Endoscope laser energy delivery system and method of use

Abstract

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

Description

[0001] This application is a divisional application of Chinese invention patent application No. 202080068269.7, filed on August 4, 2020, entitled "Endoscopic Laser Energy Transmission System and Method of Use".

[0002] Priority Statement

[0003] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 62 / 882,837, filed August 5, 2019, and U.S. Provisional Patent Application Serial No. 62 / 894,280, filed August 30, 2019, pursuant to 35 U.S. SC §119(e), the entire contents of which are incorporated herein by reference. Technical Field

[0004] This disclosure generally relates to endoscopic laser systems, and more specifically to systems and methods for controlling laser energy delivered to a target during endoscopic surgery. Background Technology

[0005] Endoscopes are typically used to provide access to the internal locations of a subject, thus providing a visual view for the physician. An endoscope is usually inserted into the patient, directing light towards the target being examined (e.g., a target anatomical structure or object) and collecting the light reflected from the object. The reflected light carries information about the object being examined. Some endoscopes include a working channel through which the operator can perform suction or transfer instruments such as brushes, biopsy needles, or forceps, or perform minimally invasive procedures to remove unwanted tissue or foreign bodies from the patient's body.

[0006] Laser or plasma systems have been used to deliver surgical laser energy to various targeted treatment areas, such as soft or hard tissues. Examples of laser therapy include ablation, coagulation, vaporization, and fragmentation. In lithotripsy applications, lasers have been used to break down stone structures in the kidneys, gallbladder, ureters, and other stone-forming areas, or to ablate large stones into smaller fragments. Summary of the Invention

[0007] This disclosure describes systems, apparatus, and methods for delivering laser energy to a target during endoscopic surgery. An exemplary method includes generating a first laser pulse train emitted from the distal end of an endoscope and incident on the target, and a distinct second laser pulse train. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level higher than the first laser energy level. In an example, the first laser pulse train is used to form a crack on the surface of a stone structure, and the second laser pulse train causes the stone structure to fragment after the crack formation.

[0008] Example 1 is a method for delivering laser therapy to a target, the method comprising: generating a first laser pulse train according to a first laser energy level, and generating a second laser pulse train according to a second laser energy level higher than the first laser energy level; and guiding the first and second laser pulse trains from a distal endoscope to the target.

[0009] In Example 2, the subject of Example 1 may optionally include: wherein a first laser pulse train is generated substantially constantly over a specific time period.

[0010] In Example 3, the subject matter of Example 2 may optionally include: wherein a second laser pulse train is generated intermittently during a specific time period during the generation of the first laser pulse train.

[0011] In Example 4, the subject matter of any one or more of Examples 1 to 3 may optionally include: wherein the second laser pulse train is located in time between two pulses of the first laser pulse train.

[0012] In Example 5, the subject matter of any one or more of Examples 1 to 4 may optionally include: generating a third laser pulse train based on a first laser energy level, wherein a second laser pulse train is located in time between the first laser pulse train and the third laser pulse train.

[0013] In Example 6, the subject matter of any one or more of Examples 1 to 5 may optionally include: directing a first laser pulse train and a second laser pulse train at the stone structure.

[0014] In Example 7, the subject matter of Example 6 may optionally include: a first laser pulse train configured to form a crack on the surface of the stone structure, and a second laser pulse train configured to cause the stone structure to fragment after the crack is formed.

[0015] In Example 8, the subject matter of any one or more of Examples 1 to 7 may optionally include: directing a first laser pulse train and a second laser pulse train at a target tissue for hemostasis or coagulation therein.

[0016] Example 9 is an apparatus comprising: at least one processor; and at least one non-transitory memory including computer program code, the at least one non-transitory memory and the computer program code being configured to use the at least one processor to cause the apparatus to: cause a laser system to emit a first laser pulse train according to a first laser energy level and to emit a second laser pulse train according to a second laser energy level higher than the first laser energy level; and to guide the first laser pulse train and the second laser pulse train from the distal end of an endoscope to a target location.

[0017] In Example 10, the subject of Example 9 may optionally include: the first laser pulse train is substantially constant over a specific time period.

[0018] In Example 11, the subject matter of Example 10 may optionally include: intermittently emitting a second laser pulse train during a specific time period during the generation of the first laser pulse train.

[0019] In Example 12, the subject matter of any one or more of Examples 9 to 11 may optionally include: wherein at least one non-transitory memory and computer program code are configured to utilize at least one processor to cause the apparatus to generate a second laser pulse train that is located in time between two pulses of the first laser pulse train.

[0020] In Example 13, the subject matter of any one or more of Examples 9 to 12 may optionally include: wherein at least one non-transitory memory and computer program code are configured to use at least one processor to cause the device to generate a third laser pulse train according to a first laser energy level, and to generate a second laser pulse train that is located in time between the first laser pulse train and the third laser pulse train.

[0021] In Example 14, the subject matter of any one or more of Examples 9 to 13 may optionally include: wherein at least one non-transitory memory and computer program code are configured to use at least one processor to cause the device to transmit a first laser pulse train and a second laser pulse train at the stone structure; and the first laser pulse train is configured to form a crack on the surface of the stone structure, and wherein the second laser pulse train is configured to cause the stone structure to fragment after the crack is formed.

[0022] In Example 15, the subject matter of any one or more of Examples 9 to 14 may optionally include: wherein at least one non-transitory memory and computer program code are configured to utilize at least one processor to enable the device to deliver a first laser pulse train and a second laser pulse train at a target tissue for hemostasis or coagulation therein.

[0023] Example 16 is a machine-readable, non-transitory program storage device that tangibly contains a machine-executable instruction program for performing operations including: generating a first laser pulse train according to a first laser energy level, and generating a second laser pulse train according to a second laser energy level higher than the first laser energy level; and guiding the first and second laser pulse trains from the distal end of an endoscope to a target location.

[0024] In Example 17, the subject matter of Example 16 may optionally include: wherein a first laser pulse train is generated substantially constantly over a specific time period, and a second laser pulse train is generated intermittently over a specific time period during the generation of the first laser pulse train.

[0025] In Example 18, the subject matter of any one or more of Examples 16 to 17 may optionally include: wherein the operation includes generating a third laser pulse train according to a first laser energy level, wherein a second laser pulse train is located in time between the first laser pulse train and the third laser pulse train.

[0026] In Example 19, the subject matter of any one or more of Examples 16 to 18 may optionally include: wherein the operation includes transmitting a first laser pulse train and a second laser pulse train at the stone structure; and wherein the first laser pulse train is configured to form a crack on the surface of the stone structure, and the second laser pulse train is configured to cause the stone structure to fragment after the crack is formed.

[0027] In Example 20, the subject matter of any one or more of Examples 16 to 19 optionally includes: wherein the operation includes delivering a first laser pulse train and a second laser pulse train to the target tissue for hemostasis or coagulation therein.

[0028] This invention description is an overview of some of the teachings of this application and is not intended to be exclusive or exhaustive of the subject matter. Further details regarding the subject matter can be found in the detailed description and the appended claims. Other aspects of this disclosure will become apparent to those skilled in the art upon reading and understanding the following detailed description and viewing the accompanying drawings, which form part of this disclosure, and none of these aspects should be considered limiting. The scope of this disclosure is defined by the appended claims and their legal equivalents. Attached Figure Description

[0029] Various embodiments are illustrated by way of example in the accompanying drawings. These embodiments are illustrative and are not intended to be exhaustive or exclusive embodiments of the subject matter.

[0030] Figure 1 A schematic diagram of an exemplary laser therapy system including a laser feedback control system is shown.

[0031] Figures 2A to 2B Examples of absorption spectra of different types of tissues, including hemoglobin (Hb) and oxyhemoglobin (HbO2), are shown.

[0032] Figures 3A to 3C Examples of absorption spectra of different types of tissues, including normal and carbonized tissues, Hb, HbO2, and melanin, are shown.

[0033] Figure 4 This is a graph showing the penetration depth of the laser output.

[0034] Figure 5 This is a block diagram illustrating a laser feedback control system used to provide laser output.

[0035] Figures 6 to 7 This is a flowchart illustrating an example of an algorithm for controlling one or more laser systems based on feedback generated by a laser feedback control system.

[0036] Figure 8 A timing diagram of an exemplary dual-laser system that uses two optical wavelengths to provide tissue ablation and coagulation is shown.

[0037] Figures 9A to 9B An example of an endoscope with a laser fiber inserted is shown.

[0038] Figures 10A to 10B An example of a laser therapy system with feedback control is shown.

[0039] Figures 11A to 11B This is a diagram illustrating an example of an endoscopic system used to identify targets using diagnostic beams such as laser beams.

[0040] Figure 12 and Figures 13A to 13B This is a graph showing the reflectance spectrum used to identify target types, such as components used to identify different types of kidney stones.

[0041] Figures 14 to 15 The light peaks corresponding to different portions of the UV wavelength are shown. Figures 13A to 13B The reflectance spectra of several types of stones.

[0042] Figures 16A to 16B Examples of reflectance spectra captured from various soft and hard tissue components on a UV-VIS spectrometer are shown.

[0043] Figure 16C An example of the FTIR spectrum of a typical rock composition is shown.

[0044] Figure 16D Examples of FTIR spectra of some soft tissue components and hard tissue components are shown.

[0045] Figures 17 to 18 A schematic diagram of a laser therapy system is shown.

[0046] Figures 19A to 19B An example of a combined laser pulse train generated using multiple (e.g., N) laser pulse trains is shown.

[0047] Figure 20 A schematic diagram of an exemplary spectroscopic system with spectroscopic feedback is shown.

[0048] Figures 21A to 21D An example of an endoscope laser system with a multi-fiber configuration is shown.

[0049] Figure 22This is a block diagram illustrating an example of a multi-fiber system used in a spectral fiber optic transmission system.

[0050] Figures 23A to 23B An example of a multi-fiber accessory with source light input and spectroscopic feedback signal is shown.

[0051] Figures 24A to 24D This is a diagram illustrating an exemplary method for calculating the distance between the far end of a laser transmission system (e.g., optical fiber) and a target.

[0052] Figures 25A to 25B The effect of the distance between the tissue and the distal end of the spectroscopic probe on the spectrum of reflected light from the target is shown.

[0053] Figure 26 An example of an endoscopic system for identifying targets using diagnostic beams such as laser beams is shown.

[0054] Figure 27 A diagram shows laser pulse sequences with different pulse energies or power levels used for laser treatment of target tissues or stone structures.

[0055] Figure 28 This is a block diagram illustrating an example machine on which any one or more of the techniques (e.g., methods) discussed herein can be performed. Detailed Implementation

[0056] This document describes systems, apparatus, and methods for delivering laser energy to a target during endoscopic surgery. An exemplary method includes providing a first laser pulse train emitted from the distal end of an endoscope and incident on a target, and a distinct second laser pulse train. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level higher than the first laser energy level. In an example, the first laser pulse train is used to create a crack on the surface of a stone structure, and the second laser pulse train causes the stone structure to fragment after the crack is created.

[0057] In endoscopic laser therapy, it is desirable to identify different tissues, apply laser energy only to the target treatment structure (e.g., cancerous tissue or a specific type of stone), and avoid or minimize exposure of non-treatment tissue (e.g., normal tissue) to laser irradiation. Conventionally, the identification of the target treatment structure of interest is performed manually by the operator, for example, by visualizing the target surgical site and its surroundings using an endoscope. Such manual methods may lack accuracy, at least in some cases, due to close access to the surgical site providing a limited surgical field, and may fail to determine the composition of the target. Biopsy techniques have been used to extract target structures (e.g., tissue) from within the body for in vitro analysis of their composition. However, in many clinical applications, it is desirable to determine the in vivo tissue composition to reduce surgical time and complexity and improve treatment outcomes. For example, in laser lithotripsy, which uses lasers to break down or pulverize stones, automatically and internally identifying specific types of stones (e.g., the chemical composition of stones in the kidneys, pancreas, bile ducts, or gallbladder) and distinguishing them from surrounding tissues would allow doctors to adjust laser settings (e.g., power, exposure time, or emission angle) to more effectively ablate the target stone while avoiding irradiating non-treatment tissue near the target stone.

[0058] Conventional endoscopic laser therapy also has limitations, namely the inability to continuously monitor tissue types (e.g., composition) during the procedure. Many moving parts exist during endoscopic surgery, and the tissue observed endoscopically may change throughout the procedure. Because conventional biopsy techniques require removing tissue samples to identify composition, they cannot monitor tissue composition throughout the procedure. Continuous monitoring and identification of structural types (e.g., soft or hard tissue types, normal tissue versus cancerous tissue, or the composition of a stone structure) at the tip of the endoscope provides physicians with more information to better tailor treatment during the procedure. For example, if a physician is pulverizing a kidney stone with a hard surface but a soft core, continuous tissue composition information via the endoscope allows the physician to adjust the laser settings based on the continuously detected stone surface composition, such as switching from a first setting that performs better on the hard surface of the stone to a second, different setting that performs better on the soft core.

[0059] Some of the features described herein can provide methods and apparatus for identifying the components (e.g., soft or hard tissue) of various targets within the body, such as in medical applications, via endoscopy. This allows a user to continuously monitor the components of the target observed endoscopically throughout the procedure. It also has the capability to be used in conjunction with a laser system, where the method can send feedback to the laser system to adjust settings based on the target's composition. This feature allows for on-the-fly adjustment of laser settings within a range of initial settings selected by the user.

[0060] Some of the features described herein can be used to provide systems and methods that measure differences in the chemical composition of a target in vivo and suggest or automatically adjust laser settings to better achieve the desired effect. Examples of targets and applications include laser lithotripsy for kidney stones and laser cutting or vaporization of soft tissue. In one example, three main components are provided: a laser, a spectroscopic system, and a feedback analyzer. In the example, the controller of the laser system can be automatically programmed to perform laser therapy using appropriate laser parameter settings based on the target composition. In the example, the laser can be controlled based on a machine learning algorithm trained using spectrometer data. Additionally or alternatively, the user (e.g., a physician) can continuously receive instructions on the target type during the procedure and be prompted to adjust the laser settings. By adjusting the laser settings and adapting the laser therapy to the compositional components of a single stone target, the stone ablation or fragmentation process can be performed faster and more energy-efficiently.

[0061] Some of the features described herein can provide systems and methods for providing data input to a feedback analyzer, including internet connectivity and connection to other surgical devices with measurement capabilities. Additionally, the laser system can provide input data to another system, such as an image processor, whereby the surgical monitor can display information relevant to the medical procedure to the user. For example, one example of this is the ability to more clearly identify different soft tissues, vascular systems, cystic tissues, and different chemical components within the same target, such as a stone, during surgery.

[0062] Some of the features described herein can provide systems and methods for identifying different target types, such as different tissue types or different stone types. In some cases, a single stone structure (e.g., a stone in the kidney, bladder, pancreatic duct, or gallbladder) may have two or more different components throughout its volume, such as calciphosphite, calcium phosphate (CaP), calcium oxalate dihydrate (COD), calcium oxalate monohydrate (COM), magnesium ammonium phosphate (MAP), or cholesterol- or uric acid-based stone structures. For example, a target stone structure may include a first portion of COD and a second portion of COM. According to one aspect, this disclosure describes systems and methods for continuously identifying different components contained in a single target (e.g., a single stone) based on the continuous collection and analysis of in vivo spectroscopic data. Treatment (e.g., laser therapy) can be adapted according to the identified target component. For example, in response to the identification of a first component (e.g., COD) in the target stone, the laser system can be programmed with first laser parameter settings (e.g., power, exposure time, or emission angle, etc.) and deliver a laser beam accordingly to ablate or pulverize the first portion. Spectroscopic data can be continuously collected and analyzed during laser therapy. In response to the identification of a second component (e.g., COM) different from the first component in the same target stone being treated, the laser therapy can be adjusted, for example, by programming the laser system with second laser parameter settings different from the laser parameter settings (e.g., differential power, exposure time, or emission angle, etc.), and accordingly delivering a laser beam to ablate or pulverize the second portion of the same target stone. In some examples, the laser system may include multiple different laser sources. Stone portions with different compositions can be treated by different laser sources. The appropriate laser to use can be determined by identifying the type of stone.

[0063] Some of the features described herein can be used in relation to laser systems for a variety of applications, where combining them with different types of laser sources may be advantageous. For example, the features described herein may be suitable for industrial or medical settings such as medical diagnostics, treatment, and surgery. Features described herein can also be used in relation to endoscopy, laser surgery, laser lithotripsy, laser settings, and / or spectroscopy.

[0064] Figure 1 A schematic diagram of an exemplary laser therapy system including a laser feedback control system 100, according to an illustrative example of this disclosure, is shown. Example applications of the laser feedback control system 100 include integration into laser systems for a wide range of applications, such as industrial and / or medical applications for treating soft (e.g., non-calcified) or hard (e.g., calcified) tissues or stone structures such as stones in the kidneys, pancreas, bile ducts, or gallbladder. For example, the systems and methods disclosed herein can be used to provide precisely controlled therapeutic treatments, such as ablation, coagulation, vaporization, etc., or ablation, fragmentation, or pulverization of stone structures.

[0065] Reference Figure 1 The laser feedback control system 100 can communicate with one or more laser systems. Although Figure 1 The laser feedback system is shown connected to the first laser system 102 and optionally (shown in dashed lines) to the second laser system 104, but additional laser systems are also contemplated within the scope of this disclosure.

[0066] The first laser system 102 may include a first laser source 106 and associated components such as a power supply, a display, a cooling system, etc. The first laser system 102 may also include a first optical fiber 108 operatively coupled to the first laser source 106. The first optical fiber 108 may be configured to transmit laser output from the first laser source 106 to the target tissue 122.

[0067] In one example, a first laser source 106 may be configured to provide a first output 110. The first output 110 may extend within a first wavelength range. According to some aspects of this disclosure, the first wavelength range may correspond to a portion of the absorption spectrum of the target tissue 122. The absorption spectrum represents the absorption coefficient within the laser wavelength range. Figure 2A The absorption spectrum of water 210 is shown by way of example. Figure 2B The absorption spectra of oxyhemoglobin 221 and hemoglobin 222 are illustrated by way of example. In such an example, the first output 110 can advantageously provide effective ablation and / or carbonization of the target tissue 122 because the first output 110 is within the wavelength range corresponding to the tissue's absorption spectrum.

[0068] For example, the first laser source 106 can be configured such that the first output 110 emitted in a first wavelength range corresponds to high absorption of the incident first output 110 by tissue (e.g., exceeding about 250 cm⁻¹). -1 In an example, the first laser source 106 may emit a first output 110 at a wavelength between approximately 1900 nm and approximately 3000 nm (e.g., corresponding to high absorption by water) and / or between approximately 400 nm and approximately 520 nm (e.g., corresponding to high absorption by oxyhemoglobin and / or deoxyhemoglobin). Clearly, there are two main mechanisms for the interaction of light with tissue: absorption and scattering. When tissue absorption is high (absorption coefficient exceeding 250 cm⁻¹),... -1 When the absorption rate is low (absorption coefficient less than 250 cm⁻¹), the first absorption mechanism dominates, while when the absorption rate is low (absorption coefficient less than 250 cm⁻¹), the first absorption mechanism dominates. -1 In the case of lasers, such as those in the 800nm ​​to 1100nm wavelength range, scattering mechanisms are dominant.

[0069] Various commercially available medical-grade laser systems can be used for the first laser source 106. For example, a semiconductor laser, such as an InXGa1-XN semiconductor laser providing the first output 110 in a first wavelength range between about 515 nm and about 520 nm or between about 370 nm and about 493 nm, can be used. Alternatively, an infrared (IR) laser, such as those summarized in Table 1 below, can be used.

[0070] Table 1 lists examples of IR lasers applicable to the first laser source 106.

[0071]

[0072] Reference Figure 1 The laser therapy system of this disclosure may optionally include a second laser system 104. As previously mentioned, the second laser system 104 includes a second laser source 116 for providing a second output 120, and associated components such as a power supply, a display, a cooling system, etc. The second laser system 104 may be operatively decoupled from the first laser source 106, or alternatively, the second laser system 104 may be operatively coupled to the first laser source 106. In some examples, the second laser system 104 may include a second optical fiber 118 (decoupled from the first optical fiber 108) operatively coupled to the second laser source 116 to transmit the second output 120. Alternatively, the first optical fiber 108 may be configured to transmit both the first output 110 and the second output 120.

[0073] In some aspects, the second output 120 may extend over a second wavelength range different from the first wavelength range. Therefore, there may be no overlap between the first and second wavelength ranges. Alternatively, the first and second wavelength ranges may have at least partial overlap with each other. According to some aspects of this disclosure, the second wavelength range may not correspond to a portion of the absorption spectrum of the target tissue 122, where the incident radiation is strongly absorbed by tissue that has not previously been ablated or carbonized (e.g., as shown in Figure 2). In some such aspects, the second output 120 may advantageously not ablate uncarbonized tissue. Furthermore, in another example, the second output 120 may ablate carbonized tissue that has previously been ablated. In additional examples, the second output 120 may provide additional therapeutic effects. For example, the second output 120 may be more suitable for coagulated tissue or blood vessels.

[0074] Laser emission can be highly absorbed by soft or hard tissues, rocks, and the like. (Example provided) Figures 3A to 3C The absorption spectra of different tissue types are shown. Figure 3A The absorption spectra of normal tissue (before ablation) 311 and carbonized tissue (after ablation) 312 are shown respectively. Figure 3BThis shows that within a certain wavelength range (e.g., 450 nm to 850 nm), the absorption spectrum decreases exponentially with increasing laser wavelength. Figure 3A and Figure 3B The source of the data shown in the figure: http: / / omlc.org / spectra / hemoglobin / ). Figure 3C Optical absorption spectra measured in different media are shown, including spectra 331A to 331C for water (at concentrations of 75%, 100%, and 4%, respectively), spectrum 332 for hemoglobin (Hb), spectrum 333 for oxyhemoglobin (HbO2), and spectra 334A to 334D for melanin (at volume fractions of 2%, 13%, 30%, and 100% for melanosomes, respectively). Figure 3C The source of the data shown in the figure, http: / / www.americanlaserstudyclub.org / laser-surgery-education / The wavelengths that are absorbed by water are in the range of 1900 nm to 3000 nm. The wavelengths that are absorbed by oxyhemoglobin and / or oxyhemoglobin are in the range of 400 nm to 520 nm. Although many surgical lasers are highly absorbed by water or hemoglobin, there is a limitation in the range of media that can absorb water, which may be why the interior of the endoscope becomes susceptible to damage from laser energy.

[0075] Figure 4 The penetration depth of a laser output, such as the second output 120, is shown. Figure 4 The source of the data shown in the figure: http: / / www.americanlaserstudyclub.org / laser-surgery-education / As can be seen therein, due to the penetration depth comparable to the characteristic size of small capillaries (e.g., between about 5 μm and about 10 μm), the second output 120 can be suitable for effective condensation. Furthermore, in some examples, referencing... Figure 3A and Figure 3B The second wavelength range can correspond to the low absorption of the second output 120 by uncarbonized tissue, but the high absorption by carbonized tissue (e.g., through the ablation of the first output 110). Clearly, the spectral characteristics of the second output 120 correspond to the high (e.g., greater than about 250 cm⁻¹) absorption of the incident second output 120 by carbonized tissue. -1 Absorption. Examples of suitable second laser sources include Ga120 lasers having a second output in a second wavelength range between approximately 750 nm and approximately 850 nm. X Al 1-X As, or In having a second output 120 in a second wavelength range between approximately 904 nm and approximately 1065 nm. X Ga 1-X As.

[0076] While two laser systems with partially overlapping spectra suitable for absorption by tissue (normal and / or carbonized) have been described above, in an alternative example, instead of the second laser system 104, the first laser system 102 can provide a second output 120. In this example, the first laser system 102 can provide a first output 110 in a first wavelength range and a second output 120 in a second wavelength range, the first wavelength range being suitable for high absorption by previously unablated “normal” tissue (e.g., as shown in Figure 2), the second wavelength range corresponding to low absorption by tissue prior to carbonization, and / or more suitable for coagulation (e.g., as shown in Figure 2). Figure 3A and Figure 3B (As shown in the diagram). The first laser system 102 can provide additional output in an additional wavelength range.

[0077] Refer again Figure 1 According to the example, the laser therapy system includes a laser feedback control system 100. Now refer to... Figure 5 As previously described, the laser feedback control system 100 can analyze the feedback signal 130 from the target tissue 122 and control the first laser system 102 and / or the second laser system 104 to produce appropriate laser output to provide the desired therapeutic effect. For example, the laser feedback control system 100 can monitor the properties of the target tissue 122 during a treatment procedure (e.g., ablation) to determine whether the tissue has been properly ablated before another treatment procedure (e.g., vascular coagulation). Therefore, the laser feedback control system 100 may include a feedback analyzer 140.

[0078] Continue to refer to Figure 5According to one example, feedback analyzer 140 can monitor the spectroscopic properties of a tissue. Spectroscopic properties may include characteristics such as reflectance, absorption index, etc. Therefore, feedback analyzer 140 may include spectroscopic sensor 142. Spectroscopic sensor 142 may include Fourier transform infrared spectroscopy (FTIR), Raman spectroscopy, UV-VIS reflectance spectroscopy, fluorescence spectroscopy, etc. FTIR is a method used for routine, simple, and rapid materials analysis. This technique has relatively good spatial resolution and provides information about the chemical composition of the material. Raman spectroscopy has good accuracy in identifying hard and soft tissue components. As a high spatial resolution technique, it is also useful for determining the component distribution within a target. UV-VIS reflectance spectroscopy is a method of collecting information from the light reflected from an object, similar to the information generated from the eye or a color image taken by a high-resolution camera, but more quantitative and more objective. Reflectance spectroscopy provides information about a material because light reflection and absorption depend on its chemical composition and surface properties. Unique information about both the surface and volume properties of a sample can also be obtained using this technique. Reflectance spectroscopy can be a valuable technique for identifying components in hard or soft tissues. Fluorescence spectroscopy is an electromagnetic spectroscopy technique for analyzing fluorescence from a sample. It involves using a light beam, typically ultraviolet light, which usually excites material compounds in the visible or IR region and causes the material compounds to emit light. This method is suitable for the analysis of some organic components, such as those in hard and soft tissues.

[0079] In the examples, the feedback analyzer 140 may optionally include an imaging sensor 144 (e.g., a CCD or CMOS camera sensitive to ultraviolet (UV), visible (VIS), or infrared (IR) wavelengths). In some examples, the spectroscopic sensor 142 may include more than a single type of spectrometer or imaging camera listed herein to enhance the sensing and detection of a variety of features (e.g., carbonized and uncarbonized tissue, vascular systems, etc.).

[0080] In some examples, the spectroscopic sensor 142 (also referred to as a spectrometer) may include any spectrometer listed herein and may additionally depend on the imaging capabilities of the endoscope used during the treatment procedure. For example, an endoscope may be used to visualize anatomical features during a treatment procedure (e.g., laser ablation of a tumor). In such cases, the imaging capabilities of the endoscope can be enhanced by the spectroscopic sensor 142. For example, a conventional endoscope may provide narrow-band imaging suitable for enhancing visualization of anatomical features (e.g., lesions, tumors, vascular systems, etc.). By combining the spectroscopic sensor 142 with endoscopic imaging (white light and / or narrow-band imaging), the detection of tissue properties such as carbonization levels can be increased for precise control of the delivery of treatment procedures.

[0081] Refer again Figure 5 The spectroscopic sensor 142 can be operatively coupled to the signal detection fiber 150. In such an example, the signal detection fiber 150 may have optical properties suitable for transmitting spectroscopic signals from tissue to the spectroscopic sensor 142. Alternatively, the spectroscopic sensor 142 can be operatively coupled to the first fiber 108 of the first laser system 102 and / or the second fiber 118 of the second laser system 104, and thereby detect spectroscopic signals via the first fiber 108 and / or the second fiber 118.

[0082] Continue to refer to Figure 1 and Figure 5 The laser feedback control system 100 includes a laser controller 160, which is operatively in communication with each of the spectroscopic sensor 142, the first laser system 102, and an optional second laser system 104. The laser controller 160 can control one or more laser systems operatively connected thereto (e.g., the first laser system 102, the second laser system 104, and / or any additional laser systems) according to one or more control algorithms described herein to control the laser output from one or more laser systems, thereby producing a desired therapeutic effect in the target tissue 122.

[0083] The laser controller 160 may include a processor, such as a microprocessor, digital signal processor (DSP), application-specific integrated circuit (ASIC), field-programmable gate array (FPGA), or any other equivalent integrated or discrete logic circuit, and any combination of such components for performing one or more functions attributed to the laser controller 160. Optionally, the laser controller 160 may be coupled to the spectroscopic sensor 142 and one or more laser systems (e.g., first laser system 102, second laser system 104, and optional laser systems not shown herein) via wired or wireless connections.

[0084] Laser controller 160 may (e.g., via a wired or wireless connection) communicate with feedback analyzer 140 to receive one or more feedback signals from feedback analyzer 140. Laser controller 160 may determine one or more characteristics of target tissue 122 based on the feedback signals, as will be further described herein. For example, laser controller 160 may compare the amplitudes of the feedback signals to present minimum and maximum amplitudes and determine tissue characteristics (e.g., carbonization, coagulation, etc.).

[0085] In some examples, the feedback analyzer 140 can continuously monitor the target tissue 122 and continuously communicate with the laser controller 160 to provide feedback signals. Therefore, the laser controller 160 can continue to maintain the laser system in one or more states until a change in the amplitude of the feedback signal is detected. When a change in the amplitude of the spectral signal is detected, the laser controller 160 can communicate with one or more laser systems and change their states to provide the desired therapeutic effect. Alternatively or additionally, the laser controller 160 can communicate with an operator (e.g., a healthcare professional) and display one or more outputs via one or more output systems indicating feedback signals, and can optionally instruct the operator to perform one or more treatment procedures using a first laser system and / or a second laser system to provide the desired therapeutic effect.

[0086] In the illustrative examples described herein, laser controller 160 can control one or more laser systems by changing the state of the laser systems. According to one aspect, laser controller 160 can control each laser system independently. For example, laser controller 160 can send different control signals to each laser system to control each laser system independently of the other laser systems. Alternatively, laser controller 160 can send a common signal to control one or more laser systems.

[0087] In some examples, each of the laser systems can be associated with two distinct states: a first state in which the laser system produces laser output, and a second state in which the laser system does not produce laser output. For example, a first laser system 102 may have a first state producing a first output 110 (e.g., within a first wavelength range) and a second state not producing the first output 110. Similarly, a second laser system 104 may have a first state producing a second output 120 (e.g., within a second wavelength range) and a second state not producing the second output 120. In such examples, a laser controller 160 can control one or more laser systems by sending control signals that change the state of the laser system from the first state to the second state or from the second state to the first state. Additionally, optionally, each laser system may have an additional state, such as a third state producing laser output within a different wavelength range. Thus, the laser controller 160 can send additional control signals to the laser systems to change their states from their current states to one or more additional states (e.g., first state to third state, second state to third state, third state to first state, and third state to second state) to produce a laser output that provides the desired therapeutic effect.

[0088] Example laser system control algorithm

[0089] Figure 6 and Figure 7 This is a flowchart illustrating examples of algorithms for controlling one or more laser systems using a laser feedback control system 100, according to some examples described in this disclosure. Figure 6 The control algorithm 600 shown, at step 602, can detect a first signal (e.g., a spectroscopic signal) by feedback analyzer 140 (e.g., spectroscopic sensor 142 or imaging sensor 144). At step 604, laser controller 160 can receive the first signal from feedback analyzer 140. The first signal may correspond to a first characteristic. At step 606, laser controller 160 can determine whether the first signal is generally equal to a first preset value. For example, laser controller 160 can compare the amplitude of the first signal with a target value or preset extreme value (e.g., maximum amplitude or minimum amplitude) and determine a first characteristic of the target tissue 122. The first characteristic may indicate the tissue characteristics after treatment (e.g., ablation or carbonization of tissue). Laser controller 160 can determine that the desired treatment effect has been achieved based on the first characteristic (comparison between the first signal and the first preset value) and can send a first control signal to first laser system 102 at step 608 to change from a first state of first laser system 102 to a second state of first laser system 102. According to the example, this may cause the first laser system 102 to no longer produce the first output 110, thereby providing a satisfactory therapeutic effect (e.g., ablation). Alternatively, if at step 606 it is determined that the first signal is not equal to the first preset (insufficient ablation), the laser controller may not send any control signal, and the feedback analyzer may continue to monitor the first signal.

[0090] Optionally, at step 612, the feedback analyzer 140 may receive a second signal different from the first signal. The second signal may indicate a first characteristic of the target tissue having a second preset value. For example, the amplitude of reflected light from the tissue may differ in the second signal from that in the first signal. At optional step 614, the laser controller 160 may receive the second signal. At optional step 616, the laser controller 160 may determine whether the second signal is generally equal to the second preset value. For example, the second signal (e.g., a spectroscopic signal or image) may indicate that the target tissue 122 has not been carbonized by the absorption of the first output 110 (e.g., the measured signal amplitude is less than the preset maximum amplitude of the spectroscopic signal or image of the ablated tissue). In some cases, such a condition may indicate insufficient ablation or other unsatisfactory treatment results, and it may be desirable to continue delivering laser output to ablate the tissue. Therefore, at optional step 618, the laser controller 160 may communicate with the first laser system 102 to send a second control signal. The second control system may maintain the first laser system 102 in a first state (e.g., continue delivering the first output 110). Alternatively, if the first laser system is in the second state (e.g., off), then at optional step 620, the second control signal can change the state of the first laser system back to the first state (e.g., on), for example to continue delivering additional ablation to the target tissue.

[0091] At optional step 620, after the laser controller 160 determines that the treatment conditions are satisfactory, the laser controller 160 may perform additional control operations to deliver additional laser output (e.g., at a different wavelength) to deliver additional treatment effects.

[0092] Figure 7 A control algorithm for controlling a dual-laser system is illustrated. Algorithm 700 can be applied to situations where laser controller 160 communicates with two or more laser systems. In some such examples, first laser system 102 can be configured to transmit a first output 110 (e.g., within a first wavelength range), and second laser system 104 can be configured to transmit a second output 120 (e.g., within a second wavelength range different from the first wavelength range), as previously described. Control algorithm 700 can control first laser system 102, second laser system 104, and optional additional laser systems.

[0093] According to control algorithm 700, at step 702, a first signal (e.g., a spectroscopic signal or image) can be detected by feedback analyzer 140. At step 704, laser controller 160 can receive the first signal from feedback analyzer 140. At step 706, laser controller 160 can determine whether the first signal is generally equal to a first preset value (e.g., within a specified tolerance limit of the first preset). For example, laser controller 160 can compare the amplitude of the first signal with a target value or a preset extreme value (e.g., maximum amplitude or minimum amplitude) and determine a first characteristic of the target tissue 122. The first characteristic can indicate the tissue characteristics after treatment (e.g., ablation or carbonization of tissue). Laser controller 160 can determine that the desired treatment effect has been achieved based on the first characteristic that meets the target value or preset standard, and can send a first control signal to first laser system 102 at step 708 to change from a first state of first laser system 102 to a second state of first laser system 102. For example, laser controller 160 may determine that ablation has been satisfactory based on reflected light from the ablated tissue and send a first control signal to the first laser system to switch the first laser system to an "off" state. Alternatively, in the illustrative example, laser controller 160 may provide an output to an operator (e.g., a healthcare professional) indicating that the desired therapeutic effect has been achieved, and / or instruct the operator to change the state of the first laser system to an "off" state.

[0094] At step 708, the laser controller 160 may also send a fourth signal to the second laser system 104 to change from a second state to a first state of the second laser system 104. For example, the second laser system 104 may be more suitable for ablating carbonized tissue. Therefore, when it is detected that the tissue has been sufficiently carbonized (e.g., at step 708), in some cases, the laser controller 160 may send a first control signal to turn off the first laser system 102 and a fourth control signal to turn on the second laser system 104. Figure 8 The diagram shows an example timing diagram of the states of the first laser system and the second laser system.

[0095] In some examples, the first control signal and the fourth control signal can be sent simultaneously. Alternatively, the first control signal and the fourth control signal can be sent sequentially.

[0096] Return to Figure 7At optional step 710, feedback analyzer 140 may detect a second signal (e.g., a spectroscopic signal or image) that is different from the first signal. For example, the second signal may indicate that the target tissue 122 has not been carbonized by the absorption of the first output 110 (e.g., the measured signal amplitude is greater than a preset maximum amplitude of the spectroscopic signal of the ablated tissue). In some cases, such a condition may indicate insufficient ablation or other unsatisfactory treatment results, and it may be desirable to continue delivering laser output to ablate the tissue. At optional step 712, laser controller may receive the second signal, and at optional step 714, compare the second signal with a second preset value. If the second signal is generally equal to the second preset value (e.g., within a specified tolerance of the second preset), then at optional step 716, laser controller 160 may send a second control signal to the first laser system and a third control signal to the second laser system. Figure 8 The diagram shows an example timing diagram of the states of the first laser system and the second laser system.

[0097] In some examples, the second control signal can change the first laser system from a second state (e.g., off) to a first state (e.g., on). Alternatively, if the first laser system is in the first state (e.g., on), the second control signal can maintain the first laser system 102 in the first state (e.g., to continue transmitting the first output 110). Optionally, at step 716, if the second laser system 104 is in its first state, the laser controller 160 can send a third control signal to the second laser system 104, thereby changing the second laser system 104 from its first state (e.g., on) to its second state (e.g., off). Alternatively, if the second laser system is in the second state, the third control signal can maintain the second laser system 104 in the second state (e.g., off).

[0098] According to some examples, the first state of each of the first laser system 102 and the second laser system 104 can correspond to the first output 110 generated by the first laser source 106 and the second output 120 generated by the second laser source 116, respectively. Therefore, the first state of each of the first laser system 102 and the second laser system 104 can represent an "on" state. In some such examples, the second state of each of the first laser system 102 and the second laser system 104 can correspond to a "off" state.

[0099] Reference Figure 5The laser feedback control system 100 may include one or more output systems 170. One or more output systems 170 may communicate with a user and / or other systems, and / or transmit signals to the user and / or other systems, such as a flushing / pumping system for treatment procedures, an optical display controller, or other systems. In some examples, the output system 170 may include a display 172. The display 172 may be a screen (e.g., a touchscreen), or, alternatively, may simply be a visual indicator (e.g., one or more LEDs of different colors). In additional examples, the output system 170 may include an auditory output system 174 (e.g., a speaker, alarm system, etc.) capable of providing auditory signals. The output system 170 may provide one or more outputs (e.g., an LED of a first color, a first message on the screen, an alarm sound of a first tone) to indicate that the desired therapeutic effect has been achieved. Outputs may be provided, for example, at step 610 and optionally at step 620. In further alternative examples, when the desired therapeutic effect is not achieved, the output system 170 may provide one or more different outputs. For example, output system 170 can provide one or more outputs (e.g., a second-color LED light, a second message on the screen, a second-tone alarm sound) to indicate that the desired therapeutic effect has not been achieved. Such outputs can prompt the operator (healthcare professional) to take one or more steps (e.g., perform additional treatment steps using one or more laser systems to provide additional laser output).

[0100] Figure 8 A timing diagram of a dual-laser system with a laser feedback control system 100 is shown, illustrating an example of tissue ablation and coagulation delivered using two optical wavelengths. However, as previously described, the laser feedback control system 100 can be used with single or multiple optical wavelength systems to optimize the delivery of laser treatment or other types of therapeutic effects targeting tissue 122. The therapeutic effects can be delivered in any order, including simultaneously. Alternatively, the therapeutic effects can be delivered at different times.

[0101] According to the example, laser energy from the first laser system 102 and the second laser system 104 can be delivered to a target (e.g., a tissue surface), for example, in this example, it can be delivered continuously to the target. The first and second laser systems can deliver their respective laser energies via the same optical fiber. Alternatively, the first and second laser systems can deliver their respective laser energies via their respective different optical fibers. Having amplitude A max The optical feedback signal 810 is reflected from the tissue surface and can be detected and analyzed by the feedback analyzer 140. The first laser system and the second laser system can alternate their respective operating states (e.g., on or off). Figure 8As shown, the first laser system 102 can be switched to its first state or remain in its first state (e.g., on) 820A, while the second laser system 104 can be switched to its second state or remain in its second state (e.g., off). The first laser can be used to ablate and carbonize tissue. During operation of the first laser system 102, a first signal can be received by the laser controller 160 and can indicate high absorption by the tissue until its amplitude decreases to a threshold level A. min Up to this point. The wavelength of the output from the first laser system 102 can be within a first wavelength range in the absorption spectrum of the target, such as a wavelength suitable for effective carbonization of the target tissue. The tissue has high absorption of laser energy. In this example, the first laser output is in the UV-VIS or deep infrared wavelength range.

[0102] Then, the laser controller 160 can change the state of the laser system, such that the first laser system 102 is in a second state (e.g., off) and the second laser system 104 is in a first state (e.g., on) 830A. The output from the second laser system 104 can be highly absorbed by the carbonized tissue, causing the carbonized tissue to be ablated and effectively removing the carbonization. The wavelength of the output from the second laser system 104 can be within a second wavelength range in the absorption spectrum of the target. The second wavelength range can be different from the first wavelength range of the output from the first laser system 102. The wavelength of the output from the second laser system 104 can also be suitable for effective condensation. In the example, the second laser output is in the infrared wavelength range (e.g., 100 μm to 300 μm). Due to the decarburization process, the amplitude of the signal (e.g., the second signal) returns to near its initial level A. max The laser controller 160 can correspondingly change the state of the laser, such that the first laser system 102 is in a first state (e.g., on) and the second laser system 104 is in a second state (e.g., off). This process can be repeated to achieve the desired effect. Figure 8 The alternating manner shown repeatedly switches the first laser system 102 and the second laser system 104 to their on states 820B and 830B, respectively, until the desired tissue ablation and / or coagulation is achieved. In some examples, an optical feedback signal 810, as discussed herein, can be provided to an electrosurgical system that can controllably adjust and optimize an electrosurgical energy different from the laser energy.

[0103] Example endoscopic system with target recognition

[0104] Figures 9 through 11 illustrate how target component analysis can be performed entirely within the endoscope. Target component analysis can be performed via spectroscopy using laser fiber and a potential camera device at the distal end of a digital endoscope.

[0105] Figures 9A to 9BAn example of an endoscope with a laser fiber inserted is shown. The elongated body portion of the exemplary endoscope 910 includes various components including a laser fiber 912, an illumination source 914, and an imaging device 916. The laser fiber 912 is an example of the optical path 108 of laser system 102 or laser system 202. The laser fiber 912 may extend along a working channel 913 within the elongated body of the endoscope 910. In some examples, the laser fiber 912 may be detachable from the endoscope. For example, the laser fiber 912 may be fed along the working channel of the endoscope before use and retrieved from the working channel of the endoscope after use.

[0106] Illumination source 914 may be part of a visualization system that allows an operator to visualize a target structure (e.g., a tissue or stone structure). Examples of an illumination source may include one or more LEDs configured to emit light distally from the elongated body of the endoscope to illuminate an area of ​​the target structure. In an example, illumination source 914 may emit white light to illuminate the target structure. White light allows the practitioner to observe discoloration or other color-based effects on tissue near the distal end of the endoscope body. In an example, illumination source 914 may emit blue light to illuminate the target structure. Blue light can be well-suited for displaying thermal tissue diffusion and thus detecting damage in the tissue. Other colors and / or color bands, such as red, amber, yellow, green, or others, may also be used.

[0107] The camera device 916 is part of a visualization system. The camera device 916 is an example of the imaging sensor 244. The camera device 916 can capture video images or one or more still images of the illuminated target structure and its surrounding environment. The video images can be real-time or near-real-time with a relatively short processing delay, allowing the practitioner to observe the target structure while manipulating the endoscope. The camera device 916 may include a lens and a multi-pixel sensor located at the focal plane of the lens. The sensor may be a color sensor, such as a sensor that provides intensity values ​​for red, green, and blue light for each pixel in the video image. The circuit board can generate a digital video signal representing the captured video image of the illuminated stone. The digital video signal may have a video refresh rate of 10Hz, 20Hz, 24Hz, 25Hz, 30Hz, 40Hz, 50Hz, 60Hz, or another suitable video refresh rate.

[0108] Figures 10A to 10B An example of a feedback-controlled laser therapy system is shown. Figure 10AIn this embodiment, the laser therapy system 1000A includes an endoscope 910 integrated with a feedback-controlled laser therapy system 1010 that receives feedback from a camera device. As an example of the laser therapy system 1000A, the laser therapy system 1000A includes an endoscope 910, a feedback-controlled laser therapy system 1010, a laser source 1020, and a light source 1030. In various examples, part or all of the feedback-controlled laser therapy system 1010 may be embedded in the endoscope 910.

[0109] As an example of a laser feedback control system 200, the feedback-controlled laser therapy system 1010 includes a spectrometer 1011 (an example of a spectroscopic sensor 242), a feedback analyzer 1012 (an example of at least a portion of a feedback analyzer 240), and a laser controller 1013 (an example of a laser controller 260). A laser source 1020 is an example of a laser system 202, and this laser source 1020 can be coupled to a laser fiber 912. Fiber-integrated laser systems can be used in endoscopic surgery because they are able to deliver laser energy through a flexible endoscope and effectively treat both hard and soft tissues. These laser systems generate laser output beams over a wide wavelength range from the UV to the IR region (200 nm to 10000 nm). Some fiber-integrated lasers generate output in wavelength ranges that are highly absorbed by soft or hard tissues, such as 1900 nm to 3000 nm for water absorption or 400 nm to 520 nm for oxyhemoglobin absorption and / or deoxyhemoglobin absorption. Table 1 above is a summary of IR lasers emitted in the high water absorption range of 1900 nm to 3000 nm.

[0110] Some fiber-integrated lasers produce output in wavelength ranges that are minimally absorbed by the target soft or hard tissue. Because their penetration depth is similar to that of small capillaries (5 μm to 10 μm), these types of lasers provide effective tissue coagulation. Examples of laser sources 1020 may include In... (The sentence is incomplete and requires further context to translate accurately.) X Ga 1-X N-semiconductor lasers, such as GaN lasers emitting 515nm to 520nm, and In lasers emitting 370nm to 493nm. X Ga 1-X N-type laser, which emits Ga2 wavelengths from 750 nm to 850 nm. X Al 1-X As laser or In laser emitting 904nm to 1065nm wavelengths X Ga 1-X As lasers, etc.

[0111] The light source 1030 can generate an electromagnetic radiation signal that can be transmitted to the target structure 122 via a first optical path extending along the elongated body of the endoscope. The first optical path can be located within the working channel 913. In one example, the first optical path can be an optical fiber separate from the laser fiber 912. In another example, such as... Figure 10A As shown, electromagnetic radiation signals can be transmitted through the same laser fiber 912 used to transmit the laser beam. The electromagnetic radiation leaves the far end of the first optical path and is projected onto the target structure and the surrounding environment. Figure 10A As shown, the target structure is within the field of view of the endoscopic imaging device 916, such that in response to electromagnetic radiation projected onto the target structure and the surrounding environment, the endoscopic imaging device 916, such as a CCD or CMOS imaging device, can collect signals reflected from the target structure 122, generate an imaging signal 1050 of the target structure, and transmit the imaging signal to the feedback-controlled laser treatment system 1010. In some examples, imaging systems other than CCD or CMOS imaging devices, such as laser scanning, can be used to collect the spectral response.

[0112] In addition to or in lieu of feedback signals (e.g., imaging signals) generated and transmitted by the camera device system 916, in some examples, signals reflected from the target structure may additionally or alternatively be collected and transmitted via a separate fiber optic channel or a laser fiber such as that associated with the endoscope 910 to the feedback-controlled laser therapy system 1010. Figure 10B An example of a laser therapy system 1000B is shown, which includes an endoscope 910 integrated with a feedback-controlled laser therapy system 1010 configured to receive feedback from a spectroscopic sensor 1070 (which is...). Figure 1 The feedback signal 130 (as in the example of Figure 2) can travel back to the feedback-controlled laser therapy system 1010 via the same optical path (e.g., laser fiber 912) used to transmit electromagnetic radiation from the light source 1030 to the target structure. In another example, the reflected spectroscopic signal 1070 can travel to the feedback-controlled laser therapy system 1010 via a second optical path, such as a separate fiber optic channel from the first fiber optic channel used to transmit electromagnetic radiation from the light source 1030 to the target structure.

[0113] The feedback-controlled laser therapy system 1010 can analyze one or more feedback signals (e.g., imaging signal 1050 of the target structure or reflected spectroscopic signal 1070) to determine the operating state of the laser source 1020. The spectrometer 1011 can generate one or more spectroscopic properties from one or more feedback signals, for example, by using one or more of an FTIR spectrometer, Raman spectrometer, UV-VIS spectrometer, UV-VIS-IR spectrometer, or fluorescence spectrometer, as discussed above regarding the reference spectroscopic sensor 242. The feedback analyzer 1012 can be configured to identify or classify the target structure into one of several structural categories or types, for example, by using one or more of a target detector 246 or a target classifier 248. The laser controller 1013 can be configured to determine the operating mode of the laser system 1020, as discussed similarly above with reference to FIG2.

[0114] Light source 1030 can produce electromagnetic radiation in the optical range from UV to IR. Table 2 below presents examples of light source 1030 applicable to the spectroscopic systems discussed herein.

[0115] Table 2: Light sources for spectroscopic systems

[0116]

[0117] In some examples, the feedback analyzer 1012 can determine the distance 1060 between the distal end of the laser fiber 912 and the target structure 122, or the distance 1060 between the distal end of the optical path used to receive the reflected signal and transmit it back to the spectrometer 1011 and the target structure 122 (e.g., Figure 10A (As shown). The distance 1060 can be calculated using spectroscopic properties, such as the reflectance spectrum generated by spectrometer 1011. If the distance 1060 meets a condition, such as decreasing to a threshold (d... th If the target structure 122 is located below or within the specified laser emission range, the laser controller 1013 can control the laser source 1020 to deliver laser energy to the target structure 122. In the example, if the target structure 122 is identified as the intended treatment structure type (e.g., a specified soft tissue type or a specified stone type), but the target structure 122 is not within the laser's range (e.g., d>d), the laser controller 1013 can control the laser source 1020 to deliver laser energy to the target structure 122. th If the laser controller 1013 generates a control signal to "lock" the laser source 1020 (i.e., prevent the laser source 1020 from emitting), then the laser controller 1013 can generate a control signal to "lock" the laser source 1020 (i.e., prevent the laser source 1020 from emitting). Information regarding the distance 1060 and that the target structure is outside the laser range (d>d) is also relevant. thInstructions can be presented to the practitioner, who can then adjust the endoscope 910, for example, repositioning the distal end of the laser fiber 912 to move it closer to the target. The distance 1060 and the type of the target structure can be continuously monitored and determined and presented to the practitioner. When the target is identified as the expected type of treatment structure and within the laser's range (d <= d...), the procedure is performed. th When the laser controller 1013 generates a control signal to "unlock" the laser source 1020, the laser source 1020 can target and emit light onto the target structure 122 according to the laser operating mode (e.g., power setting). An example of a method for calculating distance 1060 based on spectroscopic data is discussed below, for example, referring to... Figure 24A and Figure 24D .

[0118] In some examples, spectrometer 1011 can be configured to further use information about the geometry and positioning of the optical path configured to transmit electromagnetic radiation from the light source to the target to generate spectroscopic properties (e.g., reflectance spectra). For example, the outer diameter of the laser fiber 912 or the outer diameter of the separate optical path used to transmit the spectroscopic signal reflected from the target to spectrometer 1011, or the angle at which the fiber or path protrudes from endoscope 910, can affect the intensity of the reflected signal. The outer diameter and / or protrusion angle can be measured and provided to spectrometer 1011 to obtain reflectance spectral data. As discussed above, the distance 1060 between the target structure and the distal end of the fiber can be calculated using spectral data, the measured outer diameter of the fiber or optical path and its protrusion angle, and / or input signals from the endoscope image processor.

[0119] Figures 11A to 11B This is a diagram illustrating an example of an endoscopic system used for identifying targets using a diagnostic beam. (See diagram for example.) Figure 11AAs shown, the endoscope system 1100A may include an endoscope 1110 and an optical fiber 1120A that can be inserted through the working channel 1112 of the endoscope 1110. The endoscope 1110 may include at least one endoscopic illumination source 1130, or otherwise coupled to at least one endoscopic illumination source 1130 via an endoscope port 1114. The at least one endoscopic illumination source 1130 may controllably provide different amounts of illumination. When the optical fiber 1120A is inserted through the working channel 1112, the optical fiber 1120A may, for example, be coupled to a non-endoscopic illumination source 1140 via the endoscope port 1114. The non-endoscopic illumination source 1140 may be different from at least one endoscopic illumination source 1130. The non-endoscopic illumination source 1140 may emit a diagnostic beam 1142 through the optical fiber 1120A and be close to the distal end 1116 of the endoscope 1110. The optical fiber 1120A may guide the diagnostic beam 1142 towards the target 1001. In the example, the non-endoscopic illumination source 1140 may be a laser source configured to emit a diagnostic beam including a laser beam. In various examples, a white light, an LED light source, or a fluorescent fluoroscopic light source may be inserted through the working channel of the endoscope or through another port such as a laparoscopic port.

[0120] Endoscopic system 1100A may include controller 1150. Controller 1150 can controllably operate at least one endoscopic illumination source 1130 in different operating modes, including, for example, a first mode having a first illumination level and a second mode having a second illumination level lower than the first illumination level. In an example, controller 1150 may generate a control signal in response to a trigger signal to change the illumination mode (e.g., from the first mode to the second mode). In an example, the endoscope includes an imaging system 1160 capable of capturing an image of target 1001, and controller 1150 may generate a control signal to the endoscope in response to a change in the brightness or intensity of the target image to change the illumination mode (e.g., from the first mode to the second mode). Hereinafter, the first mode is referred to as a high illumination mode, and the second mode as a low illumination mode. In an example, the high illumination mode and the low illumination mode may be provided by respective different endoscopic illumination sources, such as a first endoscopic illumination source configured to emit illumination light in the high illumination mode and different second endoscopic illumination sources configured to emit illumination light in the low illumination mode. Illumination light can be emitted near the distal end 1116 of endoscope 1110. In this example, the illumination light can travel through an optical path different from that of fiber optic 1120A within the working channel 1112. This optical path can guide the illumination light 1132 to the same target 1001 on which a diagnostic beam is projected.

[0121] When at least one endoscopic illumination source 1130 changes from a high illumination mode to a low illumination mode, the controller 1150 may generate a control signal to a non-endoscopic illumination source 1140 to emit a diagnostic beam 1142 (e.g., a laser beam with a lower energy level than the treatment beam). In this example, the low illumination mode includes turning off the endoscope's illumination. By dimming the illumination at the target site in the low illumination mode, the reflection of the diagnostic beam incident on the target from the target can be enhanced, which can help improve target identification.

[0122] In some examples, when the illumination mode is in the second mode, the controller 1150 can generate a control signal to the display to show an image of the target, wherein the image is a previous or modified image of the target's current image. The controller 1150 can determine the composition of the target based on a diagnostic beam incident on the target and light reflected from the diagnostic beam from the target. In an example, the controller 1150 can determine a first component of a first portion of the stone target and a distinct second component of a second portion of the stone target. Based on the identified components of the distinct portions of the target, the controller 1150 can program a first laser setting, or generate a suggestion to program the first laser setting to target the first portion of the stone target. The controller 1150 can also program a second laser setting different from the first laser setting, or generate a suggestion to program the second laser setting to target the second portion of the stone target.

[0123] In the example, after the non-endoscopic illumination source 1140 has stopped emitting the diagnostic beam 1142, the controller 1150 can generate a control signal to the endoscope to change the illumination mode from a low illumination mode back to a high illumination mode.

[0124] Figure 11B An example of an endoscope system 1100B is shown, which is a variant of the endoscope system 1100A. In this example, the diagnostic beam 1142 can be transmitted via optical fiber 1120B. Unlike optical fiber 1120A, which is inserted into the working channel 1112 of the endoscope 1110, optical fiber 1120B can be detached from the working channel 1112. In some examples, such as Figure 11B As shown, the diagnostic beam 1142 can be transmitted via a secondary port 1115, separate from the endoscope port 1114 used for transmitting endoscopic illumination light, such as the laparoscopic port in the example. The optical fiber 1120B can be positioned such that both the distal end 116 of the endoscope 1110 and the distal end of the optical fiber 1120B are targeted at the target 1001.

[0125] Figure 12 and Figures 13A to 13BThis is a graph illustrating reflectance spectral data used to identify different types of targets, such as the components of several different types of kidney stones, via UV-VIS or UV-VIS-IR spectroscopy. Reflectance spectral data is collected by targeting each image of five main types of kidney stones, including calcium oxalate stones (monohydrate), calcium oxalate stones (dihydrate), calcium phosphate stones, struvite stones, and uric acid stones, with a UV-VIS or UV-VIS-IR spectrometer. In this example, electromagnetic radiation may include one or more ultraviolet wavelengths between 10 nm and 400 nm. In another example, such as... Figure 12 As shown, reflectance spectra used to identify different types of targets can be recorded by a spectrometer in the wavelength range of 200 nm to 1100 nm. The reflectance spectra of kidney stone components are shown, including magnesium ammonium phosphate (AMMAG) hydrate, calcium oxalate (CA) monohydrate, calcium oxalate (CA) hydrate, calcium phosphate (CA), and uric acid. The reflectance spectra of these stone components are more distinguishable in the lower wavelength range (e.g., below 400 nm) than in the higher wavelength range (e.g., above 400 nm). Figure 13A It shows Figure 12 The reflectance spectra shown are a portion of the 200 nm to 400 nm wavelength range, including the magnesium ammonium phosphate hydrate spectrum 1310, the calcium oxalate monohydrate spectrum 1320, the calcium oxalate hydrate spectrum 1330, the calcium phosphate spectrum 1340, and the uric acid spectrum 1350. This UV wavelength range is a region where differences can be identified in the spectrum of the stone image. Figure 13B The reflectance spectra of various kidney stone components in the wavelength range of 400 nm to 700 nm are shown, including cystine spectrum 1360, uric acid spectrum 1370, and calcium oxalate monohydrate spectrum 1380. UV-VIS spectroscopy or UV-VIS-IR spectroscopy can be used to distinguish between different types of targets, such as different types of kidney stones.

[0126] Therefore, since the UV wavelength range is promising in distinguishing different target components such as kidney stones, there is a need for a light source within the system that allows analysis of this region. Figure 14 The light peaks 1410, 1420, 1430 and 1440 are shown, respectively, covering portions of the UV wavelength range around 250 nm, 280 nm, 310 nm and 340 nm. Figure 15 These light peaks 1410 to 1440 and from Figures 13A to 13B The normalized reflectance spectra of several types of stones overlap. These peaks, 1410 to 1440, demonstrate a potential light source that would allow a spectrometer to analyze the composition of the target in the UV wavelength.

[0127] Figure 16AExamples of normalized reflectance spectra captured from various tissue types on a UV-VIS spectrometer are shown, including cartilage spectrum 1610, bone spectrum 1620, muscle spectrum 1630, fat spectrum 1640, and liver tissue spectrum 1650. Figure 16B Another example of normalized reflectance spectra captured from various soft and hard tissues on a UV-VIS spectrometer is shown, including cartilage spectrum 1610, bone spectrum 1620, muscle spectrum 1630, fat spectrum 1640, liver tissue spectrum 1650, and blood vessel spectrum 1660. Figures 16A to 16B The reflectance spectral data shown demonstrates the feasibility of analyzing the composition of a target using methods applicable within the working channel of an endoscope. Similar to the spectra captured from stone images, the UV-VIS region can be used to identify different types of targets. Figure 16C Examples of FTIR spectra of typical stone compositions are shown, and Figure 16D These are example FTIR spectra of some soft and hard tissue components.

[0128] Example laser treatment system

[0129] The features described herein can be used in relation to laser systems for a wide range of applications, and it may be advantageous to combine them with different types of laser sources in various applications. For example, the features described herein may be suitable for industrial or medical settings, such as medical diagnostics, treatment, and surgery.

[0130] The features described herein can be used with a spectroscopic system that can be combined with fiber-optic integrated laser systems and endoscopes.

[0131] Figures 17 to 18 Schematic diagrams of laser therapy systems according to various examples described in this disclosure are shown. The laser therapy system may include a laser system configured to deliver laser energy to a target, and a laser feedback control system configured to couple to the laser system. The laser system may include one or more laser modules 1710A to 1710N (e.g., solid-state laser modules) capable of emitting similar or different wavelengths from UV to IR. The number of integrated laser modules, their output power, emission range, pulse shape, and pulse train are selected to balance system cost and the performance required to deliver the desired effect to the target.

[0132] One or more laser modules 1710A to 1710N can be integrated with optical fibers and included in a laser coupling system. Fiber-integrated laser systems can be used in endoscopic surgery because they are able to transmit laser energy through a flexible endoscope and effectively treat both hard and soft tissues. These laser systems produce laser output beams over a wide wavelength range (e.g., 200 nm to 10000 nm) from the UV to the IR region. Some fiber-integrated lasers produce outputs in wavelength ranges that are highly absorbed by soft or hard tissues, such as 1900 nm to 3000 nm for water absorption or 400 nm to 520 nm for oxyhemoglobin absorption and / or deoxyhemoglobin absorption. Various IR lasers can be used as laser sources in endoscopic surgery, such as those described above with reference to Table 1.

[0133] Laser modules 1710A to 1710N can each consist of multiple solid-state laser diodes integrated into an optical fiber to increase output power and deliver emission to the target. Some fiber-integrated lasers produce output in the wavelength range where absorption by the target soft or hard tissue is minimal. These types of lasers provide effective tissue coagulation because their penetration depth is similar to the diameter of a small capillary (5 μm to 10 μm). The fiber-integrated laser modules 1710A to 1710N described according to the various examples in this disclosure have several advantages. In the examples, the light emitted by the laser module has symmetrical beam quality and a circular and smooth (uniform) intensity distribution. A compact cooling device is integrated into the laser module, making the entire system compact. The fiber-integrated laser modules 1710A to 1710N can be easily combined with other fiber optic components. Additionally, the fiber-integrated laser modules 1710A to 1710N support standard fiber optic connectors that allow the modules to operate well with most optical modules without requiring alignment. Furthermore, the fiber-integrated laser modules 1710A to 1710N can be easily replaced without altering the alignment of the laser coupling system.

[0134] In some examples, the laser module can generate laser output in a wavelength range that is highly absorbed by materials such as soft or hard tissue, stone, bone, teeth, etc., for example, 1900nm to 3000nm for water absorption or 400nm to 520nm for oxyhemoglobin and / or deoxyhemoglobin absorption, such as... Figure 3C As shown. In some examples, the laser module can generate laser output in a wavelength range that is poorly absorbed by targets such as soft or hard tissue, stones, bones, teeth, etc. This type of laser provides more effective tissue coagulation because the penetration depth is similar to the diameter of small capillaries (e.g., 5 μm to 10 μm), such as Figure 3C As shown. Commercially available solid-state lasers are potential emission sources for laser modules. Examples of laser sources for laser modules may include In...X Ga 1-X N-semiconductor lasers, such as GaN (emitting 515nm to 520nm) or In... X Ga 1-X N (emitting 370nm to 493nm), GaXAl1-XAs laser (emitting 750nm to 850nm), or InXGa1-XAs laser (emitting 904nm to 1065nm). This laser source can also be used for tissue coagulation applications.

[0135] The laser feedback control system may include one or more subsystems, such as, for example, a spectroscopic system 1720, a feedback analyzer 1730, and a laser controller 1740.

[0136] Spectroscopic System 1720

[0137] The spectroscopic system 1720 can transmit control light signals from a light source to a target, such as, but not limited to, stones, soft or hard tissue, inclusions, teeth, or industrial targets, and collect spectral response data reflected from the target. This response can be transmitted to a spectrometer via a separate optical fiber, laser fiber, or endoscope system. The spectrometer can transmit digital spectral data to a system feedback analyzer 1730. Examples of light sources for the spectroscopic system covering the optical range from UV to IR can include those described above with reference to Table 2. Figure 20 A schematic diagram of a spectroscopic system 1720 with a feedback analyzer 1730 is shown in the example.

[0138] Optical spectroscopy is a powerful and simple method for the rapid analysis of both organic and inorganic materials. According to various examples described in this disclosure, spectroscopic light sources can be integrated into separate fiber optic channels, laser fibers, or endoscopic systems. The light source signal reflected from the target can be rapidly collected by an imaging system and transmitted to the spectrometer, which includes detectors such as CCD or CMOS sensors that can be included in a digital endoscope. Other imaging systems, such as laser scanning, can also be used to collect the spectroscopic response. Optical spectroscopy offers several advantages. It can be easily integrated with fiber laser transmission systems. It is a non-destructive technique for detecting and analyzing the chemical composition of materials and can perform analyses in real time. Optical spectroscopy can be used to analyze different types of materials, including, for example, hard and soft tissues, stone structures, etc.

[0139] Various spectroscopic techniques can be used individually or in combination to analyze target chemical composition and generate spectroscopic feedback. Examples of such spectroscopic techniques can include UV-VIS reflectance spectroscopy, fluorescence spectroscopy, Fourier transform infrared spectroscopy (FTIR), or Raman spectroscopy. Table 2 above presents examples of light sources for spectroscopic systems covering the optical region from UV to IR and applicable to the examples. Tungsten halogen light sources are commonly used for spectroscopic measurements in the visible and near-IR ranges. Deuterium light sources are known for their stable output and are used for UV absorption or reflectance measurements. A combination of halogen and deuterium lamps produces a wide spectral range light source providing a smooth spectrum from 200 nm to 2500 nm. Xenon light sources are used in applications where long lifespan and high output power are required, such as for fluorescence measurements. LED and laser diode light sources provide high power at precise wavelengths; they have long lifespans, short warm-up times, and high stability. Spectroscopic light sources can be integrated into separate fiber optic channels, laser fibers, or endoscope systems. The light source signal reflected from the target can be rapidly detected and transmitted to the spectrometer via a separate fiber optic channel or laser fiber.

[0140] Feedback Analyzer 1730

[0141] Feedback analyzer 1730 can receive input from various sources, including spectroscopic response data from a spectrometer, to suggest or directly adjust laser system operating parameters. In an example, feedback analyzer 1730 can compare the spectroscopic response data with an available database archive of target component data. Based on the spectroscopic system feedback, the signal analyzer detects the target material composition and suggests laser operating modes (also known as laser settings), such as operating parameters for at least one laser module, to achieve effective tissue treatment of the identified tissue components. Examples of operating parameters may include at least one laser wavelength, pulsed or continuous wave (CW) emission mode, peak pulse power, pulse energy, pulse rate, pulse shape, and simultaneous or sequential emission of pulses from at least one laser module. Although not explicitly described, sequential pulses include a train of pulses combined to deliver a selected pulse energy. A pulse, as described herein, generally refers to the time between the start and stop of laser emission from the laser module. As long as the selected average laser power is maintained, the intensity of the laser energy during each pulse can vary in shape with an increasing or decreasing ramp or sinusoidal distribution, or any other shape, alone or in combination with a pulse sequence. For example, if only a single pulse exists, a 2W average power setting with a pulse energy of 1J occurs at a frequency of 2Hz. However, the energy can also be delivered as two rapid, consecutive 0.5J pulses occurring at a rate of 2Hz. Each of these pulses may have similar or different pulse shapes. The feedback analyzer 1730 utilizes algorithms and input data to directly adjust or suggest laser operating parameters, such as those described in the example above.

[0142] In some examples, the feedback analyzer 1730 can use input data based on a specially developed algorithm to calculate and control the distance between the distal end of the laser delivery system 1701 (optical fiber) and the target. In the case of a moving target (e.g., a stone), the feedback analyzer 1730 can adjust or suggest laser operating parameters that utilize steam bubbles in water to create a suction effect, pulling the target, which exceeds a predetermined threshold, closer to the distal end of the optical fiber. This feature minimizes the effort required for the user to maintain an effective treatment distance from the moving target. The distance between the target and the distal end of the optical fiber can be calculated using spectral data, the known outer diameter of each optical fiber and its angle of protrusion from the endoscope, and / or input signals from the endoscope image processor. Figures 24A to 24D An example method for calculating the distance between the far end of the laser transmission system 1701 (optical fiber) and the target is shown. Figures 24A to 24B The figure shows the dependence of the spectroscopic reflection signal on the distance between the target and the laser transmission system 1701. Figure 24A Examples of reflected signal intensity at 730 nm measured at different distances between the tissue and the distal end of the spectroscopic probe are shown. Figure 24BExamples of reflected signal intensity at 450 nm measured at different distances between the tissue and the distal end of the spectroscopic probe are shown. Such dependence can be determined using spectral data and information about the geometry of the laser delivery system. Analysis of the spectroscopic signal allows for rapid distance estimation and the transmission of this information to the user.

[0143] Figure 24C This is an exemplary algorithm for calculating the distance between an optical fiber and a target tissue. In one example, the spectroscopic system controls the transmission of light signals from a light source to the target, collects spectral response data from the target, transmits the response signal to a spectrometer, and sends digital spectral data from the spectrometer to a feedback analyzer. For example... Figure 24C As shown, calibration curve 1000 represents the relationship between the intensity of the spectroscopic reflected signal (e.g., the spectroscopic signal reflected from the target structure in response to electromagnetic radiation) and the distance 1060 between the distal end of the optical fiber using the feedback signal reflected from the target structure and the target structure (e.g., shown in Figures 10 and 11). Calibration curve 1000 can be generated by measuring the intensity of the reflected signal at different distances between the tissue and the distal end of the spectroscopic probe when the target structure is projected with electromagnetic radiation at a specific wavelength (e.g., 450 nm or 730 nm). By referencing the calibration curve, analysis of the spectroscopic signal allows for rapid estimation of the distance.

[0144] An exemplary process for generating calibration curves is as follows. First, reference values ​​can be calculated for each distance. The calibration curve itself may not be used to identify distances because the light reflection intensity depends on factors such as the reflectivity of the sample. An example of a reference value used to eliminate the influence of the sample's reflectivity is as follows:

[0145] Reference value = dI / dx * 1 / I (1)

[0146] During an in vivo surgical procedure, the operator can move the fiber optic cable or endoscope while continuously recording spectroscopic feedback until the reflectance spectrum of the target tissue components can be detected.

[0147] Reference Figure 24C The first spectrum can be measured at a distance x1 where the reflected signal intensity is I1. At this point, the actual value of x1 and the curve of the reflected signal intensity are unknown. Then, the distal end of the fiber optic cable or endoscope (reflected light detector) can be moved further, and the next reflected light intensity I2 corresponding to a distance x2 can be measured. x2 can be close to x1, such that the curve between x1 and x2 can be approximated as linear. At this point, the curve of x1, x2, and the reflected signal intensity is unknown. A comparison value can be calculated using I1, I2, and Δ(x2-x1), as follows:

[0148] Comparison value = Δ(I2-I1) / Δ(x2-x1)*1 / I1(2)

[0149] Then, search for a reference value that matches the comparison value. If only one reference value (x) is found... r If the value is the same as the comparison value given in equation (2), then x can be determined. r Let x1 be the distance. If there are two reference values ​​(x1, x2, x3, x4, x5, x6, x7, x8, x9, x1, x1, x1, x2 ...2, x1, x2, x2, x1, x2, x2, x1, x2, x2, x3 r1 x r2 If this is the case, the fiber optic cable or the distal end of the endoscope (reflected light detector) can be moved further, and the next reflected light intensity I3 corresponding to the distance x3 can be measured. x3 can be close to x2, such that the curve between x2 and x3 can be approximated as linear. At this point, the curves of x1, x2, x3, and the reflected signal intensity are unknown. New comparison values ​​can be calculated using I1, I2, I3, Δ(x2-x1), and Δ(x3-x2) as follows.

[0150] Comparison value = Δ(I3-I2) / Δ(x3-x2)*1 / I2(3)

[0151] Then, search for x in the reference value. r1 +Δ(x2-x1) and x r2 +Δ(x2-x1) is the same reference value. The reference value can be compared with the comparison value given in equation (3). The distance that is more similar to the reference value and the comparison value is estimated as the actual distance.

[0152] Reference Figure 24D During an in vivo surgical procedure, an example method may include moving an optical fiber or endoscope and continuously recording spectroscopic feedback until the reflectance spectrum of the target component is detected. In the primary case of moving the distal end of the spectrum toward the target, the intensity of the detected reflected light will initially be weak and will increase as the distance between the target and the end of the fiber decreases. For example, the first spectrum is measured at a distance d1 where the reflected signal intensity is I1. Continuing to move the distal end of the fiber or endoscope slightly toward the target and continuously collecting reflection data, the method can measure the next reflected light intensity I2 corresponding to a distance d2. The method may then include calculating the value of the slope of the change in reflected signal intensity = Δ(I2-I1) / Δ(d2-d1). To make the calculated slope independent of the reflected signal intensity, the calculated slope can be normalized. The final formula for calculating the slope of the change in reflected signal intensity at the measurement distance becomes:

[0153] Slope (normalized) = [Δ(I2-I1) / Δ(d2-d1)] / I o (4)

[0154] Among them: I o =Average(I1,I2)

[0155] The method then compares the calculated slope with the slope on a calibration curve in the library to allow estimation of the required distance. All calculations can be performed quickly using software.

[0156] Figures 25A to 25B The effect of the distance between the tissue and the distal end of the spectroscopic probe on the spectrum of reflected light from the target is shown. Figure 25A Exemplary normalized UV-VIS reflectance spectra of various soft tissue types are shown, including bladder endothelial spectrum 2511, gastric endothelial spectrum 2512, gastric smooth muscle spectrum 2513, subureteral spectrum 2514, ureteral endothelial spectrum 2515, renal calyx spectrum 2516, bladder muscle spectrum 2517, and medulla spectrum 2518. Figure 25B Exemplary UV-VIS reflectance spectra of a specific tissue are shown at different distances between the tissue and the distal end of the spectroscopic probe, such as from 0 inches to 0.25 inches. Figure 25A Some examples of animal soft tissue spectra are shown. Figure 25B Exemplary UV-VIS reflectance spectra of tissue recorded at different distances between the tissue and the distal end of the spectroscopic probe are presented. In this example, the reflectance signal intensity at two spectral maxima, 450 nm and 730 nm, was measured at different distances between the target tissue and the distal end of the presented spectroscopic probe, as referenced above. Figures 24A to 24B The subject of discussion.

[0157] Laser Controller 1740

[0158] The laser controller 1740 can be integrated with a laser coupling system. The laser coupling system couples one or more laser modules (e.g., solid-state laser modules) to an optical fiber. The laser controller 1740 can be coupled to a feedback analyzer 1730, which can send an optimization signal with suggested settings directly to the laser controller 1740 (automatic mode), or request operator approval to adjust laser settings (semi-automatic mode). Figure 17 This is a schematic diagram of a fully automated laser system. Figure 18 This is a schematic diagram of a semi-automatic laser system in which the system requires user approval, for example, via a user interface including input 1850 and display 1860. In the example, the laser settings can be adjusted within a set range, which can be predetermined by the user at the start of the process.

[0159] In some examples, the laser controller 1740 can combine two or more laser pulse trains to create a combined laser pulse train. Figure 19AAn example is shown in which the laser controller 1740 can generate multiple (e.g., N) laser pulse trains 1910A to 1910N, combine the laser pulse trains 1910A to 1910N into a combined pulse train 1920, and expose the target at 1930 using the combined pulse train. Figure 19B This diagram illustrates an example of an output laser pulse train 1942 composed of three different laser trains 1941A, 1941B, and 1941C emitted from different laser modules. As shown, laser trains 1941A, 1941B, and 1941C can be turned on and / or off at different times depending on a feedback analyzer signal. In the example shown, the output combined laser pulse train 1942 may include temporally overlapping portions of two or more of the laser trains 1941A, 1941B, and 1941C.

[0160] By utilizing a combination of laser modules 1910A to 1910N, a spectroscopic system 1720, and a feedback analyzer 1730, as described herein, the laser feedback system 1740 can continuously identify the components of a target via an endoscope and update the laser settings throughout the process.

[0161] The main components of the laser system can be easily customized according to the target medical procedure. For example, the laser controller 1740 supports different laser types and combinations thereof. This allows for a wide range of output signal options, including power, wavelength, pulse rate, pulse shape and profile, single laser pulse trains, and combined laser pulse trains. The operating mode of the laser system can be automatically adjusted or suggested for each desired optical effect. The spectroscopic system collects information about the target material, which is useful for diagnostic purposes and is used to confirm that the laser parameters are optimal for the target. The feedback analyzer 1730 can automatically optimize the operating mode of the laser system and reduce the risk of human error.

[0162] Internet of Things (IoT) System 1750

[0163] In some examples, the laser system may include an optional IoT system 1750 that supports storing a spectral database archive on a cloud 1752, enabling rapid access to the spectral and optimal setting database archive, and facilitating communication between the cloud 1752 and the feedback analyzer 1730. The cloud storage of data supports the use of artificial intelligence (AI) technologies to provide input to the feedback analyzer 1730 and provides immediate access to algorithm and database improvements.

[0164] Based on the various examples described herein, IoT system 1750 may include a network in which components of the laser system can communicate and interact with other components via the Internet. IoT supports rapid access to a spectral database archive stored on cloud 1752 and performs communication between cloud 1752 and feedback analyzer 1730. Additionally, all components of the laser system can be remotely monitored and controlled via the network if needed. An example of such successful connectivity is the Internet of Things in Healthcare (also known as the Internet of Health), which is a available application of IoT for medical and health-related purposes, including data collection and analysis for research and monitoring.

[0165] In various examples, the IoT system 1750 can support access to various cloud resources, including cloud-based detection, identification, or classification of target structures (e.g., stone structures or anatomical tissue). In some examples, a machine learning (ML) engine can be implemented in the cloud 1752 to provide cloud-based target detection, identification, or classification services. The ML engine can include trained ML models (e.g., machine-readable instructions executable on one or more microprocessors). The ML engine can receive target spectral data from the laser system or retrieve target spectral data stored in the cloud 1752, perform target detection, identification, or classification, and generate outputs such as labels representing tissue type (e.g., normal tissue or cancerous lesions or tissue at a specific anatomical location) or stone type (e.g., stones in the kidney, bladder, pancreaticobiliary duct, or gallbladder with specific components). Target spectral data, along with other clinical data collected from the patient before or during surgery, can be automatically uploaded to the cloud 1752 at the end of the procedure or other predetermined times. Alternatively, the system user (e.g., a clinician) can be prompted to upload data to the cloud 1752. In some examples, the output may additionally include the probability that the target is identified as tissue or stone, or the probability that the target is classified as a specific tissue type or stone type. For example, during endoscopic laser surgery, system users (e.g., clinicians) can use such a cloud service to obtain near real-time information about target tissue or stones within the body.

[0166] In some examples, the ML engine may include a training module configured to train an ML model using training data, such as training data stored in Cloud 1752. The training data may include spectral data associated with target information, such as labels identifying target types (e.g., stone types or tissue types). The training data may include laboratory data based on spectral analysis of multiple tissue types and / or stone types. Additionally or alternatively, the training data may include clinical data obtained in vitro or in vivo from multiple patients. In some examples, patient identification information may be removed from patient clinical data (e.g., spectral data) before it is used to upload to Cloud 1752 to train the ML model or to perform target detection, identification, or classification using the trained ML model. The system may associate the deidentified patient clinical data with labels from the identification data source (e.g., hospital, laser system identification, surgery time). Clinicians may analyze and confirm target types (e.g., stone or tissue type) during or after surgery and associate the target types with the deidentified patient clinical data to form training data. Using de-identified patient clinical data can advantageously increase the robustness of cloud-based ML models because it can include additional data from a large patient population to train the ML model. This can also improve the performance of ML models in identifying rare stone types, since spectroscopic data from rare stone types are difficult to obtain clinically or from the laboratory.

[0167] Various ML model architectures and algorithms can be used, such as decision trees, neural networks, deep learning networks, support vector machines, etc. In some examples, training of the ML model can be performed continuously or periodically, or near real-time when additional spectroscopic data becomes available. Training involves tuning one or more ML model parameters using algorithms until the trained ML model meets a specified training convergence criterion. The resulting trained ML model can be used for cloud-based object detection, recognition, or classification. Utilizing ML models trained with a large amount of data stored in Cloud 1752, along with additional data added to them continuously or periodically, as described in this paper, cloud-connected ML-based object recognition can improve the accuracy and robustness of in vivo object detection, recognition, and classification.

[0168] Example endoscopic laser system

[0169] Figures 21A to 21D Endoscopic laser systems 2100A and 2100B, including an endoscope 2110 with an integrated multi-fiber accessory, are shown, as well as systems including... Figure 10AThe illustration shows an example of a surgical laser system with feedback-controlled laser therapy system 1010 and laser source 1020. Alternatively, the spectroscopic response can be collected by an imaging system including a detector such as a CCD or CMOS sensor and transmitted to a spectrometer. Target composition analysis can be performed via spectroscopy through one or more cores of a multi-fiber accessory, while the target is illuminated with a light source transmitted through one or more other cores of the multi-fiber accessory.

[0170] like Figure 21A As shown, the endoscopic laser system 2100A includes a multi-fiber accessory comprising an optical path 2116 for transmitting spectroscopic signals back to the spectrometer 1011 and for delivering surgical laser energy from the laser source 1020 to the target structure. In one example, the optical path 2116 includes optical fibers embedded within and extending along the elongated body of the endoscope 2110. In another example, the optical path 2116 includes two or more optical fibers extending along the elongated body of the endoscope 2110. The laser controller 1013 can control the timing of laser emission such that the transmission of spectroscopic signals and the delivery of laser energy occur at different times or simultaneously.

[0171] The multi-fiber accessory may include two or more light source fibers 2114 embedded in and extending along the elongated body of the endoscope 2110. This is by way of example and not limitation. Figure 21C A radial cross-sectional view of an elongated body of an endoscope 2110 is shown, wherein a plurality of light source optical fibers 2114 and optical paths 2116 are longitudinally positioned within the elongated body of the endoscope, and the light source optical fibers 2114 are radially distributed, for example, along the circumference of the optical path 2116 on a radial cross-section relative to the elongated body of the endoscope, around the optical path 2116. Figure 21C In the example shown, the optical path 2116 can be located substantially at the central longitudinal axis of the elongated body of the endoscope 2110. This is by way of example, not limitation. Figure 21C As shown, six light source fibers can be positioned around optical path 2116. Other numbers of light source fibers and / or other positions of the light source fibers relative to optical path 2116 can be used. For example, Figure 21D Two light source fibers 2114 are shown, radially positioned on opposite sides of optical path 2116. The light source fibers 2114 can be coupled to light source 1030. Alternatively, the light source fibers 2114 can be coupled to, for example... Figures 9A to 9BThe illumination source 914 is shown. Light from the endoscope light source—illumination source 914 (e.g., one or more LEDs) or a remote light source 1030 such as external to the endoscope—can illuminate the target and generate a spectroscopic signal reflected from the target surface, which can be collected for spectroscopic analysis. The feedback analyzer 1012 can determine the distance 1060 between the distal end of the endoscope 2110 and the target structure 122, as shown in Figures 10 and 11.

[0172] Figure 21B An endoscopic laser system 2100B including multiple fiber optic accessories is shown. Instead of transmitting laser energy via optical path 2116, a separate laser fiber 2120 can be used to transmit surgical laser energy from laser source 1020 to the target structure. Optical path 2116 serves as a dedicated spectroscopic signal fiber for transmitting spectroscopic signals back to spectrometer 1011.

[0173] Figure 22 and Figures 23A to 23B This shows what can be used, for example, the reference above. Figures 21A to 21D Examples of multi-fiber systems for discussing spectroscopic fiber optic transmission systems are provided. In, for instance... Figure 22 In the example shown, the multi-fiber system 2200 includes a first fiber 2210 coupled to a light source and configured to direct illumination light at a target, and a separate second fiber 2220 coupled to a spectrometer and configured to transmit a reflected signal (e.g., light reflected from the target) indicating the spectroscopic properties of the target to the spectrometer.

[0174] Figures 23A to 23B This is a diagram of an exemplary multi-fiber accessory with source light input and spectral feedback signal. (See diagram for example.) Figure 23A As shown, the multi-fiber accessory 2300A may include a distal portion 2310, a transition portion 2320A, and a proximal portion 2330A. The distal portion 2310 includes an axis that can be sized and shaped to surround the first fiber 2210 and the second fiber 2220, and the transition portion 2320A is proximate to the distal portion 2310. The first fiber 2210 and the second fiber 2220 may be embedded in and extend along the longitudinal axis of the distal portion 2310. This axis may be sized and shaped to extend through the working channel of the endoscope. In some examples, the first fiber 2210 may include two or more fibers, each coupled to a light source, and / or the second fiber 2220 may include one or more fibers. In some examples, such as... Figures 21C to 21DAs shown, the second optical fiber 2220 may be radially distributed around the first optical fiber 2210. In the example, at least one of the second optical fibers 2220 may extend along the fundamental central longitudinal axis of the axis. Two or more first optical fibers 2210 may be radially positioned on opposite sides of the second optical fibers 2220 extending along the central longitudinal axis of the axis.

[0175] The near-end portion 2330A includes a first connector 2332 configured to connect to a light source and a second connector 2334 configured to connect to a spectrometer. A transition portion 2320A interconnects the far-end portion 2310 and the near-end portion 2330A, and the transition portion 2320A can be configured to couple the first connector 2332 to a first optical fiber 2210 and the second connector 2334 to a second optical fiber 2220. Therefore, the transition portion 2320A provides a transition for the optical fibers 2210 and 2220 from their respective first connector 2332 and second connector 2334 to a single axis.

[0176] The shaft may include an insertable distal end 2312 extending distally from the distal portion 2310. The insertable distal end 2312 may be configured for insertion into a patient. The proximal portion 2300A may be associated with a handle (e.g., included in a handle) for user operation of the multi-fiber accessory 2300A. In the example, at least a portion of the multi-fiber accessory 2300A (e.g., one or more of the distal portion 2310, the transition portion 2320A, or the proximal portion 2330A) may be included in or insertable into the working channel of the endoscope.

[0177] Figure 23B Another example of the multi-fiber accessory 2300B is shown; the multi-fiber accessory 2300B is a variant of the multi-fiber accessory 2300A. Figure 23B In the example shown, the proximal portion 2330B may also include a third connector 2336, configured to couple a laser source to one of optical fibers 2210 or 2220. Similar to... Figure 23A The transition portion 2320B interconnects the distal portion 2310 and the proximal portion 2330B. Laser energy generated from the laser source can be transmitted from the proximal portion 2330B to the distal portion 2310 via one of optical fibers 2210 or 2220, and delivered to the target treatment site via the insertable distal end 2312. In some examples, the multi-fiber accessory 2300B may also include a laser fiber different from optical fibers 2210 or 2220. The laser fiber can be positioned within the working channel of the endoscope, for example, within the axis. Laser energy generated from the laser source can be transmitted to the distal portion 2310 via the laser fiber.

[0178] Example applications of laser systems

[0179] Laser systems as described in the various examples of this disclosure can be used in a number of applications, such as endoscopic hard tissue surgery or endoscopic soft tissue surgery, to improve the effectiveness of ablation, coagulation, vaporization or other laser effects.

[0180] One application of laser systems in tissue surgery concerns the use of laser systems to provide effective tissue ablation and coagulation, rather than two separate foot pedals as is often used in commercial equipment such as laser and plasma devices. Example systems utilize two or more solid-state laser modules emitting at two different wavelengths, along with a UV-VIS reflectance spectroscopy system. These solid-state laser modules are coupled via fiber optics to a laser controller, which transmits the spectral signals to a feedback analyzer that suggests alternative settings to the user before adjustment.

[0181] In one example, two laser modules may be provided: a first laser module that emits light at a high tissue absorption wavelength for a more efficient ablation / carbonization process, and a second laser module that emits light at a lower tissue absorption wavelength for more efficient coagulation, for example, due to its penetration depth being similar to the diameter of a small capillary. Examples of the first laser module may include: an InXGa1-XN semiconductor laser emitting UV-VIS: GaN (emitting 515 nm to 520 nm); InXGa1-XN (emitting 370 nm to 493 nm); or an IR laser emitting within the high water absorption range of 1900 nm to 3000 nm summarized in Table 1. Examples of the second laser module may include: GaXAl1-XAs emitting 750 nm to 850 nm, or InXGa1-XAs emitting 904 nm to 1065 nm. Both the first and second laser modules can be coupled to a laser controller via a laser coupling system.

[0182] The spectroscopic light source can be integrated into a separate fiber optic channel, laser fiber, or endoscope system. The spectroscopic light source signal reflected from the target can be rapidly detected and transmitted to a spectrometer via a separate fiber optic channel or laser fiber. Alternatively, the spectroscopic system can collect spectroscopic signals from an imaging system containing detectors such as CCD or CMOS sensors. Based on feedback from the spectroscopic system, a signal analyzer can detect the target material composition and suggest first or second laser module settings for effective tissue treatment, transmitting the signal to an output system that provides recommended settings to the user.

[0183] This example allows for tissue ablation and coagulation by utilizing two or more laser pulses in which the optical wavelengths are controlled by a feedback analyzer system. However, feedback control can be used with single or multiple optical wavelength systems to optimize the simultaneous delivery of specific effects to the target. From the user's perspective alone, these effects may appear simultaneous; the features described herein are not limited to delivering wavelengths at exactly the same time.

[0184] Figure 8 An example time-operation diagram of such a laser with spectral feedback is presented. As described therein, the amplitude is A. max The optical feedback signal is continuously transmitted to and reflected from the target surface, and detected and analyzed by a signal analyzer. The user can then turn on the first laser, or, after selecting soft tissue ablation, keep the first laser on while the second laser is off. During the operation of the first laser, the optical feedback signal is highly absorbed by the carbonized tissue until its amplitude decreases to a threshold level A. min Then, the signal analyzer changes the state of the lasers, turning off the first laser and turning on the second laser. The second laser is highly absorbed by the carbonized tissue; therefore, the carbonized tissue is ablated, which effectively removes the carbonization. The wavelength of the second laser also provides effective condensation. Due to the decarburization process, the amplitude of the optical feedback pulse returns to near its initial level A. max When this occurs, the signal analyzer changes the laser state back to the first laser on and the second laser off. This process can be repeated until the desired amount of tissue ablation and coagulation is achieved.

[0185] Another application of the laser system relates to an efficient laser lithotripsy procedure for fragmenting kidney or bladder stones in patients. This application relates to a process in which the target is first heated using multi-wavelength laser energy with wavelengths that are less absorbed by the target, and then fragmented, for example, kidney stones, using stronger absorption wavelengths. During laser lithotripsy, fragmentation of kidney or bladder stones may occur due to photothermal effects. High laser energy can be absorbed by the stone, causing the temperature to rise rapidly above a threshold for chemical decomposition, leading to its breakdown and fragmentation. In one example, laser lithotripsy may include a two-stage process. The first stage is a preheating stage, in which the stone is heated using laser energy of a first wavelength, which causes absorption of low laser energy by the stone. The subsequent second stage involves applying laser energy of a second wavelength, which causes absorption of stronger laser energy by the stone than the first wavelength. This multi-step process allows for better control of vapor bubble generation and reduces the intensity of the shock waves generated during fragmentation (reducing stone recoil).

[0186] In the example, the laser system utilizes two or more solid-state laser modules emitting at two different wavelengths, along with a spectral system. These solid-state laser modules are coupled via optical fibers to a laser controller, which transmits spectral signals to a feedback analyzer that suggests alternative settings to the user before adjustment. A first laser module can emit a lower stone / water absorption wavelength for effective preheating, while a second laser module can emit a higher stone / water absorption wavelength for more effective stone fragmentation. In this application, the first laser module can produce output at the lower stone or water absorption wavelength. The laser provides effective and uniform stone preheating. Examples of a first laser source for the first laser module could include GaXAl1-XAs emitting 750 nm to 850 nm, or InXGa1-XAs emitting 904 nm to 1065 nm. Examples of a second laser source may include an InXGa1-XN semiconductor laser that emits UV-VIS laser light, such as a GaN laser that emits 515 nm to 520 nm, or an InXGa1-XN laser that emits 370 nm to 493 nm, or an IR laser that emits light in the high water and rock absorption range of 1900 nm to 3000 nm and is summarized in Table 1.

[0187] Both the first and second laser modules can be coupled to the laser controller via a laser coupling system. The spectroscopic light source can be integrated into a separate fiber optic channel, laser fiber, or endoscope system. The spectroscopic light source signal reflected from the target can be rapidly detected and transmitted to the spectrometer via a separate fiber optic channel or laser fiber. Alternatively, the spectroscopic system can collect spectroscopic signals from an imaging system containing detectors such as CCD or CMOS sensors.

[0188] Based on spectral system feedback, the signal analyzer can detect the target material composition and suggest settings for either the first or second laser module to achieve an efficient multi-step stone processing procedure, transmitting the signal to an output system that provides suggested settings to the user. The laser system can simultaneously deliver effective stone preheating and fracturing using two or more laser pulses from the laser module, with the light wavelength controlled by the feedback analyzer system. However, feedback control can be used with single or multiple light wavelength systems to optimize the simultaneous delivery of specific effects on the target stone composition.

[0189] Another application of laser systems concerns the ablation of hard tissues such as teeth and bone, which requires high laser output power. The effectiveness of laser surgery on soft tissues relies on the low-temperature vaporization of water at 100°C; however, hard tissue cutting requires extremely high ablation temperatures—up to 5,000°C. To deliver enhanced output power, laser systems can couple a greater number of laser modules to increase the integrated output power to a level sufficient to treat the target. The following lasers can be used as emission sources: InXGa1-XN semiconductor lasers emitting UV-VIS: GaN (emitting 515nm to 520nm); InXGa1-XN (emitting 370nm to 493nm); or IR lasers from 1900nm to 3000nm summarized in Table 1. Laser sources suitable for the laser modules used in this example may include, for example, GaXAl1-XAs lasers emitting 750nm to 850nm, or InXGa1-XAs lasers emitting 904nm to 1065nm.

[0190] Laser modules can be integrated into a laser controller with a laser coupling system. To achieve the required high power, multiple laser modules can be coupled into the system. Spectroscopic sources can be integrated into separate fiber optic channels, laser fibers, or endoscope systems. Spectroscopic signals reflected from the target can be rapidly detected and transmitted to a spectrometer via a separate fiber optic channel or laser fiber. Alternatively, the spectroscopic system can collect spectroscopic signals from an imaging system containing detectors such as CCD or CMOS sensors.

[0191] Based on spectral system feedback, the signal analyzer can detect the target material composition and suggest laser module settings and quantities to achieve the required output power and an efficient multi-step treatment process. The signal is then transmitted to an output system that provides the user with recommended setup information. By increasing the number of laser modules included in the treatment process, the laser system can simultaneously deliver the required high laser output power, using two or more laser pulses in which the light wavelength is controlled by the feedback analyzer system. Feedback control can be used with single or multiple light wavelength systems to optimize the simultaneous delivery of specific effects on the target stone composition. From the user's perspective, these effects may appear simultaneous; however, they are not limited to delivering wavelengths at exactly the same time.

[0192] The features described herein can be used to provide a method for identifying target components. In some cases, the target can be a medical target, such as soft and hard tissue within the body using a surgical attachment. This attachment can be used with an endoscope or laparoscope. The attachment can consist of a single device containing multiple optical fibers, the purpose of which is that at least one fiber provides illumination from the light source and at least one fiber directs the reflected light to a spectrometer. This allows the user to continuously monitor the composition of the tissue or target throughout the procedure, with or without direct endoscopic visualization. It also has the ability to be used in conjunction with a laser system, where the attachment can send feedback to the laser system to adjust the settings based on the composition of the tissue or target. This feature will allow for immediate adjustment of the laser settings within the range of initial laser settings selected by the user. The features described herein can be used with a spectroscopic system that can be used with a fiber-optic integrated laser system. The spectroscopic light source can be transmitted via at least one fiber in the multi-fiber attachment. The light source signal reflected from the target can be rapidly collected and transmitted to the spectrometer via additional fibers in the multi-fiber attachment.

[0193] An example method can use spectral input data to calculate and control the distance between the distal end of a laser delivery system 1701 (e.g., an optical fiber) and a tissue or target based on an algorithm. This method can be applied to both soft and hard tissue types in in vivo surgical procedures. The distance between the target and the distal end of the optical fiber can be calculated based on the analysis of spectral data. The outer diameter of each optical fiber and its angle of protrusion from the endoscope affect the intensity of the reflected light; these are measured to obtain spectral data. Using features as described herein, the distance can be calculated without sequential illumination by light having different numerical aperture values.

[0194] In the case of moving stones, this method allows for control of distance and adjustment or suggestion of laser operating parameters that utilize steam bubbles in water to generate a suction effect, thereby pulling targets exceeding a predetermined threshold closer to the distal end of the fiber. This feature minimizes the effort required for the user to maintain an effective treatment distance from the moving target.

[0195] UV-VIS-IR reflectance spectroscopy, according to the various examples discussed in this disclosure, can be used alone or in combination with other spectroscopic techniques to create spectroscopic feedback, including analyzing the chemical composition of materials and measuring the intensity of reflected light during in vivo diagnostic or therapeutic procedures. Reflected light may produce the same information as the eye or a color image captured by a high-resolution imaging device, but it is more quantitative and objective. Reflectance spectroscopy provides information about materials because light reflection and absorption depend on their chemical composition and surface properties. This technique can also be used to obtain unique information about both the surface and overall properties of a sample.

[0196] Another application of laser systems concerns the process of identifying target types, such as determining the composition of a stone target during laser lithotripsy. Based on some examples discussed in this article, an endoscopic system has a light source, and this light is directed through the endoscope to the target inside the body to provide illumination. The physician uses a laser system to break up stones under illumination from the endoscopic system. This situation can cause some problems if a laser system is used to detect the composition of the stone. The light reflected from the stone is weak, while the illumination from the endoscopic system is strong. Therefore, it may be difficult to analyze the composition of the stone under illumination from the endoscopic system.

[0197] Figure 26 An example of an endoscope system 2600 configured to use a diagnostic beam, such as a laser beam, to identify a target (e.g., the composition of a stone target). System 2600 may include a controller 2650 that controls both an endoscope light source 2630 and a laser generator module 2640. The controller 2650 can detect commands input by a physician via the laser system to activate a stone composition detection mode. The controller 2650 can then send a command to the endoscope light source 2630 to stop illumination or switch from a high-illumination mode to a low-illumination mode, in which reduced illumination is projected onto the target for a period of time. During such low-illumination or no-illumination periods, the laser system 2640 can emit a laser beam toward the target and receive reflected light from the stone. A detector 2660 can use the reflected light to perform target identification. By dimming (or turning off) the illumination of the target site in low-illumination mode, the reflection of the laser beam incident on the target can be enhanced, which can help improve target identification.

[0198] Once detector 2660 determines that target recognition is complete, it can send a termination command to controller 2650. Controller 2650 can then send a command to re-illuminate the target or switch back from low illumination to high illumination mode. In one example, when endoscope light source 2630 receives a command to stop illumination or switch from high illumination to low illumination mode, image processor 2670 in endoscope system 2600 can capture a still image of the target and display it on the endoscope system's monitor for a period of time. Variations of the endoscope system 2600 for target recognition have been envisioned, such as those mentioned above. Figures 11A to 11B Those that were discussed.

[0199] Figure 27Figure 2700 illustrates laser pulse sequences with different pulse energy or power levels, which may include, for example, a first pulse train 2710 and a second pulse train 2720. The pulses in the second pulse train 2720 have a higher energy or power level than the pulses in the first pulse train 2710. The first pulse train 2710 and the second pulse train 2720 can be generated by corresponding laser sources, and each of the first pulse train 2710 and the second pulse train 2720 is emitted from the distal end of the endoscope in the form of a corresponding laser beam. The first pulse train 2710 can be generated substantially constant in time, for example, within a specific time period (e.g., controlled by the user). The second pulse train 2720 can be generated intermittently in time, for example, within a specific time period during the transmission of the first pulse train 2710. For example, the second pulse train 2720 can be transmitted between two pulses of the first pulse train 2710 or between two trains of the first pulse train 2710. Figure 27 In the example shown, the pulses in the first pulse train 2710 have a constant energy or power level, and the second pulse train 2720 includes only one pulse with a higher energy or power level than the first pulse train 2710. In some examples, the second pulse train 2720 may include two or more pulses, each with a higher energy or power level than the first pulse train 2710.

[0200] Laser lithotripsy systems can be used to treat conditions such as... Figure 27 The laser pulse sequence shown is used to simulate the rupture and fragmentation of stone structures, such as a kidney. Figure 27 As shown, the sequence represents time in the X direction of the figure, but is also annotated with positions "A" and "B" on the stone or other target. Therefore, the sequence of laser pulses represents a spatiotemporal pattern of laser pulses with different pulse energy or power levels. In this example, position "A" is at or near the center of the stone or other target, while position "B" is at or near the periphery of the stone or other target. The laser pulses emitted between positions "A" and "B" illustrate pulses emitted when the laser fiber 140 translates from position "A" to position "B," or pulses emitted when the laser fiber 140 translates from position "B" to position "A," which may include, for example, the use of an actuator. The first pulse train 2710 can be selected to induce a crack in the target stone without shattering it. Therefore, in Figure 27In this process, such a first pulse train 2710 can begin at position "A" and proceed towards the center of the stone, then towards position "B" towards the periphery of the stone, and then return towards position "A" at the center of the stone. At this point, a higher energy pulse 2720 can be transmitted in the first attempt to shatter the target stone. If such shattering by the higher energy pulse 2720 is unsuccessful, a further first pulse train 2710 can be transmitted from the position towards the center of the stone to position "B" towards the periphery of the stone, and then return towards position "A" at the center of the stone. At this point, another higher energy pulse 2720 can be transmitted in the second attempt to shatter the target stone. Further iterations are also possible. The same or different positions "B" towards the periphery of the stone can be used for various iterations, wherein different positions "B" in different iterations generate multiple cracks along such a path from position "A" to such different periphery positions "B". It may be preferable to use only the higher energy pulse 2720 towards the center of the stone, for example, to minimize the impact of the second pulse train 2720 on nearby tissue.

[0201] In some examples, Figure 27 The laser pulse sequences shown, with different pulse energies or power levels, can be used by an endoscopic system that provides hemostasis or coagulation at a target site. In the example, the first pulse train 2710 and the second pulse train 2720 can be delivered to the target site in a spatiotemporal pattern, such as temporal alternation, to facilitate an effective hemostasis or coagulation process.

[0202] Pulses with different energy or power levels, such as a first pulse train 2710 and a second pulse train 2720, can be controllably activated via a user-operable actuator, such as a button or foot pedal. For example, a user can activate the transmission of the first pulse train 2710 using a first activation mode (e.g., a single press of a button or foot pedal) and activate the transmission of the second pulse train 2720 using a second activation mode (e.g., two presses of a button or foot pedal). In the example, the first pulse train 2710 and the second pulse train 2720 can be controlled via their respective independent actuators. Additionally or alternatively, the first pulse train 2710 and the second pulse train 2720 can be controllably and automatically activated, for example, based on feedback signals from the target. For example, a spectrometer can collect spectroscopic data of the target, and a feedback analyzer can analyze the spectroscopic data to identify the composition of different parts of the stone structure. Based at least on such identification, different energy pulses, such as the first pulse train 2710 or the second pulse train 2720, can be transmitted to different parts of the target having their respective identified components.

[0203] Figure 28A block diagram of an example machine 2800 on which any one or more of the techniques (e.g., methods) discussed herein can be generally shown. Based on the examples discussed in this disclosure, portions of this description can be applied to the computational framework of various parts of a laser therapy system.

[0204] In alternative implementations, machine 2800 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, machine 2800 may operate as a server machine, a client machine, or both in a server-client network environment. In the example, machine 2800 may be used as a peer-to-peer (P2P) (or other distributed) network environment. Machine 2800 may be a personal computer (PC), tablet PC, set-top box (STB), personal digital assistant (PDA), mobile phone, web application, network router, switch, or bridge, or any machine capable of (sequentially or otherwise) executing instructions specifying actions to be taken by that machine. Furthermore, although only a single machine is shown, the term "machine" may also be considered as any collection of machines that individually or jointly execute a set (or more) of instructions to perform any one or more of the methods discussed herein, such as cloud computing, Software as a Service (SaaS), or other computer cluster configurations.

[0205] As described herein, examples may include logic or multiple components or mechanisms, or may be operated by logic or multiple components or mechanisms. A circuit group is a collection of circuits implemented in a tangible entity including hardware (e.g., simple circuits, gates, logic, etc.). The members of a circuit group may vary over time and with changes in the underlying hardware. A circuit group includes members that can perform a specified operation individually or in combination during operation. In the examples, the hardware of the circuit group may be invariably designed to perform the specified operation (e.g., hardwired). In the examples, the hardware of the circuit group may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) to encode instructions for the specified operation, and the variably connected physical components may include computer-readable media that are physically modified (e.g., magnetic ground, electric ground, movable placement of massless particles, etc.). When the physical components are connected, the underlying electrical properties of the hardware composition are altered, for example, from an insulator to a conductor or from a conductor to an insulator. Instructions enable embedded hardware (e.g., an execution unit or loading mechanism) to create portions of the circuit group in the hardware via variable connections to perform the specified operation during operation. Therefore, when the device is in operation, the computer-readable medium is communicatively coupled to other components of the circuit group members. In the example, any component of the physical components can be used in more than one member of more than one circuit group. For example, in operation, an execution unit can be used at one point in time in a first circuit of a first circuit group and reused at different times by a second circuit in the first circuit group or by a third circuit in the second circuit group.

[0206] Machine (e.g., computer system) 2800 may include a hardware processor 2802 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), main memory 2804, and static memory 2806, some or all of which may communicate with each other via an interconnect link (e.g., a bus) 2808. Machine 2800 may also include a display unit 2810 (e.g., a raster display, a vector display, a holographic display, etc.), an alphanumeric input device 2812 (e.g., a keyboard), and a user interface (UI) navigation device 2814 (e.g., a mouse). In the example, display unit 2810, input device 2812, and UI navigation device 2814 may be a touchscreen display. Machine 2800 may additionally include a storage device (e.g., a drive unit) 2816, a signal generation device 2818 (e.g., a speaker), a network interface device 2820, and one or more sensors 2821 such as a global positioning system (GPS) sensor, a compass, an accelerometer, or other sensors. Machine 2800 may include output controller 2828, for example, serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connections, for communicating or controlling one or more peripheral devices (e.g., printers, card readers, etc.).

[0207] Storage device 2816 may include a machine-readable medium 2822 on which one or more sets of data structures or instructions 2824 (e.g., software) are stored, which implement or are utilized by any one or more of the techniques or functions described herein. Instructions 2824 may also reside wholly or at least partially within main memory 2804, static memory 2806, or hardware processor 2802 during execution of the instructions by machine 2800. In this example, one or any combination of hardware processor 2802, main memory 2804, static memory 2806, or storage device 2816 may constitute a machine-readable medium.

[0208] Although machine-readable medium 2822 is shown as a single medium, the term "machine-readable medium" can include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) configured to store one or more instructions 2824.

[0209] The term "machine-readable medium" can include any medium capable of storing, encoding, or carrying instructions for execution by machine 2800 and causing machine 2800 to perform any one or more of the techniques of this disclosure, or capable of storing, encoding, or carrying data structures used by or associated with such instructions. Examples of non-limiting machine-readable media can include solid-state memory as well as optical and magnetic media. In examples, mass-capacity machine-readable media includes machine-readable media having a plurality of particles having invariant (e.g., rest) mass. Therefore, mass-capacity machine-readable media are not transient propagating signals. Specific examples of mass-capacity machine-readable media can include: non-volatile memory, such as semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EPSOM)) and flash memory devices; disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0210] Commands 2824 can also be sent or received via the communication network 2826 through the network interface device 2820 using a transmission medium, utilizing any of several transport protocols (e.g., Frame Relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), Hypertext Transfer Protocol (HTTP), etc.). Example communication networks may include local area networks (LANs), wide area networks (WANs), packet data networks (e.g., the Internet), mobile phone networks (e.g., cellular networks), conventional telephone (POTS) networks, and wireless data networks (e.g., those referred to as…). The Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards, known as The IEEE 802.16 family of standards, the IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, etc. In the example, network interface device 2820 may include one or more physical jacks (e.g., Ethernet, coaxial, or telephone jacks) or one or more antennas for connecting to communication network 2826. In the example, network interface device 2820 may include multiple antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) technologies. The term "transmission medium" should be considered to include any intangible medium capable of storing, encoding, or carrying instructions for execution by machine 2800, and the term "transmission medium" should be considered to include digital or analog communication signals or other intangible media to facilitate communication of such software.

[0211] Additional Notes

[0212] The above detailed description includes reference to the accompanying drawings, which form part of the detailed description. For illustration, the drawings show specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples may include elements other than those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Furthermore, the inventors contemplate examples using any combination or substitution of these elements (or one or more aspects of these elements) shown or described with respect to a particular example (or one or more aspects of a particular example) or with respect to other examples shown or described herein (or one or more aspects of other examples).

[0213] In this disclosure, as is common in patent disclosures, the terms "a" or "an" are used to include one or more, regardless of any other instance or use of "at least one" or "one or more." In this disclosure, unless otherwise indicated, the term "or" is used to refer to a non-exclusive "or," such that "A or B" includes "A but not B," "B but not A," and "A and B." In this disclosure, the terms "comprising" and "in..." are used as concise English equivalents to the corresponding terms "including" and "wherein." Furthermore, in the appended claims, the terms "comprising" and "including" are open-ended, meaning that a system, apparatus, article, ingredient, formulation, or process that includes elements other than those listed after such terms in the claims is still considered to fall within the scope of the claims. Additionally, in the appended claims, the terms "first," "second," and "third," etc., are used merely as designations and are not intended to impose numerical requirements on their objects.

[0214] The above description is intended to be illustrative and not restrictive. For example, the examples (or one or more aspects of the examples) described above can be used in combination with each other. Other embodiments can be used by those skilled in the art, for example, upon review of the above description. The abstract provided is to conform to 37C.FR §1.72(b) to enable the reader to quickly determine the nature of the technical disclosure. An abstract is provided and it is understood that the abstract will not be used to interpret or limit the scope or meaning of the claims. Furthermore, in the specific embodiments described above, various features may be combined to organize the disclosure. This should not be construed as meaning that all unclaimed disclosed features are necessary for any claim. Rather, the subject matter of the invention may lie in fewer than all features of a particular disclosed embodiment. Therefore, the appended claims are thus incorporated into the specific embodiments as examples or embodiments, wherein each claim is an independent, separate embodiment, and such embodiments are contemplated to be combined with each other in various combinations or substitutions. The scope of the invention should be determined by reference to the appended claims and the full scope of the equivalents granted by such claims.

Claims

1. A medical laser system, comprising: Multiple laser sources, each configured to be controllably activated to produce a corresponding laser output; as well as A controller circuit configured to selectively activate two or more of the plurality of laser sources to generate combined laser outputs delivered to different locations on the anatomical target, the combined laser outputs including a first combined laser output to a first location on the anatomical target and a second combined laser output to a second location different from the first location.

2. The medical laser system according to claim 1, wherein, The controller circuit is configured to selectively activate two or more of the plurality of laser sources at corresponding different times.

3. The medical laser system according to claim 1, wherein, The controller circuit is configured to selectively activate two or more of the plurality of laser sources at corresponding times, such that at least a portion of the corresponding laser outputs from the two or more laser sources overlap in time.

4. The medical laser system according to claim 1, wherein, The combined laser output includes a spatiotemporal pattern of (i) a first laser pulse generated by a first laser source among the plurality of laser sources and (ii) a second laser pulse generated by a second laser source among the plurality of laser sources.

5. The medical laser system according to claim 4, wherein, The spatiotemporal pattern includes the alternating emission of a first or more laser pulses and a second or more laser pulses in multiple iterations.

6. The medical laser system of claim 1, further comprising a lithotripsy device operably coupled to the plurality of laser sources for treating stone structures. in, The controller circuit is configured to guide the first combined laser output to the periphery of the stone structure via the lithotripsy device, and to guide the second combined laser output to the center or near the stone structure.

7. The medical laser system according to claim 1, wherein, Two or more of the selectively activated laser sources are each configured to produce corresponding laser outputs that differ in at least one aspect of output power, wavelength or wavelength range, pulse shape or pulse train.

8. The medical laser system according to claim 1, wherein, Two or more of the selectively activated laser sources are each configured to produce a corresponding laser output in the ultraviolet to infrared wavelength region.

9. The medical laser system according to claim 8, wherein, Two or more of the selectively activated laser sources are each configured to produce corresponding laser outputs of different wavelengths or different wavelength ranges.

10. The medical laser system according to claim 8, wherein, Two or more of the selectively activated laser sources are each configured to produce corresponding laser outputs of substantially the same wavelength or substantially the same wavelength range.

11. The medical laser system according to claim 1, wherein, The controller is configured to also selectively activate two or more of the plurality of laser sources based on the therapeutic objective of the target, the therapeutic objective including at least one of tissue coagulation, tissue ablation, tissue vaporization, or stone fragmentation.

12. The medical laser system according to claim 1, wherein, The controller circuit is configured to: Identify the features of the anatomical target; and Two or more of the plurality of laser sources are selectively activated, at least in part, based on the characteristics of the identified anatomical target.

13. A method for delivering laser treatment to an anatomical target using a medical system comprising multiple laser sources, the method comprising: Selectively activate two or more of the plurality of laser sources to generate a combined laser output, the combined laser output including a first combined laser output and a second combined laser output; as well as The first combined laser output is directed to a first position of the anatomical target, and the second combined laser output is directed to a second position of the anatomical target that is different from the first position.

14. The method according to claim 13, wherein, Selectively activating two or more of the plurality of laser sources includes activating the two or more of the plurality of laser sources at corresponding different times.

15. The method according to claim 13, wherein, Selectively activating two or more of the plurality of laser sources includes activating the two or more laser sources at corresponding times such that at least a portion of the corresponding laser outputs from the two or more laser sources overlap in time.

16. The method according to claim 13, wherein, The combined laser output includes a spatiotemporal pattern of (i) a first laser pulse generated by a first laser source among the plurality of laser sources and (ii) a second laser pulse generated by a second laser source among the plurality of laser sources.

17. The method according to claim 16, wherein, The spatiotemporal pattern includes the alternating emission of a first or more laser pulses and a second or more laser pulses in multiple iterations.

18. The method according to claim 13, wherein, The first combined laser output is directed to the periphery of the stone structure, and the second combined laser output is directed to the center or near the stone structure.

19. The method according to claim 13, wherein, Selectively activating two or more of the plurality of laser sources includes generating laser outputs from corresponding laser sources that differ in at least one aspect of output power, wavelength or wavelength range, pulse shape or pulse train.

20. The method of claim 13, further comprising identifying features of the anatomical target, in, Selectively activating two or more of the plurality of laser sources is at least in part based on the characteristics of the identified anatomical target.

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