Laser fiber that enables lateral positioning and intensity variation

Abstract

A lithotripsy or other medical laser treatment system may include a transverse actuator that laterally displaces a distal portion of a laser fiber that may be scanned or otherwise controlled to generate a spatial or spatiotemporal targeting pattern, e.g., without having to laterally move an endoscope carrying the laser fiber in a longitudinal channel such as a working line. Target stones may be selectively weakened along the pattern, e.g., using lower energy pulses, before being fragmented, e.g., by higher energy shock pulses.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims the benefit of priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application Serial No. 62 / 882,837 filed on August 5, 2019, U.S. Provisional Patent Application Serial No. 63 / 000,570 filed on March 27, 2020, and U.S. Provisional Patent Application Serial No. 63 / 027,007 filed on May 19, 2020, the entire contents of which are incorporated herein by reference. Technical Field

[0003] This document relates generally to endoscopic laser systems and, more particularly, to systems and methods for varying the lateral positioning of a laser fiber and the intensity of laser pulses. Background Art

[0004] In laser lithotripsy, pulses of laser energy can be applied endoscopically via a laser fiber to a target such as the kidney, bile duct, gallbladder or other stones, for example, to break the stones into various pieces. However, the various pieces produced can be scattered throughout the body. The pieces produced may be too large to dissolve or to pass naturally through the body, and may require a doctor to retrieve them, such as using a suction device, forceps, baskets or other retrieval devices. Retrieving the stone fragments can be very time-consuming and difficult. The presence and nature of any stone fragments produced may present further challenges to the patient. Summary of the invention

[0005] The document further describes a laser therapy system, such as a lithotripsy system or other medical system that may include a laser fiber that may be configured to provide one or both of a variable lateral positioning and a variable laser pulse intensity. The distal end of the laser fiber may be scanned or otherwise actuated to change the lateral positioning of the laser fiber, for example relative to the center or other reference longitudinal axis of a working lumen or other longitudinal channel of a rigid or flexible endoscope or other elongated medical device. In this way, the laser fiber may be repositioned at one or more of the various lateral positionings without moving or repositioning the endoscope. Laser pulses may be emitted at such different lateral positionings. The intensity of such laser pulses may also be controlled, for example, to allow laser pulses of different intensities to be emitted at different lateral positionings. The lateral positioning or repositioning of the laser fiber, the change in laser pulse intensity, or both may be useful, for example, for delivering a sequence or pattern of laser energy to a kidney stone or other stone or other target. The pattern may be selected to help improve or optimize the way a target is treated, for example, the way a stone is disintegrated. This may help reduce the size or migration of the resulting fragments of a disintegrated kidney stone or other stone or other target. This, in turn, can help reduce or avoid the need or complexity of any fragment retrieval by the physician.

[0006] Example 1 is a laser therapy system that allows for delivery of laser energy from different lateral positions via an endoscope without requiring lateral repositioning of the endoscope. The laser therapy system includes: a laser fiber including a distal portion configured to be inserted into a patient through a longitudinal channel of an endoscope; and wherein the distal portion of the laser fiber is actuatable to be at least laterally positionable within the longitudinal channel and adjustably relative to the longitudinal channel at a selected position of a plurality of available lateral shifted positions within the longitudinal channel of the endoscope.

[0007] In Example 2, the subject matter of Example 1 can optionally include: wherein the distal portion of the laser fiber includes a bend.

[0008] In Example 3, the subject matter of Example 2 can optionally include wherein the distal portion of the laser fiber is rotatable about the longitudinal channel.

[0009] In Example 4, the subject matter of any one or more of Examples 1 to 3 optionally includes: wherein the laser fiber is configured to be coupled to a laser source, the laser source being controlled by a controller circuit system to provide a first laser pulse and a second laser pulse via the laser fiber, wherein the second laser pulse comprises a higher energy than the first laser pulse, wherein the second pulse is emitted laterally closer to the center of the target than when the first laser pulse was emitted without requiring the endoscope to be laterally repositioned.

[0010] In Example 5, the subject matter of any one or more of Examples 1 to 4 optionally includes at least one actuator configured to actuate lateral displacement of the distal portion of the laser fiber in a specified pattern based on a control signal provided by the controller circuitry.

[0011] In Example 6, the subject matter of Example 5 can optionally include: wherein the distal portion of the laser fiber is further actuatable to be longitudinally translatable relative to the at least one actuator.

[0012] In Example 7, the subject matter of any one or more of Examples 5 to 6 optionally includes: wherein at least one actuator includes: a first actuator configured to actuate lateral displacement of a distal portion of the laser fiber; and a different second actuator configured to actuate longitudinal translation of the laser fiber.

[0013] In Example 8, the subject matter of any one or more of Examples 5 to 7 optionally includes wherein the controller circuit system is configured to use the feedback signal to generate a control signal for actuating at least one actuator in response to electromagnetic radiation of the target.

[0014] In Example 9, the subject matter of Example 8 optionally includes: wherein the feedback signal includes imaging data or spectral data.

[0015] In Example 10, the subject matter of any one or more of Examples 8 to 9 optionally includes: wherein the controller circuit system is configured to use information about the distance between the distal end of the laser fiber and the target to generate a control signal for actuating at least one actuator.

[0016] In Example 11, the subject matter of any one or more of Examples 1 to 10 optionally includes: wherein the distal portion of the laser fiber is at least one of: capable of being electromagnetically, electrostatically, or piezoelectrically actuated to be displaced laterally within and relative to the longitudinal channel when actuated according to a control signal provided by the controller circuit system.

[0017] In Example 12, the subject matter of any one or more of Examples 1 to 11 optionally includes: wherein the laser fiber is coupled to a laser source, and the laser source is controlled by a controller circuit system to provide a lateral pattern of lower energy laser pulses toward the periphery of the target and at least one higher energy laser pulse toward the center of the target without requiring lateral repositioning of the endoscope.

[0018] In Example 13, the subject matter of Example 12 optionally includes: wherein the transverse pattern includes at least one of a spiral pattern, a serpentine pattern, a star pattern, or a zigzag pattern.

[0019] In Example 14, the subject matter of any one or more of Examples 1 to 13 optionally includes: wherein the distal portion of the laser fiber is capable of being actuated to be at least laterally positioned within the longitudinal channel and adjustably relative to a central longitudinal axis of the longitudinal channel at a selected position among a plurality of available lateral displacement positions within the longitudinal channel of the endoscope.

[0020] In Example 15, the subject matter of any one or more of Examples 1 to 14 optionally includes: wherein the distal portion of the laser fiber is capable of being actuated to be adjustably positioned at least laterally within the longitudinal channel and relative to the central longitudinal axis of the laser fiber at a selected position among a plurality of available lateral displacement positions within the longitudinal channel of the endoscope.

[0021] In Example 16, the subject matter of any one or more of Examples 5 to 10 optionally includes: wherein at least one actuator is configured to: actuate a distal portion of the laser fiber to be adjustably positioned at least laterally within the longitudinal channel and relative to the longitudinal channel at a selected position among a plurality of available lateral displacement positions within the longitudinal channel of the endoscope while maintaining the endoscope laterally stationary.

[0022] In Example 17, the subject matter of Example 16 optionally includes: wherein the at least one actuator is located at a distal portion of the laser fiber.

[0023] In Example 18, the subject matter of any one or more of Examples 16 to 17 optionally includes: wherein the at least one actuator is located at a proximal portion of the laser fiber.

[0024] Example 19 is a method of laser therapy via an endoscope that allows for at least laterally redirecting a laser beam relative to a target area without moving the endoscope. The method includes: providing a laser fiber configured to extend through a longitudinal channel of an endoscope; and issuing or receiving a control signal to actuate the following operations: positioning a distal portion of the laser fiber at least laterally within the longitudinal channel of the endoscope at a selected position among a plurality of available laterally displaced positions within the longitudinal channel of the endoscope.

[0025] In Example 20, the subject matter of Example 19 can optionally include: wherein the laser fiber is actuated by the controller to provide the first laser pulse and the second laser pulse via the laser fiber, wherein the second laser pulse comprises a higher energy than the first laser pulse.

[0026] In Example 21, the subject matter of Example 20 optionally includes: wherein, without requiring lateral repositioning of the endoscope, the second laser pulse is emitted when the distal portion of the laser fiber is relatively closer to the center of the target area than when the first laser pulse was emitted.

[0027] In Example 22, the subject matter of any one or more of Examples 20 to 21 optionally includes: wherein the second laser pulse is emitted after a specified time interval when the first laser pulse is emitted, and wherein the first laser pulse is repeatedly emitted to consistently apply the first laser pulse energy to the target area.

[0028] In Example 23, the subject matter of Example 22 can optionally include wherein the first laser pulses are repeatedly emitted while being directed along the pattern boundary toward a lateral periphery of the target area, wherein the second laser pulses are applied laterally closer to a center of the target area.

[0029] In Example 24, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein the distal portion of the laser fiber is laterally displaced in a helical pattern according to a control signal provided by the controller.

[0030] In Example 25, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein the distal portion of the laser fiber is laterally displaced in a serpentine pattern according to a control signal provided by the controller.

[0031] In Example 26, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein the distal portion of the laser fiber is laterally displaced in a zigzag pattern according to a control signal provided by the controller.

[0032] In Example 27, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein the distal portion of the laser fiber is laterally displaced in a star pattern according to a control signal provided by the controller.

[0033] In Example 28, the subject matter of any one or more of Examples 19 to 27 optionally includes using information about at least one of a morphology or a composition of at least a portion of a target area to select or control a target pattern including different target lateral positioning.

[0034] In Example 29, the subject matter of any one or more of Examples 19 to 28 optionally includes issuing or receiving a control signal for actuating a distal portion of the laser fiber to shift laterally in a specified pattern to emit one or more laser pulses toward a lateral periphery of the target area before emitting one of a plurality of laser pulses closer to a center of the target area.

[0035] Example 30 is a laser therapy system for laser therapy via an endoscope that allows a laser beam to be at least laterally redirected toward a target without moving the endoscope, the system comprising: a laser fiber configured to extend through a longitudinal channel of the endoscope; and a device for issuing or receiving a control signal for positioning a distal portion of the laser fiber at least laterally at a selected position among a plurality of available laterally displaced positions within the longitudinal channel of the endoscope.

[0036] In Example 31, the subject matter of Example 30 optionally includes: wherein the laser fiber is coupled to a laser source controlled by a controller circuit system to provide a first laser pulse and a second laser pulse via the laser fiber, wherein the second laser pulse comprises a higher energy than the first laser pulse, and wherein the second pulse is emitted laterally closer to the center of the target than when the first laser pulse is emitted without requiring lateral repositioning of the endoscope.

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

[0038] In the drawings, which are not necessarily drawn to scale, like reference numerals may describe like components in different views. Like reference numerals with different letter suffixes may represent different instances of similarity.

[0039] Figure 1A A side cross-sectional view of a portion of an endoscope system is shown.

[0040] Figure 1B An end view of the lateral actuator and laser fiber is shown.

[0041] Figure 1C An end view of the lateral actuator and the laser fiber with stabilizer is shown.

[0042] Figure 1D A side cross-sectional view of a portion of an endoscope system is shown.

[0043] Figure 1E to Figure 1G Various examples of side cross-sectional views of a portion of an endoscope system are shown.

[0044] Figure 1H and Fig. 1IAn example of a system that uses a feedback signal reflected from a target to control and adjust the positioning of a laser fiber relative to the distal end of an endoscope is shown.

[0045] Figure 2 A side cross-sectional view of a portion of an endoscope system is shown.

[0046] Figure 3 A graph using different laser energies is shown.

[0047] FIG. 4A to FIG. 4D Various examples of varying spatial or spatiotemporal trajectories of a laser beam that can be actuated laterally, for example, without moving the endoscope, are shown. DETAILED DESCRIPTION

[0048] This document describes examples of methods that can help address the problem of controlling stone fragmentation during lithotripsy or other laser surgery or treatment, for example, which can include the use of a laser fiber that can be driven to be laterally positioned or repositioned, for example, relative to an arbitrary reference longitudinal axis of a working channel or other longitudinal passage of an endoscope or other instrument, for example, without requiring the endoscope or other instrument to be moved or repositioned. This can allow multiple pulses or patterns of multiple pulses to first disrupt or otherwise prepare a target stone, for example, at different target locations, at different intensities, or both, and then use a later delivered laser pulse to fragment the stone at a desired location and intensity. This may help break the stone into pieces small enough to pass naturally from the body, thereby reducing, minimizing, or avoiding the need for physician intervention to remove the fragments.

[0049] Figure 1A An example of a portion of an endoscope or similar medical system such as an endoscopic laser lithotripsy system 100 is shown. Figure 1A In an example of, the lithotripsy system 100 may include or be coupled to at least one laser source 130. The laser source 130 may be mechanically and optically connected to a laser fiber 140, which may include a single optical fiber or a bundle of optical fibers. The laser fiber 140 may be introduced via a proximal access port 142 to extend within a working conduit or other longitudinal channel 145 or lumen of an endoscope 110 or similar instrument. The endoscope 110 may include a proximal handle portion 112 and an elongated distal portion 113, which may be configured to be inserted into a patient's body, for example, via an orifice or incision. The endoscope 110 may be used to provide visual inspection or treatment of soft (e.g., non-calcified) tissue or hard (e.g., calcified) tissue, and to visualize or disintegrate or otherwise treat kidney stones or other stones or other targets.

[0050] exist Figure 1A In the embodiment of the present invention, the laser source 130 may include one or more laser sources, such as a diode or a diode-pumped thulium fiber laser, a holmium laser, a green laser, a YAG laser, or other types of lasers. The laser source 130 may be configured to provide a laser output of variable energy intensity. For example, a lower energy intensity may be used, for example, to provide a "targeting" beam or for treating soft (e.g., non-calcified) tissue, and one or more higher energy intensities may be used, for example, to provide a "treatment" beam to hard (e.g., calcified) tissue or stones. Multiple higher energy intensity treatment beam levels may be provided, for example, on a pulse-by-pulse or target position-dependent basis, for example, to establish, adjust, or tune the desired treatment pulse energy intensity to a specified level.

[0051] exist Figure 1A , the endoscope 110 may include or provide visualization and illumination optics, for example, may include a visualization optical path 160 and an illumination optical path 150, each of which may extend longitudinally along the elongated body 113 of the endoscope 110, for example, from a proximal handle 112 portion of the endoscope 110 to a distal portion of the endoscope 110. An eyepiece or camera or imaging display 115 may be disposed or coupled to the visualization optical path 160, for example, at or near the proximal handle 112 portion of the endoscope, which may, for example, allow user visualization or machine visualization of a target area 117 at or near the distal end of the endoscope 110. Such a target area 117 can be illuminated by light 170, which can be provided by an illumination light source 118 at the proximal end of the illumination optical pathway 150 and emitted from the distal end of the optical illumination pathway 150, or the light can be emitted from an LED or other illumination source that can be located at or near the distal end of the endoscope, such as having an electrical conductor extending longitudinally to provide power thereto.

[0052] exist Figure 1AIn the embodiment of the present invention, the endoscope 110 can include an elongated distal body portion 113 having a certain length. The endoscope 110 can include a working conduit or longitudinal channel 145 or other lumen extending along its length. The endoscope 110 can be rigid (e.g., rigid when inserted into an area with tissue, a rigid endoscope has sufficient cylindrical strength for insertion through long tubular anatomical structures, etc.) or flexible (e.g., flexible such as to follow the contours of a curved anatomical region (such as a ureter or biliary region)). The working conduit or longitudinal channel 145 or other lumen can define a reference longitudinal axis such as a central longitudinal axis extending therethrough, which is straight when the distal portion 113 of the endoscope 110 is straight, and which is curved when the distal portion 113 of the endoscope 110 is curved (e.g., in an implementation in which the endoscope is flexible). At the distal portion 113 of the endoscope 110, a central longitudinal axis can be defined extending longitudinally through a working conduit or longitudinal channel 145 or other lumen.

[0053] The method may include providing the ability to position or reposition a distal portion of the laser fiber 140 at least laterally relative to the longitudinal channel 145, such as relative to a reference longitudinal axis, such as a central longitudinal axis of a working tube or longitudinal channel 145 or other lumen through which the laser fiber 140 of the endoscope 110 extends. This may allow a user to view a target area via the visualization optical pathway 160 and position the distal portion of the endoscope 110 within the longitudinal channel 145 with the target stone in view and targeted by the laser fiber 140. Different lateral locations of the stone may then be targeted, for example, by positioning or repositioning the distal portion of the laser fiber 140 at different locations within the working tube or longitudinal channel 145 or other lumen through which the laser fiber 140 of the endoscope 110 extends. For example, this may allow the distal portion of the laser fiber 140 to be selectively positioned at a desired location, such as on a grid on an XY plane, which may be defined as extending orthogonal to the central longitudinal axis of the longitudinal channel 145 of the distal portion 113 of the endoscope 110.

[0054] For example, an actuator 185 may be included, for example, which may be located at or near the distal end of the endoscope to, for example, actuate lateral positioning or repositioning of a distal portion of the laser fiber 140 within and relative to the longitudinal channel 145 of the distal portion 113 of the endoscope 110. This may allow scanning or other lateral adjustments to the aiming of the laser fiber 140 without requiring the endoscope 110 to be bent or moved laterally. The controller circuit system 120 may be in electrical communication with the actuator 185, for example, via the electrical communication bus 127, to, for example, remotely control the actuator 185 to establish the lateral positioning of the laser fiber 140. The electrical communication bus 127 may include electrical connections extending along the laser fiber 140 or within the distal portion 113 of the body of the endoscope 110, for example, to connect with the actuator 185 or to electrical contacts thereof.

[0055] The actuator 185 can be controlled to position or reposition the distal portion of the laser fiber 140 within the longitudinal channel 145 of the distal portion 113 of the endoscope 110 to, for example, allow for delivery of laser energy via the endoscope 110 from different lateral positions without requiring lateral repositioning of the endoscope 110. For conceptual clarity of illustration and explanation, such positioning or repositioning of the distal portion of the laser fiber 140 is described herein relative to a longitudinal reference axis, such as a central longitudinal axis or other reference longitudinal axis. However, such lateral positioning or repositioning of the distal portion of the laser fiber 140 by the actuator 185 can be relative to another suitable fixed reference position, including relative to an internal lateral dimension such as the inner diameter (ID) of the longitudinal channel 145 itself.

[0056] The actuator 185 can be operated to actuate positioning or movement of the distal portion of the laser fiber 140, for example, to position the distal portion of the laser fiber 140 at a selected lateral position of a plurality of available lateral positions. Movement of the distal portion of the laser fiber 140 can be actuated and directed without requiring movement of the endoscope 110 or movement of the laser source 130. By allowing a user to maintain visualization of the target area 117 at a given position or location of the endoscope 110 via the stationary visualization path 160, precise aiming, re-aiming, or both by the distal portion of the laser fiber 140 (e.g., by moving the distal portion of the laser fiber 140 laterally within and relative to the longitudinal channel 145) can be accomplished along with ease of positioning and aiming for the user.

[0057] The actuator 185 may be connected to or otherwise operably coupled to one or both of the laser fiber 140 and the endoscope 110, for example, to actuate lateral positioning of a distal portion of the laser fiber 140 within the longitudinal channel 145 or relative to the endoscope 110. For example, the actuator 185 may include one or more of an electromagnetic element, an electrostatic element, a piezoelectric element, or other actuation element, for example, to actuate or otherwise allow lateral positioning of the laser fiber 140 relative to a working line or other longitudinal channel 145 of the endoscope 110 or relative to another reference location that the endoscope 110 can use as a reference frame.

[0058] For example, Figure 1B An end view of an example of a portion of the actuator 185 is shown, which portion may be located within the longitudinal passage 145, for example, and which portion may have a circular outer peripheral inner diameter. Figure 1B As shown in FIG. 1 , the actuator 185 may include at least one permanent magnet or electromagnet 190, which may be fixed, for example, to the distal portion of the laser fiber 140. The one or more permanent magnets or electromagnets 190 may be affected by a magnetic field or electromagnetic field generated by the actuator 185. Such a magnetic field or electromagnetic field may be generated to actuate the distal portion of the laser fiber 140 in one of a plurality of laterally displaced positions (in Figure 1B Such a magnetic or electromagnetic field may be generated via at least one permanent magnet or electromagnet 191, which may be fixed, for example, at a desired location relative to the longitudinal channel 145, such as may be fixed within the longitudinal channel 145 or within the body of the endoscope 110 at or near the outer inner diameter of the longitudinal channel 145. Such a magnetic or electromagnetic field influence may be used to laterally move the distal portion of the laser fiber 140 to a specified lateral location relative to a fixed reference frame of the endoscope 110 (e.g., relative to the longitudinal channel 145 of the endoscope 110).

[0059] Figure 1CAn example of a portion of an actuator 185 is shown in which such electromagnetic actuation of lateral movement or positioning may optionally be combined with and aided by a mechanical stabilizer or positioning stage 192, which may include grooves or recesses, for example, that may help provide a plurality of well-defined stable lateral positions at which the laser fiber 140 may "rest" when not electromagnetically positioned or repositioned by the actuator 185. For example, a series of linear grooves spaced at well-specified distances in a semi-disc-shaped stabilizer stage 192 may define a series of available lateral positions at which the laser fiber 140 (or a second engagement mechanism) may be mechanically stabilized and from which sub-targeted laser pulses may be emitted toward a target object. Such linear translation may be actuated by controlling the influence of linearly actuated permanent magnets or electromagnets 191A-191B on permanent magnets or electromagnets 190 (fixed to laser fiber 140), which may be located, for example, at the end of a linear arrangement on stage 192 toward available lateral positioning. Rotational actuation of the mechanical stabilizer stage 192 by controlling the influence of one or more permanent magnets or electromagnets 194, which may be fixed to be distributed around the perimeter of the longitudinal channel 145, on one or more permanent magnets or electromagnets 193 fixed to stage 192 may also provide rotational planar lateral positioning, for example to allow secondary aiming of the laser fiber 140 in polar coordinates without requiring lateral repositioning of the endoscope 110. An XY arrangement of grooves spaced at well-defined, specified distances in the stabilizer may similarly define a planar matrix of available lateral positioning for planar lateral positioning and secondary aiming in Cartesian coordinates. Additionally, illustrative examples of the second engagement mechanism or mechanical stabilizer or positioning stage 192 may include a pawl or gear arrangement.

[0060] Additionally or alternatively, the actuator 185 can use attractive or repulsive electrostatic forces, or both, between the distal portion of the laser fiber 140 and a fixed reference frame provided by the endoscope 110 to, for example, laterally position or reposition the distal portion of the laser fiber 140 relative to such a fixed reference frame. Such electrostatic actuation of lateral movement can optionally be combined with and assisted by a mechanical stabilizer or positioning stage 192, such as described herein.

[0061] Additionally or alternatively, the actuator 185 may use a piezoelectric or ferroelectric material to impart a force between the distal portion of the laser fiber 140 and a fixed reference frame provided by the endoscope 110, for example, to laterally position or reposition the distal portion of the laser fiber 140 relative to such a fixed reference frame. Such piezoelectric or ferroelectric actuation of lateral movement may optionally be combined with and assisted by a mechanical stabilizer or positioning stage 192, such as described herein. Optionally, the mechanical stabilizer or positioning stage 192 may be part of a mechanical lithotripsy device that may be included in or introduced into the endoscope 110 to, for example, deliver ultrasound or other mechanical impact energy to a kidney stone or other calculus or other target object. This may provide an additional lithotripsy approach that may provide the user with further flexibility to accomplish specific tasks or goals related to reduction or elimination or remodeling of a target object.

[0062] In general, any actuator 185 capable of imparting a force between the distal portion of the laser fiber 140 and the fixed reference frame provided by the endoscope 110 is contemplated alone or optionally in combination with a mechanical stabilizer or positioning stage. By configuring the actuator 185 to be remotely controlled, for example via the control circuit system 120, such lateral positioning or repositioning of the distal portion of the laser fiber 140 can allow for multiple positions of secondary aiming of a target object located near the distal end of the endoscope 110 or other instrument without the need to reposition such an endoscope 110 or other instrument. This may be useful for a user to keep the target object within the field of view, and such secondary aiming can be used to deliver a desired spatiotemporal sequence or sequence of laser pulses at various desired locations of the target object, including customizing the energy level of one or more individual laser pulses. This can allow a user to deliver the desired energy to the desired location in the desired spatial sequence or spatiotemporal sequence, which in turn can help determine how the target object will ultimately fragment. By doing so, one or more desired fragmentation characteristics can be encouraged or obtained. This in turn can alleviate post-fragmentation tasks or complications.

[0063] The actuator 185 can be operated as a scanner to direct the leading edge 141 of the laser fiber 140 to a certain angle or direction, for example, according to an input voltage or other control signal. The actuator 185 can be controlled to direct the leading edge 141 of the laser fiber 140 to emit laser beam pulses along a specified spatial pattern or spatiotemporal pattern (without moving the endoscope 110), and the actuator 185 can include, for example, the ability to adjust the laser pulse energy intensity on a pulse-by-pulse basis at one or more such secondary aiming positions within the spatial pattern or spatiotemporal pattern. In an example, the distance between such available secondary aiming positions can be equal to or exceed the diameter of the laser fiber 140. In another example, the distance between such secondary aiming positions can be less than the diameter of the laser fiber 140, which can, for example, allow overlap of pulses delivered from adjacent secondary aiming positions in a plurality of available secondary aiming positions.

[0064] The laser source 130 can be configured to provide a variable laser output to the target object via the laser fiber 140, and the variable laser output can include, for example, a low-energy continuous wave laser output for aiming or an adjustable variable higher-energy pulsed laser output. In an example, the initial positioning of the endoscope 110 and the aiming performed using the laser source 130 can be used alone or together with other information. For example, such other information can be provided by a user via a user interface to establish one or more features of a spatial pattern or a spatiotemporal pattern for secondary aiming at one or more locations of a target stone or object. For example, by using an aiming or alignment laser beam provided by the laser source 130, a user can select the center of a target stone or object. Such target positioning information can be recorded by the control circuit system 120 and can be used to initiate an appropriate spatial pattern or a spatiotemporal pattern for secondary aiming at one or more locations of a target stone or object, which can be based, for example, at least in part on the initial user aiming at the center of the target stone or object. Similarly, the user can use the aiming laser beam provided by the laser source 130 to select one or more locations on the periphery of the target stone or object and the target center, and the control circuit system 120 can record such information and use such information to establish, for example, an appropriate spatial pattern or spatiotemporal pattern for secondary aiming of one or more locations of the target stone or object based at least in part on such initial user aiming of the center and periphery of the target stone or object. Other user input information or pre-operation or interoperation imaging information can be provided to the control circuit system 120, for example, via one or more user interface devices or sensors, such as information about one or more characteristics of the target stone or object or the environment of the target stone or object can be provided. Such information can be used by the control circuit 120, for example, based on such single-dimensional or multi-dimensional information to select sub-targets of an appropriate spatial or spatiotemporal pattern. Such selection can be algorithmic in nature, for example, can involve weighted or mixed information or can use machine learning techniques or artificial intelligence techniques to select appropriate spatial patterns or spatiotemporal patterns for secondary aiming, for example, based on training data involving other target stones or objects or target environments that exhibit one or more similar characteristics.

[0065] Figure 1DAn example of a system 100 is shown that may include an optical fiber 140 that may include a distal portion that may include, for example, an arcuate portion or other off-axis bend 143 or curved portion that may be oriented at an angle to a center or other longitudinal axis of the endoscope 110. The bend 143 may be used alone or in conjunction with lateral positioning provided by an actuator 185 to, for example, secondary aim one or more locations within or even outside of the inner diameter (ID) of a working tube or other longitudinal channel 145 or other lumen of the endoscope 110 through which the laser fiber 140 extends. Additionally or alternatively, the actuator 185 may optionally include a rotational actuation capability to, for example, rotate the curved distal portion of the laser fiber 140 for secondary aiming. The actuator 185 need not be located entirely at the distal portion of the endoscope 110. Instead, a portion of the actuator 185 may be located at the proximal handle 112 for example to rotate or vibrate the laser fiber 140 to, for example, obtain a desired orientation of a curved or straight distal portion of the laser fiber 140. Additionally or alternatively, the actuator 185 may optionally include a bending actuation capability to, for example, adjust the bend of the distal portion of the laser fiber 140 for secondary aiming, for example, electromagnetically, electrostatically, piezoelectrically, or otherwise, as explained herein. Additionally or alternatively, the position of the secondary aiming, the peripheral boundary of the secondary aiming, or both may be controlled by one or more of such rotational actuation, bending actuation, or lateral actuation. As explained herein, such various actuations may be useful during laser aiming (e.g., continuous wave) or laser therapy (e.g., pulsed) and do not require moving the endoscope 110 or the laser source 130.

[0066] Figure 1E to Figure 1G An example of a system 100 is shown in which a laser fiber 140 can be longitudinally axially translated to various positions relative to the distal end of an endoscope 110. Figure 1E and Figure 1FAs shown in , such axial translation of the laser fiber 140 can include axial translation (e.g., sliding) relative to the longitudinal direction of the actuator 185. This can allow the actuator 185 to remain within the endoscope 110 to, for example, provide lateral positioning or repositioning of the laser fiber 140, while still allowing the laser fiber 140 to be freely repositioned axially, which can, for example, include the laser fiber protruding outward from the distal end of the working tube or other lumen of the endoscope 110, or, for example, can include retracting the laser fiber to be flush with the working tube or other longitudinal channel 145 or lumen of the endoscope 110, or being slightly pulled in the working tube or other longitudinal channel 145 or lumen of the endoscope 110. Regardless of the positioning of the axial translation of the distal side 141 of the laser fiber 140, the laser fiber 140 can still be laterally adjustably positioned relative to the longitudinal channel 145 or other fixed reference frame of the endoscope 110. The lateral positioning of the distal portion of the laser fiber 140 can be selected from a plurality of available lateral positionings (e.g., such as Figure 1B The laser fiber 140 can be moved laterally without moving the endoscope 110 or the laser source 130. Figure 1E An example is shown in which the distal end face 141 of the laser fiber 140 can be longitudinally translated and positioned to extend out of the endoscope 110 and into the body to, for example, accomplish positioning of the laser fiber 140 to a desired treatment site.

[0067] In some examples, more than one actuator may be used to separately actuate and control different motions of laser fiber 140 . Figure 1G An example of a system 100 including two separate actuators in an endoscope is shown. In the example shown therein, a first actuator 185A can control the longitudinal axial translation of the laser fiber 140, and a different second actuator 185B can control the lateral positioning of the laser fiber 140.

[0068] Figure 1H and Fig. 1I An example of a system 100 is shown that uses a feedback signal reflected from a target to control and adjust the position of a laser fiber 140 relative to the distal end of an endoscope 110. The feedback signal may be generated in response to electromagnetic radiation (e.g., light 170) from the target. Figure 1H, the target is brought within the field of view of the endoscopic camera or imaging device 125 through the optical path 160. In response to the electromagnetic radiation of the target, the signal reflected from the target can be collected by the endoscopic camera or imaging device 125. The imaging data of the target can be transmitted to the feedback analyzer 182 through the optical path 160. The feedback analyzer 182 may include a spectrometer configured to generate one or more spectral characteristics based on the imaging data. The controller circuit system 120 can use the one or more spectral characteristics to adjust the laser settings of the laser source 130. The feedback analyzer 182 can additionally calculate the distance between the distal end of the laser fiber 140 and the target. The controller circuit system 120 can control the actuator 185 to adjust the positioning of the distal end of the optical fiber based on the calculated distance between the distal end of the laser fiber 140 and the target. For example, if the calculated distance exceeds the desired laser shot range (within a specified margin), the controller circuit system 120 can generate a control signal to control the actuator 185 to slide the laser fiber 140 toward the target until the distal end of the fiber arrives within the laser shot range relative to the target. In some examples, spectral information of the target from the feedback analyzer 182 can be used by the controller circuit system 120 to determine the movement and positioning of the laser fiber 140 via the actuator 185.

[0069] In some examples, in addition to or instead of transmitting the imaging signal via optical path 160, the signal reflected from the target may be collected and transmitted via a different optical path. Fig. 1I In the embodiment of the present invention, the laser fiber 140 can be used to deliver the laser beam to the target and to transmit the spectral data of the target back to the feedback analyzer 182. The beam splitter 183 can guide the reflected feedback signal to the feedback analyzer 182. The feedback analyzer 182 can generate one or more spectral characteristics based on the spectral signal, and the controller circuit system 120 can use the one or more spectral characteristics to adjust the laser settings of the laser source 130. Similar to the above reference Figure 1H As discussed above, feedback analyzer 182 may additionally calculate the distance between the distal end of laser fiber 140 and the target. Controller circuitry 120 may control actuator 185 to adjust the positioning of the distal end of the fiber based on the calculated distance, optionally in conjunction with spectral information of the target from feedback analyzer 182.

[0070] Figure 2An example of a portion of a system 200 similar to system 100 is shown, wherein the laser source 130 may include a combination of two laser sources, for example, the laser source 130 may include, for example, a therapeutic laser source 210 that may provide a therapeutic laser beam (e.g., pulsed, higher energy) and an aiming laser source 220 that may provide an aiming beam (e.g., continuous wave, lower energy). The therapeutic beam 210 may include laser pulses of adjustable or variable energy. For example, a lower energy pulse may be used to first form cracks on a target surface of a stone or other target, for example, according to a desired or specified spatial pattern or spatiotemporal pattern. Then, one or more higher energy pulses may be used to fragment the stone or other target, which may, for example, be biased toward fragmentation along the previously established cracks. By doing so, the morphology of the resulting fragments may be better controlled.

[0071] In an example, instead of or in addition to delivering laser pulses of adjustable or variable energy, the treatment beam may include laser energy that can be delivered at a variable peak power. For example, instead of delivering laser energy at a specific pulse width and constant amplitude, the pulse width may be increased by a factor and the amplitude may be reduced by the same factor, so that the same amount of laser energy may be delivered at different power levels. Variable energy and variable power may be used together or separately in a laser pulse sequence that may, for example, be delivered to a target area according to a desired spatiotemporal pattern. For example, a low peak power with a long pulse width may help evaporate organic or inorganic matter in a target stone (e.g., for calcium oxalate monohydrate crystals, delivering laser energy at a lower temperature may help energy penetrate to a deeper depth), for example, to help accelerate thermal degradation of the target stone. After delivering laser energy at a lower peak power (e.g., with a long pulse width), if desired, laser energy may then be delivered at a higher peak power, with a shorter pulse width to generate a thermal gradient in the target stone.

[0072] Figure 3 A spatiotemporal diagram 300 is shown using a spatiotemporal sequence of laser pulses having different pulse energies or power levels, which may include, for example, a lower energy pulse 310 and a higher energy laser pulse 320. Figure 3, the sequence represents time in the X-direction of the figure, but also has locations "A" and "B" on the stone or other target labeled. In this example, location "A" is at or near the center of the stone or other target, while location "B" is at or near the periphery of the stone or other target. The laser pulses emitted between locations "A" and "B" show pulses emitted as the laser fiber 140 is translated from location "A" to location "B" or as the laser fiber 140 is translated from location "B" to location "A" - for example, which may include the use of actuator 185. Lower energy pulses 310 may be selected to induce cracks in the target stone without fragmenting the target stone. Thus, in Figure 3 In the embodiment of the present invention, such a lower energy pulse 310 may be emitted from position "A" toward the center of the stone, then travel toward position "B" toward the periphery of the stone, and then return to position "A" toward the center of the stone, at which time a higher energy pulse 320 may be transmitted in a first attempt to break the target stone. If such breaking by the higher energy pulse 320 is unsuccessful, another lower energy pulse 310 may be transmitted from a position toward the center of the stone toward position "B" toward the periphery of the stone, and then return to position "A" at the center of the stone, at which time another higher energy pulse 320 may be transmitted in a second attempt to break the target stone. Further iterations are also possible. The same or different positions "B" toward the periphery of the stone may be used for various iterations, wherein different positions "B" in different iterations produce multiple cracks along such a path from position "A" to such different peripheral positions "B". Preferably, a higher energy pulse 320 may be used only toward the center of the stone, for example to minimize the effect of the higher energy pulse 320 on nearby tissues. Figure 3 The spatiotemporal pattern shown in is an illustrative example of one such pattern that may be obtained, for example, using actuator 185, which may be remotely controlled using control circuitry 120 as explained above.

[0073] FIG. 4A to FIG. 4D An example of a spatial pattern or spatiotemporal pattern is shown that may be obtained, for example, without requiring the user to reposition the endoscope 110 using an actuator 185, which may be remotely controlled, for example, using the control circuit system 120. As explained herein, such lateral positioning actuation of the laser fiber 140 may be accompanied by rotational positioning actuation to, for example, provide secondary aiming, such as according to polar coordinates.

[0074] exist Figure 4AIn the embodiment of the present invention, lower energy laser pulses may be emitted starting from a peripheral location "B" at the periphery of the target stone B, and such pulses may be applied along the spiral path 400 toward a central location "A" where a higher energy pulse may be emitted in an attempt to fragment a pre-fractured or pre-weakened target stone after treatment of the target stone by the lower energy pulse. As explained herein, multiple iterations are possible, and multiple iterations may also optionally vary one or more of the energy or power levels, for example.

[0075] exist Figure 4B 4, lower energy laser pulses may be initiated at a peripheral location "B" and may continue along the serpentine path 420. Higher energy laser pulses "A" may be applied at or near the center location "A" of the target stone either on the initial path or after the serpentine path is complete. As explained herein, further iterations are possible, further iterations may, for example, be initiated at or near the same or different peripheral location "B", further iterations may, for example, also optionally vary one or more of the energy or power levels.

[0076] exist Figure 4C In the embodiment of the present invention, lower energy laser pulses may be emitted starting at peripheral location "B" and may continue to be emitted along a "star-shaped" path of linear segments, such as from peripheral location "B" to peripheral location "C" to peripheral location "D" to peripheral location "E" to peripheral location "F" and then to peripheral location "B". Then, higher energy laser pulses may be emitted and directed toward the center location "A".

[0077] exist Figure 4D 4, lower energy laser pulses may be initiated at peripheral locations "B" and may travel through the target stone along a zigzag pattern 440. Higher energy laser pulses may then be initiated and directed toward the center location "A". As explained herein, further iterations are possible, further iterations may, for example, be initiated at or near the same or different peripheral locations "B", further iterations may, for example, also optionally vary one or more of the energy or power levels.

[0078] The above description emphasizes a use case involving lithotripsy via endoscopic instruments. However, the present technology may also be applied using other minimally invasive instruments (e.g., laparoscopes, arthroscopy, etc.) or even using guides in open surgery. The present laser secondary aiming, which does not require a mobile guide device, may also be used with medical treatment techniques other than lithotripsy, or may be used for laser surgery or other uses involving targeted delivery of laser energy. Targets may include not only kidney stones, gallstones, gallbladder stones, or other stones, but may also include bone or cartilage or other hard or soft tissues.

[0079] In the example of tissue ablation where the target includes tissue to be ablated or coagulated rather than a target stone, the desired spatiotemporal pattern may include providing fixed or variable energy, fixed or variable power, or fixed or variable wavelength laser energy from one or more laser sources, for example in a pulsed continuous wave or otherwise, to, for example, facilitate one or more of cutting or coagulation, or to balance or otherwise coordinate between these two or other objectives.

[0080] The above detailed description includes reference to the accompanying drawings that form a part of the detailed description. The accompanying drawings show specific embodiments in which the present invention can be put into practice by way of illustration. These embodiments are also referred to as "examples" in this article. Such examples may include elements other than those shown or described. However, the inventors also contemplate examples that only provide those shown or described elements. In addition, the inventors also contemplate examples using any combination or arrangement of those elements (or one or more aspects thereof) shown or described with respect to a specific example (or one or more aspects thereof) or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0081] In the event of an inconsistency in usage between this document and any document incorporated by reference, the usage in this document controls.

[0082] In this document, the terms "a" or "an" are used to include one or more than one, as is common in patent documents, independent of any other instance or usage of "at least one" or "one or more". In this document, unless otherwise noted, the term "or" is used to represent a non-exclusive or, such that "A or B" includes "A but not B", "B but not A", and "A and B". In this document, the terms "including" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "wherein". In addition, in the following claims, the terms "including" and "comprising" are open-ended, that is, a system, device, article, composition, preparation, or process in a claim that includes elements other than those listed after such a term is still considered to fall within the scope of the claim. In addition, in the appended claims, the terms "first", "second", and "third", etc. are used merely as labels and are not intended to impose numerical requirements on their objects.

[0083] The above description is intended to be illustrative rather than restrictive. For example, the above examples (or one or more aspects thereof) can be used in combination with each other. For example, a person of ordinary skill in the art can use other embodiments after reading the above description. An abstract is provided to enable the reader to quickly determine the nature of the technical disclosure. Submitting an abstract is based on the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the above specific embodiments, various features can be combined together to streamline the disclosure. This should not be interpreted as meaning that the disclosed features that are not claimed for protection are necessary for any claim. Instead, the subject matter of the invention may not lie in all the features of a specific disclosed embodiment. Therefore, the attached claims are incorporated into the specific embodiments as examples or embodiments herein, and each claim exists independently as a separate embodiment, and it is expected that such embodiments can be combined with each other in various combinations or arrangements. The scope of the present invention should be determined with reference to the attached claims and the full scope of equivalents enjoyed by such claims.

Claims

1. A laser therapy system that allows delivery of laser energy via an endoscope from different positions in a transverse direction perpendicular to a longitudinal direction of the endoscope without requiring repositioning of the endoscope in the transverse direction, the laser therapy system comprising: a laser fiber including a distal portion configured to be inserted into a patient through a longitudinal channel of the endoscope; as well as an actuator including an electromagnetic element or an electrostatic element that can be actuated to adjustably position the distal portion of the laser fiber within the longitudinal channel and relative to the longitudinal channel at least in the transverse direction at a selected position of a plurality of available positions displaced in the transverse direction within the longitudinal channel of the endoscope, Wherein, the electromagnetic element includes a plurality of electromagnetic elements, which are circumferentially arranged on the distal portion of the endoscope and the laser fiber, and are used to generate lateral movement of the laser fiber in the longitudinal channel, or the electrostatic element includes a plurality of electrostatic elements, which are circumferentially arranged on the distal portion of the endoscope and the laser fiber, and are used to generate lateral movement of the laser fiber in the longitudinal channel.

2. The system according to claim 1, wherein: The distal portion of the laser fiber includes a bend.

3. The system according to claim 2, wherein: The distal portion of the laser fiber is rotatable about the longitudinal channel.

4. The system according to any one of claims 1 to 3, wherein: The laser fiber is configured to be coupled to a laser source that is controlled by a controller circuit system to provide a first laser pulse and a second laser pulse via the laser fiber, wherein the second laser pulse includes a higher energy than the first laser pulse, and wherein the second laser pulse is emitted closer to the center of the target in the lateral direction than when the first laser pulse is emitted without requiring repositioning of the endoscope in the lateral direction.

5. The system according to any one of claims 1 to 3, wherein: The actuator is configured to displace a distal portion of the laser fiber in the lateral direction in a specified pattern based on control signals provided by controller circuitry.

6. The system according to claim 5, wherein: The distal portion of the laser fiber can also be actuated to be longitudinally translatable relative to the actuator.

7. The system of claim 5, further comprising a second actuator configured to actuate longitudinal translation of the laser fiber.

8. The system according to claim 5, wherein: The controller circuitry is configured to use a feedback signal to generate a control signal for actuating the actuator in response to electromagnetic radiation from a target.

9. The system according to claim 8, wherein: The feedback signal includes imaging data or spectral data.

10. The system according to any one of claims 8 to 9, wherein: The controller circuitry is configured to use information about a distance between a distal end of the laser fiber and the target to generate a control signal for actuating the actuator.

11. The system according to any one of claims 1 to 3, wherein: The laser fiber is coupled to a laser source that is controlled by a controller circuit system to provide a lateral pattern of lower energy laser pulses toward the periphery of the target and at least one higher energy laser pulse toward the center of the target without requiring repositioning of the endoscope in the lateral direction.

12. The system according to claim 11, wherein: The transverse pattern includes at least one of a spiral pattern, a serpentine pattern, a star pattern, or a zigzag pattern.

13. The system according to any one of claims 1 to 3, wherein: The actuator is actuatable so that a distal portion of the laser fiber is adjustably positioned within the longitudinal channel and at least in the transverse direction relative to a central longitudinal axis of the longitudinal channel at a selected position among a plurality of available positions displaced in the transverse direction within the longitudinal channel of the endoscope.

14. The system according to any one of claims 1 to 3, wherein: The actuator is actuatable so that a distal portion of the laser fiber is adjustably positioned within the longitudinal channel and at least in the transverse direction relative to a central longitudinal axis of the laser fiber at a selected position among a plurality of available positions displaced in the transverse direction within the longitudinal channel of the endoscope.

15. The system of claim 1, wherein: The actuator is located at a distal portion of the laser fiber.

16. The system of claim 1, wherein: The actuator is located partially at a proximal portion of the laser fiber.

17. The system of any one of claims 1 to 3, comprising a stabilizer stage configured to stabilize the distal portion of the laser fiber after being positioned, the stabilizer stage comprising a plurality of grooves or recesses in which the distal portion of the laser fiber is placed.

18. The system of claim 17, further comprising a rotation mechanism capable of rotating the stabilizer table about a longitudinal axis of the endoscope.

19. A laser therapy system for laser therapy via an endoscope, allowing redirection of a laser beam towards a target at least in a transverse direction perpendicular to the longitudinal direction of the endoscope without moving the endoscope, the system comprising: a laser fiber configured to extend through a longitudinal channel of the endoscope; an actuator including an electromagnetic or electrostatic element actuatable to position the distal portion of the laser fiber at least in the transverse direction at a selected position of a plurality of available positions displaced in the transverse direction within the longitudinal channel of the endoscope; as well as means for sending or receiving control signals to or from said actuator, Wherein, the electromagnetic element includes a plurality of electromagnetic elements, which are circumferentially arranged on the distal portion of the endoscope and the laser fiber, and are used to generate lateral movement of the laser fiber in the longitudinal channel, or the electrostatic element includes a plurality of electrostatic elements, which are circumferentially arranged on the distal portion of the endoscope and the laser fiber, and are used to generate lateral movement of the laser fiber in the longitudinal channel.

20. The system of claim 19, wherein: The laser fiber is coupled to a laser source controlled by a controller circuit system to provide a first laser pulse and a second laser pulse via the laser fiber, wherein the second laser pulse includes a higher energy than the first laser pulse, and wherein the second laser pulse is emitted closer to the center of the target in the lateral direction than the first laser pulse is emitted without requiring repositioning of the endoscope in the lateral direction.

21. The system of any one of claims 19 to 20, comprising a stabilizer stage configured to stabilize the distal portion of the laser fiber after being positioned, the stabilizer stage comprising a plurality of grooves or recesses in which the distal portion of the laser fiber is placed.

22. The system of claim 21 further comprising a rotation mechanism capable of rotating the stabilizer table about a longitudinal axis of the endoscope.

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