Tissue protection systems and methods

Abstract

A probe configured to deliver energy to a first tissue is placed in the first tissue, and an imaging device is configured to image a second tissue with the probe placed in the first tissue. Image data from the second tissue is processed to assess the impact of the energy source on the second tissue. In some embodiments, image data from the second tissue is used to adjust energy to the first tissue, for example by increasing or decreasing energy to the second tissue. In some embodiments, the placement of the probe in the first tissue is evaluated using image data from the first tissue or the second tissue or force sensor data from the probe, and the placement of the probe in the first tissue is adjusted to reduce tissue changes in the second tissue associated with the placement of the probe in the first tissue.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of the filing date of U.S. patent application No. 18 / 163,164, filed on February 1, 2023, which is incorporated herein by this reference in its entirety. Background Art

[0002] Existing methods of using energy sources to remove tissue may be less than ideal in at least some respects. Work related to the present disclosure has shown that existing methods of using an energy source to treat a first tissue may have undesirable effects on a second tissue. For example, while some types of energy may be effective in treating the first tissue, the energy used to treat the first tissue may have incidental effects on the second tissue, which may at least partially reduce the function of the second tissue. Furthermore, in some cases, treatment of tissue of a first organ may have incidental effects on the second organ.

[0003] This collateral effect can occur in many ways, such as an unexpected amount of energy or a less-than-ideal alignment of the probe with the tissue structure. Probes can be used to treat many types of tissues and organs, and work related to the present disclosure has shown that misalignment of the probe may result in unexpected effects on tissues spaced apart from the probe. Moreover, if the tissue being treated reacts in an unpredictable manner, then in at least some cases, there is a possibility that the energy source may have a collateral effect on a second tissue. For example, in the case of prostate tissue surgery, the verumontanum and trigone area are tissue structures that may potentially be altered during surgery, with undesirable consequences in at least some cases. The trigone area is sensitive to stretching and transmits signals to the brain to empty the bladder. However, damage to the trigone area may produce a sensation that the bladder should be emptied, even when this is not the case, which may cause discomfort to the patient in some cases. The verumontanum of the prostate is associated with sexual function, and in at least some cases, damage to the verumontanum may result in reduced sexual function in men.

[0004] In view of the foregoing, it would be desirable to have improved surgical systems and methods that ameliorate at least some of the above-mentioned limitations of the prior art. Summary of the Invention

[0005] The presently disclosed systems and methods provide for improved treatment of tissue with an energy source while reducing potential undesired effects on other tissue. In some embodiments, a probe is configured to deliver energy to a first tissue, and an imaging device is configured to image a second tissue. Image data from the second tissue is processed to assess the effect of the energy source on the second tissue. In some embodiments, the image data from the second tissue is used to adjust the energy to the first tissue, for example, by increasing or decreasing the energy to the second tissue. In some embodiments, the image data from one or more of the first tissue or the second tissue is used to assess the placement of the probe in the first tissue, and the placement of the probe in the first tissue is adjusted to reduce tissue changes in the second tissue related to the placement of the probe in the first tissue. In some embodiments, the probe is coupled to a force sensor to measure the pull of the tissue on the probe, which can reduce potential undesired effects on the second tissue.

[0006] Incorporated by Reference All patents, applications, and publications mentioned and identified in this manifestly incorporated by reference in their entirety, and should be considered fully incorporated herein even if not otherwise specifically referred to in the text. BRIEF DESCRIPTION OF DRAWINGS

[0007] A better understanding of the features, advantages, and principles of the present disclosure will be obtained by reference to the following detailed description and drawings that sets forth illustrative embodiments, in which: Figure 1 A front view of a system for performing tissue resection in a patient is shown in accordance with some embodiments of the present disclosure; Figure 2 A system for performing tissue resection in a patient is schematically illustrated in accordance with some embodiments; Figure 3A A top view of a probe arrangement is shown in accordance with some embodiments; Figure 3B A longitudinal view, such as a sagittal view, of a probe arrangement is shown in accordance with some embodiments; Figure 3C A perspective view of a probe arrangement is shown in accordance with some embodiments; Figure 4 Treatment of a patient is shown in accordance with some embodiments; Figure 5 A probe placed in a first tissue and a response of a second tissue to the probe placed in the first tissue is shown in accordance with some embodiments; Figure 6 An image of a treatment probe with identifiable tissue structures is shown in accordance with some embodiments, which image can be processed to determine the location and positioning of the tissue structures; Figure 7An image of a patient shown on a display during treatment is shown identifying tissue structures according to some embodiments; Figure 8 An arm coupled to a probe having sensors configured to measure pulling of the probe by tissue in response to placement of the probe is shown according to some embodiments; Figures 9A to 9C A user interface screen of a system having one or more transverse images of tissue and a treatment contour is shown; Figure 10 A user interface screen of a system having a longitudinal image (such as a sagittal image) of tissue and a treatment contour is shown according to some embodiments; Figure 11 A method of treating a first tissue and adjusting treatment based on a response of a second tissue to treatment of the first tissue is shown according to some embodiments; Figure 12 A method of adjusting a probe placed in a first tissue in response to stretching of a second tissue is shown according to some embodiments; Figure 13 A method of measuring a force related to pulling of a probe by tissue and adjusting the probe in response to the pulling of the probe by the tissue is shown according to some embodiments; and Figure 14 A two-dimensional convolutional neural network is shown according to some embodiments. DETAILED DESCRIPTION

[0008] The following detailed description provides a better understanding of the features and advantages of the application described in the present disclosure according to embodiments disclosed herein. Although the detailed description includes many specific embodiments, these embodiments are provided by way of example only and should not be construed as limiting the scope of the application disclosed herein.

[0009] The presently disclosed systems and methods are well-suited for use with a variety of probes and diagnostic and surgical procedures. Although reference is made to therapeutic probes, including energy sources, and transrectal ultrasound ("TRUS") probes for use in prostate surgery, the present disclosure is well-suited for use with probes inserted into many types of tissues, organs, cavities, and lumens (e.g., brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ears, nose, mouth, tumors, cancers, soft tissues (e.g., bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord, and neural tissue), cartilage, hard biological tissues (e.g., teeth, bones), and lumens (e.g., Such as vascular lumens, nasal lumens and nasal cavities, sinuses, colon, urethra lumens, gastric lumens, airways, esophageal lumens, transesophageal, intestinal lumens, anal lumens, vaginal lumens, transabdominal, abdominal cavity, throat, airway, lung passage)) many types of probes; and surgeries, such as kidney surgery, ureteral surgery, kidney stone surgery, prostate surgery, tumor surgery, cancer surgery, brain surgery, heart surgery, eye surgery, conjunctival surgery, liver surgery, gallbladder surgery, bladder surgery, spinal surgery, orthopedic surgery, arthroscopic surgery, liposuction, colonoscopy, intubation, minimally invasive incision, minimally invasive surgery, etc.

[0010] The presently disclosed systems and methods are well suited for combination with existing probes, such as imaging and therapeutic probes. For example, examples of such probes include laser therapy probes, water jet probes, RF therapy probes, radiotherapy probes, ultrasound therapy probes, phacoemulsification probes, imaging probes, endoscopic probes, resectoscope probes, ultrasound imaging probes, A-scan ultrasound probes, B-scan ultrasound probes, 3D ultrasound probes, Doppler ultrasound probes, transrectal ultrasound probes, transvaginal ultrasound probes, longitudinal plane ultrasound imaging probes, sagittal plane ultrasound imaging probes, transverse plane ultrasound imaging probes, and transverse and longitudinal plane (e.g., sagittal plane) ultrasound imaging probes.

[0011] One or more images described herein can be generated in a number of ways and can include one or more of longitudinal images, sagittal images, parasagittal images, or transverse images. In some embodiments, longitudinal images include images generated with an elongate imaging probe, where the longitudinal images extend along a plane corresponding to an elongate axis of the imaging probe, and transverse images extend along a plane transverse to the elongate axis of the probe (e.g., substantially perpendicular to the elongate axis of the probe and the corresponding longitudinal images). The elongate probe can be inserted into a patient in any suitable orientation. In some embodiments, the probe is inserted into the patient substantially along the patient’s midline, such that the longitudinal images correspond to sagittal images of the patient. In some embodiments, the elongate imaging probe includes a TRUS probe, and the longitudinal images include sagittal images, although other probes with different orientations can be used to generate images in accordance with the present disclosure. Although reference is made to an ultrasound probe inserted into a patient, in some embodiments the imaging device includes an external imaging probe, where the longitudinal images and transverse images can refer to one or more arrays of the external imaging probe. In some embodiments, one or more images are generated from a 3D tomographic image dataset, such as a Digital Imaging and Communications in Medicine (DICOM) image dataset.

[0012] The presently disclosed systems, methods, and devices are well suited for combination with many prior surgical procedures such as waterjet prostate enucleation, transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HOLEP), prostate brachytherapy, as well as with surgical robotic systems and automated surgical procedures. The following patent applications describe examples of systems, methods, probes, and procedures suitable for incorporation in accordance with the present disclosure: PCT / US 2013 / 028441, filed February 28, 2013, entitled AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT, published as WO 2013 / 130895; PCT / US 2014 / 054412, filed September 5, 2014, entitled AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT, published as WO 2015 / 035249; PCT / US 2015 / 048695, filed September 5, 2015, entitled PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF TARGET ORGAN IMAGES, published as WO 2016037137; PCT / US 2019 / 038574, filed June 21, 2019, entitled ARTIFICIAL INTELLIGENCE FOR ROBOTIC SURGERY, published as WO 2019246580 Al on December 26, 2019; PCT / US 2020 / 021756, filed March 9, 2020, entitled ROBOTIC ARMS AND METHODS FOR TISSUE RESECTION AND IMAGING, published as WO / 2020 / 181290; PCT / US 2020 / 058884, filed November 4, 2020, entitled SURGICAL PROBES FOR TISSUE RESECTION WITH ROBOTIC ARMS, published as WO / 2021 / 096741;PCT / US2021 / 070760, filed on June 23, 2021, entitled “INTEGRATION OF ROBOTIC ARMS WITH SURGICAL PROBES,” published as WO / 2021 / 263276; and PCT / US2021 / 038175, filed on June 21, 2021, entitled “SYSTEMS AND METHODS FOR DEFINING AND MODIFYING RANGE OF MOTION OF PROBE USED IN PATIENT TREATMENT,” published as WO / 2021 / 262565; the entire disclosures of these patent applications are incorporated herein by reference.

[0013] In some embodiments, the placement of the energy source provides improved position accuracy. The energy source can include any suitable energy source, such as one or more of the following: an electrode, a ring electrode, a laser source, a thermal energy source, a mechanical energy source, a mechanical shear, an ultrasonic probe, a cavitation ultrasonic probe, a water jet (e.g., a fixed pressure water jet), a plasma source, a steam source, a pulverizer, a transurethral needle, a photoablation source, a radiation energy source, a microwave energy source, or a water jet evacuation source. The energy source can be combined with other treatments and compounds (e.g., photochemotherapeutic agents). For example, the imaging probe can include any suitable probe, such as an endoscopic probe, a resection mirror probe, an ultrasonic imaging probe, an A-scan ultrasonic probe, a B-scan ultrasonic probe, a Doppler ultrasonic probe, a transrectal ultrasonic probe, a transvaginal ultrasonic probe, a sagittal plane ultrasonic imaging probe, a transverse plane ultrasonic imaging probe, and a transverse plane and sagittal plane ultrasonic imaging probe.

[0014] Figure 1An exemplary embodiment of a system 400 for performing a treatment on a patient is shown. The system 400 can include a treatment probe 450 as described herein and an imaging probe 460 as described herein. The treatment probe 450 can be coupled to a first arm 442 and the imaging probe 460 is coupled to a second arm 444. One or both of the first arm 442 and the second arm 444 can include a robotic arm, movement of which can be controlled by one or more computing devices operably coupled to the arms. The treatment probe 450 can include a device for removing target tissue from a target site within a patient. The treatment probe 450 can be configured to deliver energy from the treatment probe 450 to the target tissue sufficient to remove the target tissue, and the energy source can include any suitable energy source as described herein. For example, the treatment probe 450 can include an electrosurgical ablation device, a laser ablation device, a transurethral needle ablation device, a water jet ablation device, a steam ablation device, a high intensity focused ultrasound (HIFU) device, or any combination thereof. The imaging probe 460 can be configured to deliver energy from the imaging probe 460 to the target tissue sufficient to image the target tissue. For example, the imaging probe 460 can include an ultrasound probe, a magnetic resonance probe, an endoscope, or a fluoroscopy probe. The first arm 442 and the second arm 444 can be configured to be independently adjustable, adjustable according to a fixed relationship, adjustable according to a user-selected relationship, independently lockable, or simultaneously lockable, or any combination thereof. The first arm 442 and the second arm 444 can have multiple degrees of freedom (e.g., six degrees of freedom) to manipulate the treatment probe 450 and the imaging probe 460, respectively. The treatment system 400 can be used to perform tissue resection in an organ of a patient, such as a prostate of a patient. The patient can be positioned on a patient support 449, such as a bed, table, chair, or platform. The treatment probe 450 can be inserted into a target site of the patient along an entry axis coinciding with an elongate axis 451 of the treatment probe. For example, the treatment probe 450 can be configured for insertion into a urethra of the patient so as to position an energy delivery region of the treatment probe within a prostate of the patient. The imaging probe 460 can be inserted into the patient at a site at or adjacent to the target site of the patient along an entry axis coinciding with an elongate axis 461 of the imaging probe. For example, the imaging probe 460 can include a transrectal ultrasound (TRUS) probe configured for insertion into a rectum of the patient to view the prostate and surrounding tissue of the patient. As Figure 1As shown, the first arm 442 and the second arm 444 can be covered in a sterile drape to provide a sterile operating environment, keep the robotic arms clean, and reduce the risk of damage to the robotic arms. Further details about various components of the system 400 suitable for use in conjunction with embodiments disclosed herein can be found in U.S. Patent No. 7,882,841, U.S. Patent No. 8,814,921, U.S. Patent No. 9,364,251, and PCT Publication No. WO 2013 / 130895, the entire disclosures of which are incorporated herein by reference.

[0015] Figure 2 An embodiment of a system 400 for performing tissue resection within a patient is schematically illustrated. System 400 may include a treatment probe 450 as described herein and may optionally include an imaging probe 460. Treatment probe 450 is coupled to console 420 and coupling mechanism 430. Coupling mechanism 430 may include one or more components of a robotic arm 442. Imaging probe 460 is coupled to imaging console 490. For example, the imaging probe may be coupled to second robotic arm 444. Patient treatment probe 450 and imaging probe 460 may be coupled to a common base 440. The patient is supported by a patient support 449. Treatment probe 450 is coupled to base 440 via a first arm 442. Imaging probe 460 is coupled to base 440 via a second arm 444. One or both of first arm 442 and second arm 444 may include robotic arms, the movement of which may be controlled by one or more computing devices operably coupled to the arms, as described in further detail herein.

[0016] Although reference is made to a common base, the robotic arm may be coupled to a bedrail, a console, or any suitable support structure for supporting the base of the robotic arm.

[0017] In some embodiments, system 400 includes a user input device 496 coupled to processor 423 for user manipulation of surgical instruments on the robotic arm. User input device 496 can be located anywhere suitable (e.g., on a control console, on a robotic arm, or on a mobile base), and one, two, three, four, or more user input devices can be used in conjunction with system 400 to provide redundant input pathways, unique input commands, or a combination thereof. In some embodiments, the user input device includes a controller that moves the distal end of a treatment probe or imaging probe in response to mechanical movement of the user input device. The distal end of the probe can be displayed on display 425, and the user can manipulate the distal end of the probe. For example, the user input device can include a six-degree-of-freedom input controller, wherein the user can move the input device in six degrees of freedom, and the distal end of the probe moves in response to the movement of the controller. In some embodiments, the six degrees of freedom include three translational degrees of freedom and three rotational degrees of freedom. For example, the processor can be configured with instructions for probe control to switch between automated image-guided treatment using an energy source and treatment using an energy source performed by the user by moving the user input device.

[0018] The patient is positioned on a patient support 449 so that the treatment probe 450 and the ultrasound probe 460 can be inserted into the patient. The patient can be placed in one or more of a number of positions, such as prone, supine, upright, or recumbent. In some embodiments, the patient is placed in a lithotomy position, and stirrups, for example, can be used. In some embodiments, the treatment probe 450 is inserted into the patient on a first side of the patient in a first direction, and the imaging probe is inserted into the patient on a second side of the patient in a second direction. For example, the treatment probe can be inserted into the patient's urethra from the front of the patient, and the imaging probe can be inserted into the patient's intestines from the back of the patient through the rectum. The treatment probe and the imaging probe can be placed in the patient with one or more of urethral tissue, urethral wall tissue, prostate tissue, intestinal tissue, or intestinal wall tissue extending therebetween.

[0019] The therapy probe 450 and the imaging probe 460 can be inserted into the patient in one or more of a number of ways. During insertion, each of the first and second arms can include a substantially unlocked configuration such that the therapy or imaging probe can be desirably rotated and translated in order to insert the probe into the patient. When the probe has been inserted to a desired location, the arms can be locked. In the locked configuration, the probes can be oriented relative to one another in one or more of a number of ways, such as parallel, skewed, horizontal, tilted, or non-parallel. As described herein, it can be helpful to determine the orientation of the probes with an angle sensor in order to map the image date of the imaging probe to the therapy probe coordinate reference. Mapping the tissue image data to the therapy probe coordinate reference space can allow for accurate positioning and treatment of tissue identified for treatment by an operator, such as a physician.

[0020] In some embodiments, the therapy probe 450 is coupled to the imaging probe 460 in order to align the therapy probe 450 based on images from the imaging probe 460. As shown, the coupling can be achieved through a common base 440. Alternatively or in combination, the therapy probe and / or the imaging probe can include magnets to hold the probes in alignment through the tissue of the patient. In some embodiments, the first arm 442 is a movable and lockable arm such that the therapy probe 450 can be positioned in a desired location within the patient. When the probe 450 has been positioned in the desired location of the patient, the first arm 442 can be locked with an arm lock 427. The imaging probe can be coupled to the base 440 through a second arm 444, which can be used to adjust the alignment of the imaging probe when the therapy probe is locked in place. For example, the second arm 444 can include a lockable and movable arm under the control of the imaging system or console and user interface. The movable arm 444 can be micro-actuatable such that the imaging probe 460 can be adjusted in small movements (e.g., on the order of a millimeter or so) relative to the therapy probe 450.

[0021] In some embodiments, the treatment probe 450 and the imaging probe 460 are coupled to angle sensors, allowing treatment control based on the alignment of the imaging probe 460 and the treatment probe 450. A first angle sensor 495 can be coupled to the treatment probe 450 via the support 438. A second angle sensor 497 can be coupled to the imaging probe 460. The angle sensors can include one or more of many types of angle sensors. For example, the angle sensors can include goniometers, accelerometers, and combinations thereof. In some embodiments, the first angle sensor 495 includes a 3D accelerometer for determining the orientation of the treatment probe 450 in three dimensions. In some embodiments, the second angle sensor 497 includes a 3D accelerometer for determining the orientation of the imaging probe 460 in three dimensions. Alternatively, or in combination, the first angle sensor 495 can include a goniometer for determining the angle of the treatment probe 450 along the elongated axis 451 of the treatment probe. The second angle sensor 497 can include a goniometer for determining the angle of the imaging probe 460 along the elongated axis 461 of the imaging probe 460. The first angle sensor 495 is coupled to the controller 424 of the treatment console 420. The second angle sensor 497 of the imaging probe is coupled to the processor 492 of the imaging console 490. Alternatively or in combination, the second angle sensor 497 may be coupled to the controller 424 of the treatment console 420.

[0022] The console 420 includes a display 425 coupled to a processor system within a component for controlling the therapeutic probe 450. The console 420 includes a processor 423 having a memory 421. A communication circuit 422 is coupled to the processor 423 and a controller 424. The communication circuit 422 is coupled to the imaging console 490 via the imaging console's communication circuit 494. An arm lock 427 of the console 420 can be coupled to the first arm 442 to lock the first arm or allow the first arm to move freely to insert the probe 450 into the patient.

[0023] Optionally, console 420 may include components of endoscope 426 coupled to anchor 24 of treatment probe 450. Endoscope 426 may include components of console 420 and an endoscope that may be inserted with treatment probe 450 to treat a patient.

[0024] In some embodiments, the console 420 includes an impedance sensor circuit 220 coupled to the energy source to measure the impedance of tissue being treated with energy from the energy source. In some embodiments, the energy source includes electrodes, and the electrodes include impedance sensors. In some embodiments, the processor is configured with instructions to adjust the amount of energy from the energy source in response to the amount of impedance. In some embodiments, the processor is configured with instructions to adjust the amount of deflection of the extension and the offset of the energy source relative to the elongated axis in response to the impedance.

[0025] In some embodiments, the console 420 includes force sensor circuitry 210 coupled to force sensors on the treatment probe. For example, a force sensor can be coupled to an extension to measure tissue resistance associated with deflection of the extension. In some embodiments, a force sensor is coupled to a link to measure tissue resistance associated with movement of the energy source away from the elongate axis. In some embodiments, a force sensor is coupled to the energy source to measure tissue resistance associated with positioning distance of the energy source from the elongate axis. In some embodiments, a force sensor is configured to measure tissue resistance associated with an amount of energy delivery from the energy source.

[0026] Optionally, the console 420 can include one or more of the modules operatively coupled with the treatment probe 450 to control aspects of treatment with the treatment probe. For example, the console 420 can include one or more of the following: an energy source 22 for providing energy to the treatment probe, a balloon inflation control 26 for affecting inflation of a balloon for anchoring the treatment probe at a target treatment site, an infusion / irrigation control 28 for controlling infusion and irrigation of the probe, an aspiration control 30 for controlling aspiration of the probe, an insufflation control 32 for controlling insufflation of a target treatment site (e.g., a prostate), or a light source 33 (such as an infrared light source, a visible light source, or an ultraviolet light source) for providing light energy to the treatment probe. For example,

[0027] The processors, controllers, and control electronics and circuitry can include one or more of many suitable components, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In some embodiments, the control electronics control a control panel of a graphical user interface (hereinafter “GUI”) to provide preoperative planning according to user-specified treatment parameters, as well as to provide user control of the surgical procedure.

[0028] The treatment probe 450 can include an anchor 24. The anchor 24 can anchor a distal end of the probe 450 when energy is delivered to the energy delivery region 20 by the probe 450. In some embodiments, the probe includes a first energy source 250 that can be offset from the elongate axis 451 of the probe by an offset distance 252, for example, by deflection of an extension as described herein, to treat tissue. The processor can be configured with instructions to perform a 3D volume resection of tissue by rotation, translation, and offset of the energy source 250 in response to computer control. The probe 450 can include a second energy source as described herein, such as a nozzle 200.

[0029] ​The treatment probe 450 can be coupled to the first arm 442 by a connection mechanism 430. The connection mechanism 430 can include components to move the energy delivery region 20 to a desired target location of a patient, for example, based on an image of the patient. The connection mechanism 430 can include a first portion 432, a second portion 434, and a third portion 436. The first portion 432 can include a substantially fixed anchor portion. The substantially fixed anchor portion 432 can be fixed to a support 438. The support 438 can include a frame of reference for the connection mechanism 430. The support 438 can include a rigid chassis or frame or housing to rigidly and hardy couple the first arm 442 to the treatment probe 450. The first portion 432 can remain substantially fixed while the second and third portions 434, 436 can move to direct energy from the probe 450 to the patient. The first portion 432 can be fixed at a substantially constant distance 437 to the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the connection mechanism allows for accurate placement of the treatment device. The first portion 432 can include a linear actuator to accurately position a second energy source, such as the high pressure nozzle 200, in the energy delivery region 20 at a desired axial location along the elongate axis 451 of the treatment probe 450. Additional actuators and connection mechanisms can be provided and operatively coupled to the processor to offset, rotate, and translate the first energy source 250 as described herein.

[0030] The elongated axis 451 of the treatment probe 450 generally extends between a proximal portion of the probe 450 proximal to the coupling mechanism 430 and a distal end having the anchor 24 attached thereto. A third portion 436 can control an angle of rotation 453 about the elongated axis 451. During treatment of a patient, the distance 439 between the energy delivery region 20 and the first portion 432 of the coupling mechanism can vary with respect to the anchor 24. The distance 439 can be adjusted as the probe is translated 418 in response to computer control to set a target position along the elongated axis 451 of the treatment probe. In some embodiments, the first portion of the coupling mechanism remains fixed while the second portion 434 adjusts the position of the energy delivery region 20 along the axis 451. The third portion 436 of the coupling mechanism adjusts the angle 453 about the axis in response to the controller 424, allowing for very precise control of the distance along the axis at the treatment angle with respect to the anchor 24. The probe 450 can include a rigid member (e.g., a spine) extending between the support 438 and the anchor 24 such that the distance from the connection mechanism 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to a treatment component as described herein to allow treatment with one or more forms of energy, such as mechanical energy from a jet, electrical energy from an electrode, or light energy from a light source (e.g., a laser source). The light source can include infrared, visible, or ultraviolet light. The energy delivery region 20 can be moved under the control of the connection mechanism 430 to deliver the desired form of energy to the patient's target tissue.

[0031] The imaging console 490 may include a memory 493, a communication circuit 494, and a processor 492. The processor 492 in corresponding circuitry is coupled to the imaging probe 460. An arm controller 491 is coupled to the arm 444 to precisely position the imaging probe 460. The imaging console may further include a display 425.

[0032] To facilitate precise control of the treatment probes and / or imaging probes during treatment of a patient, one or more of the treatment probes or imaging probes may be coupled to a computer-controllable robotic arm. Figure 2The system 400 shown, one or both of the first arm 442 coupled to the therapy probe 450 and the second arm 444 coupled to the imaging probe 460 as described herein can comprise a computer-controlled robotic arm. The robotic arm can be operably coupled with one or more computing devices configured to control movement of the robotic arm. For example, the first robotic arm 442 can be operably coupled with the processor 423 of the console 420, or the second robotic arm 444 can be operably coupled with the processor 492 of the imaging console 490 and / or the processor 423 of the console 420. The one or more computing devices, such as the processors 423 and 492, can comprise computer-executable instructions for controlling movement of the one or more robotic arms. The first and second robotic arms can be substantially similar in construction and function, or they can differ to suit particular functional requirements for controlling movement of the therapy probe and the imaging probe.

[0033] The robotic arms can comprise 6 or 7 or more joints to allow movement of the arms under computer control. Suitable robotic arms are commercially available from several manufacturers, such as RoboDK, Inc., Kinova, Inc., and several others.

[0034] The one or more computing devices operably coupled to the first and second robotic arms can be configured to automatically control movement of the therapy probe and / or the imaging probe. For example, the robotic arms can be configured to automatically adjust the position and / or orientation of the therapy probe and / or the imaging probe during treatment of the patient according to one or more preprogrammed parameters. The robotic arms can be configured to automatically move the therapy probe and / or the imaging probe along a pre-planned or programmed treatment or scan profile that can be stored on a memory of the one or more computing devices. In alternative or in addition to automatic adjustment of the robotic arms, the one or more computing devices can be configured to control movement of the therapy probe and / or the imaging probe in response to user input (e.g., through a graphical user interface of the therapy device). In alternative or in addition to automatic adjustment of the robotic arms, the one or more computing devices can be configured to control movement of the therapy probe and / or the imaging probe in response to real-time localization information (e.g., in response to anatomical structures identified in one or more images captured by the imaging probe or other imaging source from which a permissible range of motion of the therapy probe and / or the imaging probe can be established) and / or position information of the therapy probe and / or the imaging probe from one or more sensors coupled to the probes and / or the robotic arms.

[0035] Figure 3A , Figure 3B and Figure 3C show a top view, a longitudinal (e.g., sagittal) view, and a perspective view, respectively, of a probe arrangement for use in tissue treatment. In particular, Figure 3A , Figure 3B and Figure 3CA relative arrangement is shown, including the position and orientation of a treatment probe 450 relative to the position and orientation of an imaging probe 460 for treating tissue (e.g., prostate tissue). The imaging probe 460 can be configured to generate a transverse image (e.g., transverse ultrasound image 310) and one or more longitudinal images (e.g., one or more longitudinal (e.g., sagittal) ultrasound images 320). In some embodiments, the energy source of the treatment probe 450 is moved at a rotation angle 453 and a translation 418 such that the tissue being treated and the energy source are within the field of view of the imaging probe 460.

[0036] like Figure 3A As shown in the top view of FIG, the treatment probe axis 451 and the imaging probe axis 461 are positioned in a substantially coplanar configuration such that the imaging probe and the treatment probe extend along a common plane. Figure 3B Top view and Figure 3C As shown in the perspective view of , the treatment probe axis 451 and the imaging probe axis 461 are positioned in a substantially coplanar and non-parallel configuration such that the imaging probe and the treatment probe extend substantially along a common plane, which allows the imaging probe to image the treatment probe with one or more longitudinal images (such as real-time longitudinal images, e.g., real-time sagittal images) along the length of the translation 418. In some embodiments, the treatment probe and the imaging probe are arranged in a substantially coplanar configuration, and the ultrasound probe is rotated to rotate the longitudinal (e.g., sagittal) field of view of the imaging probe so as to image the treatment probe along the length of the longitudinal field of view. Referring again to Figure 3A For example, the imaging probe 460 may be rotated about the elongated axis 461 by an angle 336 to align the therapeutic probe 450 so that the sagittal field of view of the imaging probe is aligned with the elongated axis 451 of the therapeutic probe within the sagittal field of view.

[0037] One or more of the therapeutic probe or the imaging probe can be moved to adjust the alignment between the imaging probe and the therapeutic probe. In some embodiments, the proximal portion of the therapeutic probe is moved from a first position to a second position. Figure 3B , the treatment probe 450 can be moved from the first position 332 to the second position 334 to adjust the alignment between the probes, for example, based on data from one or more fiducials as described herein.

[0038] In some embodiments, the imaging probe 460 and the treatment probe 450 are aligned to be substantially coplanar with each other within a margin of error, such that the imaging probe 460 can image the treatment probe 450 and the treatment probe's energy source during treatment, e.g., where the treatment probe is within the imaging probe's field of view (such as a longitudinal (e.g., sagittal) image field of view). In some embodiments, the treatment probe is aligned with the imaging probe such that the treatment probe is visible along the length of the imaging probe's longitudinal (e.g., sagittal) view.

[0039] In some embodiments, for example, the imaging probe 460 and the treatment probe 450 can be slightly misaligned (e.g., beyond the margin of error) such that the treatment probe can disappear from a portion of the longitudinal (e.g., sagittal) image because a portion of the imaging probe extends beyond the longitudinal (e.g., sagittal) field of view. In some embodiments, this can result in the imaging probe 460 not imaging a portion of the treatment with the longitudinal (e.g., sagittal) image. In some embodiments, the treatment probe 450 and the imaging probe 460 can be arranged in a substantially skewed orientation (e.g., beyond the margin of error) as described herein such that the treatment probe extends beyond the longitudinal (e.g., sagittal) field of view of the imaging probe but is within the field of view of the transverse image of the imaging probe. In such embodiments, the treatment can be monitored in real-time with the transverse image, where the imaging probe is moved to maintain the energy source and tissue being treated simultaneously within the transverse field of view of the imaging probe. In some embodiments, the transverse view of the tissue and energy source can reduce the sensitivity of the alignment between the two probes, and the imaging probe can be moved (e.g., in sync) with the energy source to image the tissue and energy source during treatment.

[0040] Figure 4 Treatment of tissue of a patient is shown. The treatment probe 450 can be inserted into a lumen of the patient (e.g., along the urethra of the patient) to treat a distal portion of the treatment region with the energy source. In some embodiments, the treatment probe 450 includes an evacuation port 472 that can be coupled to a suction source as described herein. In some embodiments, the treatment probe 450 is configured to release energy from the energy source 250, and the treatment probe can include an energy treatment probe 470 configured to release energy from the energy source 250 by rotation and translation as described herein. In some embodiments, the energy source of the treatment probe 470 is configured to rotate and translate relative to other components of the treatment probe 451 (e.g., the suction port). The treatment profile 474 is shown by the dashed line. As shown, the resection procedure has begun, and the energy treatment probe 470 has been moved proximally from the distal end of the treatment profile 474 such that tissue has been removed from the distal portion of the distal treatment region according to the treatment profile 474. In some embodiments, the suction port actively suctions fluid and tissue products during the procedure, and can include components of a fluid management system. In some embodiments, the energy source of the energy treatment probe is rotated a certain angle and translated along a specified length of the treatment profile according to the treatment profile shown on the user interface. In some embodiments, the depth of resection is controlled according to the treatment profile based on user input into the user interface.

[0041] The first tissue treated with the energy source can include any suitable tissue as described herein (such as tissue of a first organ), and the second tissue imaged with the first tissue can include any suitable tissue as described herein (such as tissue of a second organ). For example, the first tissue can include tissue of a prostate 510, and the second tissue can include tissue of a bladder 520. In some embodiments, the prostate 510 includes a mid- lobe 512, where a distal portion of the mid-lobe 512 extends into the bladder 520 so as to form an intravesical prostate protrusion 514. In some embodiments, the bladder 520 includes a wall 522 and trigone tissue 524. In some embodiments, the trigone tissue includes tissue of a region of bladder tissue generally defined by the entry of the ureters at two ureteral orifices into the bladder and the opening of the urethra at the internal urethral orifice into the bladder. In some embodiments, the second tissue includes a tissue wall, such as the bladder wall 522. An edge of the second tissue can include a contour 526 that can be monitored (e.g., imaged) in real-time while treating the first tissue to assess the effect of the treatment energy source on the second tissue (e.g., the trigone) due to the first tissue (e.g., the prostate).

[0042] While the imaging device for generating the image can include any suitable imaging device as described herein, in some embodiments, the imaging device includes a real-time ultrasound imaging device (such as a probe) having a frame rate in a range from about 5 Hertz (Hz) to about 250 Hz and a delay from when the imaging energy is released from the imaging device until the image is shown on a display in a range from about 10 milliseconds (ms) to about 1000 ms.

[0043] While the second tissue can be monitored in many ways, in some embodiments, the second tissue includes a structure of the second tissue that has sufficient contrast in the image to identify the structure of the second tissue. In some embodiments, the tissue structure includes a tissue wall, such as a wall of an organ (such as a bladder). Data from the image of the tissue structure can be processed to determine information from the tissue structure, such as one or more of a shape contour, a contrast, a tilt, a movement, or a blurring of the tissue structure. In some embodiments, the tissue structure includes a surface contour 526 of the second tissue that moves with a movement 530 in response to the energy source treating the first tissue. In some embodiments, the surface contour 526 moves from a first contour to a second contour 532 and a third contour 534, which can be viewed sequentially in a real-time image of the second tissue. For example, the movement of the second tissue in response to the treatment of the first tissue can include one or more of a stretching, a compression, a rotation, a translation, a deflection, or a deformation. In some embodiments, the processor is configured to detect the movement of the second tissue in response to the treatment of the first tissue, and to adjust the energy source.

[0044] When in Figure 4The terms "proximal" and "distal" as used in the illustrated examples of FIGS. 1-6 and elsewhere herein are from the perspective of the surgical system. Thus, the distal end of the treatment probe is the portion of the probe that is inserted furthest into the patient.

[0045] Figure 5 A probe 450 is shown placed in a first tissue, such as the prostate 510, and the response of a second tissue, such as the bladder wall 522, to the probe placed in the first tissue. The probe 450 and the elongated axis of the probe 451 are shown placed at an adjusted position 550 to reduce the response of the second tissue to the placement of the probe 450 in the first tissue. In some embodiments, the engagement of the probe with the first tissue, such as the prostate 510, causes a tensioning or compression of the second tissue, such as the tissue of the bladder wall 522, that moves the second tissue away from its natural position and orientation relative to other tissues. The initial position and orientation of the elongated axis of the probe is shown with dashed lines 540. At the initial position and orientation of the probe placed in the first tissue, such as the prostate, the position of the second tissue, such as the tissue of the bladder wall 522, changes in response to the placement of the probe as shown by dashed lines 542. In some embodiments, the placement of the probe in the first tissue causes the second tissue to bulge such that the surface profile of the second tissue appears elevated in one or more images of the second tissue, such as a series of real-time images of the second tissue. Alternatively, the second tissue can appear compressed in the one or more images. For example, the one or more images can include any suitable images as described herein, such as one or more longitudinal (e.g., sagittal) images 320, or one or more transverse images 310, and combinations thereof. In some embodiments, the one or more images include a plurality of transverse images, such as a series of transverse images, to detect the lateral stretching of the tissue from a first side of the probe toward a second side of the probe.

[0046] The processor as described herein can be configured to process the image data to generate an output to move the probe in response to one or more of the images of the probe or force sensor data related to the tissue engagement of the probe as described herein. In some embodiments, the output is provided through a user interface, such as a display, to provide an indication to a user to adjust the position of the probe. Alternatively or in combination, the output can include instructions to a robotic arm to adjust the position of the probe. In some embodiments, the output instructions to move the robotic arm are combined with a first user input to confirm the movement of the probe prior to moving the probe with the robotic arm, and a second user input to confirm that the repositioned probe is appropriate. Although reference is made to a robotic arm, the probe can be adjusted manually, for example by a user manipulating a proximal end of the probe.

[0047] Figure 6An image 610 of the treatment probe 451 is shown with identifiable tissue structures that can be processed to determine the location, position, size, shape, and contour of the tissue structures as described herein. The image 610 can be shown on the display 425 as described herein. The identifiable tissue structures shown in the image on the display can include any suitable tissue structures as described herein. In some embodiments, for example, the one or more tissue structures include one or more of the prostate 510, the middle lobe 512, the intravesical prostate protrusion 514, the bladder 520, the bladder wall 522, the edge of the bladder wall between the wall 522 and the interior of the bladder 520, the trigone tissue 524, or the colliculus of the prostate 650. One or more of the identified tissue structures can be shown on the display. In some embodiments, an initial outline of the one or more identified structures is highlighted on the display at a first time (e.g., by a first modification of the pixels of the first image), and as the treatment progresses, the one or more structures can be shown on the display at a second time by a second modification of the pixels of the second image, which can allow the user to see the progress of the treatment and make adjustments as helpful.

[0048] The image 610 can include one or more images of the tissue shown on the display, such as real-time images of the tissue and the probe. The one or more images can be generated with any suitable imaging device as described herein, such as a transrectal ultrasound probe. For example, the one or more images can include one or more of a longitudinal image, a sagittal image, or a transverse image. For example, the treatment profile 474 can be superimposed on the one or more images, and the treatment profile can include a three-dimensional treatment profile. In some embodiments, a scale 620 is superimposed on the image of the tissue to show the relative scale of the tissue shown on the display relative to the tissue and the treatment profile 474. The scale 620 can include a radially extending component 622 that extends away from the elongate axis of the treatment probe 450 and a longitudinally extending component 624 that extends along the elongate axis of the treatment probe 450. The treatment profile 472 can include a radial component 632 that corresponds to the distance from the energy source and the elongate axis of the probe, and a longitudinal component 634 that corresponds to the distance along the elongate axis of the probe, which can correspond to the position of the energy source along the elongate axis during the treatment. In some embodiments, the processor is configured with instructions to superimpose a treatment marker 640 on the image of the tissue, where the marker corresponds to the longitudinal position of the energy source along the treatment axis.

[0049] While treatment contours can be generated in many ways, in some embodiments, the treatment contour includes a three-dimensional (3D) treatment contour generated from multiple images, such as a treatment contour generated from longitudinal images (such as sagittal images) and multiple transverse images. In some embodiments, the 3D treatment contour includes a 3D volumetric tissue removal contour. An example of a user interface for generating a three-dimensional treatment contour from transverse images and longitudinal (e.g., sagittal) images is described in PCT / US 2019 / 038574, entitled ARTIFICIAL INTELLIGENCE FOR ROBOTIC SURGERY, published as WO 2019246580 Al on December 26, 2019, the entire disclosure of which was previously incorporated by reference herein.

[0050] Figure 7 Identified tissue structures from the images 700 of the patient shown on the display 425 during treatment are shown. The identified tissue structures shown on the images can be highlighted for the user to see, for example, by highlighting or other pixel modification (such as a marker) of the images. In some embodiments, a first tissue, such as the prostate 510, is highlighted. Alternatively or in combination, a boundary 720 of a second tissue, such as the triangular zone, is highlighted, and can be identified with a marker, such as one or more labels 722.

[0051] In some embodiments, an initial contour of one or more of the first tissue or the second tissue is shown on the display 425 and superimposed on the subsequent images. For example, an initial contour 710 of the intravesical prostatic protrusion (“IPP”) can be shown on the display and superimposed on the subsequent images, and can be identified with a marker, such as one or more labels 712. This can allow the user to compare the real-time images of the tissue to the initial contour. For example, the treatment marker 740, the images 700, and the initial contour 710 can be used to assess the progress of the treatment. Alternatively or in combination, an initial contour of the second tissue can be shown on the display and superimposed on the subsequent images to assess the effect of the treatment on the second tissue.

[0052] Figure 8Shown is an arm 442 coupled to a probe having sensors configured to measure a force 850 from tissue pulling on the probe 450 in response to placement of the probe. In some embodiments, force 850 includes a first component 850a and a second component 850b, which are measured by one or more sensors to determine the direction and magnitude of the force exerted by the tissue on the distal portion of the probe. In some embodiments, second force component 850b corresponds to stretching of the tissue, such as stretching of a second tissue in response to placement of the probe in the first tissue, as described herein. In some embodiments, first component 850a corresponds to tissue pulling the probe distally (e.g., away from handpiece 804) in a direction corresponding to the probe's elongated axis 451. Alternatively, or in combination, first component 850a can correspond to the probe pressing against tissue, such as where tissue presses into the probe along the elongated axis 451. Work related to the present disclosure suggests that engaging the probe with a natural lumen (e.g., the urethra) can provide at least some frictional resistance to movement of the probe. The amount of force pulling the probe can range from about 0 Newtons ("N") to about 12.2 N. In some embodiments, the first force component 850a includes a longitudinal force component, and the second force component 850b includes a radial force component. In some embodiments, the first force component ranges from about 0 N to about 2 N, and the second force component ranges from about 0 N to about 12 N.

[0053] In some embodiments, the processor is configured to provide an indication to the user to adjust the probe in response to the amount of force applied to the probe (e.g., a force greater than approximately 12 N). In some embodiments, for example, the processor is configured to generate a notification if the combined force components are greater than approximately 6 N. Alternatively, or in combination, for example, the processor may be configured to generate a notification if any force component is greater than approximately 5 N. In some embodiments, the processor is configured to provide the indication if the force applied to the probe along its longitudinal axis is greater than a first amount or if the radial component is greater than a second amount. For example, the processor may be configured to generate a first notification if the first force component is greater than approximately 1 N or if the second force component is greater than approximately 5 N. In some embodiments, the indication includes a first indication if the longitudinal component is greater than the first amount and a second indication if the radial component is greater than the second amount. For example, the processor may be configured to generate a first indication if the amount of force in the longitudinal direction is greater than approximately 2 N and a second indication if the radial force is greater than approximately 12 N, or to generate a first notification if the longitudinal force is greater than approximately 1 N and a second notification if the radial force is greater than approximately 5 N. These values ​​are exemplary, and as one of ordinary skill in the art will appreciate, any suitable values ​​may be used.

[0054] In some embodiments, the radial component corresponds to an amount of force along a plane that is transverse to the elongate axis of the probe (e.g., perpendicular to the elongate axis of the probe). In some embodiments, the radial component includes a combination of force vectors along a plane that is transverse to the elongate axis of the probe. For example, the force vectors can include components of a three-dimensional (3D) force vector, where a first force component corresponds to a 3D force vector component along the axis of the probe, and a second force component includes radial components corresponding to second and third 3D force vector components that are perpendicular to the first 3D force vector component.

[0055] While the force 850 can be measured in many ways, in some embodiments, the force 850 is measured with the probe in a substantially fixed first position. In some embodiments, the probe is moved to a second position to reduce the force of the tissue on the probe. The second position can include a substantially fixed position to measure the force on the probe at the second position. The force 850 measured at the first position and the second position can include one or more force components at each position, such as a first component 850a and a second component 850b.

[0056] In some embodiments, image data is combined with force sensor data to determine whether the probe placement is suitable to reduce tissue stretch as described herein. The image data can include any suitable image data as described herein, such as image data from one or more of the first tissue or the second tissue. In some embodiments, the image data includes image data from the first tissue. Alternatively or in combination, the image data can include image data from the second tissue, such as a bladder wall as described herein. In some embodiments, first image data of the tissue acquired prior to placing the probe is compared to second image data acquired after placing the probe, and data from the comparison is combined with the force sensor data to determine whether to adjust the probe.

[0057] While the one or more sensors can be calibrated in many ways, in some embodiments, the one or more sensors are calibrated to measure a tissue force pulling on the probe. Alternatively or in combination, the sensors can be calibrated to measure a compression force from a push on the probe by the tissue as described herein. In some embodiments, the force sensor data from the one or more sensors is calibrated to provide a zero force reading when the probe has been placed on the arm in the freestanding configuration. The calibration data can include an offset value for one or more sensor readings corresponding to the freestanding configuration. The calibration data can be stored on one or more components of the processor as described herein. The calibration data can include one or more parameters to convert the sensor readings to force values corresponding to an amount of force on the probe, such as an amount of force from the first component and an amount of force from the second component.

[0058] In some embodiments, one or both of the arms coupled to the therapeutic and imaging probes can include one or more sensors to detect tissue forces on the one or more probes in response to placement of the one or more probes in the tissue. In some embodiments, the pull of the probes by the tissue in response to placement of the probes is measured using one or more sensors located on one or more of the probes, the handpiece, the handpiece, or an instrument driver (such as a motor assembly as described herein). In some embodiments, tissue engaged with the distal portion of the probes responds to the placement of the probes with at least one force 850 corresponding to stretching of the tissue. For example, the at least one force 850 can include one or more components, such as a force component that pulls the probes distally away from the handpiece or a radial force component, and combinations thereof.

[0059] Reference again Figure 1 and Figure 2 , one or more of the first arm 442 or the second arm 444 can be operably coupled to a force sensor configured to detect a pull of the tissue on the one or more probes in response to placement of the probes. In some embodiments, the arm 442 is coupled to a motor assembly 802. For example, the arm 442 can include any suitable arm as described herein, such as a robotic arm or a manually positionable arm. The motor assembly 802 can be coupled to a handpiece 804 of the probe 450 to move the probe using one or more connection mechanisms as described herein.

[0060] Examples of robotic arms and connecting mechanisms suitable for use in accordance with the present disclosure are described in PCT / US 2020 / 021756, filed on March 9, 2020, entitled “ROBOTIC ARMS AND METHODS FOR TISSUE RESECTION AND IMAGING,” published as WO / 2020 / 181290, and PCT / US 2019 / 038574, filed on June 21, 2019, entitled “ARTIFICIAL INTELLIGENCE FOR ROBOTIC SURGERY,” published on December 26, 2019 as WO 2019246580 A1, the entire disclosures of which have been previously incorporated herein by reference.

[0061] According to some embodiments, one or more X-direction force sensors 810 , one or more Y-direction force sensors 812 , and / or one or more Z-direction force sensors 814 may be provided on the robotic arm 442 , the handpiece 804 , and / or the probe 450 .

[0062] In some embodiments, the handpiece 804 and the treatment probe 450 are sterile and configured for single use, and the motor assembly 802 and the arm 442 comprise non-sterile reusable components. The handpiece 804 can comprise a connection mechanism for the energy source to move, for example, by rotation and translation as described herein. For example, the sensors for measuring force on the probe 450 can comprise one or more sensors on the motor assembly 802 at which the motor assembly connects to the arm 804. In some embodiments, the one or more X-direction force sensors 810, the one or more Y-direction force sensors 812, and the one or more Z-direction force sensors 814 are located at the position at which the motor assembly 802 connects to the arm 442. In some embodiments, the sensors comprise one or more load cells. The sensors can comprise calibrated sensors to measure the force of tissue on the probe 450. While the sensors can be configured in many ways, in some embodiments, for example, the one or more X-direction force sensors 810 and the one or more Y-direction force sensors 812 are configured to measure radial forces in response to pulling by tissue on the arm, which can include moment, and the Z-direction force sensors are configured to measure force along the axis 451 of the probe 450.

[0063] For example, the one or more force sensors can comprise strain gauges, pressure sensors, or piezoelectric transducers. In some embodiments, the strain gauges comprise any of several configurations of Wheatstone bridges. A Wheatstone bridge circuit converts small changes in resistance to a measurable voltage difference, which can be equivalent to the applied force. The force sensors can be coupled to a handpiece, such as any of the handpiece embodiments described herein. In some cases, the one or more force sensors are operatively coupled to an imaging probe, a treatment probe, or both.

[0064] In some embodiments, the circuitry for operating the force sensors is insulated and isolated from the imaging probe and the treatment probe. This allows the probes to meet any patient leakage current requirements and reduces any noise picked up by the probes, enhancing the signal-to-noise ratio (S / N) of the force sensors. In some embodiments, the signal lines from the force sensors can be twisted together and optionally can be shielded to maintain signal integrity, improve noise immunity, and maintain adequate S / N ratio. The force sensors can be formed of any suitable material, and in some cases, the portions of the sensors that can come into contact with the patient before, during, or after treatment are formed of a biocompatible material.

[0065] In some embodiments, the one or more force sensors are sized to fit on or within a probe shaft, such as an imaging probe or treatment probe shaft. The force sensors can be configured with any suitable strain sensitivity "k", which is the ratio between the relative changes in resistance. The strain sensitivity is a dimensionless number and is referred to as the gauge factor ("GF"). Linear pattern strain gauges can be used to measure strain in a single direction on the handpiece. Conductive signal wires can be bonded to the pads of the sensor, which carry the signal to an input amplifier. The one or more sensors can be bonded to one or more probes on a carrier substrate, which can insulate the sensors from any metal of the probes, such as a metal probe shaft.

[0066] Displacement of the handpiece in the Z direction can be detected by the spring and sensor 814. With this configuration, the entire probe assembly can be slid a suitable distance to prevent the probe from being driven into the tissue wall. The probe assembly can be disposed on a sliding carriage 820, which can be elastically supported against a simple spring to provide a constant and known force "K" spring constant. Accurate distance measurements, such as by displacement of the carriage, can be made over a short distance, such as less than 2 inches, with suitable arrangements. Other position encoder linear sensors can be used in combination, or in the alternative. For example, a linear variable differential transformer (LVDT) is an electromechanical sensor used to convert mechanical motion into a variable current, and can be used to measure resistance to insertion force on the probe. An optical encoder, or any of several suitable inductive linear encoders. The sensor can measure force based on an inductive linear encoder 824, and can be disposed non-contacting to ensure high reliability. A high resolution encoder 824 can be provided, with linear resolution between about 15 microns for digital encoders to about 54 microns for analog encoders, for example.

[0067] One or more sensors may be provided on one or more robotic arms to measure position, orientation, force, or some other parameter. In some cases, two sensors may be part of the robotic arm assembly and can be used to determine unexpected movement. These sensors may be internal encoders located at one or more joints of the robotic arm, or an inertial measurement unit (IMU) 822. An IMU is an electronic sensor device that measures and reports one or more parameters, such as force, angular rate, and / or sensor orientation, and may utilize a combination of accelerometers, gyroscopes, and / or magnetometers. Some IMUs suitable for incorporation into one or more robotic arms may have a full-scale acceleration range of ±2 / ±4 / ±8 / ±16 g (“g” values ​​relate to acceleration due to gravity) and a wide angular rate range of ±125 / ±250 / ±500 / ±1000 / ±2000 / ±4000 degrees per second (“dps”). The IMU can detect forces acting on the robotic arm and transmit the magnitude and / or direction of the external forces to a computing device, such as a robotic control system. One or more IMUs 822 may provide feedback that may be used to control one or more robotic arms to compensate for vibration, positional awareness, and stabilization compensation.

[0068] As described herein, the arm 442 can interface with the probe 450 using sensors to facilitate one or more of coarse position alignment, intermediate position alignment, and fine position alignment. For example, the probe can be associated with a beacon 830 (e.g., an IR beacon), and the robotic arm 442 can carry an IR receiver 832 capable of detecting emissions from the IR beacon 830 for coarse alignment. One or more alignment reference points 834 can be associated with the probe 450, and one or more alignment sensors 836 can be associated with the robotic arm 442. The alignment sensors 836 can detect the positions of the alignment reference points and, therefore, determine the position of the robotic arm 442 relative to the probe 450, as described herein. In some embodiments, a distance sensor (e.g., a Hall effect sensor or a distance switch) is used to detect alignment between the probe and the arm so that the probe can engage the arm, for example, to lock the probe to the arm once the arm has been properly maneuvered into position.

[0069] In some embodiments, when treatment has been completed, the arm may be disconnected from the probe while the user is holding the probe, and the arm pulled away from the probe, eg, automatically.

[0070] In some embodiments, the first arm 442 and the second arm 444 comprise robotic arms, for example, as described with reference to Figure 1 and Figure 2As shown. One or more computing devices operably coupled to the robotic arm (e.g., a processor of console 420 or console 490 as described herein) may include instructions to control movement of the robotic arm in response to forces detected by the sensor, for example, to prevent excessive compression or stretching of anterior tissue and resulting damage to the tissue and / or the probe. In an exemplary use case of a treatment system for prostate tissue resection, the treatment probe is ideally positioned at the anterior center of the patient's prostate cavity, but without excessively compressing the anterior prostate to prevent unintended damage to the urethra / prostate. For example , excessive tissue bleeding, necrosis, perforation) and / or damage to one or both of the imaging and therapeutic probes. Similarly, the imaging probe (which may be a TRUS probe) is ideally positioned within the patient's rectum with sufficient anterior compression to visualize the prostate and the therapeutic probe, but without excessive compression of the tissue to avoid accidental injury to the rectum ( For example , tissue bleeding or perforation) and / or damage to one or both of the imaging probe and the treatment probe. The treatment probe, the first robotic arm coupled to the treatment probe, the imaging probe, and / or the second robotic arm 444 coupled to the imaging probe can be provided with a force sensor configured to detect anterior compression or stretching of the tissue by the probe. The detected force level can be transmitted to a processor operably coupled to the robotic arm and compared to a force threshold value preprogrammed or stored in a memory of the computing system. If the detected force exceeds the threshold, the movement of the robotic arm can be adjusted to move the probe away from the anterior tissue, thereby at least partially alleviating the compression or stretching of the anterior tissue.

[0071] Figures 9A to 10 A user interface is shown that can be used to adjust tissue treatment of a first tissue based on a response of a second tissue to the treatment of the first tissue. The adjustment can be performed by the user, automatically by processor instructions, or a combination of both, such as by user confirmation of a modified treatment plan, such as a modified treatment outline superimposed on an image.

[0072] Figures 9A to 9C A user interface screen of the system is shown with one or more transverse images of tissue and a treatment profile.

[0073] refer to Figure 9A , illustrates a user interface 1700 that may be used with the apparatus and methods described herein. The user interface 1700 may include two main areas, such as an instruction area 1702 and a control area 1704. The illustrated layout of the user interface 1700 is exemplary, and any suitable layout or arrangement of information and control inputs may be utilized without departing from the scope of this disclosure.

[0074] Instruction region 1702 may be used to remind and / or prompt the user of the system regarding the next procedural step in a sequence of steps. For example, as illustrated, instruction region 1702 indicates in scan window 1706 the tissue of one or more organs (e.g., the prostate) that an imaging device (e.g., a TRUS probe) is currently scanning. Scan window 1706 may display the region of the anatomical structure that is currently being scanned or that should be scanned for the current procedural step, as described below. The views provided include transverse views of the tissue of an organ (e.g., the prostate), although other views (e.g., longitudinal and sagittal views) may be displayed as described herein.

[0075] The anatomical structure selection window 1708 provides the user with the ability to select the portion of the anatomical structure for which a treatment contour is to be established. As shown, the user has selected "prostate" as the portion of the anatomical structure for which a treatment contour is to be set.

[0076] In some embodiments, safety and efficacy parameter window 1750 displays the values ​​of one or more safety or efficacy parameters for a subject as described herein, in response to the resection profile and ultrasound image. For example, efficacy value X may include one or more of a target efficacy value or an efficacy value determined in response to the resection profile and the structure of the image. For example, window 1750 may display a target efficacy value determined for the patient in consultation with the patient and a predicted efficacy value generated in response to the resection profile and the image. Window 1750 may also display a target safety value determined for the patient in consultation with the patient and a predicted safety value generated in response to the resection profile and the image. These values ​​may be determined in real time in response to the treatment profile (e.g., the resection profile shown on a display) and the structure of the image (e.g., the ultrasound image). The safety parameter may include a value X, and the efficacy parameter may include a value Y.

[0077] As the user adjusts the resection profile, the X and Y values ​​displayed on the display change. The processor can be configured with instructions to generate an initial resection profile in response to the ultrasound image and target safety and efficacy values ​​that may have been previously agreed upon by the patient and physician. This initial resection profile can be provided on the display and adjusted by the user.

[0078] When a portion of an anatomical structure is selected, an image corresponding to the selected portion of the anatomical structure can be displayed. For example, a real-time image captured by an in-situ imaging system can be displayed. In some cases, a TRUS probe will be placed near the patient's prostate and real-time imaging of that area will be provided. In the control area 1704 of the user interface 1700, the user can specify the area to be treated. The system is programmed with default values ​​that help the user select an appropriate treatment plan. For example, if the user has selected the prostate, as shown, the control window 1704 initially displays an arc 1710 with an angle 1712 and a radius 1714. Arc 1710 defines a tissue resection contour, where the treatment area within arc 1710 is treated, and areas outside arc 1710 are excluded from treatment. Arc control handles 1716a and 1716b are provided and allow the user to control each leg of arc 1710 to adjust angle 1712. The display shows the selected angle 1712 and can be used to precisely adjust angle 1712 to define the appropriate treatment area. The resection profile initially shown on the display can include a profile determined in response to desired safety and efficacy values. The vertex 1718 of the arc 1710 shows the placement of the treatment probe. In some cases, the treatment probe provides energy delivery to treat the affected area. In some cases, as described herein, the treatment probe is rotated about its longitudinal axis to direct the treatment energy. Thus, the treatment area will resemble the arc 1710 with a radius 1714 commensurate with the energy intensity. When the arc control handles 1716A, B are adjusted to define the tissue resection profile and treatment area, these settings are stored for later use during the procedure and control the degree of rotation of the treatment probe with energy delivery during resection.

[0079] The user interface 1700 may include user input 1760 for the user to select parameters for a model used to determine the values ​​of one or more of the safety parameters and efficacy parameters as disclosed herein. This parameter selection may allow the user to select parameters that may be more helpful than other parameters, as well as remove parameters that may be less helpful for a particular patient than other parameters. For example, if the user believes that a parameter such as age is not very helpful for predicting an outcome, the user may deselect that parameter as an input to the classifier model used to predict an outcome. Alternatively, if the user believes that age is a helpful parameter, the user may select age as a parameter to be used as an input to the classifier model.

[0080] The user interface 1700 may include a user input 1770 for the user to select data to be displayed on the display. For example, the data displayed on the display may include visualization data. In some embodiments, after user adjustments, the user may select whether to display a proposed treatment profile superimposed on the patient's planned treatment profile on the display. This may help the user determine the extent to which the patient's planned treatment profile deviates from the profile suggested by the algorithm. The user may also select additional types of visualization data to be displayed on the display. For example, the user may select a planned trajectory for the energy source used for treatment.

[0081] refer to Figure 9B User interface 1700 shows that different portions of the anatomy have been selected in anatomy selection window 1708 within instruction region 1702. In some embodiments, as described herein, the different portions of the anatomy correspond to different transverse image locations along a longitudinal or sagittal image. As shown, the middle lobe has been selected as the treatment region within anatomy selection window 1708, and control region 1704 has been updated to show imaging associated with the middle lobe anatomy, such as one or more transverse images. In some embodiments, the one or more images include a series of transverse images, such as a series of real-time images. As previously described, control region 1704 overlays a display of a resection outline defined by a treatment boundary including arc 1710. Arc 1710 is customizable by user manipulation of arc control handles 1716A, B, and in some cases, by specifying a radius 1714. Arc 1710 defines a resection outline and treatment region, and different resection outlines and treatment regions can be provided for different anatomical regions. For example, as shown, instruction region 1702 allows the user to select between prostate, bladder neck, and middle lobe within anatomy selection window 1708. In some embodiments, a transverse ultrasound image is provided for each location corresponding to the selected tissue.Window 1750 can display the safety parameter X and the efficacy parameter Y, and these values ​​can change in real time as the user adjusts the resection profile, for example.

[0082] Similar to the prostate setting, when the mid-lobe anatomy is selected, an image of the treatment region is shown in the control area 1704 (e.g., with a TRUS probe correctly positioned to image the anatomical feature of interest), and the user can designate a treatment region for that anatomical feature. Multiple resection contours and corresponding treatment regions established by the user can be input into a user interface provided by the computer, which can save the treatment plan for execution by the surgeon by manually manipulating the energy source according to the treatment contours as described herein or automatically moving the energy source through one or more linkages under processor control.

[0083] In some embodiments, the processor is configured with instructions to adjust the treatment profile based on a response of the second tissue to the treatment of the first tissue. In some embodiments, the arc 1710 is adjusted in response to image treatment data of the second tissue, such as the trigone of the bladder. For example, if the image data during treatment indicates that the second tissue is receiving more than would be helpful amount of energy from the treatment of the first tissue, the arc can be decreased. Alternatively or in combination, the radial distance of the treatment profile from the apex 1718 can be adjusted (e.g., decreased) in response to image data from the second tissue, such as the trigone, indicating that the second tissue has received more than would be helpful amount of energy from the treatment of the first tissue. Although these adjustments can be performed manually by a user, in some embodiments, the processor is configured with instructions to output the adjusted profile. The adjusted profile can be superimposed on the screen for the user to receive and accept or adjust the adjusted treatment profile using user input as described herein.

[0084] Referring to Figure 9C The user interface 1700 is shown. As shown, in the anatomy selection window 1708, the prostate is selected, and the control area 1704 shows real-time imaging data of the selected anatomy. The anatomy selection window 1708 has been further updated to select an option denoted “Adjust Apical Protection Zone” 1720. This refers to a treatment plan designed to protect the veru from over- resection. For example, the apical protection zone can be configured in many ways, and can include a butterfly cut profile. In some embodiments, the treatment profile is configured to not resect tissue at an angle corresponding to the apical protection zone in order to define a butterfly cut. Although reference is made to an apical protection zone, the protection zone can include one or more protection zones to protect a delicate tissue structure of a second tissue, such as a tumor or the retina of an eye, as described herein. In some embodiments, the veru 1725 is visible in the transverse image. In some embodiments, the veru is identified, for example, with one or more image processing algorithms of an artificial intelligence algorithm, such as a convolutional neural network, as described herein.

[0085] As shown, once the "adjust verumontanum protection zone" 1720 radio button has been selected, a new overlay appears on the control area 1704 and defines a verumontanum arc 1722 as part of the arc 1710. The verumontanum arc 1722 shares the vertex 1718 with the arc 1710 and can share the radius 1714 length. In some embodiments, the user adjusts the radius of the arc 1722 to reduce the radius of the treatment depth (such as the resection depth) in order to reduce the likelihood of damage to the verumontanum. For example, the treatment depth of a first tissue, such as benign prostatic hyperplasia tissue, can be adjusted to reduce the likelihood of damage to a second tissue, such as the verumontanum ("veru"). In some embodiments, the penetration depth of the tissue resection profile corresponds to a resection depth of substantially zero within the verumontanum protection zone, but any suitable radial depth from the energy source near the vertex can be used. In some embodiments, the user adjusts the penetration depth along the arc 1722 to a second position 1727 of reduced depth to reduce the likelihood of potential damage to the verumontanum. In some embodiments, the radial distance from the vertex 1718 to the second position 1727 is adjusted automatically. In some embodiments, the distance is adjusted, for example, automatically or manually, during treatment in response to image data of the verumontanum while treating tissue at another location as described herein.

[0086] The verumontanum arc 1722 includes a treatment profile that defines an area associated with the verumontanum protection zone 1724. In prostate surgery, there can be a risk / reward tradeoff between the efficacy of the procedure and male sexual function as described herein. The aggressiveness of the prostate resection treatment is related to proximity to the verumontanum. If tissue is resected closer to the verumontanum, the effectiveness of the prostate treatment for benign prostatic hyperplasia can increase. However, the risk of male sexual dysfunction can also increase. A window 1750 that provides safety parameters and efficacy parameters can assist the user in adjusting the treatment profile for a patient to meet target safety and efficacy metrics. Similar metrics and adjustments can be provided for other tissues as described herein, such as metrics for the trigone region of the bladder and urinary function.

[0087] In some embodiments, the verumontanum is an anatomical landmark near the entrance of the ejaculatory ducts into the urethra and can also be referred to as the seminal colliculus. The structure of the verumontanum is composed of striated muscle fibers of the external sphincter that interweave with smooth muscle tissue from the urethral wall. Some described embodiments herein allow for targeted specific treatment of prostate tissue in close proximity to the verumontanum. According to some embodiments, the verumontanum protection zone 1724 is defined as a region of the prostate that is within a radius of 5 mm from the verumontanum. In some embodiments, the verumontanum protection zone 1724 is defined as a region of the prostate that is within a radius of 3 mm from the verumontanum. In some embodiments, the verumontanum protection zone 1724 is defined as a region of the prostate that is within a radius of 2 mm from the verumontanum. In some embodiments, the verumontanum protection zone 1724 is defined as a region of the prostate that is within a radius of 1 mm from the verumontanum. In some embodiments, the verumontanum protection zone 1724 is defined as a region of the prostate that is within a radius of 0.5 mm from the verumontanum. In some embodiments, the verumontanum protection zone 1724 is defined as a region of the prostate that is within a radius of 0.1 mm from the verumontanum. Figures 9A to 9CIn the illustrated embodiment, the user can specify the ablation profile as a treatment plan for individual regions of a first tissue of a first organ, such as the prostate. For example, a treatment plan can be created that includes unique treatments and treatment profiles for each of the prostate, the bladder neck, and the mid-leaf, as well as unique plans and profiles for the apical region. In some embodiments, a unique treatment plan and treatment profile is developed for the mid-leaf of the prostate and the triangular region of the bladder with the intravesicular prostate protrusion, for example, using transverse images. The treatment profile for the first tissue, such as the mid-leaf of the prostate, can be adjusted in response to image data from one or more images of the second tissue, such as images of one or more of the apical or the prostate.

[0088] The user can adjust the ablation profile in response to the safety and efficacy parameters shown on the display.

[0089] Although Figures 9A to 9C While the display is involved in coupling to the surgical system, in some embodiments, similar images and user input can be used for remote treatment planning and pre-planning at a remote location away from the surgical instrument, such as in another room or building that can be in another state or country. The processor can be configured with instructions for the user to plan the treatment, and these parameters can be stored and loaded onto the processor of the surgical system. For example, diagnostic images of a patient can be generated prior to treatment, for example, in an imaging lab. The images can be shown to the user on a display of a mobile device, and the user can adjust the treatment profile and other aspects of the treatment. Once accepted, the treatment parameters, for example, the ablation profile, can be loaded onto the surgical instrument.

[0090] Figure 10 A user interface screen of a system with longitudinal (e.g., sagittal) images of the tissue and a treatment profile is shown. In some embodiments, the user interface 1800 shows a longitudinal (e.g., sagittal) view of the treatment region, with the anatomically distal organ on the left side of the graph. The user interface can include the transverse interface 1700 and the longitudinal (e.g., sagittal) interface 1800 to plan three-dimensional treatment profiles for 3D volume tissue removal. This screen displays information from the treatment plan that has been entered, such as the rotation angle 1802 of the treatment probe (which is 135 degrees in this example) and the ablation depth 1804 (which is 24.3 mm in the illustrated example), although any suitable values can be used.

[0091] The user interface 1800 allows for further refinement of the treatment plan by manipulating the treatment contours 1806. The treatment contours 1806 generally follow the anatomical curve fit 1808 of the region of interest. In some cases, the system can detect anatomical features, such as by one or more algorithms performed on the ultrasound imaging, such as image analysis, feature recognition, edge detection, or some other algorithm or combination of algorithms, to detect recommended boundaries of the anatomical features and / or resection contours and recommended boundaries of the treatment region.

[0092] The system can present information overlays on the ultrasound imaging information, which can include anatomical portions of the organ, instructions, resection contours, and other information. In the illustrated user interface 1800, the overlay identifies regions corresponding to the mid-leaf region 1810, the bladder neck region 1812, and the mid-prostate region 1814. Each of these identified regions can have a different treatment plan associated with it. For example, the mid-leaf region 1810 can have a specified resection angle, resection depth, and translation distance of tissue resection that can be different from the treatment plan specific to the bladder neck region 1812, which can also be different from the treatment plan for the mid-prostate region 1814.

[0093] The processor can be configured to not only identify the tissue structure of individual anatomical regions, but also store information about recommended and selected treatment plans for each region. For example, information from previous surgeries can be stored in a database corresponding to one or more treatment plans for a single organ or portions of a single organ. This information from previous surgeries can be used to train a classifier or neural network as described herein. The trained classifier or neural network can generate an appropriate recommended treatment plan including multiple tissue resection contours. The recommended resection contours can be generated and presented on the display with the predicted safety value X and the predicted safety value Y in the window 1750. As the treatment plan including multiple cut contours is modified by the user, the processor can receive the modified treatment plan, cut contours, and ultrasound images, and the trained classifier or neural network can be used to generate updated safety and efficacy parameters shown on the display 1750. The trained classifier or neural network can also receive patient information, such as age, height, weight, symptoms, and other information as described herein as input to determine values of the safety and efficacy parameters and to generate the treatment plan.

[0094] The user interface 1800 may include controls for allowing the user to adjust the treatment plan. For example, a treatment start control 1816, a treatment end control 1818, and a verumontanum start control 1820. Any of these controls can be manipulated by the user to modify the resection profile of the treatment plan. For example, the user can move one or more controls to modify the resection profile, such as by modifying the resection depth, the position of the resection start control 1816, or the position of the verumontanum start control 1820. The changes made by the user at the user interface 1800 are stored in the memory of the associated computing system for later execution or simultaneous execution during surgery. In some cases, the program is executed by the robotic equipment that executes the program according to the resection boundary limits.

[0095] The user interface 1800 further includes informational and / or educational components, such as a procedure guide region 1822 that provides guidance to the user of the system. For example, as illustrated, the procedure guide region 1822 includes a checklist of procedure setup steps for the user to perform, such as positioning the handpiece 1824, positioning the TRUS probe 1826, and aligning the handpiece and TRUS probe 1826.

[0096] The procedure guidance area further includes creating and / or modifying the treatment plan, such as by providing the user with the opportunity to input and / or modify the resection angle 1830 , the registration of the treatment probe 1832 , and the cutting profile 1834 .

[0097] like Figure 10 As shown, the setup steps for the procedure have been completed, as indicated by the check marks next to the handpiece 1824, TRUS 1826, alignment 1828, angle 1830, and registration 1832. At this stage in the illustrated example, the user should still complete the contour 1834 adjustments. Upon completion of the setup and planning steps in the user interface 1800, the user can indicate that the procedure is ready to begin by selecting the treatment icon 1836, at which point the system can autonomously begin the procedure according to the treatment plan.

[0098] Once treatment has been initiated using a treatment profile, the user can make additional adjustments to the treatment profile based on the response of the second tissue to the treatment of the first tissue, as described herein. In some embodiments, the user adjusts the treatment profile from a first treatment profile to a second treatment profile using one or more controls of the user interface. For example, the first treatment profile 1010 can be adjusted to the second treatment profile 1020, and the patient can then be treated using the second treatment profile 1020. In some embodiments, the treatment profile of a first tissue (e.g., the middle lobe of the prostate) is adjusted relative to a second tissue (e.g., the bladder wall 522 and trigone tissue 525), although adjustments can be made relative to any first and second tissues as described herein. In some embodiments, the treatment profile is adjusted relative to a contour 526 (e.g., the contour of the inner wall of the bladder).

[0099] In some embodiments, the first treatment profile comprises a first closest distance to the second tissue, wherein the first closest distance defines a first gap between the first treatment profile and the second tissue, and the second treatment profile comprises a second closest distance to the second tissue, wherein the second closest distance defines a second gap between the second treatment profile and the second tissue. For example, the length of the first gap can be different from the length of the second gap. Again referring to Figure 10 In the illustrated example, first treatment contour 1010 may define a first closest distance from triangular tissue 524, and second treatment contour 1020 may define a second closest distance from triangular tissue 524, where the second distance is greater than the first distance. By adjusting the gap distance, the effect of treatment of the first tissue on the second tissue can be appropriately adjusted. While reference is made to adjustments being made on a user interface, in some embodiments, adjustments are automatically made by a processor, for example, using appropriate instructions. In some embodiments, the second contour is presented to the user on a display of the user interface for acceptance and modification. The user can choose to accept the initially presented processor-generated second contour, or modify the presented second contour and then accept the user-modified contour.

[0100] While reference is made to using images for treatment planning and adjusting treatment profiles based on images, other approaches may also be used. In some embodiments, for example, one or more tissue markers may be located using another device (such as an endoscope or tissue sensor configured to detect anatomical structures or tissue transitions). Based on reference anatomical data, the location of a second tissue may be determined based on the location of the reference anatomical markers. In some embodiments, one or more visual markers are identified endoscope-wise, and the treatment plan is adjusted by the user in response to the one or more visual markers. The location of the visual markers can be used to estimate the location of the second tissue (such as tissue in the trigone). In some embodiments, the external urethral sphincter is visible in the endoscopic image, and the location of the second tissue (such as the trigone) is estimated based on the location of the visual markers (such as the external sphincter). In some embodiments, for example, the tissue marker includes the bladder opening to the urethra, which can be seen endoscope-wise. While reference is made to determining the location of the bladder opening to the urethra using an endoscope, other methods and devices may also be used. In some embodiments, for example, the urethra-bladder opening is measured using one or more of optical, ultrasonic, or electrical impedance measurements. In some embodiments, for example, the marker is measured with an impedance probe comprising two or more electrodes, wherein the position of the marker corresponds to a change in impedance. In some embodiments, as the probe passes from the urethra to the opening of the bladder, there is less tissue to engage the electrodes in the opening to the bladder, causing the impedance to change.

[0101] In some embodiments, the handpiece includes one or more markers (e.g., depth markers) to indicate the location of the energy source or tissue mapping probe. In some embodiments, this information about the depth of the energy source can be used, along with other data, to determine when the energy source is proximate to a second tissue (e.g., the trigone). In some embodiments, for example, the handpiece is configured to move the tissue mapping probe via calibrated translation to determine the depth of the tissue markers to estimate the location of the second tissue.

[0102] The treatment profile can also be adjusted in response to a tumor (such as cancerous tissue, such as a tumor). Work related to the present disclosure shows that in approximately 80% of prostate cancer cases, the cancer is located in the peripheral area of ​​the prostate, and in approximately 20% of prostate cancer cases, the cancer is located in the transition zone of the prostate. For example, the treatment profile as described herein can be adjusted in response to the shape profile of the tumor. In some embodiments, the shape profile is adjusted to selectively treat the cancer area. Alternatively, the shape profile can be adjusted to reduce the interaction of the energy source with the cancer area.

[0103] In some cases, the treatment plan is stored in a database with other treatment plans and can include data about the patient and the treatment plan, such as patient age, weight, height, symptoms, length of symptoms, diagnosis, prior treatment history, treatment efficacy, medication history, etc. Past treatment plans can include data for multiple historical treatments (such as angles and resection contours) for multiple patients and can be stored as historical treatment plan data.

[0104] The historical treatment plan data can be analyzed by one or more suitable algorithms as described herein, such as one or more of an artificial intelligence algorithm, supervised machine learning, unsupervised machine learning, neural network, or convolutional neural network. In some cases, the historical treatment plan data is analyzed by one or more machine learning algorithms and can be used to train a classifier. For example, a neural network can analyze historical treatment data to provide a recommended treatment plan for one or more current patients. For example, based on historical treatment data, a neural network can be used to build, train, and deploy a machine learning model, including preparing and labeling historical treatment data, selecting an algorithm, training a model, validating a model, adjusting and optimizing a model, deploying a model, predicting future treatment plans, and providing treatment plans for current or future patients.

[0105] In some examples, an artificial intelligence algorithm, such as a convolutional neural network, can be implemented to analyze visual data, such as ultrasound imaging from a TRUS probe, and provide feedback to feed into a machine learning model. Visual data analysis can include identifying anatomical features and related locations, sizes, shapes, health, and other information.

[0106] A processor as described herein can be configured with instructions to provide a user interface, images, and windows as described herein, for example, with reference to Figures 9A to 10 Alternatively or in combination, a processor can be configured with instructions to adjust a treatment contour of a first tissue in response to image data from a second tissue as described herein. In some embodiments, the processor is configured with instructions to superimpose a proposed modified treatment contour on an image of the tissue, prompt a user to accept or modify the treatment contour, and then complete the treatment in response to the modified treatment contour.

[0107] Figure 11 A method 1100 of treating a first tissue and adjusting the treatment based on a response of a second tissue to the treatment of the first tissue is shown.

[0108] At step 1105, a therapy probe is inserted into the patient to treat a first tissue of the patient. In some embodiments, the therapy probe includes an energy source. For example, the energy source can include one or more of: an electrode, a ring electrode, a laser source, a mechanical energy source, a mechanical shears, an ultrasound probe, a cavitation ultrasound probe, a water jet (e.g., a fixed pressure water jet), a plasma source, a vapor source, a morcellator, a transurethral needle, a light ablation source, a radiant energy source, a microwave energy source, or a water jet evacuation source.

[0109] At step 1110, an imaging device is positioned to image the second tissue and the first tissue. The imaging device can include one or more of: an ultrasound transducer array, an external ultrasound transducer array, an ultrasound transducer array on a probe including an energy source, an ultrasound probe, an elongated ultrasound probe sized to be placed in a lumen, a transrectal ultrasound probe, a transvaginal ultrasound probe, a magnetic resonance imaging, a magnetic resonance probe, an endoscope, or a fluorescence imaging device.

[0110] At step 1115, the first tissue and the second tissue are imaged individually or together or a combination of both. In some embodiments, the image data includes a series of real-time images. While any suitable acquisition rate and frame rate can be used, in some embodiments, the series of real-time images includes a frame rate of at least one hertz and a latency of no more than one second from when imaging energy is released from the imaging device until the image is shown on a display.

[0111] At step 1120, one or more tissue structures of the first tissue are identified and associated data, such as shape data or contrast data, is generated. The associated data can include any suitable data generated with any suitable algorithm as described herein.

[0112] In some embodiments, the anatomical structure of the first tissue structure includes one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a lens of an eye.

[0113] At step 1125, one or more tissue structures of the second tissue are identified and associated data is generated. The associated data can include any suitable data generated with any suitable algorithm as described herein.

[0114] In some embodiments, the first tissue includes a first tissue structure, and the second tissue includes a second tissue structure different from the first tissue structure. The second tissue structure can include any suitable tissue, such as one or more connective tissues, muscle tissue, epithelial tissue, muscle tissue, or anatomical structures associated with contrast in the image data. In some embodiments, the second tissue structure includes a second type of tissue adjacent to a third type of tissue or adjacent to a fluid to provide contrast in the image data from the second tissue structure. For example, the fluid can include a liquid, such as urine.

[0115] In some embodiments, the anatomical structure of the second tissue structure includes one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, a prostate colliculus, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, a retina of an eye.

[0116] In some embodiments, the first tissue includes tissue of a first organ, and the second tissue includes tissue of a second organ different from the first organ, and wherein the processor is configured to process image data from the tissue of the second organ and output data corresponding to a response of the second tissue to an energy source directed to the tissue of the first organ.

[0117] In some embodiments, the second tissue structure includes a tissue wall facing the first tissue structure, and wherein one or more of a treatment profile, movement of the energy source, or the energy source is adjusted in response to image data from the tissue wall. For example, the image data from the tissue wall can include one or more of: a shape profile of the tissue wall, a contrast of the tissue wall, a blur of the tissue wall, a movement of the tissue wall, a deflection of the tissue wall, or a deformation of the tissue wall.

[0118] At step 1130, a three-dimensional treatment profile is generated. For example, the three-dimensional treatment profile can include a three-dimensional treatment profile having an associated transverse image and a longitudinal (e.g., sagittal) image, as described herein. The transverse image and the longitudinal (e.g., sagittal) image can be generated by a user manipulating an imaging probe (such as an ultrasound probe) and capturing the transverse image at an appropriate location corresponding to an anatomical structure of the, as described herein. Alternatively or in combination, the associated transverse image and the longitudinal (e.g., sagittal) image can include a 3D image, such as a 3D image from a 3D ultrasound probe or other 3D imaging device configured to generate transverse images at predetermined distances along a tissue. In some embodiments, the 3D image includes a tomographic image.

[0119] In some embodiments, a corresponding movement of the energy source and an amount of energy from the energy source is determined to treat tissue according to the treatment profile, e.g., to resect tissue to the treatment profile as described herein. For example, the energy source can be configured with one or more of an amount of energy, a power, an irradiance profile, a flow rate, or a pressure. The movement of the probe can be configured to provide a corresponding rotational and translational movement (such as a velocity) to treat tissue according to the treatment profile, e.g., to resect tissue to a depth of the treatment profile.

[0120] At step 1135, the three-dimensional profile is output to a display of the user interface and superimposed on an associated image, such as one or more of a transverse image or a longitudinal (e.g., sagittal) image as described herein.

[0121] At step 1140, the three-dimensional treatment profile is adjusted in response to a user input.

[0122] At step 1145, energy from an energy source is directed to the first tissue to treat the first tissue. As described herein, the energy source can be selectively directed to the first tissue and the second tissue with movement of the energy source, such as one or more of a rotation of the energy source or a translation of the energy source. In some embodiments, the energy from the energy source is scanned over the first tissue at a scan rate, and the second tissue moves according to the scan rate. In some embodiments, wherein the scan rate includes an angular sweep rate, and the second tissue moves according to the angular sweep rate, such that the movement of the tissue corresponds to the angular sweep rate. In some embodiments, the energy source includes a mechanical energy source, such as a water jet, and the tissue moves according to a sweep rate of the water jet. While the sweep rate of the energy source can include any suitable sweep rate, in some embodiments, the sweep rate is in a range from about 1 Hz to about 20 Hz, and an angle of each sweep is in a range from about 20 degrees to about 180 degrees.

[0123] At step 1150, the first tissue is imaged while the energy source treats the first tissue. In some embodiments, the treatment probe is coupled to the first connection mechanism and an imaging device, such as an ultrasound probe, is coupled to the second connection mechanism. The energy source is moved according to the treatment profile and the imaging device is moved with the energy source to maintain the second tissue or one or more of the second tissues within a field of view of the imaging device. In some embodiments, the processor is configured to move the imaging device in synchronization with the energy source to maintain the second tissue within the field of view of the imaging device. Alternatively, the processor can be configured to move the imaging device asynchronously with the energy source, for example, by stepped movement of the imaging device, to maintain the second tissue within the field of view of the imaging device. In some embodiments, the image data includes a plurality of lateral images of the treatment probe, the first tissue, and the second tissue, and the imaging device is moved to maintain the energy source, the first tissue, and the second tissue within a lateral field of view of the imaging device.

[0124] At step 1155, the image data from the images of the first tissue is processed. In some embodiments, a target tissue resection profile of the first tissue is compared to a measured tissue resection profile of the first tissue. For example, the comparison of the target tissue resection profile to the measured tissue resection profile can be output from a software module of the processor to a display of the user interface.

[0125] At step 1160, the second tissue is imaged while the energy source treats the first tissue.

[0126] At step 1165, the image data from the images of the second tissue taken while the first tissue is treated is processed.

[0127] At step 1170 , a response of the second tissue to the treatment of the first tissue is determined. In some embodiments, the image data from the second tissue structure includes one or more of a shape profile of the second tissue structure, a contrast of the second tissue structure, a blurring of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure. In some embodiments, the movement of the second tissue is measured in response to the energy from the energy source and one or more of the energy source, the movement of the energy source, or the treatment profile is adjusted in response to the movement of the second tissue.

[0128] In some embodiments, the response of the second tissue to the treatment of the first tissue is assessed using differences between images taken at different times. In some embodiments, the image data from the second tissue structure includes a first image at a first time and a second image at a second time. For example, the processor is configured to determine a response to the energy source being directed to the first tissue based on the first image and the second image, which can be assessed by changes in one or more of a shape profile of the second tissue structure, a contrast of the second tissue structure, a blurring of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure.

[0129] While any suitable images can be used, in some embodiments, the first image includes a first longitudinal (e.g., sagittal) image, the second image includes a second longitudinal (e.g., sagittal) image, and the probe includes an elongate probe shown extending along the first longitudinal (e.g., sagittal) image and the second longitudinal (e.g., sagittal) image.

[0130] At step 1175, the treatment of the first tissue is correlated to the movement of the second tissue, for example to a sweep rate of the energy source directed to the first tissue. In some embodiments, the amount of movement of the second tissue corresponds to the sweep rate and is determined from the images. In some embodiments, the movement of the second tissue is correlated to an angular sweep rate of the energy source in order to determine the effect of the treatment of the first tissue on the second tissue.

[0131] At step 1180, data corresponding to the response of the second tissue to the treatment of the first tissue is output.

[0132] At step 1185, the data from the second tissue is output to a user interface for evaluation by a user, such as a healthcare professional.

[0133] At step 1190, user input from the user interface is received, where the input relates to the second tissue output data, such as output data provided to a display of the user interface. In some embodiments, the processor outputs data to the user interface in response to the image data from the second tissue, and receives input from the user to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to the input from the user. In some embodiments, the proposed modified treatment profile is generated with the processor and superimposed with one or more images of the tissue as described herein.

[0134] At step 1195, the treatment of the first tissue is adjusted based on the response of the second tissue to the treatment of the first tissue. The adjustment can include any suitable adjustment as described herein. In some embodiments, the processor is configured to adjust one or more of the energy source or a treatment profile of the first tissue structure in response to the image data from the second tissue structure.

[0135] In some embodiments, the processor includes components of a feedback loop to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue. The processor can be configured to automatically adjust the treatment in real time. Alternatively or in combination, the treatment can be adjusted in response to user input.

[0136] In some embodiments, the processor automatically adjusts one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0137] While the treatment can be adjusted in many ways, in some embodiments, the energy source is adjusted by one or more of: movement, rotation, translation, angular velocity, translational velocity, energy from the energy source, power from the energy source, pump power, laser power, or electrical power.

[0138] In some embodiments, the first tissue is treated according to a treatment profile, and the treatment profile is adjusted in response to image data from the second tissue. For example, the first tissue can be treated according to a first treatment profile, and the first treatment profile is adjusted in response to image data from the second tissue to generate a second tissue profile.

[0139] In some embodiments, the processor adjusts the energy source to treat the first tissue with reduced interaction of the energy source with the second tissue in response to image data from the second tissue. Alternatively or in combination, in some embodiments, the processor adjusts the energy source to treat the first tissue with increased interaction of the energy source with the second tissue in response to image data from the second tissue.

[0140] At step 1199, the first tissue is treated with the adjusted treatment profile.

[0141] Although Figure 11 A method 1100 of treating a first tissue and adjusting treatment of the first tissue based on a response of a second tissue to treatment of the first tissue is shown, in accordance with an embodiment. However, those of ordinary skill in the art will recognize many adaptations and variations. For example, the steps can be performed in any order, and can be performed at least partially concurrently. Some of the steps can be omitted. Some of the steps can be repeated. Some of the steps can be combined. Some of the steps can include sub-steps of other steps.

[0142] Figure 12 A method 1200 of adjusting a probe placed in a first tissue in response to stretching of a second tissue is shown. In some embodiments, for example, the first tissue includes tissue of a first organ, and the second tissue includes tissue of a second organ.

[0143] At step 1205, image data is acquired from a first tissue of the subject and a second tissue of the subject. The image data can include any suitable image data as described herein.

[0144] At step 1210, a probe is placed in the subject to treat the first tissue of the subject. The first tissue can include any suitable tissue as described herein. In some embodiments, the probe includes an energy source as described herein.

[0145] At step 1215, the position of the probe in the first tissue is fixed. In some embodiments, the probe is supported on an arm, and the position of the arm is fixed as described herein.

[0146] At step 1220, image data is acquired from the first tissue of the subject and the second tissue of the subject with the probe placed in the subject to treat the first tissue. For example, the image data can be acquired with the position of the probe fixed. For example, the image data can include any suitable images and tissue structures as described herein, and can include images of the wall of the second tissue.

[0147] At step 1230, the image data is processed to identify one or more tissue structures of the second tissue and associated shape data. The one or more tissue structures can include any suitable tissue structures as described herein. For example, the associated shape data can include any data related to a shape as described herein, such as shape profile data, deflection data, or sag height data related to a degree of inclination of the tissue.

[0148] At step 1240, the image data is processed to generate data related to tissue stretch of the second tissue. The image data can be processed in any suitable manner as described herein, such as using an artificial intelligence algorithm (such as a convolutional neural network). In some embodiments, the shape data of the second tissue is compared to reference shape data of the second tissue (such as population reference data). Alternatively or in combination, shape data from a first image of the tissue structure can be compared to shape data from a second image of the tissue structure to determine a change in the shape data. The first image can include an image prior to placement of the probe, and the second image can include an image with the probe placed in the first tissue.

[0149] At step 1250, the data related to tissue stretch is output. The output can be provided, for example, to a software module or a user interface.

[0150] At step 1260, the data related to tissue stretch is output to a user interface. In some embodiments, the output includes one or more of an alert, notification, or message to a user to adjust one or more of an angle, position, or pose of the probe.

[0151] At step 1270, a determination is made to move the probe in the first tissue to reduce the stretch of the second tissue. In some embodiments, the movement includes a direction to reduce the stretch of the second tissue, and can include movement of at least a portion of the probe generally toward the second tissue.

[0152] At step 1275, user input is received to adjust the probe. In some embodiments, the proposed movement is provided to a user interface for user confirmation, and the probe is moved with a robotic arm as described herein.

[0153] At step 1280, placement of the probe in the first tissue is adjusted to reduce the stretch of the second tissue. For example, the adjustment can include adjusting one or more of a placement, an angle, a position, or a six degrees of freedom (6DOF) pose of the probe in response to the data related to the stretch of the second tissue. For example, the adjustment can be made by manual manipulation by a user, or by a robotic arm, or combinations thereof. In some embodiments, for example, the processor includes instructions to cause a first module to output the data related to the stretch of the second tissue, and to cause a second module to receive the data related to the stretch of the second tissue and adjust one or more of the angle, the position, or the 6DOF pose of the probe.

[0154] At step 1285, user input is received to confirm the adjustment of the probe in the first tissue. In some embodiments, this helps ensure that the probe has been properly adjusted for treatment.

[0155] At step 1290, the first tissue of the patient is treated with the adjusted probe placement.

[0156] Although Figure 12 A method 1200 is shown of adjusting a probe placed in a first tissue in response to a stretch of a second tissue, according to an embodiment, but those of ordinary skill in the art will recognize many adaptations and variations. For example, the steps can be performed in any order, and can be performed at least partially simultaneously. Some of the steps can be omitted. Some of the steps can be repeated. Some of the steps can be combined. Some of the steps can include sub-steps of other steps.

[0157] Figure 13 A method 1300 is shown of measuring a force related to a pull of a tissue on a probe and adjusting the probe in response to the pull of the tissue on the probe.

[0158] At step 1305, sensor data is acquired from one or more sensors in the case of a free-standing configuration of the probe position. In some embodiments, this includes a calibration step. In some embodiments, the sensor data has been previously calibrated, for example, prior to the probe being placed in the patient.

[0159] At step 1310, a probe is placed in a subject to treat a first tissue of the subject.

[0160] At step 1315, the position of the probe in the tissue is fixed. In some embodiments, the position of the probe is fixed prior to measuring the pull of the tissue on the probe.

[0161] At step 1320, sensor data is received from one or more sensors, wherein the probe is coupled to the arm in a fixed configuration.

[0162] At step 1330, the sensor data is processed.

[0163] At step 1340, the sensor data is processed to generate data related to the pull of the first tissue on the probe.

[0164] At step 1350, data related to the pull of the tissue on the probe is output.

[0165] At step 1360, data related to the pull of the tissue on the probe is output to a user interface.

[0166] At step 1370, a determination is made to move the probe to reduce the pull of the tissue on the probe.

[0167] At step 1375, user input to adjust the probe is received.

[0168] At step 1380, placement of the probe in the first tissue is adjusted according to the force from the pull of the first tissue on the probe.

[0169] At step 1385, user input confirming the adjustment of the probe in the first tissue is received.

[0170] At step 1390, the first tissue of the patient is treated with the adjusted placement of the probe.

[0171] Although Figure 13 Although a method 1300 of measuring a force related to a pull of a tissue on a probe and adjusting the probe in response to the pull of the tissue on the probe according to an embodiment is shown, one of ordinary skill in the art will recognize many adaptations and variations. For example, the steps can be performed in any order and can be performed at least partially simultaneously. Some of the steps can be omitted. Some of the steps can be repeated. Some of the steps can be combined. Some of the steps can include sub-steps of other steps.

[0172] Any one or more of the steps of the method 1100, the method 1200, and the method 1300 can be combined. A processor as described herein can be configured to perform any one or more of the steps of the method 1100, the method 1200, or the method 1300 in any suitable combination of steps. In some embodiments, for example, sensor data related to pulling of a probe by a first tissue is combined with image data from a second tissue, such as data related to stretching of the second tissue.

[0173] Figure 14 An artificial intelligence (“AI”) algorithm suitable for incorporation is shown in accordance with embodiments of the present disclosure. In some embodiments, for example, the artificial intelligence algorithm includes one or more of: image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion.

[0174] In some embodiments, the AI algorithm includes a two-dimensional convolutional neural network (CNN) 2100. In some embodiments, the AI, such as a CNN, is configured to identify one or more tissue structures of one or more tissues, and to process images, identify tissue structures, and determine a response of the tissue to a treatment. As described herein, the tissue can include a first tissue, or a second tissue, or a combination thereof. A dataset 2102 is initially provided, which can include imagery from historical treatment data of prior patients and procedures. A convolution operation 2104 produces data in a second dataset 2106, which in turn applies a pooling layer 2108 to produce a pooled layer 2110 of subsample data to further compress the spatial size of the feature representation. The subsample data can be convolved 2112 to produce a third dataset 2114, which can further apply a pooling layer 2116 to provide subsample data 2118. The subsample data 2118 can pass through a first fully connected layer 2120 and a second fully connected layer 2122 to generate a classification matrix output 2124. One or more filters can be applied at each convolutional layer to provide different types of feature extraction. After the model is defined, the model can be compiled, and the model can utilize accuracy of feature recognition as a performance metric. The model can be trained over time, such as by using historical procedure data as training data, and validated against predictions of the model, and validated over time until predictions of the model converge with true data.

[0175] While trained models can be configured in a variety of ways, in some embodiments, the trained model is configured to identify tissue structures and output one or more metrics associated with the tissue structures, such as one or more of shape data or movement data as described herein.

[0176] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions, such as those contained within the modules described herein. In their most basic configuration, these computing devices can each include at least one memory device and at least one physical processor.

[0177] As used herein, the term "memory" or "memory device" generally refers to any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. In one example, a memory device can store, load, and / or maintain one or more of the modules described herein. Examples of memory devices include, without limitation, Random Access Memory (RAM), Read Only Memory (ROM), flash memory, Hard Disk Drives (HDDs), Solid-State Drives (SSDs), optical disk drives, buffers, variations or combinations thereof, or any other suitable storage memory.

[0178] Additionally, as used herein, the term "processor" or "physical processor" generally refers to any type or form of hardware-implemented processing unit capable of interpreting and / or executing computer-readable instructions. In one example, a physical processor can access and / or modify one or more modules stored in a memory device described above. Examples of physical processors include, without limitation, microprocessors, microcontrollers, Central Processing Units (CPUs), Field-Programmable Gate Arrays (FPGAs) implementing softcore processors, Application-Specific Integrated Circuits (ASICs), portions of one or more of them, variations or combinations thereof, or any other suitable physical processors. A processor can include a distributed processor system (e.g., running a parallel processor) or remote processors (such as servers) and combinations thereof.

[0179] Although illustrated as separate elements, the method steps described and / or illustrated herein can represent portions of a single application. Additionally, in some embodiments, one or more of these steps can represent or correspond to one or more software applications or programs, which, when executed by a computing device, can cause the computing device to perform one or more tasks, such as method steps.

[0180] Additionally, one or more of the devices described herein can transform data, physical devices, and / or representations of physical devices from one form to another. Additionally or alternatively, one or more of the modules described herein can transform a processor, volatile memory, non-volatile memory, and / or any other portion of a computing device from one form to another by executing on the computing device, storing data on the computing device, and / or interacting with the computing device.

[0181] As used herein, the term “computer-readable medium” generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable media include, without limitation, transmission-type media, such as carrier waves and non-transitory-type media, such as magnetic-storage media (e.g., hard disk drives, tape drives, and floppy disks), optical-storage media (e.g., optical disks such as CDs, DVDs, and Blu-ray disks), electronic-storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0182] Those of ordinary skill in the art will appreciate that any of the processes or methods disclosed herein can be modified. The process parameters and sequence, which are described and / or illustrated herein are given by way of example only and can be varied as desired. For example, while the steps illustrated and / or described herein can be shown or discussed in a particular order, these steps do not necessarily need to be performed in the order illustrated or discussed.

[0183] The various illustrative methods described and / or illustrated herein can omit one or more of the steps described or illustrated herein or include additional steps in addition to those disclosed. Further, the steps of any of the methods disclosed herein can be combined with any one or more of the steps of any of the other methods disclosed herein.

[0184] A processor as described herein can be configured to perform one or more steps of any of the methods disclosed herein. Alternatively or in combination, a processor can be configured to combine one or more steps of one or more methods as disclosed herein.

[0185] The terms "connected to" and "coupled to" (and their derivatives), unless otherwise identified, are to be interpreted as permitting both direct and indirect (i.e. via other elements or components) connections. In addition, the terms "a" or "an", as used in the specification and in claims, are to be construed as meaning "at least one". Finally, for ease of use, the terms "including" and "having" (and their derivatives), as used in the specification and in claims are interchangeable with and have the same meaning as the word "comprising."

[0186] A processor as disclosed herein can be configured with instructions to perform any one or more steps of any method as disclosed herein.

[0187] It will be understood that, although the terms "first," "second," "third," etc. can be used herein to describe various layers, elements, components, regions, or sections, these terms are not intended to denote any particular order or sequence. These terms are used merely to distinguish one layer, element, component, region, or section from another layer, element, component, region, or section. A first layer, element, component, region, or section as described herein can be termed a second layer, element, component, region, or section without departing from the teachings of the present disclosure.

[0188] As used herein, the term "or" is used in an inclusive sense, i.e., at least one of the items listed is present.

[0189] As used herein, characters such as numbers refer to similar elements.

[0190] As used herein, the term "e.g." means, for example.

[0191] The present disclosure includes the following numbered clauses.

[0192] Clause 1. A system for treating a tissue of a subject, the system comprising: a probe comprising an energy source to direct energy to a first tissue to treat the first tissue; an imaging device configured to acquire image data from the first tissue and a second tissue proximate to the first tissue; and a processor coupled to the energy source and the imaging device, the processor configured to process the image data from the second tissue and output data corresponding to a response of the second tissue to the energy source directed to the first tissue.

[0193] Clause 2. The system of the preceding clause, wherein the processor is configured to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0194] Clause 3. The system of any of clauses 1-2, wherein the processor is configured to automatically adjust one or more of the treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0195] Clause 4. The system of any of clauses 1-3, wherein the processor is configured to output data to a user interface in response to image data from the second tissue, and receive input from a user to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to input from the user.

[0196] Clause 5. The system of any of clauses 1-4, wherein the processor comprises components of a feedback loop for adjusting one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0197] Clause 6. The system of any of clauses 1-5, wherein the energy source is adjusted by one or more of movement, rotation, translation, angular velocity, translational velocity, energy from the energy source, power from the energy source, pump power, laser power, or electrical power.

[0198] Clause 7. The system of any of clauses 1-6, wherein the processor is configured to adjust the energy source to treat the first tissue with reduced interaction of the energy source with the second tissue in response to image data from the second tissue.

[0199] Clause 8. The system of any of clauses 1-7, wherein the processor is configured to adjust the energy source to treat the first tissue with increased interaction of the energy source with the second tissue in response to image data from the second tissue.

[0200] Clause 9. The system of any of clauses 1-8, wherein the processor is configured to treat the first tissue according to a treatment profile, and adjust the treatment profile in response to image data from the second tissue.

[0201] Clause 10. The system of any one of clauses 1 to 9, wherein the processor is configured to treat the first tissue according to a first treatment profile and to adjust the first treatment profile to generate a second tissue profile in response to image data from the second tissue.

[0202] Clause 11. A system as described in any of clauses 1 to 10, wherein the first treatment profile includes a first closest distance to the second tissue, the first closest distance defining a first gap between the first treatment profile and the second tissue, and wherein the second treatment profile includes a second closest distance to the second tissue, the second closest distance defining a second gap between the second treatment profile and the second tissue, the first gap being different from the second gap.

[0203] Clause 12. The system of any one of clauses 1 to 11, wherein the first gap is smaller than the second gap.

[0204] Clause 13. The system of any one of clauses 1 to 12, wherein the first gap is larger than the second gap.

[0205] Clause 14. The system of any of Clauses 1 to 13, wherein the first treatment profile comprises a three-dimensional ("3D") treatment profile, and the second treatment profile comprises a 3D treatment profile.

[0206] Clause 15. A system as described in any of clauses 1 to 14, wherein the processor is configured to compare a target tissue resection profile of the first tissue with a measured tissue resection profile of the first tissue and output a comparison of the target tissue resection profile and the measured tissue resection profile.

[0207] Clause 16. A system as described in any of clauses 1 to 15, wherein the processor is configured to measure movement of the second tissue in response to energy from the energy source and to adjust one or more of the energy source, movement of the energy source, or the treatment profile in response to the movement of the second tissue.

[0208] Clause 17. A system as described in any of clauses 1 to 16, wherein the first tissue comprises tissue of a first organ and the second tissue comprises tissue of a second organ different from the first organ, and wherein the processor is configured to process image data from the tissue of the second organ and output data corresponding to a response of the second tissue to the energy source directed to the tissue of the first organ.

[0209] Clause 18. A system as described in any of clauses 1 to 17, wherein the first tissue comprises a first tissue structure and the second tissue comprises a second tissue structure different from the first tissue structure, and wherein the processor is configured to adjust one or more of the energy source or the treatment profile of the first tissue structure in response to image data from the second tissue structure.

[0210] Clause 19. A system as described in any of clauses 1 to 18, wherein the image data from the second tissue structure includes one or more of the following: a shape outline of the second tissue structure, a contrast of the second tissue structure, a blur of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure.

[0211] Clause 20. A system as described in any of clauses 1 to 19, wherein the image data from the second tissue structure includes a first image at a first time and a second image at a second time, and the processor is configured to determine, based on the first image and the second image, one or more of a shape contour of the second tissue structure, a contrast of the second tissue structure, a blur of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure in response to a change in the energy source being directed to the first tissue.

[0212] Clause 21. The system of any one of clauses 1 to 20, wherein the second tissue structure comprises one or more connective tissue, muscle tissue, epithelial tissue, muscle tissue, or anatomical structures associated with contrast in the image data.

[0213] Clause 22. A system as described in any of clauses 1 to 21, wherein the second tissue structure comprises a second type of tissue adjacent to a third type of tissue or adjacent to a fluid to provide the contrast in image data from the second tissue structure, and optionally wherein the fluid comprises a liquid.

[0214] Clause 23. A system as described in any of clauses 1 to 22, wherein the anatomical structure of the second tissue structure includes one or more of the following: tissue wall, vesicle, lumen, lumen wall, bladder, bladder wall, bladder neck, bladder neck wall, trigone tissue, ureteral orifice, internal urethral orifice, external urethral sphincter, ureter, ureteral wall, prostate, prostate lobe, intravesical prostatic protuberance, prostate capsule, prostate spermatophore, internal sphincter and external sphincter, artery, arterial wall, vein, vein wall, retina of the eye.

[0215] Clause 24. The system of any of clauses 1-23, wherein the anatomical structure of the first tissue structure comprises one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesicular prostate protrusion, a prostate capsule, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, a lens of an eye.

[0216] Clause 25. The system of any of clauses 1-24, wherein the second tissue structure comprises a tissue wall facing the first tissue structure, and wherein the processor is configured to adjust one or more of the treatment profile or the energy source in response to image data from the tissue wall.

[0217] Clause 26. The system of any of clauses 1-25, wherein the first tissue structure comprises a tissue wall spaced apart from a wall of the second tissue structure, a gap extending between the tissue wall and the second tissue structure, and wherein the processor is configured with instructions to adjust one or more of the treatment profile or the energy source in response to image data from the wall of the second tissue structure.

[0218] Clause 27. The system of any of clauses 1-26, wherein the image data from the tissue wall comprises one or more of: a shape profile of the tissue wall, a contrast of the tissue wall, a blur of the tissue wall, a movement of the tissue wall, a deflection of the tissue wall, or a deformation of the tissue wall.

[0219] Clause 28. The system of any of clauses 1-27, wherein the processor is configured to process image data from one or more of the first tissue or the second tissue with one or more of: an artificial intelligence algorithm, image enhancement, image segmentation, a neural network, a convolutional neural network, a transformer, a transformer machine learning model, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion.

[0220] Clause 29. The system of any of clauses 1-28, wherein the energy source comprises one or more of: an electrode; a ring electrode; a laser source; a mechanical energy source; a mechanical shears; an ultrasound probe; a cavitation ultrasound probe; a water jet, such as a fixed pressure water jet; a plasma source; a steam source; a pulverizer; a transurethral needle; a light ablation source; a radiant energy source; a microwave energy source; or a water jet evacuation source.

[0221] Clause 30. The system of any of clauses 1 to 29, wherein the imaging device comprises one or more of: an ultrasound transducer array, an external ultrasound transducer array, an ultrasound transducer array on a probe comprising the energy source, an ultrasound probe, an elongate ultrasound probe sized to be placed in a lumen, a transrectal ultrasound probe, a transvaginal ultrasound probe, a magnetic resonance imaging, a magnetic resonance probe, an endoscope, or a fluorescence imaging device.

[0222] Clause 31. The system of any of clauses 1 to 30, wherein the image data comprises one or more of longitudinal image data, sagittal image data, transverse image data, or 3D ultrasound image data, and optionally wherein the image data comprises real-time image data.

[0223] Clause 32. The system of any of clauses 1 to 31, wherein the image data comprises a first image from a first time and a second image from a second time, the first and second images showing the probe, the first tissue, and the second tissue, and wherein the second tissue moves between the first and second images in response to energy delivered to the first tissue.

[0224] Clause 33. The system of any of clauses 1 to 32, wherein the first image comprises a first longitudinal image and the second image comprises a second longitudinal image, and the probe comprises an elongate probe shown extending along the first and second longitudinal images.

[0225] Clause 34. The system of any of clauses 1 to 33, wherein the first longitudinal image comprises a first sagittal image, the second longitudinal image comprises a second sagittal image, the elongate probe is shown extending along the first and second sagittal images.

[0226] Clause 35. The system of any of clauses 1 to 34, wherein the image data comprises a series of real-time images, and optionally wherein the series of real-time images comprises a frame rate in a range of about 5 Hertz (Hz) to about 250 Hz and a delay from when imaging energy is released from the imaging device until an image is shown on a display in a range of about 10 milliseconds (ms) to about 1000 ms.

[0227] Clause 36. The system of any of clauses 1 to 35, wherein the processor is configured to scan energy from the energy source at a scan rate on the first tissue, and the second tissue moves in accordance with the scan rate.

[0228] Clause 37. The system of any of clauses 1 to 36, wherein the scan rate comprises an angular sweep rate, and the second tissue moves according to the angular sweep rate.

[0229] Clause 38. The system of any of clauses 1 to 37, wherein the processor is configured to determine an amount of movement of the second tissue corresponding to the sweep rate, and optionally wherein the processor is configured to correlate movement of the second tissue with the angular sweep rate.

[0230] Clause 39. The system of any of clauses 1 to 38, wherein the sweep rate is in a range of about 0.25 Hz to about 30 Hz, and an angle of each sweep is in a range of about 10 degrees to about 240 degrees.

[0231] Clause 40. The system of any of clauses 1 to 39, wherein the energy source comprises a water jet, the first tissue comprises a bladder-inlaid lobe of a prostate extending at least partially into a portion of a bladder, the second tissue comprises trigone tissue, and the processor is configured to process image data from the trigone tissue and output data corresponding to a response of the trigone tissue to energy directed to the bladder-inlaid lobe of the prostate, and optionally wherein the lobe comprises a middle lobe of the prostate.

[0232] Clause 41. The system of any of clauses 1 to 40, further comprising a linkage coupled to the processor and the energy source to move the energy source according to the treatment profile.

[0233] Clause 42. The system of any of clauses 1 to 41, wherein the treatment probe is coupled to a first linkage and an ultrasound device is coupled to a second linkage, and the processor is configured to move the energy source according to the treatment profile and move the imaging device with the energy source to maintain the second tissue within a field of view of the imaging device.

[0234] Clause 43. The system of any of clauses 1 to 42, wherein the processor is configured to move the imaging device synchronously with the energy source to maintain the second tissue within a field of view of the imaging device.

[0235] Clause 44. The system of any of clauses 1 to 43, wherein the image data comprises a plurality of lateral images of the treatment probe, the first tissue, and the second tissue, and wherein the processor is configured to move the imaging device to maintain the energy source, the first tissue, and the second tissue within a lateral field of view of the imaging device.

[0236] Clause 45. A method for treating tissue of a subject, the method comprising: directing energy from an energy source to a first tissue to treat the first tissue; acquiring image data from the first tissue and a second tissue proximate to the first tissue with an imaging device; and processing image data from the second tissue with a processor; and outputting data corresponding to a response of the second tissue to the energy source directed to the first tissue.

[0237] Clause 46. The method of clause 45, wherein the processor adjusts one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0238] Clause 47. The method of any of clauses 45-46, wherein the processor automatically adjusts one or more of the treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0239] Clause 48. The method of any of clauses 45-47, wherein the processor outputs data to a user interface in response to image data from the second tissue, and receives input from a user to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to input from the user.

[0240] Clause 49. The method of any of clauses 45-48, wherein the processor comprises components of a feedback loop for adjusting one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

[0241] Clause 50. The method of any of clauses 45-49, wherein the energy source is adjusted by one or more of: movement, rotation, translation, angular velocity, translational velocity, energy from energy source, power from energy source, pump power, laser power, or electrical power.

[0242] Clause 51. The method of any of clauses 45-50, wherein the processor adjusts the energy source to treat the first tissue with reduced interaction of the energy source with the second tissue in response to image data from the second tissue.

[0243] Clause 52. The method of any of clauses 45-51, wherein the processor adjusts the energy source to treat the first tissue with increased interaction of the energy source with the second tissue in response to image data from the second tissue.

[0244] Clause 53. The method of any of clauses 45-52, wherein the first tissue is treated according to a treatment contour, and the treatment contour is adjusted in response to image data from the second tissue.

[0245] Clause 54. The method of any of clauses 45-53, wherein the first tissue is treated according to a first treatment contour, and the first treatment contour is adjusted in response to image data from the second tissue to generate a second tissue contour.

[0246] Clause 55. The method of any of clauses 45-54, wherein the first treatment contour includes a first closest distance to the second tissue, the first closest distance defining a first gap between the first treatment contour and the second tissue, and wherein the second treatment contour includes a second closest distance to the second tissue, the second closest distance defining a second gap between the second treatment contour and the second tissue, the first gap being different than the second gap.

[0247] Clause 56. The method of any of clauses 45-55, wherein the first gap is less than the second gap.

[0248] Clause 57. The method of any of clauses 45-56, wherein the first gap is greater than the second gap.

[0249] Clause 58. The method of any of clauses 45-57, wherein the first treatment contour comprises a three-dimensional (“3D”) treatment contour, and the second treatment contour comprises a 3D treatment contour.

[0250] Clause 59. The method of any of clauses 45-58, wherein the processor is configured to compare a target tissue resection contour of the first tissue to a measured tissue resection contour of the first tissue, and output a comparison of the target tissue resection contour to the measured tissue resection contour.

[0251] Clause 60. The method of any of clauses 45-59, wherein movement of the second tissue is measured in response to energy from the energy source, and one or more of the energy source, movement of the energy source, or the treatment contour is adjusted in response to the movement of the second tissue.

[0252] Clause 61. The method of any of clauses 45-60, wherein the first tissue comprises tissue of a first organ and the second tissue comprises tissue of a second organ different from the first organ, and wherein the processor is configured to process image data from the tissue of the second organ and output data corresponding to a response of the second tissue to the energy source directed to the tissue of the first organ.

[0253] Clause 62. The method of any of clauses 45-61, wherein the first tissue comprises a first tissue structure and the second tissue comprises a second tissue structure different from the first tissue structure, and wherein the processor is configured to adjust one or more of the energy source or a treatment profile of the first tissue structure in response to image data from the second tissue structure.

[0254] Clause 63. The method of any of clauses 45-62, wherein the image data from the second tissue structure comprises one or more of a shape profile of the second tissue structure, a contrast of the second tissue structure, a blurring of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure.

[0255] Clause 64. The method of any of clauses 45-63, wherein the image data from the second tissue structure comprises a first image at a first time and a second image at a second time, and the processor is configured to determine one or more of a shape profile of the second tissue structure, a contrast of the second tissue structure, a blurring of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure in response to a change in the energy source directed to the first tissue based on the first image and the second image.

[0256] Clause 65. The method of any of clauses 45-64, wherein the second tissue structure comprises one or more connective tissue, muscle tissue, epithelial tissue, muscle tissue, or an anatomical structure associated with contrast in the image data.

[0257] Clause 66. The method of any of clauses 45-65, wherein the second tissue structure comprises a second type of tissue adjacent to a third type of tissue or adjacent to a fluid to provide the contrast in the image data from the second tissue structure, and optionally wherein the fluid comprises a liquid.

[0258] Clause 67. The method of any of clauses 45-66, wherein the anatomical structure of the second tissue structure comprises one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, a prostate colliculus, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a retina of an eye.

[0259] Clause 68. The method of any of clauses 45-67, wherein the anatomical structure of the first tissue structure comprises one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a lens of an eye.

[0260] Clause 69. The method of any of clauses 45-68, wherein the second tissue structure comprises a tissue wall facing the first tissue structure, and wherein one or more of the treatment profile, movement of the energy source, or the energy source is adjusted in response to image data from the tissue wall.

[0261] Clause 70. The method of any of clauses 45-69, wherein the first tissue structure comprises a tissue wall spaced apart from a wall of the second tissue structure, a gap extending between the tissue wall and the second tissue structure, and wherein one or more of the treatment profile, movement of the energy source, or the energy source is adjusted in response to image data from the wall of the second tissue structure.

[0262] Clause 71. The method of any of clauses 45-70, wherein the image data from the tissue wall comprises one or more of: a shape profile of the tissue wall, a contrast of the tissue wall, a blur of the tissue wall, a movement of the tissue wall, a deflection of the tissue wall, or a deformation of the tissue wall.

[0263] Clause 72. The method of any of clauses 45-71, wherein the image data from one or more of the first tissue or the second tissue is processed with one or more of: an artificial intelligence algorithm, image enhancement, image segmentation, a neural network, a convolutional neural network, a transformer, a transformer machine learning model, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion.

[0264] Clause 73. A method as described in any of clauses 45 to 72, wherein the energy source includes one or more of the following: an electrode; a ring electrode; a laser source; a mechanical energy source; a mechanical shear; an ultrasonic probe; a cavitating ultrasonic probe; a water jet, such as a fixed pressure water jet; a plasma source; a steam source; a morcellator; a transurethral needle; a photoablation source; a radiation energy source; a microwave energy source; or a water jet evacuation source.

[0265] Clause 74. A method as described in any of clauses 45 to 73, wherein the imaging device comprises one or more of: an ultrasound transducer array, an external ultrasound transducer array, an ultrasound transducer array on a probe comprising the energy source, an ultrasound probe, an elongated ultrasound probe sized for placement in a lumen, a transrectal ultrasound probe, a transvaginal ultrasound probe, magnetic resonance imaging, a magnetic resonance probe, an endoscope, or a fluorescence imaging device.

[0266] Clause 75. A method as described in any of clauses 45 to 74, wherein the image data includes one or more of longitudinal image data, sagittal image data, transverse image data, or 3D ultrasound image data, and optionally wherein the image data includes real-time image data.

[0267] Clause 76. A method as described in any of clauses 45 to 75, wherein the image data includes a first image from a first time and a second image from a second time, the first image and the second image showing the probe, the first tissue and the second tissue, and wherein the second tissue moves between the first image and the second image in response to energy delivered to the first tissue.

[0268] Clause 77. The method of any one of clauses 45 to 76, wherein the first image comprises a first longitudinal image and the second image comprises a second longitudinal image, and the probe comprises an elongated probe shown extending along the first longitudinal image and the second longitudinal image.

[0269] Clause 78. The method of any one of clauses 45 to 77, wherein the first longitudinal image comprises a first sagittal image, the second longitudinal image comprises a second sagittal image, and the elongated probe is shown extending along the first sagittal image and the second sagittal image.

[0270] Clause 79. The method of any of clauses 45-78, wherein the image data comprises a series of real-time images, and optionally wherein the series of real-time images comprises a frame rate ranging from about 5 Hertz (Hz) to about 250 Hz and a latency ranging from about 10 milliseconds (ms) to about 1000 ms from when imaging energy is released from the imaging device until an image is shown on a display.

[0271] Clause 80. The method of any of clauses 45-79, wherein energy from the energy source is scanned over the first tissue at a scan rate, and the second tissue moves according to the scan rate.

[0272] Clause 81. The method of any of clauses 45-80, wherein the scan rate comprises an angular sweep rate, and the second tissue moves according to the angular sweep rate.

[0273] Clause 82. The method of any of clauses 45-81, wherein an amount of movement of the second tissue corresponding to the sweep rate is determined, and optionally, the movement of the second tissue is correlated to the angular sweep rate.

[0274] Clause 83. The method of any of clauses 45-82, wherein the sweep rate ranges from about 0.25 Hz to about 30 Hz, and an angle of each sweep ranges from about 10 degrees to about 240 degrees.

[0275] Clause 84. The method of any of clauses 45-83, wherein the energy source comprises a water jet, the first tissue comprises a bladder mid-leaf of a prostate extending at least partially into a portion of a bladder, the second tissue comprises trigone tissue, and image data from the trigone tissue is processed and data is output from the processed image data, the output data corresponding to a response of the trigone tissue to energy directed to the bladder mid-leaf of the prostate, and optionally wherein the leaf comprises a mid-leaf of the prostate.

[0276] Clause 85. The method of any of clauses 45-84, wherein a connection mechanism coupled to the processor and the energy source moves the energy source according to the treatment profile.

[0277] Clause 86. The method of any of clauses 45-85, wherein the treatment probe is coupled to a first connection mechanism, and an ultrasound device is coupled to a second connection mechanism, and the energy source is moved according to the treatment profile, and the imaging device is moved with the energy source to maintain the second tissue within a field of view of the imaging device.

[0278] Clause 87. The method of any one of clauses 45-86, wherein the processor is configured to move the imaging device in synchronization with the energy source to maintain the second tissue within a field of view of the imaging device.

[0279] Clause 88. The method of any one of clauses 45-87, wherein the image data comprises a plurality of lateral images of the treatment probe, the first tissue, and the second tissue, and wherein the imaging device is moved to maintain the energy source, the first tissue, and the second tissue within a lateral field of view of the imaging device.

[0280] Clause 89. A system for treating a subject, the system comprising: a probe comprising an energy source to direct energy to a first tissue to treat the first tissue; an imaging device configured to acquire image data from the first tissue and a second tissue proximate to the first tissue; and a processor coupled to the energy source and the imaging device, the processor configured to process the image data from the second tissue and output data related to a stretch of the second tissue in response to a placement of the probe.

[0281] Clause 90. The system of clause 89, wherein the first tissue comprises tissue of a first organ and the second tissue comprises tissue of a second organ.

[0282] Clause 91. The system of any one of clauses 89-90, wherein the processor is configured to output the data related to the stretch of the second tissue to a user interface.

[0283] Clause 92. The system of any one of clauses 89-91, wherein the processor is configured to output one or more of an alert, a notification, or a message to a user to adjust one or more of an angle, a position, or a pose of the probe.

[0284] Clause 93. The system of any one of clauses 89-92, wherein the processor is configured to receive an input from the user related to a response of the user to one or more of the alert, the notification, or the message.

[0285] Clause 94. The system of any one of clauses 89-93, wherein the processor is configured to adjust one or more of a placement, an angle, a position, or a six degrees of freedom (6 DOF) pose of the probe in response to data related to a stretch of the probe.

[0286] Clause 95. The system of any one of clauses 89 to 94, further comprising a connection mechanism coupled to the probe and the processor, the connection mechanism configured to adjust one or more of the placement, angle, position, or 6 DOF posture of the probe.

[0287] Clause 96. The system of any one of clauses 89 to 95, wherein the connection mechanism comprises a connection mechanism of a robotic arm.

[0288] Clause 97. A system as described in any of clauses 89 to 96, wherein the processor includes instructions for causing the first module to output data related to stretching of the second tissue, and for causing the second module to receive data related to stretching of the second tissue and adjust one or more of the angle, position, or 6 DOF posture of the probe.

[0289] Clause 98. A system as described in any of clauses 89 to 97, wherein the processor is configured to output data related to stretching of the second tissue to a user interface and receive user input responsive to the data provided to the user interface, and adjust one or more of the placement, angle, position, or posture of the probe responsive to the user input.

[0290] Clause 99. A system as described in any of clauses 89 to 98, wherein the first tissue comprises tissue of a first organ, the second tissue comprises tissue of a second organ, and wherein the processor is configured to output data corresponding to stretching of the probe in response to the tissue of the second organ engaging the tissue of the first organ.

[0291] Clause 100. A system as described in any of clauses 89 to 99, wherein the first tissue includes a first tissue structure capable of being detected in the image data, and the processor is configured to identify the first tissue structure and compare contour data of the first tissue structure with reference contour data to determine stretching of the first tissue.

[0292] Clause 101. The system of any one of clauses 89 to 100, wherein the reference contour data comprises data from a first image of the tissue prior to placement of the probe.

[0293] Clause 102. The system of any one of clauses 89 to 101, wherein the first tissue comprises a first tissue structure detectable in the image data, and the second tissue comprises a second tissue structure detectable in the image data.

[0294] Clause 103. The system of any of clauses 89 to 102, wherein the probe is configured to direct the energy source to the first tissue structure, and the processor is configured to identify the second tissue structure and compare profile data of the second tissue structure to reference profile data to determine a stretch of the second tissue.

[0295] Clause 104. The system of any of clauses 89 to 103, wherein the reference profile data comprises data from a first image of the tissue prior to placement of the probe.

[0296] Clause 105. The system of any of clauses 89 to 104, wherein the second tissue structure comprises a wall, and the processor is configured to compare profile data of the wall to reference wall profile data to determine a stretch of the wall.

[0297] Clause 106. The system of any of clauses 89 to 105, further comprising one or more sensors coupled to the probe to detect a force from the probe engaging the tissue.

[0298] Clause 107. The system of any of clauses 89 to 106, wherein the one or more sensors are configured to detect tissue pulling on the probe.

[0299] Clause 108. The system of any of clauses 89 to 107, wherein the tissue pulling on the probe comprises a wall of a lumen.

[0300] Clause 109. The system of any of clauses 89 to 108, wherein the wall comprises a urethral wall.

[0301] Clause 110. A method of detecting a stretch of tissue in a subject, the method comprising: acquiring, from an imaging device, image data of a first tissue and a second tissue proximate to the first tissue with a probe placed in the first tissue, the probe comprising an energy source for directing energy to the first tissue to treat the first tissue; and processing, with a processor, the image data from the second tissue to generate output data related to a stretch of the second tissue in response to the placement of the probe in the first tissue.

[0302] Clause 111. The method of clause 110, wherein the first tissue comprises tissue of a first organ and the second tissue comprises tissue of a second organ.

[0303] Clause 112. The method of any of clauses 110-111, wherein the processor outputs the data related to the stretch of the second tissue to a user interface.

[0304] Clause 113. The method of any of clauses 110-112, wherein the processor outputs one or more of an alert, a notification, or a message to a user to adjust one or more of an angle, a position, or a pose of the probe.

[0305] Clause 114. The method of any of clauses 110-113, wherein the processor receives input from the user related to the user’s response to one or more of the alert, the notification, or the message.

[0306] Clause 115. The method of any of clauses 110-114, wherein one or more of a placement, an angle, a position, or a six degree of freedom (6 DOF) pose of the probe is adjusted in response to data related to the stretch of the probe.

[0307] Clause 116. The method of any of clauses 110-115, further comprising a connection mechanism coupled to the probe and the processor, the connection mechanism configured to adjust one or more of a placement, an angle, a position, or a 6 DOF pose of the probe.

[0308] Clause 117. The method of any of clauses 110-116, wherein the connection mechanism comprises a connection mechanism of a robotic arm.

[0309] Clause 118. The method of any of clauses 110-117, wherein the processor comprises instructions to cause a first module to output data related to the stretch of the second tissue and to cause a second module to receive the data related to the stretch of the second tissue and adjust one or more of an angle, a position, or a 6 DOF pose of the probe.

[0310] Clause 119. The method of any of clauses 110-118, wherein the processor is configured to output data related to the stretch of the second tissue to a user interface and receive user input in response to the data provided to the user interface, and adjust one or more of a placement, an angle, a position, or a pose of the probe in response to the user input.

[0311] Clause 120. The method of any of clauses 110-119, wherein the first tissue comprises tissue of a first organ, the second tissue comprises tissue of a second organ, and wherein the processor is configured to output data corresponding to a stretch of the tissue of the second organ in response to the tissue of the first organ engaging the probe.

[0312] Clause 121. The method of any of clauses 110-120, wherein the first tissue comprises a first tissue structure detectable in the image data, and the processor is configured to identify the first tissue structure and compare profile data of the first tissue structure to reference profile data to determine a stretch of the first tissue.

[0313] Clause 122. The method of any of clauses 110-121, wherein the reference profile data comprises data from a first image of the tissue prior to placement of the probe.

[0314] Clause 123. The method of any of clauses 110-122, wherein the first tissue comprises a first tissue structure detectable in the image data, and the second tissue comprises a second tissue structure detectable in the image data.

[0315] Clause 124. The method of any of clauses 110-123, wherein the probe is configured to direct the energy source to the first tissue structure, and the processor is configured to identify the second tissue structure and compare profile data of the second tissue structure to reference profile data to determine a stretch of the second tissue.

[0316] Clause 125. The method of any of clauses 110-124, wherein the reference profile data comprises data from a first image of the tissue prior to placement of the probe.

[0317] Clause 126. The method of any of clauses 110-125, wherein the second tissue structure comprises a wall, and the processor is configured to compare profile data of the wall to reference wall profile data to determine a stretch of the wall.

[0318] Clause 127. The method of any of clauses 110-126, wherein one or more sensors coupled to the probe detect a force from the probe engaging the tissue.

[0319] Clause 128. The method of any of clauses 110-127, wherein the one or more sensors detect a tissue pulling the probe.

[0320] Clause 129. The method of any of clauses 110-128, wherein the pulling of the probe by the tissue comprises a wall of a lumen.

[0321] Clause 130. The method of any of clauses 110-129, wherein the wall comprises a urethral wall.

[0322] Clause 131. A system for treating tissue of a subject, the system comprising: a probe comprising an energy source for directing energy to the tissue to treat the tissue, the probe sized to be inserted into the subject; an arm coupled to the probe to support the probe; one or more sensors coupled to the probe to measure a force from the tissue pulling the probe; a processor coupled to the one or more sensors, the processor configured to output data related to the force from the tissue pulling the probe to a user interface.

[0323] Clause 132. The system of clause 131, wherein the arm and the probe form a fixed pose when the sensor measures the force and the processor provides the data.

[0324] Clause 133. The system of any of clauses 131-132, wherein the arm comprises a robotic arm.

[0325] Clause 134. The system of any of clauses 131-133, wherein the arm comprises a manually movable arm configured to allow a user to move the arm to reduce the force from the tissue pulling the probe.

[0326] Clause 135. The system of any of clauses 131-134, wherein the processor is configured to determine a force vector corresponding to a direction of the tissue pulling the probe.

[0327] Clause 136. A method for treating tissue of a subject, the method comprising: receiving data from one or more sensors coupled to a probe to measure a force from the tissue pulling the probe, wherein the probe comprises an energy source for directing energy to the tissue to treat the tissue, wherein the probe is supported with an arm, wherein the probe is inserted into the subject; processing the sensor data to output data related to the force from the tissue pulling the probe to a user interface.

[0328] Clause 137. The method of clause 136, wherein the arm and the probe comprise a fixed pose when the one or more sensors measure the force of the tissue pulling the probe.

[0329] Clause 138. The method of any of clauses 136-137, wherein the arm comprises a robotic arm.

[0330] Clause 139. The method of any of clauses 136-138, wherein the arm comprises a manually movable arm configured to allow a user to move the arm to reduce the force from the tissue to the sensor.

[0331] Clause 140. The method of any of clauses 136-139, wherein the processor is configured to determine a vector corresponding to a direction in which the tissue pulls the probe.

[0332] Clause 141. A computer readable medium configured to perform the method of any of the preceding claims.

[0333] Clause 142. A system comprising a processor configured to perform the method of any of the preceding claims.

[0334] Embodiments of the present disclosure have been shown and described as illustrated herein, and are provided by way of example only. Numerous adaptations, changes, variations, and alternatives to those embodiments will become apparent to those of ordinary skill in the art without departing from the scope of the present disclosure. Several alternatives and combinations are disclosed herein. It is intended that the scope of the presently disclosed application be limited only by the appended claims and their equivalents.

Claims

1. A system for treating tissue of a subject, the system comprising: a probe comprising an energy source for directing energy to a first tissue to treat the first tissue; an imaging device configured to acquire image data from the first tissue and a second tissue proximate to the first tissue; as well as A processor is coupled to the energy source and the imaging device, the processor being configured to process the image data from the second tissue and output data corresponding to a response of the second tissue to the energy source directed to the first tissue.

2. The system of claim 1, wherein: The processor is configured to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

3. The system of claim 2, wherein: The processor is configured to automatically adjust one or more of the treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

4. The system of claim 1, wherein: The processor is configured to output data to a user interface in response to image data from the second tissue, and to receive input from a user to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to the input from the user.

5. The system of claim 1, wherein: The processor includes components of a feedback loop for adjusting one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

6. The system of claim 1, wherein: The energy source is modulated by one or more of: movement, rotation, translation, angular velocity, translation velocity, energy from the energy source, power from the energy source, pump power, laser power, or electrical power.

7. The system of claim 6, wherein: The processor is configured to adjust the energy source in response to image data from the second tissue to treat the first tissue with reduced interaction of the energy source with the second tissue.

8. The system of claim 6, wherein: The processor is configured to adjust the energy source in response to image data from the second tissue to treat the first tissue with increased interaction of the energy source with the second tissue.

9. The system of claim 1, wherein: The processor is configured to treat the first tissue according to a treatment profile and to adjust the treatment profile in response to image data from the second tissue.

10. The system of claim 1, wherein: The processor is configured to treat the first tissue according to a first treatment profile and to adjust the first treatment profile in response to image data from the second tissue to generate a second tissue profile.

11. The system of claim 10, wherein: The first treatment profile includes a first closest distance to the second tissue, the first closest distance defining a first gap between the first treatment profile and the second tissue, and wherein the second treatment profile includes a second closest distance to the second tissue, the second closest distance defining a second gap between the second treatment profile and the second tissue, the first gap being different from the second gap.

12. The system of claim 11, wherein: The first gap is smaller than the second gap.

13. The system of claim 11, wherein: The first gap is larger than the second gap.

14. The system of claim 10, wherein: The first treatment profile comprises a three-dimensional ("3D") treatment profile, and the second treatment profile comprises a 3D treatment profile.

15. The system of claim 1, wherein: The processor is configured to compare a target tissue resection profile for the first tissue with a measured tissue resection profile for the first tissue and output a comparison of the target tissue resection profile and the measured tissue resection profile.

16. The system of claim 1, wherein: The processor is configured to measure movement of the second tissue in response to energy from the energy source and adjust one or more of the energy source, movement of the energy source, or the treatment profile in response to the movement of the second tissue.

17. The system of claim 1, wherein: The first tissue comprises tissue of a first organ and the second tissue comprises tissue of a second organ different from the first organ, and wherein the processor is configured to process image data from the tissue of the second organ and output data corresponding to a response of the second tissue to the energy source directed to the tissue of the first organ.

18. The system of claim 1, wherein: The first tissue includes a first tissue structure and the second tissue includes a second tissue structure different from the first tissue structure, and wherein the processor is configured to adjust one or more of the energy source or the treatment profile of the first tissue structure in response to image data from the second tissue structure.

19. The system of claim 18, wherein: The image data from the second tissue structure includes one or more of: a shape outline of the second tissue structure, a contrast of the second tissue structure, a blur of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure.

20. The system of claim 19, wherein: The image data from the second tissue structure includes a first image at a first time and a second image at a second time, and the processor is configured to determine, based on the first image and the second image, one or more of a shape contour of the second tissue structure, a contrast of the second tissue structure, a blur of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure in response to the energy source being directed to the first tissue.

21. The system of claim 18, wherein: The second tissue structure includes one or more of connective tissue, muscle tissue, epithelial tissue, muscle tissue, or anatomical structures associated with contrast in the image data.

22. The system of claim 21, wherein: The second tissue structure comprises tissue of the second type adjacent to tissue of a third type or adjacent to a fluid to provide said contrast in image data from the second tissue structure, and optionally wherein the fluid comprises a liquid.

23. The system of claim 21, wherein: The anatomical structure of the second tissue structure includes one or more of the following: tissue wall, vesicle, lumen, lumen wall, bladder, bladder wall, bladder neck, bladder neck wall, trigone tissue, ureteral orifice, internal urethral orifice, external urethral sphincter, ureter, ureteral wall, prostate, prostate lobe, intravesical prostatic protuberance, prostate capsule, prostate spermatophore, internal sphincter and external sphincter, artery, arterial wall, vein, vein wall, retina of the eye.

24. The system of claim 21, wherein: The anatomical structure of the first tissue structure includes one or more of the following: tissue wall, vesicle, lumen, lumen wall, bladder, bladder wall, bladder neck, bladder neck wall, ureteral orifice, internal urethral orifice, external urethral sphincter, ureter, ureteral wall, prostate, prostate lobe, intravesical prostatic protuberance, prostate capsule, internal sphincter and external sphincter, artery, arterial wall, vein, vein wall, lens of the eye.

25. The system of claim 18, wherein: The second tissue structure includes a tissue wall facing the first tissue structure, and wherein the processor is configured to adjust one or more of the treatment profile or the energy source in response to image data from the tissue wall.

26. The system of claim 25, wherein: The first tissue structure includes a tissue wall that is spaced apart from a wall of the second tissue structure with a gap extending between the tissue wall and the second tissue structure, and wherein the processor is configured with instructions to adjust one or more of the treatment profile or the energy source in response to image data from the wall of the second tissue structure.

27. The system of claim 25, wherein: The image data from the tissue wall includes one or more of: a shape outline of the tissue wall, a contrast of the tissue wall, a blur of the tissue wall, a movement of the tissue wall, a deflection of the tissue wall, or a deformation of the tissue wall.

28. The system of claim 1, wherein: The processor is configured to process image data from one or more of the first tissue or the second tissue using one or more of the following: artificial intelligence algorithms, image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multimodal image fusion.

29. The system of claim 1, wherein: The energy source includes one or more of the following: an electrode; a ring electrode; a laser source; a mechanical energy source; a mechanical shear; an ultrasonic probe; a cavitating ultrasonic probe; a water jet, such as a fixed pressure water jet; a plasma source; a steam source; a pulverizer; a transurethral needle; a photoablation source; a radiation energy source; a microwave energy source; or a water jet evacuation source.

30. The system of claim 1, wherein: The imaging device includes one or more of the following: an ultrasound transducer array, an external ultrasound transducer array, an ultrasound transducer array on a probe including the energy source, an ultrasound probe, an elongated ultrasound probe sized to be placed in a lumen, a transrectal ultrasound probe, a transvaginal ultrasound probe, magnetic resonance imaging, a magnetic resonance probe, an endoscope, or a fluorescence imaging device.

31. The system of claim 1, wherein: The image data comprises one or more of longitudinal image data, sagittal image data, transverse image data, or 3D ultrasound image data, and optionally wherein the image data comprises real-time image data.

32. The system of claim 1, wherein: The image data includes a first image from a first time and a second image from a second time, the first image and the second image showing the probe, the first tissue, and the second tissue, and wherein the second tissue moves between the first image and the second image in response to energy delivered to the first tissue.

33. The system of claim 32, wherein: The first image includes a first longitudinal image, and the second image includes a second longitudinal image, and the probe includes an elongated probe shown extending along the first longitudinal image and the second longitudinal image.

34. The system of claim 33, wherein: The first longitudinal image includes a first sagittal image, the second longitudinal image includes a second sagittal image, and the elongated probe is shown extending along the first sagittal image and the second sagittal image.

35. The system of claim 32, wherein: The image data comprises a series of real-time images, and optionally wherein the series of real-time images comprises a frame rate in the range of about 5 Hertz (Hz) to about 250 Hz and a delay in the range of about 10 milliseconds (ms) to about 1000 ms from when imaging energy is released from the imaging device until an image is shown on a display.

36. The system of claim 1, wherein: The processor is configured to scan energy from the energy source across the first tissue at a scan rate, and the second tissue moves according to the scan rate.

37. The system of claim 36, wherein: The scanning rate includes an angular sweep rate, and the second tissue moves according to the angular sweep rate.

38. The system of claim 37, wherein: The processor is configured to determine an amount of movement of the second tissue corresponding to the sweep rate, and optionally wherein the processor is configured to correlate the movement of the second tissue to the angular sweep rate.

39. The system of claim 37, wherein: The sweep rate is in a range of about 0.25 Hz to about 30 Hz, and the angle of each sweep is in a range of about 10 degrees to about 240 degrees.

40. The system of claim 1, wherein: The energy source comprises a water jet, the first tissue comprises an inner bladder lobe of a prostate extending at least partially into a portion of a bladder, the second tissue comprises trigone tissue, and the processor is configured to process image data from the trigone tissue and output data corresponding to a response of the trigone tissue to energy directed to the inner bladder lobe of the prostate, and optionally wherein the lobe comprises a median lobe of the prostate.

41. The system of claim 1, further comprising a coupling mechanism coupled to the processor and the energy source to move the energy source according to the treatment profile.

42. The system of claim 1, wherein: The treatment probe is coupled to a first coupling mechanism and the ultrasound device is coupled to a second coupling mechanism, and the processor is configured to move the energy source according to the treatment profile and to move the imaging device with the energy source to maintain the second tissue within a field of view of the imaging device.

43. The system of claim 42, wherein: The processor is configured to move the imaging device in synchronization with the energy source to maintain the second tissue within a field of view of the imaging device.

44. The system of claim 42, wherein: The image data includes a plurality of transverse images of the treatment probe, the first tissue, and the second tissue, and wherein the processor is configured to move the imaging device to maintain the energy source, the first tissue, and the second tissue within a transverse field of view of the imaging device.

45. A method for treating tissue in a subject, the method comprising: directing energy from an energy source to a first tissue to treat the first tissue; acquiring image data from the first tissue and a second tissue proximate to the first tissue using an imaging device; as well as processing the image data from the second tissue with a processor; as well as Data corresponding to a response of the second tissue to the energy source directed to the first tissue is output.

46. ​​The method of claim 1, wherein The processor adjusts one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

47. The method of claim 46, wherein The processor automatically adjusts one or more of the treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

48. The method of claim 1, wherein The processor outputs data to a user interface in response to image data from the second tissue, and receives input from a user to adjust one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to the input from the user.

49. The method of claim 1, wherein The processor includes components of a feedback loop for adjusting one or more of a treatment profile, movement of the energy source, or energy from the energy source in response to image data from the second tissue.

50. The method of claim 1, wherein The energy source is modulated by one or more of: movement, rotation, translation, angular velocity, translation velocity, energy from the energy source, power from the energy source, pump power, laser power, or electrical power.

51. The method of claim 50, wherein: The processor adjusts the energy source in response to image data from the second tissue to treat the first tissue with reduced interaction of the energy source with the second tissue.

52. The method of claim 50, wherein: The processor adjusts the energy source in response to image data from the second tissue to treat the first tissue with increased interaction of the energy source with the second tissue.

53. The method of claim 1, wherein The first tissue is treated according to a treatment profile, and the treatment profile is adjusted in response to image data from the second tissue.

54. The method of claim 1, wherein The first tissue is treated according to a first treatment profile, and the first treatment profile is adjusted in response to image data from the second tissue to generate a second tissue profile.

55. The method of claim 54, wherein The first treatment profile includes a first closest distance to the second tissue, the first closest distance defining a first gap between the first treatment profile and the second tissue, and wherein the second treatment profile includes a second closest distance to the second tissue, the second closest distance defining a second gap between the second treatment profile and the second tissue, the first gap being different from the second gap.

56. The method of claim 55, wherein: The first gap is smaller than the second gap.

57. The method of claim 55, wherein: The first gap is larger than the second gap.

58. The method of claim 54, wherein: The first treatment profile comprises a three-dimensional ("3D") treatment profile, and the second treatment profile comprises a 3D treatment profile.

59. The method of claim 1, wherein The processor is configured to compare a target tissue resection profile for the first tissue with a measured tissue resection profile for the first tissue and output a comparison of the target tissue resection profile and the measured tissue resection profile.

60. The method of claim 1, wherein Movement of the second tissue is measured in response to energy from the energy source, and one or more of the energy source, movement of the energy source, or the treatment profile is adjusted in response to the movement of the second tissue.

61. The method of claim 1, wherein The first tissue comprises tissue of a first organ and the second tissue comprises tissue of a second organ different from the first organ, and wherein the processor is configured to process image data from the tissue of the second organ and output data corresponding to a response of the second tissue to the energy source directed to the tissue of the first organ.

62. The method of claim 1, wherein The first tissue includes a first tissue structure and the second tissue includes a second tissue structure different from the first tissue structure, and wherein the processor is configured to adjust one or more of the energy source or the treatment profile of the first tissue structure in response to image data from the second tissue structure.

63. The method of claim 62, wherein: The image data from the second tissue structure includes one or more of: a shape outline of the second tissue structure, a contrast of the second tissue structure, a blur of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure.

64. The method of claim 63, wherein The image data from the second tissue structure includes a first image at a first time and a second image at a second time, and the processor is configured to determine, based on the first image and the second image, one or more of a shape contour of the second tissue structure, a contrast of the second tissue structure, a blur of the second tissue structure, a movement of the second tissue structure, a deflection of the second tissue structure, or a deformation of the second tissue structure in response to the energy source being directed to the first tissue.

65. The method of claim 62, wherein The second tissue structure includes one or more of connective tissue, muscle tissue, epithelial tissue, muscle tissue, or anatomical structures associated with contrast in the image data.

66. The method of claim 65, wherein The second tissue structure comprises tissue of the second type adjacent to tissue of a third type or adjacent to a fluid to provide said contrast in image data from the second tissue structure, and optionally wherein the fluid comprises a liquid.

67. The method of claim 65, wherein The anatomical structure of the second tissue structure includes one or more of the following: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureteral wall, a prostate, a prostate lobe, an intravesical prostatic protuberance, a prostate capsule, a prostate spermatophore, an internal sphincter and an external sphincter, an artery, an arterial wall, a vein, a vein wall, or the retina of an eye.

68. The method of claim 65, wherein The anatomical structure of the first tissue structure includes one or more of the following: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureteral wall, a prostate, a prostate lobe, an intravesical prostatic protuberance, a prostate capsule, an internal sphincter and an external sphincter, an artery, an arterial wall, a vein, a vein wall, or a lens of an eye.

69. The method of claim 62, wherein The second tissue structure includes a tissue wall facing the first tissue structure, and wherein one or more of the treatment profile, the movement of the energy source, or the energy source is adjusted in response to image data from the tissue wall.

70. The method of claim 69, wherein The first tissue structure includes a tissue wall that is spaced apart from a wall of the second tissue structure with a gap extending between the tissue wall and the second tissue structure, and wherein the treatment profile, the movement of the energy source, or one or more of the energy sources are adjusted in response to image data from the wall of the second tissue structure.

71. The method of claim 69, wherein The image data from the tissue wall includes one or more of: a shape outline of the tissue wall, a contrast of the tissue wall, a blur of the tissue wall, a movement of the tissue wall, a deflection of the tissue wall, or a deformation of the tissue wall.

72. The method of claim 45, wherein Image data from one or more of the first tissue or the second tissue is processed using one or more of the following: artificial intelligence algorithms, image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multimodal image fusion.

73. The method of claim 45, wherein: The energy source includes one or more of the following: an electrode; a ring electrode; a laser source; a mechanical energy source; a mechanical shear; an ultrasonic probe; a cavitating ultrasonic probe; a water jet, such as a fixed pressure water jet; a plasma source; a steam source; a pulverizer; a transurethral needle; a photoablation source; a radiation energy source; a microwave energy source; or a water jet evacuation source.

74. The method of claim 45, wherein The imaging device includes one or more of the following: an ultrasound transducer array, an external ultrasound transducer array, an ultrasound transducer array on a probe including the energy source, an ultrasound probe, an elongated ultrasound probe sized to be placed in a lumen, a transrectal ultrasound probe, a transvaginal ultrasound probe, magnetic resonance imaging, a magnetic resonance probe, an endoscope, or a fluorescence imaging device.

75. The method of claim 45, wherein The image data comprises one or more of longitudinal image data, sagittal image data, transverse image data, or 3D ultrasound image data, and optionally wherein the image data comprises real-time image data.

76. The method of claim 45, wherein The image data includes a first image from a first time and a second image from a second time, the first image and the second image showing the probe, the first tissue, and the second tissue, and wherein the second tissue moves between the first image and the second image in response to energy delivered to the first tissue.

77. The method of claim 76, wherein The first image includes a first longitudinal image, and the second image includes a second longitudinal image, and the probe includes an elongated probe shown extending along the first longitudinal image and the second longitudinal image.

78. The method of claim 77, wherein The first longitudinal image includes a first sagittal image, the second longitudinal image includes a second sagittal image, and the elongated probe is shown extending along the first sagittal image and the second sagittal image.

79. The method of claim 76, wherein The image data comprises a series of real-time images, and optionally wherein the series of real-time images comprises a frame rate in the range of about 5 Hertz (Hz) to about 250 Hz and a delay in the range of about 10 milliseconds (ms) to about 1000 ms from when imaging energy is released from the imaging device until an image is shown on a display.

80. The method of claim 45, wherein Energy from the energy source is scanned across the first tissue at a scan rate, and the second tissue moves according to the scan rate.

81. The method of claim 80, wherein The scanning rate includes an angular sweep rate, and the second tissue moves according to the angular sweep rate.

82. The method of claim 81, wherein An amount of movement of the second tissue corresponding to the sweep rate is determined, and optionally, the movement of the second tissue is correlated to the angular sweep rate.

83. The method of claim 81, wherein The sweep rate is in a range of about 0.25 Hz to about 30 Hz, and the angle of each sweep is in a range of about 10 degrees to about 240 degrees.

84. The method of claim 45, wherein The energy source comprises a water jet, the first tissue comprises a middle lobe of a prostate extending at least partially into a portion of a bladder, the second tissue comprises trigone tissue, and image data from the trigone tissue is processed and data is output from the processed image data, the output data corresponding to a response of the trigone tissue to energy directed to the middle lobe of the prostate, and optionally wherein the lobe comprises the middle lobe of the prostate.

85. The method of claim 45, wherein A connection mechanism coupled to the processor and the energy source moves the energy source according to the treatment profile.

86. The method of claim 45, wherein The treatment probe is coupled to a first coupling mechanism and an ultrasound device is coupled to a second coupling mechanism and moves the energy source according to the treatment profile and moves the imaging device with the energy source to maintain the second tissue within the field of view of the imaging device.

87. The method of claim 86, wherein The processor is configured to move the imaging device in synchronization with the energy source to maintain the second tissue within a field of view of the imaging device.

88. The method of claim 86, wherein The image data includes a plurality of transverse images of the treatment probe, the first tissue, and the second tissue, and wherein the imaging device is moved to maintain the energy source, the first tissue, and the second tissue within a transverse field of view of the imaging device.

89. A system for treating a subject, the system comprising: a probe comprising an energy source for directing energy to a first tissue to treat the first tissue; an imaging device configured to acquire image data from the first tissue and a second tissue proximate to the first tissue; as well as A processor is coupled to the energy source and the imaging device, the processor being configured to process image data from the second tissue and output data related to stretching of the second tissue in response to placement of the probe.

90. The system of claim 89, wherein: The first tissue includes tissue of a first organ, and the second tissue includes tissue of a second organ.

91. The system of claim 89, wherein: The processor is configured to output data related to the stretching of the second tissue to a user interface.

92. The system of claim 91, wherein: The processor is configured to output one or more of an alert, notification, or message to a user to adjust one or more of the angle, position, or posture of the probe.

93. The system of claim 92, wherein: The processor is configured to receive input from the user related to the user's response to one or more of the alert, the notification, or the message.

94. The system of claim 89, wherein The processor is configured to adjust one or more of a placement, angle, position, or six degrees of freedom (6 DOF) pose of the probe in response to data related to stretching of the probe.

95. The system of claim 94, further comprising a connection mechanism coupled to the probe and the processor, the connection mechanism configured to adjust one or more of the placement, angle, position, or 6 DOF posture of the probe.

96. The system of claim 95, wherein: The connecting mechanism includes a connecting mechanism of a robotic arm.

97. The system of claim 94, wherein The processor includes instructions for causing a first module to output data related to stretching of the second tissue and for causing a second module to receive data related to stretching of the second tissue and adjust one or more of an angle, position, or 6 DOF pose of the probe.

98. The system of claim 94, wherein: The processor is configured to output data related to stretching of the second tissue to a user interface and receive user input responsive to the data provided to the user interface, and adjust one or more of the placement, angle, position, or posture of the probe responsive to the user input.

99. The system of claim 89, wherein: The first tissue comprises tissue of a first organ, the second tissue comprises tissue of a second organ, and wherein the processor is configured to output data corresponding to stretching of the tissue of the second organ in response to the tissue of the first organ engaging the probe.

100. The system of claim 89, wherein The first tissue includes a first tissue structure detectable in the image data, and the processor is configured to identify the first tissue structure and compare contour data of the first tissue structure to reference contour data to determine stretching of the first tissue.

101. The system of claim 100, wherein: The reference contour data includes data from a first image of the tissue prior to placement of the probe.

102. The system of claim 89, wherein: The first tissue includes a first tissue structure detectable in the image data, and the second tissue includes a second tissue structure detectable in the image data.

103. The system of claim 102, wherein: The probe is configured to direct the energy source to the first tissue structure, and the processor is configured to identify the second tissue structure and compare contour data of the second tissue structure to reference contour data to determine stretching of the second tissue.

104. The system of claim 103, wherein: The reference contour data includes data from a first image of the tissue prior to placement of the probe.

105. The system of claim 102, wherein: The second tissue structure includes a wall, and the processor is configured to compare contour data of the wall with reference wall contour data to determine stretching of the wall.

106. The system of claim 89, further comprising one or more sensors coupled to the probe to detect force from the probe engaging the tissue.

107. The system of claim 99, wherein: The one or more sensors are configured to detect tissue pulling on the probe.

108. The system of claim 107, wherein: The tissue that pulls the probe includes a wall of a lumen.

109. The system of claim 108, wherein: The wall comprises a urethral wall.

110. A method of detecting tissue stretch in a subject, the method comprising: acquiring image data of a first tissue and a second tissue proximate to the first tissue from an imaging device with a probe positioned in the first tissue, the probe including an energy source for directing energy to the first tissue to treat the first tissue; as well as Image data from the second tissue is processed with a processor to generate output data related to stretching of the second tissue in response to placement of the probe in the first tissue.

111. The method of claim 110, wherein The first tissue includes tissue of a first organ, and the second tissue includes tissue of a second organ.

112. The method of claim 110, wherein: The processor outputs the data related to the stretching of the second tissue to a user interface.

113. The method of claim 112, wherein: The processor outputs one or more of an alert, notification, or message to a user to adjust one or more of the angle, position, or posture of the probe.

114. The method of claim 113, wherein The processor receives input from the user related to the user's response to one or more of the alert, the notification, or the message.

115. The method of claim 110, wherein One or more of a placement, angle, position, or six degrees of freedom (6 DOF) pose of the probe is adjusted in response to data related to the stretching of the probe.

116. The method of claim 115, further comprising a connection mechanism coupled to the probe and the processor, the connection mechanism configured to adjust one or more of a placement, angle, position, or 6DOF pose of the probe.

117. The method of claim 116, wherein The connecting mechanism includes a connecting mechanism of a robotic arm.

118. The method of claim 115, wherein The processor includes instructions for causing a first module to output data related to stretching of the second tissue and for causing a second module to receive data related to stretching of the second tissue and adjust one or more of an angle, position, or 6 DOF pose of the probe.

119. The method of claim 115, wherein The processor is configured to output data related to stretching of the second tissue to a user interface and receive user input responsive to the data provided to the user interface, and adjust one or more of the placement, angle, position, or posture of the probe responsive to the user input.

120. The method of claim 110, wherein The first tissue comprises tissue of a first organ, the second tissue comprises tissue of a second organ, and wherein the processor is configured to output data corresponding to stretching of the tissue of the second organ in response to the tissue of the first organ engaging the probe.

121. The method of claim 110, wherein The first tissue includes a first tissue structure detectable in the image data, and the processor is configured to identify the first tissue structure and compare contour data of the first tissue structure to reference contour data to determine stretching of the first tissue.

122. The method of claim 121, wherein The reference contour data includes data from a first image of the tissue prior to placement of the probe.

123. The method of claim 110, wherein The first tissue includes a first tissue structure detectable in the image data, and the second tissue includes a second tissue structure detectable in the image data.

124. The method of claim 123, wherein The probe is configured to direct the energy source to the first tissue structure, and the processor is configured to identify the second tissue structure and compare contour data of the second tissue structure to reference contour data to determine stretching of the second tissue.

125. The method of claim 124, wherein The reference contour data includes data from a first image of the tissue prior to placement of the probe.

126. The method of claim 123, wherein The second tissue structure includes a wall, and the processor is configured to compare contour data of the wall with reference wall contour data to determine stretching of the wall.

127. The method of claim 110, wherein One or more sensors coupled to the probe detect force from the probe engaging the tissue.

128. The method of claim 123, wherein The one or more sensors detect tissue pulling on the probe.

129. The method of claim 128, wherein The tissue that pulls the probe includes a wall of a lumen.

130. The method of claim 129, wherein The wall comprises a urethral wall.

131. A system for treating tissue in a subject, the system comprising: a probe comprising an energy source for directing energy to the tissue to treat the tissue, the probe being sized to be inserted into the subject; an arm coupled to the probe to support the probe; one or more sensors coupled to the probe to measure a force from the tissue pulling on the probe; A processor is coupled to the one or more sensors, the processor being configured to output data related to a force from the tissue pulling on the probe to a user interface.

132. The system of claim 131, wherein: The arm and probe form a fixed pose while the sensor measures the force and the processor provides the data.

133. The system of claim 131, wherein: The arm comprises a robotic arm.

134. The system of claim 131, wherein: The arm includes a manually movable arm configured to allow a user to move the arm to reduce a force from the tissue pulling on the probe.

135. The system of claim 131, wherein The processor is configured to determine a force vector corresponding to a direction in which the tissue pulls on the probe.

136. A method for treating tissue in a subject, the method comprising: receiving data from one or more sensors coupled to a probe to measure a force from the tissue pulling on the probe, wherein the probe includes an energy source for directing energy to the tissue to treat the tissue, wherein the probe is supported by an arm, wherein the probe is inserted into the subject; The sensor data is processed to output data related to a force from the tissue pulling on the probe to a user interface.

137. The method of claim 136, wherein The arm and the probe include a fixed pose when the one or more sensors measure a force of the tissue pulling on the probe.

138. The method of claim 136, wherein The arm comprises a robotic arm.

139. The method of claim 136, wherein The arm includes a manually movable arm configured to allow a user to move the arm to reduce a force from the tissue to the sensor.

140. The method of claim 136, wherein The processor is configured to determine a vector corresponding to a direction in which the tissue pulls the probe.

141. A computer readable medium configured to perform the method of any preceding claim.

142. A system comprising a processor configured to perform the method of any preceding claim.

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