Medical systems, devices, and related methods

Abstract

The present invention relates to a medical system comprising an insertion device comprising a handle and a delivery portion, a laser fiber, a conductive wire, and a lock. The laser fiber extends through the insertion device and is coupled to a laser slider to control the position of the laser fiber relative to a distal end of the delivery portion. The conductive wire extends through the insertion device and is coupled to a wire slider to control the position of the laser fiber relative to the distal end of the delivery portion. The lock is positioned within the handle and is movable to selectively lock movement of the laser slider or movement of the wire slider.

Description

TECHNICAL FIELD

[0001] Various aspects of the present disclosure generally relate to medical systems, devices, and related methods. More particularly, the present disclosure relates to medical systems, devices, and methods for delivering laser energy and delivering electrical energy in medical procedures. BACKGROUND

[0002] Medical lasers have been used for a variety of therapeutic procedures, including, for example, urology, neurology, otolaryngology, general anesthetized ophthalmology, dentistry, gastroenterology, cardiology, gynecology, as well as thoracic and plastic surgery. These procedures often require precisely controlled and directed energy delivery in order to successfully complete the desired procedure. Typically, a surgical probe is used to deliver laser energy to the body. The surgical probe typically includes an optical fiber coupled to a laser source, where the probe can be positioned such that the distal end of the probe is positioned near the target tissue. Laser energy is directed out of the distal end of the optical fiber onto the desired portion of the target tissue.

[0003] The medical professional performing the particular procedure manipulates the optical fiber into position near the target tissue and sets the laser power and mode for treating the target tissue. If there is bleeding and laser hemostasis is to be used, it is sometimes necessary to change the power and mode settings from one mode to another. However, some laser sources and / or laser fibers are not suitable for delivering energy to coagulate blood or otherwise stop bleeding. In these aspects, the user can need to remove the laser fiber and introduce another energy delivery or treatment device to assist in stopping bleeding or otherwise treating the tissue. Manually switching between devices can be time consuming, especially during the performance of the treatment. Furthermore, removing one device and delivering another device can increase the risk of injury, which complicates the procedure, increases stress on the user, and otherwise increases the risk and duration of the procedure.

[0004] The systems, devices, and methods of the present disclosure can correct some of the aforementioned shortcomings, and / or address other aspects of the prior art. SUMMARY

[0005] Examples of the present disclosure relate to medical systems, devices, and methods, among other things. Each of the examples disclosed herein can include one or more features described in connection with any other disclosed example.

[0006] In one example, a medical system can include an insertion device including a handle and a delivery portion, a laser fiber, a conductive wire, and a lock. The laser fiber can extend through the insertion device and can be coupled to a laser slider to control a position of the laser fiber relative to a distal end of the delivery portion. The conductive wire can extend through the insertion device and can be coupled to a wire slider to control a position of the laser fiber relative to the distal end of the delivery portion. The lock can be positioned within the handle and can be movable to selectively lock movement of the laser slider or movement of the wire slider.

[0007] The medical system can include one or more of the following aspects. The lock can include first and second side arms. In a first configuration, the first side arm can extend from a first side of the handle and the second side arm can be within or aligned with a second side of the handle opposite the first side. In a second configuration, the second side arm can extend from the second side of the handle and the first side arm can be within or aligned with the first side of the handle. The lock can include a front arm and a back arm. The front arm and the back arm can be laterally offset from each other. In the first configuration, the front arm can block distal movement of the wire slider to limit distal movement of the conductive wire and can allow distal movement of the laser slider and the laser fiber. In the second configuration, the back arm can block distal movement of the laser slider to limit distal movement of the laser fiber and can allow distal movement of the wire slider and the conductive wire.

[0008] The medical system can further include a spring within the handle for biasing distal movement of the wire slider. The wire slider can include a rod portion extending distally through a portion of the spring and the rod portion can limit distal extension of the wire slider. The laser fiber can include a distal end cap to direct laser energy. The distal end cap can include side openings to form a side-firing distal end. The laser slider can be movably positioned on a top portion of the handle and the wire slider can be movably positioned on a bottom portion of the handle. A proximal end of the laser fiber can be configured to be coupled to a laser energy source and a proximal end of the conductive wire can be configured to be coupled to an electrical energy source. The medical system can further include a first actuator configured to control laser energy delivery from the laser energy source to the laser fiber and a second actuator configured to control electrical energy delivery from the electrical energy source to the conductive wire. The laser fiber can be configured to deliver up to 180 W of 532 nm light.

[0009] In another example, a medical device can include a handle, a delivery portion extending from the handle, a first slider movably coupled to the handle and configured to control movement of a first energy delivery device, a second slider movably coupled to the handle and configured to control movement of a second energy delivery device, and a lock positioned at least partially within the handle. The lock can be movable between a first position in which a portion of the lock prevents the first slider from moving distally and a second position in which a portion of the lock prevents the second slider from moving distally.

[0010] The medical device can include one or more of the following aspects. The medical device can further include a spring coupled to a distal end of the second slider to bias movement of the second slider distally. The lock can include first and second side arms, a front arm, and a back arm. In a first configuration, the first side arm can extend from a first side of the handle and the second side arm can be positioned within or aligned with a second side of the handle opposite the first side. In a second configuration, the second side arm can extend from the second side of the handle and the first side arm can be positioned within or aligned with the first side of the handle. The front arm and the back arm can be laterally offset from each other such that, in the first configuration, the front arm can prevent the wire slider from moving distally so as to limit movement of the conductive wire distally and can allow the laser slider and the laser fiber to move distally. In the second configuration, the back arm can prevent the laser slider from moving distally so as to limit movement of the laser fiber distally and can allow the wire slider and the conductive wire to move distally.

[0011] In yet another example, a method of providing treatment to a treatment site can include positioning a distal end of a delivery portion of a medical device at the treatment site. The delivery portion can be coupled to a handle that includes a laser slider, a wire slider, and a lock. The laser slider can be coupled to a laser fiber and controllable to extend or retract the laser fiber from the distal end of the delivery portion. The wire slider can be coupled to a conductive wire and controllable to extend or retract the conductive wire from the distal end of the delivery portion. The lock can be movable to selectively limit distal movement of one of the laser slider or the wire slider. The method can further include positioning the lock in a first position in which the lock prevents the wire slider from moving distally to extend the laser fiber by moving the laser slider distally, deliver laser energy through the laser fiber to the treatment site to vaporize tissue, retract the laser fiber by moving the laser slider proximally, and positioning the lock in a second position in which the lock prevents the laser slider from moving proximally to extend the conductive wire by moving the wire slider distally and deliver electrical energy through the conductive wire to the treatment site to cauterize or coagulate tissue.

[0012] The method can include one or more of the following aspects. The lock can include two side arms and a front arm and a back arm. The front arm and the back arm can be laterally offset from each other, and the lock can be moved between the first position and the second position by pushing one of the side arms into or in alignment with a side of the handle. BRIEF DESCRIPTION OF DRAWINGS

[0013] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various example embodiments and together with the description, explain the principles of the disclosure.

[0014] Figure 1A A medical system is shown in accordance with aspects of the present disclosure, and Figure 1B A distal portion of the medical system is shown in Figure 1A

[0015] Figure 2A Another medical system is shown in accordance with aspects of the present disclosure, and Figures 2B-2D A distal portion of the medical system is shown in Figure 2A different views in different configurations;

[0016] Figure 3A A side view of yet another medical system is shown in accordance with aspects of the present disclosure, and Figures 3B-3F A cross-sectional view and a top view of portions of the medical system are shown in Figure 3A DETAILED DESCRIPTION DETAILED DESCRIPTION

[0017] Examples of the present disclosure include systems, devices, and methods for facilitating and improving the efficacy and safety of minimally invasive surgical procedures. For example, aspects of the present disclosure can relate to medical devices and methods for delivering laser energy and electrical energy during a medical procedure using a medical device, such as, for example, a procedure to treat tissue. In some embodiments, the medical systems, devices, and methods of the present disclosure can be used to treat a prostate of a patient, for example, to treat benign prostatic hyperplasia (“BPH”) or prostate enlargement, which can cause uncomfortable urinary symptoms, obstruction of urine flow from the bladder, and other bladder, urethra, or kidney problems. The medical systems, devices, and methods of the present disclosure can be used with systems for prostate photoselective vaporization (“PVP”), such as the GreenLight® (Boston Scientific Corp.) laser therapy for PVP, for example, the GreenLight® 532 laser system, the GreenLight® XPS laser system, the GreenLight® PerfX laser system, or the GreenLight® HPS laser system. TM laser systems for soft tissue treatment, particularly for PVP or vaporization of prostate tissue in BPH treatment. PVP systems can be used to deliver energy to vaporize or evaporate tissue that causes obstruction of urine flow, thereby clearing the obstruction. PVP treatment systems are generally described in U.S. Patent Nos. 6,554,824 and 6,986,764, which are hereby incorporated by reference in their entireties.​

[0018] Reference will now be made in detail to the present disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.

[0019] The terms "proximal" and "distal" as used herein refer to the relative positions of components of an example medical or insertion device. As used herein, "proximal" refers to a position relatively closer to the outside of the body or to an operator using the medical or insertion device. Conversely, "distal" refers to a position relatively further from the operator using the medical or insertion device or closer to the inside of the body.

[0020] The foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the features claimed. As used herein, the terms "comprises," "comprising," "including," "includes," "has," "have," or other variations thereof, are intended to cover a non-exclusive inclusion such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but can include other elements not expressly listed or inherent to such process, method, article, or apparatus. Further, the term "exemplary" is used herein in the sense of "example" rather than "ideal." As used herein, the terms "about," "substantially," and "approximately" mean values within + / - 5% of the stated value.

[0021] Figure 1A A medical system 10 is shown that includes a laser fiber 12 and a wire 14 that can be inserted by an insertion device 16 for delivery to a treatment site. The medical system 10 can also include a tube 18, such as an irrigation tube for delivering a saline solution or an aspiration tube for removing fluid or material. Although not shown, proximal portions of the laser fiber 12, wire 14, and tube 18 can be connected to one or more controllers, energy or fluid sources, etc. The insertion device 16 can be a cystoscope or other suitable insertion device and can include one or more lumens through which the fiber 12, wire 14, and tube 18 are inserted to reach the treatment site. As Figure 1A and 1B As shown, a distal portion 12A of the laser fiber 12 can extend distally beyond the insertion device 16.

[0022] The laser fiber 12 can be an optical fiber, such as a MoXy® optical fiber by Boston Scientific Corp. The wire 14 can be a metallic wire, such as a stainless steel wire. The tube 18 can be a polymeric tube, such as a polyurethane tube. TMOptical fiber. During surgical procedures including PVP treatment of BPH, laser fiber 12 can deliver 532nm laser energy to tissue from a compatible laser console. Laser fiber 12 may include one or more insulating layers, cladding layers, buffer layers, coatings, etc., to insulate and / or guide the energy delivered through laser fiber 12. Laser fiber 12 may include a distal end cap 20. Distal end cap 20 may include a side opening 22 so that laser fiber 12 emits laser energy out of side opening 22, thereby forming a side-emitting distal end. For example, laser fiber 12 can deliver up to 180W of 532nm light to tissue through the side opening 22 in distal end cap 20. Distal end cap 20 may be formed of a conductive material, such as a metal or conductive ceramic material. Alternatively, although not shown, distal end cap 20 may include a distal opening to deliver laser energy distally out of the distal opening for treating tissue.

[0023] Wire 14 may be a thin conductive wire (e.g., smaller than laser fiber 12) and may be formed of any suitable conductive material, such as a metallic material. Furthermore, the proximal end of wire 14 may be coupled to an electrical energy source, such as an RF current generator, to conduct electrical energy. Wire 14 may include one or more coatings and / or insulating layers to insulate and / or guide the energy conducted by wire 14.

[0024] like Figure 1B As shown, the distal portion of the wire 14 can be coupled to the distal portion 12A of the laser fiber 12, for example, to the distal end cap 20. In one aspect, the distal portion of the wire 14 can be fixedly coupled to the distal end cap 20 by welding, brazing, or other means. Thus, the user can deliver electrical energy to the tissue by energizing an electrical power source, causing the wire 14 to conduct energy and energize the distal end cap 20. The energized distal end cap 20 can be applied to the tissue, for example, to help cauterize and / or coagulate the tissue, thereby helping to stop bleeding or reduce bleeding. In this way, the user can deliver laser energy to the tissue via the laser fiber 12 through the side opening 22, and then deliver electrical energy to the tissue via the wire 14 and the distal end cap 20. The application sites of the laser energy and electrical energy can be controlled by the position of the distal end cap 20, for example, by extending or retracting the laser fiber 12 relative to the insertion device 16. Therefore, users can treat tissue with laser energy (i.e., vaporize) and also with electrical energy (i.e., burn and / or coagulate) without removing the laser fiber 12 or wire 14 from the insertion device or otherwise moving the components of the system 10.

[0025] Figures 2A-2D Alternative examples according to this disclosure are shown, wherein elements similar to medical system 10 are indicated by reference numerals plus 100. (See attached figures.) Figure 2AAs shown, the medical system 110 includes an insertion device 116 having a laser fiber 112 extending therethrough. The insertion device 116 can be a cystoscope or other suitable insertion device. The insertion device 116 can include a handle 130 and a delivery portion 132 including a distal extension 134. As described below, the distal extension 134 can include a conductive portion 142 Figure 2B ). The handle 130 can include one or more actuators, such as a trigger 136, and can also be coupled to one or more additional actuators, such as a foot pedal 138, via a cable 140. The one or more actuators can control laser energy delivery to tissue via the laser fiber 112, and can also control electrical energy delivery to tissue via the conductive portion 142.

[0026] Figure 2B is a side view of a distal portion 110A of the medical system 110, and Figure 2C and 2D are perspective views of the distal portion 110A in different configurations. As shown in Figure 2B , the laser fiber 112 and the distal extension 134 extend distally from the delivery portion 132. The laser fiber 112 can include a distal end cap 120, which can be a side-firing laser end cap having a side opening 122 to emit laser energy A, as described above. In the extended configuration as shown in Figure 2B , the laser fiber 112 can extend distally beyond the distal extension 134 such that at least the distal end cap 120 extends distally beyond the distal extension 134.

[0027] The distal extension 134 can include a conductive portion 142, for example, at a distal-most end of the distal extension 134. The conductive portion 142 can be formed of any suitable material, such as a metal or partially metal material, a conductive ceramic material, or the like. As described above with respect to the wire 14, the conductive portion 142 can be coupled to an energy source (i.e., an RF energy source, which is not shown). For example, the conductive portion 142 can be coupled to and energized via an internal conductive wire (not shown) extending through the handle 130 and the delivery portion 132. The conductive portion 142 can be energized and can be applied to tissue in order to help cauterize and / or coagulate tissue. Further, the conductive portion 142 can be electrically insulated from the rest of the distal extension 134 and the delivery portion 132 in order to control the size or amount of tissue that receives electrical energy. In one aspect, the conductive portion 142 can be formed of a conductive ceramic, and the rest of the distal extension 134 can be formed of a non-conductive ceramic.

[0028] Figure 2C shows the laser fiber 112 in an extended position, and Figure 2D shows the laser fiber 112 in a retracted position. Figure 2C and2D Both show the laser fiber 112 with a distal end cap 120A that can allow the laser fiber 112 to be used as an end-firing laser fiber, e.g., with a distal opening 122A, rather than a side-firing configuration with a side opening 122. In either aspect, the laser fiber 112 is movable relative to the delivery portion 132 by extending or retracting the laser fiber 112 relative to the handle 130 via a longitudinal or rotational actuator on the handle 130, e.g., a slider 144 on the handle 130, or any other suitable control mechanism. The laser fiber 112 is movable within a laser lumen 146 through the delivery portion 132. When the laser fiber 112 is in an extended position, laser energy can be emitted (e.g., as a beam 124) to treat (e.g., vaporize) tissue. When the laser fiber 112 is in a retracted position, electrical energy can be delivered to the conductive portion 142, and the conductive portion 142 can be applied to tissue to treat (e.g., cauterize or coagulate) the tissue. Thus, a user can treat tissue with laser energy (i.e., vaporize) and can also treat tissue with electrical energy (i.e., cauterize and / or coagulate) without removing the laser fiber 112 or the delivery portion 132 from the treatment site, without inserting additional electrodes or elements into the treatment site, and without otherwise moving elements of the system 110. Figure 2B The side-firing as shown or the end-firing as shown can be used to treat (e.g., vaporize) tissue. When the laser fiber 112 is in the retracted position, electrical energy can be delivered to the conductive portion 142, and the conductive portion 142 can be applied to tissue to treat (e.g., cauterize or coagulate) the tissue. Thus, a user can treat tissue with laser energy (i.e., vaporize) and can also treat tissue with electrical energy (i.e., cauterize and / or coagulate) without removing the laser fiber 112 or the delivery portion 132 from the treatment site, without inserting additional electrodes or elements into the treatment site, and without otherwise moving elements of the system 110. Figure 2C The side-firing as shown or the end-firing as shown can be used to treat (e.g., vaporize) tissue. When the laser fiber 112 is in the retracted position, electrical energy can be delivered to the conductive portion 142, and the conductive portion 142 can be applied to tissue to treat (e.g., cauterize or coagulate) the tissue. Thus, a user can treat tissue with laser energy (i.e., vaporize) and can also treat tissue with electrical energy (i.e., cauterize and / or coagulate) without removing the laser fiber 112 or the delivery portion 132 from the treatment site, without inserting additional electrodes or elements into the treatment site, and without otherwise moving elements of the system 110.

[0029] In addition, the delivery portion 132 can include one or more additional lumens (e.g., for irrigation, aspiration, etc.) and can include one or more visualization units 148 (e.g., cameras, illumination devices, etc.). Moreover, although the laser fiber 112, the delivery portion 134, and other components are shown as generally cylindrical, these components can take any suitable shape.

[0030] In one aspect, the distal extension 134 and the conductive portion 142 can have a shape that can facilitate pushing and / or adjusting the position of tissue and can also facilitate insertion of the medical system 110 into a treatment site. In this aspect, the distal extension 134 including the conductive portion 142 can include a rounded, angled, or otherwise damage-preventing distal tip 150, and / or can include a "duckbill" shape with a narrow distal-most portion that widens in the proximal direction. The distal extension 134 can extend about 10 to 12 mm from the delivery portion 132, and the conductive portion 142 can be about half the length of the distal extension 134. In this aspect, the conductive portion 142 can be within the range of a camera positioned within the visualization unit 148. The conductive portion 142 and the distal extension 134 can include a groove 152 that is at least partially aligned with the laser lumen 146 to accommodate and / or support a portion of the laser fiber 112 when the laser fiber 112 is in the extended position.

[0031] The user can move the handle 130, and thus the delivery portion 132, the distal extension 134, and the conductive portion 142, as well as the distal tip 150, can be used to adjust the position of the tissue being treated. In this regard, the distal tip 150 can contact the tissue being moved, and the conductive portion 142 can be de-energized. Alternatively, the conductive portion 142 can be energized, and the distal tip 150 can be used to move and treat (i.e., cauterize and / or coagulate) the tissue. For example, the distal tip 150 can be used to move tissue during a PVP procedure or during an enucleation procedure to remove prostate tissue (e.g., where the laser fiber 112 is a holmium laser fiber). In these regards, the user can deliver laser energy (i.e., vaporize or enucleate) to the tissue, can deliver electrical energy (i.e., cauterize and / or coagulate) to the tissue, and / or adjust the position of the tissue without removing the laser fiber 112 or the delivery portion 132 from the treatment site, without inserting additional electrodes or elements into the treatment site, and without otherwise moving elements of the system 110.

[0032] Figures 3A-3F An alternative example in accordance with the present disclosure is shown, where elements similar to the medical system 10 are represented by reference numerals plus 200. As Figure 3A and 3B shown, the medical system 210 includes an insertion device 216 having a laser fiber 212 and a wire 214 extending therethrough. The wire 214 can include an electrode at a distal end, such as a cauterization and / or coagulation electrode.

[0033] The insertion device 216 can be a cystoscope or other suitable insertion device. The insertion device 216 can include a handle 230 and a delivery portion 232. Although not shown, the delivery portion 232 can include one or more lumens, such as a first lumen to receive the laser fiber 212 and a second lumen to receive the wire 214. The handle 230 can include one or more actuators, such as a trigger, and can also be coupled to one or more additional actuators, such as a foot pedal, via a cable 240, as described with reference to Figure 2A The one or more actuators can control laser energy delivery via the laser fiber 212, and can also control electrical energy delivery via the wire 214. For example, a foot pedal similar to the foot pedal 138 in Figure 2A may be coupled to the handle 230 and can control laser energy delivery via the laser fiber 212. Likewise, a trigger similar to the trigger 136 in Figure 2A may be positioned on the handle 230 and can control electrical energy delivery via the wire 214.

[0034] Further, the handle 230 can include one or more sliders to control extension and / or retraction of the laser fiber 212 and the wire 214. For example, a laser slider 244 can be coupled (directly or indirectly) to a portion of the laser fiber 212, and a wire slider 260 can be coupled (directly or indirectly) to a portion of the wire 214. The handle 230 can also include a lock 270 to help control extension and / or retraction of the laser fiber 212 and the wire 214. For example, the lock 270 can help prevent the laser fiber 212 and the wire 214 from both extending distally from the delivery portion 232 at the same time, as exposure to laser energy can damage the wire 214 or a distal electrode coupled to the wire 214. Similarly, exposure to electrical energy can damage the laser fiber 212 and / or an end cap on the laser fiber 212.

[0035] The laser slider 244 can be positioned on a top portion of the handle 230 and movable relative to the handle 230, e.g., within a slot on the handle 230. The laser slider 244 can be coupled to the laser fiber 212 via a slider arm 264. For example, the slider arm 264 can be coupled to and / or surround one or more portions of the laser fiber 212, and forward or rearward movement of the laser slider 244 relative to the handle 230 can move the slider arm 264, and thus the laser fiber 212, forward or rearward relative to the insertion device 216. Thus, movement of the laser slider 244 on the handle 230 can control extension and / or retraction of the laser fiber 212 relative to the distal end of the delivery portion 232. Further, it is noted that the laser slider 244 can be coupled to and / or surround one or more portions of the laser fiber 212 in any suitable configuration (e.g., via a friction fit coupling, an adhesive coupling, a rocker arm coupling, etc.).

[0036] The wire slider 260 can be positioned on a bottom portion of the handle 230 and movable relative to the handle 230, e.g., within another slot on the handle 230. The wire slider 260 can be coupled to and / or surround a portion of the wire 214. Forward or rearward movement of the wire slider 260 relative to the handle 230 can extend or retract the wire 214 relative to the insertion device 216. Further, it is noted that the wire slider 260 can be coupled to and / or surround one or more portions of the wire 214 in any suitable configuration (e.g., via a friction fit coupling, an adhesive coupling, a rocker arm coupling, etc.). Further, movement of the wire slider 260 in at least one direction (e.g., forward) can be biased by a spring 280. The wire slider 260 can include a rod 282 that extends forward from the wire slider 260 within a portion of the spring 280 to help retain the spring 280. Further, the rod 282 can limit forward movement of the wire slider 260, and thus forward movement of the wire 214, by abutting an interior portion of the handle 230 in the forward position. Figure 3E )

[0037] Lock 270 can include two side arms 272 and 274 that can selectively extend from the sides of handle 230 depending on the position of lock 270. Lock 270 can also include a rear arm 276 and a front arm 278. Rear arm 276 and front arm 278 can be laterally offset from one another. In this regard, lock 270 can be positioned in at least two positions to selectively lock movement of laser sled 244 or wire sled 260.

[0038] Figure 3C and 3D Lock 270 is shown in a first position, which can correspond to a laser and / or vaporization mode. In this first position, lock 270 can prevent movement of wire sled 260 so that wire 214 can not extend from delivery portion 232, while laser sled 244 and laser fiber 212 can extend and / or retract. In this first position, first side arm 272 can extend from one side of handle 230, and second side arm 274 can be retracted within or aligned with the other side of handle 230. Figure 3D In addition, a rear portion of front arm 278 can abut a front portion of wire sled 260, thereby preventing movement of wire sled 260. In this configuration, a user can extend laser fiber 212 by moving laser sled 244 and deliver laser energy to treat tissue without the risk of wire 214 extending unexpectedly.

[0039] Figure 3E and 3F Lock 270 is shown in a second position, which can correspond to a burn and / or coagulation mode. In this second position, lock 270 can prevent movement of laser sled 244 so that laser fiber 212 can not extend from delivery portion 232, while wire sled 260 and wire 214 can extend and / or retract. Lock 270 can be moved from the first position to the second position by a user pushing first side arm 272 into handle 230. As a result, in the second position, second side arm 274 can extend from one side of handle 230, and first side arm 272 can be retracted within or aligned with the other side of handle 230. Figure 3F In addition, a rear portion of rear arm 276 can abut a front portion of laser sled 244 and / or sled arm 264, thereby preventing movement of laser sled 244. In this configuration, a user can extend wire 214 by extending wire sled 260 and deliver electrical energy to treat tissue without the risk of laser fiber 212 extending unexpectedly.

[0040] As Figure 3B and 3EAs shown, the extension of the wire 214 can be biased by the spring 280. Thus, a user can extend the wire 214 distally via the wire slider 260, but the spring 260 biases the wire slider 260 proximally such that when the user removes the distal pressure on the wire slider 260, the wire 214 returns to the retracted position. Moreover, the extension can be limited by the engagement or abutment of the rod 282 with the interior portion of the handle 230. Thus, as shown, the wire 214 can not extend as far from the delivery portion 232 as the laser fiber 212. Figure 3F As shown, the wire 214 can not extend as far from the delivery portion 232 as the laser fiber 212. Figure 3D ).

[0041] In some aspects, the movement of the laser slider 244, and thus the laser fiber 212, can not be biased. During a procedure, the laser fiber 212 is typically extended for a longer duration than the wire 214, and a user can wish to maintain the laser fiber 212 in the extended position without having to maintain pressure on the laser slider 244. However, as the laser slider 244 and the laser fiber 212 are extended proximally, the laser slider 244 can laterally abut a portion of the rear arm 276 in the longitudinal direction of the handle 230. Thus, the laser slider 244 can block the rear arm 276, thereby preventing the lock 270 from moving from the first position (laser mode) to the second position (cauterization and / or coagulation mode). The user can move the laser slider 244 to the distal position to retract the laser fiber 212, and then can move the lock from the first position to the second position to extend the wire 214 and treat the tissue.

[0042] The medical system 210 can help control the extension of the laser fiber 212 and the wire 214. For example, a user can deliver laser energy (i.e., vaporization) via the laser fiber 212 and can deliver electrical energy (i.e., cauterization and / or coagulation) via the wire 214 without having to remove the laser fiber 212, the wire 214, or the delivery portion 232 from the treatment site, without having to insert additional electrodes or elements into the treatment site, and without having to otherwise move elements of the system 210. Moreover, the lock 270 and the spring 280 can help prevent the laser fiber 212 and the wire 214 from being simultaneously extended distally from the delivery portion 232. As described above, the wire 214 can include a distal electrode (e.g., a cauterization and / or coagulation electrode), and the wire 214 and / or the distal electrode can be damaged if exposed to laser energy from the laser fiber 212.

[0043] Once the delivery portion 232 is inserted into the treatment site, the user can position the lock 270 in the first position (laser mode) by pushing the second side arm 274 into the handle 230 such that the first side arm 272 extends from the handle 230. Figure 3C and 3D). In this position, the front arm 278 abuts a portion of the wire sled 260. The user can then extend the laser fiber 212 from the delivery portion 232 by moving the laser sled 244 distally. The user can deliver laser energy to the tissue by activating the laser source (e.g., via a trigger, foot pedal, etc.) in order to vaporize the tissue at the treatment site. In the event that the tissue bleeds or otherwise becomes damaged during the application of the laser energy, the user can position the lock 270 in the second position (e.g., by retracting the laser sled 244 and pushing the first side arm 272 into the handle 230 so that the second side arm 274 extends from the handle 230) ( Figure 3E and 3F ). In this position, the rear arm 276 abuts a portion of the laser sled 244. The user can then extend the wire 214 from the delivery portion 232 by moving the wire sled 260 distally. The user can deliver electrical energy to the tissue by activating the electrical energy source (e.g., via a trigger, foot pedal, etc.) in order to cauterize and / or coagulate the tissue at the treatment site. The user can manually retract the wire 214 by moving the wire sled 260, or the spring 280 can automatically return the wire sled 260 to the distal position. The user can then continue to treat the tissue at the treatment site by selectively positioning the lock 270 in the first position or the second position. In any of the above steps, the user can reposition the distal end of the delivery portion 232 in order to treat different areas of the treatment site.

[0044] While much of the disclosure is directed to the treatment of prostate tissue, particularly for the treatment of BPH, it is further contemplated that the systems and procedures discussed herein can equally be applied to other medical procedures. For example, the medical systems 10, 110, 210 can be used for any medical procedure that requires both laser energy and electrical energy. In one aspect, the medical systems 10, 110, 210 can be used to deliver laser energy to a kidney stone in a percutaneous nephrolithotomy (“PCNL”) procedure, and to deliver electrical energy to cauterize and / or coagulate any tissue damaged during the laser energy delivery. The systems and methods described above can also be used for procedures to break up and / or treat ureteral stones, gallstones, bile duct stones, polyps, etc. Further, the medical system 210 can be used for any medical procedure that requires two different energy delivery devices, where exposure to the first energy can damage the second energy delivery device.

[0045] While the principles of the disclosure have been described herein with reference to illustrative examples for particular applications, it is to be understood that the disclosure is not limited to the foregoing. Those having ordinary skill in the art, and access to the teachings provided herein, will recognize additional modifications, applications, embodiments, and permutations of the features described herein that are within the scope of the features described herein. Accordingly, the claimed features are not to be seen as being limited by the foregoing description.

Claims

1. A medical system comprising: an insertion device comprising a handle and a delivery portion; a laser fiber, wherein the laser fiber extends through the insertion device and is coupled to a laser slider to control a position of the laser fiber relative to a distal end of the delivery portion; a conductive wire, wherein the conductive wire extends through the insertion device and is coupled to a wire slider to control a position of the laser fiber relative to a distal end of the delivery portion; and a lock positioned within the handle, wherein the lock is movable to selectively lock movement of the laser slider or movement of the wire slider, the lock comprising a first side arm, a second side arm, a front arm, and a back arm, the first and second side arms selectively extending from sides of the handle depending on a position of the lock, and the front and back arms being laterally offset from one another, wherein in a first configuration, the first side arm extends from a first side of the handle and the second side arm is within or aligned with a second side of the handle opposite the first side, and in a second configuration, the second side arm extends from the second side of the handle and the first side arm is within or aligned with the first side of the handle, wherein in the first configuration, the front arm prevents distal movement of the wire slider to limit distal movement of the conductive wire, and the laser slider and the laser fiber are permitted to move distally, wherein in the second configuration, the back arm prevents distal movement of the laser slider to limit distal movement of the laser fiber, and the wire slider and the conductive wire are permitted to move distally.

2. The medical system of claim 1, further comprising a spring within the handle to bias distal movement of the wire slider.

3. The medical system of claim 2, wherein, the wire slider comprises a rod portion that extends distally through a portion of the spring, and the rod portion limits distal extension of the wire slider.

4. The medical system of claim 1, wherein, the laser fiber comprises a distal end cap that directs laser energy.

5. The medical system of claim 4, wherein, the distal end cap comprises a side opening to form a side firing distal end.

6. The medical system of claim 1, wherein, the laser slider is movably positioned on a top portion of the handle, and the wire slider is movably positioned on a bottom portion of the handle.

7. The medical system of claim 1, wherein, a proximal end of the laser fiber is configured to be coupled to a laser energy source, and a proximal end of the conductive wire is configured to be coupled to an electrical energy source.

8. The medical system of claim 7, further comprising: a first actuator configured to control laser energy delivery from the laser energy source to the laser fiber; and a second actuator configured to control electrical energy delivery from the electrical energy source to the conductive wire.

9. The medical system of claim 8, wherein, the laser fiber is configured to deliver up to 180 W of 532 nm light.

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