for example in a plane orthogonal to the optical axis. A B scan delivers morphological data of the material along the scanned line or area, so this Information for surface processing of the material advantageous for controlling the surgical instrument can serve. Finally a combination of an A-scan and a B-scan is conceivable, at that is in three different directions - preferably each orthogonal to each other - scanned becomes.

Scanning is preferably carried out in at least one direction transverse to the optical axis of the illumination beam path by rotation of an optical component, wherein the optical component in the measuring arm lies. The optical component can e.g. a deflection prism or one Include deflecting mirror on the head part of the surgical instrument. alternative or additionally this can be done by scanning in two different directions Rotation of a light guide about its longitudinal axis take place, the measuring arm runs at least partially in the light guide and wherein the light guide in a corresponding management unit guided is. The rotation of the light guide can be continuous or can also be carried out as a periodic back and forth rotary movement. A leadership unit can be a tube or comprise a tube in or in which the light guide (around its longitudinal axis). The inside diameter of the tube or the tube is larger than the outside diameter of the light guide and to choose that a as little friction as possible Movement of the light guide can take place so that torsion of the light guide does not occur if possible.

The classification of tumors Material or tissue can in particular be detected by detection of Raman or luminescent light, in particular fluorescence light detection possible. With these detection methods, spectroscopic information about the Material won. On the one hand, autofluorescence of the material can be stimulated on the other hand can - one appropriate marking with fluorescent dye provided - a fluorescent dye be stimulated.

The light from the light source is like this select that like required Raman light and / or luminescent light, in particular fluorescent light, is stimulable.

Labeling with fluorescent substances can in a known manner, e.g. B. done by systemic administration. It is but also possible suitable fluorescent markers directly to the operating field spray. For that is it is preferred to use the surgical instrument, especially the head part, a spray device for contrast or fluorescent substances.

The light from the light source can preferably be a Cause two or more photons excitation. Such light sources are, for example, short-pulse lasers in the infrared wavelength range Emit light. This light is focused in the material So that the the light intensity in the focus area is high enough to or multi-photon excitation process to effect. The use of multi-photon excitation is therefore particularly advantageous if because the excitation light has a wavelength which is in the infrared range and therefore - due to lower scattering processes Material - deeper can penetrate into the material than the excitation light One-photon excitation with shorter ones wavelength the case is.

For selecting the light from the light source for the Illumination of the operating field is in the illumination beam path of the analysis system advantageously an illumination filter system to provide that one wavelength or transmitted a wavelength range. Then a light source can be used for lighting, the light over one huge spectral range emitted. By changing a filter of the illumination filter system are different wavelengths or Wavelength ranges used. The same applies Laser light sources that emit light of several different wavelengths. This makes it possible to illuminate the operating field with light of different wavelengths that in advantageously different with the same surgical instrument Tissue types can be assessed.

The illumination filter system can preferably include a color filter or tunable filter. As a color filter can be an appropriately coated interference filter or a colored glass filter serve. A tunable filter can e.g. in the form of a battery-optic tunable filter can then be used particularly advantageously, if a laser light source is used to illuminate the operating field, which emits light of several different wavelengths.

Such a filter essentially consists of a birefringent crystal through one on one side of the crystal arranged piezo crystal with high-frequency vibrations is applied, whereby a wave propagates in the crystal. This creates a Bragg grating on which the laser light from from a zero order to a first order can be. With a suitable arrangement of the filter in the illumination beam path can thereby one or more wavelengths - also simultaneously - for the lighting of the operating field, the light of each selected wavelength with the filter each varied in intensity or optimally set can be. Can continue for the selection of the illuminating light in a correspondingly acousto-optical way Modulators and / or acousto-optical deflectors can be used.

In the detection beam path is advantageous to provide a detection filter system, the light of a wavelength or of a wavelength range for the Detection transmitted. The detection filter system can also include a color filter, i.e. an appropriately coated interference filter or a colored glass filter. Then, with a suitable choice of lighting and detection filter light from luminescence, in particular fluorescence or Phosphorescence, but also Raman light can be excited and detected. If the illumination beam path and the detection beam path partially collapse to achieve a compact structure, can using a color beam splitter - e.g. a dichroic Beam splitter - separated again be, as is common for example in conventional fluorescence microscopy.

The illumination beam path can a dot-shaped or circular Operate area lighting. Spot lighting will be convenient generated by appropriate lenses in the illumination beam path are suitably arranged. Spot lighting is mainly used for optical coherence tomography chosen become.

As another detection method to characterize the material of the operating area is the acousto-optical spectroscopy provided. This is the area of operation pulsed light from the light source. That with light acted upon material in the operating area at least absorbed some of the pulsed light, causing the temperature of this Material increased. This in turn causes this material to expand so that there is a Pressure wave propagates in the surrounding material of the surgical area. This pressure wave is detected with a time sensor using a pressure sensor, the detection preferably on the material surface of the Area of operation.

An evaluation of those generated by the pressure sensor Detection signals enabled it, conclusions on to pull the material properties, in particular this can Material limits are detected. Acousto-optical spectroscopy is therefore a useful addition in a particularly advantageous manner to the purely optical detection methods, especially if that Material of the operating area is highly light-absorbing and one Detection of deeper material areas in the operating area is problematic with the purely optical detection methods.

As a light source for acousto-optical spectroscopy a Nd: YAG laser can be used, which is in Q-switched mode operated light pulses with a wavelength of 532 nm (2nd harmonic) generated. These light pulses have a pulse duration of 5 ns with a Power of up to 100 mJ.

As a pressure sensor, for example a PVDF film can be used as described in the article "Depth profiling of absorbing soff materials using photoacoustic methods ", J.A. Viator, S.L. Jacques, S.A. Prahl, IEEE J. Selected Topics Q.E. 5, 989-996 (1999), is described. This pressure sensor has a sensor area of approximately 1 mm × 1 mm and could for example be arranged on the head part of the surgical instrument.

In a particularly preferred embodiment, the illuminating beam path and / or the detection beam path has a light guide. A single glass fiber or a glass fiber bundle can serve as the light guide. If a monochromatic laser is used as the light source, the use of a single-mode optical fiber can be advantageous. In this case, the single-mode Lichtleiffa is on the light decoupling side This is a point-shaped light decoupling, which can be mapped to the operating field with a corresponding optics to a point-shaped lighting. In principle, the material properties of the light guide are to be selected such that the light guide has the lowest possible attenuation for the illuminating and in particular for the detection light. This is particularly advantageous for the detection of Raman light, which usually has an even lower intensity than fluorescent light.

The lighting beam path and the detection beam path can at least in some areas in at least one light guide run. This means that at least two light guides must be provided, namely one, in which the illuminating beam path, and another in which the Detection beam path, runs. It is therefore preferred that the illuminating beam path runs in a light guide and that for the detection beam path a plurality of light guides are provided, which reflect that on the operating field, Collect scattered, excited or induced light from the head of the surgical instrument. Especially when detecting fluorescent or Raman light it is advantageous due to the low intensity of the fluorescent or Raman light, if several detection channels are provided, which the one to be detected Collect light from the operating field and feed it to the detector. Also can thus several measuring points sensed in the operating area become.

The lighting beam path and the detection beam path at least in some areas in the same Light guide or run in the same light guides. Then in the Illumination and detection beam path - preferably between light source and light guide on the one hand and detector and light guide on the other hand - a beam splitter to provide the light of the light source in the direction of the light guide reflected and the light of the detection beam path in the direction of the detector. All over particularly advantageously, several Light guides can be provided, each in each of the light guides the illumination beam path and the detection beam path run. In particular if this fiber optic outdoors of the head part are arranged, several lighting and partial detection beam paths formed, each illuminate the operating field and that reflected, scattered, excited or induced light again can collect. This lighting or detection can be used to evaluate the material occur simultaneously at several points in the operating field in a pattern that essentially corresponds to the arrangement of the light guides on Head part of the surgical instrument corresponds.

There are several options, such as the one Optical fibers can be arranged on the head part of the surgical instrument can. If only one light guide is provided, it can be inside or outside of the headboard. If several light guides are provided, so can these can also be arranged inside and / or outside the head part. With an essentially cylindrical head part of the surgical instrument the light guides in the outer area the head part is circular Take up the order. The longitudinal axis of the light guide or the light guide is substantially parallel to a longitudinal axis the head part arranged.

For focusing the lighting beam path can advantageously be provided a grin lens attached to the end of the light guide is arranged, the operating area or field is facing. A grin lens is characterized by the use of a material with a location-dependent refractive index, a so-called gradient index (grin) glass. One differentiates essentially two groups of gradient index glasses, namely radial and axial. Here radial grins are provided, in the form of Rod lenses are used and have a basic refractive index along the central axis of the Glass blanks on. There are also further changes in the refractive index, which are described as a function of the radial distance from the central axis can. Grin lenses are achromatic lenses in terms of their performance and pressed aspherical Lentils far superior. Because of their ability diffraction limited focus, their high destruction threshold and their low surface scatter, they are particularly suitable for high quality Laser systems. You make additional ones Optical elements for aberration correction are superfluous and can therefore be size, weight, complexity and reduce costs of optical systems. In particular, they can at the operating field facing end of an optical fiber for effective Focusing the illuminating light with a space-saving design be used.

In a preferred embodiment is for that Analysis system a display device provided that is connected to the control unit and the surgeon acoustic and / or visual information from the detection signal provides. An acoustic display device can, for example, an alarm signal output if the diagnosis of the material of the operating field reveals the existence The cutting or suction process must be stopped because otherwise it is intact Fabric material damaged would. A display device that provides the surgeon with visual information, for example be designed as a monitor. This allows the result of the diagnosis - possibly an image of the operating field overlaid - displayed be so that the The operator can use this display to see how he is currently doing this Machined material.

In principle, the surgical instrument can be positioned and controlled in a computer-controlled manner, so that, for example, an operation can be completely planned in advance by a surgeon is then carried out automatically. In this respect, corresponding positioning devices for the head part of the surgical instrument are required. In a preferred embodiment, the surgical instrument is designed for manual operation by the surgeon. For this purpose, a handle part is provided on the head part, with which the surgeon holds and positions the surgical instrument. The handle part preferably comprises an operating element which is connected to the control unit. With this control element, for example, the surgical instrument can be switched on and off manually. Another control element arranged on the handle part then serves to control the cutting, removal or suction process.

For the operation of the surgical instrument is usually a supply unit provided that is connected to the head part via a supply line is. This supply unit provides the surgical instrument energy required to cut, vacuum or remove material to disposal. If the surgical instrument is designed to suction material or if the surgical instrument has a suction module the supply unit preferably provides the head part with a necessary negative pressure to disposal. In this case, the head part is a suction head for vacuuming material educated.

In a very particularly preferred embodiment is a tubular trained suction line provided through the material from the Surgical field is suction. The suction line includes one for Illumination and detection beam path transparent light Suction line material and the lighting and / or detection beam path extends in the transparent suction line material. To avoid loss of light the inside and outside of the suction line are preferably mirrored trained so that light loss remain as small as possible on the mirrored suction line surfaces. By This measure can in a particularly advantageous manner the suction line itself as Optical fibers are used, so that the manufacturing costs for the suction line be reduced and its construction is simplified. The light the light source is preferably on a side facing away from the operating field End of tubular trained suction line coupled into the suction line material. In the same way, the tubular suction line can be formed at this end the detection light of the detection beam path are coupled out.

If the headboard is surgical Electrode system, e.g. trained as Pulse Electron Avalance Knife the supply unit supplies the electrical necessary for operation Energy to ignite a plasma at the tip of the headboard and / or to generate a shock wave. The electrode system includes one essentially centrally arranged electrode and one coaxial with it arranged further electrode with a supply unit are electrically coupled. There is a between the two electrodes Insulator provided, which is light-guiding and in which the illumination beam path and / or the detection beam path runs at least in some areas. The insulator is preferably made of glass or plastic, taking care that the Glass or the plastic for the light of the illumination and / or detection beam path is transparent should be. This also advantageously allows the head part the surgical instrument can be manufactured simply and easily, so ultimately material and manufacturing costs are also kept low can.

Finally, the supply unit comprise a laser, the light for laser ablation of the material generated. So far with a surgical instrument suitably designed for laser ablation for example, corneal surgery on the human eye with considerable improved control and control options through the measurement options, which the analysis system for offers the material to be processed or processed. This is a check of how much material the cornea has removed was done using optical coherence tomography possible, what the precision the operation improved in a particularly advantageous manner.

The invention is explained below the drawing is explained in more detail by way of example. The drawing shows:

1 1 shows a schematic representation of a surgical instrument for aspirating material in an operating field,

2 to 4 schematic representations of exemplary embodiments of surgical instruments for suctioning material,

5 to 10 schematic representations of exemplary embodiments of surgical instruments for cutting material,

11 is a schematic representation of the cross section of a head part of a surgical instrument for cutting material and

12 is a schematic representation of the cross section of a head part of another surgical instrument for cutting material.

1 shows an operating instrument for suctioning material from an operating field or area 1 which is a supply unit 2 , a control unit 3 and an optical unit 4 having. The optical unit 4 includes a light source 5 and a detector 6 , The supply unit 2 is with the headboard 7 via the supply line 8th connected. The control unit 3 controls the surgical instrument and in particular the supply unit 2 via the control line 9 , The light source 5 is also from the control unit 3 over a line 35 driven.

Next is in 1 indicated that an illumination beam path 10 from the light source 5 partly along the supply line 8th over the head part 7 to the operating field 1 runs. A detection beam path 11 runs from the operating field 1 over the headboard 7 partly along the supply line 8th to the detector 6 ,

The surgical field 1 is the light source with light 5 illuminated. That on the operating field 1 reflected, scattered or excited light passes through the detection beam path 11 , and the detector 6 detects light intensity in the detection beam path 11 and generates a dependent detection signal that over the line 12 the control unit 3 is fed.

The 2 to 4 each show a surgical instrument 1 , which is designed to suction material. The headboard 7 is a tubular suction head through which the material is extracted. To the headboard 7 is the suction line 13 trained supply line attached, the suction line 13 is only partially shown. The headboard 7 the 2 comprises a tubular suction line 13 , through which the material of the operating field can be extracted.

The suction line 13 has one for the light of the illuminating beam path 10 and the detection beam path 11 transparent suction line material in which the illumination beam path 10 and the detection beam path 11 runs. The inner surface of the suction line 14 and the suction line outer surface 15 are mirrored so that the suction line material works as a tubular light guide. Accordingly, the end face 16 of the suction line material and that of a light coupler 17 facing end surface of the suction line material is not mirrored. The light from the light source is with the light coupler 17 at one of the operating fields 1 opposite end of the tubular suction line 13 coupled into the suction line material. In the same way, the detection light with the light coupler 17 decoupled from the suction line material and the detector of the optical unit 4 fed.

In 3 Another surgical instrument for suctioning material is shown. Here too is the headboard 7 designed as a tubular suction head, through the material from the surgical field 1 can be suctioned off. The lighting of the operating field 1 takes place with light from the light source 5 that with an optical fiber 18 to the headboard 7 to be led. Thus, the illuminating beam path includes 10 the light guide 18 , which is central in the head part 7 substantially parallel to the longitudinal axis of the head part 7 runs. Detection light, which is created by fluorescence, is used with light guides 19 of the detection beam path 11 to the detector 6 guided.

The detection beam path points 11 the 3 several light guides 19 on that in the outer area of the suction head of the head part 7 substantially parallel to the longitudinal axis of the head part 7 are arranged and can produce a circular lighting pattern in cross section. For simplicity, are in 3 only two light guides 19 shown.

The detector 6 detects the light intensity of the light in the detection beam path 11 , and the detection signal dependent thereon is sent to the control unit 3 fed. The control unit 3 evaluates the detection signal and makes the result available through the optical display device 20 - a monitor. This is visual information that corresponds to the detected fluorescence intensity. The light guides 19 are at the end of the head part facing the operating field 7 - Based on the cross section of the head part 7 - Arranged in a circle so that the outlet ends of the light guide 19 form an annular pattern. This ring pattern is schematic on an optical display device 20 shown. The intensity of the displayed points changes depending on how the current detection result turns out.

4 shows an embodiment, similar to the surgical instrument of 3 , Here are the illuminating beam path 10 and the detection beam path 11 in a light guide 21 guided. The light guide 21 is central in the head part 7 arranged. It is the only light guide in this embodiment. With the dashed outline is the optical unit 4 indicated that next to the light source 5 and the detector 6 a beam splitter 22 has on the one hand transparent to the light of the light source 5 and on the other hand the detection light of the detection beam path caused here by Raman scattering 11 to the detector 6 divides.

The 5 to 10 each show a schematic representation of an operating instrument for cutting material in an operating field, only that of the operating field 1 facing part of the headboard 7 is shown. Here, the head part includes 7 an essentially centrally located electrode 23 and a further electrode arranged coaxially with it 24 , Between the two electrodes 23 . 24 is an isolator 25 provided that can be designed light-guiding. Both electrodes 23 . 24 are with a (in the 5 to 10 Not shown) connected to the supply unit that supplies electrical energy, so that in the 5 to 10 shown electrode arrangement of the surgical instrument works as a Pulse Electron Avalance Knife.

The in the 5 and 6 Exemplary embodiments of the analysis system shown on the head part each comprise a light guide 26 through which part of the illuminating beam path 10 and the detection beam path 11 is guided, which are also part of a measuring arm of a Michelson interferometer. The material of the operating field 1 is measured according to the principle of optical coherence tomography. The light guide 26 located in 5 except half of the headboard 7 , in 6 inside the isolator 25 , For focusing the illuminating light on the operating field 1 is at the operating field 1 facing end of the light guide 26 a grin lens 27 arranged. In the embodiments of the 5 and 6 optical coherence tomography takes place in the A-scan mode, with scanning in one direction along the optical axis 28 of the illumination beam path 10 by changing the effective optical length of a - not shown - reference arm while simultaneously detecting the light of the detection beam path 11 he follows.

This in 7 shown surgical instrument essentially corresponds to that of 5 , but here an optical coherence tomography takes place in the B-scan mode. The surgical field 1 becomes in a direction transverse to the optical axis 28 of the illumination beam path 10 by periodically turning the light guide back and forth 26 scanned. The light guide 26 is in a guide unit designed as a tube 29 guided so that a rotation of the light guide 26 about its longitudinal axis 30 is possible in the installed state. The rotation of the light guide 26 is with a double arrow 31 indicated.

The 8th and 9 each show a headboard 7 of a surgical instrument in which fluorescent light detection of the material in the surgical field 1 he follows. The lighting beam path 10 runs in a light guide 32 , and the detection beam path 11 runs in a light guide 33 , Here are in 8th both light guides 32 and 33 on the outside of the headboard 7 arranged; in 9 they lie within the head part 7 , namely in the isolator 25 ,

10 shows a headboard 7 of a surgical instrument in which the detection beam path 11 the operating field 1 on a (in 10 not shown) conducts fluorescence detector. There is a light guide for this 34 provided in which the detection beam path 11 runs at least partially. The light guide 34 is also on the outside of the headboard 7 arranged. The lighting of the operating field 1 takes place in the embodiment 10 through the isolator 25 which is transparent to the light from the light source, for example made of glass.

The 11 and 12 each show a cross section through a head part 7 of a surgical instrument in a front area of the head part 7 that is near the operating field 1 lies. A Raman detection is provided in both cases, whereby in 11 the illuminating beam path 10 three light guides 32 and the detection beam path 11 three light guides 33 having. The light guides 32 and 33 the 11 are in the isolator 25 and parallel to the electrode with respect to their longitudinal axes 23 arranged.

In 12 however, the illuminating beam path runs 10 due to the transparent, for example made of glass, insulator 25 , The detection beam path 11 comprises three light guides 33 that in the isolator 25 and parallel to the electrode with respect to their longitudinal axes 23 are arranged.

Claims (17)

Surgical instrument for cutting, removing or aspirating material in an area of surgery ( 1 ), with a headboard ( 7 ) with which the material in the surgical area ( 1 ) can be cut, removed or suctioned, characterized by a non-imaging analysis system which has - a light source ( 5 ), an illumination beam path ( 10 ), a detector ( 6 ) and a detection beam path ( 11 ), whereby - the illumination beam path ( 10 ) from the light source ( 5 ) over the headboard ( 7 ) to the area of operation ( 1 ) and the detection beam path ( 11 ) from the area of operation ( 1 ) over the headboard ( 7 ) to the detector ( 6 ) runs so that the area of operation ( 1 ) with light from the light source ( 5 ) illuminable and at the operating area ( 1 ) reflected, scattered, excited or induced light in the detection beam path ( 11 ) can be coupled in non-imaging, and - the detector ( 6 ) Light intensity in the detection beam path ( 11 ) is detected and a detection signal dependent thereon is generated. Surgical instrument according to claim 1, characterized by a control unit ( 3 ), which evaluates the detection signal and uses this evaluation to switch on, switch off, reduce or increase the cutting, removal or suction of material. Surgical instrument according to claim 1 or 2, characterized characterized that the Analysis system a Michelson interferometer for optical coherence tomography having. Surgical instrument according to Claim 3, characterized in that the Michelson interferometer scans the surgical area ( 1 ) in a direction along the optical axis ( 28 ) of the illumination beam path ( 10 ) enables, in particular by varying a focal length of the lighting ( 10 ) and detection beam path ( 11 ) at the operating area ( 1 ). Surgical instrument according to claim 3 or 4, characterized in that the Michelson interferometer is used to scan the surgical area ( 1 ) in at least one direction transverse to the optical axis ( 28 ) of the illumination beam path ( 10 ) takes place, preferably by means of a rotation of a deflection prism or a deflection mirror. Surgical instrument according to one of claims 1 to 5, characterized in that the light from the light source ( 5 ) Excite Raman light and / or luminescent light, in particular fluorescent light bar, in particular by two or more photon excitation. Surgical instrument according to one of claims 1 to 6, characterized in that in the illuminating beam path ( 10 ) a preferably tunable illumination filter system is provided, which has a wavelength or a wavelength range of the light of the light source ( 5 ) for the lighting of the operating area ( 1 ) transmitted. Surgical instrument according to one of claims 1 to 7, wherein in the detection beam path ( 11 ) a detection filter system is provided, which transmits light of a wavelength or a wavelength range. Surgical instrument according to one of claims 1 to 8, wherein the illumination beam path ( 10 ) punctiform or circular lighting of the operating area ( 1 ) causes. Surgical instrument according to one of Claims 1 to 9, characterized in that the surgical area (for acousto-optical spectroscopy) 1 ) with pulsed light from the light source ( 5 ) can be acted upon, the light-acted material in the operating area ( 1 ) absorbs pulsed light, and that a pressure sensor is provided with which a pressure wave in the material can be detected in a time-resolved manner. Surgical instrument according to one of claims 1 to 10, characterized in that the illuminating beam path ( 10 ) and / or the detection beam path ( 11 ) a light guide ( 18 . 19 . 21 . 26 . 32 . 33 . 34 ), preferably the illuminating beam path ( 10 ) and the detection beam path ( 11 ) at least in some areas in the same light guide ( 21 . 26 ) or runs in the same light guides. Surgical instrument according to claim 11, characterized in that for focusing the illuminating beam path ( 10 ) a grin lens ( 27 ) is provided, which at one end of the light guide ( 26 . 32 ) is arranged, which corresponds to the operating area ( 1 ) is facing. Surgical instrument according to one of claims 1 to 12, characterized in that the analysis system is a display device ( 20 ), which provides acoustic and / or visual information for an operator from the detection signal. Surgical instrument according to one of claims 1 to 13, characterized in that the head part ( 7 ) is designed as a surgical suction head for suctioning off material. Surgical instrument according to claim 14, characterized in that a tubular suction line ( 13 ) is provided, through which material can be extracted from the operating area and which is used for light from the lighting ( 10 ) and detection beam path ( 11 ) includes transparent suction line material, the lighting ( 10 ) and detection beam path ( 11 ) runs in the transparent suction line material, preferably the light from the light source ( 5 ) in an area of operation ( 1 ) opposite end of the suction line ( 13 ) can be coupled into the suction line material. Surgical instrument according to one of claims 1 to 13, characterized in that the head part ( 2 ) has an electrosurgical electrode system. Surgical instrument according to claim 16, characterized in that the electrode system has an essentially centrally arranged electrode ( 23 ) and another coaxial electrode ( 24 ) between which an isolator ( 25 ) is provided and that the illumination beam path ( 10 ) and / or the detection beam path ( 11 ) at least in some areas in the isolator ( 25 ) runs.