Medical laser system and method for operating medical laser system

Abstract

A medical laser system and a method of operating the same are disclosed. A medical laser system includes a laser source configured to generate laser energy and an optical fiber for directing the laser energy to a target; and control circuitry configured to: receive a signal reflected from a target in response to the electromagnetic radiation; generating a reflected signal parameter associated with the received reflected signal; generating a calibration curve indicative of a relationship between a value of the reflected signal parameter and a corresponding fiber-to-target distance from the distal end of the fiber to the outer surface of the target; determining the change rate of the value of the reflected signal parameter on the distance from the plurality of optical fibers to the target; determining whether the target is within a particular laser emission range based on a comparison between the determined rate of change and the generated calibration curve; and controllably adjusting at least one of an output setting of the laser source or a position of the distal end of the optical fiber relative to the target based at least in part on the determination of whether the target is within the particular laser emission range.

Description

[0001] This application is a divisional application of the Chinese invention patent application filed on August 4, 2020, with international application number PCT / US2020 / 044867, invention name “Selective Laser Emission for Tissue Safety”, and application number 202080064217.2 after entering the Chinese national phase.

[0002] Priority claim

[0003] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 62 / 882,837 filed on August 5, 2019 and U.S. Provisional Patent Application Serial No. 63 / 017,450 filed on April 29, 2020, which are incorporated herein by reference in their entirety. Technical Field

[0004] This document relates generally to laser surgical systems and, more particularly, to laser endoscopic systems for selectively applying surgical laser to a target while maintaining tissue safety. Background Art

[0005] Endoscopes are often used to provide access to the patient's internal locations, so that visual access is provided to the doctor. Some endoscopes are used for minimally invasive surgery to remove unwanted tissue or foreign matter from the patient's body. For example, clinicians use nephroscopes to examine the renal system and perform various surgeries under direct visual control. In percutaneous nephrolithotomy (PCNL) surgery, a nephroscope is placed into the renal pelvis through the patient's flank. Stones or masses from different parts of the body, including, for example, the urinary system, gallbladder, nasal cavity, gastrointestinal tract, stomach, or tonsils, can be visualized and extracted.

[0006] 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 therapy include ablation, coagulation, vaporization, fragmentation, etc. In lithotripsy applications, lasers have been used to break up stone structures in the kidney, gallbladder, ureter, and other stone-forming sites or to ablate large stones into smaller fragments. In endoscopic laser therapy, it is desirable to apply the laser only to the target treatment structure (e.g., stone or cancerous tissue) and to protect non-treatment tissue from unintended laser irradiation. Summary of the invention

[0007] This document describes systems, devices, and methods for identifying different tissue types or stone types with different compositions in the body during a medical procedure such as laser endoscopic surgery and automatically adjusting therapy based on the identified tissue type or stone type. An exemplary electrosurgical treatment system includes: an electrosurgical energy system configured to generate electrosurgical energy for delivery to a target in a subject's body; and a controller circuit configured to receive a signal reflected from the target in response to electromagnetic radiation generated by a light source and generate one or more spectral characteristics based on the reflected signal. The controller circuit can use the one or more spectral characteristics to identify the target as one of a plurality of structural types with respective different compositions; and determine an operating mode of the electrosurgical energy system based on the identification of the target. In an example, the control circuit can control the electrosurgical energy system to deliver electrosurgical energy to a specific type of target of interest, such as a stone type or cancerous tissue, and adjust laser settings based on the classified tissue type or stone type.

[0008] According to an embodiment of the present application, a medical laser system is provided, the medical laser system comprising: a laser source configured to generate laser energy and an optical fiber for guiding the laser energy to a target; and a control circuit system, the control circuit system being configured to: receive a signal reflected from the target in response to electromagnetic radiation; generate a reflection signal parameter associated with the received reflection signal; generate a calibration curve indicating a relationship between a value of the reflection signal parameter and a corresponding fiber-to-target distance from a distal end of the optical fiber to an outer surface of the target; determine a rate of change of the value of the reflection signal parameter over a plurality of fiber-to-target distances; determine whether the target is within a specific laser emission range based on a comparison between the determined rate of change and the generated calibration curve; and controllably adjust at least one of an output setting of the laser source or a position of the distal end of the optical fiber relative to the target based at least in part on the determination of whether the target is within the specific laser emission range.

[0009] According to an embodiment of the present application, a method for operating a medical laser system to deliver laser energy to a target via an optical fiber is provided, the method comprising: irradiating the target with electromagnetic radiation; sensing a signal reflected from the target in response to the electromagnetic radiation using a sensor; generating a reflection signal parameter based on the reflection signal using a control circuit system; generating a calibration curve indicating a relationship between a value of the reflection signal parameter and a corresponding fiber-to-target distance from the distal end of the optical fiber to the outer surface of the target; determining a rate of change of the value of the reflection signal parameter over a plurality of fiber-to-target distances; determining whether the target is within a specific laser emission range based on a comparison between the determined rate of change and the generated calibration curve; and controllably adjusting at least one of an output setting of a laser source or a position of the distal end of the optical fiber relative to the target based at least in part on the determination of whether the target is within the specific laser emission range.

[0010] Example 1 is an electrosurgical treatment system, which includes: an electrosurgical energy system configured to generate electrosurgical energy for delivery to a target in a subject's body; and a controller circuit configured to: receive a signal reflected from the target in response to electromagnetic radiation generated by a light source; generate one or more spectral characteristics based on the received reflected signal; use the one or more spectral characteristics to identify the target as one of a plurality of structural types having respective different components; and determine an operating mode of the electrosurgical energy system based on the identification of the target, the operating mode including delivery or cessation of delivery of electrosurgical energy or energy parameter settings for the electrosurgical energy system.

[0011] In Example 2, the subject matter of Example 1 optionally includes wherein the electrosurgical energy system includes a laser system configured to generate a laser beam for delivery to a target in a body of a subject, and the energy parameter settings include laser parameter settings.

[0012] In Example 3, the subject matter of Example 2 optionally includes: wherein the controller circuit is configured to: generate a reflection spectrum using the received reflection signal, the reflection spectrum representing the reflection intensity at multiple wavelengths; and generate one or more spectral characteristics, generating the one or more spectral characteristics includes extracting one or more spectral features from the reflection spectrum, the one or more spectral features including: the reflection intensity at a specific wavelength; statistical characteristics of the reflectivity at two or more different wavelengths; or graphical features of a graphical representation of the reflection spectrum.

[0013] In Example 4, the subject matter of Example 3 may optionally include wherein the controller circuit is configured to identify the target as one of a stone structure or an anatomical structure using the one or more spectral characteristics.

[0014] In Example 5, the subject matter of any one or more of Examples 3 to 4 optionally includes: wherein the controller circuit is configured to: classify a target into one of a plurality of stone types having respective different compositions using one or more spectral characteristics; adjust laser parameter settings for a laser system based on the classified stone type of the target; and generate a control signal for the laser system based on the adjusted laser parameter settings to transmit a laser beam to a target of the classified stone type.

[0015] In Example 6, the subject matter of Example 5 optionally includes: wherein the controller circuit is configured to classify the target as one of the kidney stone types, the kidney stone type including at least one of the following: calcium phosphate (CaP) stones; magnesium ammonium phosphate (MAP) stones; calcium oxalate monohydrate (COM) stones; cholesterol-based stones; calcium oxalate dihydrate (COD) stones; or uric acid (UA) stones.

[0016] In Example 7, the subject matter of any one or more of Examples 3 to 6 optionally includes: wherein the controller circuit is configured to: classify the target into one of a plurality of tissue types using one or more spectral characteristics; and determine an operating mode of the laser system based on the classified tissue type of the target.

[0017] In Example 8, the subject matter of Example 7 optionally includes: wherein the controller circuit is configured to: classify the target as a treatment area or a non-treatment area using one or more spectral characteristics; and generate a control signal for the laser system to transmit the laser beam to the treatment area and stop transmission of the laser beam to the non-treatment area.

[0018] In Example 9, the subject matter of any one or more of Examples 7 to 8 optionally includes: wherein the controller circuit is configured to: classify a target as normal tissue or cancerous tissue using one or more spectral characteristics; and generate a control signal for the laser system to transmit a laser beam to the target of the classified cancerous tissue, and to stop the transmission of the laser beam if the target is classified as normal tissue.

[0019] In Example 10, the subject matter of any one or more of Examples 1 to 9 optionally includes: wherein the controller circuit is configured to determine the operating mode of the electrosurgical energy system, and determining the operating mode of the electrosurgical energy system includes one of the following: if the target is identified as a stone structure, determining that the operating mode of the electrosurgical energy system is a first operating mode; if the target is identified as an anatomical structure, determining that the operating mode of the electrosurgical energy system is a second operating mode; if the target is identified as neither an anatomical structure nor a stone structure, determining that the operating mode of the electrosurgical energy system is a third operating mode.

[0020] In Example 11, the subject matter of any one or more of Examples 2 to 9 optionally includes an endoscope coupled to the laser system, the endoscope comprising a controller circuit and at least one optical path configured to transmit one or more of a laser beam, a signal reflected from a target, or electromagnetic radiation generated by a light source.

[0021] In Example 12, the subject matter of Example 11 optionally includes: wherein the controller circuit is further configured to: calculate a distance between a target and a distal end of at least one optical path using at least one of the one or more spectral characteristics; and if (1) the target is identified as a treatment structure type and (2) the calculated distance is within a specified laser emission range, determine an operating mode of the laser system, the operating mode including delivering a laser beam to the target.

[0022] In Example 13, the subject matter of any one or more of Examples 11 to 12 can optionally include: wherein the at least one optical path includes a first optical path configured to transmit a signal reflected from the target to a spectral sensor coupled to the controller circuit.

[0023] In Example 14, the subject matter of Example 13 can optionally include: wherein the first optical path is further configured to transmit the laser beam to a target.

[0024] In Example 15, the subject matter of any one or more of Examples 13 to 14 can optionally include: wherein the first optical path is further configured to transmit electromagnetic radiation from the light source to the target.

[0025] In Example 16, the subject matter of any one or more of Examples 13 to 15 can optionally include: wherein the at least one optical path includes a second optical path separate from the first optical path, the second optical path configured to transmit the laser beam to the target.

[0026] In Example 17, the subject matter of any one or more of Examples 11 to 16 may optionally include: wherein the controller circuit is configured to further use information about an outer diameter of at least one optical path to generate the one or more spectral characteristics.

[0027] In Example 18, the subject matter of any one or more of Examples 11 to 17 optionally includes: wherein the controller circuit is configured to: further use information about the angle of protrusion of the distal end of at least one optical path relative to the endoscope to generate one or more spectral characteristics.

[0028] In Example 19, the subject matter of any one or more of Examples 1 to 18 optionally includes: wherein the electromagnetic radiation generated by the light source includes one or more of: ultraviolet waves; visible light waves; or infrared waves.

[0029] In Example 20, the subject matter of any one or more of Examples 1 to 19 optionally includes: wherein the control circuit is coupled to a spectral sensor, the spectral sensor is configured to sense a signal reflected from the target in response to electromagnetic radiation irradiating the target structure, the spectral sensor comprising one or more of: a Fourier transform infrared (FTIR) spectrometer; a Raman spectrometer; a UV-VIS spectrometer; a UV-VIS-IR spectrometer; or a fluorescence spectrometer.

[0030] In Example 21, the subject matter of any one or more of Examples 1 to 20 may optionally include: wherein the control circuit is coupled to an imaging sensor, the imaging sensor being configured to sense a signal reflected from the target in response to electromagnetic radiation irradiating the target structure.

[0031] Example 22 is a method for controlling an electrosurgical energy system to deliver electrosurgical energy to a target in a subject's body, the method comprising: irradiating the target with electromagnetic radiation generated by a light source; sensing a signal reflected from the target in response to the electromagnetic radiation via a spectral sensor coupled to a controller circuit; using the sensed reflected signal, generating one or more spectral characteristics via the controller circuit; using the one or more spectral characteristics, identifying the target as one of a plurality of structural types having respective different components via the controller circuit; and generating a control signal via the controller circuit to operate the electrosurgical energy system in an operating mode based on the identification of the target, the operating mode comprising delivering or stopping the delivery of electrosurgical energy or setting energy parameters for the electrosurgical energy system.

[0032] In Example 23, the subject matter of Example 22 can optionally include wherein the control signal is generated to operate the laser system in an operation mode based on the identification of the target, the operation mode comprising delivery or cessation of delivery of a laser beam or laser parameter settings for the laser system.

[0033] In Example 24, the subject matter of any one or more of Examples 22 to 23 optionally includes: generating a reflection spectrum using the sensed reflection signal, the reflection spectrum representing the reflection intensity at multiple wavelengths, and wherein generating one or more spectral characteristics includes extracting one or more spectral features from the reflection spectrum, the one or more spectral features including: the reflection intensity at a specific wavelength; statistical characteristics of the reflectivity at two or more different wavelengths; or graphical features of a graphical representation of the reflection spectrum.

[0034] In Example 25, the subject matter of any one or more of Examples 23 to 24 optionally includes: using one or more spectral characteristics to classify a target into one of a plurality of stone types having respective different compositions; adjusting laser parameter settings for a laser system based on the classified stone type of the target; and generating a control signal for the laser system based on the adjusted laser parameter settings to transmit a laser beam to a target of the classified stone type.

[0035] In Example 26, the subject matter of any one or more of Examples 23 to 25 optionally includes: classifying the target into one of a plurality of tissue types using one or more spectral characteristics; and determining an operating mode of the laser system based on the classified tissue type of the target.

[0036] In Example 27, the subject matter of Example 26 optionally includes: classifying the target as a treatment area or a non-treatment area using one or more spectral characteristics; and generating a control signal for the laser system to transmit the laser beam to the treatment area and stop transmission of the laser beam to the non-treatment area.

[0037] In Example 28, the subject matter of any one or more of Examples 26 to 27 optionally includes: classifying a target as normal tissue or cancerous tissue using one or more spectral characteristics; and generating a control signal for a laser system to transmit a laser beam to the target of the classified cancerous tissue, and to stop the transmission of the laser beam if the target is classified as normal tissue.

[0038] In Example 29, the subject matter of any one or more of Examples 23 to 28 optionally includes: wherein determining the operating mode of the electrosurgical energy system includes one of the following: if the target is identified as a stone structure, determining that the operating mode of the electrosurgical energy system is a first operating mode; if the target is identified as an anatomical structure, determining that the operating mode of the electrosurgical energy system is a second operating mode; or if the target is identified as neither an anatomical structure nor a stone structure, determining that the operating mode of the electrosurgical energy system is a third operating mode.

[0039] In Example 30, the subject matter of any one or more of Examples 23 to 29 optionally includes: using at least one of the one or more spectral characteristics to calculate a distance between a target and a distal end of an optical path associated with the endoscope; and if (1) the target is identified as a treatment structure type and (2) the calculated distance is within a specified laser emission range, determining an operating mode of the laser system, the operating mode including delivering a laser beam to the target.

[0040] In Example 31, the subject matter of any one or more of Examples 23 to 30 optionally includes: wherein generating one or more spectral characteristics includes using geometry and positioning information about at least one optical path, wherein the at least one optical path is associated with the endoscope and is configured to transmit one or more of a laser beam, a signal reflected from a target, or electromagnetic radiation generated by a light source, wherein the geometry and positioning information includes at least one of an outer diameter of the at least one optical path or an angle of protrusion of a distal end of the at least one optical path relative to the endoscope.

[0041] Example 32 is at least one non-transitory machine-readable storage medium, which includes instructions that, when executed by one or more processors of the machine, cause the machine to perform operations including: irradiating a target in a subject's body with electromagnetic radiation generated by a light source; receiving a signal reflected from the target in response to the electromagnetic radiation; using the reflected signal to generate one or more spectral characteristics; using the one or more spectral characteristics, identifying the target as one of a plurality of structural types having respective different components; and generating a control signal to operate an electrosurgical energy system in an operating mode based on the identification of the target, the operating mode including the delivery or cessation of delivery of electrosurgical energy or the setting of energy parameters for the electrosurgical energy system.

[0042] In Example 33, the subject matter of Example 32 can optionally include wherein the control signal is generated to operate the laser system in an operation mode based on the identification of the target, the operation mode comprising delivery or cessation of delivery of a laser beam or laser parameter settings for the laser system.

[0043] In Example 34, the subject matter of any one or more of Examples 32 to 33 optionally includes: wherein the instructions cause the machine to perform operations further including: using the received reflection signal to generate a reflection spectrum representing the reflection intensity at multiple wavelengths, and wherein the operation of generating one or more spectral characteristics includes extracting one or more spectral features from the reflection spectrum, the one or more spectral features including: the reflection intensity at a specific wavelength; statistical characteristics of the reflectivity at two or more different wavelengths; or graphical features of a graphical representation of the reflection spectrum.

[0044] In Example 35, the subject matter of any one or more of Examples 32 to 34 optionally includes: wherein the operation of identifying the target as one of a plurality of structure types includes: using one or more spectral characteristics to identify the target as one of a stone structure or an anatomical structure.

[0045] In Example 36, the subject matter of any one or more of Examples 32 to 35 optionally includes: wherein the instructions cause the machine to perform operations further including: classifying a target into one of a plurality of stone types having respective different compositions using one or more spectral characteristics; adjusting laser parameter settings for an electrosurgical energy system based on the classified stone type of the target; and generating a control signal for the electrosurgical energy system based on the adjusted laser parameter settings to transmit a laser beam to a target of the classified stone type.

[0046] In Example 37, the subject matter of any one or more of Examples 32 to 36 optionally includes: wherein the instructions cause the machine to perform operations further comprising: classifying the target into one of a plurality of tissue types using one or more spectral characteristics; and determining an operating mode of the laser system based on the classified tissue type of the target.

[0047] In Example 38, the subject matter of any one or more of Examples 32 to 37 optionally includes: wherein the instructions cause the machine to perform operations further comprising: calculating a distance between a target and a distal end of an optical path associated with an endoscope using at least one of the one or more spectral characteristics; and determining an operating mode of the laser system if (1) the target is identified as a treatment structure type and (2) the calculated distance is within a specified laser emission range, the operating mode comprising delivering a laser beam to the target.

[0048] In Example 39, the subject matter of any one or more of Examples 32 to 38 optionally includes: wherein the operation of generating one or more spectral characteristics includes: using geometry and positioning information about at least one optical path, wherein the at least one optical path is associated with the endoscope and is configured to transmit one or more of a laser beam, a signal reflected from a target, or electromagnetic radiation generated by a light source, wherein the geometry and positioning information includes at least one of an outer diameter of the at least one optical path or an angle of protrusion of a distal end of the at least one optical path relative to the endoscope.

[0049] This summary is an overview of some of the teachings of this application and is not intended as an exclusive or exhaustive treatment of this subject matter. More details about this subject matter can be found in the specific embodiments and the appended claims. Other aspects of this disclosure will be apparent to those skilled in the art after reading and understanding the following specific embodiments and viewing the accompanying drawings that form a part of this disclosure, and each aspect should not be considered to have a limiting meaning. The scope of this disclosure is defined by the appended claims and their legal equivalents. BRIEF DESCRIPTION OF THE DRAWINGS

[0050] Various embodiments are shown by way of example in the figures of the accompanying drawings. Such embodiments are illustrative and are not intended to be exhaustive or exclusive of the present subject matter.

[0051] Figure 1 is a block diagram illustrating an example of a laser therapy system configured to provide laser therapy to a target structure in the body, such as an anatomical structure or a stone structure.

[0052] Figure 2 is a block diagram illustrating a portion of a laser feedback control system and an environment in which the system may be used.

[0053] Figure 3A is a graph showing examples of normalized reflectance spectra for different kidney stone types.

[0054] Figure 3B is a graph showing examples of normalized reflectance spectra for different kidney tissue types.

[0055] FIG. 4A to FIG. 4C is a diagram illustrating an example of an endoscope configured to provide feedback controlled laser therapy.

[0056] FIG. 5A to FIG. 5B is a diagram illustrating a portion of an exemplary endoscope configured to provide feedback-controlled laser therapy.

[0057] Figure 6 An example of a laser therapy system is shown that includes an endoscope integrated with a feedback-controlled laser therapy system that receives camera feedback.

[0058] Figure 7 An example of a laser therapy system is shown that includes an endoscope integrated with a feedback-controlled laser therapy system that receives spectral sensor feedback.

[0059] FIG. 8A to FIG. 8C An example of a laser therapy system including an endoscope with an integrated multi-fiber cable attachment is shown.

[0060] Fig. 9 A laser therapy system is shown that includes a dedicated spectroscopy signal cable and a separate surgical laser cable.

[0061] Fig.10 An example of a calibration curve is shown, which represents the relationship between the intensity of the spectral reflection signal using the feedback signal reflected from the target structure and the distance between the distal end of the fiber cable and the target structure.

[0062] Fig.11is a flow chart illustrating a method for controlling a laser system to deliver a laser beam to a target structure, such as an anatomical structure or a stone structure, in a body of a subject.

[0063] Fig.12 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

[0064] Laser endoscopy is a medical procedure for observing and operating internal organs, and the surgical laser is transmitted to the target body part to achieve a specific diagnosis or therapeutic effect. Laser endoscopy has been used for the treatment of soft tissue and hard tissue (e.g., to damage or destroy cancer cells) or for lithotripsy applications. For example, in PCNL, a practitioner can insert a rigid scope into the patient's back and into the patient's kidney through an incision. The practitioner can locate certain stones in the kidney or upper ureter through the scope, and break the stone into smaller fragments by irradiating the stone with a relatively high-power infrared laser beam by means of the scope. The laser beam can ablate the stone into smaller fragments. The stone fragments can then be removed from the kidney. The scope can include an endoscope, a nephroscope and / or a cystoscope.

[0065] In endoscopic laser therapy, it is necessary to identify different tissues, apply laser energy only to the target treatment structure (e.g., cancerous tissue or a specific stone type), and avoid or reduce the exposure of non-treatment tissue (e.g., normal tissue) to laser irradiation. Conventionally, the 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 the limited surgical field of view provided due to the narrow access to the surgical site, and the composition of the target may not be determined. Biopsy techniques have been used to extract the target structure (e.g., tissue) from the body to analyze its composition in vitro. However, in many clinical applications, it is necessary to determine the tissue composition in vivo to reduce surgical time and complexity and improve efficacy. For example, in laser lithotripsy, where a laser is applied to break up or powder stones, automatically and in vivo identifying specific types of stones (e.g., the chemical composition of kidney stones, pancreaticobiliary stones, or gallbladder stones) and distinguishing specific types of stones from surrounding tissue will allow the physician to adjust laser settings (e.g., power, exposure time, or emission angle) to more effectively ablate the target stone while avoiding irradiating non-treatment tissue near the target stone.

[0066] Conventional endoscopic laser therapy also has the limitation that tissue type (e.g., composition) cannot be continuously monitored during surgery. There are many moving parts during endoscopic surgery, and the tissue observed from the endoscope may change during the entire operation. Since conventional biopsy techniques need to take out tissue samples to identify components, they cannot monitor the composition of tissues during the entire operation. Continuously monitoring and identifying structural types (e.g., soft tissue type or hard tissue type, normal tissue and cancerous tissue, or the composition of stone structure) at the tip of the endoscope can provide doctors with more information to better adjust treatment during surgery. For example, if a doctor is pulverizing 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, for example, 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.

[0067] For at least the above reasons, the inventors have recognized an unmet need for systems and methods capable of identifying distinct structure types having respective distinct compositions in vivo and tailoring therapy based on the identification of the structure types.

[0068] This article describes systems, devices, and methods for identifying different structural types with different components in the body during a medical procedure and adjusting the surgical laser output accordingly. An exemplary laser treatment system includes: a laser system configured to generate a laser beam for delivery to a target in the body; and a controller circuit configured to receive a signal reflected from the target in response to electromagnetic radiation generated by a light source and generate one or more spectral characteristics based on the reflected signal. The controller circuit can use one or more spectral characteristics to identify the target as one of a plurality of structural types, such as tissue types or stone types with different components. The laser system can be controlled to operate in an operating mode based on the identification of the target. The operating mode can include the delivery or cessation of the delivery of the laser beam or the setting of laser parameters for the laser system. In an example, the control circuit can control the laser system to: emit a laser beam to a target of interest, such as a stone type or cancerous tissue, and adjust the laser settings based on the classified tissue type or stone type.

[0069] The systems, devices and methods according to various embodiments discussed herein provide improved in vivo target structure diagnosis and laser therapy. For endoscopy, laser surgery, laser lithotripsy, laser settings and / or spectroscopy, the features described herein can be used. Examples of targets and applications can include laser lithotripsy of kidney stones and laser cutting or vaporization of soft tissue. In an example of an endoscopic system incorporating features as described herein, tissue types or stone types or components can be identified and monitored in vivo. The laser settings can be adjusted using automatic and in vivo identification of the chemical composition of the target such as the tissue type or stone type to achieve the best transmission of laser energy. The ability to continuously monitor and identify tissue types or stone types allows for instant adjustment of laser settings. For example, according to various aspects of this document, a laser system can provide input data to another system such as an image processor, whereby a surgical monitor can display information related to medical surgery to a user. An example of this is: more clearly identifying different soft tissues, vascular systems, capsular tissues, and different chemical compositions in the same target such as stones in the field of view during surgery. With improved identification and classification of target structures, patients can be protected from accidental or misplaced laser delivery, and improved efficacy and tissue safety can be achieved.

[0070] According to various embodiments discussed herein, the present document also provides techniques for estimating and controlling the distance between the laser cable and the target structure. For example, if the appropriate target element (e.g., a cancerous lesion or a stone) is not within the range of the laser, the laser can be "locked", i.e., prevented from emitting. For example, when the present technology is used in a laser lithotripsy procedure, if there are no stones within the range of the laser (e.g., only tissue is within the range of the laser), the laser can be locked. This locking control can also be used to ensure that the target is within the optimal emission distance to improve the performance of existing laser lithotripsy systems, save power, improve patient safety, and improve the efficacy of stone ablation.

[0071] Figure 11 is a block diagram showing an example of a laser treatment system 100 configured to provide laser treatment to a target structure 122 in a subject's body, such as an anatomical structure (e.g., soft tissue, hard tissue, or abnormal tissue such as cancerous tissue) or a stone structure (e.g., a kidney stone or a pancreatic duct stone or a gallbladder stone). The laser treatment system 100 may include a laser feedback control system 101 and at least one laser system 102. The laser feedback control system 101 may be configured to receive a signal reflected from a target in response to electromagnetic radiation generated by a light source, generate one or more spectral characteristics using the reflected signal from the target, identify the target as one of a plurality of structure types (e.g., a stone type or a tissue type) having respective different compositions, and determine an operating mode of the laser system based on the identified structure type. The laser feedback control system 101 may be used in various applications, such as industrial and / or medical applications for treating soft (e.g., non-calcified) tissue or hard (e.g., calcified) tissue or a stone structure such as a kidney stone or a pancreatic duct stone or a gallbladder stone. In some examples, laser therapy system 100 can deliver precisely controlled therapeutic treatments to tissue or other anatomical structures (e.g., tissue ablation, coagulation, vaporization, etc.) or treatments to non-anatomical structures (e.g., ablating or pulverizing stone structures).

[0072] The laser feedback control system 101 may be in operation in communication with one or more laser systems. Figure 1 A laser feedback system is shown connected to the first laser system 102 and optionally (shown in dashed lines) to the second laser system 104. Additional laser systems are contemplated within the scope of the present disclosure. The first laser system 102 may 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 may also include a first optical path 108 operably coupled to the first laser source 106. In an example, the first optical path 108 includes an optical fiber. The first optical path 108 may be configured to transmit a laser beam from the first laser source 106 to the target structure 122.

[0073] The laser feedback control system 101 can analyze the feedback signal 130 from the target structure 122 and control the first laser system 102 and / or the second laser system 104 to generate appropriate laser output to provide the desired therapeutic effect. For example, the laser feedback control system 101 can monitor the characteristics of the target structure 122 during a therapeutic procedure (e.g., ablating a stone such as a kidney stone into smaller fragments) to determine whether the tissue is properly ablated before another therapeutic procedure (e.g., vascular coagulation).

[0074] In an example, the first laser source 106 can be configured to provide a first output 110. The first output 110 can extend over a first wavelength range, such as a wavelength range corresponding to a portion of an absorption spectrum of the target structure 122. Because the first output 110 is within a wavelength range corresponding to an absorption spectrum of tissue, the first output 110 can provide effective ablation and / or carbonization of the target structure 122.

[0075] In an example, the first laser source 106 can be configured such that the first output 110 emitted within the first wavelength range corresponds to high absorption of the incident first output 110 by the tissue (e.g., greater than about 250 cm -1 ). In example aspects, the first laser source 106 can emit a first output 110 between about 1900 nanometers (nm) and about 3000 nm (e.g., corresponding to high absorption of water) and / or between about 400 nm and about 520 nm (e.g., corresponding to high absorption of 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; when the absorption is low (absorption coefficient is less than 250cm -1 ), such as lasers in the wavelength range of 800nm ​​to 1100nm, the scattering mechanism dominates.

[0076] Various commercially available medical grade laser systems may be suitable for the first laser source 106. For example, a semiconductor laser such as an InXGa1-XN semiconductor laser may be used that provides a first output 110 within a first wavelength range between about 515 nm and about 520 nm or between about 370 nm and about 493 nm. Alternatively, an infrared (IR) laser such as those summarized in Table 1 below may be used.

[0077] Table 1 Example list of suitable IR lasers

[0078]

[0079] The optional second laser system 104 may include a second laser source 116 for providing a second output 120 and associated components such as a power supply, display, cooling system, etc. The second laser system 104 may be operably separate from the first laser source 106, or alternatively the second laser system 104 may be operably coupled to the first laser source 106. In some embodiments, the second laser system 104 may include a second optical fiber 118 (separate from the first optical path 108) operably coupled to the second laser source 116 for transmitting the second output 120. Alternatively, the first optical path 108 may be configured to transmit both the first output 110 and the second output 120.

[0080] In certain aspects, the second output 120 may extend within 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 at least partially overlap each other. In advantageous aspects of the present disclosure, the second wavelength range may not correspond to a portion of the absorption spectrum of the target structure 122, where the incident radiation is strongly absorbed by tissue that has not been previously ablated or carbonized. In some such aspects, the second output 120 may advantageously not ablate uncarbonized tissue. Furthermore, in another embodiment, the second output 120 may ablate previously ablated carbonized tissue. In additional embodiments, 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.

[0081] Figure 22 is a block diagram showing at least a portion of a laser feedback control system 200 and an environment in which the laser feedback control system 200 can be used. The laser feedback control system 200, which is an example of the laser feedback control system 101, can include a feedback analyzer 240, a memory 250, and a laser controller 260. According to one aspect of the subject matter described herein, the feedback analyzer 240 can include a spectral sensor 242, which is configured to: sense a spectral signal reflected from the target structure 122 and generate one or more spectral characteristics according to the reflected signal. The spectral characteristics can include characteristics such as reflectivity, reflection spectrum, absorption index, etc. Examples of the spectral sensor 242 can include a Fourier transform infrared (FTIR) spectrometer, a Raman spectrometer, a UV-VIS spectrometer, a UV-VIS-IR spectrometer, or a fluorescence spectrometer, etc. Each spectral sensor 242 corresponds to a spectral technology. For example, UV-VIS reflectance spectroscopy can be used to collect information from light reflected from an object, which is similar to information generated from a color image produced by the eye or a high-resolution camera, but the information is more quantitative and more objective. Because the reflection and absorption of light depends on its chemical composition and surface properties, reflectance spectroscopy can provide information about materials. Information about both the surface and volume properties of a sample can be obtained using this technique. Reflectance spectroscopy can be used to identify the composition of hard tissue or soft tissue. Fluorescence spectroscopy is a type of electromagnetic spectroscopy that analyzes fluorescence from a sample. Fluorescence spectroscopy involves the use of a beam of light, usually ultraviolet light, that excites a material compound, usually in the visible region or the infrared region, and causes the material compound to emit light. This method can be applied to the analysis of some organic components such as hard tissue and soft tissue. FTIR spectroscopy can be used for rapid material analysis, and has relatively good spatial resolution and provides information about the chemical composition of the material. Raman spectroscopy can be used to identify hard tissue components and soft tissue components. As a high spatial resolution technique, Raman spectroscopy is also useful for determining the distribution of components within a target.

[0082] The spectroscopic techniques described above may be used alone or in combination to analyze the feedback signal 130 reflected from the target structure 122 to create a spectral feedback and extract spectral characteristics indicative of a structure type having respective distinct components.

[0083] The feedback analyzer 240 may optionally include an imaging sensor 244. Examples of imaging sensors 244 may include imaging cameras, such as CCD or CMOS cameras that are sensitive to ultraviolet (UV), visible (VIS) wavelengths, or infrared (IR) wavelengths in embodiments. In some embodiments, the spectral sensor 242 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 tissues, vasculature, etc.).

[0084] In some examples, the spectral sensor 242 may include any of the spectrometers listed herein, and may additionally rely on the imaging capabilities of the endoscope used during the therapeutic procedure. For example, an endoscope may be used to visualize anatomical features during a therapeutic procedure (e.g., laser ablation of a tumor). In this case, the imaging capabilities of the endoscope may be enhanced by the spectral sensor 242. For example, a conventional endoscope may provide narrowband imaging suitable for enhanced visualization of anatomical features (e.g., lesions, tumors, vasculature, etc.). Combining the spectral sensor 242 with endoscopic imaging (white light and / or narrowband imaging) may enhance detection of tissue characteristics, such as carbonization levels, to precisely control the delivery of therapeutic treatments.

[0085] In an example, the spectral sensor 242 may be operably coupled to the signal transmission path 280. The signal transmission path 280 may include an optical fiber having optical characteristics suitable for transmitting the spectral signal reflected from the tissue to the spectral sensor 242. Alternatively, the spectral sensor 242 may be operably coupled to the first optical path 108 of the first laser system 102 and / or the second optical path 118 of the second laser system 104, thereby detecting the spectral signal via the first optical path 108 and / or the second optical path 118.

[0086] The feedback analyzer 240 may include one or more of a target detector 246 or a target classifier 248. The target detector 246 may be configured to identify the target structure 122 as one of a plurality of structural categories using spectral characteristics such as those generated by the spectral sensor 242, optionally in combination with imaging characteristics sensed by the optional imaging sensor 244. In an example, the target detector 246 may identify the target structure 122 as a category of stone structure or a category of anatomical structure using one or more spectral characteristics. Examples of stone structures may include stones or stone fragments in different stone formation sites such as the urinary system, gallbladder, nasal cavity, gastrointestinal tract, stomach, or tonsils. Examples of anatomical structures may include soft tissues (e.g., muscles, tendons, ligaments, blood vessels, fascia, skin, fat, and fibrous tissue), hard tissues such as bones, connective tissues such as cartilage, and the like.

[0087] In an example, the feedback analyzer 240 can generate a reflection spectrum using the received reflection signal, and extract one or more spectral features from the reflection spectrum. The reflection spectrum represents the reflection intensity at multiple wavelengths. Reflectivity can be determined as a portion of the incident electromagnetic power reflected at the surface of the material. Reflectivity represents the effectiveness of the material surface in reflecting radiant energy such as electromagnetic radiation emitted from a light source. The reflection spectrum can be formatted as a data array or a graphical representation that can also be referred to as a spectral reflectance curve. In an example, the reflection spectrum represents the reflectivity at a wavelength in the range of about 400nm to 1000nm.

[0088] refer to FIG. 3A to FIG. 3B , different classes of structures may have different reflection intensities. For example, the reflection spectrum of a stone structure (e.g., a kidney stone) may be different from the reflection spectrum of an anatomical structure (e.g., a subject's soft tissue or hard tissue). As an example, Figure 3A Examples of normalized reflectance spectra of different kidney stone types are shown. The reflectance spectra correspond to a wavelength range of about 400 nm to 700 nm and are normalized with respect to the reflectance intensity at 700 nm. As an example, Figure 3B Normalized reflectance spectra of different kidney tissue types are shown. The reflectance spectra correspond to a wavelength range of about 400 nm to 900 nm and are normalized with respect to the reflectance intensity at 900 nm.

[0089] like Figure 3A As shown in Figure 2, the reflectance spectrum of kidney stones shows that as the wavelength increases from 400nm to 700nm, the reflectance increases almost monotonically. Figure 3B As shown, the reflectance spectrum of kidney tissue shows that the reflectance changes significantly in the wavelength range of 400nm to 650nm, and the reflectance decreases almost monotonically as the wavelength increases from 650nm to 850nm.

[0090] One or more spectral features may be extracted from the reflectance spectrum or normalized reflectance spectrum of a known stone structure, e.g. Figure 3A Similarly, one or more spectral features can be extracted from the reflectance spectrum or normalized reflectance spectrum of a known anatomical structure, such as Figure 3B As shown (hereinafter referred to as "tissue reflection characteristics"). Examples of characteristic reflection characteristics may include: a reflection spectrum (or normalized reflection spectrum) at a specific wavelength or within a wavelength range, a statistical value calculated based on the reflection spectrum (e.g., a change in reflectivity at two or more different wavelengths, a rate of change of reflectivity within a wavelength range, etc.), or a graphical feature representing the morphology of at least a portion of a spectral reflectivity curve (e.g., a slope, a curvature, a segment of a curve, etc.). The stone reflection characteristics and tissue reflection characteristics may be stored in the memory 250 of the laser feedback control system 200.

[0091] In order to identify the target structure 122 as a stone structure or an anatomical structure, in one example, the target detector 246 can extract one or more target reflection features from a reflection spectrum generated according to the spectral signal reflected from the target structure 122. If the target reflection feature exceeds a feature threshold or falls within a value range, the target detector 246 can identify the target structure 122 as a stone structure, or if the target reflection feature falls below the feature threshold or falls outside the value range, the target detector 246 can identify the target structure 122 as renal tissue. The feature threshold or value range can be determined using the stone reflection feature and the tissue reflection feature. In an example, the feature threshold can be determined as a threshold that separates the stone reflection feature and the tissue reflection feature with a specified boundary.

[0092] In some examples, the target detector 246 can perform a trend analysis on the reflection intensity of the target structure 122 within a wavelength range, and identify the target structure 122 based on the trend of the reflection intensity (or "reflection trend"). In an example, a reflection trend can be generated within a first range of 400nm to 550nm. If there is a monotonically increasing reflectivity trend within the first wavelength range shown, the target structure 122 can be identified as a stone structure. If there is no monotonically increasing reflectivity trend within the first wavelength range, the target structure 122 can be identified as renal tissue. In another example, a reflectivity trend can be generated within a second range of 650nm to 700nm. If there is a monotonically increasing reflectivity trend within the second wavelength range, the target structure 122 can be identified as a stone structure. If there is a monotonically decreasing trend within the second wavelength range, the target structure 122 can be identified as renal tissue.

[0093] In another example, the target detector 246 may use a template matching method to identify the target structure 122 as a stone structure or an anatomical structure. The target reflection feature may be compared with at least one of the stone reflection features or at least one of the tissue reflection features stored in the memory 250 to determine whether the matching criteria are met. For example, if the dissimilarity measure between the target reflection feature and the stone reflection feature is below a first similarity threshold, the target structure 122 may be identified as a stone structure, or if the dissimilarity measure between the target reflection feature and the tissue reflection feature is below a second similarity threshold, the target structure 122 may be identified as renal tissue.

[0094] In addition to such as Figure 3A and Figure 3B In addition to the inter-class differences in reflectance spectra between stone structures and anatomical structures shown and compared, different structure types within the same class may also exhibit different reflectance properties, such as reflectance spectra. As an example, Figure 3AAn example of intra-class differences in reflectance spectra between multiple stone types is shown. As shown therein, across a wavelength range of 400 nm to 700 nm, a brushite stone (which is a calcium phosphate (CaP) stone) 311 has a higher normalized reflectance than a calcium oxalate dihydrate (COD) stone 312, which has a higher normalized reflectance than a calcium oxalate monohydrate (COM) stone 313, which has a higher normalized reflectance than a magnesium ammonium phosphate (MAP) stone 314. As an example, Figure 3B The intra-class differences in reflectance spectra between multiple renal tissue types are shown. As shown therein, the normalized reflectance of the bladder 321 tends to be higher than the normalized reflectance of the ureter 322, the calyx 323, the medulla 324, and the cortex 325 across the wavelength range of 400nm to 900nm. In a specific wavelength range (e.g., 450nm to 500nm), the ureter 322 has a higher normalized reflectance than the calyx 323, the calyx 323 has a higher normalized reflectance than the medulla 324, and the medulla 324 has a higher normalized reflectance than the cortex 325.

[0095] The target classifier 248 can use the intra-class differences in reflectance spectra between different structure types of the same class as described above to classify the target structure 122 as one of multiple structure types of the same class, such as a specific tissue type within the class of identified anatomical structures, or to classify the target structure 122 as a specific stone type within the class of identified stone structures. In an example, the target classifier 248 can classify the identified kidney stone as one of stone types with different chemical compositions, such as one of a CaP stone, a MAP stone, a COM stone, a COD stone, a cholesterol-based stone, or a uric acid (UA) stone. The classification can be based on reflectance at a specific wavelength, a statistical feature of the reflectance at two or more different wavelengths (e.g., a variance or other measure of variation), or one or more of graphical features generated from a graphical representation of the reflectance spectra. For example, based on a graphical representation of the reflectance spectra, such as Figure 3A As shown by the different normalized reflectance spectra between the various stone types, the target classifier 248 can compare the normalized reflectance at a specific wavelength (e.g., 550 nm) or wavelength range to one or more thresholds to classify the target structure 122 as a specific stone type.

[0096] In another example, the target classifier 248 can be configured to classify the identified anatomical structure into one of a plurality of tissue types using one or more spectral characteristics. In an example, the target classifier 248 can be configured to classify the identified renal tissue into one of tissue types having different anatomical locations, such as calyceal tissue, cortical tissue, medullary tissue, or ureteral tissue. For example, based on Figure 3B As shown by the different normalized reflectance spectra between the various tissue types, the target classifier 248 can classify the target structure 122 as a specific tissue type based on a comparison between the normalized reflectance at a specific wavelength (e.g., 480 nm) or wavelength range and one or more reflectance thresholds.

[0097] In another example, the target classifier 248 can be configured to classify the identified anatomical structure as normal tissue or abnormal tissue (e.g., cancerous tissue). Normal tissue and cancerous tissue can exhibit different reflectance spectra with different shapes, peak positions (i.e., the wavelength at which the reflectance spectrum reaches a peak in the wavelength range). The classifier 248 can be configured to classify the identified anatomical structure as a treatment area (e.g., a tumor or polyp for removal) or a non-treatment area (e.g., a blood vessel, muscle, etc.). The classification can be based on one or more of the reflectance at a specific wavelength, the statistical characteristics of the reflectance at two or more different wavelengths (e.g., the variance or other variation measure), or the graphical features (e.g., the slope) generated from the graphical representation of the reflectance spectrum.

[0098] Return to reference Figure 2 , the laser controller 260 can be in operative communication with the feedback analyzer 240 and the laser system 202. The laser system 202 can represent the first laser system 102, the optional second laser system 104, and / or any additional laser systems. The laser controller 260 can control the laser systems 202 operatively connected thereto according to one or more control algorithms described herein to control the laser output from the one or more laser systems to produce a desired therapeutic effect in the target structure 122.

[0099] According to example embodiments, the laser controller 260 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 circuit system, and any combination of such components for performing one or more of the functions attributed to the laser controller 260. Optionally, the laser controller 260 may be coupled to the feedback analyzer 240 and the laser system 202 via a wired or wireless connection. The laser controller 260 may communicate with the feedback analyzer 240 (e.g., via a wired or wireless connection) and determine an operating mode of the laser system 202 based on an identification of the target structure 122 (e.g., as determined by the target detector 246), or determine an operating mode of the laser system 202 based on a classification of the target structure 122 (e.g., as determined by the target classifier 248).

[0100] In some examples, the laser system 202 can be associated with one of two different operating modes or states: a first state in which the laser system 202 generates a laser output and a second state in which the laser system 202 does not generate a laser output. For example, the first laser system 102 can have a first state in which the first output 110 is generated (e.g., within a first wavelength range) and a second state in which the first output 110 is not generated. Similarly, the second laser system 104 can have a first state in which the second output 120 is generated (e.g., within a second wavelength range) and a second state in which the second output 120 is not generated. In these embodiments, the laser controller 260 can control the laser system 220 by sending a control signal that changes the operating state of the laser system from the first state to the second state or from the second state to the first state. In some examples, the laser system 202 can have additional states, such as a third state in which a laser output is generated according to a different laser irradiation parameter setting (e.g., a different wavelength range and / or power output). Thus, the laser controller 260 can send additional control signals to the laser system(s) to change its state from its current state to one or more additional states (e.g., the first state to the third state, the second state to the third state, the third state to the first state, and the third state to the second state) to produce a laser output that provides the desired therapeutic effect.

[0101] In an example, if the target is identified as a stone structure, the laser controller 260 may generate a first control signal for the laser system 202 to operate in a first operating mode; if the target is identified as an anatomical structure, the laser controller 260 may generate a second control signal for the laser system to operate in a second operating mode; if the target is identified as neither an anatomical structure nor a stone structure, the laser controller 260 may generate a third control signal for the laser system to operate in a third operating mode. In an example, the first operating mode may include activating the laser system 202 to deliver a laser beam programmed with a first irradiation parameter setting to ablate or pulverize an identified stone, such as a kidney stone. In an example, the second operating mode may include stopping laser delivery or delivering a laser beam programmed with a second irradiation parameter setting different from the first irradiation parameter setting to the identified tissue. In an example, the third operating mode may include causing the laser system 202 to pause delivery of laser energy. Laser irradiation parameters may include wavelength, power, power density, pulse parameters (eg, pulse width, pulse rate, amplitude, duty cycle), exposure time, total dose or energy, and the like.

[0102] In some examples, the laser controller 260 may determine an operating mode of the laser system 202 based on classifying the target structure 122 as one of a plurality of stone types, such as CaP stones, MAP stones, COM stones, COD stones, cholesterol-based stones, or uric acid (UA) stones, as determined by the target classifier 248. The laser controller 260 may adjust irradiation parameter settings based on the classification of the stone type and generate control signals to control the laser system 202 to deliver laser energy to the target structure 122 according to the adjusted irradiation parameter settings.

[0103] In some examples, laser controller 260 can determine an operating mode for laser system 202 based on classifying target structure 122 as one of the following multiple tissue types: for example, kidney tissue at different anatomical locations (e.g., Figure 3B The anatomical structure may be a renal calyceal tissue, cortical tissue, medullary tissue, or ureteral tissue as shown), normal or abnormal tissue (e.g., cancerous tissue), a treatment area (e.g., a tumor or polyp to be removed), or a non-treatment area (e.g., blood vessels, muscles, etc.). The laser controller 260 may adjust irradiation parameter settings based on the classification of the tissue type, and generate a control signal for the laser system 202 to deliver laser energy to the identified anatomical structure according to the adjusted irradiation parameter settings.

[0104] In some examples, irradiation parameter settings may be determined for a plurality of stone types and / or for a plurality of tissue types, respectively. Stone type-irradiation parameter setting correspondences or tissue type-irradiation parameter setting correspondences may be created and stored in the memory 250, for example, in a lookup table, an associative array, etc. The laser controller 260 may use one of such stored correspondences to determine the irradiation parameter setting corresponding to the classified stone type or the classified tissue type.

[0105] In various examples, the feedback analyzer 240 can continuously monitor the target structure 122, collect and analyze feedback signals, and continuously communicate with the laser controller 260. Thus, the laser controller 260 can continue to maintain the laser system in one or more states until a change in feedback is detected (e.g., a different category of the target structure 122, a different tissue type, or a different stone type). When a change in feedback is detected, the laser controller 260 can communicate with one or more laser systems and change their states to provide the desired therapeutic effect. Alternatively or additionally, the laser controller 260 can communicate with an operator (e.g., a medical professional) and display one or more outputs via one or more output systems indicating the feedback signals, and optionally can instruct the operator to perform one or more treatment protocols using the first laser system and / or the second laser system to provide the desired therapeutic effect.

[0106] In the illustrative examples described herein, laser controller 260 can control more than one laser system by changing the operating state of each laser system. According to one aspect, laser controller 260 can control each laser system independently. For example, laser controller 260 can send different control signals to each laser system to control each laser system independently of other laser systems. Alternatively, laser controller 260 can send a common signal to control one or more laser systems.

[0107] The laser feedback control system 200 can be operatively communicated with an output system 270. The output system 270 can communicate with the feedback analyzer 240 and / or transmit the signals received and the information generated by the feedback analyzer 240 to a user and / or other systems, such as an irrigation suction / pumping system or an optical display controller or other system for therapy treatment. Examples of the transmitted signals and information may include one or more of the following: feedback signal 130 (e.g., a spectral signal reflected from a target tissue or stone), spectral characteristics generated by the spectral sensor 242 or optionally by the optional imaging characteristics generated by the optional imaging sensor 244, identification of the target structure 122 generated by the target detector 246, or classification of the target structure 122 generated by the target classifier 248. In an example, the output system 270 may include a display 272, such as a screen (e.g., a touch screen), or alternatively include a visual indicator (e.g., one or more colors of LED lights). In an example, the output system 270 may include an auditory output system 274 (e.g., a speaker, an alarm system, etc.) capable of providing an auditory signal. Output system 270 may provide one or more outputs (e.g., an LED light of a first color, a first message on a screen, an alarm of a first tone) to indicate that a desired therapeutic effect has been achieved (e.g., ablation of a stone structure such as a kidney stone or carbonization of an abnormal tissue such as cancerous tissue). In some examples, when the desired therapeutic effect has not been achieved, output system 270 may provide one or more different outputs. For example, output system 270 may provide one or more outputs (e.g., an LED light of a second color, a second message on a screen, an alarm of a second tone) to indicate that the desired therapeutic effect has not been achieved. In some examples, different outputs (e.g., LED lights of different colors, different messages on a screen, or alarms of different tones) may be used to indicate on output system 270 the different identified structural categories (e.g., stone structure vs. anatomical structure) or the different classified structural types (e.g., such as Figure 3A Different types of stones shown or Figure 3B Such output can prompt an operator (e.g., a medical professional) to take appropriate action, such as providing additional treatment using one or more laser systems.

[0108] According to one aspect of the present document, the laser feedback control system 101 or a variant thereof, such as the laser feedback control system 200, can be implemented at least in part in an endoscope used in a medical procedure to fragment and remove stone structures (e.g., kidney stones or pancreaticobiliary stones or gallbladder stones or stone fragments) or anatomical structures such as tumor tissue. A laser lithotripsy procedure can be performed through a nephroscope. Figure 4A A side view of an exemplary endoscope 400 is shown. Figure 4B An end view of the distal tip of an endoscope 400 is shown. Examples of endoscope 400 may include nephroscopes, cystoscopes, ureteroscopes, and other various endoscopes with different applications. The endoscope includes a body 402 that is at least partially insertable into a patient's kidney. The body 402 may include a handle, a hub, or other grippable proximal portion 404, an elongated rigid portion 406 extending from the grippable proximal portion 404, and a flexible distal portion 408 extending distally from the elongated rigid portion 406 to a distal end 410. An articulation controller 414 may be located on the grippable proximal portion 404. When a human hand grips the grippable proximal portion 404, the articulation controller 414 can be actuated by the thumb of the human hand. The articulation controller 414 can adjust the position of the flexible distal portion 408. Also located on the grippable proximal portion 404 may include an electrical port 424 that may be coupled (e.g., via one or more wires 126 extending along the body 402) to a substrate 416 (e.g., a substrate 416) located on the distal end 410 of the body 402. Figure 4B 4. The substrate 416 may include one or more of a circuit board, a hybrid chip, a ceramic component, or other suitable components or elements. The electrical port 424 may receive power to power the circuit board on the substrate 416. The substrate 416, such as a circuit board, may wirelessly communicate the digital video signal to a display device external to the endoscope 400, such as a user device, a display, a computer monitor, a head-up display, a wearable display, a virtual reality display, an augmented reality display, etc.

[0109] Optical fiber 428 (such as Figure 4B (shown) is Figure 1 The first optical path 108 of the embodiment of the present invention can be integrated into the endoscope 400. For example, the optical fiber 428 can extend along the working channel in the body 402 of the endoscope 400. In some examples, the optical fiber 428 can be separated from the endoscope. For example, the optical fiber 428 can be fed along the working channel of the endoscope before use and retracted from the working channel of the endoscope after use.

[0110] The optical fiber 428 can be coupled to a laser or laser transmitter outside the endoscope 400 via a suitable connector and transmit a laser beam to a target structure, such as a stone structure, to ablate the target structure into stone fragments. The laser beam generated by the laser transmitter can have a wavelength corresponding to the spectral peaks of absorption of human blood and saline, such as 2100nm, 1942nm, etc. For example, a wavelength in the range between 1900nm and 3000nm can correspond to a spectral region absorbed by water, and a wavelength between 400nm and 520nm can correspond to a spectral region absorbed by oxygenated hemoglobin and / or deoxygenated hemoglobin. For example, a thulium fiber laser can generate a laser beam with a wavelength of 1908nm or 1940nm, a thulium:YAG laser can generate a laser beam with a wavelength of 2010nm, a holmium:YAG laser can generate a laser beam with a wavelength of 2120nm, and an erbium:YAG laser can generate a laser beam with a wavelength of 2940nm. Other wavelengths within these ranges can also be used. In general, it may be beneficial to deliver a laser beam that has significant absorption in blood and saline because such a laser beam may be minimally invasive to surrounding tissue, which may reduce or eliminate damage to tissue at or near the stone structure. The laser may provide light having an output power that falls within a suitable output power range, such as between 20 watts and 120 watts, between about 20 watts and about 120 watts, etc. These output power ranges are examples only, and other suitable output powers or output power ranges may also be used. The optical fiber 428 may be a multimode optical fiber or a single-mode optical fiber.

[0111] The laser controller 432 can be located on the grippable proximal portion 404. The laser controller 432 can switch the state of the laser beam between an operational state ("on") and a non-operational state ("off"). For example, the laser controller 432 can direct a wired and / or wireless signal to a laser located outside the endoscope 400. The signal can turn the laser on or off. In some implementations, a practitioner can adjust one or more settings of the laser, such as output power, on the housing of the laser. In some implementations, a practitioner can adjust one or more settings of the laser via the laser controller 432.

[0112] During a typical procedure, the practitioner can manipulate the laser controller 432 so that the laser can operate for a period of time, such as one minute, two minutes, three minutes, four minutes, or any suitable length of time. During the period of laser operation, the practitioner can manipulate the body 402 to move the delivered laser beam across the surface of the stone structure. In some examples, the laser power level and exposure time are such that the practitioner can safely turn the laser power on and off by hand without the need for a mechanized or automated exposure mechanism. The laser power can also be low enough so that accidental exposure of surrounding tissue does not damage the tissue.

[0113] Practitioners can ablate the stone structure by powdering the surface of the stone structure. Powdering can wear the stone structure in a controlled manner, and can produce stone particles that can be smaller than the stone fragments obtained by crushing or pulverizing the stone structure. For example, the size of a typical kidney stone can be between about 1mm and about 20mm. Crushing or pulverizing kidney stones can produce kidney stone fragments that may be smaller than the size of the stone, and the size of the kidney stone fragments is, for example, between a few millimeters and less than about 10 millimeters. Powdering kidney stones can produce kidney stone particles that can be less than about 1mm in size.

[0114] To remove stones or stone fragments, the practitioner can use a stone extraction device, such as a basket, that can be passed through an orifice in the endoscope 400. The practitioner can use the stone extraction device to select and remove individual fragments. In addition to or in lieu of the stone extraction device, the endoscope 400 can include a flushing system to flush away stone fragments. The flushing system can include a flushing controller 438 located on the grippable proximal portion 404 and can operably control the flow of flushing fluid through the flushing lumen 434 and the suction of fluid and waste through the suction lumen 436.

[0115] The endoscope 400 may optionally include a tube, lumen, additional working channel, or other passageway 440 within the body of the endoscope 400. The practitioner may use the passageway 440 to deploy a separate tool or instrument, such as a lithotripter, stone retrieval basket, or other suitable tool or instrument.

[0116] The endoscope 400 can include a visualization system at the distal end 410 of the body 402 to allow an operator to visualize stone fragments. The visualization system can illuminate the working area of ​​the stone (e.g., a kidney stone or a pancreaticobiliary stone or a gallbladder stone) and can generate a video image or one or more static images of the illuminated area of ​​the stone. The visualization system can direct the video image to a display, such as a video monitor. The display can be located outside the endoscope 400 and can be visible during the stone removal procedure.

[0117] The visualization system may include at least one light source 418 located on a substrate 416. The substrate 416 may be a circuit board that mechanically supports the light source 418 and powers the light source 418. Examples of the light source 418 may include a light emitting diode (LED), a xenon lamp, etc. In an example, the light source 418 may emit light distally away from the distal end 410 of the body 402 to illuminate the stone. In some examples, an external light source (e.g., outside the endoscope 400) may be used to provide light transmitted through the body 402 (e.g., via an optical path therein) to illuminate the stone. The light source 418 may emit white light to illuminate the stone. White light may allow a practitioner to observe discoloration or other color-based effects on the stone or on the tissue near the distal end 410 of the body 402. The light source 418 may emit blue light to illuminate the stone. Blue light may be very suitable for displaying thermal tissue diffusion and thereby detecting damage in the tissue. Other colors and / or color bands may be used, such as red, amber, yellow, green, or other colors.

[0118] Each light source 418 can be coupled to an optional lens 420 that can adjust the angle of light output from the light source 418 (see Figure 4B ). Lens 420 can narrow the light output from light source 418. Lens 420 can widen the light output from light source 418. Such angular adjustment can help ensure that stones and tissues are adequately illuminated within a specified angular field of view.

[0119] The visualization system may include a camera 422 located on the substrate 416 (see Figure 4B ). The substrate 416 can be a circuit board that mechanically supports the camera 422 and provides power to the camera 422. The camera 422 can capture a video image of the irradiated stone or one or more static images. The video image can be real-time or near real-time due to a relatively short processing delay, so that the practitioner can observe the stone and surrounding tissue while the practitioner manipulates the body 402 and controls the endoscope 400. The camera 422 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 ​​of red light, green light, 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 irradiated 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 other suitable video refresh rates.

[0120] Figure 4CAnother example of an endoscope, also referred to as a ureteroscope 470, that can be used for ureteroscopic surgery is shown. Similar to endoscope 400, ureteroscope 470 can be used to provide feedback-controlled laser therapy. Ureteroscope 470 includes a grippable proximal portion 474 that is distinct from grippable portion 404 of endoscope 400. Ureteroscope 470 can include an elongated shaft 476 that facilitates insertion of scopes into smaller ureters and maximizes visibility when used with an access sheath.

[0121] Figure 5 to Fig. 9 Various examples of endoscopes and their use in feedback-controlled laser therapy systems, such as laser therapy system 100 , are shown. Figure 5A is a cross-sectional view of an elongated body portion of an exemplary endoscope 510 including various components, Figure 5B 5 is a cross-sectional view of the elongated body of the endoscope 510. The endoscope 510 may include a laser cable 512, an illumination light 514, and a camera 516. The laser cable 512 is an example of an optical path 108 of the laser system 102 or the laser system 202. The laser cable 512 may extend along a working channel 513 within the elongated body of the endoscope 510. In some examples, the laser cable 512 may be detachable from the endoscope. For example, the laser cable 512 may be fed along the working channel of the endoscope before use and retracted from the working channel of the endoscope after use.

[0122] The irradiation light 514 can be part of a visualization system that allows an operator to visualize a target structure (e.g., a tissue structure or a stone structure). An example of an irradiation light 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 irradiation light 514 can emit white light to illuminate the target structure. White light can allow a practitioner to observe discoloration or other color-based effects on stones or tissues near the distal end of the body of the endoscope. In an example, the irradiation light 514 can emit blue light to illuminate the target structure. Blue light can be very suitable for showing thermal tissue diffusion and thereby detecting damage in the tissue. Other colors and / or color bands can also be used, such as red, amber, yellow, green, or other colors.

[0123] Camera 516 is part of the visualization system. Camera 516 is an example of imaging sensor 244. Camera 516 can capture a video image or one or more static images of the irradiated target structure and the surrounding environment. The video image can be real-time or near real-time due to a relatively short processing delay, so that the practitioner can observe the target structure while the practitioner manipulates the endoscope. Camera 516 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 ​​of red light, green light, 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 irradiated stone. The digital video signal can have a video refresh rate of 10Hz, 20Hz, 24Hz, 25Hz, 30Hz, 40Hz, 50Hz, 60Hz or other suitable video refresh rates.

[0124] Figure 6 An example of a laser therapy system 600 is shown that includes an endoscope 510 integrated with a feedback-controlled laser therapy system 610 that receives camera feedback. The laser therapy system 600, which is an example of the laser therapy system 100, includes the endoscope 510, the feedback-controlled laser therapy system 610, a laser source 620, and a light source 630. In various examples, a portion or all of the feedback-controlled laser therapy system 610 may be embedded in the endoscope 510.

[0125] The feedback-controlled laser therapy system 610, which is an example of the laser feedback control system 200, includes a spectrometer 611 (an example of the spectral sensor 242), a feedback analyzer 612 (an example of at least a portion of the feedback analyzer 240), and a laser controller 613 (an example of the laser controller 260). The laser source 620 is an example of the laser system 202 and can be coupled to the laser fiber cable 512. The fiber-cable integrated laser system can be used for endoscopic surgery due to its ability to deliver laser energy through a flexible endoscope and effectively treat hard and soft tissues. These laser systems generate laser output beams in a wide wavelength range from the UV to the IR region (200nm to 10000nm). Some fiber-cable integrated lasers generate outputs in wavelength ranges that are highly absorbed by soft or hard tissues, such as 1900nm to 3000nm for water absorption or 400nm to 520nm for oxygenated hemoglobin and / or deoxygenated hemoglobin absorption. Table 1 above is a summary of IR lasers emitting in the high water absorption range of 1900 nm to 3000 nm.

[0126] 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 can provide effective tissue coagulation due to a penetration depth similar to the diameter of a small capillary tube, 5 μm to 10 μm. Examples of laser sources 620 may include In lasers that emit UV-VIS. X Ga 1-X N semiconductor lasers, such as GaN lasers emitting at 515nm to 520nm, In lasers emitting at 370nm to 493nm X Ga 1-X N laser, emitting 750nm to 850nm Ga X Al 1- X As laser or In laser emitting 904nm to 1065nm X Ga 1-X As laser, etc.

[0127] The light source 630 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 513. In an example, the first optical path can be an optical fiber separate from the laser cable 512. In another example, as shown in FIG. Figure 6 As shown, the electromagnetic radiation signal can be transmitted through the same laser fiber cable 512 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 6 As shown, the target structure is within the field of view of the endoscopic camera 516, so that in response to electromagnetic radiation projected onto the target structure and the surrounding environment, the endoscopic camera 516 (e.g., a CCD or CMOS camera) can collect signals reflected from the target structure 122, generate an imaging signal 650 of the target structure, and transmit the imaging signal to the feedback-controlled laser treatment system 610.

[0128] In some examples, in addition to or in lieu of feedback signals (e.g., imaging signals) generated and transmitted by camera system 516, signals reflected from the target structure may additionally or alternatively be collected and transmitted to a feedback-controlled laser therapy system 610 via a separate fiber optic cable channel or laser cable such as associated with endoscope 510. Figure 7 An example of a laser treatment system 700 is shown that includes an endoscope 510 integrated with a feedback-controlled laser treatment system 610 configured to receive spectral sensor feedback. The reflected spectral signal 750 (which is a laser beam) can be transmitted to the target structure through the same optical path used to transmit electromagnetic radiation from the light source 630 to the target structure, such as a laser fiber cable 512. Figure 1 and Figure 2In another example, the reflected spectral signal 750 can be propagated to the feedback-controlled laser therapy system 610 via a second optical path, such as a fiber optic channel separate from the first optical fiber that transmits electromagnetic radiation from the light source 630 to the target structure.

[0129] The feedback-controlled laser therapy system 610 can analyze one or more feedback signals (e.g., imaging signal 650 or reflection spectrum signal 750 of the target structure) to determine the operating state of the laser source 620. The spectrometer 611 can generate one or more spectral characteristics based on the one or more feedback signals, such as 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 spectral sensor 242. The feedback analyzer 612 can be configured to identify or classify the target structure into one of a plurality of structure categories or structure types, such as by using one or more of the target detector 246 or the target classifier 248. The laser controller 613 can be configured to determine the operating mode of the laser system 620, such as by using one or more of the target detector 246 or the target classifier 248. Figure 2 Similar discussed.

[0130] Light source 630 can generate electromagnetic radiation in the optical range from UV to IR. Table 2 below

[0131] The table presents examples of light sources 630 for use with the exemplary spectroscopy systems discussed herein.

[0132] Table 2: Light sources for spectroscopy systems

[0133]

[0134] In some examples, the feedback analyzer 612 can determine a distance 660 (eg, Figure 6 660 between the distal end of the optical path for receiving the reflected signal and transmitting the reflected signal back to the spectrometer 611 and the target structure 122. The distance 660 can be calculated using the spectral characteristics generated by the spectrometer 611, such as the reflection spectrum. If the distance 660 meets the condition, such as falling within the threshold (d th ) or falls within the specified laser emission range, the laser controller 613 can control the laser source 620 to transmit laser energy to the target structure 122. In an example, if the target structure 122 is identified as an 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 613 can generate a control signal to "lock" the laser source 620 (i.e., prevent the laser source 620 from firing). Information about the distance 660 and the target structure outside the range of the laser (d>d th ) is presented to the practitioner, who can then adjust the endoscope 510, such as repositioning the distal end of the laser cable 512 to move closer to the target. The distance 660 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 613 may generate a control signal to "unlock" the laser source 620, and the laser source 620 may aim at the target structure 122 and emit according to the laser operation mode (eg, power setting). Fig.10 An example of a method for calculating distance 660 from spectral data is discussed.

[0135] In some examples, the spectrometer 611 can be configured to generate spectral characteristics (e.g., a reflection spectrum) further using information about the geometry and positioning of an optical path configured to transmit electromagnetic radiation from a light source to a target. For example, the outer diameter of the laser cable 512 or the outer diameter of a separate optical path for transmitting a spectral signal reflected from a target to the spectrometer 611 or the angle at which the cable or optical path protrudes from the endoscope 510 can affect the intensity of the reflected signal. The outer diameter and / or the protrusion angle can be measured and provided to the spectrometer 611 to obtain the reflection spectral data. As described above, the spectral data, the measured outer diameter of the cable or optical path and the angle at which it protrudes, and / or the input signal from the endoscope image processor can be used to calculate the distance 660 between the target structure and the distal end of the cable.

[0136] FIG. 8A to FIG. 8C A laser therapy system 800 is shown, which includes an endoscope 810 with an integrated multi-fiber cable attachment and a surgical laser system, which includes a feedback-controlled laser therapy system 610 and a laser source 620. The multi-fiber cable attachment includes an optical path 816 for transmitting the spectral signal back to the spectrometer 611 and for transmitting the surface laser energy from the laser source 620 to the target structure. The laser controller 613 can control the timing of the laser emission so that the transmission of the spectral signal and the transmission of the laser energy can occur at different times. The multi-fiber cable attachment also includes a plurality of light source cables 814 embedded in the endoscope 810 and extending along the elongated body of the endoscope 810. By way of example and not limitation, Figure 8B Six light source cables 814 are shown distributed radially around the optical path 816, for example distributed circumferentially relative to the optical path 816 in a radial cross section of the elongated body of the endoscope. Figure 8BIn the example shown, the optical path 816 can be located substantially at the central longitudinal axis of the elongated body of the endoscope 810. Other numbers of light source cables and / or other locations of the light source cables relative to the optical path 816 can be used. For example, Figure 8C Two light source cables 814 are shown positioned radially at opposite sides of the optical path 816 .

[0137] The light source cable 814 can be coupled to the light source 630, as described above with reference to Figure 6 to Figure 7 Alternatively, the light source cable 814 may be coupled to a FIG. 5A to FIG. 5B The illumination light 514 is shown. Light from the endoscope light source, the illumination light 514 (e.g., one or more LEDs), or a remote light source 630, for example, external to the endoscope, can function to illuminate the target and generate a spectral signal reflected from the target surface, which can be collected for spectral analysis. The feedback analyzer 612 can determine the distance 660 between the distal end of the endoscope 810 and the target structure 122, such as Figure 6 to Figure 7 Similar to that shown.

[0138] Fig. 9 Laser therapy system 900 is shown as a variation of the illustrated laser therapy system 800. Instead of delivering laser energy through optical path 816, a separate surgical laser fiber cable 820 can be used to deliver surface laser energy from laser source 620 to the target structure. Optical path 816 is used as a dedicated spectroscopy signal cable for transmitting the spectroscopy signal back to spectrometer 611.

[0139] Fig.10 is a graph showing a calibration curve 1000 representing the relationship between the spectral reflection signal intensity of the feedback signal reflected from the target structure (e.g., the spectral signal reflected from the target structure in response to electromagnetic radiation) and the distance 660 between the distal end of the fiber cable and the target structure, e.g. Figures 6 to 9 When the target structure is irradiated by electromagnetic radiation at a specific wavelength (e.g., 450nm or 730nm), a calibration curve 1000 can be generated by measuring the intensity of the reflected light at different distances between the tissue and the distal end of the spectroscopic probe. By referring to the calibration curve, analysis of the spectroscopic signal allows a quick estimation of the distance.

[0140] An exemplary process for generating a calibration curve is as follows. First, a reference value for each distance may be calculated. The calibration curve itself cannot be used to identify the distance because the light reflection intensity depends on the reflectivity of the specimen, etc. An example of a reference value for eliminating the effect of the reflectivity of the specimen is as follows:

[0141] Reference value = dI / dx*1 / I(1)

[0142] During an in vivo surgical procedure, the operator can move the fiber optic cable or endoscope while continuously recording the spectral feedback until the reflectance spectrum of the target tissue component can be detected.

[0143] Reference Fig.10 , a first spectrum can be measured at a distance x1 where the reflected light intensity is I1. At this point, the actual value of x1 and the curve of the reflected signal intensity are unknown. Then, the fiber cable or the distal end of the endoscope (reflected light detector) can be continuously moved, 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 approximated as linear. At this point, 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:

[0144] Comparison value = δ(I2-I1) / δ(x2-x1)*1 / I1(2)

[0145] Then, search among the reference values ​​for a reference value that is identical to the comparison value. If only one reference value (x r ) is the same as the comparison value given in equation (2), then x r can be determined as the distance of x1. If there are two reference values ​​(x r1 , x r2 ), the cable or the distal end of the endoscope (reflected light detector) can be continuously moved, and the next reflected light intensity I3 corresponding to the distance x3 can be measured. x3 can be close to x2, so that the curve between x2 and x3 can be approximated as linear. At this time, the curves of x1, x2, x3 and the reflected signal intensity are unknown. A new comparison value can be calculated as follows using I1, I2, I3, δ(x2-x1) and δ(x3-x2).

[0146] Comparison value = δ(I3-I2) / δ(x3-x2)*1 / I2(3)

[0147] Then, search the reference values ​​for the value that matches x r1 +δ(x2-x1) and x r2 +δ(x2-x1) is the same as a reference value. The reference value can be compared with the comparison value given in equation (3). The distance at which the reference value is more similar to the comparison value is estimated as the actual distance.

[0148] During an in vivo surgical procedure, an example method may include moving a fiber optic cable or endoscope while continuously recording spectral feedback until a reflected light spectrum of a target component is detected. In most cases, as the distal end of the spectrum moves toward the target, the detected reflected light intensity will initially be weak and will increase as the distance between the target and the end of the fiber optic cable decreases. For example, a first spectrum is measured at a distance d1 where the reflected light intensity is I1. The distal end of the fiber optic cable or endoscope continues to move slightly toward the target and continues to collect reflection data, and the method may measure the next reflected light intensity I2 corresponding to the distance d2. The method may then include calculating a value for the slope of the reflected signal change = δ(I2-I1) / δ(d2-d1)[1]. In order to make the calculated slope value independent of the reflected light intensity, the calculated slope may be normalized. The final formula for calculating the slope of the reflected light at the measured distance becomes:

[0149] Slope (normalized) = [δ(I2-I1) / δ(d2-d1)] / I0(4)

[0150] Where: I0 = average value (I1, I2)

[0151] The method can then compare the calculated slope to the slope on the calibration curve in the library to allow an estimate of the required distance. All calculations can be done quickly using software.

[0152] Fig.11 1 is a flow chart showing a method 1100 for controlling a laser system to deliver a laser beam to a target structure in a subject's body, such as an anatomical structure (e.g., soft tissue, hard tissue, or abnormal tissue such as cancerous tissue) or a stone structure (e.g., a kidney stone or a pancreaticobiliary stone or a gallbladder stone). The method 1100 can be implemented in and performed by a laser therapy system, such as the laser therapy system 100 or a variant thereof, such as the laser feedback control system 200. Although the processes of the method 1100 are drawn in a flow chart, they need not be performed in a particular order. In various examples, some of the processes may be performed in an order different from that shown herein.

[0153] At 1110, a target in the subject's body is illuminated with electromagnetic radiation generated by a light source, such as light source 630. The light source can generate electromagnetic radiation in an optical range from UV to IR. Examples of light sources and corresponding wavelengths of electromagnetic radiation are shown in Table 2 above. The electromagnetic radiation can be transmitted to the target structure via an optical path extending along the elongated body of the endoscope, such as described above with reference to Figures 6 to 9Alternatively, the light source may include an illumination lamp, such as one or more LEDs of a visualization system, located at the distal end of the endoscope and configured to illuminate the target structure and the surrounding environment during endoscopic surgery, such as FIG. 5A to FIG. 5B shown.

[0154] At 1120, a signal reflected from the target in response to electromagnetic radiation can be sensed by a spectral sensor, for example, using spectral sensor 242 or a variation thereof. Examples of spectral sensors can include a Fourier transform infrared (FTIR) spectrometer, a Raman spectrometer, a UV-VIS spectrometer, a UV-VIS-IR spectrometer, or a fluorescence spectrometer. The reflected signal can be transmitted to the spectral sensor via an optical path, for example, Figure 2 The signal transmission path 250 shown in FIG. 8 or FIG. Fig. 9 The optical path 816 shown in FIG. 8 has optical properties suitable for transmitting the spectral signal reflected from the tissue to the spectral sensor. Alternatively, the spectral sensor can be operably coupled to a laser fiber cable for transmitting the laser beam, such as Figure 1 The first optical path 108 or the second optical fiber 118 shown, Figure 6 to Figure 7 The laser cable 512 shown or FIG. 8A to FIG. 8C Light path 816 is shown.

[0155] Additionally or alternatively, one or more imaging sensors may be used, such as Figure 2 The imaging sensor 244 shown is used to sense the reflected signal from the target in response to the electromagnetic radiation. Examples of imaging sensors may include imaging cameras, such as CCD or CMOS cameras that are sensitive to ultraviolet (UV), visible light (VIS), or infrared (IR) wavelengths in embodiments. The camera may be embedded in the endoscope, for example, camera 516 is incorporated into endoscope 510, as shown in Figures 5 to 6. Figure 7 shown.

[0156] At 1130, the Figure 2 The feedback analyzer 240 shown generates one or more spectral characteristics based on the sensed reflection signal. The spectral characteristics may include characteristics such as reflectivity, reflection spectrum, absorption index, etc. The spectral characteristics may indicate a structural category (e.g., anatomical tissue or calculus) or a specific structural type indicating the chemical composition of the target structure. In an example, the spectral characteristics may include a reflection spectrum representing the reflection intensity at multiple wavelengths. The reflectivity may be determined as a portion of the incident electromagnetic power reflected at the surface of the material. The reflectivity represents the effectiveness of the material surface in reflecting radiant energy, such as electromagnetic radiation emitted from a light source. The reflection spectrum may be formatted as a data array or a graphical representation also referred to as a spectral reflectance curve.

[0157] The spectral characteristics may include one or more characteristic spectral features extracted from a reference spectrum. Examples of characteristic reflectance features may include a reflectance intensity (or normalized reflectance spectral intensity) at a specific wavelength or within a wavelength range, a statistical value calculated from the reflectance spectrum (e.g., a change in reflectance at two or more different wavelengths, a rate of change of reflectance within a wavelength range, etc.), or a graphical feature representing the morphology of at least a portion of a spectral reflectance curve (e.g., a slope, a curvature, a segment of a curve, etc.).

[0158] In some examples, the spectral characteristics (e.g., a reflectance spectrum) can be further generated using geometric and positioning information about at least one optical path associated with the endoscope and configured to transmit one or more of a laser beam, a signal reflected from a target, or electromagnetic radiation generated by a light source. The geometric and positioning information can include an outer diameter of the at least one optical path and / or an angle of protrusion of a distal end of the at least one optical path relative to the endoscope.

[0159] At 1140, based on one or more spectral characteristics, the target structure can be identified as one of a plurality of structure types having respective components, for example using the feedback analyzer 240. In an example, the target structure can be identified as a category of stone structure or a category of anatomical structure, for example using the target detector 246. Examples of stone structures can include stones or stone fragments in various stone forming sites such as the urinary system, gallbladder, nasal cavity, gastrointestinal tract, stomach, or tonsils. Examples of anatomical structures can include soft tissue (e.g., muscle, tendon, ligament, blood vessel, fascia, skin, fat, and fibrous tissue), hard tissue such as bone, connective tissue such as cartilage, etc. As described above with reference to FIG. 3A to FIG. 3B As discussed, stone structures (e.g., kidney stones) and anatomical structures (e.g., soft tissue or hard tissue of a subject) may have different reflectance spectra. Spectral features extracted from the reflectance spectrum of a target structure can be used to classify the target structure as a stone structure or an anatomical structure (e.g., soft tissue or hard tissue), as described above with reference to Figure 2 and FIG. 3A to FIG. 3B As described.

[0160] Additionally or alternatively, the target structure may be classified as one of one or more tissue types in a plurality of stone types, for example using target classifier 248. FIG. 3A to FIG. 3BAs shown, different structural types (e.g., stone categories or anatomical structure categories) within the same category may exhibit different reflective characteristics. Such intra-category reflectance spectrum differences can be used to classify the target structure into a specific structural type, such as a specific tissue type within the identified anatomical structure category or a specific stone type within the identified stone structure category. Classification can be based on one or more of the reflectivity at a specific wavelength, the statistical characteristics of the reflectivity at two or more different wavelengths (e.g., variance or other variation metrics), or the graphical features generated according to the graphical representation of the reflectance spectrum. In an example, the identified stone target (e.g., kidney stone) can be classified as one of the stone types with different chemical compositions, such as one of CaP stones, MAP stones, COM stones, COD stones, cholesterol-based stones, or uric acid (UA) stones. In an example, the identified tissue target can be classified as one of the tissue types with different anatomical locations. For example, the renal tissue target can be classified as one of the calyceal tissue, cortical tissue, medullary tissue, or ureteral tissue. In another example, the identified tissue target can be classified as normal tissue or abnormal tissue (e.g., cancerous tissue). In yet another example, the identified tissue target can be classified as a treatment area (e.g., a tumor or polyp to be removed) or a non-treatment area (e.g., blood vessels, muscles, etc.). The spectral features extracted from the reflectance spectrum of the target structure can be used to classify the target structure as a specific stone type or a specific tissue type, as described above with reference to Figure 2 and FIG. 3A to FIG. 3B As described.

[0161] At 1150, a control signal may be generated, for example using the laser controller 260, to operate the laser system in an operating mode based on the identification of the target. The operating mode may include the delivery of a laser beam or the cessation of the delivery of a laser beam or a laser parameter setting for the laser system. In an example, if the target is identified as a stone structure, the laser system may operate in a first operating mode; if the target is identified as an anatomical structure, the laser system may operate in a second operating mode; or if the target is identified as neither an anatomical structure nor a stone structure, the laser system may operate in a third operating mode. In an example, the first operating mode may correspond to activating the laser system for delivering a laser beam programmed with a first irradiation parameter to ablate or pulverize an identified stone, such as a kidney stone. In an example, the second operating mode may correspond to cessation of delivering laser energy to the identified tissue or delivering a laser beam programmed with a second irradiation parameter setting different from the first irradiation parameter setting to treat the identified tissue. In an example, the third operating mode may correspond to causing the laser system to pause the delivery of laser energy. Examples of laser irradiation parameters may include wavelength, power, power density, pulse parameters (eg, pulse width, pulse rate, amplitude, duty cycle), exposure time, total dose or energy, and the like.

[0162] In some examples, irradiation parameter settings may be determined for a plurality of stone types and / or a plurality of tissue types, respectively. Stone type-irradiation parameter setting correspondences or tissue type-irradiation parameter setting correspondences may be created and stored in the memory 250, such as in a lookup table, an associative array, etc. The laser controller 260 may use one of such stored correspondences to determine the irradiation parameter setting corresponding to the classified stone type or the classified tissue type.

[0163] In some examples, determining the operating mode of the laser system can be further based on the distance 660 between the target structure and the distal end of the optical path, such as Figure 6 to Figure 7 The distance 660 between the distal end of the laser fiber cable 512 and the target structure 122 is shown or as shown in FIG. Fig. 9 The distance 660 between the distal end of the optical path 816 for receiving and transmitting the reflected signal and the target structure 122 is shown. The distance 660 can be calculated using spectral characteristics such as the reflection spectrum. Additionally, in some examples, the distance 660 can be calculated using the measured outer diameter of the fiber or optical path and the angle of its protrusion and / or the input signal from the endoscope image processor.

[0164] If the distance 660 satisfies a condition, such as falling below a threshold or falling within a specified laser emission range, the laser system may be controlled to deliver the laser beam to the target structure. In an example, if the target structure is identified as an intended treatment structure type (e.g., a specified soft tissue type or a specified stone type), but the target structure is not within the range of the laser (e.g., d>d th ), a control signal can be generated to "lock" the laser source and prevent the laser source from emitting toward the target. th ) can be presented to the practitioner, who can then adjust the endoscope, for example to reposition the distal end of the laser cable. The distance 660 and the target structure type can be continuously monitored 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 ), a control signal may be generated to "unlock" the laser source to aim at and emit a laser beam to the target structure according to the laser operating mode (e.g., power setting). The distance 660 may be calculated using a pre-generated calibration curve that represents the relationship between the spectral reflection signal intensity and the distance 660 between the distal end of the fiber cable and the target structure, as described above with reference to Fig.10 As described.

[0165] Fig.12 A block diagram of an example machine 1200 is generally shown on which any one or more of the techniques (e.g., methods) discussed herein may be performed. Portions of the present description may be applied to the computing framework of various portions of the laser therapy system 100 (e.g., the laser feedback control system 101), the laser feedback control system 200, or the control circuitry integrated into an endoscope, such as the endoscope 400.

[0166] In alternative embodiments, machine 1200 can operate as an independent device, or can be connected (e.g., networked) to other machines. In a networked deployment, machine 1200 can operate with the capabilities of a server machine, a client machine, or both in a server-client network environment. In an example, machine 1200 can act as a peer machine in a peer-to-peer (P2P) (or other distributed) network environment. Machine 1200 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 capable of (sequentially or otherwise) executing instructions specifying the action to be taken by the machine. In addition, although only a single machine is shown, the term "machine" should also be considered to include any collection of machines that execute a set (or multiple sets) of instructions individually or jointly to execute any one or more methods of the methods discussed herein, such as cloud computing, software as a service (SaaS), and other computer cluster configurations.

[0167] As described herein, examples may include logic or multiple components or mechanisms, or may be operated by logic or multiple components or mechanisms. A circuit set is a collection of circuits implemented in a tangible entity including hardware (e.g., simple circuits, gates, logic, etc.). Circuit set membership may be flexible over time and underlying hardware variability. A circuit set includes members that can perform specified operations individually or in combination when operating. In an example, the hardware of a circuit set may be immutably designed to perform a specific operation (e.g., hard wiring). In an example, the hardware of a circuit set may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) to encode instructions for a specific operation, and the variably connected physical components include a computer-readable medium that is physically modified (e.g., magnetically, electrically, removably placed particles of constant aggregation, etc.). When connecting physical components, the basic electrical properties of the hardware components are changed, for example, from an insulator to a conductor or from a conductor to an insulator. The instructions enable embedded hardware (e.g., an execution unit or a loading mechanism) to create members of a circuit set in hardware via variable connections to perform parts of a specified operation when operating. Thus, when the apparatus is operating, the computer-readable medium is communicatively coupled to other components of the circuit set members. In an example, any of the physical components may be used in more than one member of more than one circuit set. For example, in operation, an execution unit may be used in a first circuit of a first circuit set at one point in time and reused by a second circuit in the first circuit set or by a third circuit in the second circuit set at a different time.

[0168] The machine (e.g., computer system) 1200 may include a hardware processor 1202 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), a main memory 1204, and a static memory 1206, some or all of which may communicate with each other via an interconnection link (e.g., a bus) 1208. The machine 1200 may also include a display unit 1210 (e.g., a raster display, a vector display, a holographic display, etc.), an alphanumeric input device 1212 (e.g., a keyboard), and a user interface (UI) navigation device 1214 (e.g., a mouse). In an example, the display unit 1210, the input device 1212, and the UI navigation device 1214 may be a touch screen display. The machine 1200 may additionally include a storage device (e.g., a drive unit) 1216, a signal generating device 1218 (e.g., a speaker), a network interface device 1220, and one or more sensors 1221 such as a global positioning system (GPS) sensor, a compass, an accelerometer, or other sensors. The machine 1200 may include an output controller 1228, 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.).

[0169] The storage device 1216 may include a machine-readable medium 1222 having stored thereon one or more sets of data structures or instructions 1224 (e.g., software) that implement or are utilized by any one or more of the techniques or functions described herein. The instructions 1224 may also reside, in whole or in part, within the main memory 1204, within the static memory 1206, or within the hardware processor 1202 during execution of the instructions 1224 by the machine 1200. In an example, one or any combination of the hardware processor 1202, the main memory 1204, the static memory 1206, or the storage device 1216 may constitute a machine-readable medium.

[0170] Although the machine-readable medium 1222 is illustrated as a single medium, the term “machine-readable medium” may include a single medium or multiple media (eg, a centralized or distributed database and / or associated caches and servers) configured to store one or more instructions 1224 .

[0171] The term "machine-readable medium" may include any medium capable of storing, encoding, or carrying instructions for execution by the machine 1200 and causing the machine 1200 to perform any one or more of the techniques of the present disclosure, or capable of storing, encoding, or carrying data structures used by such instructions or data structures associated with such instructions. Non-limiting machine-readable medium examples 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 plurality of particles having a constant (e.g., stationary) mass. Therefore, the large-capacity machine-readable medium is not a transient propagation 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.

[0172] The instructions 1224 may also be sent or received over a communication network 1226 using a transmission medium via the network interface device 1220 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 communication 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 16 family of standards), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, etc. In an example, the network interface device 1220 may include one or more physical jacks (e.g., Ethernet jacks, coaxial jacks, or telephone jacks) or one or more antennas for connecting to the communication network 1226. In an example, the network interface device 1220 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 1200, and includes digital or analog communication signals or other intangible media to facilitate communication of such software.

[0173] According to the implementation methods including the above embodiments, the following technical solutions are also disclosed:

[0174] (1) An electrosurgical treatment system comprising:

[0175] an electrosurgical energy system configured to generate electrosurgical energy for delivery to a target in a body of a subject; and

[0176] A controller circuit, the controller circuit being configured to:

[0177] receiving a signal reflected from the target in response to electromagnetic radiation generated by a light source;

[0178] generating one or more spectral characteristics based on the received reflected signal;

[0179] identifying the target as one of a plurality of structural types having respective distinct compositions using the one or more spectral characteristics; and

[0180] An operating mode of the electrosurgical energy system is determined based on the identification of the target, the operating mode comprising delivery or cessation of delivery of the electrosurgical energy or energy parameter settings for the electrosurgical energy system.

[0181] (2) An electrosurgical treatment system according to (1), wherein the electrosurgical energy system includes a laser system configured to generate a laser beam for delivery to a target in the subject's body, and the energy parameter setting includes a laser parameter setting.

[0182] (3) The electrosurgical treatment system according to (2), wherein the controller circuit is configured to:

[0183] generating a reflection spectrum using the received reflection signal, the reflection spectrum representing reflection intensity at a plurality of wavelengths; and

[0184] Generating one or more spectral characteristics includes: extracting one or more spectral features from the reflection spectrum, the one or more spectral features including:

[0185] Reflection intensity at a specific wavelength;

[0186] The statistical characteristics of reflectivity at two or more different wavelengths; or

[0187] The graphical representation of the reflectance spectrum is graphically characteristic.

[0188] (4) The electrosurgical treatment system of (3), wherein the controller circuit is configured to: use the one or more spectral characteristics to identify the target as one of a stone structure or an anatomical structure.

[0189] (5) The electrosurgical treatment system according to any one of (3) to (4), wherein the controller circuit is configured to:

[0190] using the one or more spectral characteristics to classify the object into one of a plurality of stone types having respective different compositions;

[0191] adjusting laser parameter settings for the laser system based on the classified stone type of the target; and

[0192] A control signal for the laser system is generated according to the adjusted laser parameter settings to deliver a laser beam to a target of the classified stone type.

[0193] (6) The electrosurgical treatment system of (5), wherein the controller circuit is configured to classify the target as one of the kidney stone types, the kidney stone type including at least one of the following:

[0194] Calcium phosphate (CaP) stones;

[0195] Magnesium ammonium phosphate (MAP) stones;

[0196] Calcium oxalate monohydrate (COM) stones;

[0197] Cholesterol-based stones;

[0198] Calcium oxalate dihydrate (COD) stones; or

[0199] Uric acid (UA) stones.

[0200] (7) The electrosurgical treatment system according to any one of (3) to (6), wherein the controller circuit is configured to:

[0201] classifying the target into one of a plurality of tissue types using the one or more spectral characteristics; and

[0202] An operating mode of the laser system is determined based on the classified tissue type of the target.

[0203] (8) The electrosurgical treatment system of (7), wherein the controller circuit is configured to:

[0204] using the one or more spectral characteristics to classify the target as a treatment area or a non-treatment area; and

[0205] A control signal is generated for the laser system to deliver a laser beam to the treatment area and to stop delivery of the laser beam to the non-treatment area.

[0206] (9) The electrosurgical treatment system of (7), wherein the controller circuit is configured to:

[0207] classifying the target as normal tissue or cancerous tissue using the one or more spectral characteristics; and

[0208] A control signal is generated for the laser system to deliver a laser beam to a target of the classified cancerous tissue and to stop delivery of the laser beam if the target is classified as normal tissue.

[0209] (10) An electrosurgical treatment system according to any one of (1) to (9), wherein the controller circuit is configured to determine an operating mode of the electrosurgical energy system, and determining the operating mode of the electrosurgical energy system includes one of the following: if the target is identified as a stone structure, determining that the operating mode of the electrosurgical energy system is a first operating mode; if the target is identified as an anatomical structure, determining that the operating mode of the electrosurgical energy system is a second operating mode; or if the target is identified as neither an anatomical structure nor a stone structure, determining that the operating mode of the electrosurgical energy system is a third operating mode.

[0210] (11) An electrosurgical treatment system according to any one of (2) to (9), comprising an endoscope coupled to the laser system, the endoscope comprising the controller circuit and at least one optical path, the at least one optical path being configured to transmit one or more of the laser beam, the signal reflected from the target, or the electromagnetic radiation generated by the light source.

[0211] (12) The electrosurgical treatment system according to (11), wherein the controller circuit is further configured to:

[0212] using at least one of the one or more spectral characteristics to calculate a distance between the target and a distal end of the at least one optical path; and

[0213] If (1) the target is identified as a treatment structure type and (2) the calculated distance is within a specified laser firing range, an operating mode of the laser system is determined, the operating mode including delivering the laser beam to the target.

[0214] (13) An electrosurgical treatment system according to any one of (11) to (12), wherein the at least one optical path includes a first optical path, which is configured to: transmit a signal reflected from the target to a spectral sensor coupled to the controller circuit.

[0215] (14) The electrosurgical treatment system according to (13), wherein the first optical path is further configured to transmit the laser beam to the target.

[0216] (15) An electrosurgical treatment system according to any one of (13) to (14), wherein the first optical path is also configured to transmit the electromagnetic radiation from the light source to the target.

[0217] (16) An electrosurgical treatment system according to any one of (13) to (15), wherein the at least one optical path includes a second optical path separated from the first optical path, and the second optical path is configured to transmit the laser beam to the target.

[0218] (17) An electrosurgical treatment system according to any one of (11) to (16), wherein the controller circuit is configured to: further use information about the outer diameter of the at least one optical path to generate the one or more spectral characteristics.

[0219] (18) An electrosurgical treatment system according to any one of (11) to (17), wherein the controller circuit is configured to: further use information about the angle of protrusion of the distal end of the at least one optical path relative to the endoscope to generate the one or more spectral characteristics.

[0220] (19) An electrosurgical treatment system according to any one of (1) to (18), wherein the electromagnetic radiation generated by the light source includes one or more of the following:

[0221] Ultraviolet waves;

[0222] Visible light waves; or

[0223] Infrared waves.

[0224] (20) An electrosurgical treatment system according to any one of (1) to (19), wherein the control circuit is coupled to a spectral sensor, the spectral sensor being configured to sense a signal reflected from the target in response to electromagnetic radiation irradiating the target structure, the spectral sensor comprising one or more of the following:

[0225] Fourier transform infrared (FTIR) spectrometer;

[0226] Raman spectrometer;

[0227] UV-VIS spectrometer;

[0228] UV-VIS-IR spectrometer; or

[0229] Fluorescence spectrometer.

[0230] (21) An electrosurgical treatment system according to any one of (1) to (20), wherein the control circuit is coupled to an imaging sensor, and the imaging sensor is configured to: sense a signal reflected from the target in response to electromagnetic radiation irradiating the target structure.

[0231] (22) A method for controlling an electrosurgical energy system to deliver electrosurgical energy to a target in a body of a subject, the method comprising:

[0232] illuminating the target with electromagnetic radiation generated by a light source;

[0233] sensing, via a spectral sensor coupled to a controller circuit, a signal reflected from the target in response to the electromagnetic radiation;

[0234] generating, via the controller circuit, one or more spectral characteristics using the sensed reflected signal;

[0235] identifying, via the controller circuit, the target as one of a plurality of structural types having respective different compositions using the one or more spectral characteristics; and

[0236] Control signals are generated via the controller circuit to operate the electrosurgical energy system in an operating mode based on the identification of the target, the operating mode including delivery or cessation of delivery of the electrosurgical energy or energy parameter settings for the electrosurgical energy system.

[0237] (23) The method of (22), wherein the control signal is generated to operate the laser system in an operation mode based on the identification of the target, the operation mode including transmission or cessation of transmission of a laser beam or laser parameter setting for the laser system.

[0238] (24) The method of any one of (22) to (23), comprising generating a reflection spectrum using the sensed reflection signal, the reflection spectrum representing reflection intensity at multiple wavelengths, and wherein generating one or more spectral characteristics comprises extracting one or more spectral features from the reflection spectrum, the one or more spectral features comprising:

[0239] Reflection intensity at a specific wavelength;

[0240] The statistical characteristics of reflectivity at two or more different wavelengths; or

[0241] The graphical representation of the reflectance spectrum is graphically characteristic.

[0242] (25) The method according to (23), further comprising:

[0243] using the one or more spectral characteristics to classify the object into one of a plurality of stone types having respective different compositions;

[0244] adjusting laser parameter settings for the laser system based on the classified stone type of the target; and

[0245] A control signal for the laser system is generated according to the adjusted laser parameter settings to deliver a laser beam to a target of the classified stone type.

[0246] (26) The method according to any one of (23) to (24), further comprising:

[0247] classifying the target into one of a plurality of tissue types using the one or more spectral characteristics; and

[0248] An operating mode of the laser system is determined based on the classified tissue type of the target.

[0249] (27) The method according to (26), comprising:

[0250] using the one or more spectral characteristics to classify the target as a treatment area or a non-treatment area; and

[0251] A control signal is generated for the laser system to deliver a laser beam to the treatment area and to stop delivery of the laser beam to the non-treatment area.

[0252] (28) The method according to any one of (26) to (27), comprising:

[0253] classifying the target as normal tissue or cancerous tissue using the one or more spectral characteristics; and

[0254] A control signal is generated for the laser system to deliver a laser beam to a target of the classified cancerous tissue and to stop delivery of the laser beam if the target is classified as normal tissue.

[0255] (29) A method according to any one of (23) to (28), wherein determining the operating mode of the electrosurgical energy system comprises one of the following: if the target is identified as a stone structure, determining that the operating mode of the electrosurgical energy system is a first operating mode; if the target is identified as an anatomical structure, determining that the operating mode of the electrosurgical energy system is a second operating mode; or if the target is identified as neither an anatomical structure nor a stone structure, determining that the operating mode of the electrosurgical energy system is a third operating mode.

[0256] (30) The method according to any one of (23) to (29), further comprising:

[0257] using at least one of the one or more spectral characteristics to calculate a distance between the target and a distal end of an optical path associated with an endoscope; and

[0258] If (1) the target is identified as a treatment structure type and (2) the calculated distance is within a specified laser emission range, determining an operating mode of the laser system includes delivering the laser beam to the target.

[0259] (31) A method according to any one of (23) to (30), wherein generating the one or more spectral characteristics includes: using geometric shape and positioning information about at least one optical path, wherein the at least one optical path is associated with an endoscope and is configured to transmit one or more of the laser beam, the signal reflected from the target, or the electromagnetic radiation generated by the light source.

[0260] Therein, the geometric shape and positioning information includes at least one of an outer diameter of the at least one optical path or a protruding angle of a distal end of the at least one optical path relative to the endoscope.

[0261] (32) at least one non-transitory machine-readable storage medium comprising instructions that, when executed by one or more processors of a machine, cause the machine to perform operations comprising:

[0262] irradiating a target in a subject's body with electromagnetic radiation produced by a light source;

[0263] receiving a signal reflected from the target in response to the electromagnetic radiation;

[0264] using the reflected signal to generate one or more spectral characteristics;

[0265] Using the one or more spectral characteristics, identifying the target as one of a plurality of structural types having respective different compositions; and

[0266] Control signals are generated to operate the electrosurgical energy system in an operating mode based on the identification of the target, the operating mode comprising delivery or cessation of delivery of electrosurgical energy or energy parameter settings for the electrosurgical energy system.

[0267] (33) At least one non-transitory machine-readable storage medium according to (32), wherein the control signal is generated to operate the laser system in an operating mode based on the identification of the target, and the operating mode includes transmitting or stopping the transmission of a laser beam or setting laser parameters for the laser system.

[0268] (34) At least one non-transitory machine-readable storage medium according to any one of (32) to (33), wherein the instructions cause the machine to perform operations further comprising: using the received reflection signal to generate a reflection spectrum representing reflection intensity at multiple wavelengths, and

[0269] The operation of generating one or more spectral characteristics comprises extracting one or more spectral features from the reflection spectrum, wherein the one or more spectral features comprise:

[0270] Reflection intensity at a specific wavelength;

[0271] The statistical characteristics of reflectivity at two or more different wavelengths; or

[0272] The graphical representation of the reflectance spectrum is graphically characteristic.

[0273] (35) At least one non-transitory machine-readable storage medium according to any one of (32) to (34), wherein the operation of identifying the target as one of multiple structure types includes: using the one or more spectral characteristics to identify the target as a stone structure or an anatomical structure.

[0274] (36) At least one non-transitory machine-readable storage medium according to any one of (32) to (35), wherein the instructions cause the machine to perform operations further comprising:

[0275] using the one or more spectral characteristics to classify the object into one of a plurality of stone types having respective different compositions;

[0276] adjusting laser parameter settings for the electrosurgical energy system based on the classified stone type of the target; and

[0277] Control signals for the electrosurgical energy system are generated based on the adjusted laser parameter settings to deliver a laser beam to a target of the classified stone type.

[0278] (37) At least one non-transitory machine-readable storage medium according to any one of (32) to (36), wherein the instructions cause the machine to perform operations further comprising:

[0279] classifying the target into one of a plurality of tissue types using the one or more spectral characteristics; and

[0280] An operating mode of the laser system is determined based on the classified tissue type of the target.

[0281] (38) At least one non-transitory machine-readable storage medium according to any one of (32) to (37), wherein the instructions cause the machine to perform operations further comprising:

[0282] using at least one of the one or more spectral characteristics to calculate a distance between the target and a distal end of an optical path associated with an endoscope; and

[0283] If (1) the target is identified as a treatment structure type and (2) the calculated distance is within a specified laser firing range, an operating mode of the laser system is determined, the operating mode including delivering the laser beam to the target.

[0284] (39) At least one non-transitory machine-readable storage medium according to any one of (32) to (38), wherein the operation of generating the one or more spectral characteristics includes: using geometry and positioning information about at least one optical path associated with the endoscope and configured to transmit one or more of the laser beam, the signal reflected from the target, or the electromagnetic radiation generated by the light source,

[0285] Therein, the geometric shape and positioning information includes at least one of an outer diameter of the at least one optical path or a protruding angle of a distal end of the at least one optical path relative to the endoscope.

[0286] Additional Notes

[0287] The above detailed description includes reference to the accompanying drawings, which form a part of the detailed description. By way of illustration, the accompanying drawings show specific embodiments in which the present invention can be implemented. These embodiments are also referred to as "examples" in this article. Such examples may include elements other than those elements shown or described. However, the inventors also consider examples that only provide those elements shown or described. In addition, the inventors also consider examples using any combination or arrangement of these elements (or one or more aspects of these elements) shown or described with respect to a specific example (or one or more aspects of a specific example) or with respect to other examples (or one or more aspects of other examples) shown or described in this article.

[0288] In this document, as is common in patent documents, the terms "a" or "an" are used to include one or more than one, regardless of any other instances or uses 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 "including" and "in..." are used as the plain English equivalents of the respective terms "comprising" and "wherein". In addition, in the appended claims, the terms "including" and "comprising" are open-ended, that is, systems, devices, articles, compositions, formulations, or processes that include elements other than those listed after such terms in the claim are still considered to fall within the scope of the claim. In addition, in the appended claims, the terms "first", "second", and "third", etc. are used only as labels and are not intended to impose numerical requirements on their objects.

[0289] The above description is intended to be illustrative rather than restrictive. For example, the above examples (or one or more aspects of the above examples) can be used in combination with each other. For example, those of ordinary skill in the art can use other embodiments after consulting the above description. The abstract is provided to comply with 37C.FR§1.72(b) to allow readers to quickly determine the essence of the disclosure of the present technology. Submitting the abstract is based on the following understanding: 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. On the contrary, the subject matter of the invention may be less than all the features of a specific disclosed embodiment. Therefore, the attached claims are thus incorporated into the specific embodiments as examples or embodiments, wherein each claim exists independently as a separate embodiment, and it is expected that such embodiments can be combined with each other in various combinations or arrangements. The scope of the present invention should be determined with reference to the attached claims and the full range of equivalents to which such claims are given power.

Claims

1. A medical laser system, comprising: a laser source configured to generate laser energy and an optical fiber for directing the laser energy to a target; as well as A control circuit system is configured to: receiving a signal reflected from the target in response to electromagnetic radiation; generating a reflection signal parameter associated with the received reflection signal; generating a calibration curve indicating a relationship between a value of the reflected signal parameter and a corresponding fiber-to-target distance from a distal end of the optical fiber to an outer surface of the target; Determining the rate of change of the value of the reflection signal parameter at multiple optical fiber to target distances; determining whether the target is within a specific laser emission range based on a comparison between the determined rate of change and a generated calibration curve; as well as Based at least in part on a determination of whether the target is within the particular laser emission range, at least one of an output setting of the laser source or a position of the distal end of the optical fiber relative to the target is controllably adjusted.

2. The medical laser system of claim 1, wherein: The reflected signal parameters include one or more of the following: a spectral parameter associated with the spectral signature of the target; or Image parameters associated with the imaging signal of the target.

3. The medical laser system of claim 1, comprising a first optical fiber separate from the optical fiber used to direct the laser energy, the first optical fiber being configured to transmit the signal reflected from the target to the control circuitry.

4. The medical laser system of claim 3, wherein: The first optical fiber is also configured to transmit electromagnetic radiation from a light source to the target.

5. The medical laser system of claim 3, further comprising a second optical fiber separate from the first optical fiber and the optical fiber for directing the laser energy, the second optical fiber being configured to transmit electromagnetic radiation from the light source to the target.

6. The medical laser system of claim 3, wherein: The control circuitry is configured to further generate the reflection signal parameter using one or more of an outer diameter of the first optical fiber or a protrusion angle of a distal end of the first optical fiber.

7. The medical laser system of claim 1, wherein: The control circuitry is configured to determine a rate of change of the reflected signal parameter over a known change in fiber-to-target distance and to generate the calibration curve based on the determined rate of change of the reflected signal parameter normalized by the generated value of the reflected signal parameter.

8. The medical laser system of claim 1, wherein: The control circuitry is configured to adjust an output setting of the laser source based at least in part on a determination of whether the target is within the particular laser shot range, including: When the target is outside the specific laser emission range, the laser source is prevented from emitting laser energy to the target; or When the target is within the specific laser emission range, the laser source is enabled to emit laser energy toward the target.

9. The medical laser system of claim 1, wherein: The control circuit system is configured to adjust the distal end of the optical fiber relative to the target or prompt a user to adjust the distal end of the optical fiber relative to the target based at least in part on a determination of whether the target is within the particular laser emission range.

10. The medical laser system of claim 1, wherein: The control circuitry is configured to determine an identification of the target as one of a plurality of structure types based on the reflected signal parameters.

11. The medical laser system of claim 10, wherein: The control circuitry is configured to adjust an output setting of the laser source or a position of the distal end of the optical fiber based further on the identification of the target.

12. The medical laser system of claim 10, wherein: The control circuit system is configured to determine a laser output mode based at least in part on an identification of the target, the laser output mode comprising one of a first operating mode when the target is identified as a stone structure, a second operating mode when the target is identified as an anatomical structure, or a third operating mode when the target is identified as neither an anatomical structure nor a stone structure.

13. A method for operating a medical laser system to deliver laser energy to a target via an optical fiber, the method comprising: irradiating the target with electromagnetic radiation; sensing, using a sensor, a signal reflected from the target in response to the electromagnetic radiation; generating a reflection signal parameter based on the reflection signal using a control circuit system; generating a calibration curve indicating a relationship between a value of the reflected signal parameter and a corresponding fiber-to-target distance from a distal end of the optical fiber to an outer surface of the target; Determining the rate of change of the value of the reflection signal parameter at multiple optical fiber to target distances; determining whether the target is within a specific laser emission range based on a comparison between the determined rate of change and a generated calibration curve; as well as Based at least in part on the determination of whether the target is within the particular laser emission range, at least one of an output setting of a laser source or a position of a distal end of the optical fiber relative to the target is controllably adjusted.

14. The method according to claim 13, wherein: The reflected signal parameters include one or more of the following: a spectral parameter associated with the spectral signature of the target; or Image parameters associated with the imaging signal of the target.

15. The method according to claim 13, comprising: A signal reflected from the target is directed to the control circuitry via a first optical fiber separate from the optical fiber used to direct the laser energy.

16. The method according to claim 15, wherein: Generating the reflection signal parameters is also based on one or more of an outer diameter of the first optical fiber or a protrusion angle of a distal end of the first optical fiber.

17. The method according to claim 13, further comprising: Determining a rate of change of the reflected signal parameter over a known change in the distance from the optical fiber to the target; as well as The calibration curve is generated based on the determined rate of change of the reflection signal parameter normalized by the generated value of the reflection signal parameter.

18. The method according to claim 13, wherein: Controllably adjusting the output setting of the laser source includes: When the target is outside the specific laser emission range, the laser source is prevented from emitting laser energy to the target; or When the target is within the specific laser emission range, the laser source is enabled to emit laser energy toward the target.

19. The method according to claim 13, comprising: Based at least in part on the determination of whether the target is within the particular laser emission range, the distal end of the optical fiber is adjusted relative to the target or a user is prompted to adjust the distal end of the optical fiber relative to the target.

20. The method of claim 13, further comprising: determining an identification of the target as one of a plurality of structural types based on the reflection signal parameters, Wherein adjusting the output setting of the laser source or the position of the distal end of the optical fiber is further based on the identification of the target.

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