User control of a medical laser system

Abstract

Systems, devices, and methods for direct user control of a medical laser system to provide adjustable laser treatment to a target without shutting off laser emissions during a medical laser procedure are described. An exemplary medical laser system comprises a laser system to emit laser pulses via an optical fiber to an anatomical target of a patient, an actuator operable by a user to spontaneously activate or adjust laser system operation, and a controller circuit to provide a feedback to the user about the spontaneous activation or adjustment of the laser system operation. The controller circuit may generate a control signal to cause the laser system to emit laser pulses in accordance with the spontaneous activation or adjustment of the operation of the laser system.

Description

USER CONTROL OF A MEDICAL LASER SYSTEMPRIORITY CLAIM

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 63 / 674,408, filed luly 23, 2024, the contents of which are hereby incorporated by reference.TECHNICAL FIELD

[0002] This document relates generally to medical laser systems, and more specifically relates to spontaneous user control of a laser system to provide adjustable laser treatment to a patient.BACKGROUND

[0003] Endoscopes are typically used to provide access to an internal location of a patient so that a doctor is provided with visual access. Some endoscopes are used in minimally invasive surgery to remove unwanted tissue or foreign objects from the body of the patient. For example, a nephroscope is used by a clinician to inspect the renal system, and to perform various procedures under direct visual control. In a percutaneous nephrolithotomy (PCNL) procedure, a nephroscope is placed through the patient’s flank into the renal pelvis. Calculi or mass from various regions of a body including, for example, urinary system, gallbladder, nasal passages, gastrointestinal tract, stomach, or tonsils, can be visualized and extracted.

[0004] Laser or plasma systems have been used for delivering surgical laser energy to various target treatment areas such as soft or hard tissue. Examples of the laser therapy include ablation, coagulation, vaporization, fragmentation, etc. In lithotripsy applications, laser has been used to break down calculi structures in kidney, gallbladder, ureter, among other stone-forming regions, or to ablate large calculi into smaller fragments. In endoscopic laser therapy, it is desirable that lasers be applied only to target treatment structures (e.g., calculi or cancerous tissue), and spare non-treatment tissue from unintended laser irradiation.SUMMARY

[0005] Medical laser systems generally allow an operator (e.g., a physician) to preset a desired laser output setting (e.g., energy or intensity levels or other laser irradiation parameters) prior to the procedure. The treatment target may contain different compositions or materials, and / or the environmental conditions in the vicinity of the treatment target may change during the procedure, both of which may require a responsive, “on the fly” adjustment of laser output setting to provide appropriate laser treatment while maintaining tissue safety. Conventionally, such “on the fly” adjustment of laser out setting generally requires temporarily shutting off the ongoing laser emission, adjusting the laser output setting (e.g., increasing or decreasing laser output power level, or values of other irradiation parameters), then switching on laser emission again. Sometimes, the operator (e.g., a physician) may be required to ask for a new laser operating mode or a new output setting from the circulating nurse during the procedure when treating different target structures or different portions of a target structure (e.g., different compositions of a calculi target). Shutting off laser emissions, even for a short period of time during the procedure, may reduce laser therapy efficacy and extend procedure time, particularly when multiple or frequent therapy adjustments are desired to treat complex targets.

[0006] The present document describes systems, devices, and methods for direct user control of a medical laser system to provide adjustable laser treatment to a target structure in a patient without the requirement of shutting off ongoing laser emissions during a medical laser procedure. The direct user control allows more convenient and efficient spontaneous adjustment of laser system operation parameters, or other system functionalities such as optical fiber positioning, irrigation and aspiration of target site, etc. An exemplary medical laser system comprises a laser system to emit laser pulses via an optical fiber to an anatomical target of a patient, and an actuator operable by a user to spontaneously activate or adjust laser system operation (e.g., a laser output setting or a laser treatment mode, among other system functionalities. The actuator may include, for example, one or more foot pedals depressible by theuser in various foot press patterns to trigger respective different laser treatment modes or laser output settings. A controller circuit of the medical laser system can provide a feedback to the user about the spontaneous activation or adjustment of the laser system operation, and generate a control signal to cause the laser system to emit laser pulses or fulfill other functionalities in accordance with the user’s spontaneous activation or adjustment of the operation of the laser system.

[0007] Example 1 is a medical laser system. The system comprises: a laser system configured to emit laser pulses via an optical fiber to an anatomical target of a patient; an actuator operable by a user to actuate spontaneous activation or adjustment of an operation of the laser system during a medical procedure without shutting off laser emissions from the laser system; and a controller circuit configured to: provide a feedback to the user about the spontaneous activation or adjustment of the operation of the laser system; and generate a control signal to cause the laser system to emit laser pulses in accordance with the spontaneous activation or adjustment of the operation of the laser system.

[0008] In Example 2, the subject matter of Example 1 optionally includes, wherein to actuate spontaneous activation or adjustment of the operation of the laser system includes to adjust one or more of a laser treatment mode or a laser output setting, or to select from a plurality of predetermined laser treatment modes or laser output settings, during the medical procedure without shutting off laser emissions.

[0009] In Example 3, the subject matter of any one or more of Examples 1-2 optionally include the actuator that can include at least one foot pedal comprising a frame and a lever pivotally mounted on the frame via a coupling member, the lever configured to be depressible to variable depths to produce the spontaneous activation or adjustment of the operation of the laser system.

[0010] In Example 4, the subject matter of Example 3 optionally includes the lever that can be configured to be depressible to one or more of a plurality of preset depth positions corresponding to respective distinct laser treatment modes or laser output settings.

[0011] In Example 5, the subject matter of Example 4 optionally includes the at least one foot pedal that comprises one or more actuation switches configured to be triggered when the lever reaches one of the plurality of preset depth positions, wherein the controller circuit is electrically coupled to the one or more actuation switches and configured to generate the control signal to cause the laser system to emit laser pulses in accordance with a laser treatment mode or laser output setting corresponding to the one of the plurality of preset depth positions reached by the lever.

[0012] In Example 6, the subject matter of any one or more of Examples 4-5 optionally includes the at least one foot pedal that comprises at least one releasable locking member configured to: lock the lever at one or more of the plurality of preset depth positions, thereby preventing pivotal movement relative to the frame; and unlock the lever from the one or more of the plurality of preset depth positions, thereby enabling pivotal movement relative to the frame.

[0013] In Example 7, the subject matter of Example 6 optionally includes the controller circuit that can be configured to generate a user perceivable feedback indicating the lever is locked at or unlocked from the one or more of the plurality of preset depth positions.

[0014] In Example 8, the subject matter of any one or more of Examples 3-7 optionally include the at least one foot pedal that can be depressible to produce the spontaneous activation or adjustment of the operation of the laser system based at least in part on a press-and-hold time of the lever being depressed and held at a depth position.

[0015] In Example 9, the subject matter of any one or more of Examples 3-8 optionally includes the at least one foot pedal that can be depressible to produce the spontaneous activation or adjustment of the operation of the laser system based at least in part on a foot press pattern of the lever being repeatably depressed.

[0016] In Example 10, the subject matter of any one or more of Examples 3-9 optionally includes the at least one foot pedal that can be forward and backward depressible to produce the spontaneous activation or adjustment of the operation of the laser system based at least in part on an ordered combination of forward and back presses.

[0017] In Example 11, the subject matter of any one or more of Examples 3-10 optionally includes the actuator that can include: a first foot pedal depressible to activate or select a laser treatment mode; and a second foot pedal depressible to change or select a laser output setting.

[0018] In Example 12, the subject matter of Example 11 optionally includes a third foot pedal, wherein the second foot pedal can be repeatably depressible to incrementally increase a value of a laser irradiation parameter, wherein the third foot pedal is repeatably depressible to incrementally decrease the value of the laser irradiation parameter.

[0019] In Example 13, the subject matter of Example 12 optionally includes the second foot pedal and the third foot pedal that differ in one or more characteristics including size, shape, color, or appearance.

[0020] In Example 14, the subject matter of any one or more of Examples 11-13 optionally includes a third foot pedal, wherein the first foot pedal is depressible to activate or select a first laser treatment mode, wherein the third foot pedal is depressible to activate or select a second laser treatment mode different from the first laser treatment mode, wherein the second foot pedal is repeatably depressible to cycle through and make a selection from a plurality of predetermined laser output settings.

[0021] In Example 15, the subject matter of any one or more of Examples 1-14 optionally includes the actuator that can be detachably affixable on a surface, the actuator configured to be communicatively coupled to and controllable by a mobile electronic device operable by the user to actuate the spontaneous activation or adjustment of the operation of the laser system.

[0022] In Example 16, the subject matter of any one or more of Examples 1-15 optionally includes the actuator that can include or be coupled to a motion detector configured to detect a user-activated motion or displacement of the optical fiber relative to the anatomical target during the medical procedure, and to trigger the spontaneous activation or adjustment of the operation of the laser system based on the detected optical fiber motion or displacement.

[0023] In Example 17, the subject matter of Example 16 optionally includes the user-activated motion or displacement of the optical fiber that caninclude a movement pattern represented by an ordered combination of forward motion and backward motion of the optical fiber, wherein the actuator is operable by a user to actuate the spontaneous activation or adjustment of the operation of the laser system in accordance with the movement pattern of the optical fiber.

[0024] In Example 18, the subject matter of any one or more of Examples 16-17 optionally includes the motion detector that can be configured to receive, from an imaging sensor, images of at least a portion of the optical fiber during the medical procedure, and to detect the motion or displacement of the optical fiber using the received images.

[0025] In Example 19, the subject matter of any one or more of Examples 16-18 optionally includes the motion detector that can be configured to detect a change in an electrical or magnetic property of a portion of the optical fiber correlated to optical fiber motion, and to detect the motion or displacement of the optical fiber based at least in part on the detected change in the electrical or magnetic property.

[0026] In Example 20, the subject matter of any one or more of Examples 16-19 optionally includes the motion detector that can be configured to detect the user-activated motion or displacement of the optical fiber by detecting a user-activated tapping of a distal tip of the optical fiber on the anatomical target, and to trigger the spontaneous activation or adjustment of the operation of the laser system based on the detected tapping.

[0027] Example 21 is a method of providing adjustable laser treatment to an anatomical target. The method comprises steps of: providing a laser system to emit laser pulses via an optical fiber to the anatomical target; via an actuator, spontaneously activating or adjusting an operation of the laser system during a medical procedure without shutting off laser emissions; providing a feedback to a user about the spontaneous activation or adjustment of the operation of the laser system; and emitting laser pulses from the laser system in accordance with the spontaneous activation or adjustment of the operation of the laser system.

[0028] In Example 22, the subject matter of Example 21 optionally includes spontaneously activating or adjusting the operation of the laser system includes adjusting one or more of a laser treatment mode or a laser outputsetting, or selecting from a plurality of predetermined laser treatment modes or laser output settings, during the medical procedure without shutting off laser emissions.

[0029] In Example 23, the subject matter of any one or more of Examples 21-22 optionally includes the actuator that can include at least one foot pedal comprising a lever pivotally mounted on a frame via a coupling member, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on the lever being depressed to variable depths, the variable depths including a plurality of preset depth positions corresponding to respective distinct laser treatment modes or laser output settings.

[0030] In Example 24, the subject matter of Example 23 optionally includes, via at least one releasable locking member on the at least one foot pedal: locking the lever at one or more of the plurality of preset depth positions, thereby preventing pivotal movement relative to the frame; and unlocking the lever from the one or more of the plurality of preset depth positions, thereby enabling pivotal movement relative to the frame.

[0031] In Example 25, the subject matter of any one or more of Examples 23-24 optionally includes spontaneously activating or adjusting the operation of the laser system based at least in part on a press-and-hold time of the lever being depressed and held at a depth position.

[0032] In Example 26, the subject matter of any one or more of Examples 23-25 optionally includes spontaneously activating or adjusting the operation of the laser system based at least in part on a foot press pattern of the lever being repeatably depressed.

[0033] In Example 27, the subject matter of any one or more of Examples 23-26 optionally includes the at least one foot pedal forward and backward depressible, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on an ordered combination of forward and back presses.

[0034] In Example 28, the subject matter of any one or more of Examples 23-27 optionally includes the at least one foot pedal that can include first and second foot pedals, wherein spontaneously activating or adjusting the operation of the laser system includes activating or selecting a laser treatmentmode by depressing the first foot pedal, and changing or selecting a laser output setting by depressing the second foot pedal.

[0035] In Example 29, the subject matter of Example 28 optionally includes changing or selecting the laser output setting, which can include incrementally increasing a value of a laser irradiation parameter by repeatedly depressing the second foot pedal; or incrementally decreasing the value of the laser irradiation parameter by repeatedly depressing a third foot pedal separate from the second foot pedal.

[0036] In Example 30, the subject matter of any one or more of Examples 21-29 optionally includes detecting a user-activated motion or displacement of the optical fiber relative to the anatomical target during the medical procedure, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on the detected optical fiber motion or displacement.

[0037] This summary is an overview of some of the teachings of the present application and not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details about the present subject matter are found in the detailed description and appended claims. Other aspects of the disclosure will be apparent to persons skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part thereof, each of which are not to be taken in a limiting sense. The scope of the present disclosure is defined by the appended claims and their legal equivalents.BRIEF DESCRIPTION OF THE DRAWINGS

[0038] Various embodiments are illustrated by way of example in the figures of the accompanying drawings. Such embodiments are demonstrative and not intended to be exhaustive or exclusive embodiments of the present subject matter.

[0039] FIG. l is a block diagram illustrating an example of a laser treatment system that provides laser treatment to a target structure.

[0040] FIG. 2 is a block diagram illustrating a medical laser system and a part of the environment in which said system may be used.

[0041] FIG. 3 illustrates an example of an endoscopic laser lithotripsy system with direct user control for spontaneous laser treatment adjustment during a procedure.

[0042] FIG. 4 illustrates an example of a unidirectional foot pedal depressible by a user to spontaneously control laser treatment.

[0043] FIG. 5 illustrates an example of a bidirectional foot pedal depressible by a user to spontaneously control laser treatment.

[0044] FIG. 6 illustrates an example of a muti-petal system operable by a user to spontaneously control laser treatment.

[0045] FIG. 7 is a flowchart illustrating an example method of providing laser treatment to an anatomical target using a medical laser system with direct user control for spontaneous laser treatment adjustment.

[0046] FIG. 8 is a block diagram illustrating an example machine upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform.DETAILED DESCRIPTION

[0047] Described herein are systems, devices, and methods for direct user control of a medical laser system to provide adjustable laser treatment to a target without shutting off laser emissions during a medical laser procedure. An exemplary medical laser system comprises a laser system to emit laser pulses via an optical fiber to an anatomical target of a patient, an actuator operable by a user to spontaneously activate or adjust laser system operation, and a controller circuit to provide a feedback to the user about the spontaneous activation or adjustment of the laser system operation. The controller circuit may generate a control signal to cause the laser system to emit laser pulses in accordance with the user’s spontaneous activation or adjustment of the operation of the laser system.

[0048] Various embodiments discussed herein provide efficient user control of a medical laser system without shutting off laser emissions during a medical laser procedure. Features described herein may be used in regard to an endoscope, laser surgery, laser lithotripsy, laser settings, and / or spectroscopy. Examples of targets and applications may include laser lithotripsy of renalcalculi and laser incision or vaporization of soft tissue. In an example of endoscopic system that incorporate the features as described herein, characteristics of tissue or calculi targets (such as types or compositions) may be identified and monitored in vivo, and laser output setting and optionally other functionalities of the medical laser system may be adjusted through direct user control without shutting off laser emissions. This may improve laser therapy efficacy and procedure success rate, reduce total procedure time, and enhance tissue safety.

[0049] FIG. l is a block diagram illustrating an example of a laser treatment system 100 configured to provide laser treatment to a target structure 122 in a body of a subject, such as anatomical structure (e.g., soft tissue, hard tissue, or abnormal such as cancerous tissue) or calculus structure (e.g., kidney or pancreobiliary or gallbladder stone). The laser treatment system 100 may include a laser feedback control system 101 and at least one laser system 102. The laser feedback control system 101 may be configured to receive a signal from the target in response to electromagnetic radiation produced by a light source, generate one or more spectroscopic properties using the reflected signal from the target, identify the target as one of a plurality of structure types with respective distinct compositions (e.g., a calculus type or an tissue type), and determine an operating mode of the laser system based on the identified structure type. The laser feedback control system 101 may be used in various applications, such as industrial and / or medical applications for treatment of soft (e.g., noncalcified) or hard (e.g., calcified) tissue, or calculi structures such as kidney or pancreobiliary or gallbladder stones. In some examples, the laser treatment system 100 may deliver precisely controlled therapeutic treatment of tissue or other anatomical structures (e.g., tissue ablation, coagulation, vaporization, or the like) or treatment of non-anatomical structures (e.g., ablation or dusting of calculi structures).

[0050] The laser feedback control system 101 may be in operative communication with one or more laser systems. FIG. 1 shows the laser feedback system connected to a first laser system 102 and optionally (shown in dotted lines) to a second laser system 104. Additional laser systems are contemplated within the scope of the present disclosure. The first laser system 102 mayinclude a first laser source 106, and associated components such as power supply, display, cooling systems and the like. The first laser system 102 may also include a first optical pathway 108 operatively coupled with the first laser source 106. In an example, the first optical pathway 108 includes an optical fiber. The first optical pathway 108 may be configured to transmit laser beams from the first laser source 106 to the target structure 122.

[0051] The laser feedback control system 101 may analyze feedback signals 130 from the target structure 122, and control the first laser system 102 and / or the second laser system 104 to generate suitable laser outputs for providing a desired therapeutic effect. For instance, the laser feedback control system 101 may monitor properties of the target structure 122 during a therapeutic procedure (e.g., ablating calculi such as kidney stones into smaller fragments) to determine if the tissue was suitably ablated prior to another therapeutic procedure (e.g., coagulation of blood vessels).

[0052] In an example, the first laser source 106 may be configured to provide a first output 110. The first output 110 may extend over a first wavelength range, such as one that corresponds to a portion of the absorption spectrum of the target structure 122. The first output 110 may provide effective ablation and / or carbonation of the target structure 122 since the first output 110 is over a wavelength range that corresponds to the absorption spectrum of the tissue.

[0053] In an example, the first laser source 106 may be configured such that the first output 110 emitted at the first wavelength range corresponds to high absorption (e.g., exceeding about 250 cm’1) of the incident first output 110 by the tissue. In example aspects, the first laser source 106 may emit first output 110 between about 1900 nanometers (nm) and about 3000 nm (e.g., corresponding to high absorption by water) and / or between about 400 nm and about 520 nm (e.g., corresponding to high absorption by oxy- hemoglobin and / or deoxy-hemoglobin). Appreciably, there are two main mechanisms of light interaction with a tissue: absorption and scattering. When the absorption of a tissue is high (absorption coefficient exceeding 250 cm’1) the first absorption mechanism dominates, and when the absorption is low (absorption coefficientless than 250 cm'1), for example lasers at 800-1100 nm wavelength range, the scattering mechanism dominates.

[0054] Various commercially available medical-grade laser systems may be suitable for the first laser source 106. For instance, semiconductor lasers such as InXGal-XN semiconductor lasers providing the first output 110 in the first wavelength range of about 515 nm and about 520 nm or between about 370 nm and about 493 nm may be used. Alternatively, infrared (IR) lasers such as those summarized in Table 1 below may be used.Table 1 Example List of suitable IR lasersLaser Wavelength Absorption Coefficient Optical Penetration DepthX (nm) (cm4) <5 (um)Thulium fiber laser: 1908 S8 / 150 114 / 67Thulium fiber laser: 1940 120 / 135 83 / 75Thulium: YAG: 2010 62 / 60 161 / 16"Holmium: YAG: 2120 24 / 24 417 / 41"Erbium:YAG: 2940 12,000 / 1,000 1 / 10

[0055] The optional second laser system 104 may include a second laser source 116 for providing a second output 120, and associated components, such as power supply, display, cooling systems and the like. The second laser system 104 may either be operatively separated from or, in the alternative, operatively coupled to the first laser source 106. In some embodiments, the second laser system 104 may include a second optical pathway 118 (separate from the first optical pathway 108) operatively coupled to the second laser source 116 for transmitting the second output 120. Alternatively, the first optical pathway 108 may be configured to transmit both the first output 110 and the second output 120.

[0056] In certain aspects, the second output 120 may extend over a second wavelength range, distinct from the first wavelength range. Accordingly, there may not be any overlap between the first wavelength range and the second wavelength range. Alternatively, the first wavelength range and the second wavelength range may have at least a partial overlap with each other. In advantageous aspects of the present disclosure, the second wavelength range may not correspond to portions of the absorption spectrum of the target structure 122 where incident radiation is strongly absorbed by tissue that has not been previously ablated or carbonized. In some such aspects, the second output 120 may advantageously not ablate uncarbonized tissue. Further, in anotherembodiment, the second output 120 may ablate carbonized tissue that has been previously ablated. In additional embodiments, the second output 120 may provide additional therapeutic effects. For instance, the second output 120 may be more suitable for coagulating tissue or blood vessels.

[0057] FIG. 2 is a block diagram illustrating a medical laser system 200 and a part of the environment in which the system 200 may operate. The system 200 can be an embodiment of the laser energy delivery system 100 for treating anatomical targets of various types, or a lithotripsy system for destructing hardened masses like kidney stones, bezoars, gallstone, among other calculi structures.

[0058] The medical laser system 200 may include one or more of a feedback control system 210, a sensor circuit 220, a laser system 230, a non- therapeutic signal source 240, a user interface 250, or a laser actuator 280. The system 200 may optionally include one or more of a fiber actuator 260 or a fiber motion / displacement detector 290. The laser system 230, which is an example of the laser system 102 or the laser system 104 shown in FIG. 1, can include a laser source, which can be an example of the first laser source 106 or the second laser source 116 as shown in FIG. 1. The laser source may generate laser pulses in accordance with a laser output setting or a laser treatment mode, each of which may be defined by one or more laser irradiation parameters with respective values. Examples of the laser irradiation parameters include intensity, power, duration, frequency, or pulse shape, exposure time, or firing angle. The laser irradiation parameters may be programmable or adjustable either automatically such as by the controller circuit 214, or manually by a user via the user interface 250. The laser pulses may be therapeutic in nature, such as for surgically removing or sampling tissue or ablating a calculi structure. Additionally or alternatively, the laser source may generate non-therapeutic laser pulses for diagnostic purposes or for distance measurement (such as a fiber-to-target distance). In some examples, the laser source may include distinct laser sources, including a first laser source (such as the first laser source 106 shown in FIG. 1) to generate the therapeutic laser pulses, and a second lase source (such as the second laser source 116 shown in FIG. 1) to generate non-therapeutic laser pulses that may be used for estimating a fiber-to-target distance.

[0059] Laser pulses generated by the laser source may be directed to the target structure 122 via an optical fiber 270, which can be an embodiment of the first optical pathway 108 or the second optical pathway 118. In an example, the optical fiber 270 is a multi-core fiber comprising a first fiber core optically coupled to the laser system 230 to direct a therapeutic laser beam to the target structure 122, and a second fiber core optically coupled to the feedback control system 210 to transmit a return signal from the target structure 122. The return signal can be generated in response to an optical or electromagnetic signal generated by the non-therapeutic signal source 240 irradiating on the target structure 122. The optical fiber 270 may be optically coupled to the non- therapeutic signal source 240 to transmit the optical or EM signal directed to the target structure 122. In some examples, the optical fiber 270 may transmit sensor data collected by one or more sensors such as located at a distal portion of the optical fiber 270.

[0060] The feedback control system 210, which is an embodiment of the feedback control system 101 shown in FIG. 1, can include a feedback analyzer 212 and a controller circuit 214. According to example embodiments, the feedback control system 210, or a part thereof (such as the feedback analyzer 212 and / or the controller circuit 214) may include processors, such as microprocessors, digital signal processors (DSPs), application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), or any other equivalent integrated or discrete logic circuitry, as well as any combinations of such components for performing one or more of the functions attributed to the feedback control system 210.

[0061] The feedback analyzer 212 may detect, localize, and identify the target structure 122 using return signal from the target structure 112 in response to an optical or EM signal irradiating thereon and / or sensor data acquired by the sensor circuit 220. In some examples, the feedback analyzer 212 may use the feedback information to determine a target characteristic, estimate a fiber-to- target distance, determine whether or not to re-position the distal end of the optical fiber 270 relative to the target structure 122, and / or to adjust a laser output setting of the laser system 230 to provide appropriate laser treatment. The sensor circuit 220 may include or be coupled to one or more sensors, including,for example, an imaging sensor such as a CCD or CMOS camera sensitive in ultraviolet (UV), visible (VIS) or infrared (IR) wavelengths. The imaging sensor can be located a distal portion of an endoscope for use during the procedure, an example of which is illustrated in FIG. 3. The imaging sensor may obtain an imaging signal of at least a portion of the target structure 122 during the procedure. In an example, the non-therapeutic signal source 240 can generate and direct electromagnetic radiation at the target structure 122, and the imaging sensor can obtain the imaging signal in response to the electromagnetic radiation incident on the target structure 122. Table 2 below shows examples of the non- therapeutic signal source 240 as applicable to the examples discussed herein.Table 2: Light sources for spectroscopic system

[0062] The imaging sensor may additionally or alternatively include or be coupled to one or more of a pressure sensor to sense a pressure signal from the target structure 122, a temperature sensor sense a temperature signal at the target structure 122, or an acoustic sensor to sense an acoustic signal produced when laser pulses incident on the target structure 122 and / or when propagate through the liquid media along the path to the target structure 122 and cause liquid to vibrate. At least some of the sensors described above may be disposed at a distal portion of the optical fiber 270.

[0063] In some examples, the feedback analyzer 212 may include a spectrometer to determine one or more spectroscopic properties, such as reflectivity, absorption index, among other spectral properties of the return signal from the target structure 122. Examples of the spectrometer 213 mayinclude a Fourier Transform Infrared spectrometer (FTIR), a Raman spectrometer, a UV-VIS reflection spectrometer, a UV-VIS-IR spectrometer, a fluorescent spectrometer, and the like. The FTIR is a method used for routine, easy and rapid materials analysis. This technique has relatively good spatial resolution and gives information about the chemical composition of the material. The Raman spectroscopy has good accuracy in identifying hard and soft tissue components. As a high spatial resolution technique, it is also useful for determining distribution of components within a target. The UV-VIS reflection spectroscopy is a method that gathers information from the light reflected off an object similar to the information yielded from the eye or a color image made by a high-resolution camera, but more quantitatively and objectively. The reflection spectroscopy offers information about the material since light reflection and absorption depends on its chemical composition and surface properties. It is also possible to get unique information about both surface and bulk properties of the sample using this technique. The reflection spectroscopy can be a valuable technique to recognize composition of hard or soft tissue. The fluorescent spectroscopy is a type of electromagnetic spectroscopy that analyzes fluorescence from a sample. It involves using a beam of light, usually ultraviolet, that excites a material compound and causes the material compound to emit light, typically in visible or IR area. The method is applicable for analysis of some organic components such as hard and soft tissue.

[0064] The feedback analyzer 212 may identify in vivo a type or composition of the target structure 122 (or a specific portion thereof) during the procedure using the one or more spectroscopic properties. In endoscopic laser therapy, it is desirable to identify target type and composition, apply appropriate laser energy only to treatment target (e.g., cancerous tissue, or a particular calculus type) while avoiding or reducing laser irradiation at non-treatment tissue (e.g., normal tissue). Conventional target identification generally requires collecting a sample of the target for in vitro analysis. Continuous monitoring and automatic in vivo tissue identification at the tip of the endoscope may advantageously reduce surgery time and complexity, give physicians more information to better adapt the treatment during the procedure, and improve therapy efficacy. For example, in laser lithotripsy that applies laser to break apartor dust calculi, automatic and in vivo recognition of calculi of a particular type (e.g., chemical composition of a kidney or pancreobiliary or gallbladder stone) and distinguishing it from surrounding tissue would allow a physician to adjust a laser setting (e.g., power, exposure time, or firing angle) to more effectively ablate the target stone, while at the same time avoiding irradiating neighboring non-treatment tissue. Commonly assigned U.S. Patent Application No. 16 / 947,488, entitled “OPTICAL FIBER-TO-TARGET DISTANCE CONTROL,” describes example methods of identifying or classifying different target structures, such as different compositions of kidney stones (e.g., calcium oxalate stone (Monohydrate), calcium oxalate stone (Dihydrate), calcium phosphate stone, struvite stone, and uric acid stone) using spectroscopic data, the description of which is hereby incorporated by reference in its entirety.

[0065] In some examples, the feedback analyzer 212 may determine a location of the target structure 122 by estimating a “fiber-to-target distance” between a distal end of the optical fiber 270 and the target structure 122 using the return signal from the target and / or one or more sensor signal transmitted through the optical fiber 270. In an example, the fiber-to-target distance may be determined or estimated using interferometry techniques. In another example, the optical or EM signal being incident on the target and producing the return signal includes a chirped laser, also known as a frequency-swept laser, which has a time-varying instantaneous frequency. The feedback analyzer 212 may estimate the fiber-to-target distance based on a coherence metric between the return laser signal and a portion of the chirped laser split from the chirped laser.

[0066] The controller circuit 214 may be coupled by wired or wireless connections to the feedback analyzer 212. The controller circuit 214 may control operation of the laser system 230 according to one or more control algorithms described herein. In some examples, the feedback analyzer 212 may continuously monitor the target structure 122, and continuously communicate with the controller circuit 214 to provide feedback control signals to adjust laser output, such as by increasing or decreasing the pulse amplitude, pulse rate, power intensity, duration, frequency, pulse shape, exposure time, among other laser irradiation parameters. The controller circuit 214 may continue maintaining the laser system 230 in a particular state (with a particular output) until a changein feedback is detected. For example, when a different target type or composition is detected, the controller circuit 214 may adjust the laser output of the laser source. In an example, for a renal stone with a hard surface with a first composition and a softer core of a second composition, continuous tissue composition through the target identification allows a first higher laser output to be used to dust the hard surface of a renal stone, and after dusting automatically or upon user confirmation switching to a different lower laser output to ablate the soft core of the stone. As an alternative to the automatic adjustment of laser output, in some examples, the controller circuit 214 may adjust the laser output in a commanded mode, in which case the controller circuit 214 may present to a user (e.g., a surgeon or an endoscopist) current laser output and information about identified target type or composition via a user interface, and recommend the user to adjust the laser output to produce desired therapeutic effect on the target structure 122.

[0067] In some examples, the controller circuit 214 may control operation of the laser system 230 further based on a fiber-to-target distance. For example, if the target structure 122 is identified as an intended treatment structure type (e.g., a specified soft tissue type or a specified calculus type), and if the fiber-to-target distance (d) satisfies a condition (e.g., falling below a threshold dth or within a specified laser firing range), then the laser pulses may be delivered to the target structure 122. However, if the target structure 122 is not within the laser firing range (e.g., d> dth), then the controller circuit 214 may produce a control signal to temporarily “lock” the laser source, such that no laser pulses are emitted to the target until the target structure 122 is within the laser firing range. The estimated fiber-to-target distance and an indication that the target structure 122 is out of laser firing range (d>dth) may be presented to the user on a user interface. The user may adjust the optical fiber 270 such as repositioning the distal end of the optical fiber 270 to move closer to the target.

[0068] In some examples, the controller circuit 214 may generate a control signal to a robotic device, such as the fiber actuator 260, to robotically adjust the position or the orientation of the distal end of the optical fiber 270 with respect to the target structure 122. For example, the fiber actuator 260 may, in response to the control signal from the controller circuit 214, automaticallyadvance or retract the optical fiber or change an orientation (e.g., an aiming angle) of the distal end of the optical fiber 270 with respect to the target structure 122. In an example, the controller circuit 214 may adjust the position or the orientation of the distal end of the optical fiber based on the identified target type or composition. A desired or optimal distance or range of distance for firing laser at the target may depend on multiple factors including the target type or composition, target location and surrounding anatomy, laser setting, procedure type, or desired tissue effect. As described above, laser output may be adjusted manually or automatically based on target type or composition, such that different portions of the target (e.g., the surface and the core of a calculi structure with respective different compositions) may be treated using different laser outputs. In addition or alternative to the adjustment of laser output, in some examples, the position or the orientation of the distal end of the optical fiber may be adjusted based on target type or composition. In an example of laser lithotripsy, as the feedback analyzer 212 continuously analyzes the target type and composition, the controller circuit 214 may control the fiber actuator 260 to advance the distal end of the optical fiber 270 closer to a renal stone target in response to an identification of a hard surface of the target to better dust the stone surface. In response to an identification of a soft core of the stone target, the fiber actuator 260 can retract the distal end of the optical fiber 270 further away from the renal stone target.

[0069] In various examples, the controller circuit 214 may adjust the operation of the laser system (such as a laser output setting) using artificial intelligence (Al) or machine learning (ML) based techniques. For example, information about the identified type or composition of the target structure may be applied to a trained ML model to automatically determine a proper laser setting to be used during the procedure. In some examples, sensor data collected from the one or more sensors in response to a trigger event, or a selected portion of continuously recorded and buffered sensor data with a specific duration that begins at a time relative to a trigger event (e.g., at or right before the trigger event) and ends prior to the laser pulses being incident on the anatomical target, may be applied directly to a trained ML model that outputs a proper laser setting.The ML model may be trained using sensor data from multiple patients that are collected or flagged in response to similar trigger events.

[0070] In some examples, the controller circuit 214 may configure the laser system to operate in one of two or more distinct operating modes or states, such as a first state wherein the laser system 230 generates a laser output, and a second state where a laser system 230 does not generate a laser output. For instance, the first laser system 102 may have a first state where a first output 110 (e.g., over the first wavelength range) is generated, and a second state where the first output 110 is not generated. Similarly, the second laser system 104 may have a first state where a second output 120 (e.g., over the second wavelength range) is generated, and a second state where the second output 120 is not generated. In such embodiments, the controller circuit 214 may control the laser system 230 by sending control signals that change the operating state the laser system from the first state to the second state, or from the second state to the first state. In some examples, the laser system 230 may have additional states, for instance, a third state where a laser output in accordance with a different laser irradiation parameter setting is generated. Accordingly, additional control signals may be sent by the controller circuit 214 to the laser system(s) to change their states from their current state to one or more additional states (e.g., first state to third state, second state to third state, third state to first state, and third state to second state) to generate laser outputs that provide a desired therapeutic effect.

[0071] In an example, the controller circuit 214 may generate a control signal to operate the laser system 230 in a first operating mode if the target is identified as a calculi structure, or a second operating mode if the target is identified as an anatomical structure, or a third operating mode if the target is identified as neither an anatomical structure nor a calculi structure. In an example, the first operating mode may include activating the laser system 230 to deliver a laser beam programmed with a first irradiation parameter setting to ablate or dust the identified calculi, such as renal stones. In an example, the second operating mode may include withholding laser delivery, or delivering a laser beam programmed with a second irradiation parameter setting different from the first irradiation parameter setting to an identified tissue. In an example, the third operating mode may include deactivating the laser system 230 fromdelivery of laser energy. The laser irradiation parameters may include wavelength, power, power density, pulse parameters (e.g., pulse width, pulse rate, amplitude, duty cycle), exposure time, total dose or energy, among others.

[0072] In some examples, the controller circuit 214 may determine the operating mode of the laser system 230 based on an identification of the target structure 122 as one of a plurality of calculi types, such as CaP stone, a MAP stone, a COM stone, a COD stone, a cholesterol-based stone, a cystine stone, or a uric acid (UA) stone, as determined by the feedback analyzer 212. The controller circuit 214 may adjust the irradiation parameter setting based on the identification of calculi type, and generate a control signal to control the laser system 230 to deliver laser energy to the target structure 122 in accordance with the adjusted irradiation parameter setting.

[0073] In some examples, the controller circuit 214 may determine the operating mode of the laser system 230 based on the identification of the target structure 122 as one of a plurality of tissue types, such as renal tissue at different anatomical locations (e.g., calyx tissue, cortex tissue, medulla tissue, ureter tissue, or bladder tissue), normal or abnormal tissue (e.g., cancerous tissue), treatment area (e.g., tumor or polyp intended for removal) or a non-treatment area (e.g., blood vessels, muscle, etc.). The controller circuit 214 may adjust the irradiation parameter setting based on the identification of tissue type, and generate a control signal to the laser system 230 that delivers laser energy to the identified anatomical structure in accordance with the adjusted irradiation parameter setting.

[0074] In some examples, the controller circuit 214 may adjust the irradiation parameter setting directly based on one or more of the spectroscopic properties or acoustic properties produced by the feedback analyzer 240 without using information about target type or target composition such as generated by the feedback analyzer 212. For example, the intensity of the feedback signal produced in response to laser firing at a target calculi structure is correlated to laser power density. The controller circuit 214 may automatically adjust an irradiation parameter setting (e.g., laser power) and optical fiber position to achieve a desired feedback signal amplitude.

[0075] In illustrative examples described herein, the controller circuit 214 may control more than one laser system by changing the operating state of each laser system. According to an aspect, the controller circuit 214 may independently control each laser system. For instance, the controller circuit 214 may send a distinct control signal to each laser system to control each laser system independently of the other laser systems. Alternatively, the controller circuit 214 may send a common signal to control one or more laser systems.

[0076] The laser actuator 280 may be operable by a user to spontaneously activate or adjust operation of the laser system 230. The laser actuator 280 may be coupled to the controller circuit 214, which controls the laser system 230 to emit laser pulses to the target structure 122 in accordance with the user’s spontaneous activation or adjustment of laser system operation. The laser actuator 280 thus provides a convenient tool for spontaneous control of laser output without the need of temporarily shutting off laser emissions, thereby reducing total procedure time and improving efficiency.

[0077] The laser system operation adjusted by the laser actuator 280 may include one or more of a laser output setting or a laser treatment mode. The laser output setting generally includes one or more individually user-programmable laser irradiation parameters. The laser treatment mode is a generally includes one or more laser irradiation parameters with predetermined values. In an example where the medical laser system 200 is used in a laser lithotripsy procedure for treating a calculi target, and the laser treatment mode may include a fragmenting mode, a dusting mode, a popcorning mode, or any combination thereof. Dusting creates much smaller fragments while fragmentation creates larger fragments. The popcoming mode a mixture of dusting and fragmentation, which in certain cases can more efficiently break down the calculi target.

[0078] An example of the laser actuator 280 is a foot pedal depressible by a user to spontaneously activate laser emission or adjust the operation of the laser system 230 during the procedure, such as unidirectional pedal 400 shown in FIG. 4. The foot pedal 400 comprises a lever 410 and a frame 420. The lever 410 is pivotally mounted on the frame 420 via a coupling member 430 (e.g., a hinge) located at substantially an edge portion of the lever 410, such that the lever 410 is forward depressible about the coupling member 430. Depressing ofthe lever 410 can be continuous or discrete. The frame 420 can provide pivotal support for the lever 410 at an idle position 440 A and one or more actuated depth positions, such as a plurality of discrete, preset actuated depth positions 440B, 440C, or 440D at different press depths as illustrated in FIG. 4. Each of the actuated depth positions corresponds to a particular laser treatment mode or laser output setting. The foot pedal 400 may include a biasing member such as affixed to the coupling member 430. The biasing member may be in the form of a torsion spring, a compression spring, among other types of spring. When the lever 410 is not depressed (i.e., in an idle state), the biasing member may urge the lever 410 toward and to remain at the idle position 440 A. When the lever 410 is depressed down to variable depths such as the preset actuated depth positions 440B, 440C, or 440D, the lever 410 can activate an actuation switch, such as one of the actuation switches 450B, 450C, and 450D corresponding to the depth positions 440B, 440C, or 440D, respectively. The actuation switches can trigger the controller circuit 214 to select or adjust the operation of the laser system 230, such as a laser treatment mode a laser output setting. By way of nonlimiting example and as illustrated in FIG. 4, the depth positions 440B, 440C, and 440D correspond to distinct preset laser output power levels. For example, pressing a higher depth can activate a higher laser power setting than pressing a lower depth. In an example, the laser output can be preset to 20 watts (W) at depth position 440B, 40W at depth position 440C, and 60W at depth position 440D. Other power levels, or different values of one or more other laser irradiation parameters may be similarly selected or adjusted by depressing the lever 410 to different depth positions. In some examples, depressing of the lever 410 can be continuous, and the laser treatment mode or laser output setting (e.g., one or more laser irradiation parameters) can be continuously adjusted according to the press depths. For example, the laser power level can be continuously changes (e.g., increased) proportional to the press depth within a predefined range between a minimum power level and a maximum power level.

[0079] In some examples, instead of using multiple actuation switches (e.g., 450B, 450C, and 450D), a single actuation switch may detect contact with the lever 410, or positions of the lever 410 relative to the single actuation switch. The single actuation switch may be a mechanical, electrical, orelectromechanical switch. In an example, the single actuation switch can be a Hall-Effect switch to produce distinct outputs for different level positions, such as relatively far and relatively near locations. In an example, the single actuation switch includes a potentiometer to convert different lever press depths to respective resistance loads in a circuit and corresponding voltage outputs, which are then used for selecting different laser treatment modes or output settings.

[0080] In some examples, the foot pedal 400 may include a releasable locking member that can lock the lever 410 one or more preset positions, such as the idle position 440A and one or more of the actuated depth position such as 440B, 440C, or 440D. The releasable locking member can be set in a lock configuration to secure the lever 410 at any one of the preset actuated depth positions, and prevent free pivotal movement about the coupling member 430 at that position. Once the lever 410 is locked, a user perceivable feedback may be generated (such as by the controller circuit 214) to alert the user about current lever position as well as the laser treatment mode or output setting corresponding to that lever position. The user perceivable feedback can be presented in the user interface in the form of text, image, sound, or haptic feedback, among others. The releasable locking member can also be set in an unlocked configuration to unlock the lever 410 from the locked position, and enable pivotal movement about the coupling member 430. In an example, the releasable locking member can be a mechanical locking means, such as multiple notches on the coupling member 430 corresponding to the preset depth positions of the lever 410. In some examples, the releasable locking member can be an electrical or electromagnetic locking means.

[0081] Transition from the lock configuration to the unlock configuration can be manually actuated, such as by depressing the lever 410 slightly from its current locked position. For example, if the lever 410 is locked at depth position 440B, a user may depress the lever 410 slightly to unlock it from its current position. If the user then releases foot press, the lever 410 can return to the idle position 440 A, such as under a tension of the biasing member (e.g., a spring), and gets locked at that position. Alternatively, once unlocked from depth position 440B, the lever 410 can be further depressed down to the next depth position 440C and gets locked at that position.

[0082] In some examples, spontaneous activation or adjustment of the operation of the laser system (such as selecting a laser treatment mode or a laser output setting) can be based on a foot press pattern or a press-and-hold time of the lever 410. In one example, the foot press pattern may include a single tap or multiple consecutive taps on the lever 410. Each foot press pattern corresponds to a unique laser treatment mode or output setting. For example, a single tap may activate a first laser treatment mode or a first output setting (e.g., a first laser power level). A double-tap may activate a second laser treatment mode or a second output setting (e.g., a second laser power level higher than the first level). A triple-tap may activate a third laser treatment mode or a third output setting (e.g., a third laser power level higher than the second level). In another example, a foot press on the level 410 can be a “short” tap (e.g., < 2 seconds) or a “long” tap (e.g., > 2 seconds). The short and long taps correspond to distinct laser treatment modes or output settings. In a laser lithotripsy procedure, for example, a short tap may trigger a popcoming mode, and a long tap may trigger a dusting mode. The short tap and the long tap may activate different output settings or values of a laser irradiation parameter. In yet another example, the foot press pattern may be represented by a sequence of taps with different press-and-hold times. For example, short-long, long-short, short-short-long, short-long-short, short-long-long multi-tap patterns can each correspond to or trigger different laser treatment modes or output settings (e.g., different values of a laser irradiation parameter).

[0083] Other types of foot pedal operable by the user for spontaneous control of laser treatment may include, for example, a bidirectional foot pedal 500 as illustrated in FIG. 5. The bidirectional foot pedal comprises a bidirectional lever 510 pivotally mounted on the frame 520 via a coupling member 530 (e.g., a hinge) located at substantially midway between a front portion 512 and a rear portion 514 of the bidirectional lever 510. The bidirectional lever 510 is forward depressible via the front lever portion 512 and backward depressible via the rear pedal lever portion 514. Similar to the discussion above with respect to the unidirectional foot pedal 400, the front portion 512 and the rear portion 514 can each be depressed to variable depths. In addition or alternative to foot press depth, number of taps, and press-and-holdtime for each foot press, the activation and adjustment of laser system operation may also be based at least in part on whether a forward press or a backward press is involved in a foot pressure pattern. In an example, a foot press pattern may include an ordered combination of forward press (“F”) and backward press (“B”) on the bidirectional lever 510. For example, F-B, B-F, F-F-B, F-B-F, and B-F-B are foot press patterns each corresponding to respective different laser treatment modes or laser output settings (e.g., different values of a laser irradiation parameter such as different power levels).

[0084] In some examples, the laser actuator 280 may be a multi-pedal system comprising two or more foot pedals operable by a user to spontaneously activate or adjust an operation of the laser system. In an example, the multipedal system may include at least one first pedal depressible to activate or select a laser treatment mode, and at least one second foot pedal depressible to change or select a laser output setting. Referring now to FIG. 6, an example multi-pedal system is a “triple-action” foot pedal 600 comprising three pedals 610A, 610B, and 610C independently pivotally coupled to a common frame 630 via respective coupling members (e.g., hinges). The three pedals 610A, 610B, and 610C may be arrange in series, and a first pedal 610A is in the middle between a second pedal 610B and a third pedal 610C. In one example, the first pedal 610A may be depressed to adjust or select a laser treatment mode. The second pedal 610B and / or the third pedal 610C, when tapped or depressed according to a “foot press pattern” (such as repeated tapping), can cause incrementally changes in laser irradiation parameter value (e.g., laser power level) associated with the selected laser treatment mode. For example, the second pedal 610B may be repeatedly tapped to incrementally increase the value of a laser irradiation parameter, and the third pedal 610C may be repeatedly tapped to incrementally decrease the value of the laser irradiation parameter. In another example, the second pedal 610B may be repeatedly tapped to cycle through a plurality of laser irradiation parameters, and press-and-hold for at least a threshold time duration (e.g., 3 seconds) to select a laser irradiation parameter. The third pedal 610C may be repeatedly tapped to cycle through a plurality of values within a preset range for the selected irradiation parameter. In another example, a “foot press pattern” can be a patterned press and / or tapping between two pedals such thepedal 61 OB (left pedal) and the pedal 6 IOC (right pedal). While holding the left pedal down, a quick tap of the right pedal of less than a threshold time (e.g., approximately one second) can decrease laser power by a predefined amount, while two quick presses of the right pedal can increase the laser power. Additionally or alternatively, while holding the right pedal down, a quick tap of the left pedal of less than a threshold time (e.g., approximately one second) can decrease laser pulse rate by a predefined amount, while two quick presses of the left pedal can increase the laser pulse rate.

[0085] In yet another example, the second pedal 61 OB and the third pedal 610C may correspond to two distinct laser treatment modes, and the first pedal 610A may cycle through and make a selection from a plurality of predetermined laser output settings, or a plurality of predetermined values of a laser irradiation parameter. For example, in a laser lithotripsy procedure, the second pedal 61 OB may be used for activating popcoming mode and the third pedal 610C may be used for activating dusting mode. The first pedal 610A may cycle through and make a selection from a plurality of laser power levels.

[0086] To make it easier to distinguish between different pedals and prevent mis-operation, in some examples the pedals 610A-610C may have different sizes, shapes, colors, or feels (when depressed). For example, when the second pedal 61 OB and the third pedal 610C are used for selecting different laser treatment modes (e.g., 61 OB for popcorning mode and 610C for dusting mode), or for providing incremental changes in parameter value (e.g., 61 OB for incremental increase and 610C for incremental decrease of laser power level), said pedals may include respective light indicators of different colors or different illuminations. In some examples, the light indicators of the second and the third pedals may change in brightness, shade, or tone of a corresponding color responsive to repeated press of the respective pedals. In an example, a light indicator on a pedal for changing laser power level may change from dark orange color or light orange color as the power increases from low to high. Alternatively, the orange color itself could be a dark orange for low power becoming more vibrant as the power increases.

[0087] The fiber motion / displacement detector 290 can detect user- activated motion or displacement of the optical fiber 270 with respect to thetarget structure 122. During a medical laser procedure, a user may maneuver the optical fiber 270 (manually or through a robotic system) to advance toward or retreat from the target structure 122. The controller circuit 214 may use such detected optical fiber motion to control laser emissions from the laser system 230. In an example, the optical fiber 270 may be moved in accordance with one of a plurality of predetermined movement patterns each represented by a forward motion (“F”, advancing toward the target), a backward move (“B”, retreating away from the target), or an ordered combination of forward and backward moves. Each movement pattern may correspond to a unique laser treatment motion or output setting as similarly describe above with respect to user-actuated foot press patterns. A correspondence between the optical fiber movement patterns and the laser operation modes or output settings (e.g., laser irradiation parameter values) can be established and stored in a memory device.

[0088] Once the motion / displacement detector 290 detects fiber motion and the movement pattern, the controller circuit 214 can determine, based on the established correspondence, a corresponding laser treatment mode or laser setting for the detected the movement pattern. The laser system 230 can emit laser pulses in accordance with the determined laser treatment mode or laser setting. For example, a single forward move may cause a step increase in a laser irradiation parameter value (e.g., a step increase of 10W of laser power level), and a single backward move may cause a step decrease in the same laser irradiation parameter value (e.g., a step decrease of 10W of laser power level). In another example, during a laser lithotripsy procedure, an F-F-B pattern (i.e., two consecutive forward moves followed by one backward move) may activate a popcoming mode, and a B-B-F pattern (i.e., two consecutive backward moves followed by one forward move) may activate a bursting mode for treating a calculi target.

[0089] The user interface 250 may be operatively in communication with the feedback control system 210. The user interface 250 can include a display unit to display information including, for example, surgical site conditions such as images, pressure, or other information sensed by the sensor circuit 220, information generated by the feedback analyzer 212 including the target identification and estimated fiber-to-target distance, and current device settingssuch as the laser output setting. The display unit can display UI elements including visual elements, alerts, tactile feedback, or any combination thereof. In some examples, the user interface 250 may generate an alert if the fiber-to-target distance exceeds a threshold or a specific range. The alert can be presented in an audible, visible, tactile, or otherwise human-perceptible format. The user interface 250 may include one or more input units to receive user programming of various components of the medical laser system 200, such as parameter values used for identifying target type or composition, estimating a fiber-to-target distance, and laser output setting. In some examples, the display unit may generate recommendations for adjusting the position or the orientation of the distal end of the optical fiber 270, or for adjusting laser output or other system parameters. A user may use the one or more input units to confirm, reject, or modify any of the recommended adjustments. In response to user spontaneously activating or adjusting an operation of the laser system via the laser actuator 280, the display unit may generate a visual feedback to the user about the spontaneous activation or adjustment of the laser system operation. In some examples, the user interface 250 may generate one or more of visual, audio, or haptic feedback about the operating state of the laser system 230, position or motion of the optical fiber 270, user engagement with the laser actuator, among others.

[0090] FIG. 3 illustrates an example of an endoscopic laser lithotripsy system 300 with direct user control for spontaneous laser treatment adjustment during a procedure. The laser lithotripsy system 300 can be an example of the medical laser system 200. The endoscopic laser lithotripsy system 300 may include an endoscope 301, a feedback control system 310, a laser source 332, and an laser fiber 334. The endoscopic laser lithotripsy system 300 may additionally include the fiber actuator 260 and the laser actuator 280 as included in the medical laser system 200. The endoscope 301 has a proximal portion and an elongate distal portion that may be configured to be inserted into a surgical site of a patient during an endoscopic laser lithotripsy procedure. The endoscope 301 may provide visual inspection or treatment of soft (e.g., non-calcified) or hard (e.g., calcified) tissue as well as for visualizing or breaking up or otherwise treating renal stones or other calculi structures or targets.

[0091] The endoscope 301 may include or provide visualization and illumination optics, such as a visualization optical pathway 360 and an illumination optical pathway 350, each of which may extend longitudinally along the elongate body of the endoscope 301. An eyepiece or camera or imaging display may be provided at or coupled to the visualization optical pathway 360 to permit user or machine visualization of a target region at or near a distal end of the endoscope 301. The target region may be illuminated by light 370, such as provided by an illumination light source 324 at a proximal end of the illumination optical pathway 350 and emitted from a distal end of the illumination optical pathway 350. The light source 324 can include, for example, a Xenon lamp, a light-emitting diode (LED), a laser diode (LD), or any combination thereof. In an example, the light source 324 may include two or more light sources that emit light having different illumination characteristics, referred to as illumination modes. In an example, the illumination modes may include a white light illumination mode, or a special light illumination mode such as a narrow band imaging mode, an auto fluorescence imaging mode or an infrared imaging mode. A special light illumination can concentrate and intensify specific wavelengths of light, for example, resulting in a better visualization of tissue or other structures at the surgical site.

[0092] The lithotripsy system 300 may include or be coupled to a laser source 332 to emit a laser beam 383 to the target structure 122. The laser source 332 can be mechanically and optically connected to the laser fiber 334, which may include a single optical fiber or a bundle of optical fibers. The laser fiber 334, which is an embodiment of the first optical pathway 108 or the second optical pathway 118, or the optical pathway included in the laser system 230, may be introduced via a proximal access port to extend within a working channel or other longitudinal passage or lumen of the endoscope 301 or similar instrument.

[0093] In some examples, the laser source 332 may include a first laser source to generate a treatment beam, and a second different laser source to generate an aiming beam. The treatment beam and the aiming beam can be directed to the target through the same or a different optical pathways. In some examples, the aiming beam may be generated using a light source different thanthe second laser source. The aiming beam may have a distinct color (e.g., green or red) to distinguish from the illumined background of the surgical site.

[0094] The lithotripsy system 300 may include one or more sensors to sense information from the anatomical target or the surgical site, including a spectroscopic sensor 322. The spectroscopic sensor 322 may be located at a distal end 336 of the laser fiber 334, and configured to sense a return signal 385 from the target structure 122. The feedback control system 310 includes a feedback analyzer 312 and a controller circuit 314. The feedback analyzer 312, which is an embodiment of the feedback analyzer 212, may include a spectrometer that generates one or more spectroscopic properties from a spectroscopic sensor signal, or one or more acoustic properties from an acoustic signal, as described above with respect to the feedback analyzer 212. The feedback analyzer 312 may detect, localize, and identify the target structure 122 using the spectroscopic signals or imaging signals. In an example, the feedback analyzer 312 may additionally recognize the target as a calculi target or anatomical target at or near the surgical site, or classify the target as one type of tissue or one type of calculi of distinct composition using the one or more spectroscopic properties. In some examples, the feedback analyzer 312 may calculate or estimate the fiber-target distance using the spectroscopic properties. The controller circuit 314 may generate a control signal to the laser source 332 to adjust a laser output setting, a control signal to the fiber actuator 260 to adjust the position or orientation of the distal end 336 of the laser fiber 334 based on the structure, composition, or type of the target.

[0095] The lithotripsy system 300 may include a camera or imaging device 325. The camera or imaging device 325 can include an imaging sensor (such as the imaging sensor 224) that can generate an imaging signal 365 of the target in response to electromagnetic radiation (e.g., illumination light 370) of the target at or near the surgical site. The imaging signal 365 may be transmitted through the optical pathway 360, or alternatively through the laser fiber 334, to the feedback control system 310 (an embodiment of the feedback control system 210). In an example, the imaging signal 365 may pass through an optical splitter before reaching the feedback analyzer 312. The feedback analyzer 312 may use the imaging signal 365 to determine target location. The feedback analyzer 312may detect, localize, and identify the target structure 122 using the spectroscopic signals or imaging signal. In an example, the feedback analyzer 312 may additionally recognize the target as a calculi target or anatomical target at or near the surgical site, or classify the target as one type of tissue or one type of calculi of distinct composition using the one or more spectroscopic properties.

[0096] The controller circuit 314 may generate a control signal to the laser source 332 to adjust a laser output setting, including one or more laser irradiation parameters, based at least in part on target location, type, or composition, among other characteristics as identified by the feedback analyzer 312. In some examples, the feedback analyzer 312 may calculate or estimate the fiber-to-target distance using the spectroscopic properties. The controller circuit 314 may generate a control signal to adjust the laser output setting based on the calculated or estimated fiber-to-target distance.

[0097] In some examples, the controller circuit 314 may generate a control signal to the fiber actuator 260 to adjust the position of the optical fiber distal end 336 relative to the target structure 122. The fiber actuator 260 may be a laser emitting end coupled to a portion of the laser fiber 334, and can be in electrical communication with the controller circuit 314. In an example, the fiber actuator 260 may be located at or near the distal end of the endoscope 301. The fiber actuator 260 may include one or more of an electromagnetic element, an electrostatic element, a piezoelectric element, or other actuating element such as to actuate or otherwise permit longitudinal or rotational positioning of the optical fiber distal end 336 with respect to the working channel or other longitudinal passage of the endoscope 301, or with respect to another reference location for which the endoscope 301 may serve as a frame of reference.

[0098] The laser actuator 280, as described above with respect to FIG. 2, may be operable by a user to provide spontaneous activation and / or spontaneous adjustment of laser output setting (e.g., a laser irradiation parameter value) of the laser source 332 during the procedure without the need of temporarily shutting off laser emissions. The laser actuator 280 may be coupled to the controller circuit 314 to control laser emissions in accordance with the user’s spontaneous activation or adjustment of the operation of the laser system. Examples of thelaser actuator 280 may include one or more foot pedals, as described above with respect to FIG. 4-6.

[0099] In some examples, the laser actuator 280 can take the form of a detachable actuator device removably affixed to an exterior surface of the endoscope 301. The detachable actuator device can be reusable, or disposable (i.e., single-use). The detachable actuator device, which is communicatively coupled to the controller circuit 314, can also be operably in communication with (e.g., via Bluetooth) and remote-controllable by an electronic device (e.g., a mobile phone) operable by the user. During the procedure, once the sterilized detachable actuator device is attached to the endoscope surface and paired with the user’s electronic device, the user can use the electronic device to spontaneously activate or adjust the operation of the laser system via the detachable actuator device. The detachable actuator device can be repositioned during the procedure if desired, and removed from the endoscope after the procedure.

[0100] In some examples, the laser actuator 280 may include or be communicatively coupled to a microphone-voice processing device configured to receive, process, and interpret a user’s verbal instructions (e.g., natural language commands) for activating the laser system and / or adjusting a laser system operation parameter. The controller circuit 314 can activate or adjust the operation of the laser system based on the interpreted verbal instructions.

[0101] The fiber motion / displacement detector 290, as described above with respect to FIG. 2, can detect user-activated motion or displacement of the laser fiber 334 (an embodiment of the optical fiber 270) relative to the target structure 122. The laser fiber 334 may be moved according to one of a plurality of predetermined movement patterns, each of which may be mapped to respective laser treatment modes or laser output settings. For the detected the movement pattern, the controller circuit 314 can determine a corresponding laser treatment mode or laser setting, and control the laser source 332 to emit laser pulses in accordance with the determined laser treatment mode or laser setting.

[0102] Various sensing technology may be used to detect laser fiber motion or displacement. In an example, the fiber motion / displacement detector 290 may include an imaging sensor to capture images of at least a portion of thelaser fiber 334 during the procedure. By way of example and as illustrated in FIG. 3, the imaging sensor may be positioned inside the endoscope 301 to face the laser fiber 334, such that a portion of laser fiber 334 falls within the field of view (FOV) of the imaging sensor when the laser fiber 334 is advanced toward (forward move) or retreated from (backward move) the target. A fiducial marker, such as a colored jacket, may be attached to or imprinted on an exterior surface of the laser fiber 334. As the laser fiber 334 moves longitudinally, the fiducial marker may go into and out of the FOV of the imaging sensor. The motion / displacement detector 290 can detect the motion or displacement, and a movement pattern, of the laser fiber 334, based on the appearance or disappearance of the fiducial marker from the capture image.

[0103] In another example, the fiber motion / displacement detector 290 may detect a change in an electrical or magnetic property of a portion of the laser fiber 334 correlated to user-activated fiber motion or displacement motion. An electrically conductive element, such as a metal ring, may be affixed to a portion of the laser fiber 334. As the laser fiber 334 moves longitudinally, the electrically conductive element (e.g., the metal ring) passes through a metal detector that detects a change in electrical or magnetic signal. The motion / displacement detector 290 can detect the motion or displacement, and a movement pattern, of the laser fiber 334, based on the detected change in electrical or magnetic signal.

[0104] In some examples, the fiber motion / displacement detector 290 may detect user-activated motion or displacement of the laser fiber 334 by detecting user-activated tapping of a distal tip of the laser fiber 334 on the target structure 122 The user may tap the distal tip of the laser fiber 334 in one of a plurality of predetermined tapping patterns each corresponding to respective different laser treatment modes or laser output settings. For example, a single-tap may correspond to a popcorning mode, and a double-tap may correspond to a dusting mode in a lithotripsy procedure. Spontaneous activation or adjustment of the operation of the laser system may be triggered in accordance with the tapping patterns.

[0105] FIG. 7 is a flowchart illustrating an example method 700 of providing adjustable laser treatment to an anatomical target. The method 700may be implemented in and executed by a laser treatment system, such as the laser treatment system 100 or a variant thereof, such as the medical laser system 200 or the endoscopic laser lithotripsy system 300. Although the processes of the method 700 are drawn in one flowchart, they are not required to be performed in a particular order. In various examples, some of the processes can be performed in a different order than that illustrated herein.

[0106] At step 710, a laser system is provided for use in a medical laser procedure to emit laser pulses via an optical fiber to an anatomical target, such as a tissue target or calculi target. An example of such laser system is the laser system 230 as described above with respect to FIG. 2. Laser pulses may be generated by a laser source of the laser system in accordance with a laser treatment mode or a laser output setting, and directed to the anatomical target via an optical fiber, such as the optical fiber 270 of FIG. 2 or the laser fiber 334 at least partially within an endoscope as illustrated in FIG. 3.

[0107] At step 720, operation of the laser system, such as the laser treatment mode or output setting (e.g., values of one or more laser irradiation parameters) may be activated or adjusted spontaneously during the medical procedure. The spontaneous activation or adjustment can be carried out by the user through a laser actuator device, such as the laser actuator 280 as described above with respect to FIGS. 2 and 3. The laser actuator device may take various forms including, for example, a foot pedal depressible by a user, such as unidirectional pedal 400 shown in FIG. 4, or a bidirectional foot pedal 500 as illustrated in FIG. 5. As described above with respect to those figures, spontaneous activation or adjustment of laser system operation (e.g., laser treatment modes or output settings) can be based on one or more of a foot press depth of the pedal lever, a press-and-hold time when the pedal lever is depressed and held at a depth position, or a foot press pattern of the pedal lever being repeatably depressed. In an example of bidirectional pedal as shown in FIG. 5, the foot press pattern may include an ordered combination of forward and back presses. Different foot press depths (continuous or discrete such as preset depth positions as shown in FIG. 4), press-and-hold times, and / or foot press patterns may correspond to respective different laser treatment modes or different laseroutput settings (e.g., different values of a laser irradiation parameter, such as different laser power levels).

[0108] The laser actuator device may additionally take the form of a multi-pedal system comprising first and second foot pedals, such as the “tripleaction” foot pedal 600 of FIG. 6. The first pedal can be depressible for activating or selecting a laser treatment mode. The second pedal is depressible for changing or selecting a laser output setting. In some example, the second foot pedal can be repeatedly depressed to incrementally increase the value of a laser irradiation parameter, and a third foot pedal separate from the second foot pedal can be repeatedly depressed to incrementally decrease the value of the laser irradiation parameter. In another example, the first foot pedal can be depressible to activate or select a first laser treatment mode, the third foot pedal can be depressible to activate or select a second laser treatment mode different from the first laser treatment mode, and the second foot pedal can be repeatably depressible to cycle through and make a selection from a plurality of predetermined laser output settings.

[0109] In addition or alternative to the various foot pedals, in some examples, spontaneous activation or adjustment of laser system operation can be made using a voice processor that receives and processes user’s verbal commands. In some examples, spontaneous activation or adjustment of laser system operation can be made based on a detection of user-activated motion or displacement of the optical fiber with respect to the target structure, such as detected by the fiber motion / displacement detector 290. When the user moves the optical fiber in accordance with a predetermined movement pattern (such as an ordered combination of forward and backward moves), the movement pattern may correspond to a unique laser treatment motion or output setting.

[0110] In certain examples, type, composition, or other characteristics of the anatomical target may be identified using sensor data collected during the procedure, including one or more spectroscopic, imaging, or acoustic data, among others. Operation of the laser system, including laser treatment modes or output settings, may be adjusted further based at least in part on the identified type or composition of the anatomical target.

[0111] At step 730, a feedback can be provided to the user about the spontaneous activation or adjustment of the operation of the laser system. The feedback may take the form of visual, audio, or haptic feedback. The user may use the one or more input units to confirm, reject, or modify the adjustments.

[0112] At step 740, laser pulses may be emitted from the laser system in accordance with the user’s spontaneous activation or adjustment of the operation of the laser system.

[0113] FIG. 8 illustrates generally a block diagram of an example machine 800 upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform. Portions of this description may apply to the computing framework of various portions of the laser treatment system 100 (e.g., the laser feedback control system 101), the medical laser system 200, or the endoscopic laser lithotripsy system 300.

[0114] In alternative embodiments, the machine 800 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine 800 may operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example, the machine 800 may act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment. The machine 800 may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations.

[0115] Examples, as described herein, may include, or may operate by, logic or a number of components, or mechanisms. Circuit sets are a collection of circuits implemented in tangible entities that include hardware (e.g., simple circuits, gates, logic, etc.). Circuit set membership may be flexible over time and underlying hardware variability. Circuit sets include members that may, alone orin combination, perform specified operations when operating. In an example, hardware of the circuit set may be immutably designed to carry out a specific operation (e.g., hardwired). In an example, the hardware of the circuit set may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) including a computer readable medium physically modified (e.g., magnetically, electrically, moveable placement of invariant massed particles, etc.) to encode instructions of the specific operation. In connecting the physical components, the underlying electrical properties of a hardware constituent are changed, for example, from an insulator to a conductor or vice versa. The instructions enable embedded hardware (e.g., the execution units or a loading mechanism) to create members of the circuit set in hardware via the variable connections to carry out portions of the specific operation when in operation. Accordingly, the computer readable medium is communicatively coupled to the other components of the circuit set member when the device is operating. In an example, any of the physical components may be used in more than one member of more than one circuit set. For example, under operation, execution units may be used in a first circuit of a first circuit set at one point in time and reused by a second circuit in the first circuit set, or by a third circuit in a second circuit set at a different time.

[0116] Machine (e.g., computer system) 800 may include a hardware processor 802 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), a main memory 804 and a static memory 806, some or all of which may communicate with each other via an interlink (e.g., bus) 808. The machine 800 may further include a display unit 810 (e.g., a raster display, vector display, holographic display, etc.), an alphanumeric input device 812 (e.g., a keyboard), and a user interface (UI) navigation device 814 (e.g., a mouse). In an example, the display unit 810, input device 812 and UI navigation device 814 may be a touch screen display. The machine 800 may additionally include a storage device (e.g., drive unit) 816, a signal generation device 818 (e.g., a speaker), a network interface device 820, and one or more sensors 821, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensors. The machine 800 may include an output controller 828, such as a serial (e.g., universal serial bus (USB), parallel,or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.).

[0117] The storage device 816 may include a machine-readable medium 822 on which is stored one or more sets of data structures or instructions 824 (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein. The instructions 824 may also reside, completely or at least partially, within the main memory 804, within static memory 806, or within the hardware processor 802 during execution thereof by the machine 800. In an example, one or any combination of the hardware processor 802, the main memory 804, the static memory 806, or the storage device 816 may constitute machine readable media.

[0118] While the machine-readable medium 822 is illustrated as a single medium, the term "machine-readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) configured to store the one or more instructions 824.

[0119] The term “machine-readable medium” may include any medium that is capable of storing, encoding, or carrying instructions for execution by the machine 800 and that cause the machine 800 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Nonlimiting machine-readable medium examples may include solid-state memories, and optical and magnetic media. In an example, a massed machine-readable medium comprises a machine-readable medium with a plurality of particles having invariant (e.g., rest) mass. Accordingly, massed machine-readable media are not transitory propagating signals. Specific examples of massed machine- readable media may include: non-volatile memory, such as semiconductor memory devices (e.g., Electrically Programmable Read-Only Memory (EPROM), Electrically Erasable Programmable Read-Only Memory (EPSOM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0120] The instructions 824 may further be transmitted or received over a communication network 826 using a transmission medium via the networkinterface device 820 utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as WiFi®, IEEE 802.16 family of standards known as WiMax®), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, among others. In an example, the network interface device 820 may include one or more physical jacks (e.g., Ethernet, coaxial, or phonejacks) or one or more antennas to connect to the communication network 826. In an example, the network interface device 820 may include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques. The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by the machine 800, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.Additional Notes

[0121] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0122] In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

[0123] The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

Claims

What is claimed is:

1. A medical laser system, comprising: a laser system configured to emit laser pulses via an optical fiber to an anatomical target of a patient; an actuator operable by a user to actuate spontaneous activation or adjustment of an operation of the laser system during a medical procedure without shutting off laser emissions from the laser system; and a controller circuit configured to: provide a feedback to the user about the spontaneous activation or adjustment of the operation of the laser system; and generate a control signal to cause the laser system to emit laser pulses in accordance with the spontaneous activation or adjustment of the operation of the laser system.

2. The medical laser system of claim 1, wherein to actuate spontaneous activation or adjustment of the operation of the laser system includes to adjust one or more of a laser treatment mode or a laser output setting, or to select from a plurality of predetermined laser treatment modes or laser output settings, during the medical procedure without shutting off laser emissions.

3. The medical laser system of any of claims 1-2, wherein the actuator includes at least one foot pedal comprising a frame and a lever pivotally mounted on the frame via a coupling member, the lever configured to be depressible to variable depths to produce the spontaneous activation or adjustment of the operation of the laser system.

4. The medical laser system of claim 3, wherein the lever is configured to be depressible to one or more of a plurality of preset depth positions corresponding to respective distinct laser treatment modes or laser output settings.

5. The medical laser system of claim 4, wherein the at least one foot pedal comprises one or more actuation switches configured to be triggered when the lever reaches one of the plurality of preset depth positions, wherein the controller circuit is electrically coupled to the one or more actuation switches and configured to generate the control signal to cause the laser system to emit laser pulses in accordance with a laser treatment mode or laser output setting corresponding to the one of the plurality of preset depth positions reached by the lever.

6. The medical laser system of claim 4, wherein the at least one foot pedal comprises at least one releasable locking member configured to: lock the lever at one or more of the plurality of preset depth positions, thereby preventing pivotal movement relative to the frame; and unlock the lever from the one or more of the plurality of preset depth positions, thereby enabling pivotal movement relative to the frame.

7. The medical laser system of claim 6, wherein the controller circuit is configured to generate a user perceivable feedback indicating the lever is locked at or unlocked from the one or more of the plurality of preset depth positions.

8. The medical laser system of any of claims 3-7, wherein the at least one foot pedal is depressible to produce the spontaneous activation or adjustment of the operation of the laser system based at least in part on a press-and-hold time of the lever being depressed and held at a depth position.

9. The medical laser system of any of claims 3-7, wherein the at least one foot pedal is depressible to produce the spontaneous activation or adjustment of the operation of the laser system based at least in part on a foot press pattern of the lever being repeatably depressed.

10. The medical laser system of any of claims 3-7, wherein the at least one foot pedal is forward and backward depressible to produce the spontaneousactivation or adjustment of the operation of the laser system based at least in part on an ordered combination of forward and back presses.

11. The medical laser system of any of claims 3-10, wherein the actuator includes: a first foot pedal depressible to activate or select a laser treatment mode; and a second foot pedal depressible to change or select a laser output setting.

12. The medical laser system of claim 11, further comprising a third foot pedal, wherein the second foot pedal is repeatably depressible to incrementally increase a value of a laser irradiation parameter, wherein the third foot pedal is repeatably depressible to incrementally decrease the value of the laser irradiation parameter.

13. The medical laser system of claim 12, wherein the second foot pedal and the third foot pedal differ in one or more characteristics including size, shape, color, or appearance.

14. The medical laser system of any of claims 11-13, further comprising a third foot pedal, wherein the first foot pedal is depressible to activate or select a first laser treatment mode, wherein the third foot pedal is depressible to activate or select a second laser treatment mode different from the first laser treatment mode, wherein the second foot pedal is repeatably depressible to cycle through and make a selection from a plurality of predetermined laser output settings.

15. The medical laser system of any of claims 1-14, wherein the actuator is detachably affixable on a surface, the actuator configured to be communicatively coupled to and controllable by a mobile electronic device operable by the user toactuate the spontaneous activation or adjustment of the operation of the laser system.

16. The medical laser system of any of claims 1-15, wherein the actuator includes or is coupled to a motion detector configured to detect a user-activated motion or displacement of the optical fiber relative to the anatomical target during the medical procedure, and to trigger the spontaneous activation or adjustment of the operation of the laser system based on the detected optical fiber motion or displacement.

17. The medical laser system of claim 16, wherein the user-activated motion or displacement of the optical fiber includes a movement pattern represented by an ordered combination of forward motion and backward motion of the optical fiber, wherein the actuator is operable by a user to actuate the spontaneous activation or adjustment of the operation of the laser system in accordance with the movement pattern of the optical fiber.

18. The medical laser system of any of claims 16-17, wherein the motion detector is configured to receive, from an imaging sensor, images of at least a portion of the optical fiber during the medical procedure, and to detect the motion or displacement of the optical fiber using the received images.

19. The medical laser system of any of claims 16-18, wherein the motion detector is configured to detect a change in an electrical or magnetic property of a portion of the optical fiber correlated to optical fiber motion, and to detect the motion or displacement of the optical fiber based at least in part on the detected change in the electrical or magnetic property.

20. The medical laser system of any of claims 16-19, wherein the motion detector is configured to detect the user-activated motion or displacement of the optical fiber by detecting a user-activated tapping of a distal tip of the opticalfiber on the anatomical target, and to trigger the spontaneous activation or adjustment of the operation of the laser system based on the detected tapping.

21. A method of providing adjustable laser treatment to an anatomical target, the method comprising: providing a laser system to emit laser pulses via an optical fiber to the anatomical target; via an actuator, spontaneously activating or adjusting an operation of the laser system during a medical procedure without shutting off laser emissions; providing a feedback to a user about the spontaneous activation or adjustment of the operation of the laser system; and emitting laser pulses from the laser system in accordance with the spontaneous activation or adjustment of the operation of the laser system.

22. The method of claim 21, wherein spontaneously activating or adjusting the operation of the laser system includes adjusting one or more of a laser treatment mode or a laser output setting, or selecting from a plurality of predetermined laser treatment modes or laser output settings, during the medical procedure without shutting off laser emissions.

23. The method of any of claims 21-22, wherein the actuator includes at least one foot pedal comprising a lever pivotally mounted on a frame via a coupling member, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on the lever being depressed to variable depths, the variable depths including a plurality of preset depth positions corresponding to respective distinct laser treatment modes or laser output settings.

24. The method of claim 23, further comprising, via at least one releasable locking member on the at least one foot pedal: locking the lever at one or more of the plurality of preset depth positions, thereby preventing pivotal movement relative to the frame; andunlocking the lever from the one or more of the plurality of preset depth positions, thereby enabling pivotal movement relative to the frame.

25. The method of any of claims 23-24, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on a press- and-hold time of the lever being depressed and held at a depth position.

26. The method of any of claims 23-25, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on a foot press pattern of the lever being repeatably depressed.

27. The method of any of claims 23-26, wherein the at least one foot pedal is forward and backward depressible, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on an ordered combination of forward and back presses.

28. The method of any of claims 23-27, wherein the at least one foot pedal includes first and second foot pedals, wherein spontaneously activating or adjusting the operation of the laser system includes activating or selecting a laser treatment mode by depressing the first foot pedal, and changing or selecting a laser output setting by depressing the second foot pedal.

29. The method of claim 28, wherein changing or selecting the laser output setting includes: incrementally increasing a value of a laser irradiation parameter by repeatedly depressing the second foot pedal; or incrementally decreasing the value of the laser irradiation parameter by repeatedly depressing a third foot pedal separate from the second foot pedal.

30. The method of any of claims 21-29, further comprising detecting a user- activated motion or displacement of the optical fiber relative to the anatomical target during the medical procedure, wherein spontaneously activating or adjusting the operation of the laser system is based at least in part on the detected optical fiber motion or displacement.

Images