WO1999004694A1

WO1999004694A1 - A system for laparoscopic ultrasound guidance of a surgical cryo-probe

Info

Publication number: WO1999004694A1
Application number: PCT/IL1998/000340
Authority: WO
Inventors: Raphael Rabinovitz; Michael Slatkine
Original assignee: Laser Industries Ltd.
Priority date: 1997-07-21
Filing date: 1998-07-20
Publication date: 1999-02-04
Also published as: IL121357A0; AU8355298A

Abstract

The present invention is a system for performing ultrasound laparoscopic cryosurgery. The system consists of an ultrasound laparoscopy system (3) including a laparoscopy probe (12) for providing an ultrasound image, a control unit (24) connected to the laparoscopy probe (12), and a display (6) connected to the control unit (24) for displaying the ultrasound image. The system (3) further consists of a cryoprobe system (4) including a cooling device (20), and a cryoprobe (14) attached to the cooling device (20). The cryoprobe (14) is inserted into the laparoscopy probe (12), movable along the laparoscopy probe (12) for penetrating, and freezing tissue.

Description

A SYSTEM FOR LAPAROSCOPIC ULTRASOUND GUIDANCE OF A

SURGICAL CRYO-PROBE

FIELD OF THE INVENTION

The present invention relates to the field of surgical devices in general

and to the field of laparoscopy assisted cryogenic surgical systems in particular.

BACKGROUND OF THE INVENTION

The use of laparoscopy for visualizing or imaging of internal organs

within a body is well known in the art and is used for diagnostic purposes, for

performing minor surgery and for obtaining tissue samples for biopsy or other

medical purposes. A laparoscopy probe is inserted into a body cavity such as the

abdomen through an opening made in the abdominal wall and the probe is

manually guided to provide an image of internal organs. The image may be

provided by an optical system such as a fiber-optic system with or without a video

imaging system. The laparoscopy probe may also include grasping or cutting for

performing surgery.

Laparoscopy systems which use optical visualizing or imaging methods

are limited in that they can only provide an image of the external part of the

viewed organs. In cases where additional information is needed such as the

location of an internal tumor or other internal abnormal tissue which is embedded

within an organ, different methods have to be used. The abdomen is opened

using conventional non-laparoscopy surgical methods. An externally placed

ultrasound probe is used to obtain an ultrasound image of the organ and to visualize the internal tumor. A cryo-probe can then be inserted into the abdomen

under direct visual control. The cryo-probe is inserted into the organ and

advanced until its tip penetrates the tumor by observing the positions of the

cryo-probe and the tumor on the ultrasound image. The cryogenic tip is then

cooled to selectively freeze the tumor without excessive damage to the

surrounding tissue. However, since the ultrasound image obtained by an external

ultrasound probe does not provide three-dimensional information about the

position of the cryo-probe relative to the tumor, the surgeon may have difficulties

in directing the cryo-probe to the tumor and in accurately positioning the tip of the

cryo-probe in the optimal position within the tumor.

Moreover, the ultrasound probe may need to be manipulated into

different positions relative to the cryo-probe to assist the surgeon in determining

the position of the cryo-probe relative to the tumor. This increases the complexity,

difficulty and duration of the operation since the surgeon may have to manipulate

the cryo-probe with one hand and the ultrasound probe with the other hand while

observing the ultrasound image on the ultrasound device display.

Additionally, the size of the incision made in the abdominal wall for such

open surgery increases the chance of post operative infection, requires time

consuming suturing of the incision and increases the post operative

hospitalization period. SUMMARY OF THE INVENTION

Accordingly, it is an object of the present invention to provide a system

for performing ultrasound laparoscopy cryo-surgery.

An aspect of the present invention is that the approaching and

penetration of the target tissue by the cryo-probe is assisted by the intersection of

the image of the target with the image of a line which represents the predicted

path of the cryo-probe on the ultrasound image.

Another aspect of the present invention is that the cryo-probe is inserted

into a suitable guide channel in the laparoscopy probe such that the cryo-probe is

placed in the image plane of the ultrasound scanner as it's tip approaches the

target tissue

There is thus provided, in accordance with a preferred embodiment of

the present invention, a system for performing ultrasound laparoscopic

cryo-surgery. The system includes an ultrasound laparoscopy system including a

laparoscopy ultrasound probe for providing an ultrasound image, a control unit

connected to the laparoscopy probe and a display connected to the control unit

for displaying an ultrasound image. The system also includes a cryo-probe

system including a cooling device and a cryo-probe attached to the cooling

device. The cryo-probe is insertable into a guide channel within the laparoscopy

probe and is movable therealong for penetrating and freezing a target tissue.

Further, in accordance with another preferred embodiment of the

present invention, the control unit further includes means for calculating and for displaying a line on the display. The line represents the predicted path line of the

cryo-probe as it is moved towards the target tissue.

Further still, in accordance with yet another preferred embodiment of

the present invention, The laparoscopy probe includes a handle for manipulating

the laparoscopy probe. The laparoscopy probe further includes an elongated

scanner probe attached to the handle and having an ultrasound scanner attached

to one end thereof. The laparoscopy probe also includes a guide sleeve attached

to the handle. The guide sleeve includes a guide channel and a scanner channel

therewithin for receiving the cryo-probe and the scanner probe, respectively.

Furthermore, in accordance with another preferred embodiment of the

present invention, the cryo-probe is inserted within the guide channel for ensuring

that the tip of the cryo-probe is placed in the image plane of the ultrasound

scanner as the tip of the cryo-probe approaches the target tissue and for

visualizing the path of the tip of the cryo-probe in the ultrasound image as the tip

approaches and penetrates the target tissue.

Furthermore, in accordance with another preferred embodiment of the

present invention, the guide channel includes a hollow conduit passing within the

guide sleeve. The guide channel has two openings, a first opening, distal from the

ultrasound scanner, and a second opening, proximal to the ultrasound scanner.

The cryo-probe is inserted into the first opening, advanced within the guide

channel and emerges from the second opening to approach and penetrate the

target tissue during the ultrasound laparoscopy cryo-surgery. Furthermore, in accordance with another preferred embodiment of the

present invention, the guide channel includes a groove formed in the guide

sleeve. The guide channel has two ends, a first end, distal from the ultrasound

scanner, and a second end, proximal to the ultrasound scanner. The cryo-probe

is inserted into the first end, advanced along the guide channel and emerges from

the second end to approach and penetrate the target tissue during the ultrasound

laparoscopy cryo-surgery.

Furthermore, in accordance with another preferred embodiment of the

present invention, the guide channel further includes at least one retainer

attached to the laparoscopy probe for retaining the cryo-probe within the groove

as the cryo-probe is advanced therealong.

Furthermore, in accordance with another preferred embodiment of the

present invention, the laparoscopy probe is moved during the ultrasound

laparoscopy cryo-surgery so as to place the image of the target tissue on the path

line.

Furthermore, in accordance with another preferred embodiment of the

present invention, the freezing of the target tissue by the cryo-probe is monitored

on the ultrasound image displayed by the display.

There is also provided, in accordance with a preferred embodiment of

the present invention, An ultrasound laparoscopy probe connectable to a system

for performing ultrasound laparoscopic cryo-surgery. The laparoscopy probe

includes a handle for manipulating the laparoscopy probe. The laparoscopy probe

further includes an elongated scanner probe attached to the handle and having an ultrasound scanner attached to one end thereof. The laparoscopy probe also

includes a guide sleeve attached to the handle. The guide sleeve includes a guide

channel and a scanner channel therewithin for receiving the cryo-probe and the

scanner probe, respectively.

Furthermore, in accordance with another preferred embodiment of the

present invention, the guide channel includes a conduit enclosed within the guide

sleeve. The conduit has two openings, a first opening, distal from the ultrasound

scanner for inserting the cryo-probe therein, and a second opening, proximal to

the ultrasound scanner.

Further still, in accordance with another preferred embodiment of the

present invention, the guide channel includes a groove within the elongated

member. The guide channel has two ends, a first end, distal from the ultrasound

scanner, for inserting the cryo-probe therein, and a second end, proximal to the

ultrasound scanner, for providing an exit point to the cryo-probe.

Furthermore, in accordance with another preferred embodiment of the

present invention, the guide channel further includes at least one retainer

attached to the guide sleeve for retaining the cryo-probe within the groove as the

cryo-probe is advanced therealong.

Further, in accordance with yet another preferred embodiment of the

present invention, the guide channel further includes at least one retainer

cryo-probe is advanced therealong. Further, in accordance with still another preferred embodiment of the

present invention, the scanner channel and the guide channel are interconnected

within the sleeve guide.

Furthermore, in accordance with yet another preferred embodiment of

the present invention, the guide sleeve is a detachable guide sleeve.

Further still, in accordance with yet another preferred embodiment of the

present invention, the guide sleeve includes means for aligning the guide sleeve

in a predetermined position relative to the ultrasound scanner for placing the tip of

the cryo-probe within the image plane of the ultrasound scanner as the tip

approaches the target tissue to visualize the path of the tip of the cryo-probe in

the ultrasound image as it approaches and penetrates the target tissue.

Finally, in accordance with another preferred embodiment of the present

invention, the ultrasound scanner is a forward looking ultrasound scanner.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is herein described, by way of example only, with

reference to the accompanying drawings, wherein:

Fig. 1 is a schematic view illustrating a laparoscopy ultrasound probe

system including a surgical cryo-probe, in accordance with a preferred

embodiment of the present invention;

Fig. 2 is a schematic longitudinal cross- section of the laparoscopy

probe of the laparoscopy ultrasound probe system of Fig. 1 ;

Fig. 3 is a schematic cross section of the guide sleeve of the

laparoscopy probe of Fig. 2 taken along the lines marked III - III;

Fig. 4 is a schematic longitudinal cross section view of part of a

laparoscopy probe having a guide sleeve with a groove shaped guide channel

therein, in accordance with another preferred embodiment of the present

invention;

Fig. 5A is a schematic cross section of the guide sleeve of the

laparoscopy probe of Fig. 4 taken along the lines marked V - V;

Fig. 5B is a transverse cross section of part of a laparoscopy probe (

not Shown) having a guide sleeve with two interconnected channels

accommodating the scanner member and a cryo-probe therein, in accordance

with still another preferred embodiment of the present invention;

Figs. 6A - 9A are schematic views illustrating different steps of a

preferred embodiment of the laparoscopic cryo- surgery method of the present invention and the positions of the laparoscopy probe and the cryo-probe of the

present invention relative to the target tissue, during these steps; and

Figs. 6B - 9B are schematic views illustrating the images displayed on

the display of the ultrasound system during the steps illustrated in Figs. 6A - 9A,

respectively.

DETAILED DESCRIPTION OF THE INVENTION

Reference is now made to Fig. 1 which is a schematic view illustrating a

laparoscopic ultrasound probe system including a surgical cryo-probe, in

accordance with a preferred embodiment of the present invention. The system 2

includes a laparoscopy system 3 and a cryo-probe system 4. The cryo-probe

system 4 includes a thin cryo-probe 14 suitably connected to a cryo-probe

cooling device 20 and a controller device 24 which controls the cooling device 20 .

The controller device 24 of Fig. 1 is a foot switch, but it can be any other suitable

device for controlling the cooling device 20. By using the controller device 24, the

surgeon can control the cooling of the tip 15 of the cryo-probe 14.

The laparoscopy system 3 includes a laparoscopy probe 12 suitably

connected to a control unit 8 and to a display 6 for generating and displaying an

ultrasound image. The laparoscopy probe 12 includes a handle 18 attached to an

elongated guide sleeve 16. Reference is now made to Fig. 2 which is a

schematic longitudinal cross-section of the laparoscopy ultrasound probe of Fig.

1. The laparoscopy probe 12 includes a scanner member 27 passing through a

scanner channel 28 within the guide sleeve 16. The scanner member 27 is

attached to the handle 18 at one end. The scanner member 27 has an ultrasound

scanner 22 attached to its second end distal from the handle 18. The ultrasound

scanner 22 performs forward looking imaging for providing an ultrasound image of

the organs or tissues positioned in front of the ultrasound scanner 22. It is noted that for a better understanding, like components are

designated by like reference numerals throughout the various figures.

Further, reference is now made to Fig. 2 which is a schematic

longitudinal cross- section of the laparoscopy probe 12 of Fig. 1. The guide

sleeve 16 also includes a hollow guide channel 26 passing therethrough and

having two open ends 17 and 19. The cryo-probe 14 can be positioned within the

guide channel 26 and can be moved therealong. The tip 15 of the cryo-probe 14

can be retained within the guide channel 26 or can be advanced along the guide

channel 26 such that it protrudes out of the open end 19 of the guide channel 26

while moving parallel to the longitudinal axis of the scanner member 27 (axis not

shown). The ultrasound scanner 22 is connected to the control unit 8 by suitable

connecting wires (not shown for the sake of clarity of illustration) passing through

the scanner member 27, for powering the ultrasonic scanner 22 and for providing

output and control signals to the control unit 8 and the handle 18. The guide

channel 26 ensures that the cryo-probe is placed in the image plane of the

ultrasound scanner as it approaches the target tissue and can therefore be

visualized to confirm a correct path to the target tissue.

In accordance with a preferred embodiment of the present invention, the

guide channel 26 is a longitudinal cavity enclosed within the guide sleeve 16 as

best seen in Fig. 3, to which reference is now made. Fig. 3 is a schematic cross

section of the guide sleeve 16 of Fig. 2 taken along the lines marked III - III.

Reference is now made to Figs. 4 and 5A and 5B. Fig. 4 is a schematic

longitudinal cross section view of part of a laparoscopy probe having a groove shaped guide channel, in accordance with another preferred embodiment of the

present invention. Fig. 5A is a schematic cross section of the guide sleeve 36 of

Fig. 4 taken along the lines marked V - V. Fig. 5B is a transverse cross section

of part of a laparoscopy probe (not Shown) having a guide sleeve with a single

channel accommodating the scanner member 27 and the cryo-probe 14 therein,

in accordance with still another preferred embodiment of the present invention.

The guide sleeve 36 of Fig. 4 is similar to the guide sleeve 16 of Fig. 2

except that instead of the guide channel 26 of Fig. 2 it includes a guide channel

34 which is shaped as an open groove formed within the guide sleeve 36 as best

seen in Fig. 5A.

The cryo-probe 14 is inserted within the guide channel 34 and can be

kept within it by suitable hooks (not shown) or by other suitable retainers (not

shown) attached to the scanner member 36 and positioned for retaining the

cryo-probe 14 within the guide channel 34. The cryo-probe 14 can be moved

within the guide channel 34 as disclosed hereinabove.

Turning to Fig 5B, the guide sleeve 46 includes therein a scanner

channel 29 and a guide channel 47. The guide channel 47 and the scanner

channel 29 are interconnected as best seen in Fig. 5B. The scanner member 27

passes through the scanner channel 29 and the cryo-probe 14 is inserted and

advanced into the guide channel 47 as disclosed hereinabove for the guide

sleeves 16 and 36.

It is noted that while the sleeve guides 16, 36 and 46 of Figs . 3, 5A and

5B, respectively, are affixed to the handle 18, in accordance with other preferred embodiments of the present invention, the sleeve guides can be detachably

attached to the handle 18 for enabling cleaning and sterilization of the sleeve

guide.

Additionally, in accordance with another preferred embodiment of the

present invention, the detachable sleeve guide includes one or more alignment

devices so that upon being attached to the handle 18 the detachable guide sleeve

is aligned in a predetermined position relative to the ultrasound scanner 22 such

that the tip 15 of the cryo-probe 14 will be positioned within the imaging plane of

the ultrasound scanner 22 when the cryo-probe 14 is inserted within the guide

channel 26 and the tip 15 approaches the target tissue. For example, the

detachable sleeve guide may include one or more aligning pins (not shown) which

are insertable into matching depressions (not shown) on the handle 18 to suitably

orient the cryo-probe 14 within the image plane of the ultrasound scanner 22.

Alternatively, the alignment devices can be one or more aligning screws

(not shown) which are inserted into suitable aligning holes (not shown) formed

within the guide sleeve and the handle 18, or any other suitable alignment

devices.

In accordance with an exemplary preferred embodiment of the present

invention, the cryo-probe system 4 can be the CRYOcare K2, 2-Probe

cryosurgical system (part number CRYO-22) equipped with a cryo-probe such as

part number CRYO-40 having an external diameter of 3 mm, Commercially

available from ENDOCARE Incorporated, CA, U.S.A. The laparoscopy system 3

can be the SHARPLAN U-SIGHT imaging system commercially available from Laser Industries Ltd. Israel or from Sharplan Laser Inc., NJ, U.S.A., including the

model 9511 laparoscopy biopsy guide for laparoscopic probe model LP-8, with a

guide channel internal diameter modified to accept the CRYO-40 cryo-probe.

Reference is now made to Figs. 6A - 9A and 6B - 9B. Figs. 6A - 9A are

schematic views illustrating different steps of a preferred embodiment of the

laparoscopic cryo- surgery method of the present invention and the positions of

the laparoscopy probe and the cryo-probe of the present invention relative to the

target tissue, during these steps. Figs. 6B - 9B are schematic views illustrating

the images displayed on the display of the ultrasound system during the steps

illustrated in Figs. 6A - 9A, respectively.

In accordance with an exemplary preferred embodiment of the present

invention, the surgeon starts by making a small incision in the abdominal wall of

the patient using standard surgical methods. The surgeon inserts the end of the

laparoscopy probe 12 to which the ultrasound scanner 22 is attached into the

abdominal cavity of the patient and activates the ultrasound scanner 22 to

generate an ultrasound image. The surgeon then manipulates the laparoscopy

probe 12 until he identifies the image 40A (Fig. 6B) of the target tissue 40 (Fig.

6A) in the ultrasound image 39A presented on the display 6 (Fig. 6). The surgeon

enables a display of a path line 41 B on the ultrasound image 39B (Fig 7B) on the

display 6 of the SHARPLAN U-SIGHT system, indicating the predicted path of the

cryo- probe 14 of Fig 7A (cryo-probe not shown). The surgeon moves the

laparoscopy probe 12 until the predicted path 41 C on the ultrasound image 39C

(Fig. 8B) intersects the image 40C of the target tissue 40 (Fig. 8A). The surgeon inserts the cryo-probe 14 (Fig. 9A) into the guide channel 26 (not shown) of the

guide sleeve 16 through the opening 17 and advances the cryo-probe 14 until it

exits out of opening 19 and advances towards the target tissue 40.

The surgeon observes the progression of the image (not shown) of the

cryo-probe 14 along the predicted path line 41 C on the ultrasound image 39D as

the cryo-probe 14 penetrates into the target tissue 40 (Fig. 9A).

After the cryo- probe 14 has penetrated the target tissue 40, the surgeon

activates ths cryo-probe cooling device 20 by using the controller device 24. The

cooling device 20 cools the tip 15 of the cryo-probe 14 so that the target tissue 40

is frozen without causing excessive damage to the tissue surrounding the target

tissue 40. The surgeon monitors the freezing of the target tissue on the display 6.

The surgeon then stops the cooling device 20 from cooling the tip 15 of the

cryo-probe 14 or by heating the tip 15 of the cryo-probe 14, by using the controller

device 24. After the target tissue 40 partially or completely thaws, the surgeon

retracts the cryo-probe 14 into the opening 19, withdraws the guide sleeve 16 of

the laparoscopy probe 12 out of the abdominal cavity of the patient and treats the

incision using conventional post- laparoscopy methods.

It is noted that, in contrast to open cryo-surgery using an external

ultrasound probe and to surgery using a laparoscopic probe and a separate

cryo-probe, the surgeon in the system of the present invention, uses only one

hand for manipulating the laparoscopy probe 12, and that after the laparoscopy

probe 12 is properly positioned the surgeon can advance the cryo-probe with the

same hand that holds the laparoscopy probe 12. This facilitates the surgeon's work, eliminates the requirement of manually coordinating the movements of both

cryo-probe and ultrasound probe encountered during ultrasound assisted open

cryo-surgery, ensures quick directing of the cryo-probe to the target tissue and

facilitates the penetration of the target tissue by providing the surgeon with the

predicted path line of the cryo-probe 14.

Additionally, the method and system disclosed hereinabove have the

advantage of allowing the surgeon to perform ultrasound laparoscopy assisted

cryo-surgery for selective freezing of tumors or other types of target tissues within

organs which cannot be visualized using optical laparoscopy devices, thus

obviating the need for performing open surgery and significantly reducing the

chances of infection, shortening surgery duration, and leading to shorter

post-operative hospitalization periods.

It is noted that while the present invention is disclosed as being

performed on humans, it can be adapted for use with animals.

It will be appreciated by those skilled in the art that, while the system

and method of the present invention were disclosed as adapted to performing

abdominal laparoscopy and cryo-surgery, other preferred embodiments of the

present invention may be adapted for performing other types of ultrasound

endoscopy assisted cryo-surgery which are included within the scope of the

present invention.

While the invention has been described with respect to a limited number

of embodiments, it will be appreciated that many variations, modifications and

other applications of the invention may be made.

Claims

1. A system for performing ultrasound laparoscopic cryo-surgery

comprising:

an ultrasound laparoscopy system including a laparoscopy

ultrasound probe for providing an ultrasound image, a control unit

connected to said laparoscopy probe and a display connected to said

control unit for displaying said ultrasound image; and

a cryo-probe system including a cooling device and a cryo-probe

attached to said cooling device, said cryo-probe being insertable into

said laparoscopy probe and movable therealong for penetrating and

freezing a target tissue.

2. The system according to claim 1 wherein said control unit further includes

means for calculating and for displaying a line on said ultrasound image

presented on said display, said line representing the predicted path line

of said cryo-probe as it is moved towards said target tissue.

3. The system according to claim 1 wherein said laparoscopy probe

comprises:

a handle for manipulating said laparoscopy probe;

an elongated scanner probe attached to said handle, said scanner

probe including an ultrasound scanner attached to one end thereof;

and a guide sleeve attached to said handle and having a guide

channel and a scanner channel therewithin for receiving said

cryo-probe and said scanner probe, respectively.

4. The system according to claim 3 wherein said cryo-probe is inserted

within said guide channel for ensuring that the tip of said cryo-probe is

placed in the image plane of said ultrasound scanner as said tip

approaches said target tissue and for visualizing the path of said tip of

said cryo-probe in said ultrasound image as said tip approaches and

penetrates said target tissue.

5. The system according to claim 3 wherein said guide channel comprises a

hollow conduit passing within said guide sleeve, said guide channel

having two openings, a first opening, distal from said ultrasound scanner,

and a second opening, proximal to said ultrasound scanner, and wherein

said cryo-probe is inserted into said first opening, advanced within said

guide channel and emerges from said second opening to approach and

penetrate said target tissue during said ultrasound laparoscopy

cryo-surgery.

6. The system according to claim 3 wherein said guide channel comprises a

groove formed in said guide sleeve, said guide channel having two ends,

a first end, distal from said ultrasound scanner, and a second end,

proximal to said ultrasound scanner and wherein said cryo-probe is

inserted into said first end, advanced along said guide channel and emerges from said second end to approach and penetrate said target

tissue during said ultrasound laparoscopy cryo-surgery.

7. The system according to claim 3 wherein said guide channel further

comprises at least one retainer attached to said guide sleeve for retaining

said cryo-probe within said guide channel as said cryo-probe is advanced

therealong.

8. The system according to claim 2 wherein said laparoscopy probe is

moved during said ultrasound laparoscopy cryo-surgery so as to place

the image of said target tissue on said path line.

9. The system according to claim 2 wherein the freezing of said target

tissue by said cryo-probe is monitored on said ultrasound image

displayed by said display.

10. The system according to claim 3 wherein said ultrasound scanner is a

forward looking ultrasound scanner.

11. The system according to claim 3 wherein said scanner channel and said

guide channel are interconnected within said guide sleeve.

12. The system according to claim 3 wherein said guide sleeve is a

detachable guide sleeve.

13. The system according to claim 3 wherein said guide sleeve includes

means for aligning said guide sleeve in a predetermined position relative to said ultrasound scanner for placing the tip of said cryo-probe within the

image plane of said ultrasound scanner as said tip approaches said

target tissue to visualize the path of said tip of said cryo-probe in said

ultrasound image as it approaches and penetrates said target tissue.

14. An ultrasound laparoscopy probe connectable to a system for performing

ultrasound laparoscopic cryo-surgery, the laparoscopy probe comprising:

a handle for manipulating said laparoscopy probe;

an elongated scanner probe attached to said handle, said scanner

probe including an ultrasound scanner attached to one end thereof

for providing an ultrasound image of a tissue; and

a guide sleeve attached to said handle and having a scanner

channel and a guide channel therewithin for receiving said scanner

probe and a cryo-probe, respectively, said cryo-probe being

insertable into said guide channel and moveable therealong for

penetrating and freezing a target tissue;

15. The ultrasound laparoscopy probe according to claim 14 wherein said

scanner channel and said guide channel are interconnected within said

guide sleeve.

16. The ultrasound laparoscopy probe according to claim 14 wherein said

guide channel comprises a conduit enclosed within said guide sleeve,

said conduit having two openings, a first opening, distal from said ultrasound scanner for inserting said cryo-probe therein, and a second

opening, proximal to said ultrasound scanner.

17. The ultrasound laparoscopy probe according to claim 14 wherein said

guide channel comprises a groove within said guide sleeve, said guide

channel having two ends, a first end, distal from said ultrasound scanner,

for inserting said cryo-probe, and a second end, proximal to said

ultrasound scanner, for providing an exit point to the tip of said

cryo-probe.

18. The ultrasound laparoscopy probe according to claim 14 wherein said

ultrasound scanner is a forward looking ultrasound scanner.

19. The ultrasound laparoscopy probe according to claim 14 wherein said

guide sleeve includes means for aligning said guide sleeve in a

predetermined position relative to said ultrasound scanner for placing the

tip of said cryo-probe within the image plane of said ultrasound scanner

as said tip approaches said target tissue to visualize the path of said tip

of said cryo-probe in said ultrasound image as it approaches and

penetrates said target tissue.