Endoscope laser-triggered suction automatic on / off

Abstract

To enable a suction or other component of an endoscope system to be cycled on and off or otherwise controlled without requiring direct user input.SOLUTION: The invention provides automatically or semi-automatically using a current or historical state of a laser generator, blurriness or other information from an image of a working area, a count of fragments of calculi, an intraoperative pressure, an intraoperative temperature, or one or more other characteristics of the laser generator or the targeted calculi.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 262,924, filed October 22, 2021, the entire contents of which are incorporated herein by reference. [Background technology]

[0002] Medical scopes, such as endoscopes, were first developed in the early 1800s and have been used to examine inside a patient's body. Such scopes can include endoscopes, laparoscopes, ureteroscopes, duodenoscopes, arthroscopes, and others that may be referred to as endoscopes or scopes. Endoscopes may be used to move fluids through organs. Some endoscopes provide irrigation, suction, or both, such as to move fluids. Laser energy may also be used inside the body. For example, a laser generator may provide laser energy inside the body, such as via a laser fiber or fiber bundle. Laser energy may be used for diagnostics or treatment, such as performing laser lithotripsy to ablate one or more stones. Ablation may break the stone into smaller pieces that may pass naturally or may be grasped, aspirated, or otherwise removed from the body via an endoscope or auxiliary tools. Summary of the Invention [Means for solving the problem]

[0003] In the drawings, which are not necessarily drawn to scale, like numbers may represent like components in different figures. Like numbers with different letter suffixes may represent different instances of the like component. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. [Brief description of the drawings]

[0004] [Figure 1] FIG. 1 illustrates an example of a portion of an endoscopic system having a suction component and a laser generator for controlling suction. [Diagram 2] FIG. 13 illustrates an example of a method for controlling aspiration and / or irrigation based on laser energy. [Diagram 3] 1A-1C show examples of methods for controlling aspiration and / or irrigation based on imaging of a working area. [Figure 4] 13A-13C illustrate examples of methods for controlling aspiration and / or irrigation based on imaging of the field of action. [Diagram 5] 13A-13C illustrate examples of methods for controlling aspiration and / or irrigation based on imaging of the field of action. [Figure 6] 13A-13C illustrate examples of methods for controlling aspiration and / or irrigation based on imaging of the field of action. [Figure 7] FIG. 1 illustrates an example of a method for determining a treatment plan based on imaging of a stone. [Figure 8] 1 is an exemplary schematic diagram of an exemplary computer-based clinical decision support system (CDSS). DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0005] The systems and techniques described herein relate to medical devices, such as endoscopes, that use aspiration or "suction" to move fluids, stones, stone dust and / or stone fragments, etc., through organs, such as kidneys, during lithotripsy. Endoscopic suction can be activated by, synchronized with, or coordinated with laser energy delivery, although suction can additionally or alternatively be coordinated with one or more additional or different functions. This can be done automatically, with no user input required to control the suction.

[0006] Endoscopes may be used to visualize targets within the body for diagnosis, treatment, or both. Endoscopes may be configured to facilitate the inflow (e.g., "irrigation") and removal (e.g., "aspiration") of fluids to flush debris from organs, improve visualization during endoscopic procedures, and the like. For example, a ureteroscope may include an irrigation fluid channel to provide saline to the kidney and an aspiration channel to aspirate stone dust and fragments during laser lithotripsy. Although stone dust and small fragments may be naturally expelled by the patient, it is beneficial to actively remove the debris during the procedure.

[0007] The inflow and outflow of fluid through the kidney may involve increases and decreases in renal pressure that may benefit from monitoring, control, or both. It may be undesirable to have suction "on" continuously throughout the entire procedure. Always "on" suction may include continuous monitoring and control, or a continuous inflow of irrigation fluid to replace fluid removed from the suction. Additionally, during periods when pulverization or other stone fragmentation is paused, suction and / or passage of fluid to the kidney may be unnecessary. It is therefore advantageous to control the suction so that it is activated only when necessary.

[0008] The systems and techniques described herein may be used to activate endoscopic suction when deemed important or desirable and suspend suction at other times. While suction may be manually controlled by a user of the endoscope (e.g., using a foot pedal or other actuator), the present systems and techniques may provide the ability to automatically control suction, such as based on one or more criteria, such as without requiring separate direct user input to activate and / or deactivate suction. For example, suction may be automatically controlled based on the state of the laser or other energy source (or associated control signal), such as being on in response to when the laser source is on or is on during laser lithotripsy, and being off in response when the laser source is off or is off.

[0009] A time-shift delay of the suction control relative to activation / deactivation of the laser generator can be provided. For example, suction can be automatically turned off when the laser is turned off, but a programmed off delay can be used to continue suction for a period of time after the laser is turned off or before the laser is turned on. For example, suction can remain "on" for a programmable or otherwise specified time (e.g., ½ second, 1 second, X seconds, etc.) before the laser begins delivering laser energy or after the laser stops delivery to move stones or debris to a desired location for ablation by energy delivery, or to provide time for dust / debris removal after laser activity, etc.

[0010] One or more criteria other than time may be used as a criterion for automatically delaying when suction is interrupted, such as when the image sensor is producing one or more images that are deemed to be sufficiently clear of dust, debris, and / or other debris. For example, a comparison of image clarity, haze, or one or more other individual or combined characteristics may be compared to a specified tolerance or a specified acceptable image. This may be performed algorithmically or using a trained model, such as to help determine or improve results using artificial intelligence and / or machine learning (AI / ML).

[0011] For example, criteria for automatically delaying when aspiration is discontinued may be based on sensor measurements of intraoperative pressure, e.g., aspiration may continue for a period of time after laser pulverization has ceased depending on when intraoperative pressure has settled to some acceptable level or range.

[0012] In gravity IV, where irrigation or other fluid delivery is based on an active mechanism such as a pump, fluid delivery can be similarly controlled, such as being based at least in part on one or more laser activation times. For example, both fluid delivery and aspiration can be automatically suspended (e.g., without the need for separate direct user input) when laser pulverization / fragmentation has ended (or after a short delay).

[0013] FIG. 1 is a schematic diagram illustrating an example of a portion of an endoscopic system 100 having a suction component 104 and a laser generator 106 for controlling suction.

[0014] The endoscopic system 100 may include an endoscope 102, a suction component 104, a laser generator 106, and a fluid source 108. The endoscopic system 100 may interact with a patient 110. For example, the endoscopic system 100 may be used to access an organ of the patient 110, such as a kidney 112. The kidney 112 may have a stone 114.

[0015] The endoscope 102 may include one or more channels, such as a working channel that allows a distal portion of an auxiliary device to be introduced to a target site within the patient 110. Separate irrigation and suction channels may be included in the body of the endoscope 102, or such functions may be performed using the working channel of the endoscope 102. Regardless of which channel is used, a distal portion of the suction component 104, a distal portion of a laser fiber from the laser generator 106, or a distal portion of an irrigation channel in fluid communication with a fluid source 108 may be provided with access to a target site within an organ (e.g., kidney 112). The endoscope 102 may include an illumination source (which may be different from the laser generator 106) or may be coupled to an illumination source via an illumination fiber or fiber bundle. This may serve to provide a means of illuminating the kidney 112 at the distal end of the endoscope, such as to aid in endoscopic visual observation via endoscope visualization optics. The endoscope 102 may be disposable or reusable. The endoscope 102 may be flexible, such as to allow the endoscope 102 to pass through an incision in the patient 110, through the urethra of the patient 110, or other means to access a kidney 112 or other target organ of the patient 110.

[0016] The irrigation fluid source 108 may provide saline or other fluid through the endoscope 102 to a treatment site within the kidney 112 or other organ. The fluid source 108 may include an intravenous (IV) bag on a pole that provides fluid by gravity. Irrigation using the fluid source 108 may be controlled by a pressure cuff, such as squeezing a component of the IV bag, by raising and lowering the IV bag, by a thumbwheel actuator, such as adjusting a valve opening of a valve, or by other means that may modify the rate at which irrigation or other fluid is provided. The fluid source 108 may be controlled to provide a continuous supply of fluid, etc. The fluid source 108 may be controlled to provide fluid at a constant rate, etc. The fluid source 108 may be controlled to provide fluid at an adjustable or even varying rate, etc. The flow rate from the fluid source 108 may be controlled manually, such as by a user of the endoscope or another caregiver. The flow rate from the fluid source 108 may be controlled automatically or semi-automatically without the need for user intervention, such as based on one or more detected or anticipated events, although such user intervention may be permitted.

[0017] The laser generator 106 may provide energy to the stone 114 through the endoscope 102, for example, via one or more optical fibers or fiber optic bundles, either of which may be referred to as a laser fiber. For example, the laser generator 106 may generate laser pulses to ablate the stone 114 into smaller fragments (such as fine powder or shards) that can be removed or passed from the patient 110. Ablation by the laser generator 106 may cause stone powder or shards. The stone powder or shards may be of a size that allows the stone to pass naturally, may be removed using suction applied from the suction component 104, or may be removed with the aid of a retrieval device or other medical equipment. In some embodiments, the laser generator 106 may be replaced by (or augmented by) another energy providing source, such as an ultrasonic energy source. The laser generator 106 may be manually controlled by a user to trigger the delivery of laser energy to the target. Alternatively or additionally, the laser generator 106 may be controlled automatically, without requiring user intervention to trigger delivery of laser energy to the target, such as when the AI / ML or other trained model identifies a stone at which the laser is directed. Alternatively or additionally, the laser generator 106 may be controlled semi-automatically, such as when the AI / ML or other trained model identifies a stone at which the laser is directed, but requests user confirmation before actually triggering delivery of the laser energy. Alternatively or additionally, the energy level of the laser pulses emitted by the laser generator 106, or the pulse repetition rate or pattern of the laser generator 106, may be determined automatically or semi-automatically. Such automatic energy levels, repetition rates, or patterns may be issued automatically, semi-automatically, or by a user. Controlling any of the aspiration, irrigation, ablation, or other functions may involve control of the positioning or movement of the endoscope 102 itself, such as by a fully robotic or robot-assisted approach, or control of one or more other end effectors associated with the endoscope 102.

[0018] The suction component 104 may provide suction to a target, or working area of ​​an organ (e.g., kidney 112) through the endoscope 102, such as through a suction channel or working channel of the endoscope 102. The suction component 104 may use suction to remove fluid from the kidney 112. The suction component 104 may use suction to remove stone powder or debris from the kidney 112. The suction rate may be established or adjusted to be substantially similar to the rate of providing irrigation or other fluids such that there is a substantially constant amount of fluid within the working area and organ. For example, if the fluid delivery rate is fast, the suction rate may be fast. Similarly, if the fluid rate is slow, the suction rate may be slow. The fluid delivery rate may be established or modified based at least in part on the suction rate. Conversely, the suction rate may be established or modified based at least in part on the fluid delivery rate.

[0019] The endoscopic system 100 may include an imaging device, imaging optics, or both. For example, a camera or other imaging device may be incorporated within the endoscope 102. The imaging device may be separate from the endoscope 102, completely separate, or separate but insertable through the endoscope 102 towards a target. The imaging device may provide one or more still or video images of a working area of ​​an organ (e.g., kidney 112). Object recognition or other image processing may be performed on the images as described herein.

[0020] The endoscopic system 100 may include or be coupled to a computing device or other controller circuitry, which may be implemented in hardware, software, firmware, or any combination thereof. The computing device may include a processor and a memory device. The memory device may include instructions that, when executed by the processor, cause the computing device to perform one or more acts or operations. The computing device may be capable of performing image processing, activating and / or deactivating the suction component 104, changing the suction rate of the suction component 104, activating and / or deactivating the laser generator 106, changing the energy level of the laser generator 106, activating and / or deactivating the fluid source 108, changing the fluid delivery rate of the fluid source 108, receiving sensed indications of one or more characteristics of the working environment from one or more sensors (e.g., temperature sensors, pressure sensors, etc.), or combinations thereof.

[0021] FIG. 2 illustrates a method 200 for controlling suction and / or irrigation based on laser energy. A computing device or controller circuit may implement the method 200. At 202, an indication may be received that the laser generator 106 is activated such that the laser generator 106 provides laser energy. A user may activate the laser generator 106 to deliver laser energy by direct user input. At 204, the suction may be modified. The suction may be modified without direct user input. For example, when the laser generator 106 is providing laser energy, the computing device may responsively trigger turning on the suction component 104 to provide suction or increase suction from a lower ambient or standby level of suction, etc. At 206, an indication may be received that the laser generator 106 is deactivated such that the laser generator 106 does not provide laser energy. At 208, the suction may be modified. The suction may be modified without additional user input. When the laser generator 106 stops providing laser energy, the computing device can responsively trigger turning off the suction component 104 to stop providing suction or reduce suction from a relatively higher "active" suction level to a relatively lower ambient or standby level. The laser generator 106 may stop providing laser energy by direct user input to the laser generator 106. The fluid delivery rate of the fluid source 108 may likewise be automatically controllably adjusted by the computing device in a manner similar to method 200. In one example, one or more parameters associated with the relative energy or power of the laser generator 106 may additionally or alternatively be used to trigger the computing device to, e.g., change the fluid delivery rate of the fluid, the suction rate of the suction, or both.For example, lowering the laser energy may trigger the computing device to lower the suction rate of the suction component 104, and increasing the laser energy may trigger the computing device to increase the suction rate of the suction component 104. Rather than waiting for an indication that the laser energy has been deactivated, the computing device may predict when to again modify suction based on the current suction rate, the current fluid rate, the current energy level, and the current pulse pattern of the energy laser. Thus, suction may be modified at 204 based on the indication received at step 202, and may be modified at 208 without an additional indication at step 206.

[0022] The timing of the suction component 104 can also be established or manipulated with or in response to changes or activation / deactivation of the laser generator 106, such as to modify the suction rate and / or adjust the activation or amount of suction, and need not be adjusted at exactly the same time. For example, the computing device may turn off (or power down) the suction component 104 in step 204 at a time difference after (or even before) the laser generator 106 is turned off (or powered down) in step 206. For example, the laser generator 106 may have a predetermined pattern of laser energy delivery when the laser generator 106 is activated such that the computing device may turn off (or power down) the suction before the deactivation (or reduction in laser energy) of the laser generator 106. The time difference may additionally or alternatively be based in whole or in part on a time delay, a temperature in the working area, a pressure in the working area, and / or other measured characteristics. Thus, the computing device may activate (at step 204) or deactivate (at step 208) the suction component 104 and / or the fluid source 108 based on a combination of settings or measurements (e.g., temperature, pressure, laser energy, or other measured characteristics). For example, at step 202, the laser generator 106 may begin delivering laser energy at time 0, and two seconds later at step 204, the suction component 104 and / or the fluid source 108 may be activated or increased. Similarly, at step 206, the laser generator 106 may stop delivering laser energy at time x, and two seconds later at step 208, the suction component 104 and / or the fluid source 108 may be deactivated or decreased. As another example, the laser generator 106 may be activated, but the laser energy may be set to a delay such that suction may be activated or modified prior to the delivery of laser energy. For example, suction may move the stone 114 to the location where the laser energy is delivered.The method 200 may be repeated as the laser generator 106 is activated and deactivated to ablate the stone 114 .

[0023] The imaging device may capture one or more images of the working area that the computing device analyzes, such as for use in determining how to automatically or semi-automatically control suction, irrigation, or another operating parameter. FIG. 3 illustrates an exemplary method 300 for controlling suction and / or irrigation based on imaging of the working area. In step 302, the imaging device may capture one or more images of the working area. Stone dust may cause the image to become blurred. In step 304, image processing by the computing device may be used to determine the blurriness of the image. If no degree of blurriness is present, the imaging device may continue to capture images in step 302, and the image processing device may continue to determine the blurriness of the image in step 304. In step 306, the computing device may activate the suction component 104 or modify the suction rate if it is determined that a degree of blurriness is present in the image. Similarly, the computing device may deactivate the suction component 104 if it is determined that less blurriness is present in the image. For example, the computing device may compare two or more images of the working area based on blurriness, such as to determine a blur trend. The computing device may predict when to activate or deactivate the suction component 104 based on the trend of smearing. Alternatively or additionally, the method 300 may be used to control irrigation, or both irrigation and suction, of the fluid source 108. The method 300, or portions thereof, may be repeated throughout the duration of the procedure. The computing device may calculate a composite index, such as one that may use one or more indicia of smearing, aspiration rate, fluid rate, laser energy or condition, or one or more other conditions of the working area to determine or predict when to activate or deactivate the suction component 104.

[0024] FIG. 4 illustrates an example of a method 400 for controlling suction and / or irrigation based on imaging of a working area. In step 402, an imaging device can provide one or more images of a working area. In step 404, a computing device can determine or track a proximity between the stone 114, or dust or debris caused by the stone 114, and a distal end of the endoscope 102. In step 406, based on a determination of such distance or proximity, the computing device can activate the suction component 104 or modify the suction rate when the distal end of the endoscope 102 is within a desired distance from the dust or debris caused by the stone 114. The computing device can deactivate the suction component 104 when the distal end of the endoscope 102 is outside a specified or desired distance from the dust or debris caused by the stone 114. Alternatively or additionally, the method 400 can be used to control irrigation, or both irrigation and suction, of the fluid source 108. The method 400, or portions thereof, can be repeated throughout the duration of a procedure.

[0025] FIG. 5 illustrates an example of a method 500 for controlling suction and / or irrigation based on imaging of a working area. In step 502, an imaging device may provide one or more images of the working area. In step 504, image processing by a computing device may be used to count the number of debris in the image of the working area. Other image processing may be performed by the computing device, such as to determine the size of one or more of the debris. In step 506, using this information or similar information, the computing device may activate the suction component 104, such as if the number of debris is greater than a certain number. The computing device may activate the suction component 104 if the size of at least one of the debris is below a certain size. For example, the computing device may activate the suction component 104 if the size of at least one of the debris is small enough to pass through the endoscope 102, such as through its working channel or another suction channel. Additionally or alternatively, using this information or similar information, the computing device may issue a control signal to the suction component 104 to deactivate or reduce suction applied by the suction component 104, such as when the number of debris falls below a certain number. For example, the computing device may issue a control signal to the suction component 104 to deactivate or turn off the suction component 104 if the number of debris reaches zero. In one example, the computing device may issue a control signal to the suction component 104 to deactivate or turn off the suction component 104 if no debris below a specified threshold size is detected. Alternatively or additionally, the method 500 may be used to control irrigation, or both irrigation and suction, of the fluid source 108. The method 500, or portions thereof, may be repeated throughout the duration of the treatment.

[0026] FIG. 6 illustrates an exemplary method 600 for controlling suction and / or irrigation based on imaging of a working area. In step 602, an imaging device can provide one or more images of the working area. In step 604, image processing by a computing device can be used to distinguish between the stone 114 or powder or fragments of the stone 114 and an organ of the patient. For example, the computing device can determine that powder or fragments of the stone 114 have settled in tissue of the organ. Then, in step 606, the computing device can issue a control signal to activate the suction component 104 when the distal tip of the endoscope 102 is within a particular distance from the powder or fragments of the stone 114 and issue a control signal to deactivate the suction component 104 when the distal tip of the endoscope 102 is outside the particular distance of the tissue. For example, the computing device can issue a control signal to deactivate the suction component 104 if the image processing indicates that the tissue has dislodged or substantially dislodged the powder or fragments of the stone 114. Alternatively or additionally, the method 600 may be used to control irrigation, or both irrigation and aspiration, of the fluid source 108. The method 600, or portions thereof, may be repeated throughout the duration of the treatment.

[0027] FIG. 7 illustrates an exemplary method 700 for determining a treatment plan based on imaging of a concretion 114. In step 702, an imaging device can provide one or more images of a working area, including the concretion 114. In step 704, a computing device can be programmed to determine one or more characteristics of the concretion 114 and / or powder or fragments of the concretion 114, such as by using information from one or more images from the imaging device or by using spectroscopic information from a response from the target concretion 114 to the illumination. The computing device can determine a size of the concretion 114 and / or powder or fragments of the concretion 114. The computing device can determine a material composition or characteristics of the concretion 114 and / or powder or fragments of the concretion 114. In step 706, based on one or more characteristics of the concretion 114 and / or powder or fragments of the concretion 114, the computing device can determine a treatment plan. For example, the computing device can determine an energy level of a laser pulse emitted by the laser generator 106. As another example, the computing device may determine the pulse repetition rate or pattern of the laser generator 106. As another example, the computing device may determine the aspiration rate and / or aspiration pattern of the aspiration component 104. The computing device may determine the fluid delivery rate and / or fluid delivery pattern of the fluid source 108. The method 700, or portions thereof, may be repeated throughout the duration of the treatment. For example, the treatment plan may be modified throughout the treatment depending on the effectiveness of the current treatment plan. Modification of the treatment plan may include pausing the delivery of ablation energy. For example, the treatment may be paused until the image is substantially clear and the stone 114 (or the location of the stone 114) can again be identified. The methods described in Figures 2-7 may be used alone or in combination.

[0028] FIG. 8 shows a schematic diagram of an exemplary computer-based clinical decision support system (CDSS) 800 configured to activate fluid or suction, deactivate fluid or suction, modify a rate of fluid flow or suction, or predict when to provide such functions based on characteristic information of a working area, such as laser energy status and / or information about the kidney 112 or stone 114. The characteristic information may include images, intraoperative temperature, or intraoperative pressure. In various embodiments, the CDSS 800 includes an input interface 802 in which patient-specific characteristic information (e.g., images, temperature, pressure) is provided as input features to an artificial intelligence (AI) model 804, a processor that performs inference operations in which the characteristic information (e.g., images, temperature, pressure) is applied to the AI ​​model to generate control signals to activate, deactivate, or adjust the rate of suction or fluid flow, and a user interface (UI) through which the rates and / or status of fluid and suction are communicated to a user, e.g., a clinician.

[0029] In some embodiments, the input interface 802 may be a direct data link between the CDSS 800 and one or more medical devices that generate at least a portion of the input features, such as an imaging device, a spectroscopic device, a thermometer, a pressure sensor, or other sensors for providing imaging, spectroscopic, temperature, pressure, or other characteristic information. For example, the input interface 802 may transmit laser energy status and / or characteristic information (e.g., images, temperature, pressure) directly to the CDSS during a therapeutic and / or diagnostic medical procedure. Additionally or alternatively, the input interface 802 may be a classical user interface that facilitates interaction between a user and the CDSS 800. For example, the input interface 802 may facilitate a user interface through which a user may manually input a laser energy treatment protocol for the laser generator 106. Additionally or alternatively, the input interface 802 may provide the CDSS 800 with access to an electronic patient record from which one or more input features, such as prior imaging of the working area, may be extracted. In any of these cases, as described above, the input interface 802 is configured to collect one or more of the following input features associated with a particular patient at or before the CDSS 800 is used to assess laser energy conditions and / or working area characteristic information, such as information regarding the kidney 112 or stone 114:

[0030] Based on one or more of the above input features, the processor performs inference operations using the AI ​​model to generate control signals to activate fluid or suction, deactivate fluid or suction, modify the rate of fluid flow or suction, or predict when such functions should be provided. For example, the input interface 802 may deliver images of the working area containing the stone 114 to an input layer of the AI ​​model, which propagates these input features through the AI ​​model to the output layer. AI models can provide computer systems with the ability to perform tasks without being explicitly programmed by making inferences based on patterns found in the analysis of data. AI models explore the research and construction of algorithms (e.g., machine learning algorithms) that can learn from existing data and make predictions on new data. Such algorithms operate by crafting AI models from example training data to make data-driven predictions or decisions, which are represented as outputs or evaluations.

[0031] Machine learning (ML) has two common modes: supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples relating inputs to outputs or outcomes) to learn relationships between inputs and outputs. The goal of supervised ML is to learn a function that best approximates the relationship between training inputs and outputs, given training data, so that the ML model can implement that same relationship to generate a corresponding output given an input. Unsupervised ML is the training of an ML algorithm using information that is not classified or labeled, allowing the algorithm to act on that information without guidance. Unsupervised ML is useful for exploratory analysis because it can automatically identify structures in data.

[0032] Common tasks in supervised ML are classification and regression problems. Classification problems, also called categorization problems, aim to classify an item into one of several categorical values ​​(e.g., is this object an apple or an orange?). Regression algorithms aim to quantify some item (e.g., by providing a score for some input values). Some examples of commonly used supervised ML algorithms are logistic regression (LR), naive Bayes, random forest (RF), neural networks (NN), deep neural networks (DNN), matrix decomposition and support vector machines (SVM).

[0033] Common tasks in unsupervised ML include clustering, representation learning, and density estimation. Some examples of commonly used unsupervised ML algorithms are K-means clustering, principal component analysis, and autoencoders.

[0034] Another type of ML is federated learning (also known as collaborative learning), where algorithms are trained across multiple distributed devices that hold local data without exchanging data. This approach contrasts with traditional centralized machine learning techniques, where all local datasets are uploaded to one server, as well as more classical distributed approaches that often assume that local data samples are distributed in the same way. Federated learning allows multiple actors to work together to create a common, robust machine learning model without sharing data, addressing important issues such as data privacy, data security, data access rights, and access to heterogeneous data.

[0035] In some examples, the AI ​​model may be trained continuously or periodically prior to execution of an inference operation by the processor. During the inference operation, patient-specific input features provided to the AI ​​model may then be propagated from an input layer, through one or more hidden layers, to an output layer that ultimately corresponds to a control signal for activating fluid or suction, deactivating fluid or suction, modifying the rate of fluid flow or suction, or predicting when to provide such functionality. For example, the AI ​​model 804 may be trained to implement the methods described in any of Figures 2-7, either alone or in combination.

[0036] Examples of the methods described herein may be at least partially machine or computer implemented. Some examples may include computer readable or machine readable media encoded with instructions operable to configure an electronic device to perform the methods described in the above examples. Such method implementations may include code, such as microcode, assembly language code, high level language code, etc. Such code may include computer readable instructions for performing various methods. The code may form part of a computer program product. Further, in one example, the code may be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer readable media, such as during execution or at other times. Examples of these tangible computer readable media may include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memory (RAM), read only memory (ROM), etc.

[0037] [Additional note 1] 1. An endoscopic system for coordinating operation of an ablation modality with at least one of ancillary aspiration and irrigation modalities, comprising: An endoscopic system comprising a controller circuit configured to issue control signals to coordinate timing or other parameters of at least one of the incidental suction and irrigation modalities with ablation timing or other ablation parameters of ablation energy emitted by the ablation modality toward an ablation target within a patient, wherein the control signals are issued automatically without requiring direct user input to control at least one of the incidental suction and irrigation modalities to relatively increase at least one of suction and irrigation in temporary coordination with the emission of the ablation energy by the ablation modality. [Additional note 2] and at least one of an imaging device, a spectroscopic device, and other sensor for providing imaging, spectroscopic, or other characteristic information regarding at least one of the ablation target within the patient and an ablation target environment within the patient; The endoscopic system of claim 1, wherein the controller circuit generates the control signal based at least in part on information from the sensor regarding at least one of the ablation target within the patient and the ablation target environment within the patient. [Additional note 3] The controller circuitry comprises: receiving a first image of the ablation target environment from the imaging device; identifying dust or debris of the ablation target from the first image; generating the control signal based on characteristic information related to the powder or debris identified in the first image; The endoscope system according to claim 2, [Additional note 4] The endoscopic system described in Appendix 3, wherein the characteristic information is blur caused by the fine dust of the ablation target in the first image. [Additional note 5] 4. The endoscope system described in claim 3, wherein the characteristic information is the number of fragments of the ablation target in the first image. [Additional note 6] The endoscopic system described in Appendix 3, wherein the characteristic information is the amount of fine powder or debris of the ablation target that has settled in the ablation target environment in the first image. [Additional note 7] The controller circuitry comprises: receiving a second image of the ablation target environment from the imaging device; identifying dust or debris of the ablation target from the second image; and generating the control signal based on characteristic information related to the powder or debris identified in the second image; and The endoscope system according to claim 3, [Additional note 8] The endoscopic system described in Appendix 7, wherein the characteristic information is a change in blur caused by the fine dust of the ablation target between the first image and the second image. [Additional note 9] The endoscopic system described in Appendix 7, wherein the characteristic information is a tendency of blur caused by the fine dust of the ablation target based on the first image and the second image. [Additional Note 10] The endoscopic system of claim 9, wherein the controller circuit predicts when to generate the control signal based on the trend of the blur caused by the fine dust of the ablation target based on the first image and the second image. [Additional Note 11] The endoscopic system described in Appendix 7, wherein the characteristic information is a change in the number of fragments of the ablation target between the first image and the second image. [Additional Note 12] The endoscopic system described in Appendix 7, wherein the characteristic information is a change in the amount of fine powder or debris of the ablation target that has settled in the ablation target environment between the first image and the second image. [Additional Note 13] The endoscopic system described in Appendix 2, wherein the characteristic information is intraoperative pressure or intraoperative temperature of the ablation target environment. [Additional Note 14] The endoscopic system described in Appendix 2, wherein the controller circuit predicts a duration between a first control signal and a second control signal based on the characteristic information. [Additional Note 15] The endoscopic system of claim 1, wherein the control signal for coordinating the timing or other parameters of at least one of the ancillary suction and irrigation modalities with the ablation timing or other ablation parameters of the ablation energy emitted by the ablation modality is emitted with a temporal shift from the ablation timing of the ablation energy. [Additional Note 16] 1. A method for coordinating operation of an ablation modality with at least one of ancillary aspiration and irrigation modalities, comprising: issuing control signals to coordinate timing or other parameters of at least one of the ancillary suction and irrigation modalities with ablation timing or other parameters of ablation energy delivered by the ablation modalities to an ablation target within a patient; A method in which the control signal is automatically issued to relatively increase at least one of suction and irrigation in temporary coordination with the emission of the ablation energy by the ablation modality without requiring direct user input to control the at least one of the concomitant suction and irrigation modalities. [Additional Note 17] receiving imaging, spectroscopic, or other characterization information regarding at least one of the ablation target within the patient and an ablation target environment within the patient; generating the control signal based at least in part on information from a sensor regarding at least one of the ablation target within the patient and an ablation target environment within the patient; The method according to claim 16, further comprising: [Additional Note 18] receiving a first image of the ablation target environment; identifying dust or debris of the ablation target from the first image; generating the control signal based on characteristic information about the powder or debris identified in the first image; The method according to claim 17, further comprising: [Additional Note 19] 19. The method of claim 18, wherein the characteristic information is blur caused by the fine dust of the ablation target in the first image. [Additional Note 20] 20. The method of claim 18, wherein the characteristic information is the number of fragments of the ablation target in the first image. [Additional Note 21] 19. The method of claim 18, wherein the characteristic information is an amount of powder or debris of the ablation target settled in the ablation target environment in the first image. [Additional note 22] receiving a second image of the ablation target environment; identifying dust or debris of the ablation target from the second image; generating the control signal based on characteristic information about the powder or debris identified in the second image; The method according to claim 18, further comprising: [Additional Note 23] 23. The method of claim 22, wherein the characteristic information is a change in blur caused by the fine dust of the ablation target between the first image and the second image. [Additional note 24] 23. The method of claim 22, wherein the characteristic information is a tendency of blur caused by the fine dust of the ablation target based on the first image and the second image. [Additional note 25] The method of claim 24, further comprising a step of predicting when to generate the control signal based on the trend of the blur caused by the fine dust of the ablation target based on the first image and the second image. [Additional note 26] 23. The method of claim 22, wherein the characteristic information is a change in the number of fragments of the ablation target between the first image and the second image. [Additional note 27] 23. The method of claim 22, wherein the characteristic information is a change in the amount of powder or debris of the ablation target settled in the ablation target environment between the first image and the second image. [Additional note 28] 18. The method of claim 17, wherein the characteristic information is intraoperative pressure or intraoperative temperature of the ablation target environment. [Additional note 29] 1. An endoscopic system for coordinating operation of an ablation modality with at least one of ancillary aspiration and irrigation modalities, comprising: a controller circuit configured to generate a treatment plan for adjusting timing or other parameters of ablation energy delivered by the ablation modality to an ablation target within a patient; and at least one of an imaging device, a spectroscopic device, and other sensor for providing imaging, spectroscopic, or other characteristic information regarding at least one of the ablation target within the patient and an ablation target environment within the patient; Equipped with An endoscopic system, wherein the controller circuit generates the treatment plan based at least in part on information from the sensor regarding at least one of the ablation target within the patient and an ablation target environment within the patient. [Additional note 30] The endoscopic system of claim 29, wherein the treatment plan further adjusts timing or other parameters of at least one of the additional suction and irrigation modalities. [Explanation of symbols]

[0038] 100 endoscopic system, 102 endoscope, 104 suction component, 106 laser generator, 108 fluid source, 110 patient, 112 kidney, 114 stone, 200 method, 300 method, 400 method, 500 method, 600 method, 700 method, 800 computer-based clinical decision support system (CDSS), 802 input interface, 804 AI model

Claims

1. An endoscope system including a controller circuit, The controller circuitry comprises: to generate control signals for coordinating the timing and other parameters of the fluid aspiration or irrigation member with the timing and other parameters of the ablation member; The control signal is generated automatically using a trained learning model; An endoscopic system wherein the trained learning model coordinates the timing and other parameters of the fluid aspiration or irrigation member with the timing or other parameters of the ablation member based at least in part on at least one of historical and real-time data from one or more sensors communicatively coupled to the controller circuit.

2. The endoscopic system of claim 1 , wherein the controller circuit is configured to control suction based on intraoperative pressure of a tabulation target environment.

3. 3. The endoscopic system of claim 2, wherein the controller circuit is configured to maintain suction for a predetermined period of time after ceasing laser ablation based on when the intraoperative pressure is within an acceptable level or range.

4. The endoscopic system of claim 1 , wherein the controller circuitry is configured to make one or more predictable adjustments to at least one of suction, irrigation, and ablation based on trends derived from historical data.

5. The endoscopic system of claim 4 , wherein the controller circuit is configured to predict when to generate the control signal based on a trend of blurring from ablation of an ablation target.

6. The endoscopic system of claim 1 , further comprising an illumination source coupled to an endoscope of the endoscopic system via an illumination fiber or fiber bundle for enhanced imaging of a target site.

7. The endoscopic system of claim 1 , wherein the controller circuitry is configured to automatically control at least one of: 1) a position of an endoscope coupled to the endoscopic system; and 2) an end effector connected to the endoscope.

8. The endoscopic system of claim 1 , wherein the controller circuit is configured to automatically pause both fluid delivery and aspiration upon completion of laser ablation.

9. the controller circuitry is configured to determine a treatment plan based on one or more characteristics of the ablation target; The endoscopic system of claim 1 , wherein the one or more characteristics of the ablation target include at least one of a size, a material composition, and another attribute of the ablation target.

10. 10. The endoscopic system of claim 9, wherein the treatment plan includes at least one of an energy level of a laser pulse from a laser generator coupled to the endoscopic system, at least one of a pulse repetition rate and pattern of the laser generator, at least one of an aspiration rate and pattern, and at least one of a fluid delivery rate and pattern.

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