WO2018219391A1 - Endpiece for an optical wave guide assembly, surgical instrument and laser unit having this endpiece - Google Patents

Abstract

The invention relates to: an endpiece (1, 1', 1") for an optical wave guide assembly (2) which guides light (3) for a therapeutic treatment of the human or animal body from a proximal end (PE) to a distal end (DE); a surgical instrument (100, 110); a catheter (120); and a laser unit (200) having this endpiece (1, 1', 1"). Finally, the invention relates to the use of optical wave guide assemblies, having an optical grating, e.g. in the form of a fibre Bragg grating (FBG), for forming an endpiece (1, 1', 1") of this type. According to the invention, this light is brought together from more than one light source (LD) to merge in the region of the treatment site, wherein light from a first source (LD) is therapeutic light with a high optical energy density, and light from a second source is light for detecting a physical parameter in the region of the treatment site.

Description

 Apex for an optical fiber array, surgical instrument and

 Laser unit comprising this apex

The invention relates to an apex for an optical waveguide arrangement which directs light for a therapeutic treatment of the human or animal body from a proximal end to a distal end, a surgical instrument and a laser unit comprising this apex. Finally, the invention relates to the use of optical waveguide arrangements which have an optical grating, for example in the form of a fiber Bragg grating, for constructing such an apex.

High-energy laser light has been increasingly used therapeutically for several years in numerous application examples. Thus, laser light is used as a scalpel replacement, but also for the treatment of tumors or for the treatment of inflammatory processes. Eventually vessels will be obliterated if necessary or reopened by ablative therapy. The number of therapeutic missions is steadily increasing. In order to direct laser light, which is used for ablation or for cutting, depending on the treatment technique of the corresponding tissue, to the application site, it is known to provide the laser light with the aid of optical waveguides, wherein at the end of the optical waveguide a specially to the application adapted optical fiber tip, the so-called apex, is arranged. Depending on the type of use, this optical fiber tip or apex has a special shape that can be adapted to the therapeutic features by appropriate shaping of the distal end. Since these apices can certainly have a complex shape, these are usually molded from plastic and holes and threads are introduced after injection into the respective apex. Plastic apices are not suitable for transmitting laser light for ablation or cutting biological tissue, as absorption of the laser light by the plastic would destroy the apex itself. Clear plastics are usually polymethyl methacrylate (PMMA), polycarbonate (PC) or polystyrene (PS). In order to avoid the penetration of the plastic by the high-energy laser light, is about in the middle of known Apices for optical fibers an opening to a Channel provided through which protrudes one end of the optical waveguide. For example, the apex thus constructed allows the ophthalmic surgeon to reproducibly apply the optical waveguide to the human eye so that both the focal point of a lens incorporated in the distal end of the optical waveguide and the angle at which the laser light is incident on the human eye, can be reproduced during manual placement between individual treatments. The use of this apex thus improves the treatment success compared to a hands-free placement of an unshaped optical fiber tip.

PCT International Application WO 2014/162268 A1 discloses an apex with a hockey stick shape intended to improve the application of laser light to laser ablation of human tissues. In this apex, laser light is derived from the apex through internal reflection and refraction. The apex disclosed therein is suitable for the ablation of tissue of larger organs, wherein in WO 2014/162268 A1 as an application example the treatment is called benign prostatic hyperplasia and differs in its structure from the apex presented here.

In the post-published German patent application 10 2017 104 673.9 an apex for an optical fiber is taught, which is suitable for the therapy of glaucoma and has special spherical-concave surfaces for placement on the sclera of the human eye.

The object of the invention is to provide a universal system for the therapeutic use of light, which allows a variety of therapeutic uses, that is versatile and still allows the measurement of physical parameters in real time.

The object of the invention is achieved in that the apex brings together light from more than one light source in the region of the treatment site, wherein light from a first source is therapeutic light with high optical energy density, and light from a second source light for detecting a physical parameter in the region of the treatment site is. Further advantageous embodiments are specified in the subclaims to claim 1. The object of the invention is also achieved by a chirguric handpiece according to claim 12, a catheter according to claim 13 and a laser system according to claim 14, all having such an apex.

According to the invention, it is thus provided that the apex fulfills various functions at the same time. The apex is designed to direct high-energy light, ie light with high optical energy density, to the treatment site for therapeutic use. By "high optical energy density" is meant an energy density sufficient to be less than or equal to a irradiance E, measured in W / m ² , in a typical therapeutic application from a distance of up to 5 cm from the treatment site and an exit angle of the light 90 ° thermally heated human or animal tissue so that it changes or optically exposed so strongly that optically induced apoptosis effects of the illuminated cells occur. The apex should also conduct light from another light source for the measurement of physical parameters to the treatment site, reflect there, wherein the reflection by an optical grating, for example in the form of a fiber Bragg grating, which occurs when changing a to be measured physical parameter in a comprehensible manner and depending on the size of the parameter changed. The change in the lattice constant of the optical grating, for example the fiber Bragg grating, finally leads to an observable, which can be attributed to the physical parameter prevailing at the treatment location.

The apex according to the invention can be constructed in various ways. Thus, it is possible to combine all optical waveguide functions, such as directing high-energy light for therapy and directing and returning laser light for the measurement of physical parameters in a fiber, or it is possible to merge different fibers only in the apex.

In constructing the apex as part of the tip of a fiber having different functions, the fiber may be selected from the group consisting of: a coaxial or eccentric fiber based on a multimode fiber having a coaxial or eccentrically confined singlemode fiber with inscribed optical grating, for example Form of a fiber Bragg grating, wherein the singlemode fiber of the Multimode fiber is separated by a cladding, a coaxial or eccentric optical fiber based on a multimode fiber with inscribed optical grating, for example in the form of a fiber Bragg grating, and a carrier fiber, which comprises a first cladding enclosed by a multi-mode fiber and a second cladding enclosed singlemode fiber, wherein the single mode fiber includes an optical grating, for example in the form of a fiber Bragg grating.

However, the apex can also be constructed differently, in that this brings together only at the treatment site, different, independent optical fibers. In this case, provision is made for the apex to combine more than one optical waveguide with different functions at the treatment location, a first recess for a first optical waveguide being arranged inside the apex, and a second recess for a second optical waveguide being arranged inside the apex. According to the invention, it is provided that at least one element is present which is selected from the group consisting of: a refractive element, for example in the form of volume structures with refractive surfaces, such as lenses, prisms or mirrors, or in the form of axicon structures, such as cones or Truncated cones and similar structures, a diffractive element and a diffuser acting. The structure can be chosen as desired, so that the light used for Threapie emerges radially as a ring, exits laterally with a preferred direction, or diffuse emerges, but it has a cylindrical Abstrahlprofil. Depending on the type of therapeutic use, the apex can be individually designed for the intended use. Depending on the type of use, it can thus be provided that the various elements decouple only radially with respect to the longitudinal axis of the apex so that an annular emission characteristic results, only decoupling laterally with respect to the longitudinal axis of the apex, so that an approximately conical emission characteristic is formed in the radial direction, only radially with respect to the longitudinal axis of the apex, but diffuse decoupling, so that there is a cylindrical radiation pattern, or only axially with respect to the longitudinal axis of the apex, so that there is an approximately conical emission in the axial direction. The radiation characteristic is determined by the therapeutic purpose. The axial radiation is suitable, for example, for the light-induced opening of totally closed coronary vessels (English: Coronary Total Occlusion, CTO), in which the light wave ladder assembly is pushed to just before the coronary closure and there the closure ablative, which means by fusing, Ablatieren or removal of the occluding plug, is opened.

In combination with the use of at least one first optical waveguide, which conducts high-energy light to the treatment site, and at least one second optical waveguide, via which physical parameters can be measured, such as, for example, by using a singlemode fiber with inscribed optical grating, for example in the form of a fiber optic grating. Bragg gratings, or a grating written directly into the apex, creates a system with a very wide range of applications.

In a first variant of the invention, provision may be made for the first recess to be provided for a first optical waveguide which conducts light for the treatment of the animal or human body, for example laser light for sclerotherapy of blood vessels, or laser light for the exemplary treatment of glaucoma, or laser light for example therapy of tumors in the urological area, triggering a light-induced apoptosis, laser light for treating a coronary total occlusion (CTO), or laser light for lipolysis, wherein the first optical waveguide is preferably a fiber optic based on a multi-mode fiber , and the second recess is provided for a second optical waveguide, which conducts light for measuring the temperature and / or the pressure in the region of the apex via an optical grating, for example in the form of a fiber Bragg grating, wherein the second optical waveguide is preferred Lichtw is based on a single-mode fiber.

Depending on the type of application, it may be necessary to measure not only the temperature at the treatment site, but also other parameters, such as the reflectivity or the light scattering of the tissue to be treated, the prevailing pH at the treatment site, or the pressure prevailing there. Especially with therapies that involve heat, or that require a specific light absorption of the tissue to be treated, it is important to always control these parameters during the therapeutic application of light. This can be done in another variant of the apex. hen that at least one further recess for another optical fiber is disposed within the apex.

Depending on the type of use, for example when used as a catheter tip or for use in openings of the body or in cut-open tissue, it is advantageous if it has an atraumatic form, wherein the atraumatic form preferably has a circular or elliptical profile and preferably a round, atraumatic distal Has tip through which the apex at the treatment site can not cause mechanical injury.

For a special purpose as a catheter tip can be provided that the atraumatic distal tip is angled to simplify by twisting an introduction into a branch of the human or animal blood or vascular system. It can be provided that the apex is made of a temperature-stable and biocompatible material, such as made by a sol-gel method quartz glass or Ormocere.

For a further special application, it can also be provided that the at least one element acting as a diffuser has nanoscale scattering particles whose average grain size is less than 100 nm, wherein preferably a narrow particle size distribution is provided with a standard deviation of the grain diameter of less than 20 nm nanoscale structure of the scattering particles is a particularly uniform and diffuse light scattering caused, which also acts depolarizing. Especially with the use of laser light, the depolarizing effect can convert the commonly polarized laser light to diffuse, but high-energy light, so that the therapeutic effect is changed, which is dependent on the Lichtpolarisation especially in structured or anisotropic tissue. Although polarization of light is of minor importance for laser-induced interstitial thermotherapy (LITT), in other therapies the polarization of therapeutic light may play an important role, as for example in the activation of pharmaceutically active substances at the treatment site.

To easily apply the light in surgical procedures by the surgeon, a surgical handpiece may have an apex as above is constructed. Also for diagnostic or combined diagnostic / therapeutic procedures, a catheter may have an apex described above.

As a complete system for the therapeutic use of high-energy light, a laser unit is used to treat the human or animal body with light. This comprises: at least one apex described above and at least one laser light source, as well as at least one sensor unit. The sensor unit measures physical conditions in the area of the apex via the second or further optical waveguide. In a preferred embodiment, it is provided that the at least one laser light source forms a controlled system together with the at least one sensor unit and a control unit. In this way, the control unit regulates the radiation power of the at least one laser light source via a feedback by the sensor unit itself. The sensor unit itself can be adapted to the measurement purpose. It has proven to be very versatile if the sensor unit is, for example, an interrogator, a spectrometer or an optical or optoelectronic filter arrangement which decomposes light from the second or further optical waveguide into its spectral components. The control unit can regulate the power of the laser light of the at least one laser light source as a function of the spectral components which change for the measurement of a physical parameter. Optionally, however, it can only display the physical parameters to the attending physician.

The invention will be explained in more detail with reference to the following figures. It shows:

1 shows a first variant of the apex according to the invention,

2 shows a second variant of the apex according to the invention,

3 shows a third variant of the apex according to the invention with a curved tip,

4 shows a fourth variant of the invention apex with diffuser,

5 shows a fifth variant of the apex according to the invention with a cavity, itself acting as a diffuser,

6 shows a laser system having an apex according to the invention on a catheter, 7 shows a first variant of a surgical handpiece having an apex according to the invention,

8 shows a second variant of a surgical handpiece having an apex according to the invention,

9 shows a first optical waveguide arrangement,

10 shows a second optical waveguide arrangement,

1 1 a third optical waveguide arrangement,

12 shows an apex of a catheter for treating a coronary total occlusion (English: Coronary Total Occlusion, CTO).

FIG. 1 shows a sketch of a first variant of the inventive apex 1 for an optical waveguide arrangement 2, which guides light 3 from a proximal end PE to a distal end DE. This apex 1 essentially has a torpedo shape or a cigar shape with a circular profile P, wherein an atraumatic tip S is provided at the distal end DE, which during insertion of the apex 1, for example as part of a catheter 120 in the bloodstream B of the human or animal body K, caused by its shape no injuries. The shape of the profile P can be circular, elliptical or organically shaped, whereby the term "organically shaped" refers to the absence of burrs and edges and all surfaces merge into one another with a constant change of the curvature. At the rear end of the apex 1 there are in this variant three recesses 4 ', 5' and 6 'for one optical waveguide 4, 5 and 6. For demonstrating the interior of the apex 1, a halved apex 1 is shown below the apex 1, which would arise through a cut AA. By the halved shape, two optically active elements, namely a reverse in relation to the light propagation direction truncated cone 10 and a cone standing on the tip 1 1 can be seen. Truncated cone 10 and cone 1 1 are formed in the apex 1 by leaving the corresponding volume. With respect to propagating light 3, which first emerges from an optical waveguide 4 in the apex 1, which is itself in the recess 4 ', the lateral surfaces of the truncated cone 10 and the cone 1 1 form reflective surfaces, because these with respect to the propagation direction of the passing light 3 exceed the critical angle of total reflection. As a result, the light 3 is reflected on the lateral surfaces of the truncated cone 10 and the cone 1 1. In this case, the light 3 changes its direction and emerges laterally in an approximately radial direction out of the apex 1. The bottom sketch shows the halved apex 1 with inserted optical waveguides 4, 5 and 6. Here, the optical waveguide 4, which has a multimode laser MMF here, conducts high-energy laser light from a proximal end PE, the source of the laser light, to a distal end DE of the apex 1. Through the truncated cone 10 and the cone 1 1, the high-energy light emerges radially out of the apex 1. The function of the two other optical fibers 5 and 6 is another. These two optical waveguides 5 and 6 are designed as a single-mode fiber SMF and have at their distal end, which is inserted in the apex 1, an inscribed optical grating, for example in the form of a fiber Bragg grating FBG. When writing an optical grating, for example in the form of a fiber Bragg grating FBG in an optical waveguide 5, 6, the structure of the fiber of the optical waveguide 5, 6 is changed with a short-time laser, so that the refractive index of the fiber material of the optical waveguide. 5 , 6 differs slightly at the location treated with the short-term laser from the refractive index of the environment of the same fiber material. As a result, partial reflection of the light conducted through the fiber of the optical waveguide 5, 6 takes place at the resulting interface between regions of different refractive index. If the refractive index of the fiber of the optical waveguide in short, successive sections at a distance of λ / 2 with respect to a reference wavelength changed so that form in the fiber material of the optical waveguide 5, 6 pairs of sections, which together have a length of λ / 2 with respect to have a reference wavelength, so does this optical grating, for example in the form of a fiber Bragg grating FBG, as a partially transmissive mirror whose reflection wavelength is very narrow band, however. The reflection wavelength is reflected and sent back to the source of the light. If the optical waveguide 5, 6 now heats up at the tip, where the optical grating is inscribed, for example in the form of a fiber Bragg grating FBG, then the length of the section pairs changes due to the thermal expansion, so that the back-reflected wavelength changes , On the basis of the change of the reflected back wavelength, the temperature in the apex can be determined 1 measure, in which using a sensor unit, the wavelength of the reflected light is accurately determined. For the correct functioning of the thus constructed thermometer, it is only necessary to write the optical grating, for example in the form of a fiber Bragg grating FBG, only at the tip of the optical waveguide 5, 6.

When operating the apex, for example, in the treatment of coronary arterial occlusions or vascular decay, it heats up by the high-energy laser light and can, although for a short time, reach temperatures of up to 1, 000 ° C. In order to avoid overheating of the apex, a control loop may be provided, in which the laser light as a heating source and the detection of the temperature by the sensor unit form a control loop, which will be described in more detail below. In the example shown here, the depth of the recess 6 'into the apex 1 is significantly deeper than the depth of the recess 5'. The corresponding single-mode fiber with the optical grating, for example in the form of a fiber Bragg grating FBG, thus extends into the region in which the light of the multimode fiber is coupled out. As a result, it is possible to measure the local temperature of the apex 1 at the location of the light exit and the temperature of the apex in the region of the coupling with the optical waveguide arrangement 2. Alternatively, it is possible to measure the temperature with the singlemode fiber 6 and with the singlemode fiber 5 other physical parameters, such as pressure or local pH.

FIG. 2 shows a sketch of a second variant of the inventive apex 1 for an optical waveguide arrangement, which guides light 3 from a proximal end to a distal end. This apex 1 shown here also essentially has a torpedo shape or a cigar shape with a circular profile P, only the half attachments 1 resulting from the section through the plane A-A being shown here.

The apex 1 shown here also has an atraumatic tip S at the distal end, which does not cause any injuries when inserting the apex 1, for example as part of a catheter 120 into the bloodstream B of the human or animal body K. Unlike the apex 1 in FIG. 1, the apex 1 sketched here has asymmetrically distributed elements, namely likewise an asymmetrical truncated cone 10 and an asymmetrical cone 11. These are something arranged laterally to an imaginary axis of the emerging from the optical waveguide 4 Liche- tes 3 and thus form elements acting as a mirror. These elements acting as a mirror truncated cone 10 and cone 1 1 also couple the light radially, but with a preferred direction. This apex 1 can be used for treatment of blood vessels, for example venous sclerotherapy or sclerotherapy, or in urological surgery to treat tumors in the urethra or urinary bladder, as well as in the ureters as kidney outflows through laser-induced apoptosis. Also in this example shown here, the depth of the recess 6 'in the apex 1 is significantly deeper than the depth of the recess 5'. The corresponding single-mode fiber with the optical grating, for example in the form of a fiber Bragg grating, thus extends into the region in which the light of the multimode fiber is coupled out. As a result, it is possible to measure the local temperature of the apex 1 at the location of the light exit and the temperature of the apex in the region of the coupling with the optical waveguide arrangement 2. Alternatively, it is possible to measure the temperature with the singlemode fiber 6 and with the singlemode fiber 5 other physical parameters, such as pressure or local pH.

The apex 1 of Figure 2 is further developed in Figure 3. A third variant of the apex 1 according to the invention for an optical waveguide arrangement is sketched in FIG. 3, which guides light 3 from a proximal end to a distal end. This apex 1 shown here also essentially has a torpedo shape or a cigar shape with a circular profile P, only the half attachments 1 resulting from the section through the plane AA being shown here. Especially in the variant shown here is that the atraumatic tip is asymmetrical and is bent in a preferred direction. This tip shape, when used as a tip of a catheter, helps insert it into branches of blood vessels. Also, this apex 1 coupled by elements truncated cone 10 and cone 1 1 light 3 radially with a preferred direction. Due to the fixed orientation of the light extraction in relation to the bent, atraumatic tip S, it is easier to determine the preferred direction of the incident light at the treatment site. When catheterized or when used with a surgical handpiece, the tip may have been fixed in a vascular branch by a corresponding rotational position, in which case the direction of the decoupled light 3 can be determined safely and thus can be targeted by the user to a treatment location. As in the previous embodiments, in the example shown here, the depth of the recess 6 'into the apex 1 is significantly deeper than the depth of the recess 5'. The corresponding single-mode fiber with the optical grating, for example in the form of a fiber Bragg grating, thus extends into the region in which the light of the multimode fiber is coupled out. As a result, it is possible to measure the local temperature of the apex 1 at the location of the light exit and the temperature of the apex in the region of the coupling with the optical waveguide arrangement 2. Alternatively, it is possible to measure the temperature with the singlemode fiber 6 and with the singlemode fiber 5 other physical parameters, such as pressure or local pH.

Finally, FIG. 4 outlines a fourth variant of the inventive apex 1 for an optical waveguide arrangement, which guides light 3 from a proximal end to a distal end. This apex 1 also has substantially a torpedo shape or a cigar shape with a circular profile P, wherein at the distal end an atraumatic tip S is provided which upon insertion of the apex 1, for example as part of a catheter 120 in the bloodstream B of the human or animal body K caused no injury by its shape. To illustrate the internal structure, here too only an open half of the apex 1 is shown, which would arise from a section through the plane AA (FIG. 1). In the interior, this apex 1 has an axicon structure 12, which generate scattered light by doping with nanoscale, that is with a particle size of less than 100 nm, particles. The truncated cone 1 1 as an axicon structure acts through the nanoscale particles acting as a diffuser element 12. In order that the light is scattered uniformly, it may be provided that the nanoscale particles have a narrow particle size distribution, the standard deviation of less with an imputed Gaussian distribution of the grain size than 20 nm. In fact, grain size distributions are distributed differently on an RRSB network. The Gaussian distribution of the grain sizes and the standard deviation are approximated here. Finally, it is also provided in this embodiment that in the example shown here, the depth of the recess 6 'in the apex 1 is significantly deeper than the depth of the recess 5'. The corresponding single mode fiber with the optical grating, for example in the form of a fiber Bragg grating extends so far into the area in which the light of the multimode fiber is coupled out. This makes it possible to measure the local temperature of the apex 1 at the location of the light exit and the temperature of the apex in the region of the coupling with the optical waveguide arrangement 2. Alternatively, it is possible to measure the temperature with the single-mode fiber 6 and with the single-mode fiber 5 a other physical parameters, such as pressure or local pH.

FIG. 5 shows a fifth variant of the inventive apex 1 for an optical waveguide arrangement which guides light 3 from a proximal end PE to a distal end DE. This apex 1 also has substantially a torpedo shape or a cigar shape with a circular profile P, wherein at the distal end DE an atraumatic tip S is provided, which in the insertion of the apex 1, for example as part of a catheter 120 in the bloodstream B of the human or animal body K caused no injury by its shape. To illustrate the internal structure, here too only an open half of the apex 1 is shown, which would arise from a section through the plane AA (FIG. 1). In the interior, this apex 1 has an axicon structure 12 'formed as a hollow body. In contrast to the construction of the fourth variant in FIG. 4, in this example the otherwise transparent apex 1 generates scattered light by doping with nanoscale particles, that is to say with a particle size of less than 100 nm. The hollow truncated cone 1 1 formed as a hollow body Axikonstruktur 12 'forms for the from the optical waveguide 4 at the foot of the truncated cone 1 1 an oblique entrance surface along the lateral surface of the truncated cone 1 first When passing into the doped apex 1, the light scatters and exits the apex 1. In order for the light to be scattered uniformly, it can also be provided in this variant that the nanoscale particles have a narrow particle size distribution which, given an assumed Gaussian distribution of the grain size, has a standard deviation of less than 20 nm. In fact, grain size distributions are redistributed on an RRSB network as in the previous example. The Gaussian distribution of the grain sizes and the standard deviation are approximated here. Finally, it is also provided in this embodiment that, in the example shown here, the depth of the recess 6 'into the apex 1 is significantly deeper than the depth of the recess. 5 '. The corresponding single-mode fiber with the optical grating, for example in the form of a fiber Bragg grating, thus extends into the region in which the light from the multimode fiber is coupled out. This makes it possible to measure the local temperature of the apex 1 at the location of the light exit and the temperature of the apex in the region of the coupling with the optical waveguide arrangement 2. Alternatively, it is possible to measure the temperature with the single-mode fiber 6 and with the single-mode fiber 5 a other physical parameters, such as pressure or local pH.

FIG. 6 finally shows a laser unit 200 which sends laser light from at least one laser light source LD, in this case laser diodes, from a proximal end to a distal end. For this purpose, the laser unit 200 has a first optical waveguide 4, and two further optical waveguides 5 and 6, which are combined via a corresponding connector V to form an optical waveguide arrangement 2. The optical waveguide assembly 2 cooperates with an apex 1 as the catheter 120, and the apex 1 can be inserted as the distal end of the catheter 120 into the bloodstream B of an animal or human body K to therapeutically apply the laser light of the laser unit 200 to the patient's vasculature. In the laser unit 200 at least one high-energy laser light source LD is arranged, which couples the light of the at least one high-energy laser light source LD into the optical waveguide 4 via a multi-mode mixer MMC (English: Multi Mode Combiner). In this case, the lights of the different laser light sources LD can also have different spectral compositions. As a result of the light 3 decoupled in the apex 1, the apex 1 heats up to temperatures of up to 1, 000 ° C. In order to avoid that the apex burns the patient internally, it is provided that via the optical waveguides 5 and 6, which are constructed as single-mode fibers SMF and in the area within the apex an optical grating, for example in the form of a fiber Bragg grating FBG , the temperature of the apex 1 is measured. For this purpose, light is sent into the optical waveguides 5 and 6, which send back a temperature-specific spectrum to a sensor unit SE in the laser unit 200 by the temperature-induced change of the inscribed optical grating, for example in the form of a fiber Bragg grating FBG. This sensor unit SE is coupled to a control unit RE which is connected to the multimotor demischer or on the laser light sources LD acts. In this way, a closed control loop, namely laser power, which is converted into heat in the apex 1, which is sent back to the laser unit based on the measurement of the temperature and there again acts on the laser power via the control unit.

FIG. 7 shows a first variant of a surgical handpiece 100, comprising an apex 1 according to the invention, which guides light 3 from an optical waveguide connection 2 to the treatment site. For administration, the user guides the surgical handpiece 100 with the apex 1 into a corresponding body cavity, into a cut in the opened body or into a vessel, where the light 3 escapes accordingly for therapy. This surgical handpiece is suitable for the therapeutic application of high-energy laser light in the field of urological surgery, in the field of photodynamic therapy and interstitial laser therapy.

Finally, it is also possible to use, for example, the apex of Figure 2 with the surgical handpiece shown here, for example, for a non-invasive therapeutic treatment or lighting.

8 shows a second, special variant of a surgical handpiece 110 having an apex 1 "according to the invention, which guides light 3 from an optical waveguide arrangement 2 to the treatment site 3. The handpiece shown here has an apex 1", which has a concave surface and is therefore suitable as an application apex for the therapeutic treatment of glaucoma. For administration, the user guides the surgical handpiece 100 with the apex 1 "onto the eye of the patient where the light 3 escapes for the therapy of glaucoma.The exact application and the destination of the high-energy light radiation is left to the therapeutic art of the attending physician.

FIGS. 9, 10 and 11 show different variants of optical waveguides, which combine more than one function.

FIG. 9 shows one end of a coaxial optical waveguide 20. This consists of a multi-mode fiber MMF, here without the typical border, which is usually with English. "Jacket" designated coat is outlined. The multimode fiber MMF, which is used for the transmission of high-energy light, such as infrared light with a Wavelength of 1 .064 nm of a Nd: YAG laser, infrared light with a wavelength of 1 .470 nm of a thulium laser or infrared light with a wavelength of 2100 nm of a holmium laser is suitably coated in a concentric manner a single mode fiber SMF is separated from the multimode fiber MMF by a "cladding" C acting as a sheath and an insulating layer, generally English. The single mode fiber SMF is separated from the multimode fiber MMF by the cladding C. In the single-mode fiber SMF, for example, light having a wavelength in the wavelength range of 1 .550 nm could be coupled in to measure changes in a physical parameter which are typical of a fiber optic grating, for example in the form of a fiber Bragg grating FBG.

The end of the coaxial optical waveguide 20 is shown on the left in a perspective view and on the right in a plan view. Below the plan is a principle diagram in which the refractive index n is plotted on the radius r. The refractive index n of the single-mode fiber SMF has a higher refractive index n than the surrounding multimode fiber MMF only in this example. The diagram is intended to make clear that the multi-mode fiber MMF and the single-mode fiber SMF differ from one another.

FIG. 10 shows one end of a coaxial optical waveguide 30. This consists of a multi-mode fiber MMF, which is also in this example without the typical border, which is usually with Engl. "Jacket" designated coat is outlined. The multimode fiber MMF, which also in this example for the transmission of high-energy light, for example infrared light with a wavelength of 1 .064 nm Nd: YAG laser, infrared light with a wavelength of 1 .470 nm Thulium laser or infrared light with a Wavelength of 2,100 nm of a holmium laser, concentrically encloses an area containing an optical grating inscribed with a femtosecond laser, for example in the form of a fiber Bragg grating FBG in the multimode fiber area. If the diameter of the multimode fiber MMF is small enough, it is possible to illuminate within the same multimode fiber MMF both a high-energy laser light beam having a first wavelength and a lower-energy laser light beam having a second wavelength, wherein the optical grating, for example in the form of a fiber -Bragg grating In its dimensions of the lattice spacings interacts only with the less energy-rich laser light, without resulting in crosstalk. This fiber is particularly suitable for the treatment of total coronary occlusion, which usually occurs in very narrow vessels with a diameter of 200 μm and less. As in FIG. 9, a perspective view of the end of the coaxial optical waveguide 30 is also shown on the left in FIG. 10, while a plan view of the end of the coaxial optical waveguide 30 is sketched on the right side.

Yet another optical waveguide is shown in FIG. Optical waveguide in Figure 1 1 consists of a functionally independent for the guidance of the light carrier TF. This encapsulates a first multimode fiber MMF, which is separated from the carrier fiber TF by a first cladding C. Furthermore, the carrier fiber TF surrounds a single-mode fiber SMF, which is likewise encased by the carrier fiber by a second cladding. As in the preceding FIG. 9, a perspective view of the end of the optical waveguide is also shown on the left in FIG. 11, whereas a plan view of the end of this optical waveguide is sketched on the right side. The principle diagram below, looking at the end, shows that the refractive indices, denoted by n, the single-mode fiber SMF and the multi-mode fiber MMF both differ from one another and differ from the refractive index of the carrier fiber which is functionless for the light pipe.

12 shows a special embodiment of an apex 1 "for an optical waveguide 30. The apex 1" essentially consists of a multimode fiber MMF, which has a very small diameter d, in this case 100 μιη. Only around the area of the apex 1 "is an optical lattice, for example in the form of a fiber Bragg grating, located approximately in the center of the multimode fiber MMF, which has the construction like the optical waveguide shown in FIG. 10. For an atraumatic design of the Finally, it is provided that the end is melted and thereby forms a lenticular structure of the surface.With a diameter of less than 100 μιη, the term "atraumatic" hardly makes sense to apply, since a tip with this small diameter always has the potential, to break a fine vein wall. LIST OF REFERENCE NUMBERS

Apex 30 eccentric fiber optic cable

'Apex

 100 surgical handpiece "Apex

 110 Surgical Handpiece Fiber Optic Array

 120 catheters

 light

 optical fiber

 200 laser unit

'Recess optical fiber array

 BG blood vessel

'Recess

 Cladding

 optical fiber

 DE distal end

'Recess

 FBG Fiber Bragg Grating

K body

0 cones

 LD laser diodes

1 truncated cone

 MMC multimode mixer

2 acting as a diffuser element, axicon structure MMF multi-mode fiber 2 'designed as a hollow body P profile

 Axicon structure PE proximal end

3 acting as a mirror EleRE control unit

 ment

 S tip

0 coaxial fiber optic cable

SE sensor unit SMF singlemode fiber V connector

TF carrier fiber

Claims

P A T E N T A N S P R E C H E 1 . Apex (1, 1 ', 1 ") for an optical waveguide arrangement (2), which guides light (3) for a therapeutic treatment of the human or animal body from a proximal end (PE) to a distal end (DE), characterized that this light from more than one light source (LD) merges in the area of the treatment site, wherein Light of a first source (LD) is therapeutic light with high optical energy density, and Light from a second source is light for detecting a physical parameter in the region of the treatment site. 2. Apex for an optical waveguide arrangement according to claim 1, characterized in that it has an optical grating, for example in the form of a fiber Bragg grating (FBG) for the light of the second source for the detection of a physical parameter in the region of the treatment location. 3. Apex for an optical waveguide arrangement according to claim 1 or 2, characterized in that this part of an optical waveguide arrangement (2), wherein the optical waveguide arrangement (2) is selected from the group consisting of: a coaxial or eccentric optical waveguide (20) based on a multimode fiber having a coaxially or eccentrically enclosed singlemode with inscribed optical grating, for example in the form of a fiber Bragg grating (FBG), wherein the singlemode fiber (SMF) is separated from the multimode fiber (MMF) by a cladding (C), a coaxial or eccentric optical waveguide (30) based on a multi-mode fiber (MMF) inscribed optical grating, for example in the form of a fiber Bragg grating (FBG), a carrier fiber (TF) comprising a multi-mode fiber (MMF) enclosed by a first cladding (C) and a single mode fiber (C) enclosed by a second cladding (C) ( SMF), wherein the single mode fiber (SMF) comprises an optical grating, for example in the form of a fiber Bragg grating (FBG). 4. Apex according to claim 1, characterized in that it combines more than one optical waveguide (4, 5) with different functions at the treatment site, wherein a first recess (4 ') for a first optical waveguide (4) within the apex (1, 1 ') is arranged, and wherein a second recess (5') for a second optical waveguide (5) within the apex (1, 1 ') is arranged, characterized in that within the apex (1, 1') at least one refractive element For example, in the form of volume structures with refractive surfaces, such as lenses, prisms or mirrors, or in the form of axicon structures, such as cones or truncated cones and similar structures, and / or at least one diffractive element, and / or at least one diffuser-acting element (12) and / or at least one reflecting element (13 ), wherein the at least one refractive element and / or the at least one diffractive element and / or the at least one diffuser-acting element (12) and / or the at least one reflective element (13) acting as a mirror individually or cooperatively light ( 3) from the apex (1, 1 ') decoupled. 5. Apex according to claim 4, characterized in that the first recess (4 ') for a first optical waveguide (4) is provided which directs light (3) for the treatment of the animal or human body (K), such as Laser light for the desquamation of blood vessels (BG), or Laser light for the treatment of glaucoma, or Laser light for the therapy of urological tumors, Laser light for the treatment of coronary total occlusion (CTO), or Laser light for lipolysis, wherein the first optical waveguide (4) is preferably a fiber optic based on a multi-mode fiber (MMF), and the second recess (5 ') for a second optical waveguide (5) is provided, the light for measuring the temperature and / or the pressure in the region of the apex (1, 1') via an optical grating, for example in the form of a fiber Bragg grating (FBG) conducts, wherein the second optical waveguide (5) is preferably a single-mode fiber based optical fiber (SMF). Apex according to claim 4 or 5, characterized in that at least one further recess (6 ') for a further optical waveguide (6) within the apex (1, 1') is arranged, wherein the further recess (6 ') preferably a different depth of the apex (1, 1 ') suffices as the second segment (5'). Apex according to one of claims 4 to 6, characterized in that it has an atraumatic form, wherein the atraumatic form preferably has a circular or elliptical profile (P) and preferably has a round, atraumatic distal tip (S). Apex according to claim 7, characterized in that the atraumatic distal tip (S) is angled to facilitate by twisting an introduction into a branch of the human or animal blood system. 9. Apex according to one of claims 1 to 8, characterized in that it is made of a temperature-stable and biocompatible material, such as produced by a sol-gel method quartz glass or Ormocere. 10. Apex according to one of claims 1 to 9, characterized in that the different elements (10, 1 1, 12, 13) light (3) only radially with respect to the longitudinal axis of the apex (1, 1 ') decouple, so that results in an annular radiation characteristic, only decouple laterally with respect to the longitudinal axis of the apex (1, 1 '), so that an approximately conical radiation pattern is formed in the radial direction, only radially decoupling with respect to the longitudinal axis of the apex (1, 1'), however, so that there is a cylindrical radiation characteristic, or only axially with respect to the longitudinal axis of the apex, so that there is an approximately conical radiation characteristic in the axial direction. 1 1. Apex according to one of claims 1 to 10, characterized in that the at least one diffuser acting as an element (12) nanoscale scattering particles (SP) whose mean grain size is less than 100 nm, preferably a narrow particle size distribution is provided with a standard deviation of the grain diameter of less than 20 nm. 12. Surgical handpiece (100, 1 10), comprising an apex (1, 1 ', 1 ") according to one of claims 1 to 8. 13. A catheter (120), comprising an apex (1, 1 ', 1 ") according to any one of claims 1 to 8. 14. A laser unit (200) for treating the human or animal body with light (3), comprising at least one apex (1, 1 ', 1 ") according to one of claims 1 to 8, at least one laser light source (LD), and at least one Sensor unit (SE), wherein the sensor unit (SE) physical states in the region of the apex (1, 1 ') via the second or further optical waveguide (5, 6) measures, wherein preferably the at least one laser light source (LD) together with the at least one Sensor unit (SE) and a control unit (RE) forms a controlled system, so that the control unit (RE) controls the radiation power of the at least one laser light source (LD) via a feedback by the sensor unit (SE). 15. Laser unit according to claim 14, characterized in that the sensor unit (SE) is an interrogator, a spectrometer or an optical or optoelectronic filter arrangement which decomposes light from the second or further optical waveguide (5, 6) into its spectral components, wherein the control unit (RE) regulates the power of the laser light of the at least one laser light source (LD) as a function of the spectral components which change for the measurement of a physical parameter. Use of a coaxial or eccentric optical waveguide (20) based on a multi-mode fiber (MMF), which includes a coaxially or eccentrically enclosed singlemode fiber (SMF) with inscribed optical grating, for example in the form of a fiber Bragg grating (FBG) the single mode fiber (SMF) is separated from the multimode fiber (MMF) by a cladding (C), a coaxial or eccentric optical waveguide (30) based on a multimode fiber (MMF) with inscribed optical grating, for example in the form of a fiber Bragg grating (FBG), a carrier fiber (TF) comprising a multi-mode fiber (MMF) enclosed by a first cladding (C) and a single mode fiber (SMF) enclosed by a second cladding (C), the single mode fiber (SMF) comprising an optical grating, For example, in the form of a fiber Bragg grating (FBG), for the construction of an apex (1 ") for an optical waveguide assembly (2), the light (3) for a therapeutic treatment of the human body or animal body from a proximal end (PE) to a distal end (DE) directs, such as a catheter for the light therapeutic treatment of coronary total occlusion (English: Coronary Total occlusion, CTO).