Lithotripsy system with dispersed laser nodes

Abstract

A lithotripsy system to deliver laser energy from one or more laser sources to a stone (e.g., to move the stone) includes a capture portion, a first laser node, and a second laser node. The capture portion is configured to move from a storage state to a deployed state. In the deployed state, the capture portion is configured to at least partially enclose the stone. The first laser node and the second laser node are coupled to the capture portion and are configured to deliver laser energy to the stone, and the first laser node is spaced apart from the second laser node.

Description

[0001] Cross-references to related applications

[0002] This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 043,310, filed on June 24, 2020, the contents of which are incorporated herein by reference in their entirety. Technical Field

[0003] This document relates to techniques for breaking up obstacles such as physiological stones or "pebbles" using lithotripsy, and more specifically, to techniques for breaking up obstacles using laser lithotripsy. Background Technology

[0004] Medical endoscopes were first developed in the early 1800s and have been used for examinations inside the body. A typical endoscope consists of a distal end including an optical or electronic imaging system and a proximal end with controls for manipulating tools and devices used to view images, with a solid or tubular elongated shaft connecting these ends. Some endoscopes allow physicians to deliver tools or treatments along one or more hollow working channels, for example, to remove tissue or retrieve objects.

[0005] Over the past few decades, there has been some progress in the field of endoscopy, particularly in the fragmentation of physiological stones in the bile ducts, urinary tract, kidneys, and gallbladder. Physiological stones in these areas can obstruct ducts and cause considerable pain to patients, thus requiring fragmentation and / or removal. Various techniques have been developed to fragment stones, including ultrasonic lithotripsy, pneumatic lithotripsy, electro-hydraulic lithotripsy (EHL), and laser lithotripsy, which includes the use of green light, YAG, or holmium lasers to break down stones. Summary of the Invention

[0006] Furthermore, the inventors have recognized that problems to be solved when performing laser lithotripsy in a living organism include the surgeon's ability to easily capture stones located within the body, break the stones, and remove stone fragments. This subject matter can provide solutions to these and other problems.

[0007] This disclosure describes a laser lithotripsy system including a deployable, expandable capture section having integrated laser nodes dispersed on its surface. The capture section can be provided, for example, in the form of a bag, basket, or support. The deployable capture section allows surgeons to capture and ablate stones using minimally invasive methods such as ureteroscopy or percutaneous nephrolithotomy (PCNL). Aspects of the laser lithotripsy system described herein can be used with endoscopes such as ureteroscopes or nephroscopes, or with individual flexible, semi-rigid, or rigid instruments or devices.

[0008] Laser nodes can direct laser energy received from at least one laser source (e.g., via one or more laser fibers) to multiple locations on the outer surface of a stone. In some examples, laser nodes can direct laser energy to the stone simultaneously. In some examples, the dispersed nature of the laser nodes allows for selective, targeted application of energy. For example, depending on the characteristics of the stone, laser energy can be applied to only one side, one portion, or certain portions of the stone. This targeted application of energy can be achieved by activating a subset of multiple laser nodes on a network of nodes.

[0009] This disclosure also describes a capturing section having an opening for receiving stones. In some examples, the opening can be closed to capture the stones within it. The capturing section can be used with a laser node, but also has applications where it can be separated from the laser node.

[0010] This overview is intended to provide an overview of the subject matter of this patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. Detailed descriptions are included to provide further information regarding this patent application. Attached Figure Description

[0011] Figure 1 A side view of a portion of a lithotripsy system according to at least one example is shown.

[0012] Figure 2 A side view of a portion of a second lithotripsy system according to at least one example is shown.

[0013] Figure 3 A side view of a portion of a third lithotripsy system according to at least one example is shown.

[0014] Figure 4 A side view of a portion of a fourth lithotripsy system according to at least one example is shown.

[0015] Figure 5A A side view of a portion of the fifth lithotripsy system in a stored state according to at least one example is shown.

[0016] Figure 5B A side view of a portion of the fifth lithotripsy system in its unfolded state, according to at least one example, is shown.

[0017] Figure 6 A side view of a portion of the sixth lithotripsy system according to at least one example is shown.

[0018] Figure 7 It shows the following based on at least one example. Figure 6 A cross-sectional view of a portion of the sixth lithotripsy system, taken from line 7-7.

[0019] Figure 8 It shows at least one example Figure 6 A plan view of the distal portion of the sixth lithotripsy system.

[0020] Figure 9A A side view of a portion of the seventh lithotripsy system in a stored state, according to at least one example, is shown.

[0021] Figure 9B A side view of a portion of the seventh lithotripsy system in its unfolded state, according to at least one example, is shown.

[0022] Figure 10 A flowchart is shown illustrating a method for transmitting laser energy in a laser therapy device, such as a laser lithotripter, according to at least one example.

[0023] In drawings that are not necessarily drawn to scale, similar reference numerals may describe similar parts in different views. Similar reference numerals with different letter suffixes may indicate different instances of similar parts. The drawings are generally illustrated by way of example rather than limitation, showing the various embodiments discussed in this document. Detailed Implementation

[0024] This disclosure provides examples of systems and methods that can help solve the problem of breaking up and collecting stones during lithotripsy, such as laser lithotripsy, or other surgical or treatment procedures. Laser lithotripsy uses an optical transmission medium or optical path, such as one or more laser fibers, to transmit laser energy from at least one laser source to a target obstacle, such as a stone.

[0025] Breaking and collecting stones can be challenging because they can be free-floating, mobile stones. Since stones are typically not confined to tissues by appendages and are free-floating, they may move during the breaking process. Another challenge is that different parts of a stone may have varying degrees of hardness, and some parts of the stone's surface may be more easily penetrated than others. Stones can be found in various organs of the body, including but not limited to the kidneys, bladder, ureters, bile ducts, and gallbladder.

[0026] Furthermore, the benefits of the method described in this paper include capturing the stone to be treated and delivering laser energy from multiple spaced-apart laser nodes to the stone to ablate it. Delivering laser energy to multiple locations across the stone's surface increases the speed of stone ablation compared to current applications that focus energy at only one point at any given time, which can reduce procedure time. This dispersed application of laser energy can also help penetrate the typically harder outer layer of the stone. Additionally, because the laser energy is directed inward toward the kidney stone, adjacent tissue can be avoided.

[0027] This disclosure also provides a solution to the problem of capturing stones to be treated and retaining captured stone fragments for removal, a solution that can be used in conjunction with other forms of lithotripsy or other surgical procedures used to capture stones or tissue within the body. Deployable capture components, such as bags, baskets, supports, forceps, grasping fingers, or containers, can capture and retain stones during treatment, as well as retain fragmented stones for removal. This can result in shorter procedure times because the stone's position is controlled and known during lithotripsy, reducing stone retreat and other unwanted movements that would require the surgeon to "chase" the stone throughout the procedure. Retaining captured stone fragments can also improve postoperative stone-free rates for patients.

[0028] For the purposes of this disclosure, "proximal end" refers to the end of the system that is closer to the device operator during use, and "remote end" refers to the end of the system that is a terminal or further away from the device operator during use.

[0029] Figure 1 A side view of an example portion of a laser lithotripsy system 100 is shown. The lithotripsy system 100 may include or be coupled to at least one laser source LS. The lithotripsy system 100 may be introduced into a patient via the working channel WC of an endoscope or similar instrument. The laser source LS may include one or more of a diode or diode-pumped thulium fiber laser, holmium laser, green laser, YAG laser, or another laser configured to deliver laser energy.

[0030] The laser lithotripsy system 100 may include a sheath 102, a capture portion 104, and a plurality of laser nodes 106. The capture portion 104 may serve as a stone holding member, configured to move from a stored state to an deployed state within a lumen 108 of the sheath (e.g., an elongated tube) to capture a stone S. The sheath 102 may have any suitable cross-section, including but not limited to: circular, oval, elliptical, polygonal, or irregular shapes.

[0031] The capture portion 104 is shown in an extended state, and the directions of movement from the stored state to the extended state and from the extended state to the stored state are indicated by movement arrows PD. The extended state can refer to a state in which the capture portion 104 is an extension and / or distal extension of the sheath 102. Movement from the stored state to the extended state can include movement of the capture portion 104 along the distal direction D and extension along lateral directions such as, but not limited to, lateral directions L1, L2, L3, L4. In other words, extension can include: the capture portion 104, when actuated by an operator, moving in a direction having a longitudinal component along the proximal-distal direction and a lateral component relative to the sheath 102. Examples of the stored state and the extended state are shown in... Figure 5A and5B The examples are shown and described in more detail.

[0032] To receive the stone S, the capturing portion 104 may include a receiving cavity 110. The receiving cavity 110 may have an inner surface 112 and an outer surface 114 configured to at least partially surround the stone S. In the deployed state, the capturing portion 104 may be configured to receive the stone S into the receiving cavity 110 through an opening 116. In some examples, the capturing portion 104 may include a layer 118 of compliant material such as a mesh. The mesh may include, but is not limited to, the type of mesh used in the repair of hernias and other tissues. Various examples of openings are described herein, including openings that remain open or openings that can be opened and / or at least partially closed by an operator.

[0033] At least one laser node 106 may be coupled to the capture section 104 to receive laser energy from the laser source LS and disperse the laser energy to the stones S. Figure 1 The example illustrates multiple laser nodes 106, including a first laser node 106A and a second laser node 106B positioned at intervals, as well as other similar laser nodes. The first laser node 106A and the second laser node 106B can be configured to guide laser energy inward from the capture portion 104 toward the receiving cavity 110. Any of the laser nodes 106 can be a side-emitting laser node to guide laser energy into the receiving cavity. In this arrangement, laser energy received from at least one laser source LS can be delivered to different portions of the stone S via at least one laser fiber 120 through the different laser nodes 106. For example, laser energy can be delivered to multiple spaced-apart locations on the stone, such as a first location 130A and a second location 132B. Various aspects of the spaced-apart laser nodes are described in further detail with respect to at least Figure 5.

[0034] Laser energy can be delivered from a laser source LS to a laser node 106 via at least one laser fiber 120. A laser coupler 126 can be located between at least one laser source LS and at least one laser node 106. The laser coupler 126 can couple laser energy from at least one laser source LS to the laser node 106 in any suitable manner to provide laser energy to the laser node 106 (e.g., via at least one fiber 120) to cause the stone S to break. For example, as... Figure 1 As shown, the laser coupler 126 may include laser optical fibers 120, each laser optical fiber 120 being individually connected to the laser source LS. Alternatively, as... Figure 3As shown, the laser coupler 326 may include a common manifold 328 connection, where laser energy generated by at least one laser source (shown as a first laser source LS1 and a second laser source LS2) can be divided into portions of the laser energy to be delivered to each of the laser nodes 306. Figure 3 Any suitable laser coupler or combination of laser couplers including any of the laser couplers described herein can be provided to deliver laser energy to laser node 106. Therefore, regardless of the specific characteristics of laser coupler 126 or manifold 128, a first portion of the laser energy generated by at least one laser source LS can be delivered to the first laser node 106A, and a second portion of the laser energy generated by at least one laser source LS can be delivered to the second laser node 106B.

[0035] By spacing or dispersing multiple laser nodes 106 along the capture section 104, the application of energy from different directions can help hold the stone S in place. This is particularly useful when laser energy is applied to the stone S in a roughly equal and relative manner. When laser energy is applied to the stone S, bubbles can be generated in the fluid, thus contributing to the backward movement. By applying laser energy from opposite directions, even if not perfectly equal and perfectly relative, a reduction in backward movement can be achieved compared to conventional lithotripsy systems that apply laser energy to a single focal point on the stone S.

[0036] In the example, Figure 1 The diagram illustrates a first laser node 106A delivering at least a portion of laser energy to a stone S along a first path 130 to a first position 130A, and a second laser node 106B delivering at least a portion of laser energy to a stone S along a second path 132 to a second position 132A. Any number of laser nodes 106 can be provided to deliver the respective portions of the laser energy. A portion of the laser energy can be described as a first laser beam, and a second portion of the laser energy can be described as a second laser beam. In some examples, the sum of all portions of the laser energy (e.g., the sum of all laser beams delivered by laser nodes 106) may be equal to the total laser energy received from or generated by the laser source LS.

[0037] Another benefit of having multiple spaced-apart laser nodes 106 is that laser energy can be delivered to the stone S, with the added benefit of heat from the dispersed laser energy spreading throughout the fluid surrounding the stone S. The laser energy can heat the fluid in or near the path of the laser energy. By delivering laser energy through different paths in the fluid, such as the first path 130 and the second path 132, rather than a single path, the same or more laser energies can be applied to the stone S while reducing localized heat in any particular part of the fluid, thus keeping the fluid relatively cool.

[0038] The total energy received from the laser source LS can be divided (e.g., partitioned) into a first portion and a second portion of laser energy. Depending on the positions of the first and second nodes 106, the first force on the stone S caused by the first portion of laser energy transmitted from the first laser node 106A to the first position 130A can counteract at least part of the second force on the stone S caused by the second portion of laser energy transmitted from the second laser node 106B to the second position 132A, thus reducing backward movement. The laser nodes 106 can simultaneously or in an interleaved or series manner direct laser energy to multiple points on the outer surface of the stone S.

[0039] Figure 1 A close-up view of the first laser node 106A is also shown. Other laser nodes 106 may be identical or similar to the first laser node 106A. The first laser node 106A may include a side-emitting laser. In other words, the distal end portion of the first laser node 106A may be configured to deflect, reflect, refract, or diffract a first portion of the laser energy. The first laser node 106A may include a distal end portion having a deflector 134 configured to deflect a first portion of the laser energy received from the laser source LS toward the receiving cavity 110 (e.g., a first laser beam along a first path 130), thereby toward the stone S trapped within the receiving cavity 110. The deflector 134 may include a first reflective surface, a mirror, or other reflecting / deflecting device to deliver the first portion of the laser energy into the receiving cavity 110. In another example, the geometry of the laser fiber 120 may include an angled surface serving as the deflector 134, which couples the laser energy at an angle from the laser node 106A toward the receiving cavity 110.

[0040] Figure 2 A side view of a second illustrative example of a laser lithotripsy system 200 is shown, wherein the capture portion 204 is shown in the unfolded open position, and the capture portion 204 is shown in the unfolded closed position 240 by a dashed line. Figure 2 The lithotripsy system can include Figure 1 Features of the lithotripsy system 100. Similar reference numerals may denote similar elements, therefore, for the sake of brevity, not all elements need to be described in further detail.

[0041] like Figure 2As shown, the capturing portion 204 can be deployed through the lumen 208 of the sheath 202. The capturing portion 204 may include a receiving cavity 210. The receiving cavity 210 may have an inner surface 212 and an outer surface 214. In the deployed state, the capturing portion 204 can be configured to receive a stone S into the receiving cavity 210 through an opening 216, such that the receiving cavity 210 can at least partially surround the stone S. In some examples, the capturing portion 204 may include a layer of compliant material such as a mesh.

[0042] The capturing section 204 can be configured to receive the stone S into the receiving cavity 210 through the opening 216. The closing member 236 may have a distal end portion coupled to the opening 116 and a proximal end portion coupled to an actuator 238, which can be actuated by an operator to close the opening 216, for example, by pulling to close the thread 216A. In some examples, the actuator 238 may be located on the sheath 202 and coupled to the sheath 202 via a handle coupled to the sheath 202. The handle can provide the user with a larger engagement portion for actuating the closing member.

[0043] When the stone S to be captured passes through opening 216 and enters receiving cavity 210, the operator can actuate, for example, by sliding actuator 238 to cause movement of closing member 236 and thus reduce the diameter of opening 216. Opening 216 can be reduced from an opening diameter to a smaller opening or closing diameter (e.g., 240, shown in hidden lines). Although actuator 238 is in Figure 2 It is shown as a sliding actuator, but any suitable actuator and actuator 238 can provide motion.

[0044] Figure 2 Illustrative examples of a lithotripsy system 200 that can be coupled to multiple laser sources, such as a first laser source LS1 and a second laser source LS2, via at least one laser fiber 220 are also shown. In some examples, the first laser source LS1 can be individually coupled to a first laser node 206A to deliver a first portion of the laser energy to a receiving cavity 210. The second laser source LS2 can be individually coupled to a second laser node 206B to deliver a second portion of the laser energy to a receiving cavity 210.

[0045] In other examples, and such as Figure 3 As shown, the first laser source LS1 and the second laser source LS2 can be coupled to two or more laser nodes 306 via a laser coupler 326 including a common manifold 328. Figure 2In the example, although two laser nodes are shown, the laser energy from the first laser source LS1 and the second laser source LS2 can be combined and divided in the common manifold 228 in any suitable manner to deliver the laser energy to any number of laser nodes 206 to break the stone S. Any of the laser couplers, including any of the manifolds described herein, can be used interchangeably with any of the trapping sections, laser nodes, layers, closure members, and actuators described herein.

[0046] Figure 3 A side view of a third illustrative example of a lithotripsy system 300 is shown. Figure 3 The lithotripsy system 300 may include Figure 1 and Figure 2 The characteristics of the lithotripsy system. Similar reference numerals can represent similar elements; therefore, for the sake of brevity, not all elements need to be described in further detail.

[0047] like Figure 3 As shown, the capture portion 304, which can unfold from the lumen 308 of the sheath 302, can be configured to receive a stone S into a receiving cavity 310 through an opening 316. A closure member 336 may include a distal end portion coupled to the opening 316 and a proximal end portion coupled to an actuator 338, which can be actuated by an operator to close the opening 316. When the stone S to be captured passes through the opening 316 and enters the receiving cavity 310, the operator may actuate, for example, by rotating the actuator 338, to cause a layer 318 to enclose the stone S and the opening 316. The layer 318 may include a compliant material, such as a mesh, sized sufficiently to cover the opening 316.

[0048] In some examples, the rotary actuator 338 is configured to rotate within a range of 45 degrees to 270 degrees to cause the layer 318 to cover the opening 316 and trap the stone S. In a potentially more preferred example, the actuator 338 is configured to rotate within a range of 140 degrees to 220 degrees to cause the layer 318 to cover the opening 316 and trap the stone S. The actuator 338 is not necessarily a rotary actuator; the rotary actuator is provided only as an example, and any other suitable actuator, including a linear sliding actuator, may be provided.

[0049] Figure 3 An example is also shown in which the lithotripsy system 300 can be configured to be coupled to multiple laser sources, such as a first laser source LS1 and a second laser source LS2. Figure 3As shown in the example, the first laser source LS1 and the second laser source LS2 can be operatively coupled to a plurality of laser nodes 306 via a common manifold 338, such as the first laser node 306A, the second laser node 306B, the third laser node 306C, the fourth laser node 306D, the fifth laser node 306E, the sixth laser node 306F, and the seventh laser node 306G. The common manifold 338 can control the laser energy from the first laser source LS1 and the second laser source LS2, and distribute the laser energy in any combination to any of the laser nodes 306A to 306G for delivery to the receiving cavity 310 to break the stone S. The laser energy can be delivered to the laser nodes via at least one laser fiber 320.

[0050] Figure 4 A side view showing a fourth illustrative example of a portion of a lithotripsy system 400. Figure 4 The lithotripsy system 400 may include Figure 1 , Figure 2 and Figure 3 Features of lithotripsy systems 100, 200, and 300. Similar reference numerals may denote similar elements; therefore, for the sake of brevity, not all elements need to be described in further detail.

[0051] The lithotripsy system 400 may include a capture portion 404 that can be deployed from a lumen 408 of a sheath 402. The capture portion 404 has a receiving cavity 410 and an opening 416. To capture a stone S, the receiving cavity 410 may scoop the stone S into the opening 416. For example, when an operator manipulates a scooping actuator 438, a scooping member 436 moves the capture portion 404 in a scooping motion. When the stone S to be captured passes through the opening 416 and enters the receiving cavity 410, the operator may actuate, for example, by sliding the scooping actuator 438 to cause movement of the closing member 436 that causes the scooping motion of the capture portion 404. Although the actuator 438 is in Figure 4 The actuator shown is a sliding actuator, but any suitable actuator and actuator movement can be provided to cause the scooping motion of the capture section 404.

[0052] At least one laser node 406 can be configured to transmit laser energy received from at least one laser source LS to the receiving cavity 410, and... Figure 1 , Figure 2 and Figure 3 The example laser nodes 106, 206 and 306 described herein are the same or similar.

[0053] Figure 5A The fifth lithotripsy system 500 in its stored state is shown, and Figure 5B The fifth lithotripsy system 500 in its deployed state is shown. Figure 5Aand Figure 5B The lithotripsy system 500 may include Figure 1 , Figure 2 , Figure 3 and Figure 4 Features of lithotripsy systems 100, 200, 300, and 400. Similar reference numerals can denote similar elements; therefore, for the sake of brevity, not all elements need to be described in further detail. Described together... Figure 5A and Figure 5B .

[0054] like Figure 5A As shown, in the working channel (WC, Figure 1 During delivery to the treatment site, such as the kidney, the lithotripsy system 500 can remain in a stored state.

[0055] like Figure 5B As shown in the unfolded or extended state, the lithotripsy system 500 may include a capture portion 504, which is capable of capturing from a lumen 508 ( Figure 5A The sheath 502 unfolds. The capturing portion 504 may have at least one support 542A, 542B, 542C, 542D around the receiving cavity 510, thereby forming a basket. The capturing portion 504 may include at least one opening 516 to receive the stone S. Figure 5A and Figure 5B The example depicts four struts 542 converging at the distal end; however, any suitable number of struts 542 can be provided for capturing the stones S. The struts 542A to 542D can be formed as four separate struts 542A to 542D joined at the distal end, such as hub 544, or the struts 542A to 542D can be integrally formed with each other or overlap each other. Suitable materials for the struts 542A to 542D can include resilient and biocompatible materials, such as nitinol, spring stainless steel, shape memory polymers, any other suitable shape memory materials, and alloys and combinations of such materials. In some examples, and as... Figure 5A and Figure 5B As shown, the capturing portion 504 may include a layer 518 of material such as a mesh, woven, or nonwoven fabric to further surround the receiving cavity 510. In some examples, the layer 518 may be at least partially transparent, thereby improving visibility during the procedure. In some examples, the layer 518 may be formed from a sheet of a flexible polymeric material such as a membrane. To improve visibility, the membrane may be a transparent membrane.

[0056] At least one laser node 506 may be coupled to the capturing section 504 to guide laser energy into the receiving cavity 510, as... Figure 1The stone S is broken as described in the lithotripsy system 100. The laser node 506 can be coupled to layer 518 as shown; however, the laser node 506 can be coupled to struts 542A to 542D and / or along struts 542A to 542D, for example, but not limited to examples omitting layer 518. The laser node 506 can receive laser energy via laser fiber 520.

[0057] like Figure 5B As shown, the capturing portion 504 can extend generally along the longitudinal direction A1 and can be laterally deployed away from the longitudinal direction A1. Laser nodes 306 can be spaced apart along the capturing portion 504 in various ways. For example, in the deployed state, a first laser node 506A can be laterally or radially spaced from a second laser node 506B along the surface of the capturing portion 504. Although the capturing portion 504 can be frustoconical or have a circular cross-section, radial spacing does not require the capturing portion 504 to be frustoconical or have a circular cross-section. Instead, the radial direction A2 can indicate a direction of extension away from the longitudinal direction A1. In some examples, the longitudinal direction A1 can extend along the longitudinal axis in a proximal-distal direction, and the radial or lateral direction A2 can extend along a radial axis (e.g., A2) perpendicular to the longitudinal axis (e.g., A1), but such geometry is not required.

[0058] In another configuration of the spaced-apart laser nodes 506, the first laser node 506A may be located at the distal end of the third laser node 506C. Furthermore, the laser nodes 506 may be spaced apart in a direction having both a longitudinal component and a transverse or radial component, such as the spacing shown between the first laser node 506A and the fourth laser node 506D.

[0059] It should be noted that Figure 5A and Figure 5B The capture section 504, as well as the other capture sections 104, 204, 304, 404, and 604 described herein, may have different uses than the example including laser node 506. For example, any of the capture sections 104, 204, 304, 404, 504, and 604 may be used to collect stones that do not require breaking before collection and removal, or the capture section may be used in conjunction with other lithotripsy systems.

[0060] Figure 6 A side view of a sixth illustrative example of a portion of a lithotripsy system 600 is shown. Figure 6 The lithotripsy system 600 may include Figure 1 , Figure 2 , Figure 3 , Figure 4Features of the lithotripsy systems 100, 200, 300, 400, and 500 in Figure 5. Similar reference numerals can denote similar elements; therefore, for the sake of brevity, not all elements need to be described in further detail.

[0061] like Figure 6 As shown in its deployed state, the lithotripsy system 600 may include a capture portion 604 capable of deploying from a sheath 602 having a lumen 608. The capture portion 604 may be similar to... Figure 5A and Figure 5B The capturing portion 504 has at least one pillar 642A to 642D and at least one opening 616, thereby forming a receiving cavity 610, such as a basket. The capturing portion 604 may include a layer 618 of a mesh, woven or nonwoven material to further surround the receiving cavity 610.

[0062] Figure 6 The Stonecrushing System 600 is similar to Figure 5A and Figure 5B The system 500, however. Figure 6 The system may also include at least partially closing the opening 616 and thereby further limiting the characteristics of the stone S. When the operator actuates the actuator 638, for example... Figure 2 When actuator 638 is used, a closing member 636 having a proximal end portion coupled to actuator 638 and a distal end portion coupled to layer 618 can be configured to move layer 618 to reduce the size of opening 616. For example, closing member 636 can cause layer 618 to move along struts 642A to 642D, for example by sliding distally along struts 642A to 642D, to close opening 616. To close opening 616, layer 618 can slide distally when actuator 638 is actuated. Actuator 638 can be any type of actuator, such as... Figure 2 The sliding actuator 238 shown is illustrated.

[0063] To slidably couple layer 618 to posts 642A-642D, capture portion 604 may include sleeves 646A-646D located around one or more of posts 642A-642D. Sleeves 646A-646D may be integrally woven into or attached to layer 618. Figure 7 It shows along Figure 6 The cross-sectional view taken by line 7-7, passing through the first sleeve 646A and the first support 642A. (See diagram below.) Figure 7 As shown, the first sleeve 646A is arranged relative to the first support 642A to slide along the first support 642A.

[0064] One or more laser nodes 606, 606A to 606D can generate lasers from at least one laser source (LS, LS1, LS2); Figures 1 to 4 The received laser energy is transmitted to the receiving cavity 610. In some examples, the system 600 may transmit a first portion of the laser energy from the first laser node 606A toward the receiving cavity 610 along a first path 630, and a second portion of the laser energy from the second laser node 606B toward the receiving cavity 610 along a second path 632 different from the first path 630.

[0065] In some examples, system 600 can be selectively controllable. For example, if the operator desires to apply laser energy selectively to specific portions of the stone S, system 600 can be configured to direct laser energy to designated laser nodes, such as a first laser node 606A and a third laser node 606C. Laser nodes 606 can simultaneously or in an interleaved or cascaded manner direct laser energy to multiple points on the outer surface of the stone S. In some examples, the dispersed nature of the laser nodes 606 enables selective, targeted application of energy. For example, depending on the characteristics of the stone S or the operator's preference, laser energy can be applied to only one side, one portion, or certain portions of the stone S. This targeted application of energy can accelerate the fracturing process and shorten the operation time.

[0066] In some examples, system 600 is selectively controllable to deliver at least a portion of the laser energy through a first laser node 606A, through a second laser node 606B, or through both the first laser node 606A and the second laser node 606B.

[0067] Although the illustrative examples show multiple laser nodes 606A to 606D, in some examples, a single laser node (any of 606A to 606D) may be coupled to the capture section 604. Such a single laser node may be configured to transmit laser energy toward the receiving cavity 610 while the capture section 604 retains the stone S and the resulting stone fragments.

[0068] Figure 8 It shows the unfolded state. Figure 6 A plan view of the distal end portion of the sixth lithotripsy system 600. (Described together) Figure 6 and Figure 8 The distal end portion of the capturing portion 604 may include a hub 644. Studs 642A to 642D may extend laterally and proximally away from the hub 644. Figure 6As shown, the closure member 636 may be attached to the actuator 638 at the proximal end portion. The closure member may be coupled to the layer 618 via at least one thread 650A, 650B, 650C (e.g., a wire, cable, rope, line, strip, band, or filament at the distal end portion).

[0069] Figure 8 A plan view of a hub 644, a portion of supports 642A to 642C, a closure member 636, and threads 650A to 650C is shown. The closure member 636 may be coupled to or integrally formed with at least one thread 650A to 650C, such that when the closure member 636 is pulled proximally, the distal end portions of the threads 650A to 650C coupled to the closure member 636 move, thereby causing layer 618 to move distally. The hub 644 may include at least one threaded guide 656 configured to guide at least one of the threads 650A, 650B.

[0070] If it has from Figure 6 Support Figure 8 As shown, the distal end portions of threads 650A to 650C may be located within channels 652A to 652C in each of the supports 642A to 642C and may be attached to a closing member 636 near the hub 644. Threads 650A to 650C may extend proximally through channels 652A to 652C in each of the respective supports 642A to 642C. Threads 650A to 650C may extend laterally through the respective channels 652A to 652C, thereby exiting the supports 542A to 542C through holes 654A to 654C in each of the respective supports 642A to 642C. Threads 65A to 650C may exit the supports 642A to 642C along the middle portion of threads 650A to 650C to exit the respective supports 642A to 642C. The proximal portions of threads 650A to 650C may be located outside of supports 642A to 642C and may be attached to corresponding sleeves 648A to 648C or to a layer 618 adjacent to the corresponding sleeves 648A to 648C. In this arrangement, when actuator 638 is actuated, proximal movement of closing member 636 causes threads 650A to 650C to move along the distal end of support 642D, thereby applying a force to layer 618 to move layer 618 distally. Actuation of actuator 638 results in at least partial closure of opening 616 (e.g., the size of opening 616 may decrease from a receiving state to a capturing state).

[0071] Threads 650A to 650C are shown in only one arrangement. In some examples, threads 650A to 650C may be located inside the capture portion 604 and inside the receiving cavity 610, or threads 650A to 650C may be located outside the capture portion 604 and outside the receiving cavity 610.

[0072] Figure 9A A side view of a portion of the seventh lithotripsy system 900 in its stored state is shown. Figure 9B A side view of a portion of the Seventh Stonecrushing System 900 in its deployed state is shown. Figure 9A and Figure 9B The lithotripsy system can include Figure 1 , Figure 2 , Figure 3 , Figure 4 Figure 5 and Figure 6 Features of lithotripsy systems 100, 200, 300, 400, 500, and 600. Similar reference numerals can denote similar elements; therefore, for the sake of brevity, not all elements need to be described in further detail.

[0073] In an alternative to a laser lithotripsy system that includes a capture device such as a bag or basket, the laser node 906 in system 900 can be coupled to layer 918, for example, a sheet or mesh that can be positioned on the surface of the stone S, to apply laser energy to the surface of the stone S at multiple locations without capturing the stone S. Figure 9A As shown in the storage state, the layer can be rolled within the lumen 902 of the sheath 908 or otherwise made compact to allow passage through the working channel (WC) of observation instruments or other equipment. Figure 1 And delivered. For example... Figure 9B As shown in the storage state, layer 918 can be unfolded by moving and extending to the far end to provide layer 918 of spaced laser nodes 906 that can be applied to the stones S.

[0074] In some examples, in any of the examples described herein, the delivery of laser energy to the stone S via the laser node can be constant or variable. In the variable examples, the laser lithotripsy system can be configured to provide laser output with variable energy intensities. For example, lower energy intensities can be used, for example, to provide a “targeting” beam or to treat soft (e.g., non-calcified) tissue, and one or more higher energy intensities can be used, for example, to provide a “treatment” beam to hard (e.g., calcified) tissue or the stone. Multiple higher energy intensity treatment beam levels can be provided, for example, on a pulse-by-pulse or target location-dependent basis, for example, to establish, adjust, or tune the desired treatment pulse energy intensity to a specified level.

[0075] Furthermore, in some examples, instead of simultaneously transmitting laser energy to the stone S through the first and second laser nodes, energy can be applied intermittently. The first and second nodes can be activated continuously or in an overlapping mode, such that at certain times, only the first or second laser node delivers energy to the stone S. In such intermittent examples, at a given time point, the first portion of the laser energy received by the first laser node can be from at least one laser source (e.g., LS, ...). Figure 1 The total laser energy generated.

[0076] Figure 10 This is a flowchart illustrating a method 1000 for transmitting laser energy in a laser therapy device (e.g., a laser lithotripter). Laser energy can be received from one or more laser sources. The methods described herein can be used... Figures 1 to 4 , Figure 5A , Figure 5B , Figures 6 to 8 , Figure 9A and Figure 9B Method 1000 can be performed using any of the laser lithotripsy systems described herein. However, method 1000 can also be used with other laser lithotripters or other laser therapy devices or procedures. Similarly, Figures 1 to 4 , Figure 5A , Figure 5B , Figures 6 to 8 , Figure 9A and Figure 9B The system can be used in conjunction with other methods.

[0077] Step 1010 may include receiving laser energy at a plurality of laser nodes from one or more laser sources operatively coupled to the plurality of laser nodes. The laser nodes may be arranged in a spaced-apart relationship along a surface of the capturing portion. This surface may form a receiving cavity for receiving stones.

[0078] Step 1020 may include transmitting laser energy from the laser node toward the receiving cavity. In some examples, the plurality of laser nodes includes a first laser node and a second laser node, wherein the first laser node is located at a distal end of the second laser node, and / or the first laser node and the second laser node are spaced laterally or radially along the surface of the capture portion.

[0079] In some examples, transmitting laser energy through multiple laser nodes in step 1020 may include a first portion of transmitting laser energy from a first laser node toward a receiving cavity along a first path, and a second portion of transmitting laser energy toward the receiving cavity along a second path different from the first path. Furthermore, any portion of transmitting laser energy from a laser node may include deflecting, reflecting, refracting, or diffracting the laser energy toward the receiving cavity.

[0080] In some examples, the delivery of laser energy through multiple laser nodes in step 1020 may include selectively controlling the delivery of a first portion of the laser energy from a first laser node and selectively controlling the delivery of a second portion of the laser energy from a second laser node, wherein the first portion of the laser energy is greater than the second portion. This selective application of laser energy can be applied to lithotripsy systems with any number of laser nodes. Furthermore, in some examples, the second portion of the laser energy may be equal to zero, such that the laser energy is delivered through the first laser node instead of the second laser node, in order to provide targeted delivery of laser energy to certain portions of the stone. This selective application can be applied to any number of laser nodes. The portion of the laser energy delivered to a node can be varied, such that any one or more of the following can occur: a node may receive all the laser energy; multiple nodes may receive a portion of the laser energy; and one or more laser nodes may not receive any laser energy.

[0081] In drawings that are not necessarily drawn to scale, similar reference numerals may describe similar parts in different views. Similar reference numerals with different letter suffixes may indicate different instances of similar parts. The drawings generally illustrate the various embodiments discussed in this document by way of example rather than limitation.

[0082] The above detailed description includes reference to the accompanying drawings, which form part of the detailed description. The drawings illustrate, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as “examples.” Such examples may include elements other than those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Furthermore, the inventors contemplate examples using any combination or substitution of those elements (or one or more aspects of those elements) shown or described with respect to a particular example (or one or more aspects of that particular example) or with respect to other examples shown or described herein (or one or more aspects of those other examples).

[0083] In this document, as is common in patent literature, the terms "a" or "an" are used to include one or more, regardless of any other example or usage of "at least one" or "one or more." In this document, 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 document, the terms "comprising" and "in..." are used as concise English equivalents to the corresponding terms "comprising" and "wherein." Furthermore, in the appended claims, the terms "comprising" and "including" are open-ended, meaning that a system, apparatus, article, composition, formulation, or treatment that includes elements other than those listed after such terms in a claim is still considered to fall within the scope of that claim. Additionally, in the following claims, the terms "first," "second," and "third," etc., are used merely as designations and are not intended to impose numerical requirements on their objects.

[0084] The above description is intended to be illustrative and not restrictive. For example, the examples (or one or more aspects of the examples) described above can be used in combination with each other. Other embodiments can be used by those skilled in the art after consulting the above description. An abstract is provided to enable the reader to quickly determine the nature of the technical disclosure. The abstract is submitted under the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Furthermore, in the above detailed description, various features may be grouped together to organize the disclosure. This should not be construed as meaning that all unclaimed disclosed features are necessary for any claim. Rather, the subject matter of the invention may lie in fewer than all features of a particular disclosed embodiment. Therefore, the appended claims are thus incorporated into the detailed description as examples or embodiments, wherein each claim is an independent, separate embodiment, and such embodiments are contemplated to be combined with each other in various combinations or substitutions. The scope of the invention should be determined by reference to the appended claims and the full scope of their equivalents.

[0085] Various explanations and examples

[0086] Example 1 is a laser lithotripsy system for delivering laser energy from one or more laser sources to a mobile stone. The system includes: a capture portion configured to move from a stored state to an deployed state, wherein, in the deployed state, the capture portion is configured to at least partially surround the mobile stone; and a first laser node and a second laser node coupled to the capture portion, the first laser node and the second laser node being configured to deliver laser energy to the mobile stone, wherein the first laser node and the second laser node are spaced apart.

[0087] In Example 2, the subject of Example 1 includes, in the deployed state, a capturing portion including a receiving cavity and an opening for receiving a movable stone in the receiving cavity, and wherein a first laser node and a second laser node are configured to guide laser energy inward from the surface of the capturing portion toward the receiving cavity.

[0088] In Example 3, the subject matter of Examples 1 to 2 includes, in the unfolded state, the first laser node is located at the far end of the second laser node.

[0089] In Example 4, the subject matter of Examples 1 to 3 includes, in the unfolded state, a first laser node and a second laser node being radially spaced apart along the surface of the capture portion.

[0090] In Example 5, the subject matter of Examples 1 to 4 includes a first laser node configured to deliver a first portion of laser energy to a mobile stone, and a second laser node configured to deliver a second portion of laser energy to a mobile stone, and wherein the system can be selectively controlled to deliver at least a portion of the laser energy through the first laser node, through the second laser node, or through both the first and second laser nodes.

[0091] In Example 6, the subject matter of Examples 1 to 5 includes a capture portion comprising a deployable support that can be actuated to deliver the capture portion to the treatment site via a working channel.

[0092] In Example 7, the subject of Examples 1 through 6 includes, where the capture portion includes a mesh.

[0093] In Example 8, the subject matter of Examples 1 to 7 includes a first laser node configured to deflect, reflect, refract, or diffract at least a portion of the laser energy.

[0094] In Example 9, the subject matter of Examples 1 to 8 includes, wherein the first laser node includes a first reflective surface configured to deflect a first portion of the laser energy.

[0095] Example 10 is a method for transmitting laser energy in a laser therapy device, the laser energy being received from one or more laser sources, the method comprising: receiving laser energy from one or more laser sources operatively coupled to the plurality of laser nodes at a plurality of laser nodes, wherein the plurality of laser nodes are arranged in a spaced-apart relationship along a surface of a capture portion, and wherein the surface forms a receiving cavity; and transmitting the laser energy from the plurality of laser nodes toward the receiving cavity.

[0096] In Example 11, the subject of Example 10 includes a plurality of laser nodes including a first laser node and a second laser node, wherein the first laser node is located at the far end of the second laser node when the capture portion is in an unfolded state.

[0097] In Example 12, the subject matter of Examples 10 to 11 includes a plurality of laser nodes including a first laser node and a second laser node, wherein, when the capture portion is in an unfolded state, the first laser node and the second laser node are laterally spaced apart along the surface of the capture portion.

[0098] In Example 13, the subject matter of Examples 10 to 12 includes the following: transmitting laser energy through multiple laser nodes includes transmitting a first portion of laser energy from a first laser node toward a receiving cavity along a first path, and transmitting a second portion of laser energy from a second laser node toward a receiving cavity along a second path different from the first path.

[0099] In Example 14, the subject matter of Example 13 includes, wherein transmitting a first portion of laser energy from a first laser node includes deflecting, reflecting, refracting, or diffracting the first portion of the laser energy.

[0100] In Example 15, the subject matter of Examples 10 to 14 includes transmitting laser energy through multiple laser nodes, which includes transmitting a first portion of laser energy through a first laser node and transmitting a second portion of laser energy through a second laser node. The method further includes selectively controlling the delivery of the first portion of laser energy from the first laser node and selectively controlling the delivery of the second portion of laser energy from the second laser node, wherein the first portion of laser energy is greater than the second portion of laser energy.

[0101] In Example 16, the subject of Example 15 includes the fact that the second part of the laser energy is equal to zero.

[0102] Example 17 is a laser therapy system for delivering laser energy from one or more laser sources to a mobile stone, the system comprising: a capture portion configured to at least partially surround the mobile stone in an deployed state; and a first laser node and a second laser node coupled to the capture portion, wherein the first laser node is configured to apply a first portion of the laser energy to a first location on the mobile stone, and wherein the second laser node is configured to apply a second portion of the laser energy to a different second location on the mobile stone.

[0103] In Example 18, the subject of Example 17 includes a first laser node spaced apart from a second laser node.

[0104] In Example 19, the subject matter of Examples 17 and 18 includes a capture portion capable of moving from a stored state to an unfolded state, and in the unfolded state, the capture portion includes a receiving cavity and an opening for receiving a movable stone into the receiving cavity, and wherein a first laser node and a second laser node are configured to guide laser energy inward from the surface of the capture portion toward the receiving cavity.

[0105] In Example 20, the subject of Examples 17 to 19 includes, in the unfolded state, the first laser node is located at the far end of the second laser node.

[0106] In Example 21, the subject matter of Examples 17 to 20 includes, in the unfolded state, a first laser node and a second laser node being laterally spaced apart along the surface of the capture portion.

[0107] In Example 22, the subject matter of Examples 17 to 21 includes a system that can be selectively controlled to deliver laser energy through a first laser node, through a second laser node, or through both the first and second laser nodes.

[0108] In Example 23, the subject matter of Examples 17 to 22 includes a capture portion comprising a deployable support that can be actuated to deliver the capture portion to the treatment site via a working channel.

[0109] Example 24 is at least one machine-readable medium including instructions that, when executed by a processing circuitry system, cause the processing circuitry system to perform operations to implement any one of Examples 1 to 23.

[0110] Example 25 is a device that includes an apparatus that implements any one of Examples 1 through 23.

[0111] Example 26 is a system that implements any one of Examples 1 through 23.

[0112] Example 27 is a method to implement any one of Examples 1 through 23.

Claims

1. A laser lithotripsy system for delivering laser energy from one or more laser sources to a mobile stone, the system comprising: A capturing portion configured to move from a stored state to an deployed state, wherein, in the deployed state, the capturing portion includes an inner surface configured to at least partially surround the movable stone; and A first laser node and a second laser node are arranged along the inner surface of the capture portion and have corresponding laser fibers. The first laser node and the second laser node include a steering element configured to deliver laser energy to the movable stone within the capture portion by steering the laser energy from a direction extending along the corresponding fiber of the respective laser node. The first laser node and the second laser node are spaced apart.

2. The system according to claim 1, wherein, In the unfolded state, the capturing portion includes a receiving cavity and an opening for receiving the movable stone into the receiving cavity.

3. The system according to claim 1, wherein, In the deployed state, the first laser node is located at the far end of the second laser node.

4. The system according to claim 1, wherein, In the deployed state, the first laser node and the second laser node are radially spaced apart along the surface of the capture portion.

5. The system according to claim 1, wherein, The first laser node is configured to deliver a first portion of the laser energy to the mobile stone, and the second laser node is configured to deliver a second portion of the laser energy to the mobile stone, and the system can be selectively controlled to deliver at least a portion of the laser energy through the first laser node, through the second laser node, or through both the first laser node and the second laser node.

6. The system according to claim 1, wherein, The capture portion includes a deployable support that can be actuated to deliver the capture portion to the treatment site via a working channel.

7. The system according to claim 1, wherein, The capturing section includes a mesh.

8. The system according to claim 1, wherein, The first laser node is configured to deflect, reflect, refract, or diffract at least a portion of the laser energy.

9. The system according to claim 1, wherein, The first laser node includes a first reflective surface configured to deflect a first portion of the laser energy.

10. A method for transmitting laser energy received from one or more laser sources in a laser therapy device, the method comprising: Receiving laser energy from one or more laser sources operatively coupled to the plurality of laser nodes at a plurality of laser nodes, wherein the plurality of laser nodes are arranged in a spaced-apart relationship along an inner surface of a capturing portion, wherein the plurality of laser nodes include a first laser node and a second laser node, and wherein the surface forms a receiving cavity; and The laser energy is transmitted from the plurality of laser nodes toward the receiving cavity by redirecting the laser energy from the direction of the laser energy extending along the respective optical fiber of each laser node using a steering element at each laser node.

11. The method according to claim 10, wherein, When the capture portion is in the deployed state, the first laser node is located at the far end of the second laser node.

12. The method according to claim 10, wherein, When the capture portion is in the deployed state, the first laser node and the second laser node are laterally spaced apart along the surface of the capture portion.

13. The method according to claim 10, wherein, Transmitting the laser energy through the plurality of laser nodes includes transmitting a first portion of the laser energy from the first laser node toward the receiving cavity along a first path, and transmitting a second portion of the laser energy from the second laser node toward the receiving cavity along a second path different from the first path.

14. The method according to claim 13, wherein, The first portion of the laser energy transmitted from the first laser node includes deflecting, reflecting, refracting, or diffracting the first portion of the laser energy.

15. The method according to claim 10, wherein, Transmitting the laser energy through the plurality of laser nodes includes transmitting a first portion of the laser energy through the first laser node and transmitting a second portion of the laser energy through the second laser node. The method further includes: The delivery of a first portion of the laser energy from the first laser node is selectively controlled, and the delivery of a second portion of the laser energy from the second laser node is selectively controlled, wherein the first portion of the laser energy is greater than the second portion of the laser energy.

16. The method according to claim 15, wherein, The second part of the laser energy is equal to zero.

17. A laser therapy system for delivering laser energy from one or more laser sources to a mobile stone, the system comprising: The capturing portion is configured to at least partially surround the movable stone in its unfolded state; as well as Arranged along the inner surface of the capture portion, each having a corresponding laser fiber for delivering laser energy, a first laser node and a second laser node, the first laser node and the second laser node including a steering element configured to deliver laser energy to the movable stone within the capture portion by steering the laser energy from a direction extending along the corresponding laser fiber. The first laser node is configured to apply a first portion of the laser energy to a first location on the movable stone, and the second laser node is configured to apply a second portion of the laser energy to a different second location on the movable stone.

18. The system according to claim 17, wherein, The first laser node is spaced apart from the second laser node.

19. The system according to claim 17, wherein, The capturing portion is capable of moving from a stored state to an unfolded state, and in the unfolded state, the capturing portion includes a receiving cavity and an opening for receiving the movable stone into the receiving cavity.

20. The system according to claim 17, wherein, In the deployed state, the first laser node is located at the far end of the second laser node.

21. The system according to claim 17, wherein, In the deployed state, the first laser node and the second laser node are laterally spaced apart along the surface of the capture portion.

22. The system according to claim 17, wherein, The system can be selectively controlled to deliver the laser energy through the first laser node, through the second laser node, or through both the first laser node and the second laser node.

23. The system according to claim 17, wherein, The capture portion includes a deployable support that can be actuated to deliver the capture portion to the treatment site via a working channel.

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