CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims benefit to each of U.S. Provisional Application Ser. No. 60/987,596, filed Nov. 13, 2007, U.S. Provisional Application Ser. No. 60/987,617, filed Nov. 13, 2007, U.S. Provisional Application Ser. No. 60/987,819, filed Nov. 14, 2007, U.S. Provisional Application Ser. No. 60/987,821, filed Nov. 14, 2007, U.S. Provisional Application Ser. No. 61/018,727, filed Jan. 3, 2008, U.S. Provisional Application Ser. No. 61/018,729, filed Jan. 3, 2008, and U.S. Provisional Application Ser. No. 60/933,736, filed Jun. 8, 2007, the contents each of which are incorporated by reference herein in their entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to a laser liposuction method. More particularly, the present invention relates to a coaxial suction system for laser lipolysis. 
       BACKGROUND OF THE INVENTION 
       [0003]    Plastic surgeons, dermatologists and their patients continually search for new and improved methods for treating the effects of an aging or otherwise damaged skin. One common procedure for rejuvenating the appearance of aged or photodamaged skin is laser skin resurfacing using a carbon dioxide laser. Another technique is non-ablative laser skin tightening, which does not take the top layer of skin off, but instead uses a deep-penetrating laser to treat the layers of skin beneath the outer epidermal layer, tightening the skin and reducing wrinkles to provide a more youthful appearance. 
         [0004]    For such techniques for laser skin tightening treatment, it has been difficult to control the depth and amount of energy delivered to the collagen without also damaging or killing the dermal cells. Much of the energy of the treatment pulse is wasted due to scattering and absorption in the outer epidermal layer, and the relatively high pulse energy required to penetrate this outer layer can cause pain and epidermal damage. 
         [0005]    Some skin tightening techniques include using a hollow tubular cannula that contains an optical fiber connected to a laser source. The cannula can be inserted subcutaneously into a patient so that the end of the fiber is located within the tissue underlying the dermis. The source emits a treatment output, for example an output pulse that is conveyed by the fiber to the dermis, which causes collagen shrinkage within the treatment area, thus tightening the skin. 
         [0006]    To improve one&#39;s health or shape, patients have also turned to surgical methods for removing undesirable tissue from areas of their body. For example, to remove fat tissue, some patients have preferred liposuction, a procedure in which fat is removed by suction mechanism because despite strenuous dieting and exercise, some of the patients cannot lose fat, particularly in certain areas. Alternatively, laser or other light sources has been applied for heating, removal, destruction (for example, killing), photocoagulation, eradication or otherwise treating (hereinafter collectively referred as “treating” or “treatment”) the tissue. 
         [0007]    Conventionally, both a skin tightening technique and a laser liposuction technique requires two steps. First, a step to insert a first cannula containing a surgical waveguide through an incision point to heat and ablate a target tissue with a laser. And second, a step to insert a second cannula through the same incision point to suction out a byproduct from the first step. 
         [0008]    In applications including those mentioned above, it is often desirable to monitor the temperature of a specific location, for example, a location within a surgical field, in real time. Such monitoring may prevent, for example, skin or other tissue damaged caused by, for example, overheating. 
       SUMMARY OF THE INVENTION 
       [0009]    The inventors have realized that for many applications it is advantageous to simultaneously treat (e.g. with a laser) body fat or other suitable tissue and suction off the byproducts of the treatment laser-tissue interaction. 
         [0010]    In some embodiments, a surgical probe apparatus includes a hand piece, where the hand piece itself includes an optical system configured to deliver therapeutic light to provide treatment of an area of tissue, and the surgical probe further includes at least one suction port configured to remove a byproduct of the treatment from the area of tissue in response to an applied vacuum. In some embodiments, at least one suction port is located proximal to the distal end of the optical fiber. In some embodiments, at least one suction port is set back from the distal end of the optical fiber towards the proximal end of the optical fiber. 
         [0011]    In some embodiments, the optical system includes an optical fiber extending between a proximal end adapted to receive therapeutic light from a light source and a distal end adapted to emit said therapeutic light into the area of tissue. 
         [0012]    In some embodiments, the surgical probe further includes: a hollow treatment cannula surrounding at least a portion of the optical fiber, a hollow suction cannula located proximal to the first cannula, the second cannula comprising the at least one suction port and adapted to, in response to the applied vacuum direct byproduct through the suction port away from the area of tissue. 
         [0013]    The handpiece includes a handle, where the treatment cannula extends from an end proximal the handle to an end distal the handle, and the suction cannula extends from an end proximal the handle to an end distal the handle. In some embodiments, the suction cannula surrounds at least a portion of the treatment cannula. 
         [0014]    In some embodiments, a portion of the treatment cannula proximal its distal end extends along a first axis and at least a portion of the suction cannula proximal its distal end extends along a second axis substantially parallel to said first axis. In some embodiments, at least a portion of the exterior of the treatment cannula is in contact with at least a portion of the exterior of the suction cannula. In some embodiments, at least a portion of the exterior of the treatment cannula is in contact with at least a portion of the interior of the suction cannula. 
         [0015]    In some embodiments, a tip of the end of the suction cannula distal to the handle includes the at least one suction port. In some embodiments, a side of the suction cannula includes the at least one suction port. In some embodiments, the suction cannula and the treatment cannula each includes a first portion proximal the handle and a second portion distal said handle, wherein the first portion of the treatment cannula is positioned within but not coaxial with the first portion of the suction cannula, and wherein the second portion of the treatment cannula is positioned within and coaxial with the second portion of the suction cannula. 
         [0016]    In some embodiments, the distal end of the optical fiber is positioned such that substantially no therapeutic light emitted from said distal end impinges on the suction cannula. In some embodiments, the distal end of the optical fiber is positioned such that at least a portion of the therapeutic light emitted from said distal end impinges on the suction cannula. 
         [0017]    In some embodiments, a vacuum unit is configured to selectively generate the applied vacuum at the at least one suction port. In some embodiments, the vacuum unit is further configured to selectively produce positive pressure at the at least one suction port. 
         [0018]    In some embodiments, the surgical probe apparatus further includes a sensor located proximal the distal end of the optical fiber, the sensor adapted to generate a signal indicative of one or more properties of the area of tissue, a sensing cannula including the sensor, the sensing cannula extending from an end proximal the handle to an end distal the handle. 
         [0019]    In some embodiments, the sensor is a temperature sensor adapted to generate a signal indicative of the temperature of the area of tissue. In some embodiments, the surgical probe apparatus further includes a processor adapted to receive the signal and control the delivery of therapeutic light based on the signal. 
         [0020]    In another embodiment, a method is defined including providing a surgical probe, where the surgical probe includes a hand piece, the hand piece itself including: an optical system configured to deliver therapeutic light and at least one suction port. The method further includes inserting a portion of the surgical probe into a patient through an incision to an area of tissue, delivering therapeutic light to treat the area of tissue using the optical system, and applying a vacuum to the suction port to remove a byproduct of the treatment. 
         [0021]    In some embodiments, the method includes defines the therapeutic light as a laser light. In some embodiments, the laser light comprises infrared laser light. 
         [0022]    In some embodiments, the hand piece includes a hollow treatment cannula surrounding at least a portion of the optical delivery system and a hollow suction cannula located proximal to the first cannula, the second cannula comprising the at least one suction port; where the applying vacuum comprises applying vacuum to the suction cannula. 
         [0023]    In some embodiments, the method further includes delivering therapeutic light to a portion of the area of tissue located proximal to an end of the suction cannula, and advancing the end of the suction cannula into said portion of the area of tissue. 
         [0024]    In some embodiments, the method further includes directing a portion of the treatment light onto the suction cannula to heat said suction cannula and advancing the heated suction cannula through the a portion of the area of tissue. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0025]    The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. 
           [0026]      FIG. 1  shows an embodiment of a surgical hand piece supporting a surgical waveguide and an independent suction unit. 
           [0027]      FIG. 2  shows an block diagram of a laser liposuction system. 
           [0028]      FIG. 3  shows a surgical hand piece where a treatment cannula supporting a surgical waveguide is interior to a suction unit cannula. 
           [0029]      FIG. 4  shows a coaxial surgical waveguide and suction unit cannula, where a fiber optic line coupled to the surgical waveguide is displaced off-axis, along the perimeter of the suction cannula. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0030]      FIG. 1  shows an embodiment of a laser liposuction probe  100 . The laser liposuction probe  100  includes a surgical hand piece  105  that supports both a surgical waveguide cannula  110  and a suction unit cannula  115 . The surgical waveguide cannula  105  supports a surgical waveguide  120 . The surgical waveguide  120  delivers energy through the liposuction probe  100 ; the suction unit cannula  115  functions to remove a byproduct through the liposuction probe  100 . 
         [0031]    In an exemplary embodiment of the laser liposuction probe  100 , the surgical hand piece  105  merges the surgical waveguide  120  and a suction tube  125  into the surgical waveguide cannula  110  and the suction unit cannula  115 , respectively. In some embodiments, the surgical waveguide cannula  110  may have a diameter of approximately 2-4 mm. In some embodiments, the suction unit cannula  115  may have a diameter of approximately 0.5-1.0 mm. In some embodiments, the surgical waveguide  120  may be a fiber optic waveguide. 
         [0032]      FIG. 2  shows a surgical hand piece  105  supporting a surgical waveguide cannula  110  and a suction unit cannula  115 . A laser  230  provides energy to a treatment site  235  through the surgical waveguide  120 . The laser  230  provides energy in accordance with a controller  240 . The controller  240  may determine one or more of the following settings for the laser  230 : a laser power, a laser pulse repetition rate, a laser duty cycle, and a laser wavelength. 
         [0033]    A suction system  245  provides a suction to remove a byproduct from the treatment site  235  through the suction unit cannula  115 . In some embodiments, the byproduct may be a fluid and/or an ablated tissue from the treatment site. The suction system  245  provides suction in accordance with the controller  240 . The controller  240  may determine one or more of the following settings for the suction system  245 : a suction pressure, a suction aperture, a suction flow rate, and a suction pulse repetition rate. 
         [0034]    The controller  240  may determine the one or more settings for the laser  230  and the suction system  245  from a set of feedback data  250  from a set of sensors mounted on or in the hand piece  105 . The set of feedback data  250  includes data taken from sensors including: a hand piece  105  acceleration sensor, a hand piece  105  velocity sensor, a hand piece  105  position sensor, a treatment site  235  temperature sensor, a treatment site  235  tissue type sensor, and a suction unit cannula  115  pressure. 
         [0035]      FIG. 3  shows a surgical hand piece  305  where a surgical waveguide cannula  310  supports a surgical waveguide  320  interior to a suction unit cannula  315 . Of course, anu suitable arrangement of treatment and suction cannulas is possible. Cross section (a) in  FIG. 3  shows the surgical waveguide cannula  310  positioned outside of the suction unit cannula  315 . In some embodiments, as shown in cross sections (b)-(d) of  FIG. 2 , the surgical waveguide cannula  310  is placed inside, either of axis or coaxial to, the larger suction unit cannula  315 . A configuration where the surgical waveguide cannula  310  is placed inside the suction unit cannula  315  has an advantageous external profile for, for example, pushing through a tissue, but the configuration may not offer the best performance for efficient fat suctioning. 
         [0036]    Various embodiments may feature other suitable cross sectional profiles, as shown in cross sections (b)-(d) of  FIG. 2 . For various applications, a suitable profile can be chosen based on one or more considerations, including efficient aspirate (or other treatment byproduct) removal, probe resistance through tissue and fat, manufacturability, and cost. 
         [0037]    In various embodiments, the surgical hand piece  305 , the surgical waveguide cannula  310 , and the suction unit cannula  315  are configured to improve and optimize a laser treatment efficiency, for example, a laser tissue interaction and a laser tissue ablation. For example, in some embodiments, a surgical waveguide tip  321  (e.g. laser probe) is set in advance of a suction unit orifice  316  to heat and disrupt the target tissue in advance of a forward stroke performed by a surgeon. 
         [0038]    In positioning the surgical waveguide tip  321  in advance of the suction unit orifice  316 , the surgical waveguide tip  321  is inhibited from directing energy from the laser into the side of the suction unit cannula  315 . Note however, in some embodiments, the surgical waveguide tip  321  can be intentionally positioned such that a portion of the energy from the laser impinges the side of the suction unit cannula  315 . For example, such a configuration may be used in applications where it is advantageous that the suction unit cannula  315  is to be heated by the laser. 
         [0039]    In various embodiments, a mechanical configuration of the surgical waveguide tip  321  and the suction unit orifice  316  may be chosen based on considerations of the application at hand. As an example, the mechanical configuration of the surgical waveguide tip  321  and the suction unit orifice  316  may be chosen based on how the surgical waveguide tip  321  and the suction unit orifice  316  move through the tissue and how effectively the suction unit orifice  316  passes tissue and fluid and remains unclogged. 
         [0040]    In some embodiments, the suction unit cannula  315  may include a temperature sensor  355 . The temperature sensor  355  may be selected from a group including: a thermocouple, a thermistor, a pyrometer, and an infrared (IR) thermal sensor. 
         [0041]      FIG. 4  shows a coaxial surgical cannula  400 . The coaxial surgical cannula  400  includes a surgical hand piece  405 , a surgical waveguide cannula  410 , and a suction unit cannula  415 , where an optical fiber  422  coupled to a surgical waveguide  420  is displaced off-axis, along the perimeter of the suction unit cannula  415 . In  FIG. 4 , the surgical waveguide  420  is positioned central to the end of both the surgical waveguide cannula  410  and the suction unit cannula  415 , thereby improving the energy distribution of the laser with respect to a coaxial surgical cannula axis  401 . In some embodiments, a circular cross section of the suction unit cannula  415  is preferred to allow for the best flow of ablated tissue and fluid. 
         [0042]    As shown in  FIG. 4 , the surgical waveguide cannula  410  deflects from the coaxial surgical cannula axis  401  at or near a surgical waveguide tip  421  to an axis displaced from the coaxial surgical cannula axis  401  along the perimeter of the suction unit cannula  415 . The geometry of  FIG. 4  allows for the addition of a temperature probe  455  to the interior of the suction unit cannula  415 . The temperature probe  455  may be selected from the following: a thermister, a thermocouple, a pyrometer, and an infrared (IR) thermal sensor. 
         [0043]    In various embodiments, the size and shape of a set of aspiration ports  460  in the suction unit cannula  415  and the suction pressure may be a function of a given application. For example, a byproduct of a set of standard liposuction surgeries and laser liposuction surgeries may be different. A standard liposuction may produce a byproduct with a chunky ‘cottage cheese’ texture, while a laser lipolysis may result in a less chunky byproduct, with a ‘smoothie’ consistency. 
         [0044]    The size and shape of the set of aspiration ports  460  may be selected based on the consistency of the liposuction and lypolysis byproduct. For example, for a typical laser lipolysis applications, the set of aspiration ports  460  may be chosen to be smaller and more numerous compared to aspiration ports for a standard liposuction. In some embodiments, to prevent clogging, the suction vary between suction and a brief high pressure pulse to disrupt clogs (i.e. a plunger effect). 
         [0045]    While various embodiments have been particularly shown and described above, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention. 
         [0046]    For example, it is to be understood that although in the examples provided above laser light is used for treatment, other sources of treatment light (e.g. flash lamps, light emitting diodes) may be used. 
         [0047]    In some embodiments, a safety accelerometer may be incorporated in a surgical waveguide assembly. For example, an accelerometer may be included within a sterile sheath and attached to, for example, the hand piece assembly. The accelerometer may be attached to for example, an electronic processor via wiring contained in the sterile sheath. During treatment, the accelerometer measures acceleration of the hand piece and may determine, for example, if the hand piece has come to rest in a single position for too long a period of time, potentially leading to unsafe heating levels, triggering, for example, a warning, or treatment laser shut off. 
         [0048]    In various embodiments, other safety devices (e.g. position sensors, temperature sensors, etc.) may similarly be incorporated with the surgical waveguide and hand piece. Control systems may process information from these safety sensors and control (e.g. shut off) the applied treatment light based on this information. 
         [0049]    One or more or any part thereof of the treatment, sensing, or safety techniques described above can be implemented in computer hardware or software, or a combination of both. The methods can be implemented in computer programs using standard programming techniques following the method and figures described herein. Program code is applied to input data to perform the functions described herein and generate output information. The output information is applied to one or more output devices such as a display monitor. Each program may be implemented in a high level procedural or object oriented programming language to communicate with a computer system. However, the programs can be implemented in assembly or machine language, if desired. In any case, the language can be a compiled or interpreted language. Moreover, the program can run on dedicated integrated circuits preprogrammed for that purpose. 
         [0050]    Each such computer program is preferably stored on a storage medium or device (e.g., ROM or magnetic diskette) readable by a general or special purpose programmable computer, for configuring and operating the computer when the storage media or device is read by the computer to perform the procedures described herein. The computer program can also reside in cache or main memory during program execution. The analysis method can also be implemented as a computer-readable storage medium, configured with a computer program, where the storage medium so configured causes a computer to operate in a specific and predefined manner to perform the functions described herein. 
         [0051]    A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. 
         [0052]    For example, it is to be understood that although in the examples provided above laser light is used for treatment, other sources of treatment light (e.g. flash lamps, light emitting diodes) may be used. 
         [0053]    As used herein the term ‘light’ is to be understood to include electromagnetic radiation both within and outside of the visible spectrum, including, for example, ultraviolet and infrared radiation. 
         [0054]    While the invention has been described in connection with the specific embodiments thereof, it will be understood that it is capable of further modification. Furthermore, this application is intended to cover any variations, uses, or adaptations of the invention, including such departures from the present disclosure as come within known or customary practice in the art to which the invention pertains, and as fall within the scope of the appended claims. 
         [0055]    All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
A surgical probe apparatus is disclosed including a handpiece which includes an optical system configured to deliver therapeutic light to provide treatment of an area of tissue; and at least one suction port configured to remove a byproduct of the treatment from the area of tissue in response to an applied vacuum.