Endoscopic laser energy delivery system and method of use

Abstract

Disclosed are systems, devices, and methods for delivering laser energy to a target during endoscopic surgery. An exemplary method includes providing a first laser pulse train and a second, different laser pulse train, emitted from a distal end of an endoscope and incident on a target. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level that is higher than the first laser energy level. In an example, the first laser pulse train is used to form cracks in a surface of a stone structure, and the second laser pulse train, after forming the cracks, causes the stone structure to fragment.

Description

[0001] Priority Declaration

[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, and U.S. Provisional Patent Application Serial No. 62 / 894,280, filed on August 30, 2019, the entire contents of which are incorporated herein by reference. Technical Field

[0003] The present disclosure relates generally to endoscopic laser systems and, more particularly, to systems and methods for controlling laser energy delivered to a target during endoscopic surgery. Background Art

[0004] Endoscopes are typically used to provide access to internal locations of a subject, thereby providing visual access for a physician. An endoscope is typically inserted into a patient's body, transmits light to a target being inspected (e.g., a target anatomical structure or object), and collects light reflected from the object. The reflected light carries information about the object being inspected. Some endoscopes include a working channel through which an operator can perform suction or pass an instrument such as a brush, biopsy needle, or forceps, or perform minimally invasive surgery to remove unwanted tissue or foreign matter from a patient's body.

[0005] Laser or plasma systems have been used to deliver surgical laser energy to various target treatment areas, such as soft or hard tissue. Examples of laser therapies include ablation, coagulation, vaporization, and fragmentation. In lithotripsy applications, lasers have been used to break up stone structures in the kidneys, gallbladder, ureters, and other stone-forming areas, or to ablate large stones into smaller fragments. Summary of the Invention

[0006] This disclosure describes systems, devices, and methods for delivering laser energy to a target during endoscopic surgery. An exemplary method includes generating a first laser pulse train and a second, different laser pulse train, emitted from a distal end of an endoscope and incident on a target. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level that is higher than the first laser energy level. In an example, the first laser pulse train is used to form cracks in a surface of a stone structure, and the second laser pulse train, after forming the cracks, causes the stone structure to fragment.

[0007] Example 1 is a method of providing laser therapy to a target, the method comprising: generating a first laser pulse train according to a first laser energy level, and generating a second laser pulse train according to a second laser energy level higher than the first laser energy level; and directing the first laser pulse train and the second laser pulse train from a distal end of an endoscope at the target.

[0008] In Example 2, the subject matter of Example 1 can optionally include: wherein the first laser pulse train is generated substantially constantly within a specific time period.

[0009] In Example 3, the subject matter of Example 2 may optionally include: wherein the second laser pulse train is intermittently generated within a specific time period during the generation of the first laser pulse train.

[0010] In Example 4, the subject matter of any one or more of Examples 1 to 3 can optionally include wherein the second laser pulse train is temporally located between two pulses of the first laser pulse train.

[0011] In Example 5, the subject matter of any one or more of Examples 1 to 4 may optionally include generating a third laser pulse train based on the first laser energy level, wherein the second laser pulse train is temporally located between the first laser pulse train and the third laser pulse train.

[0012] In Example 6, the subject matter of any one or more of Examples 1 to 5 may optionally include directing the first laser pulse train and the second laser pulse train at the stone structure.

[0013] In Example 7, the subject matter of Example 6 can optionally include the first laser pulse train being configured to form cracks on a surface of the stone structure, and the second laser pulse train being configured to induce fragmentation of the stone structure after forming the cracks.

[0014] In Example 8, the subject matter of any one or more of Examples 1 to 7 may optionally include directing the first laser pulse train and the second laser pulse train at the target tissue for hemostasis or coagulation therein.

[0015] Example 9 is an apparatus comprising: at least one processor; and at least one non-volatile memory comprising computer program code, the at least one non-volatile memory and the computer program code being configured to, utilizing the at least one processor, cause the apparatus to: cause a laser system to emit a first laser pulse train according to a first laser energy level and to emit a second laser pulse train according to a second laser energy level that is higher than the first laser energy level; and to direct the first laser pulse train and the second laser pulse train from a distal end of an endoscope at a target.

[0016] In Example 10, the subject matter of Example 9 may optionally include the first laser pulse train being substantially constant over a specific time period.

[0017] In Example 11, the subject matter of Example 10 may optionally include intermittently emitting the second laser pulse train during a specific time period during the generation of the first laser pulse train.

[0018] In Example 12, the subject matter of any one or more of Examples 9 to 11 optionally includes: wherein the at least one non-transitory memory and the computer program code are configured to, with the at least one processor, cause the apparatus to generate a second laser pulse train temporally between two pulses of the first laser pulse train.

[0019] In Example 13, the subject matter of any one or more of Examples 9 to 12 optionally includes: wherein the at least one non-transitory memory and the computer program code are configured to, with the at least one processor, cause the apparatus to generate a third laser pulse train according to the first laser energy level, and to generate a second laser pulse train temporally between the first laser pulse train and the third laser pulse train.

[0020] In Example 14, the subject matter of any one or more of Examples 9 to 13 optionally includes: wherein the at least one non-volatile memory and the computer program code are configured to, using at least one processor, cause the apparatus to transmit a first laser pulse train and a second laser pulse train at the stone structure; and the first laser pulse train is configured to form a crack on the surface of the stone structure, and wherein the second laser pulse train is configured to cause fragmentation of the stone structure after the crack is formed.

[0021] In Example 15, the subject matter of any one or more of Examples 9 to 14 optionally includes: wherein the at least one non-transitory memory and the computer program code are configured to, using the at least one processor, cause the device to deliver the first laser pulse train and the second laser pulse train at the target tissue for hemostasis or coagulation therein.

[0022] Example 16 is a non-transitory program storage device readable by a machine, tangibly embodying an instruction program executable by the machine for performing operations, the operations comprising: generating a first laser pulse train according to a first laser energy level, and generating a second laser pulse train according to a second laser energy level higher than the first laser energy level; and directing the first laser pulse train and the second laser pulse train from a distal end of an endoscope at a target.

[0023] In Example 17, the subject matter of Example 16 can optionally include wherein the first laser pulse train is generated substantially constantly within a specific time period, and the second laser pulse train is generated intermittently within a specific time period during which the first laser pulse train is generated.

[0024] In Example 18, the subject matter of any one or more of Examples 16 to 17 can optionally include wherein the operation includes generating a third laser pulse train according to the first laser energy level, wherein the second laser pulse train is temporally located between the first laser pulse train and the third laser pulse train.

[0025] In Example 19, the subject matter of any one or more of Examples 16 to 18 optionally includes: wherein the operation includes transmitting a first laser pulse train and a second laser pulse train at the stone structure; and wherein the first laser pulse train is configured to form a crack on the surface of the stone structure, and the second laser pulse train is configured to cause fragmentation of the stone structure after the crack is formed.

[0026] In Example 20, the subject matter of any one or more of Examples 16 to 19 optionally includes wherein the operation includes delivering the first laser pulse train and the second laser pulse train at the target tissue for hemostasis or coagulation therein.

[0027] This summary is an overview of some of the teachings of this application and is not intended to be an exclusive or exhaustive treatment of the subject matter. Further details on 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 examining the accompanying drawings, which form a part of this disclosure, and no aspect should be construed as having a limiting meaning. The scope of the present disclosure is defined by the appended claims and their legal equivalents. BRIEF DESCRIPTION OF THE DRAWINGS

[0028] Various embodiments are shown by way of example in the figures of the accompanying drawings. These embodiments are illustrative and are not intended to be exhaustive or exclusive of the present subject matter.

[0029] Figure 1 A schematic diagram of an exemplary laser therapy system including a laser feedback control system is shown.

[0030] Figures 2A to 2B Examples of absorption spectra of different types of tissue including hemoglobin (Hb) and oxyhemoglobin (HbO2) are shown.

[0031] Figures 3A to 3C Examples of absorption spectra of different types of tissues including normal and carbonized tissues, Hb, HbO2, and melanin are shown.

[0032] Figure 4 is a graph showing the penetration depth of laser output.

[0033] Figure 5 is a block diagram illustrating a laser feedback control system for providing laser output.

[0034] Figures 6 and 7 is a flow chart illustrating an example of an algorithm for controlling one or more laser systems based on feedback generated by a laser feedback control system.

[0035] Figure 8A timing diagram of an exemplary dual laser system providing tissue ablation and coagulation using two wavelengths of light is shown.

[0036] Figures 9A to 9B An example of an endoscope with a laser fiber inserted therein is shown.

[0037] FIG. 10A to FIG. 10B An example of a feedback-controlled laser therapy system is shown.

[0038] Figures 11A to 11B is a diagram illustrating an example of an endoscope system for identifying a target using a diagnostic beam such as a laser beam.

[0039] Figure 12 and 13A to 13B is a graph showing reflectance spectra used to identify target types, for example, to identify components of different types of kidney stones.

[0040] Figures 14 and 15 The light peaks corresponding to different parts of the UV wavelength are shown as well 13A to 13B Reflectance spectra of several types of stones.

[0041] 16A to 16B Examples of reflectance spectra captured from various soft and hard tissue components on a UV-VIS spectrometer are shown.

[0042] Figure 16C Examples of FTIR spectra of typical stone compositions are shown.

[0043] Figure 16D Examples of FTIR spectra of some soft and hard tissue components are shown.

[0044] Figures 17 and 18 A schematic diagram of a laser therapy system is shown.

[0045] Figures 19A to 19B An example of a combined laser pulse train generated using multiple (eg, N) laser pulse trains is shown.

[0046] Figure 20 A schematic diagram of an exemplary spectroscopy system with spectroscopy feedback is shown.

[0047] 21A to 21D An example of an endoscopic laser system with a multi-fiber configuration is shown.

[0048] Figure 22 is a block diagram illustrating an example of a multi-fiber system as used in an optical fiber delivery system for spectroscopy.

[0049] FIG. 23A to FIG. 23B An example of a multi-fiber accessory with source light input and spectroscopy feedback signal is shown.

[0050] 24A to 24D is a diagram illustrating an exemplary method of calculating the distance between a distal end of a laser delivery system (eg, an optical fiber) and a target.

[0051] FIG. 25A to FIG. 25B The effect of the distance between the tissue and the distal end of the spectroscopy probe on the spectrum of the reflected light from the target is shown.

[0052] Figure 26 An example of an endoscope system for identifying a target using a diagnostic beam such as a laser beam is shown.

[0053] Figure 27 Diagram showing laser pulse sequences with different pulse energies or power levels for laser treatment of target tissue or stone structures.

[0054] Figure 28 is a block diagram illustrating an example machine upon which any one or more of the techniques (eg, methodologies) discussed herein may be performed. DETAILED DESCRIPTION

[0055] Systems, devices, and methods for delivering laser energy to a target during endoscopic surgery are described herein. An exemplary method includes providing a first laser pulse train and a second, different laser pulse train, emitted from a distal end of an endoscope and incident on a target. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level that is higher than the first laser energy level. In an example, the first laser pulse train is used to form cracks in a surface of a stone structure, and the second laser pulse train, after forming the cracks, causes the stone structure to fragment.

[0056] In endoscopic laser therapy, it is desirable to identify different tissues, apply laser energy only to target treatment structures (e.g., cancerous tissue or a specific type of stone), and avoid or reduce exposure of non-treatment tissues (e.g., normal tissue) to laser irradiation. Conventionally, identification of the target treatment structure of interest is performed manually by an operator, for example by visualizing the target surgical site and its surroundings through an endoscope. Such manual methods may lack accuracy in at least some cases, for example due to close access to the operating site providing a limited surgical field of view, and may not be able to determine the composition of the target. Biopsy techniques have been used to extract target structures (e.g., tissues) from the body for analysis of their composition in vitro. However, in many clinical applications, it is desirable to determine the composition of tissues in the body to reduce surgical time and complexity and to improve treatment effectiveness. For example, in laser lithotripsy, which uses lasers to break up or crush stones, automatically and in vivo identifying specific types of stones (e.g., the chemical composition of stones in the kidney or pancreatic bile duct or gallbladder) and distinguishing them from surrounding tissue would allow the physician to adjust laser settings (e.g., power, exposure time, or emission angle) to more effectively ablate the target stone while avoiding irradiation of non-treatment tissue near the target stone.

[0057] Conventional endoscopic laser therapy also has a limitation in that it cannot continuously monitor tissue type (e.g., composition) during surgery. There are many moving parts during endoscopic surgery, and the tissue observed through the endoscope may change throughout the surgery. Because conventional biopsy techniques require taking out tissue samples to identify the composition, they cannot monitor the composition of the tissue throughout the surgery. Continuously monitoring and identifying the structure type (e.g., soft tissue type or hard tissue type, normal tissue versus cancerous tissue, or the composition of the stone structure) at the tip of the endoscope can provide doctors with more information to better adapt treatment during surgery. For example, if a doctor is crushing a kidney stone with a hard surface but a soft core, the continuous tissue composition information through the endoscope can allow the doctor to adjust the laser settings based on the continuously detected stone surface composition, such as adjusting from a first setting that performs better on the hard surface of the stone to a second, different setting that performs better on the soft core of the stone.

[0058] Some features described herein may provide methods and apparatus capable of identifying the composition of various targets (e.g., soft tissue or hard tissue) in vivo, such as in medical applications, through an endoscope. This may allow a user to continuously monitor the composition of the target observed through the endoscope throughout the procedure. This also has the ability to be used in conjunction with a laser system, where the method may send feedback to the laser system to adjust settings based on the composition of the target. This feature may allow for instant adjustment of laser settings within a range of settings selected by the user.

[0059] Some features as described herein can be used to provide the following systems and methods that measure differences such as the chemical composition of a target in vivo and recommend laser settings or automatically adjust laser settings to better achieve the desired effect. Examples of targets and applications include laser lithotripsy of kidney stones and laser cutting or vaporization of soft tissue. In one example, three main components are provided: a laser, a spectroscopy system, and a feedback analyzer. In an example, a controller of the laser system can automatically program the laser therapy using appropriate laser parameter settings based on the target composition. In an example, the laser can be controlled based on a machine learning algorithm trained using spectrometer data. Additionally or alternatively, a user (e.g., a physician) can continuously receive an indication of the target type during the procedure and be prompted to adjust the laser settings. By adjusting the laser settings and adapting the laser therapy to the compositional portion of a single stone target, the stone ablation or comminution process can be performed faster and in a more energy-efficient manner.

[0060] Some features described herein can provide systems and methods for providing data input to a feedback analyzer, including internet connectivity and connections to other surgical devices with measurement capabilities. Additionally, the laser system can provide input data to another system, such as an image processor, so that a surgical monitor can display information related to the medical procedure to the user. For example, one example of this is more clearly identifying different soft tissues, vasculature, and cystic tissue in the field of view during surgery, as well as different chemical compositions within the same target, such as a stone.

[0061] Some features as described herein can provide systems and methods for identifying different target types such as different tissue types or different stone types. In some cases, a single stone structure (e.g., a stone of the kidney, bladder, pancreaticobiliary duct or gallbladder) may have two or more different components in its entire volume, such as brushite, calcium phosphate (CaP), calcium oxalate dihydrate (COD), calcium oxalate monohydrate (COM), magnesium ammonium phosphate (MAP) or a stone structure based on cholesterol or based on uric acid. For example, the target stone structure can include a first portion of COD and a second portion of COM. According to one aspect, the present disclosure describes a system and method for continuously identifying the different components contained in a single target (e.g., a single stone) based on the continuous collection and analysis of in vivo spectroscopy data. Treatment (e.g., laser therapy) can be adapted according to the target component identified. For example, in response to the identification of the first component (e.g., COD) in the target stone, the laser system can be programmed using a first laser parameter setting (e.g., power, exposure time or emission angle, etc.), and accordingly transmits a laser beam to ablate or crush the first portion. Spectroscopic data can be continuously collected and analyzed during laser therapy. In response to identifying a second component (e.g., COM) different from the first component in the same target stone being treated, the laser therapy can be adjusted, for example by programming the laser system with a second laser parameter setting that is different from the laser parameter setting (e.g., different power or exposure time or emission angle, etc.), and delivering the laser beam accordingly to ablate or fragment the second portion of the same target stone. In some examples, the laser system can include multiple different laser sources. Stone portions of different compositions can be treated by different laser sources. The use of the appropriate laser can be determined by identifying the stone type.

[0062] Some of the features described herein can be used in connection with laser systems for various applications where combining different types of laser sources can be advantageous. For example, the features described herein can be applicable in industrial or medical settings, such as medical diagnostics, therapy, and surgery. The features described herein can be used in connection with endoscopy, laser surgery, laser lithotripsy, laser settings, and / or spectroscopy.

[0063] Figure 1 A schematic diagram of an exemplary laser therapy system including a laser feedback control system 100 is shown according to an illustrative example of the present disclosure. Example applications of the laser feedback control system 100 include integration into laser systems for many applications, such as industrial and / or medical applications for treating soft (e.g., non-calcified) or hard (e.g., calcified) tissue or stone structures, such as stones in the kidney, pancreatic bile duct, or gallbladder. For example, the systems and methods disclosed herein can be used to provide precisely controlled therapeutic treatments, such as ablation, coagulation, vaporization, etc., or to ablate, fragment, or pulverize stone structures.

[0064] Reference Figure 1 , the laser feedback control system 100 can be in operative communication with one or more laser systems. Figure 1 The laser feedback system is shown connected to a first laser system 102 and optionally (shown in dashed lines) to a second laser system 104, although additional laser systems are contemplated within the scope of the present disclosure.

[0065] The first laser system 102 can include a first laser source 106, and associated components such as a power supply, a display, a cooling system, etc. The first laser system 102 can also include a first optical fiber 108 operably coupled to the first laser source 106. The first optical fiber 108 can be configured to transmit laser output from the first laser source 106 to a target tissue 122.

[0066] In one example, the first laser source 106 can be configured to provide a first output 110. The first output 110 can extend within a first wavelength range. According to some aspects of the present disclosure, the first wavelength range can correspond to a portion of an absorption spectrum of the target tissue 122. The absorption spectrum represents the absorption coefficient within the laser wavelength range. Figure 2A The absorption spectrum of water 210 is shown by way of example. Figure 2B By way of example, an absorption spectrum of oxyhemoglobin 221 and an absorption spectrum of hemoglobin 222 are shown. In such an example, the first output 110 can advantageously provide effective ablation and / or carbonization of the target tissue 122 because the first output 110 is within a wavelength range corresponding to the absorption spectrum of the tissue.

[0067] For example, the first laser source 106 can be configured such that the first output 110 emitted in the first wavelength range corresponds to high absorption of the incident first output 110 by tissue (e.g., greater than about 250 cm -1 In an exemplary aspect, the first laser source 106 can emit a first output 110 between about 1900 nanometers and about 3000 nanometers (e.g., corresponding to high absorption by water) and / or between about 400 nanometers and about 520 nanometers (e.g., corresponding to high absorption by oxyhemoglobin and / or deoxyhemoglobin). Obviously, there are two main mechanisms by which light interacts with tissue: absorption and scattering. When the absorption of tissue is high (absorption coefficient exceeds 250 cm -1 ), the first absorption mechanism is dominant, while when the absorption is low (absorption coefficient is less than 250cm -1 ), such as lasers in the 800nm ​​to 1100nm wavelength range, the scattering mechanism dominates.

[0068] Various commercially available medical-grade laser systems can be suitable for use as the first laser source 106. For example, a semiconductor laser can be used, such as an InXGa1-XN semiconductor laser that provides a first output 110 within a first wavelength range between about 515 nanometers and about 520 nanometers or between about 370 nanometers and about 493 nanometers. Alternatively, an infrared (IR) laser can be used, such as those summarized in Table 1 below.

[0069] Table 1 Example list of IR lasers suitable for the first laser source 106

[0070]

[0071] Reference Figure 1 The laser treatment system of the present disclosure may optionally include a second laser system 104. As previously mentioned, the second laser system 104 includes a second laser source 116 for providing a second output 120, as well as associated components such as a power supply, a display, a cooling system, etc. The second laser system 104 can be operably separate from the first laser source 106, or in the alternative, the second laser system 104 can be operably coupled to the first laser source 106. In some examples, the second laser system 104 can include a second optical fiber 118 (separate from the first optical fiber 108) that is operably coupled to the second laser source 116 to transmit the second output 120. Alternatively, the first optical fiber 108 can be configured to transmit both the first output 110 and the second output 120.

[0072] In some aspects, the second output 120 may extend over a second wavelength range that is different from the first wavelength range. Thus, there may not be any overlap between the first wavelength range and the second wavelength range. Alternatively, the first wavelength range and the second wavelength range may have at least partial overlap with each other. According to some aspects of the present disclosure, the second wavelength range may not correspond to a portion of the absorption spectrum of the target tissue 122, where the incident radiation is strongly absorbed by tissue that has not been previously ablated or carbonized (e.g., as shown in FIG. 2 ). In some such aspects, the second output 120 may advantageously not ablate uncarbonized tissue. Furthermore, in another example, the second output 120 may ablate carbonized tissue that has previously been ablated. In additional examples, the second output 120 may provide additional therapeutic effects. For example, the second output 120 may be more suitable for coagulating tissue or blood vessels.

[0073] Laser emission can be highly absorbed by soft or hard tissue, stones, etc. By way of example, Figures 3A to 3C Absorption spectra of different tissue types are shown. Figure 3A The absorption spectra of normal tissue (before ablation) 311 and carbonized tissue (after ablation) 312 are shown respectively. Figure 3BIt shows that within a certain wavelength range (e.g., 450 nm to 850 nm), the absorption spectrum decays exponentially with the laser wavelength. Figure 3A and Figure 3B The sources of the data shown are: http: / / omlc.org / spectra / hemoglobin / ). Figure 3C Optical absorption spectra measured in different media are shown, including spectra 331A to 331C for water (at concentrations of 75%, 100%, and 4%, respectively), spectrum 332 for hemoglobin (Hb), spectrum 333 for oxyhemoglobin (HbO2), and spectra 334A to 334D for melanin (at volume fractions of 2%, 13%, 30%, and 100%, respectively, for melanosomes). Figure 3C The sources of the data shown in http: / / www.americanlaserstudyclub.org / laser-surgery-education / The wavelengths absorbed by water are in the range of 1900 nm to 3000 nm. The wavelengths absorbed by oxyhemoglobin and / or oxyhemoglobin are in the range of 400 nm to 520 nm. Although many surgical lasers are highly absorbed by water or hemoglobin, there is a limit to the range of media that absorb water, which may be the reason why the interior of the endoscope may become damaged by the laser energy.

[0074] Figure 4 The penetration depth of a laser output such as the second output 120 is shown. Figure 4 The sources of the data shown are: http: / / www.americanlaserstudyclub.org / laser-surgery-education / As seen therein, the second output 120 may be suitable for efficient coagulation due to a penetration depth comparable to the characteristic size of small capillaries (e.g., between about 5 μm and about 10 μm). Figure 3A and Figure 3B , the second wavelength range may correspond to low absorption of the second output 120 by tissue that has not been carbonized, but high absorption by tissue that has been carbonized (e.g., by ablation of the first output 110). Notably, the spectral characteristics of the second output 120 correspond to high absorption (e.g., greater than about 250 cm) of the incident second output 120 by carbonized tissue. -1 ) absorption. Examples of suitable second laser sources include GaN lasers having a second output 120 in a second wavelength range between about 750 nanometers and about 850 nanometers. X Al 1-X As, or In having a second output 120 in a second wavelength range between about 904 nanometers and about 1065 nanometers X Ga 1-X As.

[0075] While two laser systems with partially overlapping spectra suitable for absorption by tissue (normal and / or carbonized) are described above, in an alternative example, instead of the second laser system 104, the first laser system 102 can provide the second output 120. In an example, the first laser system 102 can provide a first output 110 in a first wavelength range suitable for high absorption by previously unablated "normal" tissue (e.g., as shown in FIG. 2 ) and a second output 120 in a second wavelength range, the first wavelength range corresponding to low absorption by tissue prior to carbonization and / or being more suitable for coagulation (e.g., as shown in FIG. 2 ). Figure 3A and Figure 3B ). The first laser system 102 can provide additional outputs in additional wavelength ranges.

[0076] Refer again Figure 1 According to an example, the laser treatment system includes a laser feedback control system 100. Referring now to Figure 5 As previously described, the laser feedback control system 100 can analyze the feedback signal 130 from the target tissue 122 and control the first laser system 102 and / or the second laser system 104 to generate appropriate laser output to provide the desired treatment effect. For example, the laser feedback control system 100 can monitor the characteristics of the target tissue 122 during a treatment process (e.g., ablation) to determine whether the tissue is properly ablated before another treatment process (e.g., coagulation of a blood vessel). Therefore, the laser feedback control system 100 can include a feedback analyzer 140.

[0077] Continue to refer to Figure 5According to one example, feedback analyzer 140 can monitor the spectroscopic properties of tissue. Spectroscopic properties can include characteristics such as reflectance and absorption index. Therefore, feedback analyzer 140 can include a spectroscopic sensor 142. Spectroscopic sensor 142 can include a Fourier transform infrared spectrometer (FTIR), a Raman spectrometer, a UV-VIS reflectance spectrometer, a fluorescence spectrometer, and the like. FTIR is a method used for routine, simple, and rapid material analysis. This technique has relatively good spatial resolution and provides information about the chemical composition of a material. Raman spectroscopy has good accuracy in identifying both hard and soft tissue components. As a high-spatial-resolution technique, it is also useful for determining the distribution of components within a target. UV-VIS reflectance spectroscopy is a method of collecting information from light reflected from an object. This information is similar to information generated from the eye or color images captured by a high-resolution camera, but is more quantitative and objective. Reflectance spectroscopy provides information about a material because light reflection and absorption depend on its chemical composition and surface properties. Using this technique, unique information about both the surface and bulk properties of a sample can also be obtained. Reflectance spectroscopy can be a valuable technique for identifying the composition of both hard and soft tissues. Fluorescence spectroscopy is a type of electromagnetic spectroscopy that analyzes fluorescence from a sample. It involves using a beam of light, typically ultraviolet light, to excite a material compound, typically in the visible or infrared region, causing it to emit light. This method is suitable for analyzing some organic components, such as hard and soft tissues.

[0078] In an example, the feedback analyzer 140 may optionally include an imaging sensor 144 (e.g., a CCD or CMOS camera sensitive to ultraviolet (UV), visible (VIS), or infrared (IR) wavelengths). In some examples, the spectroscopy sensor 142 may include more than a single type of spectrometer or imaging camera listed herein to enhance sensing and detection of various features (e.g., carbonized and non-carbonized tissue, vasculature, etc.).

[0079] In some examples, the spectroscopic sensor 142 (also referred to as a spectrometer) can include any of the spectrometers listed herein and can additionally rely on the imaging capabilities of the endoscope used during the treatment procedure. For example, an endoscope can be used to visualize anatomical features during a treatment procedure (e.g., laser ablation of a tumor). In such a case, the imaging capabilities of the endoscope can be enhanced by the spectroscopic sensor 142. For example, a conventional endoscope can provide narrowband imaging suitable for enhancing visualization of anatomical features (e.g., lesions, tumors, vasculature, etc.). By combining the spectroscopic sensor 142 with endoscopic imaging (white light and / or narrowband imaging), detection of tissue characteristics such as carbonization levels can be increased to precisely control the delivery of the therapeutic treatment.

[0080] Refer again Figure 5 , the spectroscopic sensor 142 can be operatively coupled to the signal detection fiber 150. In such an example, the signal detection fiber 150 can have optical properties suitable for transmitting the spectroscopic signal from the tissue to the spectroscopic sensor 142. Alternatively, the spectroscopic sensor 142 can be operatively coupled to the first optical fiber 108 of the first laser system 102 and / or the second optical fiber 118 of the second laser system 104, and thereby detect the spectroscopic signal via the first optical fiber 108 and / or the second optical fiber 118.

[0081] Continue to refer to Figure 1 and Figure 5 , the laser feedback control system 100 includes a laser controller 160 that is in operable communication with each of the spectroscopy sensor 142, the first laser system 102, and the optional second laser system 104. The laser controller 160 can control the one or more laser systems operatively connected thereto (e.g., the first laser system 102, the second laser system 104, and / or any additional laser systems) in accordance with one or more control algorithms described herein to control laser output from the one or more laser systems to produce a desired therapeutic effect in the target tissue 122.

[0082] The laser controller 160 may include a processor, such as a microprocessor, a digital signal processor (DSP), an application specific integrated circuit (ASIC), a field programmable gate array (FPGA), or any other equivalent integrated or discrete logic circuitry, and any combination of such components for performing one or more functions attributed to the laser controller 160. Optionally, the laser controller 160 may be coupled to the spectroscopy sensor 142 and one or more laser systems (e.g., the first laser system 102, the second laser system 104, and optional laser systems not shown herein) via a wired or wireless connection.

[0083] The laser controller 160 can communicate with the feedback analyzer 140 (e.g., via a wired or wireless connection) to receive one or more feedback signals from the feedback analyzer 140. The laser controller 160 can determine one or more characteristics of the target tissue 122 based on the feedback signals, as will be further described herein. For example, the laser controller 160 can compare the amplitude of the feedback signal to present a minimum amplitude and a maximum amplitude and determine a characteristic of the tissue (e.g., carbonization, coagulation, etc.).

[0084] In some examples, the feedback analyzer 140 can continuously monitor the target tissue 122 and continuously communicate with the laser controller 160 to provide a feedback signal. Thus, the laser controller 160 can continue to maintain the laser system in one or more states until a change in the amplitude of the feedback signal is detected. When a change in the amplitude of the spectroscopy signal is detected, the laser controller 160 can communicate with one or more laser systems and change their states to provide the desired treatment effect. Alternatively or in addition, the laser controller 160 can communicate with an operator (e.g., a healthcare professional) and display one or more outputs via one or more output systems indicating the feedback signal, and can optionally instruct the operator to perform one or more treatment procedures using the first laser system and / or the second laser system to provide the desired treatment effect.

[0085] In the illustrative examples described herein, laser controller 160 can control one or more laser systems by changing the state of the laser systems. According to one aspect, laser controller 160 can independently control each laser system. For example, laser controller 160 can send different control signals to each laser system to control each laser system independently of the other laser systems. Alternatively, laser controller 160 can send a common signal to control one or more laser systems.

[0086] In some examples, each of the laser systems can be associated with two different states: a first state in which the laser system produces laser output, and a second state in which the laser system does not produce laser output. For example, the first laser system 102 can have a first state in which it produces a first output 110 (e.g., within a first wavelength range) and a second state in which it does not produce the first output 110. Similarly, the second laser system 104 can have a first state in which it produces a second output 120 (e.g., within a second wavelength range) and a second state in which it does not produce the second output 120. In such an example, the laser controller 160 can control one or more laser systems by sending control signals that change the state of the laser system from the first state to the second state or vice versa. Additionally, each laser system can optionally have additional states, such as a third state in which it produces laser output within a different wavelength range. Thus, the laser controller 160 can send additional control signals to the laser systems to change their states from their current state to one or more additional states (e.g., first state to third state, second state to third state, third state to first state, and third state to second state) to produce laser output that provides a desired therapeutic effect.

[0087] Example Laser System Control Algorithm

[0088] Figure 6 and Figure 7 is a flow chart illustrating an example of an algorithm for controlling one or more laser systems using the laser feedback control system 100 according to some examples as described in this disclosure. Figure 6 In the control algorithm 600 shown, at step 602, a first signal (e.g., a spectroscopic signal) may be detected by the feedback analyzer 140 (e.g., the spectroscopic sensor 142 or the imaging sensor 144). At step 604, the laser controller 160 may receive the first signal from the feedback analyzer 140. The first signal may correspond to a first characteristic. At step 606, the laser controller 160 may determine whether the first signal is generally equal to a first predetermined value. For example, the laser controller 160 may compare the amplitude of the first signal to a target value or a predetermined extreme value (e.g., a maximum amplitude or a minimum amplitude) and determine a first characteristic of the target tissue 122. The first characteristic may indicate a characteristic of the tissue after treatment (e.g., ablation or carbonization of the tissue). Based on the first characteristic (the comparison between the first signal and the first predetermined value), the laser controller 160 may determine that the desired treatment effect has been achieved and, at step 608, may send a first control signal to the first laser system 102 to change from the first state of the first laser system 102 to the second state of the first laser system 102. According to an example, this may result in the first laser system 102 no longer generating the first output 110, thereby providing a satisfactory treatment effect (e.g., ablation). Alternatively, if at step 606, it is determined that the first signal is not generally equal to the first preset (not sufficient ablation), the laser controller may not send any control signal, and the feedback analyzer may continue to monitor the first signal.

[0089] Optionally, at step 612, the feedback analyzer 140 may receive a second signal different from the first signal. The second signal may indicate a first characteristic of the target tissue having a second predetermined value. For example, the amplitude of reflected light from the tissue may be different in the second signal than in the first signal. At optional step 614, the second signal may be received by the laser controller 160. At optional step 616, the laser controller 160 may determine whether the second signal generally equals the second predetermined value. For example, the second signal (e.g., a spectroscopic signal or image) may indicate that the target tissue 122 has not been carbonized by absorption of the first output 110 (e.g., the measured signal amplitude is less than a predetermined maximum amplitude of the spectroscopic signal or image of ablated tissue). In some cases, such a condition may indicate inadequate ablation or other unsatisfactory treatment effect, and it may be desirable to continue delivering laser output to ablate the tissue. Therefore, at optional step 618, the laser controller 160 may communicate with the first laser system 102 to send a second control signal. The second control system may maintain the first laser system 102 in the first state (e.g., continue delivering the first output 110). Alternatively, if the first laser system is in the second state (eg, off), at optional step 620, the second control signal may change the state of the first laser system to the first state (eg, on), for example, to continue delivering additional ablation to the target tissue.

[0090] At optional step 620, after the laser controller 160 determines satisfactory delivery of the treatment condition, the laser controller 160 may perform additional control operations to deliver additional laser output (eg, at a different wavelength) to deliver additional treatment effects.

[0091] Figure 7 A control algorithm for controlling a dual laser system is shown. Algorithm 700 can be applicable to situations where the laser controller 160 is in operative communication with two or more laser systems. In some such examples, the first laser system 102 can be configured to transmit a first output 110 (e.g., within a first wavelength range), and the second laser system 104 can be configured to transmit a second output 120 (e.g., within a second wavelength range different from the first wavelength range), as previously described. Control algorithm 700 can control the first laser system 102, the second laser system 104, and optionally, additional laser systems.

[0092] According to the control algorithm 700, at step 702, the feedback analyzer 140 may detect a first signal (e.g., a spectroscopic signal or an image). At step 704, the laser controller 160 may receive the first signal from the feedback analyzer 140. At step 706, the laser controller 160 may determine whether the first signal is generally equal to a first preset value (e.g., within a first preset specified tolerance). For example, the laser controller 160 may compare the amplitude of the first signal to a target value or preset extreme value (e.g., a maximum amplitude or a minimum amplitude) and determine a first characteristic of the target tissue 122. The first characteristic may indicate a characteristic of the tissue after receiving a therapeutic treatment (e.g., ablation or carbonization of the tissue). The laser controller 160 may determine that a desired therapeutic effect has been achieved based on the first characteristic meeting the target value or preset criteria, and may send a first control signal to the first laser system 102 at step 708 to change from the first state of the first laser system 102 to the second state of the first laser system 102. For example, the laser controller 160 may determine that ablation has been satisfactory based on reflected light from the ablated tissue and send a first control signal to the first laser system to transition the first laser system to an "off" state. Alternatively, in the illustrative example, the laser controller 160 may provide an output to an operator (e.g., a healthcare professional) to indicate that a desired treatment effect has been achieved and / or to instruct the operator to change the state of the first laser system to an "off" state.

[0093] At step 708, the laser controller 160 may also send a fourth signal to the second laser system 104 to change from the second state of the second laser system 104 to the first state of the second laser system 104. For example, the second laser system 104 may be more suitable for ablating carbonized tissue. Therefore, upon detecting that the tissue has been sufficiently carbonized (e.g., at step 708), in some cases, the laser controller 160 may send the first control signal to turn off the first laser system 102 and send the fourth control signal to turn on the second laser system 104. Figure 8 An example timing diagram of the states of the first laser system and the second laser system is shown in FIG.

[0094] In some examples, the first control signal and the fourth control signal may be sent simultaneously. Alternatively, the first control signal and the fourth control signal may be sent sequentially.

[0095] Back to Figure 7At optional step 710, the feedback analyzer 140 may detect a second signal (e.g., a spectroscopic signal or image) that is different from the first signal. For example, the second signal may indicate that the target tissue 122 has not been carbonized by absorption of the first output 110 (e.g., the measured signal amplitude is greater than a preset maximum amplitude of the spectroscopic signal for ablation of tissue). In some cases, such a condition may indicate insufficient ablation or other unsatisfactory treatment effect, and it may be desirable to continue delivering laser output so that tissue can be ablated. At optional step 712, the laser controller may receive the second signal and, at optional step 714, compare the second signal to a second preset value. If the second signal is generally equal to the second preset value (e.g., within a second preset specified tolerance), at optional step 716, the laser controller 160 may send a second control signal to the first laser system and a third control signal to the second laser system. Figure 8 An example timing diagram of the states of the first laser system and the second laser system is shown in FIG.

[0096] In some examples, the second control signal may change the first laser system from the second state (e.g., off) to the first state (e.g., on). Alternatively, if the first laser system is in the first state (e.g., on), the second control signal may maintain the first laser system 102 in the first state (e.g., to continue transmitting the first output 110). Optionally, at step 716, if the second laser system 104 is in its first state, the laser controller 160 may send a third control signal to the second laser system 104 to change the second laser system 104 from the first state (e.g., on) of the second laser system 104 to the second state (e.g., off) of the second laser system 104. Alternatively, if the second laser system is in the second state, the third control signal may maintain the second laser system 104 in the second state (e.g., off).

[0097] According to some examples, the first state of each of first laser system 102 and second laser system 104 can correspond to first output 110 being generated by first laser source 106 and second output 120 being generated by second laser source 116, respectively. Thus, the first state of each of first laser system 102 and second laser system 104 can represent an "on" state. In some such examples, the second state of each of first laser system 102 and second laser system 104 can correspond to an "off" state.

[0098] Reference Figure 5The laser feedback control system 100 may include one or more output systems 170. The one or more output systems 170 may communicate with a user and / or other systems and / or transmit signals to the user and / or other systems, such as an irrigation, aspiration / pumping system, an optical display controller, or other systems used for the treatment. In some examples, the output system 170 may include a display 172. The display 172 may be a screen (e.g., a touch screen), or, in an alternative embodiment, may simply be a visual indicator (e.g., one or more colored LEDs). In additional examples, the output system 170 may include an auditory output system 174 (e.g., a speaker, an alarm system, etc.) capable of providing an auditory signal. The output system 170 may provide one or more outputs (e.g., an LED of a first color, a first message on a screen, an alarm of a first tone) to indicate that a desired treatment effect has been achieved. The output may be provided, for example, at step 610 and optionally at step 620. In further optional examples, the output system 170 may provide one or more different outputs when the desired treatment effect has not been achieved. For example, the output system 170 may provide one or more outputs (e.g., a second color LED light, a second message on the screen, a second tone alarm sound) to indicate that the desired treatment effect has not been achieved. Such outputs may prompt the operator (healthcare professional) to take one or more steps (e.g., performing additional treatment steps using one or more laser systems to provide additional laser output).

[0099] Figure 8 A timing diagram of a dual laser system with a laser feedback control system 100 is shown according to an example of delivering tissue ablation and coagulation using two optical wavelengths. However, as previously described, the laser feedback control system 100 can be used with single or multiple optical wavelength systems to optimize the delivery of laser therapy or other types of therapeutic effects to target tissue 122. The therapeutic effects can be delivered in any order, including simultaneously. Alternatively, the therapeutic effects can be delivered at different times.

[0100] According to an example, the laser energy from the first laser system 102 and the second laser system 104 can be delivered to a target (e.g., a tissue surface), for example, in an example, can be delivered to the target continuously. The first laser system and the second laser system can deliver their respective laser energy via the same optical fiber. Alternatively, the first laser system and the second laser system can deliver their respective laser energy via different optical fibers. max The optical feedback signal 810 is reflected from the tissue surface and can be detected and analyzed by the feedback analyzer 140. The first laser system and the second laser system can alternate their respective operating states (eg, on state or off state). Figure 8As shown, the first laser system 102 can be switched to its first state or maintained in its first state (e.g., on) 820A, while the second laser system 104 can be switched to the second state or maintained in the second state (e.g., off). The first laser can be used to ablate and carbonize tissue. During operation of the first laser system 102, a first signal can be received by the laser controller 160 and can indicate high absorption by the tissue until its amplitude decreases to a threshold level A. min The wavelength of the output from the first laser system 102 can be within a first wavelength range within the absorption spectrum of the target, such as a wavelength suitable for effective carbonization of the target tissue. Tissue has a high absorption of laser energy. In an example, the first laser output is within the UV-VIS or deep infrared wavelength range.

[0101] The laser controller 160 can then change the state of the laser systems so that the first laser system 102 is in the second state (e.g., off) and the second laser system 104 is in the first state (e.g., on) 830A. The output from the second laser system 104 can be highly absorbed by the carbonized tissue so that the carbonized tissue is ablated, effectively removing the carbonization. The wavelength of the output from the second laser system 104 can be within a second wavelength range in the absorption spectrum of the target. The second wavelength range can be different from the first wavelength range of the output from the first laser system 102. The wavelength of the output from the second laser system 104 can also be suitable for effective coagulation. In an example, the second laser output is in the infrared wavelength range (e.g., 100 μm to 300 μm). Due to the decarburization process, the amplitude of the signal (e.g., the second signal) returns to near the initial level A max The laser controller 160 may change the state of the laser accordingly so that the first laser system 102 is in a first state (eg, on) and the second laser system 104 is in a second state (eg, off). This process may be repeated so that the laser system 102 is in a first state (eg, on) and the second laser system 104 is in a second state (eg, off). Figure 8 The alternating manner shown repeatedly switches the first laser system 102 and the second laser system 104 to their on states 820B and 830B, respectively, until the desired tissue ablation and / or coagulation is achieved. In some examples, an optical feedback signal 810, as discussed herein, can be provided to an electrosurgical system that can controllably adjust and optimize electrosurgical energy other than laser energy.

[0102] Example Endoscopy System with Object Recognition

[0103] Figures 9 to 11 illustrate how target composition analysis can be performed entirely within the endoscope.Target composition analysis can be performed via spectroscopy using a laser fiber and potentially a camera on the distal end of a digital endoscope.

[0104] Figures 9A to 9BAn example of an endoscope with an inserted laser fiber is shown. The elongated body portion of the exemplary endoscope 910 contains various components, including a laser fiber 912, an illumination source 914, and a camera 916. The laser fiber 912 is an example of the optical path 108 of the laser system 102 or the laser system 202. The laser fiber 912 can extend along a working channel 913 within the elongated body of the endoscope 910. In some examples, the laser fiber 912 can be separate from the endoscope. For example, the laser fiber 912 can be fed along the working channel of the endoscope before use and retrieved from the working channel of the endoscope after use.

[0105] The illumination source 914 can be part of a visualization system that allows the operator to visualize a target structure (e.g., a tissue or stone structure). Examples of an illumination source can include one or more LEDs configured to emit light distally away from the distal end of the elongated body of the endoscope to illuminate an area of ​​the target structure. In an example, the illumination source 914 can emit white light to illuminate the target structure. White light can enable the practitioner to observe discoloration or other color-based effects on tissue near the distal end of a stone or the endoscope body. In an example, the illumination source 914 can emit blue light to illuminate the target structure. Blue light can be well suited to showing thermal tissue diffusion and thereby detecting damage in tissue. Other colors and / or color bands can also be used, such as red, amber, yellow, green, or others.

[0106] Camera 916 is part of the visualization system. Camera 916 is an example of imaging sensor 244. Camera 916 can capture a video image or one or more static images of the illuminated target structure and the surrounding environment. The video images can be real-time, or nearly real-time with a relatively short processing delay, so that the practitioner can observe the target structure while the practitioner manipulates the endoscope. Camera 916 can include a lens and a multi-pixel sensor located at the focal plane of the lens. The sensor can be a color sensor, such as a sensor that provides intensity values ​​for red, green, and blue light for each pixel in the video image. The circuit board can generate a digital video signal representing the captured video image of the illuminated stone. The digital video signal can have a video refresh rate of 10 Hz, 20 Hz, 24 Hz, 25 Hz, 30 Hz, 40 Hz, 50 Hz, 60 Hz, or another suitable video refresh rate.

[0107] FIG. 10A to FIG. 10B An example of a feedback controlled laser therapy system is shown. Figure 10A, laser therapy system 1000A includes endoscope 910 integrated with feedback-controlled laser therapy system 1010 that receives feedback from a camera. Laser therapy system 1000A, an example of laser therapy system 100, includes endoscope 910, feedback-controlled laser therapy system 1010, laser source 1020, and light source 1030. In various examples, a portion or all of feedback-controlled laser therapy system 1010 may be embedded in endoscope 910.

[0108] Feedback-controlled laser therapy system 1010, an example of laser feedback control system 200, includes spectrometer 1011 (an example of spectroscopic sensor 242), feedback analyzer 1012 (an example of at least a portion of feedback analyzer 240), and laser controller 1013 (an example of laser controller 260). Laser source 1020 is an example of laser system 202, and laser source 1020 can be coupled to laser fiber 912. Fiber-integrated laser systems can be used for endoscopic surgery because they can deliver laser energy through flexible endoscopes and effectively treat both hard and soft tissues. These laser systems generate laser output beams over a wide range of wavelengths, from the UV to the IR region (200 nm to 10,000 nm). Some fiber-integrated lasers generate output in wavelength ranges that are highly absorbed by soft or hard tissues, such as 1900 nm to 3000 nm for water absorption or 400 nm to 520 nm for oxyhemoglobin absorption and / or deoxyhemoglobin absorption. Table 1 above is a summary of IR lasers emitting in the high water absorption range of 1900 nm to 3000 nm.

[0109] Some fiber-integrated lasers produce output in a wavelength range that is least absorbed by the target soft or hard tissue. These types of lasers provide effective tissue coagulation due to a penetration depth similar to the diameter of a small capillary (5 μm to 10 μm). Examples of laser sources 1020 may include In lasers that emit UV-VIS. X Ga 1-X N semiconductor lasers, such as GaN lasers emitting at 515 nm to 520 nm, In lasers emitting at 370 nm to 493 nm, X Ga 1-X N laser, which emits GaN lasers at 750nm to 850nm X Al 1-X As laser or In laser emitting 904nm to 1065nm X Ga 1-X As laser, etc.

[0110] The light source 1030 can generate an electromagnetic radiation signal that can be transmitted to the target structure 122 via a first optical path extending along the elongated body of the endoscope. The first optical path can be located within the working channel 913. In an example, the first optical path can be an optical fiber separate from the laser fiber 912. In another example, Figure 10A As shown, the electromagnetic radiation signal can be transmitted through the same laser fiber 912 used to transmit the laser beam. The electromagnetic radiation leaves the distal end of the first optical path and is projected onto the target structure and the surrounding environment. Figure 10A As shown, the target structure is within the field of view of the endoscopic camera 916, so that in response to electromagnetic radiation projected onto the target structure and the surrounding environment, the endoscopic camera 916, such as a CCD or CMOS camera, can collect signals reflected from the target structure 122, generate an imaging signal 1050 of the target structure, and transmit the imaging signal to the feedback-controlled laser treatment system 1010. In some examples, an imaging system other than a CCD or CMOS camera, such as a laser scanner, can be used to collect the spectroscopic response.

[0111] In addition to or in lieu of feedback signals (e.g., imaging signals) generated and transmitted by the camera system 916, in some examples, signals reflected from the target structure can additionally or alternatively be collected and transmitted to the feedback-controlled laser therapy system 1010 via a separate fiber optic channel or laser fiber, such as associated with the endoscope 910. Figure 10B An example of a laser therapy system 1000B is shown that includes an endoscope 910 integrated with a feedback-controlled laser therapy system 1010 configured to receive spectroscopy sensor feedback. Figure 1 2 ) can travel back to the feedback-controlled laser therapy system 1010 via the same optical path (e.g., laser fiber 912) used to transmit electromagnetic radiation from the light source 1030 to the target structure. In another example, the reflected spectroscopy signal 1070 can travel to the feedback-controlled laser therapy system 1010 via a second optical path, such as a separate fiber channel from the first optical fiber that transmits electromagnetic radiation from the light source 1030 to the target structure.

[0112] The feedback-controlled laser therapy system 1010 can analyze one or more feedback signals (e.g., an imaging signal 1050 of a target structure or a reflected spectroscopic signal 1070) to determine an operating state of the laser source 1020. The spectrometer 1011 can generate one or more spectroscopic characteristics from the one or more feedback signals, for example, by using one or more of an FTIR spectrometer, a Raman spectrometer, a UV-VIS spectrometer, a UV-VIS-IR spectrometer, or a fluorescence spectrometer, as discussed above with reference to the spectroscopic sensor 242. The feedback analyzer 1012 can be configured to identify or classify the target structure into one of a plurality of structural categories or structural types, for example, by using one or more of the target detector 246 or the target classifier 248. The laser controller 1013 can be configured to determine an operating mode of the laser system 1020, as similarly discussed above with reference to FIG. 2.

[0113] The light source 1030 may generate electromagnetic radiation in the optical range from UV to IR. Table 2 below presents examples of light sources 1030 for spectroscopy systems suitable for the examples discussed herein.

[0114] Table 2: Light sources for spectroscopy systems

[0115]

[0116] In some examples, the feedback analyzer 1012 can determine the distance 1060 between the distal end of the laser fiber 912 and the target structure 122, or the distance 1060 between the distal end of the optical path for receiving the reflected signal and transmitting the reflected signal back to the spectrometer 1011 and the target structure 122 (e.g., Figure 10A ). The distance 1060 can be calculated using spectral characteristics such as the reflection spectrum generated by the spectrometer 1011. If the distance 1060 meets a condition, such as falling below a threshold value (d th ) or within the specified laser emission range, the laser controller 1013 can control the laser source 1020 to transmit laser energy to the target structure 122. In an example, if the target structure 122 is identified as the intended treatment structure type (e.g., a specified soft tissue type or a specified stone type), but the target structure 122 is not within the laser range (e.g., d>d th ), the laser controller 1013 can generate a control signal to "lock" the laser source 1020 (ie, prevent the laser source 1020 from firing). Information about the distance 1060 and the target structure is outside the laser range (d>d th) can be presented to the practitioner, who can then adjust the endoscope 910, such as repositioning the distal end of the laser fiber 912 to move closer to the target. The distance 1060 and the target structure type can be continuously monitored and determined and presented to the practitioner. When the target is identified as the intended treatment structure type and is within the range of the laser (d <= d th ), the laser controller 1013 can generate a control signal to "unlock" the laser source 1020, and the laser source 1020 can be targeted and fired at the target structure 122 according to the laser operating mode (e.g., power setting). An example of a method for calculating the distance 1060 from spectroscopy data is discussed below, for example with reference to Figure 24A and Figure 24D .

[0117] In some examples, the spectrometer 1011 can be configured to further use information about the geometry and positioning of an optical path configured to transmit electromagnetic radiation from a light source to a target to generate spectroscopic characteristics (e.g., a reflection spectrum). For example, the outer diameter of the laser fiber 912 or the outer diameter of a separate optical path used to transmit the spectroscopic signal reflected from the target to the spectrometer 1011, or the angle at which the fiber or path protrudes from the endoscope 910 can affect the intensity of the reflected signal. The outer diameter and / or the protrusion angle can be measured and provided to the spectrometer 1011 to obtain the reflection spectrum data. As discussed above, the distance 1060 between the target structure and the distal end of the optical fiber can be calculated using the spectral data, the measured outer diameter of the fiber or optical path and its protrusion angle, and / or an input signal from the endoscope image processor.

[0118] Figures 11A to 11B FIG is a diagram showing an example of an endoscope system for identifying a target using a diagnostic beam. Figure 11AAs shown, endoscope system 1100A may include endoscope 1110 and optical fiber 1120A that can be inserted through working channel 1112 of endoscope 1110. Endoscope 1110 may include at least one endoscope illumination source 1130 or be otherwise coupled to at least one endoscope illumination source 1130 via endoscope port 1114. The at least one endoscope illumination source 1130 can controllably provide varying amounts of illumination. Upon insertion of optical fiber 1120A through working channel 1112, optical fiber 1120A can be coupled to a non-endoscopic illumination source 1140, for example, via endoscope port 1114. The non-endoscopic illumination source 1140 can be distinct from the at least one endoscope illumination source 1130. The non-endoscopic illumination source 1140 can emit a diagnostic beam 1142 through optical fiber 1120A and proximate to the distal end 1116 of endoscope 1110. Optical fiber 1120A can direct the diagnostic beam 1142 toward target 1001. In an example, the non-endoscopic illumination source 1140 can be a laser source configured to emit a diagnostic beam including a laser beam. In various examples, a white light lamp, an LED light source, or a fluoroscopic light source can be inserted through a working channel of an endoscope or through another port such as a laparoscope port.

[0119] Endoscope system 1100A may include a controller 1150. Controller 1150 may controllably operate at least one endoscope illumination source 1130 in different operating modes, including, for example, a first mode having a first illumination level and a second mode having a second illumination level lower than the first illumination level. In an example, controller 1150 may generate a control signal in response to a trigger signal to change the illumination mode (e.g., from the first mode to the second mode). In an example, the endoscope includes an imaging system 1160 that can capture an image of a target 1001, and controller 1150 may generate a control signal to the endoscope in response to a change in brightness or intensity of the target image to change the illumination mode (e.g., from the first mode to the second mode). Hereinafter, the first mode will be referred to as the high illumination mode, and the second mode will be referred to as the low illumination mode. In an example, the high illumination mode and the low illumination mode may be provided by different endoscope illumination sources, such as a first endoscope illumination source configured to emit illumination light in the high illumination mode and a second endoscope illumination source configured to emit illumination light in the low illumination mode. Illumination light can be emitted near the distal end 1116 of the endoscope 1110. In an example, the illumination light can travel through an optical pathway within the working channel 1112 that is different from the optical fiber 1120A. The optical pathway can direct the illumination light 1132 to the same target 1001 on which the diagnostic beam is projected.

[0120] When at least one endoscope illumination source 1130 changes from a high illumination mode to a low illumination mode, the controller 1150 may generate a control signal to the non-endoscopic illumination source 1140 to emit a diagnostic beam 1142 (e.g., a laser beam having a lower energy level than a therapeutic beam). In an example, the low illumination mode includes turning off the illumination of the endoscope. By dimming the illumination at the target site in the low illumination mode, reflection of the diagnostic beam incident on the target from the target may be enhanced, which may help improve target identification.

[0121] In some examples, when the illumination mode is in the second mode, the controller 1150 can generate a control signal to the display to display an image of the target, wherein the image is a previous image or a modified image of the current image of the target. The controller 1150 can determine the composition of the target based on the diagnostic light beam incident on the target and the light from the diagnostic light beam reflected from the target. In an example, the controller 1150 can determine a first composition of a first portion of the stone target and determine a second, different composition of a second portion of the stone target. Based on the identified compositions of the different portions of the target, the controller 1150 can program a first laser setting, or generate a suggestion to program the first laser setting, to target the first portion of the stone target. The controller 1150 can also program a second laser setting, different from the first laser setting, or generate a suggestion to program the second laser setting, to target the second portion of the stone target.

[0122] In an example, after the non-endoscopic illumination source 1140 has stopped emitting the diagnostic light beam 1142, the controller 1150 can generate a control signal to the endoscope to change the illumination mode from the low illumination mode back to the high illumination mode.

[0123] Figure 11B An example of an endoscope system 1100B is shown, which is a variation of the endoscope system 1100A. In this example, a diagnostic beam 1142 can be transmitted through an optical fiber 1120B. Unlike the optical fiber 1120A inserted into the working channel 1112 of the endoscope 1110, the optical fiber 1120B can be provided separately from the working channel 1112. In some examples, such as Figure 11B As shown, diagnostic beam 1142 can be delivered through a secondary port 1115, such as a laparoscopic port in the example, separate from endoscope port 1114 for delivering endoscopic illumination light. Fiber 1120B can be positioned so that distal end 116 of endoscope 1110 and the distal end of fiber 1120B are both directed toward target 1001.

[0124] Figure 12 and 13A to 13Bis a graph showing reflectance spectral data used to identify different types of targets via UV-VIS spectroscopy or UV-VIS-IR spectroscopy, for example, for identifying the composition of several different types of kidney stones. Reflectance spectral data is collected by targeting a UV-VIS spectrometer or UV-VIS-IR spectrometer at each image of five major types of kidney stones, including calcium oxalate stones (monohydrate), calcium oxalate stones (dihydrate), calcium phosphate stones, struvite stones, and uric acid stones. In an example, the electromagnetic radiation may include one or more ultraviolet wavelengths between 10 nm and 400 nm. In another example, as Figure 12 As shown, reflectance spectra for identifying different types of targets can be recorded using a spectrometer within a wavelength range of 200 nm to 1100 nm. Shown are reflectance spectra of kidney stone components, including ammonium magnesium phosphate (AMMAG) hydrate, calcium oxalate (CA) monohydrate, calcium oxalate (CA) hydrate, calcium phosphate (CA), and uric acid. The reflectance spectra of these stone components are more distinguishable in the lower wavelength range (e.g., below 400 nm) than in the higher wavelength range (e.g., above 400 nm). Figure 13A Shown Figure 12 The portion of the reflectance spectrum shown in FIG. 13 is within the wavelength range of 200 nm to 400 nm, including a spectrum of magnesium ammonium phosphate hydrate 1310, a spectrum of calcium oxalate monohydrate 1320, a spectrum of calcium oxalate hydrate 1330, a spectrum of calcium phosphate 1340, and a spectrum of uric acid 1350. This UV wavelength range is an area where differences can be identified in the spectrum of the stone image. Figure 13B Reflectance spectra of various kidney stone components in the 400 nm to 700 nm wavelength range are shown, including a cystine spectrum 1360, a uric acid spectrum 1370, and a calcium oxalate monohydrate spectrum 1380. Using UV-VIS spectroscopy or UV-VIS-IR spectroscopy, it is possible to distinguish between different types of targets, such as different types of kidney stones.

[0125] Therefore, since the UV wavelength range shows promise in, for example, differentiating between different target components such as kidney stones, there is a need for a light source within the system that will allow analysis of this area. Figure 14 Light peaks 1410, 1420, 1430, and 1440 are shown covering respective portions of the UV wavelength range around 250 nm, 280 nm, 310 nm, and 340 nm, respectively. Figure 15 These light peaks 1410 to 1440 are compared with the 13A to 13B The normalized reflectance spectra of several types of stones overlap. These light peaks 1410 to 1440 demonstrate potential light sources that would allow a spectrometer to analyze the composition of a target in the UV wavelength.

[0126] Figure 16AExamples of normalized reflectance spectra captured from various tissue types on a UV-VIS spectrometer are shown, including a cartilage spectrum 1610 , a bone spectrum 1620 , a muscle spectrum 1630 , a fat spectrum 1640 , and a liver tissue spectrum 1650 . Figure 16B Another example of normalized reflectance spectra captured from various soft and hard tissues on a UV-VIS spectrometer is shown, including a cartilage spectrum 1610, a bone spectrum 1620, a muscle spectrum 1630, a fat spectrum 1640, a liver tissue spectrum 1650, and a blood vessel spectrum 1660. 16A to 16B The reflectance spectral data shown in [1] demonstrate the feasibility of analyzing the composition of a target using methods that can be used within the working channel of an endoscope. Similar to the spectra captured from the stone image, the UV-VIS region can be used to identify different types of targets. Figure 16C shows examples of FTIR spectra of typical stone compositions, and Figure 16D Figures 2 and 3 show example FTIR spectra of some soft and hard tissue components.

[0127] Example Laser Therapy System

[0128] The features described herein can be used in connection with laser systems for various applications where combining different types of laser sources may be advantageous. For example, the features described herein may be applicable to industrial or medical settings, such as medical diagnosis, treatment, and surgery.

[0129] Features as described herein may be used with spectroscopy systems that may be used in conjunction with fiber-integrated laser systems and endoscopes.

[0130] Figures 17 and 18 A schematic diagram of a laser therapy system according to various examples as described in the present disclosure is shown. The laser therapy system may include a laser system configured to deliver laser energy directed toward a target, and a laser feedback control system configured to be coupled to the laser system. The laser system may include one or more laser modules 1710A to 1710N (e.g., solid-state laser modules) that can emit similar or different wavelengths from UV to IR. The number of integrated laser modules, their output power, emission range, pulse shape, and pulse train are selected to balance system cost and the performance required to deliver the desired effect to the target.

[0131] One or more laser modules 1710A to 1710N can be integrated with an optical fiber and included in a laser coupling system. Fiber-integrated laser systems can be used for endoscopic surgery because they are able to pass laser energy through a flexible endoscope and effectively treat hard and soft tissues. These laser systems generate laser output beams over a wide wavelength range (e.g., 200 nm to 10,000 nm) from the UV to IR regions. Some fiber-integrated lasers generate outputs in wavelength ranges that are highly absorbed by soft or hard tissues, such as 1900 nm to 3000 nm for water absorption or 400 nm to 520 nm for oxyhemoglobin absorption and / or deoxyhemoglobin absorption. Various IR lasers can be used as laser sources in endoscopic surgery, such as those described above with reference to Table 1.

[0132] Laser modules 1710A to 1710N can each be composed of multiple solid-state laser diodes integrated into optical fibers to increase output power and transmit the emission to the target. Some fiber-integrated lasers produce output in a wavelength range that is least absorbed by the target soft or hard tissue. These types of lasers provide effective tissue coagulation due to a penetration depth similar to the diameter of a small capillary (5 μm to 10 μm). The fiber-integrated laser modules 1710A to 1710N described in accordance with various examples in this disclosure have several advantages. In the examples, the light emitted by the laser module has a symmetrical beam quality, a circular and smooth (uniform) intensity distribution. A compact cooling device is integrated into the laser module, making the entire system compact. The fiber-integrated laser modules 1710A to 1710N can be easily combined with other fiber optic components. Additionally, the fiber-integrated laser modules 1710A to 1710N support standard fiber optic connectors that allow the modules to operate well with most optical modules without alignment. Furthermore, the fiber-integrated laser modules 1710A-1710N can be easily replaced without changing the alignment of the laser coupling system.

[0133] In some examples, the laser module can generate laser output in a wavelength range that is highly absorbed by some materials such as soft or hard tissue, stone, bone, teeth, etc., for example, 1900nm to 3000nm for water absorption or 400nm to 520nm for oxygenated hemoglobin and / or deoxygenated hemoglobin absorption, as shown in FIG. Figure 3C In some examples, the laser module can generate laser output in a wavelength range that is poorly absorbed by the target, such as soft tissue or hard tissue, stone, bone, teeth, etc. This type of laser provides more efficient tissue coagulation because the penetration depth is similar to the diameter of a small capillary (e.g., 5 μm to 10 μm), such as Figure 3C As shown. Commercially available solid-state lasers are potential emission sources for laser modules. Examples of laser sources for laser modules may include InX Ga 1-X N semiconductor lasers, such as GaN (emitting 515nm to 520nm) or In X Ga 1-X N (emitting at 370 nm to 493 nm), GaXAl1-XAs laser (emitting at 750 nm to 850 nm), or InXGa1-XAs laser (emitting at 904 nm to 1065 nm). Such laser sources can also be used in tissue coagulation applications.

[0134] The laser feedback control system may include one or more subsystems including, for example, a spectroscopy system 1720 , a feedback analyzer 1730 , and a laser controller 1740 .

[0135] Spectroscopy System 1720

[0136] The spectroscopy system 1720 can transmit a control light signal from a light source to a target, such as, but not limited to, calculus, soft or hard tissue, a conjugate, a tooth, or an industrial target, and collect spectral response data reflected from the target. The response can be transmitted to a spectrometer via a separate optical fiber, a laser fiber, or an endoscopic system. The spectrometer can transmit the digital spectral data to a system feedback analyzer 1730. Examples of light sources for the spectroscopy system that cover the optical range from UV to IR include those described above with reference to Table 2. Figure 20 A schematic diagram of a spectroscopy system 1720 is shown, in an example, with a feedback analyzer 1730 .

[0137] Optical spectroscopy is a powerful method that can be used for simple and rapid analysis of organic and inorganic materials. According to various examples described in the present disclosure, the spectroscopic light source can be integrated into a separate fiber optic channel, laser fiber, or endoscope system. The light source signal reflected from the target can be quickly collected and transmitted to a spectrometer by an imaging system that includes a detector such as that included in a digital endoscope, such as a CCD or CMOS sensor. Other imaging systems such as laser scanning can also be used to collect the spectroscopic response. Optical spectroscopy has several advantages. It can be easily integrated with the fiber laser delivery system 1701. It is a non-destructive technique for detecting and analyzing the chemical composition of materials, and the analysis can be performed in real time. Optical spectroscopy can be used to analyze different types of materials including, for example, hard and soft tissues, stone structures, etc.

[0138] Various spectroscopic techniques can be used, alone or in combination, to analyze the target chemical composition and generate spectroscopic feedback. Examples of such spectroscopic techniques can include UV-VIS reflectance spectroscopy, fluorescence spectroscopy, Fourier transform infrared spectroscopy (FTIR), or Raman spectroscopy, among others. Table 2 above presents examples of light sources for spectroscopic systems covering the optical region from UV to IR and suitable for the examples. Tungsten halogen light sources are commonly used for spectroscopic measurements in the visible and near-IR ranges. Deuterium light sources are known for their stable output, and they are used for UV absorption or reflectance measurements. A mixture of halogen and deuterium lamps produces a wide spectral range light source that provides a smooth spectrum from 200nm to 2500nm. Xenon light sources are used in applications where long life and high output power are required, such as for fluorescence measurements. LED and laser diode light sources provide high power at precise wavelengths; they have long life, short warm-up times, and high stability. Spectroscopic light sources can be integrated into separate fiber channels, laser fibers, or endoscope systems. The light source signal reflected from the target can be quickly detected and transmitted to the spectrometer via a separate fiber channel or laser fiber.

[0139] Feedback Analyzer 1730

[0140] Feedback analyzer 1730 can receive input from various sources, including spectroscopic response data from a spectrometer, to recommend or directly adjust laser system operating parameters. In an example, feedback analyzer 1730 can compare the spectroscopic response data with an available database archive of target component data. Based on the spectroscopic system feedback, a signal analyzer detects the target material composition and recommends a laser operating mode (also referred to as laser settings), such as operating parameters for at least one laser module, to achieve effective tissue treatment of the identified tissue component. Examples of operating parameters can include at least one laser wavelength, pulsed or continuous wave (CW) emission mode, peak pulse power, pulse energy, pulse rate, pulse shape, and simultaneous or sequential emission of pulses from at least one laser module. Although not explicitly described, sequential pulses include a train of pulses combined to deliver a selected pulse energy. As described herein, a pulse generally refers to the time between the start and stop of laser emission from a laser module. As long as the selected average laser power is maintained, the intensity of the laser energy during each pulse can vary to have an increasing or decreasing ramp or sinusoidal profile, or any other profile, alone or in combination with a pulse sequence. For example, if there is only one pulse, a 2W average power setting with a pulse energy of 1J occurs at a frequency of 2Hz. However, the energy may also be delivered as two 0.5J pulses occurring in rapid succession at a rate of 2Hz. Each of these pulses may have a similar pulse shape or a different pulse shape. Feedback analyzer 1730 utilizes algorithms and input data to directly adjust or recommend laser operating parameters, such as those described in the examples above.

[0141] In some examples, the feedback analyzer 1730 can utilize input data to calculate and control the distance between the distal end of the laser delivery system 1701 (optical fiber) and the target based on a specially developed algorithm. In the case of a moving target (e.g., a stone), the feedback analyzer 1730 can adjust or recommend laser operating parameters that use steam bubbles in water to create a suction effect to pull targets that exceed a predetermined threshold closer to the distal end of the optical fiber. This feature minimizes the effort required by the user to maintain an effective treatment distance from a moving target. The distance between the target and the distal end of the optical fiber can be calculated using spectral data, the known outer diameter of each optical fiber and its angle of protrusion from the endoscope, and / or input signals from the endoscope's image processor. 24A to 24D This is shown by way of an example method of calculating the distance between the distal end of the laser delivery system 1701 (fiber optic) and the target. FIG. 24A to FIG. 24B The dependence of the spectroscopic reflection signal on the distance between the target and the laser delivery system 1701 is shown in FIG. Figure 24A Shown are examples of reflected signal intensities at 730 nm measured at different distances between tissue and the distal end of the spectroscopy probe. Figure 24BAn example of the reflected signal intensity at 450 nm measured at different distances between the tissue and the distal end of the spectroscopy probe is shown. Such dependence can be determined using spectral data and information about the geometry of the laser delivery system. Analysis of the spectroscopy signal allows for a rapid estimation of the distance and the communication of this information to the user.

[0142] Figure 24C is an exemplary algorithm for calculating the distance between an optical fiber and a tissue target. In one example, a spectroscopy system sends a control light signal from a light source to a target, collects spectral response data from the target, transmits the response signal to a spectrometer, and sends the digital spectral data from the spectrometer to a feedback analyzer. Figure 24C As shown, calibration curve 1000 represents the relationship between the intensity of a spectroscopic reflection signal (e.g., a spectroscopic signal reflected from a target structure in response to electromagnetic radiation) and a distance 1060 (e.g., as shown in FIG. 10 to FIG. 11 ) between the distal end of an optical fiber and the target structure using a feedback signal reflected from the target structure. Calibration curve 1000 can be generated by measuring the intensity of the reflection signal at different distances between the tissue and the distal end of the spectroscopic probe when the target structure is projected with electromagnetic radiation of a specific wavelength (e.g., 450 nm or 730 nm). By referring to the calibration curve, analysis of the spectroscopic signal allows for a rapid estimation of the distance.

[0143] An exemplary process for generating a calibration curve is as follows. First, a reference value for each distance can be calculated. The calibration curve itself may not be useful for identifying distances because the intensity of light reflection depends on, for example, the reflectivity of the specimen. An example of a reference value for eliminating the influence of the specimen's reflectivity is as follows:

[0144] Reference value = dI / dx*1 / I (1)

[0145] During an in vivo surgical procedure, the operator can move the optical fiber or endoscope while continuously recording the spectroscopic feedback until the reflectance spectrum of the target tissue component can be detected.

[0146] Reference Figure 24C , the first spectrum can be measured at a distance x1 where the reflected signal intensity is I1. At this time, the actual value of x1 and the curve of the reflected signal intensity are unknown. Then, the optical fiber or the distal end of the endoscope (reflected light detector) can be continued to move, and the next reflected light intensity I2 corresponding to the distance x2 can be measured. x2 can be close to x1 so that the curve between x1 and x2 can be approximately linear. At this time, the curves of x1, x2 and the reflected signal intensity are unknown. The comparison value can be calculated using I1, I2 and Δ(x2-x1) as follows:

[0147] Comparison value = Δ(I2-I1) / Δ(x2-x1)*1 / I1 (2)

[0148] Then, search the reference values ​​for the same reference value as the comparison value. If only one reference value (x r ) is the same as the comparison value given in equation (2), then it can be determined that x r is the distance of x1. If there are two reference values ​​(x r1 , x r2 ), the optical fiber or the distal end of the endoscope (the reflected light detector) can be moved further, and the next reflected light intensity I3 corresponding to distance x3 can be measured. x3 can approach x2, so that the curve between x2 and x3 can be approximately linear. At this point, the curves of x1, x2, x3, and the reflected signal intensity are unknown. A new comparison value can be calculated using I1, I2, I3, Δ(x2 - x1), and Δ(x3 - x2) as follows.

[0149] Comparison value = Δ(I3-I2) / Δ(x3-x2)*1 / I2 (3)

[0150] Then, search the reference values ​​for the value that matches x r1 +Δ(x2-x1) and x r2 +Δ(x2-x1) the same reference value. The reference value can be compared with the comparison value given in equation (3). The distance whose reference value is more similar to the comparison value is estimated as the actual distance.

[0151] Reference Figure 24D , during an in vivo surgical procedure, an example method may include moving the optical fiber or endoscope and continuously recording spectroscopic feedback until a reflection spectrum of a target component is detected. In the primary case where the distal end of the spectrum moves toward the target, the intensity of the detected reflected light will initially be weak and will increase as the distance between the target and the optical fiber end decreases. For example, a first spectrum is measured at a distance d1 where the reflected signal intensity is I1. Continue to move the optical fiber or endoscope distal end slightly toward the target and continuously collect reflection data, and the method can measure the next reflected light intensity I2 corresponding to the distance d2. The method can then include calculating a value of a slope of change in reflected signal intensity = Δ(I2-I1) / Δ(d2-d1). In order to make the value of the calculated slope independent of the reflected signal intensity, the calculated slope can be normalized. The final formula for calculating the slope of change in reflected signal intensity at the measured distance becomes:

[0152] Slope (normalized) = [Δ(I2-I1) / Δ(d2-d1)] / I o (4)

[0153] Among them: I o =Average(I1,I2)

[0154] The method can then compare the calculated slope with the slope on a calibration curve in the library to allow estimation of the required distance. All calculations can be done quickly using software.

[0155] FIG. 25A to FIG. 25B The effect of the distance between the tissue and the distal end of the spectroscopy probe on the spectrum of the reflected light from the target is shown. Figure 25A Exemplary normalized UV-VIS reflectance spectra of various soft tissue types are shown, including bladder endothelium spectrum 2511, stomach endothelium spectrum 2512, stomach smooth muscle spectrum 2513, subureteral spectrum 2514, ureteral endothelium spectrum 2515, renal calyceal spectrum 2516, bladder muscle spectrum 2517, and medulla spectrum 2518. Figure 25B Shown are exemplary UV-VIS reflectance spectra of a particular tissue recorded at different distances between the tissue and the distal end of the spectroscopy probe, for example, from 0 inches to 0.25 inches. Figure 25A Some examples of animal soft tissue spectra are shown. Figure 25B Exemplary UV-VIS reflectance spectra of tissue recorded at different distances between the tissue and the distal end of the spectroscopic probe are presented. In this example, the reflected signal intensities at two spectral maxima at 450 nm and 730 nm are measured at different distances between the target tissue and the distal end of the presented spectroscopic probe, as described above with reference to FIG. 24A to FIG. 24B discussed.

[0156] Laser Controller 1740

[0157] The laser controller 1740 can be integrated with a laser coupling system. The laser coupling system couples one or more laser modules (e.g., solid-state laser modules) into an optical fiber. The laser controller 1740 can be coupled to a feedback analyzer 1730, which can send an optimization signal with recommended settings directly to the laser controller 1740 (automatic mode) or request operator approval to adjust the laser settings (semi-automatic mode). Figure 17 It is a schematic diagram of the fully automatic laser system. Figure 18 is a schematic diagram of a semi-automatic laser system in which the system requires user approval, for example, via a user interface including input 1850 and display 1860. In an example, the laser settings may be adjusted within a set range, which in an example may be predetermined by the user at the beginning of the process.

[0158] In some examples, laser controller 1740 can combine two or more laser pulse trains to create a combined laser pulse train. Figure 19AAn example is shown in which the laser controller 1740 can generate multiple (eg, N) laser pulse trains 1910A through 1910N, combine the laser pulse trains 1910A through 1910N into a combined pulse train 1920 , and expose a target at 1930 using the combined pulse train. Figure 19B is a diagram illustrating an example of an output laser pulse train 1942 composed of three different laser trains 1941A, 1941B, and 1941C emitted from different laser modules. As shown therein, laser trains 1941A, 1941B, and 1941C can be turned on and / or off at different times based on a feedback analyzer signal. In the example shown therein, the output combined laser pulse train 1942 may include a portion in which two or more of laser trains 1941A, 1941B, and 1941C overlap in time.

[0159] Utilizing the combination of laser modules 1910A-1910N, spectroscopy system 1720, and feedback analyzer 1730, a laser feedback system 1740 as described herein can continuously identify the composition of the target through the endoscope and update the laser settings throughout the procedure.

[0160] The main components of the laser system can be easily customized according to the target medical procedure. For example, the laser controller 1740 supports different laser types and their combinations. This allows a wide range of output signal options, including power, wavelength, pulse rate, pulse shape and profile, single laser pulse trains and combined laser pulse trains. The operating mode of the laser system can be automatically adjusted or suggested for each desired optical effect. The spectroscopy system collects information about the target material that is useful for diagnostic purposes and is used to confirm that the laser parameters are optimal for the target. The feedback analyzer 1730 can automatically optimize the operating mode of the laser system and reduce the risk of human error.

[0161] Internet of Things (IoT) System 1750

[0162] In some examples, the laser system can include an optional IoT system 1750 that supports storage of a spectral database archive on the cloud 1752, supports rapid access to the spectral and optimal settings database archive, and enables communication between the cloud 1752 and the feedback analyzer 1730. Cloud storage of data supports the use of artificial intelligence (AI) techniques to provide input to the feedback analyzer 1730 and enables immediate access to algorithm and database improvements.

[0163] According to various examples described herein, IoT system 1750 can include a network in which components of the laser system can communicate and interact with other components via the Internet. The IoT supports rapid access to a spectral database archive stored on cloud 1752 and facilitates communication between cloud 1752 and feedback analyzer 1730. Additionally, all components of the laser system can be remotely monitored and controlled via the network if desired. An example of such a successful connection is the Internet of Medical Things (also known as the Internet of Health Things), which is a useful application of the IoT for medical and health-related purposes, including data collection and analysis for research and monitoring.

[0164] In various examples, IoT system 1750 can support access to various cloud resources, including cloud-based detection, identification, or classification of target structures (e.g., stone structures or anatomical tissue). In some examples, a machine learning (ML) engine can be implemented in cloud 1752 to provide cloud-based target detection, identification, or classification services. The ML engine can include a trained ML model (e.g., machine-readable instructions executable on one or more microprocessors). The ML engine can receive target spectroscopy data from the laser system or retrieve target spectroscopy data stored in cloud 1752, perform target detection, identification, or classification, and generate output such as a label indicating tissue type (e.g., normal tissue or cancerous lesions or tissue at a specific anatomical site) or stone type (e.g., stones of a specific composition in the kidney, bladder, pancreaticobiliary duct, or gallbladder). Among other clinical data collected from the patient before or during surgery, the target spectroscopy data can be automatically uploaded to cloud 1752 at the end of the procedure or at other predetermined times. Alternatively, the system user (e.g., clinician) can be prompted to upload the data to cloud 1752. In some examples, the output may additionally include a probability of the target being identified as tissue or stone, or a probability of the target being classified as a particular tissue type or stone type. For example, when performing endoscopic laser surgery, a system user (e.g., a clinician) can use such a cloud service to obtain near real-time information about target tissue or stones in the body.

[0165] In some examples, the ML engine may include a training module configured to train an ML model using training data, such as that stored in the cloud 1752. The training data may include spectroscopic data associated with target information, such as a label identifying a target type (e.g., stone type or tissue type). The training data may include laboratory data based on spectroscopic analysis of multiple tissue types and / or stone types. Additionally or alternatively, the training data may include clinical data acquired from multiple patients in vitro or in vivo. In some examples, patient identification information may be removed from the patient clinical data (e.g., spectroscopic data) before the patient clinical data (e.g., spectroscopic data) is uploaded to the cloud 1752 to train the ML model or to perform target detection, recognition, or classification using the trained ML model. The system may associate the de-identified patient clinical data with a label identifying the data source (e.g., hospital, laser system identification, surgery time). The clinician may analyze and confirm the target type (e.g., stone or tissue type) during or after surgery and associate the target type with the de-identified patient clinical data to form training data. Using de-identified patients can advantageously increase the robustness of cloud-based ML models because additional data from a large patient population can be included to train the ML models. This can also improve the performance of ML models in identifying rare stone types, for which spectroscopy data is difficult to obtain clinically or in the laboratory.

[0166] Various ML model architectures and algorithms can be used, such as decision trees, neural networks, deep learning networks, support vector machines, etc. In some examples, training of the ML model can be performed continuously or periodically, or in near real time as additional spectroscopy data is made available. Training involves adjusting one or more ML model parameters through an algorithm until the trained ML model meets specified training convergence criteria. The resulting trained ML model can be used for cloud-based target detection, recognition, or classification. Utilizing an ML model trained using a large amount of data stored in the cloud 1752 and additional data continuously or periodically added thereto, target recognition with cloud connectivity as described herein can improve the accuracy and robustness of in vivo target detection, recognition, and classification.

[0167] Example Endoscopic Laser System

[0168] 21A to 21D An endoscopic laser system 2100A and 2100B comprising an endoscope 2110 with an integrated multi-fiber attachment and a laser system comprising Figure 10AAn example of a surgical laser system is shown with a feedback-controlled laser therapy system 1010 and a laser source 1020. Alternatively, the spectroscopic response can be collected by an imaging system containing a detector such as a CCD or CMOS sensor and transmitted to a spectrometer. Target composition analysis can be performed via spectroscopy through one or more cores of a multi-fiber accessory while illuminating the target with a light source transmitted through one or more other cores of the multi-fiber accessory.

[0169] like Figure 21A As shown, endoscopic laser system 2100A includes a multi-fiber accessory that includes an optical path 2116 for transmitting spectroscopy signals back to spectrometer 1011 and for transmitting surgical laser energy from laser source 1020 to a target structure. In an example, optical path 2116 includes an optical fiber embedded within and extending along the elongated body of endoscope 2110. In another example, optical path 2116 includes two or more optical fibers extending along the elongated body of endoscope 2110. Laser controller 1013 can control the timing of laser emission so that the transmission of spectroscopy signals and the transmission of laser energy occur at different times or simultaneously.

[0170] The multi-fiber attachment may include two or more light source fibers 2114 embedded in and extending along the elongated body of the endoscope 2110. By way of example and not limitation, Figure 21C A radial cross-section of the elongated body of an endoscope 2110 is shown, wherein a plurality of light source fibers 2114 and an optical path 2116 are longitudinally positioned within the elongated body of the endoscope, and the light source fibers 2114 are radially distributed around the optical path 2116, for example, along a circumference relative to the optical path 2116 on a radial cross-section of the elongated body of the endoscope. Figure 21C In the example shown, the optical path 2116 can be located substantially at the central longitudinal axis of the elongated body of the endoscope 2110. By way of example and not limitation, Figure 21C As shown, six light source fibers can be positioned around the optical path 2116. Other numbers of light source fibers and / or other positions of the light source fibers relative to the optical path 2116 can be used. For example, Figure 21D Two light source fibers 2114 are shown positioned radially at opposite sides of the optical path 2116. The light source fibers 2114 can be coupled to the light source 1030. Alternatively, the light source fibers 2114 can be coupled to Figures 9A to 9B10 and 11 . Light from an endoscope light source, illumination source 914 (e.g., one or more LEDs) or a remote light source 1030, such as external to the endoscope, can illuminate the target and generate a spectroscopic signal reflected from the target surface that can be collected for spectroscopic analysis. A feedback analyzer 1012 can determine a distance 1060 between the distal end of the endoscope 2110 and the target structure 122, as similar to that shown in FIG. 10 and FIG. 11 .

[0171] Figure 21B An endoscopic laser system 2100B including a multi-fiber attachment is shown. Instead of delivering laser energy through optical path 2116, a separate laser fiber 2120 can be used to deliver surgical laser energy from the laser source 1020 to the target structure. Optical path 2116 serves as a dedicated spectroscopy signal fiber for transmitting spectroscopy signals back to the spectrometer 1011.

[0172] Figure 22 and FIG. 23A to FIG. 23B It is shown that it can be used for example with reference to 21A to 21D An example of a multi-fiber system for optical fiber delivery systems for spectroscopy is discussed. Figure 22 In the example shown, the multi-fiber system 2200 includes a first optical fiber 2210 coupled to a light source and configured to direct illumination light at a target, and a separate second optical fiber 2220 coupled to a spectrometer and configured to transmit a reflection signal indicative of a spectroscopic characteristic of the target (e.g., light reflected from the target) to the spectrometer.

[0173] FIG. 23A to FIG. 23B FIG is a diagram of an exemplary multi-fiber accessory with a source light input and a spectroscopy feedback signal. Figure 23A As shown, the multi-fiber attachment 2300A may include a distal portion 2310, a transition portion 2320A, and a proximal portion 2330A. The distal portion 2310 includes an axis that may be sized and shaped to surround a first optical fiber 2210 and a second optical fiber 2220, and the transition portion 2320A is proximal to the distal portion 2310. The first optical fiber 2210 and the second optical fiber 2220 may be embedded in and extend along the longitudinal axis of the distal portion 2310. The axis may be sized and shaped to extend through a working channel of an endoscope. In some examples, the first optical fiber 2210 may include two or more optical fibers, each coupled to a light source, and / or the second optical fiber 2220 may include one or more optical fibers. In some examples, as Figures 21C to 21DAs shown, the second optical fibers 2220 can be radially distributed around the first optical fibers 2210. In an example, at least one of the second optical fibers 2220 can extend along a substantially central longitudinal axis of the shaft. Two or more first optical fibers 2210 can be positioned radially on opposite sides of the second optical fibers 2220 extending along the central longitudinal axis of the shaft.

[0174] The proximal portion 2330A includes a first connector 2332 configured to connect to a light source and a second connector 2334 configured to connect to a spectrometer. The transition portion 2320A interconnects the distal portion 2310 and the proximal portion 2330A, and the transition portion 2320A can be configured to couple the first connector 2332 to the first optical fiber 2210 and the second connector 2334 to the second optical fiber 2220. Thus, the transition portion 2320A provides a transition of the optical fibers 2210 and 2220 from their respective first connectors 2332 and second connectors 2334 to a single axis.

[0175] The shaft can include an insertable distal end 2312 extending distally from the distal portion 2310. The insertable distal end 2312 can be configured to be inserted into a patient. The proximal portion 2300A can be associated with (e.g., included in) a handle for a user to operate the multi-fiber accessory 2300A. In an example, at least a portion of the multi-fiber accessory 2300A (e.g., one or more of the distal portion 2310, the transition portion 2320A, or the proximal portion 2330A) can be included in or insertable into a working channel of an endoscope.

[0176] Figure 23B Another example of a multi-fiber accessory 2300B is shown, which is a variation of the multi-fiber accessory 2300A. Figure 23B In the example shown, the proximal portion 2330B may further include a third connector 2336 configured to couple the laser source to one of the optical fibers 2210 or 2220. Figure 23A Transition portion 2320B interconnects distal portion 2310 and proximal portion 2330B. Laser energy generated by a laser source can be transmitted from proximal portion 2330B to distal portion 2310 via one of optical fibers 2210 or 2220 and delivered to a target treatment site via insertable distal end 2312. In some examples, multi-fiber accessory 2300B can also include a laser fiber different from optical fibers 2210 or 2220. The laser fiber can be positioned in a working channel of an endoscope, such as within a shaft. Laser energy generated by a laser source can be transmitted to distal portion 2310 via the laser fiber.

[0177] Example Applications of Laser Systems

[0178] Laser systems as described according to various examples in this disclosure can be used in many applications, such as endoscopic hard tissue surgery or endoscopic soft tissue surgery, to improve the effectiveness of ablation, coagulation, vaporization, or other laser effects.

[0179] One application of laser systems for tissue surgery involves using a laser system to provide effective tissue ablation and coagulation, rather than two different foot pedals, as is often used on commercial devices such as laser and plasma devices. An example system uses two or more solid-state laser modules emitting at two different wavelengths, coupled to a laser controller via optical fibers, and a UV-VIS reflectance spectroscopy system that transmits spectral signals to a feedback analyzer that suggests alternative settings to the user before adjustments are made.

[0180] In one example, two laser modules can be provided, including: a first laser module that can emit at a high tissue absorption wavelength for a more efficient ablation / carbonization process, and a second laser module that can emit at a lower tissue absorption wavelength for more efficient coagulation, for example, due to a penetration depth similar to the diameter of a small capillary. Examples of the first laser module can include: an InXGa1-XN semiconductor laser emitting UV-VIS: GaN (emitting 515nm to 520nm); InXGa1-XN (emitting 370nm to 493nm), or an IR laser emitting in the high water absorption range of 1900nm to 3000nm summarized in Table 1. Examples of the second laser module can include: GaXAl1-XAs emitting at 750nm to 850nm, or InXGa1-XAs emitting at 904nm to 1065nm. Both the first laser module and the second laser module can be coupled to a laser controller via a laser coupling system.

[0181] The spectroscopic light source can be integrated into a separate fiber channel, laser fiber, or endoscope system. The spectroscopic light source signal reflected from the target can be rapidly detected and transmitted to a spectrometer via a separate fiber channel or laser fiber. Alternatively, the spectroscopic system can collect spectroscopic signals from an imaging system containing a detector such as a CCD or CMOS sensor. Based on the spectroscopic system feedback, a signal analyzer can detect the target material composition and recommend a first or second laser module setting to achieve effective tissue treatment. The signal is then transmitted to an output system that provides the recommended setting information to the user.

[0182] This example allows for tissue ablation and coagulation by utilizing two or more laser pulses in which the wavelength of light is controlled by a feedback analyzer system. However, feedback control can be used with single or multiple wavelength systems to optimize the simultaneous delivery of specific effects to a target. These effects may be simultaneous only from the user's perspective; the features described herein are not limited to delivering wavelengths at exactly the same time.

[0183] Figure 8 An example temporal operation diagram of such a laser with spectroscopic feedback is presented in . As described therein, where the amplitude is A max The optical feedback signal is continuously transmitted to and reflected from the target surface and detected and analyzed by the signal analyzer. The user can then turn on the first laser, or keep the first laser on while the second laser is off after selecting to ablate soft tissue. During operation of the first laser, the optical feedback signal is highly absorbed by the carbonized tissue until its amplitude decreases to a threshold level A. min The signal analyzer then changes the state of the lasers so that the first laser is off and the second laser is on. The second laser is highly absorbed by the carbonized tissue; therefore, the carbonized tissue is ablated, which effectively removes the carbonization. The wavelength of the second laser also provides effective coagulation. Due to the decarburization process, the amplitude of the optical feedback pulse returns to near the initial level A max When this occurs, the signal analyzer changes the state of the lasers back to the first laser being on and the second laser being off. The above process can be repeated until the desired amount of tissue ablation and coagulation is achieved.

[0184] Another application of laser systems relates to an efficient laser lithotripsy procedure for fragmenting kidney or bladder stones in patients. This application relates to a process that uses multi-wavelength laser energy with wavelengths less absorbed by the target to first heat the target, and then fragments the target, such as a kidney stone, using a more strongly absorbed wavelength. During laser lithotripsy, fragmentation of kidney or bladder stones may occur due to a photothermal effect. High laser energy can be absorbed by the stone, causing the temperature to rapidly rise above the threshold for chemical breakdown, leading to its breakdown and fragmentation. In one example, laser lithotripsy can include a two-stage process. The first stage is a preheating stage, in which laser energy at a first wavelength is used to heat the stone, resulting in low laser energy absorption by the stone. This second stage then involves applying laser energy at a second wavelength, resulting in stronger laser energy absorption by the stone than the first wavelength. This multi-step process allows for better control of steam bubble generation and reduces the intensity of the shock wave generated during the fragmentation process (reducing the stone recoil effect).

[0185] In an example, a laser system utilizes two or more solid-state laser modules emitting at two different wavelengths, coupled to a laser controller via optical fiber, and a spectroscopy system that transmits spectral signals to a feedback analyzer that suggests alternative settings to the user before adjustments are made. The first laser module can emit at a lower rock / water absorption wavelength for efficient preheating, and the second laser module can emit at a higher rock / water absorption wavelength for more efficient rock fragmentation. The first laser module in this application can produce an output at a lower rock or water absorption wavelength. The laser provides efficient and uniform rock preheating. Examples of a first laser source for the first laser module can include GaXAl1-XAs, which emits at 750nm to 850nm, or InXGa1-XAs, which emits at 904nm to 1065nm. Examples of the second laser source may include an InXGa1-XN semiconductor laser that emits UV-VIS laser light, such as a GaN laser that emits between 515 nm and 520 nm, or an InXGa1-XN laser that emits between 370 nm and 493 nm, or an IR laser that emits within the high water and stone absorption range of 1900 nm to 3000 nm and is summarized in Table 1.

[0186] Both the first laser module and the second laser module can be coupled to a laser controller via a laser coupling system. The spectroscopy light source can be integrated into a separate fiber channel, laser fiber, or endoscope system. The spectroscopy light source signal reflected from the target can be quickly detected and transmitted to a spectrometer via a separate fiber channel or laser fiber. Alternatively, the spectroscopy system can collect the spectroscopy signal from an imaging system containing a detector such as a CCD or CMOS sensor.

[0187] Based on the spectroscopy system feedback, the signal analyzer can detect the target material composition and recommend a first laser module setting or a second laser module setting to achieve an effective multi-step stone treatment process, and transmit a signal to an output system for providing the recommended setting information to the user. The laser system can simultaneously deliver effective stone preheating and fragmentation by utilizing two or more laser pulses from the laser modules, where the optical wavelength is controlled by the feedback analyzer system. However, feedback control can be used with single or multiple optical wavelength systems to optimize the simultaneous delivery of specific effects on the target stone composition.

[0188] Another application of laser systems involves performing ablation procedures on hard tissues, such as teeth and bone, which require high laser output power. The effectiveness of soft tissue laser surgery relies on water vaporization at temperatures as low as 100°C; however, hard tissue cutting procedures require very high ablation temperatures—up to 5,000°C. To deliver increased output power, the laser system can couple a larger number of laser modules to increase the integrated output power to a level sufficient to treat the target. The following lasers can be used as emission sources: UV-VIS emitting InXGa1-XN semiconductor lasers: GaN (emitting at 515nm to 520nm); InXGa1-XN (emitting at 370nm to 493nm); or the IR lasers (1900nm to 3000nm) summarized in Table 1. Laser sources suitable for the laser modules of this example may include, for example, GaXAl1-XAs lasers emitting at 750nm to 850nm, or InXGa1-XAs lasers emitting at 904nm to 1065nm.

[0189] The laser module can be integrated into a laser controller with a laser coupling system. To achieve the required high power, a large number of laser modules can be coupled into the system. The spectroscopy light source can be integrated into a separate fiber channel, laser fiber, or endoscope system. The spectroscopy light source signal reflected from the target can be quickly detected and transmitted to the spectrometer through a separate fiber channel or laser fiber. Alternatively, the spectroscopy system can collect the spectroscopy signal from an imaging system containing a detector such as a CCD or CMOS sensor.

[0190] Based on the spectroscopy system feedback, the signal analyzer can detect the target material composition and recommend laser module settings and the number of laser modules to achieve the desired output power and an effective multi-step treatment process. This signal is then transmitted to an output system that provides the user with the recommended settings. By increasing the number of laser modules involved in the treatment process, the laser system can simultaneously deliver the desired high laser output power using two or more laser pulses whose wavelengths are controlled by the feedback analyzer system. Feedback control can be used with single or multiple wavelength systems to optimize the simultaneous delivery of specific effects on the target stone composition. These effects may appear simultaneous from the user's perspective alone; however, they are not limited to delivering wavelengths at exactly the same time.

[0191] The features described herein can be used to provide methods for identifying target composition. In some cases, the target can be a medical target, such as soft or hard tissue within the body, using a surgical attachment. The attachment can be used with an endoscope or laparoscope. The attachment can consist of a single device containing multiple optical fibers, with at least one fiber providing light source illumination and at least one fiber directing reflected light to a spectrometer. This allows the user to continuously monitor the composition of the tissue or target throughout the procedure, with or without direct endoscopic visualization. This also has the capability to be used in conjunction with a laser system, where the attachment can provide feedback to the laser system to adjust settings based on the composition of the tissue or target. This feature allows for instant adjustment of laser settings within a set range of the original laser settings selected by the user. The features described herein can be used with a spectroscopy system that can be used with a fiber-integrated laser system. The spectroscopic light source can be transmitted through at least one fiber in the multi-fiber attachment. The light source signal reflected from the target can be rapidly collected and transmitted to the spectrometer via an additional fiber in the multi-fiber attachment.

[0192] An example method can utilize spectroscopy input data based on an algorithm to calculate and control the distance between the distal end of a laser delivery system 1701 (e.g., an optical fiber) and tissue or a target. The method can be applied to both soft and hard tissue types for in vivo surgical procedures. The distance between the target and the distal end of the optical fiber can be calculated based on analysis of the spectral data. The outer diameter of each optical fiber and the angle at which it protrudes from the endoscope affect the intensity of the reflected light; these are measured to obtain the spectral data. Using features as described herein, the distance can be calculated without sequential illumination with light having different numerical aperture values.

[0193] In the case of moving stones, the method can control the distance and can adjust or recommend laser operating parameters that use steam bubbles in water to create a suction effect to pull targets that exceed a predetermined threshold closer to the distal end of the optical fiber. This feature minimizes the effort required by the user to maintain an effective treatment distance from the moving target.

[0194] UV-VIS-IR reflectance spectroscopy, according to the various examples discussed in this disclosure, can be used alone or in combination with other spectroscopic techniques to create spectroscopic feedback, including analyzing the chemical composition of materials and measuring the intensity of reflected light during in vivo diagnostic or therapeutic procedures. Reflected light can potentially produce the same information as a color image captured by the eye or a high-resolution camera, but it is more quantitative and objective. Reflectance spectroscopy provides information about a material because light reflection and absorption depend on its chemical composition and surface properties. This technique can also be used to obtain unique information about both the surface and bulk properties of a sample.

[0195] Another application of laser systems involves identifying target types, such as determining the composition of a target stone during laser lithotripsy. According to some examples discussed herein, an endoscopic system includes a light source, and the light source provides illumination to a target within the human body through an endoscope's light guide. A doctor uses a laser system to break up a stone under the illumination from the endoscopic system. However, using a laser system to detect the stone's composition can be problematic. Light reflected from the stone is weak, while the illumination from the endoscopic system is strong. Therefore, analyzing the stone's composition under the illumination provided by the endoscopic system can be difficult.

[0196] Figure 26 An example of an endoscope system 2600 configured to use a diagnostic beam, such as a laser beam, to identify a target (e.g., to identify the composition of a stone target) is shown. System 2600 may include a controller 2650 that can control both an endoscope light source 2630 and a laser generator module 2640. Controller 2650 can detect a command input by a physician via the laser system to activate a stone composition detection mode. Controller 2650 can then send a command to the endoscope light source 2630 to stop illumination or switch from a high illumination mode to a low illumination mode, in which a reduced amount of illumination is projected onto the target for a certain period of time. During such low or no illumination periods, laser system 2640 can emit a laser beam toward the target and receive reflected light from the stone. Detector 2660 can use the reflected light to perform target identification. By dimming (or turning off) the illumination of the target area in low illumination mode, reflection of the laser beam incident on the target from the target can be enhanced, which can help improve target identification.

[0197] Once the detector 2660 determines that target identification is complete, the detector 2660 can send a termination command to the controller 2650. The controller 2650 can then send a command to re-illuminate the target, or switch from low illumination back to high illumination mode. In one example, when the endoscope light source 2630 receives a command to stop illumination or switch from high illumination mode to low illumination mode, the image processor 2670 in the endoscope system 2600 can capture a still image of the target and display the still image on the monitor of the endoscope system during a time period. Variations of the endoscope system 2600 for identifying a target have been envisioned, such as those described above with reference to Figures 11A to 11B those discussed.

[0198] Figure 27Graph 2700 shows a sequence of laser pulses having different pulse energies or power levels, which may include, for example, a first pulse train 2710 and a second pulse train 2720. The pulses in the second pulse train 2720 have a higher energy or power level than the pulses in the first pulse train 2710. The first pulse train 2710 and the second pulse train 2720 may be generated by respective laser sources and each of the first pulse train 2710 and the second pulse train 2720 may be emitted from the distal end of the endoscope in the form of respective laser beams. The first pulse train 2710 may be generated substantially constantly in time, for example, within a specific time period (e.g., controlled by a user). The second pulse train 2720 may be generated intermittently in time, for example, within a specific time period during the transmission of the first pulse train 2710. For example, the second pulse train 2720 may be transmitted between two pulses of the first pulse train 2710 or between two trains of the first pulse train 2710. In the example Figure 27 In the example shown, the pulses in first pulse train 2710 have a constant energy or power level, and second pulse train 2720 includes only one pulse having a higher energy or power level than first pulse train 2710. In some examples, second pulse train 2720 may include two or more pulses, each having a higher energy or power level than first pulse train 2710.

[0199] Laser lithotripsy systems can be used Figure 27 The laser pulse sequence shown is used to provide disruption and fragmentation of stone structures such as kidneys. Figure 27 As shown, the sequence represents time in the X direction of the figure, but is also annotated with positions "A" and "B" on the rock or other target. Thus, the sequence of laser pulses represents a spatiotemporal pattern of laser pulses having different pulse energies or power levels. In this example, position "A" is at or near the center of the rock or other target, while position "B" is at or near the periphery of the rock or other target. The laser pulses emitted between positions "A" and "B" illustrate pulses emitted when the laser fiber 140 is translated from position "A" to position "B", or when the laser fiber 140 is translated from position "B" to position "A", which may include, for example, the use of an actuator. The first pulse train 2710 may be selected to induce cracks in the target rock without chipping the target rock. Thus, in Figure 27In this embodiment, such a first pulse train 2710 can be emitted starting at position "A" toward the center of the stone, then proceeding toward position "B" toward the periphery of the stone, and then returning toward position "A" located at the center of the stone, at which point a higher energy pulse 2720 can be delivered in a first attempt to fragment the target stone. If such fragmentation by the higher energy pulse 2720 is unsuccessful, a further first pulse train 2710 can be delivered from a position toward the center of the stone to a position "B" toward the periphery of the stone, and then returning toward position "A" at the center of the stone, at which point another higher energy pulse 2720 can be delivered in a second attempt to fragment the target stone. Further iterations are also possible. The same or different positions "B" toward the periphery of the stone can be used in various iterations, with different positions "B" in different iterations generating multiple cracks along such a path from position "A" to such different peripheral positions "B". It may be preferable to use only higher energy pulses 2720 toward the center of the stone, for example, to minimize the impact of the second pulse train 2720 on nearby tissue.

[0200] In some examples, Figure 27 The laser pulse sequences shown in FIG. 27 with different pulse energies or power levels can be used by an endoscopic system to provide hemostasis or coagulation at a target site. In an example, a first pulse train 2710 and a second pulse train 2720 can be delivered to a target site in a spatiotemporal pattern, such as an alternating manner in time, to promote an effective hemostasis or coagulation process.

[0201] Pulses with different energy or power levels, such as the first pulse train 2710 and the second pulse train 2720, can be controllably activated via a user-operable actuator, such as a button or a foot pedal. For example, the user can use a first activation mode (e.g., a single press of a button or a foot pedal) to activate the delivery of the first pulse train 2710, and use a second activation mode (e.g., two presses of a button or a foot pedal) to activate the delivery of the second pulse train 2720. In an example, the first pulse train 2710 and the second pulse train 2720 can be controlled via separate actuators. Additionally or alternatively, the first pulse train 2710 and the second pulse train 2720 can be controllably activated automatically, for example, based on a feedback signal from the target. For example, a spectrometer can collect spectroscopic data of the target, and a feedback analyzer can analyze the spectroscopic data to identify the composition of different parts of the stone structure. Based at least on such identification, different energy pulses, such as the first pulse train 2710 or the second pulse train 2720, can be delivered to different parts of the target having the respective identified composition.

[0202] Figure 28A block diagram generally illustrates an example machine 2800 on which any one or more of the techniques (eg, methods) discussed herein may be performed. Portions of this description may be applied to the computing framework of various portions of a laser therapy system, according to examples discussed in this disclosure.

[0203] In an alternative embodiment, machine 2800 can be operated as an independent device or can be connected (for example, networked) to other machines. In a networked deployment, machine 2800 can operate with the ability of a server machine, a client machine or both in a server-client network environment. In an example, machine 2800 can be used as a peer-to-peer machine in a peer-to-peer (P2P) (or other distributed) network environment. Machine 2800 can be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile phone, a web application, a network router, a switch or a bridge, or any machine that can (sequentially or otherwise) execute the instruction of the action to be taken by the machine. In addition, although only a single machine is shown, the term "machine" can also be considered to include executing one group (or multiple groups) of instructions individually or jointly to execute any one or more of the machines discussed herein, such as cloud computing, software as a service (SaaS) or other computer cluster configuration methods.

[0204] As described herein, examples may include, or may be operated by, logic or multiple components or mechanisms. A circuit group is a collection of circuits implemented in a tangible entity comprising hardware (e.g., simple circuits, gates, logic, etc.). The members of a circuit group may change over time and with changes in the underlying hardware. A circuit group includes members that can perform a specified operation individually or in combination when in operation. In an example, the hardware of the circuit group may be designed to perform the specified operation (e.g., hardwired). In an example, the hardware of the circuit group may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) to encode instructions for the specified operation, and the variably connected physical components may include computer-readable media that are physically modified (e.g., magnetically, electrically, by the removable placement of a constant mass particle, etc.). When the physical components are connected, the underlying electrical properties of the hardware components are changed, such as from an insulator to a conductor or vice versa. The instructions enable embedded hardware (e.g., an execution unit or a loading mechanism) to create members of the circuit group in the hardware via variably connected components to perform portions of the specified operation when in operation. Thus, when the device is in operation, the computer-readable medium is communicatively coupled to the other components of the circuit group members. In an example, any component of the physical components can be used in more than one member of more than one circuit group. For example, in operation, an execution unit can be used in a first circuit of a first circuit group at one point in time and reused at a different time by a second circuit of the first circuit group or by a third circuit of the second circuit group.

[0205] The machine (e.g., a computer system) 2800 may include a hardware processor 2802 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), a main memory 2804, and a static memory 2806, some or all of which may communicate with each other via an interconnection link (e.g., a bus) 2808. The machine 2800 may also include a display unit 2810 (e.g., a raster display, a vector display, a holographic display, etc.), an alphanumeric input device 2812 (e.g., a keyboard), and a user interface (UI) navigation device 2814 (e.g., a mouse). In an example, the display unit 2810, the input device 2812, and the UI navigation device 2814 may be a touch screen display. The machine 2800 may additionally include a storage device (e.g., a drive unit) 2816, a signal generating device 2818 (e.g., a speaker), a network interface device 2820, and one or more sensors 2821, such as a global positioning system (GPS) sensor, a compass, an accelerometer, or other sensors. The machine 2800 may include an output controller 2828, such as a serial (e.g., universal serial bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate with or control one or more peripheral devices (e.g., a printer, a card reader, etc.).

[0206] The storage device 2816 may include a machine-readable medium 2822 having stored thereon one or more data structures or instructions 2824 (e.g., software) that implement or are utilized by any one or more of the techniques or functionality described herein. The instructions 2824 may also reside, in whole or in part, within the main memory 2804, within the static memory 2806, or within the hardware processor 2802 during execution of the instructions by the machine 2800. In an example, one or any combination of the hardware processor 2802, the main memory 2804, the static memory 2806, or the storage device 2816 may constitute a machine-readable medium.

[0207] Although the machine-readable medium 2822 is shown as a single medium, the term "machine-readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) configured to store one or more instructions 2824.

[0208] The term "machine-readable medium" may include any medium that can store, encode, or carry instructions for execution by the machine 2800 and that causes the machine 2800 to perform any one or more of the techniques of the present disclosure, or that can store, encode, or carry data structures used by such instructions or data structures associated with such instructions. Non-limiting examples of machine-readable media may include solid-state memory and optical and magnetic media. In an example, a large-capacity machine-readable medium includes a machine-readable medium having a plurality of particles, the particles having a constant (e.g., stationary) mass. Therefore, a large-capacity machine-readable medium is not a transient propagating signal. Specific examples of large-capacity machine-readable media may include: non-volatile memory, such as semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EPSOM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0209] Instructions 2824 may also be sent or received over a communications network 2826 using a transmission medium via the network interface device 2820 using any of a number of transmission protocols (e.g., Frame Relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), Hypertext Transfer Protocol (HTTP), etc.). Example communications networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), a mobile telephone network (e.g., a cellular network), a plain old telephone (POTS) network, and a wireless data network (e.g., a wireless network known as a cellular network). The Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards, known as 2.16 family of standards), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, etc. In an example, the network interface device 2820 may include one or more physical jacks (e.g., Ethernet, coaxial, or telephone jacks) or one or more antennas for connecting to the communication network 2826. In an example, the network interface device 2820 may include multiple antennas to communicate wirelessly using at least one of single-input multiple-output (SIMO) technology, multiple-input multiple-output (MIMO) technology, or multiple-input single-output (MISO) technology. The term "transmission medium" should be taken to include any intangible medium that can store, encode, or carry instructions for execution by the machine 2800, and the term "transmission medium" should be taken to include digital communication signals or analog communication signals or other intangible media to facilitate the communication of such software.

[0210] Additional Notes

[0211] The above detailed description includes reference to the accompanying drawings, which form a part of the detailed description. As an explanation, the accompanying drawings show specific embodiments in which the present invention can be put into practice. 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 have also considered examples in which only those elements shown or described are provided. In addition, the inventors have also considered examples of any combination or permutation of these elements (or one or more aspects of these elements) shown or described with respect to a particular example (or one or more aspects of a particular example) or with respect to other examples (or one or more aspects of other examples) shown or described in this article.

[0212] In this disclosure, as is common in patent disclosures, the terms "a" or "an" are used to include one or more than one, regardless of any other instance or usage of "at least one" or "one or more." In this disclosure, unless otherwise indicated, the term "or" is used to refer to a non-exclusive or, such that "A or B" includes "A but not B," "B but not A," and "A and B." In this disclosure, the terms "including" and "in..." are used as the plain English equivalents of the respective terms "comprising" and "wherein." Furthermore, in the appended claims, the terms "including" and "comprising" are open-ended, that is, systems, devices, articles, compositions, formulas, or processes that include elements in addition to those listed after such terms in a claim are still considered to fall within the scope of the claim. Furthermore, 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.

[0213] The above description is intended to be illustrative, not restrictive. For example, the examples described above (or one or more aspects of the examples) can be used in combination with each other. For example, other embodiments may be used by those of ordinary skill in the art after consulting the above description. The abstract provided is in accordance with 37 CFR § 1.72 (b) so that the reader can quickly determine the nature of the disclosure of this technology. The abstract is submitted with the understanding that the abstract 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 organize the disclosure. This should not be interpreted as meaning that for any claim, the disclosed features that are not claimed for protection are all necessary. Instead, the subject matter of the invention may lie in less than all the features of a particular disclosed embodiment. Therefore, the appended claims are hereby incorporated into the specific embodiments as examples or embodiments, wherein each claim is independently a separate embodiment, and it is expected that such embodiments can be combined with each other in various combinations or permutations. The scope of the present invention should be determined with reference to the appended claims and the full scope of equivalents authorized by such claims.

Claims

1. A device for laser treatment, comprising: at least one processor; and at least one non-transitory memory comprising computer program code, the at least one non-transitory memory and the computer program code being configured to, with the at least one processor, cause the apparatus to: causing the laser system to emit a first laser pulse train according to a first laser energy level and a second laser pulse train according to a second laser energy level higher than the first laser energy level; and directing the first laser pulse train and the second laser pulse train from a distal end of an endoscope at respective different spatial locations of a single target in a spatiotemporal pattern, Wherein, in the spatiotemporal mode, the second laser pulse train is iteratively applied toward the center of the target and the first laser pulse train is applied toward the periphery of the target, so that the second laser pulse train has minimal effect on tissue surrounding the target.

2. The device according to claim 1, wherein The first laser pulse train has a specific pulse rate within a specific time period.

3. The device according to claim 2, wherein The second laser pulse train is intermittently emitted within a specific time period during which the first laser pulse train is generated.

4. The device according to any one of claims 1 to 3, wherein The at least one non-transitory memory and the computer program code are configured to, with the at least one processor, cause the apparatus to generate the second laser pulse train temporally between two pulses of the first laser pulse train.

5. The device according to claim 1, wherein The at least one non-transitory memory and the computer program code are configured to: with the at least one processor, cause the apparatus to generate a third laser pulse train according to the first laser energy level, and to generate the second laser pulse train temporally between the first laser pulse train and the third laser pulse train.

6. The device according to any one of claims 1 to 3, wherein: The at least one non-transitory memory and the computer program code are configured to, with the at least one processor, cause the apparatus to deliver the first laser pulse train at or near a periphery of a single stone structure and the second laser pulse train at or near a center of the single stone structure; and The first laser pulse train is configured to form a crack on the surface of the single stone structure, and wherein the second laser pulse train is configured to cause fragmentation of the single stone structure after forming the crack.

7. The device according to any one of claims 1 to 3, wherein: The at least one non-transitory memory and the computer program code are configured to, with the at least one processor, cause the device to deliver the first and second laser pulse trains at target tissue for hemostasis or coagulation therein.

8. A non-transitory program storage device readable by a machine, tangibly embodying a program of instructions executable by the machine for performing operations comprising: generating a first laser pulse train according to a first laser energy level and generating a second laser pulse train according to a second laser energy level higher than the first laser energy level; as well as directing the first laser pulse train and the second laser pulse train from a distal end of an endoscope at respective different spatial locations of a single target in a spatiotemporal pattern, Wherein, in the spatiotemporal mode, the second laser pulse train is iteratively applied toward the center of the target and the first laser pulse train is applied toward the periphery of the target, so that the second laser pulse train has minimal effect on tissue surrounding the target.

9. The non-transitory program storage device according to claim 8, wherein: The first laser pulse train is generated at a specific pulse rate within a specific time period, and the second laser pulse train is intermittently generated within a specific time period during which the first laser pulse train is generated.

10. The non-transitory program storage device according to claim 9, wherein: The operations include generating a third laser pulse train based on the first laser energy level, wherein the second laser pulse train is temporally located between the first laser pulse train and the third laser pulse train.

11. The non-transitory program storage device according to any one of claims 8 to 10, wherein: The operation includes delivering the first laser pulse train at or near the periphery of a single stone structure and delivering the second laser pulse train at or near the center of the single stone structure; as well as The first laser pulse train is configured to form cracks on the surface of the single stone structure, and the second laser pulse train is configured to cause fragmentation of the single stone structure after forming the cracks.

12. The non-transitory program storage device according to any one of claims 8 to 10, wherein: The operation includes delivering the first laser pulse train and the second laser pulse train at target tissue for hemostasis or coagulation therein.

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