Lateral positioning and intensity varying laser fiber

Abstract

In some embodiments, a lithotripsy or other medical laser treatment system may include a lateral actuator that laterally displaces a distal portion of a laser fiber, the distal portion of the laser fiber can be scanned or otherwise controlled to generate a spatial or spatio-temporal sub-aiming pattern, for example, without moving an endoscope carrying the laser fiber laterally in a longitudinal channel, such as a working conduit. The target stone may be selectively weakened along the pattern, e.g., using a lower energy pulse, prior to fragmentation, e.g., by a higher energy impact pulse.

Description

[0001] This application is a divisional application of a Chinese patent application filed on February 7, 2022, with application number 202080056068.5 and invention title "Laser Optical Fiber with Lateral Positioning and Strength Variation". The international filing date of the corresponding PCT international application of the above-mentioned parent application is August 4, 2020, and the international application number is PCT / US2020 / 044858.

[0002] Cross - reference to related applications

[0003] This application claims the benefit of priority of U.S. Provisional Patent Application Serial No. 62 / 882,837 filed on August 5, 2019, U.S. Provisional Patent Application Serial No. 63 / 000,570 filed on March 27, 2020, and U.S. Provisional Patent Application Serial No. 63 / 027,007 filed on May 19, 2020, under 35 U.S.C.§119(e). The entire contents of these U.S. provisional patent applications are incorporated herein by reference. Technical field

[0004] This document generally relates to endoscopic laser systems, and more particularly to systems and methods for varying the lateral positioning of a laser optical fiber and the intensity of laser pulses. Background art

[0005] In laser lithotripsy, pulses of laser energy can be applied endoscopically via a laser optical fiber to a target such as a kidney, bile duct, gallbladder, or other stones, for example, to fragment the stones into various pieces. However, the various pieces produced will be scattered within the body. The pieces produced may be too large to dissolve or pass through the body naturally and may require a doctor to retrieve them, such as using a suction device, forceps, basket, or other retrieval device. Retrieving stone fragments can be very time - consuming and difficult. The presence and basic nature of any stone fragments produced may pose further challenges to the patient. Summary of the invention

[0006] This document further describes laser therapy systems, such as lithotripsy systems or other medical systems that may include a laser fiber, which can be configured to provide one or both of varying lateral positioning and varying laser pulse intensity. The distal end of the laser fiber can be scanned or otherwise actuated to change the lateral positioning of the laser fiber relative to, for example, the center or other reference longitudinal axis of the working lumen or other longitudinal channel of a rigid or flexible endoscope or other elongate medical device. In this way, the laser fiber can be repositioned at one or more of a variety of lateral positions without the need to move or reposition the endoscope. Laser pulses can be emitted at such different lateral positions. The intensity of such laser pulses can also be controlled to, for example, permit the emission of laser pulses of different intensities at different lateral positions. The lateral positioning or repositioning of the laser fiber, the variation of the laser pulse intensity, or both may be useful, for example, for delivering a sequence or pattern of laser energy to a kidney stone or other stone or other target. A pattern can be selected to help improve or optimize the way the target is treated - for example, the way a stone is fragmented. This can help reduce the size or migration of the resulting fragments of the fragmented kidney stone or other stone or other target. In turn, this can help reduce or avoid the need or complexity for a physician to retrieve any fragments.

[0007] A medical laser system is provided for delivering laser therapy to a target of a patient from different lateral positions perpendicular to a longitudinal channel of an endoscope. The medical laser system includes: a fiber optic cable including a distal portion configured to be inserted into the patient's body via the longitudinal channel of the endoscope; at least one actuator configured to controllably actuate the distal portion of the fiber optic cable to adjustably laterally position at least within the longitudinal channel; a laser source operably coupled to the fiber optic cable; and a controller circuit configured to: generate a first control signal to the at least one actuator to actuate a controlled movement of the fiber optic cable, including a lateral shift of the distal portion of the fiber optic cable within the longitudinal channel in a specified pattern; and generate a second control signal to the laser source to adjust a laser output directed to the target via the fiber optic cable laterally positioned according to the specified pattern, including delivering a first laser output toward a periphery of the target and delivering a second laser output different from the first laser output toward a center of the target.

[0008] Example 1 is a laser therapy system that allows delivery of laser energy from different lateral positions via an endoscope without the need for lateral repositioning of the endoscope. The laser therapy system includes: a laser fiber that includes a distal portion configured to be inserted into a patient's body via a longitudinal channel of the endoscope; and wherein the distal portion of the laser fiber can be actuated to be positioned at a selected position among a plurality of available lateral displacement positions that are at least laterally adjustable within and relative to the longitudinal channel of the endoscope within the longitudinal channel.

[0009] In Example 2, the subject matter of Example 1 optionally includes: wherein the distal portion of the laser fiber includes a bend.

[0010] In Example 3, the subject matter of Example 2 optionally includes: wherein the distal portion of the laser fiber can rotate around the longitudinal channel.

[0011] In Example 4, the subject matter of any one or more of Examples 1 to 3 optionally includes: wherein the laser fiber is configured to be coupled to a laser source that is controlled by a controller circuitry to provide a first laser pulse and a second laser pulse via the laser fiber, wherein the second laser pulse includes higher energy compared to the first laser pulse, and wherein the second pulse is emitted laterally closer to the center of the target compared to when the first laser pulse is emitted without the need for lateral repositioning of the endoscope.

[0012] In Example 5, the subject matter of any one or more of Examples 1 to 4 optionally includes at least one actuator configured to actuate the lateral displacement of the distal portion of the laser fiber in a specified pattern according to a control signal provided by the controller circuitry.

[0013] In Example 6, the subject matter of Example 5 optionally includes: wherein the distal portion of the laser fiber can also be actuated to be longitudinally translatable relative to the at least one actuator.

[0014] In Example 7, the subject matter of any one or more of Examples 5 to 6 optionally includes: wherein the at least one actuator includes: a first actuator configured to actuate the lateral displacement of the distal portion of the laser fiber; and a different second actuator configured to actuate the longitudinal translation of the laser fiber.

[0015] In Example 8, the subject matter of any one or more of Examples 5 to 7 optionally includes: wherein the controller circuitry is configured to generate a control signal for actuating the at least one actuator using a feedback signal in response to electromagnetic radiation of the target.

[0016] In Example 9, the subject matter of Example 8 optionally includes: wherein the feedback signal includes imaging data or spectral data.

[0017] In Example 10, the subject matter of any one or more of Examples 8-9 optionally includes: wherein the controller circuitry is configured to use information regarding the distance between the distal end of the laser fiber and the target to generate a control signal for actuating at least one actuator.

[0018] In Example 11, the subject matter of any one or more of Examples 1-10 optionally includes: wherein the distal portion of the laser fiber is at least one of the following: when actuated according to a control signal provided by the controller circuitry, can be actuated electromagnetically, electrostatically, or piezoelectrically to shift transversely within and relative to the longitudinal channel.

[0019] In Example 12, the subject matter of any one or more of Examples 1-11 optionally includes: wherein the laser fiber is coupled to a laser source that is controlled by the controller circuitry to provide a lateral pattern of lower energy laser pulses toward the periphery of the target and at least one higher energy laser pulse toward the center of the target without the need for lateral repositioning of the endoscope.

[0020] In Example 13, the subject matter of Example 12 optionally includes: wherein the lateral pattern includes at least one of a spiral pattern, a serpentine pattern, a star pattern, or a zigzag pattern.

[0021] In Example 14, the subject matter of any one or more of Examples 1-13 optionally includes: wherein the distal portion of the laser fiber can be actuated to be positioned at a selected one of a plurality of available lateral displacement positions within the longitudinal channel of the endoscope and at least transversely adjustable relative to the central longitudinal axis of the longitudinal channel.

[0022] In Example 15, the subject matter of any one or more of Examples 1-14 optionally includes: wherein the distal portion of the laser fiber can be actuated to be positioned at a selected one of a plurality of available lateral displacement positions within the longitudinal channel of the endoscope and at least transversely adjustable relative to the central longitudinal axis of the laser fiber.

[0023] In Example 16, the subject matter of any one or more of Examples 5-10 optionally includes: wherein at least one actuator is configured to: actuate the distal portion of the laser fiber to be positioned at a selected one of a plurality of available lateral displacement positions within the longitudinal channel of the endoscope and at least transversely adjustable relative to the longitudinal channel while keeping the endoscope laterally stationary.

[0024] In Example 17, the subject matter of Example 16 optionally includes: wherein at least one actuator is located at the distal portion of the laser fiber.

[0025] In Example 18, the subject matter of any one or more of Examples 16 to 17 optionally includes: wherein at least one actuator is located at a proximal portion of the laser fiber.

[0026] Example 19 is a method of laser therapy via an endoscope that allows for at least lateral reorientation of a laser beam relative to a target area without moving the endoscope. The method includes: providing a laser fiber configured to extend through a longitudinal channel of the endoscope; and emitting or receiving a control signal for actuating: positioning a distal portion of the laser fiber at a selected position among a plurality of available lateral displacement positions within the longitudinal channel of the endoscope at least laterally within the longitudinal channel of the endoscope.

[0027] In Example 20, the subject matter of Example 19 optionally includes: wherein the laser fiber is actuated by a controller to provide a first laser pulse and a second laser pulse via the laser fiber, and wherein the second laser pulse includes higher energy compared to the first laser pulse.

[0028] In Example 21, the subject matter of Example 20 optionally includes: wherein the second laser pulse is emitted when the distal portion of the laser fiber is relatively closer to the center of the target area compared to when the first laser pulse is emitted, without lateral repositioning of the endoscope.

[0029] In Example 22, the subject matter of any one or more of Examples 20 to 21 optionally includes: wherein the second laser pulse is emitted after a specified time interval when the first laser pulse is emitted, and wherein the first laser pulse is repeatedly emitted to uniformly apply the first laser pulse energy to the target area.

[0030] In Example 23, the subject matter of Example 22 optionally includes: wherein the first laser pulse is repeatedly emitted while being guided along a pattern boundary towards a lateral periphery of the target area, and wherein the second laser pulse is applied more laterally closer to the center of the target area.

[0031] In Example 24, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein the distal portion of the laser fiber is laterally displaced in a spiral pattern according to a control signal provided by a controller.

[0032] In Example 25, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein the distal portion of the laser fiber is laterally displaced in a serpentine pattern according to a control signal provided by a controller.

[0033] In Example 26, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein, the distal portion of the laser fiber is laterally displaced in a zigzag pattern according to a control signal provided by a controller.

[0034] In Example 27, the subject matter of any one or more of Examples 19 to 23 optionally includes: wherein, the distal portion of the laser fiber is laterally displaced in a star pattern according to a control signal provided by a controller.

[0035] In Example 28, the subject matter of any one or more of Examples 19 to 27 optionally includes using information about at least one of the morphology or constitution of at least a portion of a target area to select or control a target pattern including different target lateral positionings.

[0036] In Example 29, the subject matter of any one or more of Examples 19 to 28 optionally includes emitting or receiving a control signal for actuating the distal portion of the laser fiber to be laterally displaced in a specified pattern to emit one or more laser pulses toward the lateral periphery of a target area before emitting one of a plurality of laser pulses closer to the center of the target area.

[0037] Example 30 is a laser therapy system for laser therapy via an endoscope, which allows for at least laterally reorienting a laser beam toward a target without moving the endoscope. The system includes: a laser fiber configured to extend through a longitudinal channel of the endoscope; and a device for emitting or receiving a control signal for positioning the distal portion of the laser fiber at a selected one of a plurality of available laterally displaced positions within the longitudinal channel of the endoscope at least laterally.

[0038] In Example 31, the subject matter of Example 30 optionally includes: wherein, the laser fiber is coupled to a laser source controlled by a controller circuitry to provide a first laser pulse and a second laser pulse via the laser fiber, wherein, compared with the first laser pulse, the second laser pulse includes higher energy, and wherein, without laterally repositioning the endoscope, the second pulse is emitted laterally closer to the center of the target than when the first laser pulse is emitted.

[0039] This summary of the invention is an overview of some of the teachings of the present application and is not intended to be an exclusive or exhaustive treatment of the subject matter. Additional details regarding the subject matter are found in the detailed description and the appended claims. After reading and understanding the following detailed description and viewing the drawings forming a part thereof, other aspects of the present disclosure will be apparent to those skilled in the art, and each aspect should not be construed as limiting. The scope of the present disclosure is defined by the appended claims and their legal equivalents. BRIEF DESCRIPTION OF THE DRAWINGS

[0040] In the drawings which are not necessarily to scale, the same reference numerals may describe the same components in different views. The same reference numerals with different alphabetical suffixes may represent different instances of similar components.

[0041] Figure 1A A side cross-sectional view showing a part of the endoscopic system is shown.

[0042] Figure 1B An end view showing a lateral actuator and the end of a laser fiber is shown.

[0043] Figure 1C An end view showing a lateral actuator and a laser fiber with a stabilizer is shown.

[0044] Figure 1D A side cross-sectional view showing a part of the endoscopic system is shown.

[0045] Figures 1E to 1G Various examples of a side cross-sectional view showing a part of the endoscopic system are shown.

[0046] Figure 1H and Figure 1I An example of a system for controlling and adjusting the positioning of a laser fiber relative to the distal end of an endoscope using a feedback signal reflected from a target is shown.

[0047] Figure 2 A side cross-sectional view showing a part of the endoscopic system is shown.

[0048] Figure 3 A graph showing the use of different laser energies is shown.

[0049] Figures 4A to 4D Various examples of the changing space or spatio-temporal trajectory of a laser beam that can be laterally actuated, for example, without moving the endoscope, are shown. DETAILED DESCRIPTION

[0050] This document describes examples of methods that can help address the problem of controlling stone fragmentation during lithotripsy or other laser surgeries or treatments. For example, it can include the use of a laser fiber such as the one that can be actuated to be laterally positioned or repositioned, for example, relative to an arbitrary reference longitudinal axis of a working channel or other longitudinal passage of an endoscope or other instrument, without the need to move or reposition the endoscope or other instrument. This can allow multiple pulses or a pattern of multiple pulses to first rupture or otherwise prepare a target stone, for example, at different target locations, with different intensities, or both, and then use laser pulses transmitted later to fragment the stone at the desired location and intensity. This may help break the stone into small enough pieces to be naturally expelled from the body, thereby reducing, minimizing, or avoiding the need for doctor intervention to remove the fragments.

[0051] Figure 1A An example of a portion of an endoscope or similar medical system, such as an endoscopic laser lithotripsy system 100, is shown. In Figure 1A this example, the lithotripsy system 100 can include or be coupled to at least one laser source 130. The laser source 130 can be mechanically and optically connected to a laser fiber 140, which can include a single optical fiber or a bundle of optical fibers. The laser fiber 140 can be introduced via a proximal entry port 142 to extend within a working channel or other longitudinal passage 145 or lumen of the endoscope 110 or similar instrument. The endoscope 110 can include a proximal handle portion 112 and an elongated distal portion 113, which can be configured to be inserted into a patient's body, for example, via an orifice or incision. The endoscope 110 can be used to provide visual inspection or treatment of soft (e.g., non-calcified) tissue or hard (e.g., calcified) tissue, and to visualize or disintegrate or otherwise treat kidney stones or other stones or other targets.

[0052] In Figure 1A this example, the laser source 130 can include one or more laser sources, such as can include diode or diode-pumped thulium fiber lasers, holmium lasers, green lasers, YAG lasers, or other types of lasers. The laser source 130 can be configured to provide a laser output with variable energy intensity. For example, a lower energy intensity can be used, for example, to provide a "targeting" beam or for treating soft (e.g., non-calcified) tissue, and one or more higher energy intensities can be used, for example, to provide a "treatment" beam to hard (e.g., calcified) tissue or stones. Multiple levels of treatment beam with higher energy intensities can be provided, for example, on a pulse-by-pulse or target location-related basis, for example, to establish, adjust, or tune the desired treatment pulse energy intensity to a specified level.

[0053] InFigure 1A In this case, the endoscope 110 may include or provide visualization and illumination optics. For example, it may include a visualization optical path 160 and an illumination optical path 150. Each of the visualization optical path and the illumination optical path may longitudinally extend along the elongated body 113 of the endoscope 110, for example, from the proximal handle 112 portion of the endoscope 110 to the distal portion of the endoscope 110. An eyepiece or a camera device or an imaging display 115 may be disposed on or coupled to the visualization optical path 160, for example, at or near the proximal handle 112 portion of the endoscope. Such an eyepiece or a camera device or an imaging display may allow for user visualization or machine visualization of a target area 117 at or near the distal end of the endoscope 110. Such a target area 117 may be illuminated by light 170, which may be provided, for example, by an illumination light source 118 at the proximal end of the illumination optical path 150 and emitted from the distal end of the optical illumination path 150, or the light may be emitted, for example, from an LED or other illumination source that may be located at or near the distal end of the endoscope, and the LED or other illumination source may have an electrical conductor that longitudinally extends to supply power thereto.

[0054] In Figure 1A this case, the endoscope 110 may include an elongated distal body portion 113 having a certain length. The endoscope 110 may include a working conduit or a longitudinal channel 145 or other lumen that extends along its length. The endoscope 110 may be rigid (e.g., rigid when inserted into an area with tissue, and a rigid endoscope has sufficient columnar strength for insertion through a long tubular anatomical structure, etc.) or flexible (e.g., flexible such as to follow the contour of a curved anatomical area such as the ureter or biliary tract area). The working conduit or the longitudinal channel 145 or other lumen may define a reference longitudinal axis, such as a central longitudinal axis, that extends therethrough. When the distal portion 113 of the endoscope 110 is straight, the axis is straight, and when the distal portion 113 of the endoscope 110 is bent (e.g., in an implementation where the endoscope is flexible), the axis is bent. At the distal portion 113 of the endoscope 110, the central longitudinal axis may be defined as longitudinally extending through the working conduit or the longitudinal channel 145 or other lumen.

[0055] The method can include providing the ability to position or reposition the distal portion of the laser fiber 140 at least laterally relative to a longitudinal channel 145, such as relative to a reference longitudinal axis such as the central longitudinal axis of a working lumen or longitudinal channel 145 or other lumen through which the laser fiber 140 of the endoscope 110 extends. This can allow the user to observe the target area via the visualization optical path 160 and position the distal portion of the endoscope 110 within the longitudinal channel 145, where the target stone is in the field of view and is targeted by the laser fiber 140. Then, different lateral positions of the stone can be targeted, for example, by positioning or repositioning the distal portion of the laser fiber 140 at different locations within the working lumen or longitudinal channel 145 or other lumen through which the laser fiber 140 of the endoscope 110 extends. For example, this can allow the distal portion of the laser fiber 140 to be selectively positioned at a desired location, such as on a grid in the XY plane, which can be defined as extending orthogonally to the central longitudinal axis of the longitudinal channel 145 of the distal portion 113 of the endoscope 110.

[0056] For example, it can include an actuator 185, which can be located at or near the distal end of the endoscope, for example, to actuate the lateral positioning or repositioning of the distal portion of the laser fiber 140 within the longitudinal channel 145 of the distal portion 113 of the endoscope 110 and relative to that longitudinal channel 145. This can allow for scanning or other lateral adjustment of the targeting of the laser fiber 140 without the need to bend or laterally move the endoscope 110. The controller circuitry 120 can be in electrical communication with the actuator 185, for example, via an electrical communication bus 127, to remotely control the actuator 185, for example, to establish the lateral positioning of the laser fiber 140. The electrical communication bus 127 can include an electrical connection extending along the laser fiber 140 or an electrical connection extending within the distal portion 113 of the body of the endoscope 110 to connect to or make electrical contact with the actuator 185.

[0057] The actuator 185 can be controlled to position or reposition the distal portion of the laser fiber 140 within the longitudinal channel 145 of the distal portion 113 of the endoscope 110, for example, to allow the delivery of laser energy from different lateral positions via the endoscope 110 without the need to re-laterally position the endoscope 110. For the sake of conceptual clarity in illustration and explanation, such positioning or repositioning of the distal portion of the laser fiber 140 is described herein relative to a longitudinal reference axis, such as a central longitudinal axis or other reference longitudinal axis. However, such lateral positioning or repositioning of the distal portion of the laser fiber 140 by the actuator 185 can be relative to another suitable fixed reference position, including relative to an internal lateral dimension such as the inner diameter (I.D.) of the longitudinal channel 145 itself.

[0058] The actuator 185 can be operated to actuate the positioning or movement of the distal portion of the laser fiber 140, for example, to position the distal portion of the laser fiber 140 at a selected lateral position among a plurality of available lateral positions. The movement of the distal portion of the laser fiber 140 can be actuated and guided without the need to move the endoscope 110 or the laser source 130. By allowing the user to maintain visualization of the target area 117 at a given position or location of the endoscope 110 via the stationary visualization path 160, precise aiming, re-aiming, or both (e.g., by moving the distal portion of the laser fiber 140 longitudinally within and transversely relative to the longitudinal channel 145) through the distal portion of the laser fiber 140 can be accomplished together with facilitating user positioning and aiming.

[0059] The actuator 185 can be connected to or otherwise operatively coupled to one or both of the laser fiber 140 and the endoscope 110, for example, to actuate the lateral positioning of the distal portion of the laser fiber 140 within the longitudinal channel 145 or relative to the endoscope 110. For example, the actuator 185 can include one or more of an electromagnetic element, an electrostatic element, a piezoelectric element, or other actuation elements to, for example, actuate or otherwise allow the lateral positioning of the laser fiber 140 relative to the working lumen or other longitudinal channel 145 of the endoscope 110 or relative to another reference position that can serve as a reference frame for the endoscope 110.

[0060] For example, Figure 1B An end view of an example of a portion of the actuator 185 is shown, which portion can be located, for example, within the longitudinal channel 145 and which portion can have a circular outer diameter, for example. As Figure 1B shown, the actuator 185 can include at least one permanent magnet or electromagnet 190, which can be fixed, for example, to the distal portion of the laser fiber 140. One or more permanent magnets or electromagnets 190 can be affected by a magnetic field or electromagnetic field generated by the actuator 185. Such a magnetic field or electromagnetic field can be generated such that it actuates the positioning or repositioning of the distal portion of the laser fiber 140 at one of a plurality of laterally displaced positions (conceptually shown by the dashed X-Y grid in Figure 1B ). Such a magnetic field or electromagnetic field can be generated via at least one permanent magnet or electromagnet 191, which can be fixed, for example, at a desired position relative to the longitudinal channel 145, such as within the longitudinal channel 145 or within the body of the endoscope 110 at or near the outer diameter of the longitudinal channel 145. Such magnetic field or electromagnetic field effects can be used to laterally move the distal portion of the laser fiber 140 to a designated lateral position relative to a fixed reference frame of the endoscope 110 (e.g., relative to the longitudinal channel 145 of the endoscope 110).

[0061] Figure 1C An example of a portion of the actuator 185 is shown, in which such electromagnetic actuation of lateral movement or positioning can optionally be combined with and assisted by a mechanical stabilizer or positioning stage 192. For example, the mechanical stabilizer or positioning stage can include, for example, grooves or recesses that can help provide a plurality of well-defined stable lateral positions where the laser fiber 140 can "rest" when not electromagnetically positioned or repositioned by the actuator 185. For example, a series of linear grooves spaced at a well-specified distance in a stabilizer stage 192 in the shape of a semi-disk can define a series of available lateral positions where the laser fiber 140 (or the second engagement mechanism) can be mechanically stabilized and from which sub-targeted laser pulses can be emitted towards the target object. Such linear translation can be actuated by controlling the influence of linear-actuating permanent magnets or electromagnets 191A to 191B on the permanent magnet or electromagnet 190 (fixed to the laser fiber 140), where the linear-actuating permanent magnets or electromagnets 191A to 191B can be located, for example, at the ends of a linear arrangement on the stage 192 towards the available lateral positions. Rotational actuation of the mechanical stabilizer stage 192 by controlling the influence of one or more permanent magnets or electromagnets 194, which can be fixed to be distributed around the perimeter of the longitudinal channel 145, on one or more permanent magnets or electromagnets 193 fixed to the stage 192 can also provide rotational-plane lateral positioning to, for example, allow the laser fiber 140 to perform sub-targeting in polar coordinates without the need for lateral repositioning of the endoscope 110. The X-Y arrangement of grooves spaced at a well-defined specified distance in the stabilizer can similarly define a planar matrix of available lateral positions for planar lateral positioning and sub-targeting in Cartesian coordinates. Additionally, illustrative examples of the second engagement mechanism or the mechanical stabilizer or positioning stage 192 can include pawl or gear arrangements.

[0062] Additionally or alternatively, the actuator 185 can use attractive or repulsive electrostatic forces or both between the distal portion of the laser fiber 140 and a fixed reference frame provided by the endoscope 110 to, for example, laterally position or reposition the distal portion of the laser fiber 140 relative to such a fixed reference frame. As described herein, for example, such electrostatic actuation of lateral movement can optionally be combined with and assisted by a mechanical stabilizer or positioning stage 192.

[0063] Additionally or alternatively, the actuator 185 can use a piezoelectric material or a ferroelectric material to apply a force between the distal portion of the laser fiber 140 and the fixed reference frame provided by the endoscope 110 to, for example, laterally position or reposition the distal portion of the laser fiber 140 relative to such a fixed reference frame. As described herein, such lateral movement by piezoelectric actuation or ferroelectric actuation can optionally be combined with and assisted by a mechanical stabilizer or positioning stage 192. Optionally, the mechanical stabilizer or positioning stage 192 can be part of a mechanical lithotripsy device that can be included in or introduced into the endoscope 110 to, for example, deliver ultrasonic or other mechanical shock energy to a kidney stone or other stone or other target object. This can provide an additional lithotripsy modality that can provide the user with further flexibility to accomplish a particular task or objective related to the reduction or elimination or reshaping of the target object.

[0064] Generally, any actuator 185 capable of applying a force between the distal portion of the laser fiber 140 and the fixed reference frame provided by the endoscope 110 is considered alone or optionally in combination with a mechanical stabilizer or positioning stage. By configuring the actuator 185 to be remotely controlled, for example, via the control circuitry 120, such lateral positioning or repositioning of the distal portion of the laser fiber 140 can allow for multiple-position sub-aiming of a target object located near the distal end of the endoscope 110 or other instrument without the need to reposition such endoscope 110 or other instrument. This can be useful for the user to keep the target object in the field of view, and such sub-aiming can be used to deliver a desired spatio-temporal sequence or sequence of laser pulses at various desired positions of the target object, including customizing the energy level of one or more individual laser pulses. This can allow the user to deliver the desired energy to the desired location in a desired spatial or spatio-temporal sequence, which in turn can help determine how the target object will ultimately fragment. By doing so, one or more desired fragmentation characteristics can be encouraged or achieved. This can in turn mitigate post-fragmentation tasks or complications.

[0065] Actuator 185 can be operated as a scanner to direct the leading edge of laser fiber 140 to an angle or direction, for example, in accordance with an input voltage or other control signal. Actuator 185 can be controlled to direct the leading edge 141 of laser fiber 140 to emit laser beam pulses along a specified spatial or spatio-temporal pattern (without moving endoscope 110), and actuator 185 can include, for example, the ability to adjust the laser pulse energy intensity on a pulse-by-pulse basis at one or more such sub-aiming positions within the spatial or spatio-temporal pattern. In an example, the distance between such available sub-aiming positions can be equal to or greater than the diameter of laser fiber 140. In another example, the distance between such sub-aiming positions can be less than the diameter of laser fiber 140, which can, for example, allow for overlap of pulses delivered from adjacent sub-aiming positions among the plurality of available sub-aiming positions.

[0066] The laser source 130 can be configured to provide a varying laser output to a target object via a laser optical fiber 140. The varying laser output can include, for example, a low-energy continuous-wave laser output for aiming or an adjustable variable higher-energy pulsed laser output. In an example, the initial positioning of the endoscope 110 and the aiming performed using the laser source 130 can be used alone or in combination with other information. For example, such other information can be provided by the user via a user interface to establish one or more characteristics of a spatial or spatio-temporal pattern for sub-aiming at one or more positions of the target stone or object. For example, by using the aiming or alignment laser beam provided by the laser source 130, the user can select the center of the target stone or object. Such target positioning information can be recorded by the control circuitry 120 and can be used to initiate an appropriate spatial or spatio-temporal pattern for sub-aiming at one or more positions of the target stone or object, which sub-aiming can be at least partially based on the initial user aiming at the center of the target stone or object. Similarly, the user can use the aiming laser beam provided by the laser source 130 to select one or more positions on the periphery of the target stone or object as well as the target center, and the control circuitry 120 can record such information and use such information to establish an appropriate spatial or spatio-temporal pattern for sub-aiming at one or more positions of the target stone or object that can be at least partially based on such initial user aiming at the center and periphery of the target stone or object. Other user input information or pre-operative or intraoperative imaging information can be provided to the control circuitry 120 via, for example, one or more user interface devices or sensors, such as information about one or more characteristics of the target stone or object or the environment of the target stone or object. Such information can be used by the control circuitry 120 to select appropriate sub-targets of a spatial or spatio-temporal pattern, for example, based on such one-dimensional or multi-dimensional information. Such selection can be algorithmic in nature, for example, can involve weighting or mixing information or can use machine learning techniques or artificial intelligence techniques to select an appropriate spatial or spatio-temporal pattern for sub-aiming, for example, based on training data involving other target stones or objects or target environments that exhibit one or more similar characteristics.

[0067] Figure 1DAn example of system 100 is shown. System 100 may include an optical fiber 140, which may include a distal portion that may include, for example, an arcuate portion or other off-axis bend 143 or curve that may be oriented at an angle to the center or other longitudinal axis of endoscope 110. Bend 143 may be used alone or in combination with lateral positioning provided by actuator 185 to, for example, sub-aim at one or more positions within or even outside the range defined by the inner diameter (ID) of the working channel or other longitudinal passage 145 or other lumen through which laser fiber 140 of endoscope 110 extends. Additionally or alternatively, actuator 185 may optionally include rotational actuation capabilities to, for example, rotate the bent distal portion of laser fiber 140 for sub-aiming. Actuator 185 need not be located entirely at the distal portion of endoscope 110. Instead, a portion of actuator 185 may be located at the proximal handle 112 to, for example, rotate or vibrate laser fiber 140 to, for example, obtain the desired orientation of the bent or straight distal portion of laser fiber 140. Additionally or alternatively, actuator 185 may optionally include bending actuation capabilities to, for example, electromagnetically, electrostatically, piezoelectrically, or otherwise adjust the bend of the distal portion of laser fiber 140 for sub-aiming as explained herein. Additionally or alternatively, the sub-aimed position, the peripheral boundary of the sub-aiming, or both may be controlled by one or more of such rotational actuation, bending actuation, or lateral actuation. Such various actuations may be useful during laser aiming (e.g., continuous wave) or laser treatment (e.g., pulsed) as explained herein and do not require movement of endoscope 110 or laser source 130.

[0068] Figures 1E to 1G An example of system 100 is shown, where laser fiber 140 may be longitudinally axially translated to various positions relative to the distal end of endoscope 110. As Figure 1E and Figure 1FAs shown, such axial translation of the laser optical fiber 140 can include axial translation (e.g., sliding) longitudinally relative to the actuator 185. This can allow the actuator 185 to remain within the endoscope 110 to provide, for example, lateral positioning or repositioning of the laser optical fiber 140, while still allowing the laser optical fiber 140 to be repositioned freely axially, which can include, for example, the laser optical fiber protruding outward from the distal end of the working channel or other lumen of the endoscope 110, or can include, for example, retracting the laser optical fiber flush with the working channel or other longitudinal channel 145 or lumen of the endoscope 110, or being slightly pulled into the working channel or other longitudinal channel 145 or lumen of the endoscope 110. Regardless of the axial translation positioning of the distal face 141 of the laser optical fiber 140, the laser optical fiber 140 can still be laterally adjustably positioned relative to the longitudinal channel 145 of the endoscope 110 or other fixed reference frame. The lateral positioning of the distal portion of the laser optical fiber 140 can be selected from a plurality of available lateral positions (e.g., as shown by the dashed grid of Figure 1B ). The lateral movement of the laser optical fiber 140 can be performed without moving the endoscope 110 or the laser source 130. Figure 1E An example is shown in which the distal face 141 of the laser optical fiber 140 can be longitudinally translated and positioned to extend out of the endoscope 110 and into the body to, for example, complete positioning the laser optical fiber 140 at a desired treatment site.

[0069] In some examples, more than one actuator can be used to separately actuate and control different movements of the laser optical fiber 140. Figure 1G An example of a system 100 including two separate actuators in an endoscope is shown. In the example shown therein, a first actuator 185A can control the longitudinal axial translation of the laser optical fiber 140, and a different second actuator 185B can control the lateral positioning of the laser optical fiber 140.

[0070] Figure 1H and Figure 1I An example of a system 100 is shown that uses a feedback signal reflected from a target to control and adjust the position of the laser optical fiber 140 relative to the distal end of the endoscope 110. The feedback signal can be generated in response to electromagnetic radiation (e.g., light 170) from the target. In Figure 1HIn this case, the target is within the field of view of the endoscopic imaging device or imaging device 125 via the optical path 160. In response to the electromagnetic radiation of the target, the signal reflected from the target can be collected by the endoscopic imaging device or imaging device 125. The imaging data of the target can be transmitted to the feedback analyzer 182 via the optical path 160. The feedback analyzer 182 can include a spectrometer configured to generate one or more spectral characteristics based on the imaging data. The controller circuitry 120 can use the one or more spectral characteristics to adjust the laser settings of the laser source 130. The feedback analyzer 182 can additionally calculate the distance between the distal end of the laser fiber 140 and the target. The controller circuitry 120 can control the actuator 185 to adjust the positioning of the distal end of the fiber based on the calculated distance between the distal end of the laser fiber 140 and the target. For example, if the calculated distance exceeds the desired laser firing range (within a specified margin), the controller circuitry 120 can generate a control signal to control the actuator 185 to slide the laser fiber 140 towards the target until the distal end of the fiber reaches within the laser firing range relative to the target. In some examples, the spectral information of the target from the feedback analyzer 182 can be used by the controller circuitry 120 to determine the movement and positioning of the laser fiber 140 via the actuator 185.

[0071] In some examples, in addition to or instead of transmitting the imaging signal via the optical path 160, the signal reflected from the target can be collected and transmitted via a different optical path. In Figure 1I this case, the laser fiber 140 can be used to deliver the laser beam to the target and to transmit the spectral data of the target back to the feedback analyzer 182. The beam splitter 183 can direct the reflected feedback signal to the feedback analyzer 182. The feedback analyzer 182 can generate one or more spectral characteristics based on the spectral signal, and the controller circuitry 120 can use the one or more spectral characteristics to adjust the laser settings of the laser source 130. Similar to the discussion made above with reference to Figure 1H the feedback analyzer 182 can additionally calculate the distance between the distal end of the laser fiber 140 and the target. The controller circuitry 120 can control the actuator 185 to adjust the positioning of the distal end of the fiber based on the calculated distance optionally together with the spectral information of the target from the feedback analyzer 182.

[0072] Figure 2An example of a portion of system 200 similar to system 100 is shown, where the laser source 130 can include a combination of two laser sources. For example, the laser source 130 can include a treatment laser source 210 that can provide a treatment laser beam (e.g., pulsed, higher energy) and a targeting laser source 220 that can provide a targeting beam (e.g., continuous wave, lower energy). The treatment beam 210 can include laser pulses with adjustable or variable energy. For example, lower energy pulses can be used to first form cracks on the target surface of a stone or other target according to a desired or specified spatial pattern or spatio-temporal pattern. Then, one or more higher energy pulses can be used to fragment the stone or other target, which may be biased to fragment along the previously established cracks. By doing so, better control over the morphology of the resulting fragments can be achieved.

[0073] In an example, instead of or in addition to delivering laser pulses with adjustable or variable energy, the treatment beam can include laser energy that can be delivered at variable peak power. For example, instead of delivering laser energy with a specific pulse width and constant amplitude, the pulse width can be increased by a factor and the amplitude decreased by the same factor, such that the same amount of laser energy can be delivered at different power levels. Variable energy and variable power can be used together or separately in a sequence of laser pulses, which can be delivered to a target area according to a desired spatio-temporal pattern. For example, low peak power with a long pulse width can help evaporate organic or inorganic materials in the target stone (e.g., for calcium oxalate monohydrate crystals, delivering laser energy at a lower temperature can help the energy penetrate to a greater depth), to, for example, help accelerate the thermal degradation of the target stone. After delivering laser energy at a lower peak power (e.g., with a long pulse width), if needed, then laser energy can be delivered at a higher peak power and shorter pulse width to create a thermal gradient in the target stone.

[0074] Figure 3 A spatio-temporal diagram 300 showing a spatio-temporal sequence of laser pulses with different pulse energies or power levels is shown, which can include, for example, lower energy pulses 310 and higher energy laser pulses 320. In Figure 3In this case, the sequence represents time in the X direction of the image, but is also marked with positions "A" and "B" on the stone or other target. In this example, position "A" is at or near the center of the stone or other target, while position "B" is at or near the periphery of the stone or other target. Laser pulses emitted between positions "A" and "B" illustrate the pulses emitted as the laser fiber 140 is translated from position "A" to position "B" or as the laser fiber 140 is translated from position "B" to position "A" - which may include, for example, using actuator 185. Lower energy pulses 310 may be selected to create cracks in the target stone without fragmenting the target stone. Thus, in Figure 3 this case, such lower energy pulses 310 may be emitted starting from position "A" towards the center of the stone, then towards position "B" at the periphery of the stone, and then back towards position "A" at the center of the stone, at which point higher energy pulses 320 may be delivered in a first attempt to fragment the target stone. If such fragmentation by the higher energy pulses 320 is unsuccessful, additional lower energy pulses 310 may be delivered from the position towards the center of the stone towards position "B" at the periphery of the stone, and then back to position "A" at the center of the stone, at which point another higher energy pulse 320 may be delivered in a second attempt to fragment the target stone. Further iterations are possible. The same or different positions "B" at the periphery of the stone may be used for various iterations, where different positions "B" in different iterations create multiple cracks along such paths from position "A" to such different peripheral positions "B". Preferably, higher energy pulses 320 may be used only towards the center of the stone, for example, to minimize the impact of the higher energy pulses 320 on nearby tissue. Figure 3 The spatio-temporal pattern shown in

[0075] Figures 4A to 4D is an illustrative example of one such pattern that may be obtained, for example, using actuator 185, which may be remotely controlled using control circuitry 120 as explained above.

[0076] In Figure 4AIn [the described method], lower energy laser pulses can be emitted starting from the peripheral position "B" at the periphery of the target stone B, and such pulses can be applied along a helical path 400 towards the central position "A", at which higher energy pulses can be emitted when attempting to fragment a pre-fractured or pre-weakened target stone after treatment with the lower energy pulses. As explained herein, multiple iterations are feasible, and multiple iterations can also optionally change one or more of the energy or power levels, for example.

[0077] In Figure 4B [the described method], lower energy laser pulses can be emitted starting at the peripheral position "B", and can continue to be emitted along a meandering path 420. Higher energy laser pulses "A" can be applied at or near the central position "A" of the target stone either on the initial path or after the meandering path is completed. As explained herein, further iterations are feasible, and further iterations can, for example, start at or near the same or a different peripheral position "B", and further iterations can also optionally change one or more of the energy or power levels, for example.

[0078] In Figure 4C [the described method], lower energy laser pulses can be emitted starting at the peripheral position "B", and can continue to be emitted along a "star" path of linear segments that, for example, travels from the peripheral position "B" to the peripheral position "C" to the peripheral position "D" to the peripheral position "E" to the peripheral position "F" and back to the peripheral position "B". Then, higher energy laser pulses can be emitted and directed towards the central position "A".

[0079] In Figure 4D [the described method], lower energy laser pulses can be emitted starting at the peripheral position "B", and can travel through the target stone along a zigzag pattern 440. Then, higher energy laser pulses can be emitted and directed towards the central position "A". As explained herein, further iterations are feasible, and further iterations can, for example, start at or near the same or a different peripheral position "B", and further iterations can also optionally change one or more of the energy or power levels, for example.

[0080] The above description emphasizes use cases involving lithotripsy via endoscopic instruments. However, the present technology can also be applied using other minimally invasive instruments (e.g., laparoscopes, arthroscopes, etc.) or even using a guide in open surgery. This laser sub-aiming that does not require movement of the guiding device can also be used with medical treatment techniques other than lithotripsy, or can be used for laser surgery or other uses involving targeted delivery of laser energy. The targets can include not only kidney stones, gallstones, biliary stones, or other stones, but also bone or cartilage or other hard or soft tissues.

[0081] In an example of tissue ablation where the target includes tissue to be ablated or coagulated rather than a target stone, the desired spatio-temporal pattern can include, for example, delivering fixed or variable energy, fixed or variable power, or fixed or variable wavelength laser energy from one or more laser sources in a pulsating continuous wave or otherwise, to, for example, facilitate one or more of cutting or coagulation, or to balance or otherwise coordinate between these two or other objectives.

[0082] The detailed description above includes references to the drawings that form a part of the detailed description. The drawings illustrate, by way of example, specific embodiments in which the invention may be practiced. Such embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples that provide only those elements shown or described. Additionally, the inventors also contemplate examples that use any combination or arrangement of those elements (or aspects thereof) shown or described with respect to a particular example (or one or more aspects thereof) or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0083] If there is any inconsistency in the usage between this document and any document incorporated by reference, the usage in this document shall prevail.

[0084] In this document, the terms "a" or "an" are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of "at least one" or "one or more." In this document, unless otherwise specified, the term "or" is used to mean non-exclusive or, such that "A or B" includes "A but not B," "B but not A," and "A and B." In this document, the terms "including" and "in which" are used as simple English equivalents of the respective terms "comprising" and "wherein." Additionally, in the following claims, the terms "including" and "comprising" are open-ended, that is, a system, apparatus, article, composition, formulation, or process that includes elements in addition to those listed after such terms is still considered to fall within the scope of that claim. Further, 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.

[0085] The above description is intended to be illustrative and not restrictive. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. For instance, those of ordinary skill in the art may use other embodiments after reading the above description. The abstract is provided to enable the reader to quickly ascertain the nature of the technical disclosure. It is submitted on the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Additionally, in the above detailed description, various features may be combined to streamline the disclosure. This should not be construed as meaning that the disclosed features not claimed are essential to any of the claims. Rather, the inventive subject matter may not lie in all features of a particular disclosed embodiment. Thus, the appended claims are hereby incorporated into the detailed description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments may be combined with each other in various combinations or permutations. The scope of the present invention should be determined with reference to the appended claims and the full scope of equivalents to such claims.

Claims

1. A medical laser system for providing laser treatment to a target of a patient from different lateral positions perpendicular to a longitudinal channel of an endoscope, the medical laser system comprising: an optical fiber including a distal portion configured to be inserted into the patient's body via the longitudinal channel of the endoscope; at least one actuator configured to controllably actuate the distal portion of the optical fiber to adjustably laterally position the distal portion at least within the longitudinal channel; a laser source operably coupled to the optical fiber; and a controller circuit configured to: generate a first control signal to the at least one actuator to actuate a controlled movement of the optical fiber, including a lateral displacement of the distal portion of the optical fiber within the longitudinal channel in a specified pattern; and generate a second control signal to the laser source to adjust a laser output guided to the target via the optical fiber laterally positioned according to the specified pattern, including delivering a first laser output toward a periphery of the target and delivering a second laser output different from the first laser output toward a center of the target.

2. The medical laser system according to claim 1, wherein, Adjusting the laser output includes adjusting one or more of power, energy, wavelength, or laser emission mode.

3. The medical laser system according to claim 1, wherein, The first laser output includes laser pulses of a first energy level, and wherein the second laser output includes laser pulses of a second energy level higher than the first energy level.

4. The medical laser system according to claim 1, wherein, Adjusting the laser output guided to the target via the optical fiber laterally positioned according to the specified pattern includes creating a spatial pattern or a spatio-temporal pattern of laser emission on the target, the spatial pattern or the spatio-temporal pattern covering the periphery and the center of the target.

5. The medical laser system according to claim 4, wherein, The spatial pattern or the spatio-temporal pattern includes one or more of a spiral pattern, a serpentine pattern, a star pattern, or a zigzag pattern.

6. The medical laser system according to claim 1, wherein, The laser source is configured to adjust the laser output to fragment different portions of a stone target.

7. The medical laser system according to claim 1, wherein, The laser source is configured to adjust the laser output to ablate different portions of a soft tissue target.

8. The medical laser system according to claim 1, wherein, The first control signal is further configured to actuate the at least one actuator to adjustably position the distal portion of the optical fiber at a selected position among a plurality of laterally displaced positions within the longitudinal channel.

9. The medical laser system according to claim 8, including a stabilizer stage within the longitudinal channel, the stabilizer stage including a plurality of grooves or recesses at the plurality of laterally displaced positions, each groove or recess being shaped to receive and stabilize the distal portion of the optical fiber after the distal portion of the optical fiber is positioned by the at least one actuator.

10. The medical laser system according to claim 8, wherein, The lateral displacement and adjustable positioning of the distal portion of the optical fiber includes moving and positioning the distal portion of the optical fiber at a selected position of a two-dimensional grid of laterally displaced positions on a plane perpendicular to a central longitudinal axis of the longitudinal channel.

11. The medical laser system according to claim 1, wherein, The controlled movement of the optical fiber further includes a longitudinal translation of the distal portion of the optical fiber relative to the at least one actuator.

12. The medical laser system according to claim 1, wherein, The controlled movement of the optical fiber further includes a rotation of the distal portion of the optical fiber about the longitudinal channel.

13. The medical laser system according to claim 1, wherein, The distal portion of the optical fiber includes an arcuate portion that is angularly oriented with respect to the central axis of the longitudinal channel, and controlled movement of the optical fiber causes the arcuate portion to sub-aim at a position different from the plurality of laterally displaced positions within the longitudinal channel.

14. The medical laser system according to claim 1, wherein, The controller circuit is configured to: measure the distance between the distal end of the optical fiber and the target; and generate at least one of the first control signal for regulating the controlled movement of the optical fiber or the second control signal for regulating the laser output directed to the target, at least in part based on the measured distance.

15. The medical laser system according to claim 1, wherein, The controller circuit is configured to: receive a feedback signal in response to optical or electromagnetic radiation of the target; and generate at least one of the first control signal for regulating the controlled movement of the optical fiber or the second control signal for regulating the laser output directed to the target, at least in part based on the received feedback signal.

16. The medical laser system according to claim 15, wherein, The controller circuit is configured to: determine the nature of the target based on the received feedback signal, the nature of the target including at least one of at least a portion of the morphology or constitution of the target; and generate at least one of the first control signal or the second control signal at least in part based on the determined nature.

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